Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
Parent’s Name Child’s name Date of Birth
MENTAL/EDUCATIONAL/CAREERS “Having the mental abilities and acquired skills (reading writing, and computing) to deal with daily life.” Ask the parent to reflect on the mental/educational/career resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original On IFSP 1ST 2ND 3RD 4TH 5TH Do you have this in place? Are you Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE interested in more related resources? (score 0, 1, or 2) High School/GED College Courses
Other Education (e.g. vocational) ESL Employment Becoming a citizen Career counseling Improving academic skills
Improving computer skills
Total score:
Other: Other:
Other:
*other is not to be included in total score
Notes: Use NUMBER KEY to fill in boxes
0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
Page 1 Baby TALK © All Rights Reserved | Version 2017_09
Page 1 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D. PHYSICAL “Having physical health and mobility.” Ask the parent to reflect on the physical resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original On IFSP 1ST 2ND 3RD 4TH 5TH Do you have this in place? Are you Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE interested in more related resources? (score 0, 1, or 2) Pre-natal care
Family Planning
Dental health (for adult)
Vision/Hearing (for adult)
Medical Doctor (for adult) Counseling Anger Management
Special medical care
Total score:
Other: Other: Other:
*other is not to be included in total score
Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 2 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D. EMOTIONAL “Being able to choose and control emotional responses, particularly to negative situations, without engaging in self- destructive behavior. This is an internal resource and shows itself through stamina, perseverance, and choices.” Ask the parent to reflect on the emotional resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Do you have this in place? Original On IFSP 1ST 2ND 3RD 4TH 5TH Are you interested in more related Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE resources? (score 0, 1, or 2) Mental Health services
Substance Abuse support Marriage/relationship counseling
Addressing depression/Anxiety Controlling emotional responses Addressing domestic violence Smoking cessation Able to make good choices Perseverance
Coping strategies Addressing Grief/Loss I am able to choose my emotions I feel safe in my environment
Total score:
Other: Other:
Other:
*other is not to be included in total score Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 3 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
FINANCIAL “Having the money to purchase goods and services.” Ask the parent to reflect on the financial resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original Do you have this in place? On IFSP 1ST 2ND 3RD 4TH 5TH Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE Are you interested in more related resources? (score 0, 1, or 2) WIC (Women Infant Children)
Cash Assistance
Medical Card SNAP (Supplemental Nutrition Assistance Program) Housing placement/assistance
Child Care assistance CCRRS
Utility Support (gas, light, phone)
Income social security for seniors SSI Disability (temporary) for injuries on the job SSI Supplemental Social Security for physical/mental disabilities Budgeting support
Child support payments
Food Assistance
Clothing assistance
Total score:
Other:
Other:
Other:
*other is not to be included in total score Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve
4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 4 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D. SPIRITUAL “Believing in a divine purpose and guidance.” Ask the parent to reflect on the spiritual resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original On IFSP 1ST 2ND 3RD 4TH 5TH Do you have this in place? Are you Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE interested in more related resources? (score 0, 1, or 2) Affiliation with a faith-based organization I can get assistance from a local faith-based organization Affiliation with non- denominational/spiritually focused organization (AA, self help, meditation, etc.) I can get assistance from a non- denominational/spiritually focused organization Total score:
Other: Other: Other:
*other is not to be included in total score
Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 5 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D. RELATIONSHIPS/ROLE MODELS “Having frequent access to adult(s) who are appropriate, who are nurturing to the child, and who do not engage in self-destructive behavior. It is largely from role models that a person learns how to live life emotionally.” Ask the parent to reflect on the relationship/role model resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original On IFSP 1ST 2ND 3RD 4TH 5TH Do you have this in place? Are you Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE interested in more related resources? (score 0, 1, or 2) I have supportive relationships with family/extended family I have supportive relationships with peer s I have someone I can go to if I have a problem I have someone positive I like to spend time with
I have someone I want to be like
Total score:
Other: Other: Other:
*other is not to be included in total score Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 6 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
SUPPORT SYSTEMS “Having friends, family, and backup resources available to access in times of need. These are external resources.” Ask the parent to reflect on the support system resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Original On IFSP 1ST 2ND 3RD 4TH 5TH Do you have this in place? Are you Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE interested in more related resources? (score 0, 1, or 2) I have someone to care for my child Knowledge of public transportation Access/means to take public transportation Access to private transportation from support system Individual access/means for private transportation (e,g, own a car) I have someone to call if I need something
I have someone I can count on I have someone to help with information about community systems Total score:
Other: Other:
Other:
*other is not to be included in total score Use NUMBER KEY to fill in boxes
Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 7 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
CHILD GROWTH AND DEVELOPMENT Ask the parent to reflect on the child growth and development resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable). *To be completed within 2 months after enrollment, ongoing every 6 months
DATE:
Original Do you have this in place? On IFSP 1ST 2ND 3RD 4TH 5TH Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE Are you interested in more related resources? (score 0, 1, or 2) *Developmental assessment or evaluation
*Vision screening
*Hearing screening
*Well child visits
*Immunization records
Dental health
Prenatal Growth and development
Stages of development
Developmental activities
Attachment, nurturing Self-regulation – as identified by parent and/or developmental screen & monitoring Social emotional development – as identified by parent and/or developmental screen & monitoring Physical development and Health – as identified by parent and/or developmental screen & monitoring Language Development, Communication, and Literacy – as identified by parent and/or developmental screen & monitoring
Notes: Use NUMBER KEY to fill in boxes
0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 8 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D. CONTINUED…CHILD GROWTH AND DEVELOPMENT Ask the parent to reflect on the child growth and development resources they may or may not have and may seek to access, along with their stage of attaining each item (as applicable).
DATE:
Do you have this in place? Original On IFSP 1ST 2ND 3RD 4TH 5TH Are you interested in more related Family Need (Y/N) UPDATE UPDATE UPDATE UPDATE UPDATE resources? (score 0, 1, or 2) Cognitive Development – as identified by parent and/or developmental screen & monitoring Approaches to Learning – as identified by parent and/or developmental screen & monitoring Toys and Sensory play
Feeding/ Mealtime
Naps/Bedtime
Nutrition
Separation Issues
Learning through play
Playing with others
Discipline
Safety
Total score:
Other: Other: Other:
*other is not to be included in total score Use NUMBER KEY to fill in boxes Notes: 0 – Does not desire 1 – Already has 2 – Desires 3 – Is beginning steps to achieve 4 – Has achieved fully *Note: If family has some of the resource, but wants more resources, score “2-Desires”
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Page 9 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
FAMILY STRENGTHS With the resources in place at this time, the family demonstrates strengths in the following areas:
Strengths at enrollment
Additional strengths at 1st update
Additional strengths at 2nd update
Additional strengths at 3rd update
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Page 10 Baby TALK Family Resource Assessment & Monitoring Based on “Framework for Understanding Poverty” by Ruby K. Payne, Ph.D.
FAMILY STRENGTHS With the resources in place at this time, the family demonstrates strengths in the following areas:
Additional strengths at 4th update
Additional strengths at 5th update
Other comments
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