VISITATION STRENGTHS AND NEEDS ASSESSMENT

(To identify the areas of focus for the visits in order to support reunification)

Mother Name:______Case number#______

Referral Date:______Date of Initial Placement:______

Parent Assessed: Date Assessment Completed:______

Section 1. Primary Observations and Assessment Factors (Child)

1. Reunion - Parent’s and children’s initial engagement, eye contact and joy at reunion.

Strength

/ Adequate / Needs
Refers to the caregiver and child(ren)’s ability to physically and emotionally engage immediately without hesitation or doubt.
·  There is direct eye contact and smiles.
·  There is anticipation and joy in the reunion.
·  There is obvious recognition and acceptance of the caregiver by the child(ren).
·  Child enjoys and seeks physical contact with parent.
·  / Refers to the caregivers’ and child(ren)’s initial engagement as sincere, but somewhat hesitant or awkward.
·  There is direct eye contact and smiles.
·  Child requires some effort to be engaged.
·  Child is receptive when greeted with age appropriate language.
·  Child demonstrates desire to connect with caregiver.
·  / Refers to the child(ren)’s fear and severe anxiety reaction with the anticipation of contact with the caregiver.
·  An infant arches away from caregiver or has a severe reaction to physical contact with caregiver.
·  Child is openly hostile or rejecting towards caregiver.
·  Child avoids eye contact with caregiver.
· 

Observations/Comments:

2. Interaction - Observable physical or verbal interactions between caregiver and child.

Strength

/ Adequate / Needs
Refers to child being able to receive caregiver’s attempts to physical closeness.
·  Child seeks caregiver’s assistance in order to get needs met.
·  Child receives and is reciprocal to love and attention (hugging or kissing) from caregiver.
·  Child verbally engages with caregiver, both initiates and responds to verbal prompts.
·  / Refers to child being able to be physically close and receptive to caregiver but may not pursue closeness.
·  Child may not seek caregiver assistance in order to get needs met but will receive it when given.
·  Child will receive physical expressions of love or attention (hugging or kissing) but may not be reciprocal to acts.
·  Child may show inconsistent responses to physical interactions.
·  Child will verbally engage with caregiver if prompted, but may rarely initiate.
·  / Refers to child being resistant to physical closeness/proximity prompted by caregiver through physical expressions of excessive anger, crying, yelling, etc.
·  Child does not initiate physical contact with caregiver at all. Child will not seek caregiver assistance for needs.
·  Child is not consoled by assistance attempts by caregiver.
·  Child is physically resistant to all caregiver attempts of physical love or attention (hugging or kissing) through crying or pushing caregiver away.
·  Child does not verbally interact with caregiver
·  Child acts disinterested or detached from physical closeness with caregiver.
·  Child is withdrawn and appears immobilized by physical contact.
·  Child may also be inappropriately enmeshed with caregiver and sustains inappropriate constant physical connectedness and proximity. (This action rotates with active avoidance of caregiver in order to qualify.)
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Observations/Comments:

3. Connectedness - Observable nonverbal interaction or observed body language between the caregiver and child.

Strength

/ Adequate / Needs
Refers to the child demonstrating ability to sustains eye contact with caregiver.
·  Child both initiates and responds to eye contact or nonverbal prompts.
·  Child will smile, laugh, and engage in reciprocal emotions with caregiver.
·  Child and Caregiver display interactional synchrony/ “emotional dance.”
·  / Refers to the child demonstrating ability to respond to eye contact or nonverbal interaction prompts by caregiver.
·  Child may not be receptive to nonverbal prompts or show inconsistent patterns or responses.
·  Child may display difficulty to stay engaged or sustain eye contact.
·  Child can respond to emotions (smile, etc.) but may not initiate.
·  / Refers to child avoiding or not engaging in eye contact or nonverbal prompts or interactions initiated by caregiver at all.
·  Child does not initiate eye contact or nonverbal interactions.
·  Child will physically face away from caregiver in avoidance of interaction.
·  Child may appear extremely disoriented or withdrawn to caregiver or surroundings.
·  Child will cry excessively at any interaction attempt of caregiver.
·  Child may appear to be in “frozen watchfulness” or fearful of caregiver.
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Observations/Comments:

4. Attachment - A persistent, affectionate, and emotional bond between the child and caregiver. Child seeks proximity with caregiver and uses the caregiver for security and comfort.

Strength

/ Adequate / Needs
Refers to the child consistently seeking proximity with caregiver.
·  Child becomes upset if caregiver leaves the room, but is easily consoled upon return.
·  Child uses caregiver as a secure base to explore surroundings or activities.
·  Infants and younger children will seek and engage in consistent eye contact with caregiver.
·  Older children will engage in games and activities with ease with caregiver.
·  / Refers to the child appearing unresponsive to caregiver’s presence.
·  Child may be distressed when parent leaves the room. Upon return, the child may be slow to warm up to the parent or may take time to be consoled by parent.
·  Child may be clingy to parent and may not explore surroundings or activities.
·  Child may have some body rigidity when close to parent.
·  Infants and younger children will be inconsistent with eye contact with caregiver.
·  Older children may act shy or slow to warm up in engaging in games or activities with caregiver.
·  Child may show problems with emotion self-regulation by throwing temper tantrums, upset, or mad and problems and does not settle down easily. (Age appropriate).
·  / Refers to the child appearing confused and disoriented or dazed in surroundings.
·  Child may be fearful of environment or caregiver and is not consoled or calmed down by any of caregiver’s attempts at all.
·  Child may display odd, frozen body postures or body rigidity when close to caregiver.
·  Child may alternate between seeking closeness to caregiver, avoiding caregiver, and resisting closeness to caregiver.
·  Infants and younger children will avoid all eye contact with caregiver.
·  Older children will not engage in games or activities with caregiver.
·  Child has extreme difficulty with emotion self-regulation. Child will throw temper tantrums; act excessively mad, sad, upset, and complete inability to self-regulate. (Age appropriate).
·  (Secondary Observation: Caregiver is not sensitive in responding to child’s needs. Caregiver does not respond to child’s signals. Caregiver does not engage in activities with child.)
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Observations/Comments:

5. Transition/ Goodbye – Refers to parent’s ability to have an adequate and positive transition to end of visit. Parent uses cleanup time appropriately. Parent shows affection to child and child reciprocates the affection. Goodbye is brief and positive.

Strength

/ Adequate / Needs
Refers to the child being able to be soothed by caregiver in the five minutes of the visit closing.
·  Child is able to hear caregiver say they are going to a safe place.
·  Child is able to hear caregiver say they will see them soon and can be comforted by caregiver.
·  Child is able to receive and replicate affection and engages in positive, brief goodbye with caregiver.
·  Child is able to return to placement provider without hesitation.
·  / Refers to the child being observed to cling to caregiver and showed distress when caregiver announced that the visit was coming to a close.
·  Child struggled to concentrate, appeared nervous and/or sad due to caregiver’s inability to regulate their own emotions.
·  Child takes more than five minutes to be transitioned and needs prompts to engage with placement provider.
/ Refers to the child persistently screaming and/or throwing tantrums when caregiver announces the visit is coming to a close.
·  Child experiences hesitancy due to fear of upsetting the parent.
·  Child receives negative messages when transitioning back to placement provider from caregiver.
·  Child shows excessive worrying about the safety of the family, as evidenced by attempting to be in the caretaking role for the parents as the visit is coming to a close.
·  Child reports a fear of leaving the visit.
·  Child reports symptoms including headache, nausea, or nervousness when separation is coming.
·  Child reports worrying about “losing” the parent.
·  Child is unable to be soothed by the caregiver and/or the child is not able to be soother by placement provider prior to leaving the building.
· 

Observations/Comments:

Section 2. Secondary Observations and Assessment Factors (Parent)

6. Attentive to Child(ren)’s Needs - Parent’s ability to meet the child’s needs and interact on an age appropriate level. Expectations are age appropriate. Parent can respond to child’s verbal and non-verbal cues. Parent has an understanding of child’s developmental needs.

Strength

/ Adequate / Needs
Refers to caregivers’ ability to meet the child(ren)’s needs and interact on an age appropriate level.
·  Caregiver implements family bonding rituals (i.e. praying, stories, singing songs, food) to reinforce attachment.
·  Caregiver is able to consistently and appropriately respond to child(ren)’s verbal and nonverbal cues.
·  Caregiver is able to play in an age appropriate and nurturing manner and has clear expectations/ understanding of child development.
·  Caregiver is dependable and sensitive in responding to child’s needs on a consistent basis.
·  Caregiver responds to child’s signals and needs in a well-timed, appropriate fashion. Caregiver encourages and allows independence and exploration of the child.
·  Caregiver engages in activities with child.
·  / Refers to caregivers’ ability to adequately respond to child(ren)’s needs.
·  Caregiver may occasionally miss child(ren)’s verbal or nonverbal cues.
·  Expectations are generally age appropriate.
·  Caregiver has an average understanding of child developmental needs.
·  Caregiver brings baby care items, activities, and snacks, but may lack the ability to be consistent.
·  Snacks may not be nutritious and caregiver may need direction toward providing healthier snacks.
·  / Refers to the caregivers’ lack of awareness of child(ren)’s needs (i.e.; unrealistic and unclear expectations).
·  Child(ren) display parentified behaviors or is not allowed to engage in age appropriate behaviors.
·  Caregiver is focused on his/her own needs and ignores the needs of child(ren).
·  Child(ren) is not engaged with caregiver or is “pushed” to remain engaged.
·  Caregivers’ lack of consideration of child(ren)’s need for nurturance and/ or guidance in activities.
·  Caregiver has failed to bring appropriate supplies or activities.
·  Caregiver is not sensitive in responding to child’s needs.
·  Caregiver does not respond to child’s signals. Caregiver does not engage in activities with child.
· 

Observations/Comments:

7. Structured Behavior Management- Parent’s ability to deal with child’s behavior. Inconsistencies in discipline do not pose safety concerns for child. Parent displays good role modeling and reinforces positive behaviors. Parents are supportive of one another’s parenting styles.

Strength

/ Adequate / Needs
Refers to caregivers’ ability to plan purposeful activities. Activities are age appropriate, supportive, and comforting.
·  Caregiver brings in essential supplies, such as diaper bag, diapers, wipes, formula and familiar comfort items, such as child(ren)’s special toys, games, art supplies, or books.
·  Brings nutritious drinks, snacks or meals when appropriate.
·  Does not require additional guidance.
Refers to caregivers’ ability to deal with child(ren)’s behavior in a constructive manner.
·  Caregiver is able to set limits and provide clear directives but is also flexible with child(ren)’s responses (giving child choices).
·  Caregiver reinforces positive behaviors and ignores/redirects negative behaviors.
·  Caregiver displays good role modeling.
·  Caregiver is able to be responsible for child(ren) throughout the visit.
·  Caregivers are supportive of one another’s parenting style.
·  / Refers to caregivers’ ability to provide adequate guidance and directives to child(ren).
·  Occasional age inappropriate discipline is utilized (i.e. too harsh or too lenient), but inconsistencies do not pose safety concerns for child(ren) and caregiver is able to maintain structure of visit.
·  Child(ren) usually cooperative with occasional difficulty with following rules.
Refers to caregivers’ ability to adequately plan for visit.
·  Caregiver brings some required items and is able to ask visitation coordinator for assistance with additional supplies.
·  Caregiver may need intervention by coordinator assisting in the initiation of an activity.
·  / Refers to caregivers’ inability to manage child(ren)’s behavior.
·  Ignores, disregards, or shows disinterest in child(ren)’s behavior.
·  Caregiver is unable to maintain the structure of visit.
·  Child(ren) is displaying disruptive behaviors throughout visit.
·  Caregiver is unable to provide appropriate role modeling.
·  Caregivers are not supportive of one another’s parenting styles.
·  Visits are often filled with silences or idleness between participants due to lack of interesting age appropriate activities.
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Observations/Comments:

8. General Behavioral Functioning of Caregiver- Parent demonstrates good coping skills, maturity and has age appropriate discussions. Parent’s appearance is clean and groomed.

Strength

/ Adequate / Needs
Refers to caregivers demonstrating the ability to be empathetic towards the child(ren); they put the child(ren)’s needs ahead of their own.
·  Caregivers demonstrate good coping skills, maturity, and have age appropriate discussion.
·  Caregivers looking clean and well groomed.
·  Caregivers appear oriented to place and time. / Refers to the caregiver’s ability to read some social cues from the child(ren) but they struggle to show empathic responses and communicate with the child (ren) above their level of reasoning or functioning.
·  Caregiver appears un-groomed and disorganized to time and place. / Refers to caregivers inability to demonstrate empathy toward the child (ren) and shows more concern for their own needs rather than focusing on the child (ren)’s.
·  Caregivers exhibits immaturity and communication with the child (ren) far exceeds what the child (ren) is capable of understanding and comprehending.
·  Caregivers’ appear disheveled, unkempt, and dirty appearance.
· 

Observations/Comments:

Draft 3-11-08 (adapted from Adams County, Colorado) page 1