Early Head Start/PAT Home Visit Plan

Child(ren)’s Name Age in Months Quarter Visit #

Scheduled Date Circle items discussed/reviewed: FPP ISP/IFSP ASQ WBC

Plan/Activities/Experiences:

Write the activitiesthat the child and parent will share during the home visit. This activity comes from the PAT Curriculum or an activity that the parent has suggested. It is individualized to he child’s needs and interests based on observation, assessment and parent input. / Observations in the following developmental areas:
Language:
Motor:During the home visit, observe and document what you see
the child doing in each of these developmental areas.
Document these along with observations made
by the parents in these four areas of development.
This allows us to share child development ideas and
appropriate expectations with parents. We also support
parents in recognizing their child’s growth, strengths, and
overall development. Be sure to verbalize the
observations / these are teachable moments!
Cognitive:
Emotional:

Health/Nutrition/Safety:

Record any discussion and/or activity with the family that revolves around these three areas. A few examples are: a snack activity, meal planning ideas, nutrition / WIC, Home Safety, anything about the child’s health /WCC.
Reminder about upcoming well-child checks or other health related appointments.

Resource Sharing/Parent Handouts:

What resources were shared? This can be general information you are giving to everyone or specific requests from parents. Ex. Baby gates, clothes, breast feeding items, blended family info.potty training info. etc. This shows that we are individualizing for each family / meeting family needs.

Child Developmental Goal:

With the parent, write a goal for the child that is realistic; one that can be a part of their daily routine. Ideally, this would be observed as an activity during the home visit, and it would also be the skill to work on over the next week.
Be realistic and base on observations and assessment data. /

Parent Sharing/Questions/Comments/Ideas/Requests:

This is where we document our conversations and relationship building with the family. We are listening to the needs of the parents/family. We want to know what suggestions they have for home visit activities or socialization activities. We need to actively listen to parent input on how we can maximize their experience with our program.
Home Activities (extending today’s activities):

It is vitally important to document that we are talking with parents about how they can extend today’s activity into their daily routine during the next week; clear, simple, understandable follow up activities designed to support continued growth This is where we get in-kind for the HA /Home Activity section of your SS /In-kind tracking sheet. Important that the activities are clear and specific in order to count as in-kind.

/ Date, time and location of next:
Home visit:______
Socialization:______
Parent meeting/family event:
______
Preparation for next visit:
This can be your preparation and/or the parents. This is the reminder for who will bring what and who will do what for the next visit.

Parent Signature Visitor Signature

Distribution: White – Child files, Yellow – Parent, Pink - PSC

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