Partnership for Children Strengths and Needs Assessment

STRENGTHS AND NEEDS ASSESSMENT

Child’s Name: __Melissa (16 year old)______

0 1 2 3 0 1 2 3

Family ¦ ¦ ¤ ¦ Medical ¦ ¦ ¤ ¦

Living Situation ¦ ¦ ¤ ¦ Physical ¤ ¦ ¦ ¦

Social Dev. ¤ ¦ ¦ ¦ Sleep ¤ ¦ ¦ ¦

Recreational ¦ ¦ ¤ ¦ Sexuality ¤ ¦ ¦ ¦

Developmental ¤ ¦ ¦ ¦ School Behavior ¤ ¦ ¦ ¦

Vocational ¦ ¦ ¦ ¤ School Achievement ¤ ¦ ¦ ¦

Legal ¦ ¦ ¤ ¦ School Attendance ¦ ¤ ¦ ¦

0 1 2 3 0 1 2 3

Family ¦ ¤ ¦ ¦ Language ¦ ¤ ¦ ¦

Interpersonal ¦ ¦ ¤ ¦ Identity ¦ ¦ ¤ ¦

Optimism ¤ ¦ ¦ ¦ Ritual ¤ ¦ ¦ ¦

Educational ¤ ¦ ¦ ¦

Vocational ¤ ¦ ¦ ¦

Talents/Interests ¦ ¦ ¤ ¦

Spiritual/Religious ¤ ¦ ¦ ¦

Community Life ¦ ¤ ¦ ¦

Relationship Permanence ¤ ¦ ¦ ¦

CAREGIVER STRENGTHS CAREGIVER NEEDS

Caregiver Name: __Parents______Caregiver Relationship to child: ______

0 1 2 3 0 1 2 3

Supervision ¦ ¦ ¤ ¦ Physical ¤ ¦ ¦ ¦

Involvement ¤ ¦ ¦ ¦ Mental Health ¤ ¦ ¦ ¦

Knowledge ¦ ¦ ¤ ¦ Substance Use ¤ ¦ ¦ ¦

Organization ¤ ¦ ¦ ¦ Developmental ¤ ¦ ¦ ¦

Social Resources ¤ ¦ ¦ ¦ Safety ¤ ¦ ¦ ¦

Residential Stability ¤ ¦ ¦ ¦

CHILD BEHAVIORAL/EMOTIONAL NEEDS CHILD RISK BEHAVIORS

0 1 2 3 0 1 2 3

Psychosis ¤ ¦ ¦ ¦ Suicide Risk ¤ ¦ ¦ ¦

Impulse/Hyper ¤ ¦ ¦ ¦ Self Mutilation ¤ ¦ ¦ ¦

Depression ¦ ¦ ¤ ¦ Other Self Harm ¦ ¦ ¤ ¦

Anxiety ¦ ¦ ¤ ¦ Danger to Others ¤ ¦ ¦ ¦

Oppositional ¦ ¤ ¦ ¦ Sexual Aggression ¤ ¦ ¦ ¦

Conduct ¤ ¦ ¦ ¦ Runaway ¤ ¦ ¦ ¦

Adj. to Trauma ¦ ¦ ¤ ¦ Delinquency ¦ ¤ ¦ ¦

Anger Control ¦ ¤ ¦ ¦ Judgment ¦ ¦ ¤ ¦

Substance Use ¦ ¦ ¤ ¦ Fire Setting ¤ ¦ ¦ ¦ Gambling ¤ ¦ ¦ ¦ Social Behavior ¤ ¦ ¦ ¦

Bullying ¤ ¦ ¦ ¦

Revised 2/2014