FAMILY STRENGTHS AND NEEDS ASSESSMENT

Case Name
[D1] / Case Number
[D2]
Assessment Date (mm/dd/yyyy)
[D3] / Name - Assessed Family
[D4]
Name - Worker
[D5] / Name - Supervisor
[D6]
SN Number / Strength or Need / Score
SN1 / Substance Abuse
[D7]No evidence of a problem.
[D8]Abuse creates some problems in family or caregiver in treatment.
[D9]Serious abuse problems. / [D10]
SN2 / Emotional Stability
[D11]No evidence or symptoms of emotional instability or psychiatric disorder.
[D12]Moderate problems that interfere with functioning.
[D13]Problems that severely limit functioning. / [D14]
SN3 / Family Violence
[D15]No threatening or assaultive behavior among family members.
[D16]Isolated incidents of past assaultive behavior.
[D17]Current pattern of intimidation, isolation, threats of harm, or verbal abuse.
[D18]Repeated assaultive behavior or any incident resulted in injury. / [D19]
SN4 / Intellectual Ability
[D20]No evidence of limitations in intellectual functioning.
[D21]Somewhat limited intellectual functioning.
[D22]Intellectual ability severely limits ability to function. / [D23]
SN5 / Health
[D24]No known health problems that affect functioning.
[D25]Moderate disability / illness; impairs ability to care for child(ren).
[D26]Serious disability / illness; severely impairs ability to care for child(ren). / [D27]
SN6 / Caregiver Victimization
[D28]No evidence of a problem.
[D29]Caregiver has been victimized. (Check all that apply.)
[D30]Caregiver(s) neglected as child(ren).
[D31]Caregiver(s) has been a victim of sexual abuse.
[D32]Caregiver(s) has been a victim of physical abuse. / [D33]
SN7 / Parenting Skills
[D34]No known / minimal deficits in parenting skills.
[D35]Needs improvement in parenting skills.
[D36]Repeated displays of abusive, neglectful, or destructive parenting patterns. / [D37]
SN8 / Environmental
[D38]Family has adequate housing, clothing, and nutrition.
[D39]Physical environment presents potential hazards to health or safety.
[D40]Conditions exist in household that have caused illness or injury.
[D41]Family is homeless. / [D42]
SN9 / Support Systems
[D43]Family has available, and uses, external support system(s).
[D44]Resources limited or have some negative impact or caregiver reluctant to use.
[D45]Caregiver unable to access internal or external resources (skill deficits).
[D46]Resources unavailable or have major negative impact. / [D47]
DEPARTMENT OF HEALTH AND FAMILY SERVICES
Division of Children and Family Services
CFS-2207 (10/2001) / STATE OF WISCONSIN
2
SN Number / Strength or Need / Score
SN10 / Financial
[D48]Family income sufficient to meet needs and is adequately managed.
[D49]Income limited, but is adequately managed.
[D50]Income insufficient or not well-managed; unable to meet basic needs / responsibilities.
[D51]Family is in financial crisis - little or no income. / [D52]
SN11 / Education / Literacy
[D53]Basic education and functional literacy skills.
[D54]Caregiver marginally educated or literate; creates some problems.
[D55]Functionally illiterate; creates major problems. / [D56]
SN12 / Problem Recognition
[D57]No problem observed or problem(s) acknowledged, wants assistance.
[D58]Problem(s) acknowledged, does not want assistance.
[D59]Problem(s) denied; uncooperative; resists assistance or intervention. / [D60]
SN13 / Family Interaction
[D61]Developmental roles / interactions appropriate.
[D62]Moderate communication or behavior problems and / or some inappropriate
role functions.
[D63]Serious family dysfunction in communication or behavior patterns, personal boundaries, attachment and roles. / [D64]
SN14 / Child(ren) Characteristics
[D65]No known emotional, behavioral, intellectual, or physical problems.
[D66]Minor problems, but little impact on functioning.
[D67]Problems in one or more areas that sometimes limit functioning.
[D68]One child has severe / chronic problems that result in serious dysfunction.
[D69]Children have severe / chronic problems that result in serious dysfunction. / [D70]
Total Strengths and Needs Score / [D71]
Comprehensive Needs Level
[D72]Low (0-10) Medium [D73](11-20)[D74]High (21-54)
Needs Level Override:
New Needs Level:
Reason For Override:
Child(ren) Problem Areas (Check all that apply.)
[D75]Substance abuse / [D76]School behavior / truancy / [D77]Life / social skills / [D78]Delinquent behavior
[D79]Health / handicap / [D80]Support system / [D81]Sex abuse issues
[D82]Emotional stability / [D83]Peers / [D84]Assaultiveness
[D85]Exceptional education needs / [D86]Intellectual ability / [D87]Status offending
Primary Needs
Rank / Area of Need
1. / [D88]
2. / [D89]
3. / [D90]
Primary Strengths
Rank / Area of Strength
1. / [D91]
2. / [D92]
3. / [D93]
CFS-2207 (10/2001) / 1

[D1]1 The Case Name pre-fills from the Name Field, in the General group box of the Family Strengths and Needs window and is not editable on the template. This data can be updated in the Last/Provider Field in the Case group box of the Maintain Case Window.

[D2]1 The Case Number pre-fills from the Case ID Field in the General group box of the Family Strengths and Needs Assessment window and is not editable on the template. This is a system generated number which cannot be edited.

[D3]1 The Assessment Date is a system derived Date based upon when the Family Strengths and Needs Assessment is created and is not editable on the template. This Date cannot be edited or changed.

[D4]1 The Assessed Family Name pre-fills from the Name field in the General group box of the Family Strengths and Needs Assessment window and is not editable on the template. This data can be updated in the Last/Provider field found of the Maintain Case Window.

[D5]1 The Worker Name pre-fills from the Worker field in the General group box of the Family Strengths and Needs Assessment window and is not editable on the template. The worker’s name can be updated by a supervisor in the First Name/MI/Last Name Field on the Basic tab of the Person Management window. If the assignment is incorrect, the supervisor needs to make the correct assignment(s) to the case.

[D6]1 The Supervisor pre-fills based upon the worker’s supervisor’s name documented on the Maintain Worker Information window and is not editable on the template. This data can be updated in the First Name/MI/Last Name field on the Basic tab of the Person Management window (if incorrectly spelt) or the Maintain Worker Information window if the worker’s supervisor is documented incorrectly.

[D7]1 The ‘No Evidence of a Problem’ checkbox is selected when that option is chosen from the ‘Substance Abuse’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D8]1 The ‘Abuse creates some problems in family or caregiver in treatment’ checkbox is selected when that option is chosen from the ‘Substance Abuse’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D9]1 The ‘Serious abuse problems’ checkbox is selected when that option is chosen from the ‘Substance Abuse’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D10]1 This score is calculated based on the option chosen for the ‘Substance Abuse’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D11]1 The ‘No evidence or symptoms of emotional instability or psychiatric disorder’ checkbox is selected when that option is chosen from the ‘Emotional Stability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D12]1 The ‘Moderate problems that interfere with functioning’ checkbox is selected when that option is chosen from the ‘Emotional Stability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D13]1 The ‘Problems that severely limit functioning’ checkbox is selected when that option is chosen from the ‘Emotional Stability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D14]1 This score is calculated based on the option chosen for the ‘Emotional Stability’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D15]1 The ‘No threatening or assaultive behavior among family members’ checkbox is selected when that option is chosen from the ‘Family Violence’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D16]1 The ‘Isolated incidents of past assaultive behavior’ checkbox is selected when that option is chosen from the ‘Family Violence’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D17]1 The ‘Current pattern of intimidation, isolation, threats of harm, or verbal abuse.’ checkbox is selected when that option is chosen from the ‘Family Violence’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D18]1 The ‘Repeated assaultive behavior or any incident resulted in injury’ checkbox is selected when that option is chosen from the ‘Family Violence’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D19]1 This score is calculated based on the option chosen for the ‘Family Violence’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D20]1 The ‘No evidence of limitations in intellectual functioning’ checkbox is selected when that option is chosen from the ‘Intellectual Ability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D21]1 The ‘Somewhat limited intellectual functioning’ checkbox is selected when that option is chosen from the ‘Intellectual Ability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D22]1 The ‘Intellectual ability severely limits ability to function’ checkbox is selected when that option is chosen from the ‘Intellectual Ability’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D23]1 This score is calculated based on the option chosen for the ‘Intellectual Ability’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D24]1 The ‘No known health problems that affect functioning’ checkbox is selected when that option is chosen from the ‘Health’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D25]1 The ‘Moderate disability/illness; impairs ability to care for child(ren)’ checkbox is selected when that option is chosen from the ‘Health’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D26]1 The ‘Serious disability/illness; severely impairs ability to care for child(ren)’ checkbox is selected when that option is chosen from the ‘Health’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D27]1 This score is calculated based on the option chosen for the ‘Health’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D28]1 The ‘No evidence of a problem’ checkbox is selected when that option is chosen from the ‘Caregiver Victimization’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D29]1 The ‘Caregiver has been victimized. (Check all that apply)’ checkbox is selected when that option is chosen from the ‘Caregiver Victimization’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D30]1 The ‘Caregiver(s) neglected as child(ren)’ checkbox is selected when that option is chosen from the ‘Caregiver Victimization’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is enabled only when the ‘Caregiver has been victimized’ checkbox is selected. This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D31]1 The ‘Caregiver(s) has been a victim of sexual abuse’ checkbox is selected when that option is chosen from the ‘Caregiver Victimization’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is enabled only when the ‘Caregiver has been victimized’ checkbox is selected. This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D32]1 The ‘Caregiver(s) has been victim of physical abuse’ checkbox is selected when that option is chosen from the ‘Caregiver Victimization’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is enabled only when the ‘Caregiver has been victimized’ checkbox is selected. This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D33]1 This score is calculated based on the option chosen for the ‘Caregiver Victimization’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D34]1 The ‘No known/minimal deficits in parenting skills’ checkbox is selected when that option is chosen from the ‘Parenting Skills’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D35]1 The ‘Needs improvement in parenting skills’ checkbox is selected when that option is chosen from the ‘Parenting Skills’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D36]1 The ‘Repeated displays of abusive, neglectful, or destructive parenting patterns’ checkbox is selected when that option is chosen from the ‘Parenting Skills’ question on the Family Strengths and Needs Assessment Window, Questions Tab (Question 1 – 7). This checkbox is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.

[D37]1 This score is calculated based on the option chosen for the ‘Parenting Skills’ question on the Question tab of the Family Needs and Strength Assessment window (Questions 1- 7). This score is not editable on the template, and can only be changed by selecting a different option from the drop down field on the window.