Assessment observation form




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Observation of Assessment Page



ASSESSMENT OBSERVATION FORM
FAW:

Program:


Observer:

Date:
Assessment Environment: Who was present? Describe any challenging situations that impacted the assessment and/or the observation.







Competency #1: FAW used effective strength-based, non-judgmental communication

skills to create a comfortable environment. Consistent Inconsistent Not Observed NA

a. FAW made introductions and maintained a personable and friendly demeanor throughout the assessment.













b. FAW waited for direction from parents or asked permission before entering the home, moving into another room or sitting.













c. FAW’s body language indicated his/her attempts to build a rapport and engage the parents, and reflected an accurate understanding of the family’s cues.













d. While discussing the purpose of the visit, the FAW ensured the family’s understand-ing of the confidential nature of the assessment.













e. There was evidence during the opening dialogue that parents and FAW had discussed the possibility of FOB being present for the assessment visit.













f. The FAW engaged the family in light informal conversation to establish rapport, and when appropriate, throughout the assessment.













g. FAW limited note taking during the visit to the intake record and other program administered forms.














Comments:

Competency #2: FAW presented the Healthy Families Program and purpose of visit in a manner that communicated respect for family’s culture and preferences. Consistent Inconsistent Not Observed NA

a. FAW spoke clearly and used appropriate language that was respectful of the family’s values, beliefs and culture.













b. FAW provided an introduction to the assessment service without mention of the home visiting component.













c. FAW provided and explanation of the program’s approach to including both parents (MOB and FOB) in every level of service provision.













d. FAW provided an explanation of consent forms and other documentation while looking for indicators of family’s understanding of information presented.














Comments:


Competency #3: FAW conducted a strength-based assessment using

skills learned for administering the Kempe. Consistent Inconsistent Not Observed NA


a. FAW used a conversational-weave approach to cover items on the Kempe with respect and tact, and limited note taking to the intake record.













b. FAW employed questions throughout the Kempe to gather not only the challenges facing the family, but also the family’s abilities and accomplishments – strengths.













c. When one parent was not present, FAW made attempts to gather information about that individual.













d. FAW employed appropriate open-ended questions to explore initial responses offered by the parents.













e. FAW refrained from intervention practice and offering unsolicited advice.













f. FAW provided information and referrals as appropriate based on the strengths and challenges identified by the family.













g. FAW attempted to end the assessment on a positive note by incorporating “strengths-identifying” questions at the conclusion of the visit.














Comments:

Competency #4: Health and Safety

Consistent Inconsistent Not Observed NA



a. FAW used windows of opportunity, when appropriate, to address health and safety using clear, direct and appropriate language, and explored family’s understanding.













b. FAW responded appropriately to any unacceptable situations (i.e. those that put child or other family member at risk of harm.)













c. FAW addressed Big 3 Issues – domestic violence, substance abuse and mental health/depression – raised by the family by offering information and referral during the conclusion of the visit.













d. FAW used a conversational-weave approach to integrate additional, program-required screening tools into the assessment (e.g. T-ACE, depression scale)














Comments:

Did FAW report that the observed assessment was a typical Assessment? Yes _______ No ________

Was verbal feedback offered to FAW by Observer? Yes _______ No ________

Summary of strengths:

Area(s) for professional development:

PCANY—HFNY Training & Staff Development Rev.12.08




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