ࡱ> { Bbjbjzz yv66$ d       $r$"//D8  @_̍Z0"$"$"$L//"$6 V: Family Needs Assessment Many families of young children have needs for information or support. If you wish, our staff are very willing to discuss these needs with you and work with you to identify resources that might be helpful. Listed below are some needs commonly expressed by families. The columns on the right will be used to check any topics you would like to discuss. At the end there is a place that may be used to describe other topics not included in the list. The information you provide through this form will be kept confidential. Would you like to discuss this topic with a staff person from our program? TOPICS NoNot Sure YesInformation 1. How children grow and develop2. How to play or talk with my child3. How to teach my child4. How to handle my childs behavior5. Information about any condition or disability my child might have6. Information about services that are presently available for my child7. Information about the services my child might receive in the futureFamily & Social Support 1. Talking with someone in my family about concerns2. Having friends to talk to3. Finding more time for myself4. Helping my spouse accept any condition our child might have5. Helping our family discuss problems and reach solutions6. Helping our family support each other during difficult times7. Deciding who will do household chores, child care, and other family tasks8. Deciding on and doing family recreational activitiesFinancial 1. Paying for expenses such as food, housing, medical care, clothing, or transportation2. Getting any special equipment my child needs3. Paying for therapy, day care, or other services my child needs4. Counseling or help in getting a job5. Paying for babysitting or respite care6. Paying for toys that my child needs Adapted from the Family Needs Survey. Donald B. Bailey, Jr. & Rune J. Simeonsson. FPG Child Development Institute, The University of North Carolina at Chapel Hill. Would you like to discuss this topic with a staff person from our program? TOPICS NoNot Sure YesExplaining to Others 1. Explaining my childs condition to my parents or my spouses parents2. Explaining my childs condition to his or her siblings3. Knowing how to respond when friends, neighbors, or strangers ask questions about my child4. Explaining my childs condition to other children5. Finding reading material about other families who have a child like mineChild Care 1. Locating babysitters or respite care providers who are willing and able to care for my child.2. Locating a day care program or preschool for my child3. Getting appropriate care for my child in a church or synagogue during religious servicesProfessional Support 1. Meeting with a minister, priest, or rabbi2. Meeting with a counselor (psychologist, social worker, psychiatrist)3. More time to talk to my childs teacher or therapistCommunity Services 1. Meeting & talking with other parents who have a child like mine2. Locating a doctor who understands me and my childs needs3. Locating a dentist who will see my child Other: Please list other topics or provide any other information that you would like to discuss . Is there a particular person with whom you would prefer to meet? Thank you for your time. We hope this form will be helpful to you in identifying the services that you feel are important. Adapted from the Family Needs Survey. Donald B. Bailey, Jr. & Rune J. Simeonsson. FPG Child Development Institute, The University of North Carolina at Chapel Hill. 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