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Parental Capability Assssment Report (For Child - )

This parental capability assessment report summarizes identifying information about the child's biological parents and other household members. It describes the family environment, community, and family history. The report also outlines circumstances leading to the child being given up for alternative placement and the social worker's interventions. Finally, it provides an assessment, evaluation, and recommendation regarding the parents' capability to care for the child.

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APRIL ANNE BALASON AGSOLID
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9K views5 pages

Parental Capability Assssment Report (For Child - )

This parental capability assessment report summarizes identifying information about the child's biological parents and other household members. It describes the family environment, community, and family history. The report also outlines circumstances leading to the child being given up for alternative placement and the social worker's interventions. Finally, it provides an assessment, evaluation, and recommendation regarding the parents' capability to care for the child.

Uploaded by

APRIL ANNE BALASON AGSOLID
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PARENTAL CAPABILITY ASSSSMENT REPORT

(For Child ___________________)

Date of Report: _________________

I. IDENTIFYING INFORMATION

Name of the Biological Father Mother (Indicate N/A in Grandparents/Custodian (To be


Parent/s this column if filled up in case parents are
single/separated/widowe deceased or nowhere to be
d found)
Address :
Age :
Religion :
Date of Birth :
Marital Status :
Date of Marriage (If :
applicable)
Educational Attainment :
Occupation/Company (If :
applicable) and monthly
income

Immediate Family Members:

Name Relationship Age Sex Educational Occupation/ Disability/ Whereabouts


Attainment Monthly Sickness, if
Income any (specify)
Other Household Members: (List all individuals living in the same house where the child resides or resided)

II. CIRCUMSTANCE OF THE REFERRAL (Include data and source of the referral/description of current
problem/concern/circumstance need for an assessment. Answerable with what, who, where, how)

III. DESCRIPTION OF THE:

A. FAMILY ENVIRONMENT (Description of the environment and house living condition of the family)

B. COMMUNITY (Describe the Purok/Barangay/Municipality/Resources etc)

C. FAMILY HISTORY/BACKGROUND (Details about grandparents/other relatives in the absence of birth parents)

(Aspects) (Facts/Information to be gathered and explored)

Physical Description Physical description/appearance of birthmother/father, body, height,


complexion, hair, eyes, nose, and disability and deformity. Birth order maybe
included.

Parent’s Personal History

Emotional/Mental Health:
Parenting Skills and Styles:

Basic Physical Needs (Housing difficulties)

Family Relationships: (Couple, Parent-Child, Among Siblings)

Communication/Interpersonal Skills:

Social Support System:

Employment/Income Management (Income = Expenses)

Community Resource Mobilization (Support service from barangay/government/non-government facilities, church,


spiritual organization if any)
Children Characteristics:

IV. CIRCURMTANCES LEADING TO THE CHILD’S BEING GIVEN UP FOR ALTERNATIVE PLACEMENT

V. SOCIAL WORKER’S INTERVENTION/S

Support Services and After Care Plan

Identified Immediate Strategy/Support Responsible Person Time Frame Result/Outcome


Problems Services Provided

VI. ASSESSMENT. EVALUATION, and RECOMMENDATION


Prepared by: Reviewed/Approved by:

_________________________ _______________________________
Name of the Case Manager/Social Worker Name of the Supervisor/Head
License No: _______________
Validity date: ______________

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