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Organization: Exchange Club CASTLE Program Name: Safe Families <br /> Funder: Children's Services Advisory Committee RFP 42007043 <br /> FAMILY RISK/PROTECTWE FACTORS <br /> Instructions: When a risk/protective factor is assessed, place a checkmark in the box if the factor needs to be addressed. Upon completion (a risk <br /> factor that is no longer a risk, or a protective factor that has been enhanced) write, "completed" in the appropriate box. (If a risk/protectivefactor <br /> does not need to be addressed, the box will be blank) <br /> RISK FACTOR INITIAL 3 MONTH 6 MONTH 9 MONTH ASSESS. AT <br /> ASSESS. ASSESS. ASSESS. ASSESS. COMPLETIO <br /> DATE: DATE: DATE: DATE: N <br /> 1. Additional parentingknowledge/ skills <br /> needed <br /> 2. Parentis history of abuse as a child <br /> 3. Parent/s history of substance abuse <br /> 4. Parentis history ofinental health issues _ <br /> 5. Domestic Violence — PosbPresent <br /> (VictmVPer etrator) <br /> 6. Inability to meet basic needs <br /> 7. Teen, young or non-traditional parent <br /> S. Lack ofsupport system <br /> 9. Parents/Children with physical <br /> handicaps or other diagnosable conditions <br /> 10. Other <br /> PROTECTIVE FACTOR INITIAL 3 MONTH 6 MONTH 9 MONTH ASSESS. AT <br /> ASSESS. ASSESS. ASSESS. ASSESS. COMPLETIO <br /> DATE: DATE: DATE: DATE: N <br /> 1.11ousing stability <br /> 2.Delay o subse uent pregnancy <br /> 3.Enrollment in childcare <br /> 4.Enrollment in healthcare <br /> 5. Child receives routine medical care <br /> 6. Livable wage employment <br /> 7. Active participation in child's school <br /> S.Positive Family Communication <br /> 9. Constructive use of time. <br /> 10. Supportive adults outside offamily <br /> AAPI SCORES <br /> AAPI-A (Pre) AAPI-B (Post) <br /> A B C D E A B C D E <br /> A B C D E A B C D E <br /> 23 <br />