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d� own <br /> Client: Counselor: <br /> Open: County: <br /> Close: Supervisor: <br /> FAMILY RISKIPROTECTIVE FACTOR ASSESSMENT <br /> Instructions: When a risk/protective factor is assessed, place a checkmark in the box if the factor needs to be <br /> addressed. Upon completion (a risk factor that is no longer a risk, or a protective factor that has been enhanced) <br /> write, "completed" in the appropriate box. <br /> RISK FACTOR INITIAL 3 MONTH 6 MONTH CLOSING 1 YEAR <br /> ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT FOLLOW UP <br /> DATE: DATE: DATE: DATE: DATE: <br /> 1. Lack of parenting <br /> knowledge/skills <br /> 2. Parent 's past <br /> History of abuse <br /> 3. Parent 's history <br /> of substance <br /> abuse/mental health <br /> issues <br /> 4. Poverty or <br /> financial stress <br /> 5. Teen or young <br /> parent <br /> 6. Social isolation <br /> 7. Other <br /> PROTECTIVE INITIAL 3 MONTH 6 MONTH CLOSING 1 YEAR <br /> FACTOR ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT FOLLOW UP <br /> DATE: DATE: DATE : DATE: DATE : <br /> 1 . Housing <br /> stability <br /> 2. Delay of <br /> subsequent <br /> pregnancy <br /> 3. Enrollment in <br /> childcare <br /> 4. Enrollment in <br /> healthcare <br /> 5. Livable wage <br /> employment <br /> 6. Involvement in <br /> child's school <br /> 7. Other <br /> COUNSELOR SIGNATURE: <br /> Word/Share/Safe Families Forms/Family Risk Prot Factor <br /> 24 <br />