Family Development - Empowerment Plan
Family Development - Empowerment Plan
|Today's Date: | |Family Member's Name: |Child's Name: |
|Intervention Plan: |
|I. Major goal (in the family member's words): |
|Probing Questions: Is there a major goal you’d like to work on? What is your main priority right now? |
| |
|II. Help family brainstorm and then choose steps to take. (Note date each will take place): |
|Steps family will take & when: |
|Probing Questions: What can be the first step to achieving this goal? By when can this step be completed? What are other possible steps you can take to |
|achieve this goal? |
|Steps worker will take & when: |
|Probing Questions: While you take the above steps, I can assist you by ___ (steps). I can complete these steps by ____ (date) . Are there any steps I |
|can take to assist you in achieving your goal? What do you think would an appropriate date to complete it? |
|Family strengths and resources (in family member's words): |
|Probing Questions: What do you see are your strengths? What resources do you have that can help you reach your goal? (Use Matrix Summary to show |
|strengths) |
| |
|Concerns (in family member's words): |
|Probing: Do you have concerns in reaching your goal? Are there any barriers you think will come up? Do you feel you have enough resources to assist you |
|in achieving your goal? |
|Concerns (in worker's words): |
|Services available (include details such as names, addresses, phone number, hours, etc.): |
|Notes: |
|Next meeting date, time, place: |
|Probing Questions: What day and time can you meet to discuss your progress? What time is best for you to meet? Would you like to meet in my office or in |
|your home? |
| |
|Family member's signature: ______________________ Date:______________ |
| |
|Worker's signature: ______________________________ Date:______________ |
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