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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