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A-2040.3 Division of Welfare and Supportive Services ASSESSMENTS Eligibility and Payments Manual

Social Work Assessments 13 Nov 01 MTL 13/05

Support System: Who do you call in an emergency? Who do you call on when you need to talk or just need advice? Friends, family, spiritual, church affiliation, social clubs? Teen Parents: Age first became sexually active; age at first pregnancy; age of absent parent; parenting classes; prenatal care history; school attendance. Issues with Children: Behavior problems; IEP; gang involvement; school attendance; parenting classes; absent parent of child(ren) involvement; current or past CPS involvement; CPS worker name and number; your method of discipline. Medical Background: Current condition(s)/diagnosis: Current treatment/physician’s name and last appointment attended; Current medications/OTC (actually taking?); History of accidents/surgery; How is ability to work affected or limited? (What can you do?)Family planning. Mental Health Background: Current or past condition/diagnosis: Current treatment/physician’s name and last appointment attended; Current treatment/counseling/medications (actually taking); History of inpatient/outpatient treatment; How is ability to work affected or limited; What type of work can you do; History of suicide attempts; behaviors: How do you currently feel? How long? Family mental health history. Disability/Incapacity: Condition/diagnosis: Date of SSI application; denial/appeal information; Advocate or legal agency involvement; Caring for disabled family member; Report of Illness and/or Essential Task Questionnaire required?