Family Support Assessment

Sentinel City® Student Report

Leila Safavi lsafavi1@u.westcoastuniversity.edu

West Coast University (canvas)-2147387035

5/12/2021

6/17/2021

Name:

ID:

First Access:

Last Access:

Email:

Tenant:

16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins

Total Time SpentTime in AssessmentsTime in City

FAMILY SUPPORT ASSESSMENT 100%Progress: Time Spent: 3 hrs 27 mins

NonNon

RelationshipName

Boy friend/ Brandi’s father (Jessi)Jessi

RelationshipName

3No

Total Household Occupants (Include Client)Ability to Pay Other Monthly Bills

No$1,250

Ability to Pay Rent / MortgageRent / Own

YesChild support

Child SupportOther Sources of Income

$544/MonthYes

Total Annual Income from EmployerEmployment Status

High School Grad

Highest Level of Education Completed

EnglishUnknown

Primary Language Spoken At HomeReligious Preference

SingleNonWhite/Non-Hispanic

Marital StatusAgeRace/Ethnicity

Candice Conway

Client Full Name

06/17/2021Leila Safavi

DateInterviewer Completing this Assessment

ADULTS IN THE HOME

FINANCIAL

GENERAL FAMILY INFORMATION

Page 1 of 3Friday, June 18, 2021

 

 

Sentinel City® Student Report

Leila Safavi lsafavi1@u.westcoastuniversity.edu

West Coast University (canvas)-2147387035

5/12/2021

6/17/2021

Name:

ID:

First Access:

Last Access:

Email:

Tenant:

16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins

Total Time SpentTime in AssessmentsTime in City

Confused

Newborn care

Confused, not sure about the father

General Childcare Arrangements / Concerns

Not sure

Child Support

JessiNo information

Information about child’s fatherPlans to breastfeed or bottle feed

No24 weeks

Prenatal care?How many weeks?

Yes

Is client currently pregnant?

Female2Brandi

GenderAgeChild

NonNo information

Are there medical issues with this child?Are Immunizations up to date for this child?

Jessi (Current boy friend)

Information about child’s father

(Sometimes $214 a week by her dad)

Child Support

Yes ($1,100 disability check monthly, and $250 a week by his dad)

Child Support

Randy (ex convict)

Information about child’s father

He is developmentally delayed.No information

Are there medical issues with this child?Are Immunizations up to date for this child?

Male6 YBrayden

GenderAgeChild

CHILDREN IN THE HOME

Page 2 of 3Friday, June 18, 2021

 

 

Sentinel City® Student Report

Leila Safavi lsafavi1@u.westcoastuniversity.edu

West Coast University (canvas)-2147387035

5/12/2021

6/17/2021

Name:

ID:

First Access:

Last Access:

Email:

Tenant:

16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins

Total Time SpentTime in AssessmentsTime in City

They need some councelling with Jessi about drug abuse and smoking cessation.

Other Notes

Frozen food and sodaYesJoe’s Grocery

Nutrition ConcernsFoodGrocery

Yes Brayden behavior due to his disability.

Concerns about physical, emotional, or behavioral problems with any of the children?

Yes, she can not leave kids by jessi.

Does the client have concerns about harming their children?

Yes, she has concerns about Brydan’s dad.

Does the client have concerns about someone threatening or physically hurting them?

Yes, she needs to get away from Jessi when he gets angry.

Does the client need to get away from an abusive relationship or harmful situation?

Yes (by her boyfriend Jessi)

Is client currently a victim of domestic violence?

yes

Has client ever been a victim of domestic violence?

NonYes

Abuse of Prescription MedicationsAlcohol Use

YesYes

Use of Illegal SubstancesSmoker

OTHER

SUBSTANCES

Page 3 of 3Friday, June 18, 2021