# Family Profile # Preschool **Family's name:** ____ **Today's date:** ____ **Name of person completing form:** ____ **Date of administration:** ____ The following items gather information about your strengths as well as the supports and resources you need to provide a safe, responsive, and emotionally nurturing environment for your child. The items focus on knowledge, skills, and resources you need in order to foster your child’s social-emotional development and competence. Although you can complete this form on your own, the preferred method is through an interview with a professional. Items that are not relevant or that you do not want to answer can be omitted. Items are accompanied by one or more examples to help you understand the item. Following the examples is a space for you to share your own examples related to each item. Please choose between most of the time, sometimes, not yet, or not sure/need more info. --- ## F-1.0 Responding to my preschooler’s needs **1.1** I understand my child’s nonverbal communication and know how to respond. Some examples might be *My child usually gets whiny or cranky when she is hungry or tired, and I ask her if she wants a snack or a nap. I dance or jump around with my child when she seems to be in a playful mood.* **Please give examples of your child’s nonverbal communication and ways that you respond:** **1.2** I understand my child’s verbal communication and know how to respond. Some examples might be *I understand my child’s words and am able to respond to him. I ask my child questions about his day (e.g., what he did, what he saw) and listen to his responses.* **Please give examples of your child’s verbal communication and ways that you respond:** **1.3** I know how to support my child’s emotional needs. Some examples might be *I encourage my child to identify and talk about her feelings when I see that she is mad, frustrated, unhappy, or excited. I have my child take deep breaths to help her calm down when she is upset. I give my child choices about her daily routines (e.g., what she wears, what story to read, what to play).* **Please give examples of how you support your child’s emotional needs:** *Social-Emotional Assessment/Evaluation Measure (SEAM™), Research Edition, by Jane Squires, Diane Bricker, Misti Waddell, Kristin Funk, Jantina Clifford, and Robert Hoselton. Copyright © 2014 Paul H. Brookes Publishing Co., Inc. All rights reserved.* --- ## Preschool Family Profile | | Most of the time | Sometimes | Not yet | Not sure/need more info | Focus area | | --- | --- | --- | --- | --- | --- | | 1.4 I use positive comments and language with my child. | | | | | | | Some examples might be *I give my child a high five when he picks up his toys. I praise my child's good response when he ignores his siblings' teasing.* | | | | | | | I understand why my child engages in inappropriate behaviors and know how to modify the environment. | | | | | | | Some examples might be *I prepare my child for a long car trip by providing books and other enjoyable activities to do in the car. I let my child choose one grocery item at the store before a tantrum occurs.* | | | | | | --- ## Preschool Family Profile | | Most of the time | Sometimes | Not yet | Not sure/need more info | Focus area | | --- | --- | --- | --- | --- | --- | | 2.1 I offer different materials and toys for my child (e.g., games and art supplies that encourage thinking skills and creativity). | | | | | | | Some examples might be *I give my child dress-up clothes and toy dishes to encourage imaginative play.* | | | | | | **2.2** I know the age-appropriate games that my child enjoys. Some examples might be *I play simple action games with my child that she enjoys (e.g., Simon Says, Red Rover). I play my child’s favorite board games with her (e.g., Candyland, Memory Game).* | Some examples might be *I provide my child with meals and snacks at regular times each day. I include my child in meal preparation when possible (e.g., picking out vegetables, measuring and stirring, helping set the table).* | | | | | | --- ## Preschool Family Profile | | Most of the time | Sometimes | Not yet | Not sure/need more info | Focus area | | --- | --- | --- | --- | --- | --- | | 3.2 I provide a rest and sleeping routine for my child that is predictable and appropriate for her age. | □ | □ | □ | □ | △ | | Some examples might be *I provide bedtime and naptime at consistent times across days and weeks. I help my child follow a simple routine before bed (e.g., taking a bath, brushing teeth, taking time to quietly read books together).* | | | | | | | **Please give examples of your child's naptime and bedtime routines:** | | | | | | | 3.3 I provide my child with predictable limits and consequences. | □ | □ | □ | □ | △ | | Some examples might be *I provide my child with consistent limits and rules (e.g., no hitting or running in the house). I notice and comment to my child when he is doing something positive and consistent with our household rules (e.g., "I like the way you are putting away your clothes").* | | | | | | | **Please give examples of how you provide predictable limits and consequences for your child:** | | | | | | | 3.4 I take time each day to play with my child. | □ | □ | □ | □ | △ | | Some examples might be *I take time each day to laugh and be silly with my child. I play rhyming games and sing songs with my child as we go through the day.* | | | | | | | **Please give examples of times of day when you play with your child and playful activities you do together:** | | | | | | --- ## Preschool Family Profile | | Most of the time | Sometimes | Not yet | Not sure/need more info | Focus area | | --- | --- | --- | --- | --- | --- | | 4.1 I have done a safety check on my home to make it safe for my child. | | | | | | | An example might be *I keep dangerous objects and harmful substances (e.g., medications, cleaning supplies, weapons) out of reach or in locked cupboards.* | | | | | | | 4.2 I have a safe way to transport my child. | | | | | | | | Some examples might be *I use a car seat that is appropriate for my child’s height and weight.* | | | | | | | 4.3 I am able to provide my child with safe care and supervision. | □ | □ | □ | □ | △ | | Some examples might be *I watch my child while he plays at the park or outdoors. I arrange for someone else to supervise or care for my child when I am unable to watch or care for him.* | | | | | | --- ## Preschool Family Profile | | Most of the time | Sometimes | Not yet | Not sure/need more info | Focus area | | --- | --- | --- | --- | --- | --- | | 4.4 I have access to regular medical and dental care for my child. | ☐ | ☐ | ☐ | ☐ | △ | | An example might be *I am able to take my child to the child health clinic for checkups (including hearing and vision) and dentist at least twice per year.* | | | | | | **4.5** I know how to manage my own feelings of anger and frustration that come up when I am with my child. Some examples might be *I have a trusted person to call for help or advice when I am struggling with my child’s behaviors and I am unsure what to do. I have ways of taking time and caring for myself regularly.*