FACS Completed Sample
Family Assessment
of Child Skills (FACS)
Date: September 30, 2021
Child Information
- Child's name: Marcus Greene
- Child's date of birth: May 24, 2017
- Family’s name and address: Veronica Greene, 3873 Red Run Road, Baltimore, MD 21211
- Person completing form: Veronica Greene
- Relationship to child: mother
- E-mail address: greene.veronica@gmail.com
- Preferred method(s) of contact: Email
- Language(s) spoken at home: English
The Family Assessment of Child Skills allows parents and other caregivers to share details about a child’s developmental skills. This information is needed to select appropriate learning goals for an IFSP or IEP. Easy-to-answer questions are listed in eight areas: Fine Motor, Gross Motor, Adaptive, Social-Emotional, Social-Communication, Cognitive, Literacy, and Math. Questions about related skills are also included.
You may complete this form independently or with help from program staff. Program staff will explain how to begin and when to stop answering questions. Please let program staff know if you have any questions or need assistance.
Fine Motor
Fine motor skills are those that involve the movement and use of the hands. These skills include grasping and releasing, using the index finger and thumb, using scissors and writing implements, drawing shapes, and printing letters.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
| 1. | Does your child move or wave their hands toward objects on people? For example, your child moves their arms back and forth toward a hanging toy. (FM.A1) |
| 2. | Does your child pick up pea-size objects such as a small piece of cereal or cracker with the thumb and index finger of either hand and without resting their arm or hand on the table? For example, your child picks up a grape using their thumb and index finger. (FM.A2) |
| 3. | Does your child stack three or more objects with either hand? For example, your child stacks three or four blocks on top of one another. (FM.A3) |
| 4. | Does your child use one finger to turn toys or objects on or off? For example, your child uses an index finger to push a button on a telephone or a toy. (FM.B1) |
| 5. | Does your child turn objects by turning either wrist? For example, your child turns their wrist to take a lid off a jar, wind up a toy, or turn a faucet on and off. (FM.B2) |
| DATE 1:9/30/21 | DATE 2: | DATE 3: | |
|---|---|---|---|
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N |
What fine motor skills do you want your child to learn?
Gross Motor
Gross motor skills involve moving and getting around in your surroundings. These skills include rolling, crawling, walking, running, jumping, skipping, and riding a bike.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
| 1. | Does your child move their head, arms, and legs independently of each other while lying on their back? (GM.A1) |
| 2. | Does your child put weight on one hand or arm while reaching with the opposite hand? (GM.A2) |
| 3. | Does your child roll over from back to stomach in both directions? (GM.A3) |
| 4. | Does your child move to a sitting position on the floor from standing, lying down, or from their hands and knees without help? (GM.A4) |
| 5. | Does your child get out of a child-size chair without help? (GM.A5) |
What gross motor skills do you want your child to learn?
Adaptive Skills
Adaptive skills involve being able to care for yourself. These skills include eating, drinking, preparing and serving food, using the toilet independently, dressing, and undressing.
| Name: Marcus Greene
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1: 9/30/21 | DATE 2: | DATE 3: |
|---|---|---|---|
| 1. | Does your child take food off a spoon without choking or gagging? (AD.A1) | Y S N | Y S N |
| 2. | Does your child eat a variety of foods and textures? (AD.A2) | Y S N | Y S N |
| 3. | Does your child eat foods using a spoon, fork, or other utensil without much spilling? (AD.A3) | Y S N | Y S N |
| 4. | Does your child drink from a cup or glass without a lid with minimal spilling? (AD.A4) | Y S N | Y S N |
| 5. | Does your child eat in socially appropriate ways? (AD.A5) | Y S N | Y S N |
| 6. | Does your child get food ready for eating by removing inedible parts? (AD.A6) | Y S N | Y S N |
| 7. | Does your child use the toilet independently? (AD.B1) | Y S N | Y S N |
| 8. | Does your child bathe and dry off with minimal assistance? (AD.B2) | Y S N | Y S N |
| 9. | Does your child brush their teeth, comb their hair, and wipe their nose with acceptable outcomes? (AD.B3) | Y S N | Y S N |
| 10. | Does your child undress without help? (AD.C1) | Y S N | Y S N |
| 11. | Does your child choose appropriate clothing for the weather and get dressed? (AD.C2) | Y S N | Y S N |
| 12. | Does your child act to relieve their distress or pain? (AD.D1) | Y S N | Y S N |
| 13. | Does your child follow known home and community safety rules? (AD.D2) | Y S N | Y S N |
| 14. | Does your child avoid dangerous conditions or objects without being told? (AD.D3) | Y S N | Y S N |
| 15. | Does your child recognize and report danger to a caregiver? (AD.D4) | Y S N | Y S N |
What adaptive skills do you want your child to learn?
Social Skills
Social skills involve interacting and participating with others. These skills include showing affection, playing with others, choosing activities, sharing, managing conflict, and identifying emotions.
| Name: Marcus Greene | |
|---|---|
| 1. | Does your child initiate a positive social behavior with a familiar adult? (SE.A1) |
| 2. | Does your child continue an interaction with a familiar adult? (SE.A2) |
| 3. | Does your child do at least two things to get ready for a usual event or routine without being asked? (SE.A3) |
| 4. | Does your child respond appropriately to others' emotions? (SE.B1) |
| 5. | Does your child recover from anger, fear, and upset? (SE.B2) |
| 6. | Does your child make positive statements about themselves? (SE.B3) |
| 7. | Does your child play with other children? (SE.C1) |
| 8. | Does your child plan and act out imaginary play? (SE.C2) |
| 9. | Does your child work with another child to plan and carry out play activity? (SE.C3) |
| 10. | Does your child follow rules while playing games? (SE.C4) |
| DATE 1:9/30/21 | DATE 2: | DATE 3: | |
|---|---|---|---|
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N |
What social-emotional skills do you want your child to learn?
Social-Communication Skills
Social-communication skills involve communicating with others. These skills include listening, speaking, and understanding conversational rules.
| Name: Marcus Greene
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1: 9/30/21 | DATE 2: | DATE 3: |
|---|---|---|---|
| 1. | Does your child turn to look at someone who is talking nearby? (SC.A1) | Y S N | Y S N |
| 2. | Does your child babble the same sound combinations? (SC.A2) | Y S N | Y S N |
| 3. | Does your child babble or use words in response to a caregiver's words? (SC.A3) | Y S N | Y S N |
| 4. | Does your child get attention and then point to an object? (SC.A4) | Y S N | Y S N |
| 5. | Does your child look in the same direction that another person is looking? (SC.B1) | Y S N | Y S N |
| 6. | Does your child point out familiar objects or people after you name them? (SC.B2) | Y S N | Y S N |
| 7. | Does your child carry out two linked directions with objects that are out of sight? (SC.B3) | Y S N | Y S N |
| 8. | Does your child respond to questions related to why, how, and when? (SC.B4) | Y S N | Y S N |
| 9. | Does your child use sentences of three words or more? (SC.C1) | Y S N | Y S N |
| 10. | Does your child start and continue social exchanges using words? (SC.D1) | Y S N | Y S N |
| 11. | Does your child use language to share information? (SC.D2) | Y S N | Y S N |
What social-communication skills do you want your child to learn?
Cognitive Skills
Cognitive skills involve mental processes and reasoning.
| Name: Marcus Greene
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1: 9/30/2021 | DATE 2: | DATE 3: |
|---|---|---|---|
| 1. | Does your child turn toward noises, objects, or people and respond? (CO.A1) | Y S N | Y S N |
| 2. | Does your child use two or more simple actions together? (CO.A2) | Y S N | Y S N |
| 3. | Does your child copy an unfamiliar gesture or movement? (CO.B1) | Y S N | Y S N |
| 4. | Does your child imitate unfamiliar words? (CO.B2) | Y S N | Y S N |
| 5. | Does your child relate an event that happened previously? (CO.B3) | Y S N | Y S N |
| 6. | Does your child search for things that are not in their usual place? (CO.C1) | Y S N | Y S N |
| 7. | Does your child recognize symbols that represent objects? (CO.C2) | Y S N | Y S N |
| 8. | Does your child sort objects based on two or more features? (CO.C3) | Y S N | Y S N |
| 9. | Does your child compare common concepts? (CO.C4) | Y S N | Y S N |
| 10. | Does your child use one object to get another that is out of reach? (CO.D1) | Y S N | Y S N |
| 11. | Does your child use different actions with objects to get new outcomes? (CO.D2) | Y S N | Y S N |
| 12. | Does your child try different methods to solve a problem? (CO.D3) | Y S N | Y S N |
| 13. | Does your child make reasonable predictions? (CO.D4) | Y S N | Y S N |
| 14. | Does your child ask questions based on simple observations? (CO.E1) | Y S N | Y S N |
| 15. | Does your child share information about what they figured out? (CO.E2) | Y S N | Y S N |
What cognitive skills do you want your child to learn?
Literacy Skills
Literacy skills involve prereading and reading skills.
| Name: Marcus Greene
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
|---|---|
| 1. | Does your child pay attention and seem to enjoy shared reading time? (LI.A1) |
| 2. | Does your child understand that writing goes in one direction? (LI.A2) |
| 3. | Does your child recognize printed words for familiar people or objects? (LI.A3) |
| 4. | Does your child say rhyming words? (LI.B1) |
| 5. | Does your child separate a compound word into its parts? (LI.B2) |
| 6. | Does your child break a word up into its separate syllables? (LI.B3) |
| 7. | Does your child break a word into its individual sounds? (LI.B4) |
| 8. | Does your child name several letters? (LI.C1) |
| 9. | Does your child describe the pictures in a book? (LI.D1) |
| 10. | Does your child retell a story with a beginning, middle, and end? (LI.D2) |
| 11. | Does your child write and draw? (LI.E2) |
| DATE 1:9/30/21 | DATE 2: | DATE 3: | |
|---|---|---|---|
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N | |
| Y S N | Y S N | Y S N |
What literacy skills do you want your child to learn?
Math Skills
Math skills include counting, comparing numbers, and recognizing and writing numbers.
| Name: Marcus Greene
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1: 9/30/21 | DATE 2: | DATE 3: | ||
|---|---|---|---|---|---|
| 1. | Does your child correctly count 3 items out loud? (MA.A1) | Y S N | Y S N | Y S N | |
| 2. | Does your child correctly count 10 items out loud? (MA.A2) | Y S N | Y S N | Y S N | |
| 3. | Does your child correctly count 20 items out loud? (MA.A3) | Y S N | Y S N | Y S N | |
| 4. | Does your child count by tens up to 100? (MA.A4) | Y S N | Y S N | Y S N | |
| 5. | Does your child compare how many items are in two small sets? (MA.B1) | Y S N | Y S N | Y S N | |
| 6. | Does your child compare how many items are in two medium sets? (MA.B2) | Y S N | Y S N | Y S N | |
| 7. | Does your child compare how many items are in two large sets? (MA.B3) | Y S N | Y S N | Y S N | |
| 8. | Does your child read and write numerals for up to 5 items? (MA.C1) | Y S N | Y S N | Y S N | |
| 9. | Does your child read and write numerals for 6 to 10 items? (MA.C2) | Y S N | Y S N | Y S N | |
| 10. | Does your child read and write numerals for 11 to 20 items? (MA.C3) | Y S N | Y S N | Y S N |
What math skills do you want your child to learn?
Intervention Priorities
Date: 9/30/21
- Getting dressed and undressed by himself
- Holding a pencil correctly
Date: ___________________
Date: ___________________