Life Skills Progression Instrument SAMPLE 1.pdf

Next LSP due //___

Next LSP due //___

Notes

by Linda Wollesen and Brad Richardson. Copyright © 2024 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Next LSP due //___

Notes

by Linda Wollesen and Brad Richardson. Copyright © 2024 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Sample

Next LSP due //___

High

5

Table of Life Skill Development

Score(NA=0) Area of life skill development Low1 1.5 2 2.5 3 3.5 4 4.5 High5 Notes
RELATIONSHIPS RELATIONSHIPS WITH FAMILY AND FRIENDS
5 1. Family/ExtendedFamily Hostile, violent, physically abusive family relationships. Conflicted, critical or verbal abuse. Separated, no contact. Inconsistent support, emotionally distant. Supportive, mutually nurturing relationships.
3 2. Boyfriend, FOB, or Spouse Hostile, violent, multiple partners, uncertain paternity. Conflicted, critical or verbal abuse. Separated, no contact. Inconsistent support, emotionally distant. Supportive, loving, committed.
4 3. Friends/Peers Hostile, violent, or high-risk friends. Conflicted, casual friendships. Very few friends, socially isolated. A few close friends for support. Many close friends, extensive support.
RELATIONSHIPS WITH CHILDREN
0 4. Attitudes to Pregnancy Unplanned and unwanted. Unplanned, ambivalent. Unplanned and accepted. Planned but unprepared. Planned, prepared, welcomed. Baby is 4 months old
5 5. Nurturing Hostile, unable to nurture. Indifference, apathy, depression. Lacks information, marital connectedness. Loves, responds inconsistently. Loving, responsive, praises.
4 6. Discipline Reportable levels of physical abuse, neglect. Uses physical punishment, frequent criticism. Ineffective boundaries, inconsistent limits. Uses age-appropriate discipline. Teaches, guides, directs behavior.
3 7. Support of Child Development Unrealistic expectations. Limited interest in development. Open to child development information. Applies child development ideas. Anticipates changes, uses appropriate resources.
5 8. Safety Child hospitalized for unintentional injury. Outpatient treatment of unintentional injury. No unintentional injury. Home or car not safe; not childproofed. Child protected, no injury, teaches safety.

Health and Medical Care

Score (NA = 0) Area of life skill development Low Notes
3 17. Prenatal Care No prenatal care. Care starts in 2nd-3rd trimester. Care starts in 1st trimester.
2.5 18. Parent Sick Care Acute or chronic conditions without treatment. Seeks care when very ill.
3 19. Family Planning No family planning method. Occasional use of family planning methods. Regular use of family planning methods.
4 20. Child Well Care None, no medical home. Seldom visits, no medical home. Has annual exam only.
4 21. Child Sick Care Medical neglect, no treatment for conditions. Timely care for minor illness. Follows treatment recommended.
4 22. Child Dental Care No dental home or care. Late treatment of dental issues. Has dental home with preventive care.
5 23. Child Immunizations None or refused. Immunizations are not complete. Complete and up-to-date immunizations.

Mental Health

Score (NA = 0) Area of life skill development Low Notes
4 24. Substance Use Chronic drug and/or alcohol use with dependence. Intermittent use, no apparent dependence. Rare use of drugs, in recovery.
2.5 25. Tobacco Use Heavy smoking, heavy second-hand exposure. Occasional use, controls second-hand.
5 26. Depression/Suicide Severe depression with suicidal thoughts. Recurrent depression without suicidal thoughts. Manages or controls depression.

Basic Essentials

Score (NA = 0) Area of life skill development Low Notes
4 30. Housing Homeless or shelter. Stable rental, lives with strangers. Lives with family. Rents or owns housing.
3 31. Food/Nutrition Relies on emergency food. Inadequate resources for food. Provides adequate amount/quality of food.
2.5 32. Transportation Inadequate resources. Limited access to public transportation.
4 33. Medical/Health Insurance None/unable to afford. Medicaid for pregnancy/emergency. Private insurance with or without co-pay.
3 34. Income None. Employed with low income. Employed with moderate income.
4 35. Child Care None used. Uses caring friend/relative with safe environment. High-quality child care.

Child Development

Area of life skill development Low
4 36. Communication* Below criteria, not enrolled. Delays; meets criteria, referred. Average development.
4 37. Gross Motor* Below criteria, not enrolled. Delays; meets criteria, referred. Average development.
5 38. Fine Motor* Below criteria, not enrolled. Delays; meets criteria, referred. Average development.
5 39. Problem Solving* Below criteria, not enrolled. Delays; meets criteria, referred. Average development.
3 40. Personal-Social* Below criteria, not enrolled. Delays; meets criteria, referred. Average development.
4 41. Social-Emotional** Shows signs of concerns, referred. Regular participation with positive results. Communicates needs, connects with parent.
3.5 42. Regulation Difficulty with self-regulation. Anxious and withdrawn. Happy, well-connected to parent.
4 43. Breast Feeding Not breast fed or very limited. Breast fed for a short duration. Breast fed for an adequate duration.

Child Name _______________________________________________ Sex _________ Race _________ Ethnicity _________ Age / (years/months)
SAMPLE