## Next LSP due ___/___/___ - Completed by _________ ## Next LSP due ___/___/___ - Completed by _________ ### Notes by Linda Wollesen and Brad Richardson. Copyright © 2024 Paul H. Brookes Publishing Co., Inc. All rights reserved. ## Next LSP due ___/___/___ - Completed by _________ ### Notes by Linda Wollesen and Brad Richardson. Copyright © 2024 Paul H. Brookes Publishing Co., Inc. All rights reserved. ## Sample ## Next LSP due ___/___/___ - Completed by _________ ### High **5** - Committed (unmarried, emotionally distant, but married, or common law). - Uses appropriate toys. - Reads with child daily. - Teaches safety to child. - Seeks and uses appropriate resources. ### 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*