The items in this section represent caregivers’ potential areas of need while simultaneously highlighting the areas in which the caregivers can be a resource for youth. In general, it is recommended that the caregiver(s) with whom the youth is currently living be rated. If the youth has been placed temporarily, then focus on the caregiver to whom the youth will be returned. If it is a long-term foster care placement, then rate that caregiver(s). If the youth is currently in a congregate care setting, such as a hospital, shelter, group home, or residential treatment center it would be more appropriate to rate the community caregivers where the youth will be placed upon discharge from congregate care. It is advised to focus on the planned permanent caregiver in this section. The caregiver rated should be noted in the record.
For situations in which a youth has multiple caregivers it is recommended to rate based on the needs of the set of caregivers as they affect the youth. For example, the supervisory capacity of a father who is not involved in monitoring or disciplining of a youth may not be relevant to the ratings. Alternatively, if the father is responsible for the children because he works the first shift and the mother works the second shift, then his skills should be factored into the ratings of the youth’s supervision.
Questions to consider for this domain: What are the resources and needs of the youth’s caregiver(s)?
Basic Design for Rating Needs
| Rating | Level of Need | Appropriate Action |
| 0 | No evidence of need | No action needed |
| 1 | Significant history or possible need that is not interfering with functioning | Watchful waiting/prevention/additional assessment |
| 2 | Need interferes with functioning | Action/intervention required |
| 3 | Need is dangerous or disabling | Immediate action/Intensive action required |
ADJUSTMENT TO TRAUMA EXPERIENCES
This rating covers the reactions of individuals to a variety of traumatic experiences. For example, this dimension covers both adjustment disorders and post-traumatic stress disorder as they are described in the DSM-5.
Questions to Consider
- Has the caregiver experienced a traumatic event?
- What are the caregiver’s current coping skills?
MEDICAL/PHYSICAL
This item refers to medical and/or physical problems that the caregiver(s) may be experiencing that prevent or limit his or her ability to parent the youth. This item does not rate depression or other mental health issues.
Questions to Consider
- How is the caregiver’s health?
- Does the caregiver have any health problems that limit their ability to care for the family?
DEVELOPMENTAL
This item describes the presence of limited cognitive capacity or developmental disabilities that challenges the caregiver’s ability to parent.
Questions to Consider
- Does the caregiver have developmental challenges that make parenting/caring for the youth difficult?
MENTAL HEALTH
This item refers to any serious mental health issues (not including substance abuse) that might limit a caregiver’s capacity for providing parenting/caregiving to the youth.
Questions to Consider
- Do caregivers have any mental health needs that make parenting difficult?
- Does anyone else in the family have serious mental health needs that the caregiver is taking care of?
Supplemental Information: Serious mental illness would be rated ‘2’ or ‘3’ unless the individual is in recovery.
SUBSTANCE USE
This item rates the impact of any notable substance use by caregivers that might limit their capacity to provide care for the youth.
Questions to Consider
- Do caregivers have any substance use needs that make parenting difficult?
- Does anyone else in the family have a serious substance use need that is impacting the resources for caregiving?
Supplemental Information: Substance-Related Disorders would be rated ‘2’ or ‘3’ unless the individual is in recovery.
PARENTAL CRIMINAL ACTIVITY*
This item refers to the caregiver’s current and/or prior history of prior misdemeanor or felony charges and/or convictions.
Questions to Consider
- Has the youth’s parents/guardian or family been involved in criminal activities or even been in jail?
SUPERVISION
This item rates the caregiver’s capacity to provide the level of monitoring and structure needed by the youth. Structure is defined in the broadest sense, and includes all of the things that parents/caregivers can do to promote positive behavior with their children.
Questions to Consider
- Does the caregiver set appropriate limits on the youth?
- Does the caregiver provide appropriate support to the youth to meet the caregiver’s expectations?
- Does the caregiver think the youth needs some help with these issues?
DISCIPLINE
Discipline refers to the caregiver’s ability to encourage positive behaviors by youth in their care through the use of a variety of different techniques including, but not limited to, praise, redirection, and punishment.
Questions to Consider
- How does the caregiver discipline the youth?
- Is the caregiver’s discipline consistent and appropriate to the situation and the youth’s developmental needs?
INVOLVEMENT IN CAREGIVING FUNCTIONS
This item refers to the degree to which the caregiver is actively involved in being a parent/caregiver.
Questions to Consider
- How involved are the caregivers in services for the youth?
- Is the caregiver an advocate for the youth?
- Would they like any help to become more involved?
Supplemental Information: This rating should be based on the level of involvement of the caregiver(s) has in the planning and provision of child welfare, behavioral health, education, primary care, and related services.
KNOWLEDGE
This item identifies the caregiver’s knowledge of the youth’s strengths and needs, and the caregiver’s ability to understand the rationale for the treatment or management of these problems.
Questions to Consider
- How does the caregiver understand the youth’s needs?
- Does the caregiver have the necessary information to meet the youth’s needs?
Supplemental Information: This item is perhaps the one most sensitive to issues of cultural awareness. It is natural to think that what you know, someone else should know and if they don‘t then it‘s a knowledge problem. In order to minimize the cultural issues, it is recommended thinking of this item in terms of whether there is information that can be made available to the caregivers so that they could be more effective in working with their youth. Additionally, the caregivers’ understanding of the youth’s diagnosis and how it manifests in the youth’s behavior should be considered in rating this item.
SAFETY
This item describes the caregiver’s ability to maintain the youth’s safety within the household. It does not refer to the safety of other family or household members based on any danger presented by the assessed youth.
Questions to Consider
- Is the caregiver able to protect the youth from harm in the home?
- Are there individuals living in the home or visiting the home that may be abusive to the youth?
ORGANIZATION
This rating should be based on the ability of the caregiver to participate in or direct the organization of the household, services, and related activities.
Questions to Consider
- Does the caregiver need or want help with managing the home?
- Does the caregiver have difficulty getting to appointments or managing a schedule?
- Does the caregiver have difficulty getting the youth to appointments or school?
SOCIAL RESOURCES
This item rates the social assets (extended family) and resources that the caregiver can bring to bear in addressing the multiple needs of the youth and family.
Questions to Consider
- Does family have extended family or friends who provide emotional support?
- Can they call on social supports to watch the youth occasionally?
RESIDENTIAL STABILITY
This item rates the housing stability of the caregiver(s) and does not include the likelihood that the child or youth will be removed from the household.
Questions to Consider
- Is the family’s current housing situation stable?
- Are there concerns that they might have to move in the near future?