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PARENT EDUCATOR NAME:E-MAIL:
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SCHOOL DISTRICT & DISTRICT CODE:
DATE:
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PROGRAM SUPERVISOR NAME:E-MAIL:
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CONSULTANT:LENGTH OF VISIT (MIN.):
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FVC:
FVC Follow-Up:
VISIT PLAN USED:
Foundational Visit #		Planning
Guide
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Virtual:In Person:Age of Children:
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Visit PreparationObservedEmergingNot
Observed
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1. Before the visit, completes a written plan using a Foundational Visit Plan or the Personal Visit Planning Guide.
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2. Identifies intent/focus for each area of emphasis & foundational plan.
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3. Chooses handouts and gathers additional materials for the visit for plan.
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4. Reviews previous family visit plans, parent/child goals, screening results and PAT milestones.
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5. Reads Parent Educator Resources and chooses key points to share.
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6. Checked-in with the family, using their input to further individualize the visit as appropriate.
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OPENING (Connect, Reflect, Agree)ObservedEmergingNot
Observed
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7. Connected around discussion/information/activity from the previous visit.
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8. Facilitated reflection on the parents' and child(ren)'s experience with continuing the activity from the last visit.
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9. Parent(s) and parent educator agree on what will happen during the visit.
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Parent-Child InteractionObservedEmergingNot
Observed
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10. Facilitated parent-child interactions, sharing rationale for the activity.
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11. Reflected with parents on the parent-child activity:
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12. Facilitated the parents' observation of the child's development and linked it to parenting behaviors.
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13. Facilitated discussion of one or more child development domain, including emerging development.
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14. Acknowledged parenting behavior listed on activity page.
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15. Incorporated literacy into the visit with book sharing activity and encouraged books beyond the visit.
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Developmental-Centered ParentingObservedEmergingNot
Observed
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16. Addressed developmental topic from lesson plan.
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Topic Discussed:
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17. Helped family connect their child's behavior with their stage of development to topic.
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Family Well-BeingObservedEmergingNot
Observed
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18. Addressed family well-being through discussion as suggested by the Foundational Plan or from Planning Guide.
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Category Discussed:
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19. Referrals made or information shared about formal and informal community resources.
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20. Followed up with family about previously recommended resources.
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21. Goals set, discussed, reviewed, and/or modified.
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22. Helped family recognize and build on their strengths and protective factors
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Protective factor:
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ClosingObservedEmergingNot
Observed
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23. Reviewed the content of the visit; sharing handouts.
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24. Affirmed strengths of the family.
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25. Engaged the family in discussion of how the visit went.
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26. Encouraged parents to repeat the parent-child activity and explore the Continued Learning section.
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27. Shared information about upcoming group connections and community events.
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28. Revisit parent and parent educator next steps.
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29. Asked the family for input regarding the next visit and scheduled next visit.
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Completion of Family Visit Record - Includes documentation of the following:ObservedEmergingNot
Observed
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30. Family strengths and protective factors.
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31. Family well-being factors discussed informal and formal resources and barriers to access.
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32. Joint planned family action steps towards goals.
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33. Parent next steps / comments / reminders
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34. Parent educator next steps/comments/reminders.
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35. Parent-child interactions-including child development and parenting behaviors.
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36. Development-centered parenting topics.
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37. Documents the personal visit no more than 48 hours after the visit, using a personal visit record.
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38. Milestones updated in family file or electronically.
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Strengths of the family visit to include how the Parent Educator Partnered, Facilitated, and Reflected with the family:
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Comments and suggestions given to the Parent Educator (pertaining to the visit):
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Goals set by Parent Educator (pertaining to the family visit)
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98
99
First Year Required Trainings: Completed
Not Completed
Date Registered
100
Foundational Curriculum Training