Family Support Assessment
Sentinel City® Student Report
Leila Safavi lsafavi1@u.westcoastuniversity.edu
West Coast University (canvas)-2147387035
5/12/2021
6/17/2021
Name:
ID:
First Access:
Last Access:
Email:
Tenant:
16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins
Total Time SpentTime in AssessmentsTime in City
FAMILY SUPPORT ASSESSMENT 100%Progress: Time Spent: 3 hrs 27 mins
NonNon
RelationshipName
Boy friend/ Brandi’s father (Jessi)Jessi
RelationshipName
3No
Total Household Occupants (Include Client)Ability to Pay Other Monthly Bills
No$1,250
Ability to Pay Rent / MortgageRent / Own
YesChild support
Child SupportOther Sources of Income
$544/MonthYes
Total Annual Income from EmployerEmployment Status
High School Grad
Highest Level of Education Completed
EnglishUnknown
Primary Language Spoken At HomeReligious Preference
SingleNonWhite/Non-Hispanic
Marital StatusAgeRace/Ethnicity
Candice Conway
Client Full Name
06/17/2021Leila Safavi
DateInterviewer Completing this Assessment
ADULTS IN THE HOME
FINANCIAL
GENERAL FAMILY INFORMATION
Page 1 of 3Friday, June 18, 2021
Sentinel City® Student Report
Leila Safavi lsafavi1@u.westcoastuniversity.edu
West Coast University (canvas)-2147387035
5/12/2021
6/17/2021
Name:
ID:
First Access:
Last Access:
Email:
Tenant:
16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins
Total Time SpentTime in AssessmentsTime in City
Confused
Newborn care
Confused, not sure about the father
General Childcare Arrangements / Concerns
Not sure
Child Support
JessiNo information
Information about child’s fatherPlans to breastfeed or bottle feed
No24 weeks
Prenatal care?How many weeks?
Yes
Is client currently pregnant?
Female2Brandi
GenderAgeChild
NonNo information
Are there medical issues with this child?Are Immunizations up to date for this child?
Jessi (Current boy friend)
Information about child’s father
(Sometimes $214 a week by her dad)
Child Support
Yes ($1,100 disability check monthly, and $250 a week by his dad)
Child Support
Randy (ex convict)
Information about child’s father
He is developmentally delayed.No information
Are there medical issues with this child?Are Immunizations up to date for this child?
Male6 YBrayden
GenderAgeChild
CHILDREN IN THE HOME
Page 2 of 3Friday, June 18, 2021
Sentinel City® Student Report
Leila Safavi lsafavi1@u.westcoastuniversity.edu
West Coast University (canvas)-2147387035
5/12/2021
6/17/2021
Name:
ID:
First Access:
Last Access:
Email:
Tenant:
16 hrs 10 mins3 hrs 28 mins12 hrs 42 mins
Total Time SpentTime in AssessmentsTime in City
They need some councelling with Jessi about drug abuse and smoking cessation.
Other Notes
Frozen food and sodaYesJoe’s Grocery
Nutrition ConcernsFoodGrocery
Yes Brayden behavior due to his disability.
Concerns about physical, emotional, or behavioral problems with any of the children?
Yes, she can not leave kids by jessi.
Does the client have concerns about harming their children?
Yes, she has concerns about Brydan’s dad.
Does the client have concerns about someone threatening or physically hurting them?
Yes, she needs to get away from Jessi when he gets angry.
Does the client need to get away from an abusive relationship or harmful situation?
Yes (by her boyfriend Jessi)
Is client currently a victim of domestic violence?
yes
Has client ever been a victim of domestic violence?
NonYes
Abuse of Prescription MedicationsAlcohol Use
YesYes
Use of Illegal SubstancesSmoker
OTHER
SUBSTANCES
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