Initial Family Needs & Strengths Inventory
Family Information
Primary Caregiver Name
Other Family Members
Contact Information
Strengths
What are the family’s current strengths?
Support Systems (extended family, friends, community, etc.)
Needs Assessment
Domain
Current Need
Notes
Housing
None
Some
Significant
Employment/Income
None
Some
Significant
Physical Health
None
Some
Significant
Mental/Behavioral Health
None
Some
Significant
Education
None
Some
Significant
Child Care
None
Some
Significant
Legal
None
Some
Significant
Other (specify)
None
Some
Significant
Additional Comments