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Family

In: Science

Submitted By klath
Words 8314
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Family Functioning Factors1
Sections A through F

Family Identifying Information:
Name

1

DOB

Relationship

Children’s Bureau of Southern California. (1997). Family Assessment Form. California: Authors. Reprinted with permission from Sandy
Sladen, LCSW.

Family Assessment Form

Family Functioning Factors

SECTION A: LIVING CONDITIONS*
A1. Cleanliness/Orderliness - Outside
Environmental Conditions
Refers to environmental health and hygiene factors (e.g. litter, garbage, vermin, clutter, odors around the exterior of the home) that are NOT WITHIN the family's control.
Need to consider intervening with owner/landlord, county health department, city code enforcement, and/or other regulatory agencies.

Score
1
1.5
2
2.5
3

STRENGTHS:
3.5
4

CONCERNS:

4.5
5

Operational Definition
Consistently clean and orderly; property very well maintained by owner/landlord and other tenants if a rental
Generally clean and orderly; no health hazards; property well maintained by owner/landlord and other tenants if a rental
Some lack of cleanliness; some disorderliness or clutter; other tenants or neighbors create messiness; slow response to problems by owner/landlord; occasional roach problem
Inadequately clean or organized; potential health hazards present; a great deal of clutter or litter/garbage; or offensive odors; consistent roach problem; property poorly maintained by owner/landlord and other tenants; very difficult to reach or get response from owner/landlord
Health hazards and violations present, e.g., overflowing trash bins/barrels, rotting food, flies; multiple vermin present; property essentially ignored by owner/landlord; other tenants do not do their part to maintain clean, healthy environment A2. Cleanliness/Orderliness - Outside Home
Maintenance
Refers to environmental health and hygiene factors (e.g., litter, garbage, vermin, clutter, odors around the exterior of the...

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