Monthly Kinship Navigator Check-In Checklist
This checklist is designed to facilitate a comprehensive monthly check-in, ensuring the well-being of the kinship family and accurate tracking of relevant changes.
Part 1: Client Demographics and Contact Information
Navigator Name
First Name
Last Name
Caregiver Name(s)
First Name
Last Name
Date of Contact
-
Month
-
Day
Year
Date
Method of Contact
Phone Call
Home Visit
Virtual Meeting
Other
Current Phone Number
Unchanged
New
Current Address
Unchanged
New
Part 2: Health and Welfare of Kin Children
1. Are the kinship children still in the home?
Yes
No
2. Do the children have any new unmet essential needs (clothing, food security, school supplies)?
No
Yes
Part 3: Household Composition and Status Changes
3. Have any new members moved in or out of the household (permanently or temporarily)?
No
Yes
4. Has the primary caregiver's employment status changed (new job, loss of job, change in hours)?
No
Yes
5. Have there been changes to household income or benefits received (Wages, SNAP, TANF, SSI, adoption subsidy)?
No
Yes
6. Has the family's custody or legal status regarding the children changed?
No
Yes
7. Are there any new legal issues or court dates the caregiver needs assistance with?
No
Yes
8. Are there any new unmet household needs (utilities, food, etc.)?
No
Yes
9. What is the status of any outstanding referrals that were provided thus far? (Free Text Field)
Part 4: Caregiver Goals and Follow-Up
Review the goals established in the family's service plan. Document progress, barriers, and next steps for the navigator in the care plan touchpoint assessment.
Part 5: Navigator Summary and Next Steps
Summary of Needs Identified:
Next Check-In Scheduled For:
/
Month
/
Day
Year
Date
Submit
Should be Empty: