FACS Completed Sample
Family Assessment of Child Skills (FACS)
Child's Information
- Child's name: Marcus Greene
- Child's date of birth: May 24, 2017
- Family’s name and address: Veronica Greene, 3873 Red Run Road, Baltimore, MD 21211
- Person completing form: Veronica Greene
- Relationship to child: Mother
- E-mail address: greene.veronica@gmail.com
- Preferred method(s) of contact: Email
- Language(s) spoken at home: English
Introduction
The Family Assessment of Child Skills allows parents and other caregivers to share details about a child’s developmental skills. This information is needed to select appropriate learning goals for an IFSP or IEP.
Assessment Instructions
For each question, observe your child use the skill first, then mark your rating:
- Y (Yes) - If your child uses the skill or if your child previously was able to do the skill.
- S (Sometimes) - If your child uses the skill sometimes, needs help, or does not consistently use it.
- N (Not yet) - If your child does not yet use the skill.
Fine Motor Skills
Fine motor skills involve the movement and use of the hands, including grasping, using utensils, and drawing.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
| 1. Does your child move or wave their hands toward objects? (FM.A1) | |
| 2. Does your child pick up pea-size objects with thumb and index finger? (FM.A2) | |
| 3. Does your child stack three or more objects? (FM.A3) | |
| 4. Does your child use one finger to turn toys on or off? (FM.B1) | |
| 5. Does your child turn objects by turning wrist? (FM.B2) | |
| DATE 1:9/30/21 | |
| --- | --- |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N |
| 6. Does your child use two hands to manipulate objects? (FM.B3) | | | 7. Does your child use three fingers to hold objects? (FM.C1) | | | 8. Does your child use a finger to activate an electronic device? (FM.D1) | |
| DATE 1:9/30/21 | DATE 2: | DATE 3: | |
|---|---|---|---|
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N |
What fine motor skills do you want your child to learn?
Gross Motor Skills
Gross motor skills involve movements for getting around, such as rolling, crawling, and jumping.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
| 1. Does your child move head, arms, and legs independently while lying on back? (GM.A1) | |
| 2. Does your child put weight on one arm while reaching with another? (GM.A2) | |
| 3. Does your child roll over in both directions? (GM.A3) | |
| 4. Does your child move to sitting position from standing? (GM.A4) | |
| 5. Does your child get out of a child-size chair without help? (GM.A5) | |
| DATE 1:9/30/21 | |
| --- | --- |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N |
| 6. Does your child crawl/creep forward 6 feet? (GM.B1) | | | 7. Does your child bend down to pick up objects? (GM.B2) | | | 8. Does your child walk around objects without bumping into them? (GM.B3) | | | 9. Does your child walk up/down stairs alternating feet? (GM.B4) | | | 10. Does your child run without bumping into things? (GM.B5) | | | 11. Does your child jump forward with feet together? (GM.B6) | |
| DATE 1:9/30/21 | DATE 2: | DATE 3: | |
|---|---|---|---|
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N | |
| Y/S/N | Y/S/N | Y/S/N |
What gross motor skills do you want your child to learn?
Adaptive Skills
Adaptive skills are those that involve caring for oneself.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 |
| --- | --- |
| 1. Does your child take food off a spoon without choking? (AD.A1) | Y/S/N |
| 2. Does your child eat a variety of foods? (AD.A2) | Y/S/N |
| 3. Does your child eat with utensils without spilling? (AD.A3) | Y/S/N |
| 4. Does your child drink from a cup without spilling? (AD.A4) | Y/S/N |
| 5. Does your child eat socially appropriately? (AD.A5) | Y/S/N |
| 6. Does your child prepare food by removing inedible parts? (AD.A6) | Y/S/N |
| 7. Does your child use the toilet independently? (AD.B1) | Y/S/N |
| 8. Does your child bathe independently? (AD.B2) | Y/S/N |
| 9. Does your child brush teeth and comb hair? (AD.B3) | Y/S/N |
| 10. Does your child undress without help? (AD.C1) | Y/S/N |
| 11. Does your child choose appropriate clothing? (AD.C2) | Y/S/N |
| 12. Does your child act to relieve distress? (AD.D1) | Y/S/N |
| DATE 1:9/30/21 | |
| --- | --- |
| 13. Does your child follow safety rules? (AD.D2) | Y/S/N |
| 14. Does your child avoid dangerous conditions without being told? (AD.D3) | Y/S/N |
| 15. Does your child report danger to a caregiver? (AD.D4) | Y/S/N |
What adaptive skills do you want your child to learn?
Social-Emotional Skills
Social skills involve interacting and participating with others.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 |
| --- | --- |
| 1. Does your child initiate positive social behavior? (SE.A1) | Y/S/N |
| 2. Does your child continue interaction with adults? (SE.A2) | Y/S/N |
| 3. Does your child get ready for routines without being asked? (SE.A3) | Y/S/N |
| 4. Does your child respond to others' emotions? (SE.B1) | Y/S/N |
| 5. Does your child recover from distress? (SE.B2) | Y/S/N |
| 6. Does your child make positive statements about themselves? (SE.B3) | Y/S/N |
| 7. Does your child play with other children? (SE.C1) | Y/S/N |
| 8. Does your child engage in imaginary play? (SE.C2) | Y/S/N |
| 9. Does your child work with peers to plan play? (SE.C3) | Y/S/N |
| 10. Does your child follow rules during games? (SE.C4) | Y/S/N |
| DATE 1:9/30/21 | |
| --- | --- |
| 11. Does your child complete independent activities? (SE.D3) | Y/S/N |
| 12. Does your child resolve disagreements? (SE.D4) | Y/S/N |
| 13. Does your child seek solutions for needs? (SE.E1) | Y/S/N |
| 14. Does your child use social rules outside home/school? (SE.E2) | Y/S/N |
| 15. Does your child follow community-specific rules? (SE.E3) | Y/S/N |
| 16. Does your child know personal information? (SE.E4) | Y/S/N |
What social-emotional skills do you want your child to learn?
Social-Communication Skills
Social-communication skills involve listening and understanding conversational rules.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 |
| --- | --- |
| 1. Does your child look at someone who is talking? (SC.A1) | Y/S/N |
| 2. Does your child babble sound combinations? (SC.A2) | Y/S/N |
| 3. Does your child babble or use words in response? (SC.A3) | Y/S/N |
| 4. Does your child get attention and point? (SC.A4) | Y/S/N |
| 5. Does your child look in the same direction as others? (SC.B1) | Y/S/N |
| 6. Does your child point out familiar objects? (SC.B2) | Y/S/N |
| 7. Does your child follow two linked directions? (SC.B3) | Y/S/N |
| 8. Does your child respond to questions? (SC.B4) | Y/S/N |
| 9. Does your child use sentences of three words or more? (SC.C1) | Y/S/N |
| DATE 1:9/30/21 | |
| --- | --- |
| 10. Does your child initiate social exchanges? (SC.D1) | Y/S/N |
| 11. Does your child use language to exchange information? (SC.D2) | Y/S/N |
What social-communication skills do you want your child to learn?
Cognitive Skills
Cognitive skills involve mental processes and reasoning.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 |
| --- | --- |
| 1. Does your child turn toward noises/objects/people? (CO.A1) | Y/S/N |
| 2. Does your child use two or more simple actions together? (CO.A2) | Y/S/N |
| 3. Does your child copy gestures? (CO.B1) | Y/S/N |
| 4. Does your child imitate unfamiliar words? (CO.B2) | Y/S/N |
| 5. Does your child relate previous events? (CO.B3) | Y/S/N |
| 6. Does your child search for things not in usual places? (CO.C1) | Y/S/N |
| 7. Does your child recognize symbols? (CO.C2) | Y/S/N |
| 8. Does your child sort objects based on features? (CO.C3) | Y/S/N |
| 9. Does your child compare common concepts? (CO.C4) | Y/S/N |
| 10. Does your child use an object to get another out of reach? (CO.D1) | Y/S/N |
| 11. Does your child use different actions with objects? (CO.D2) | Y/S/N |
| DATE 1:9/30/21 | |
| --- | --- |
| 12. Does your child try different methods to solve a problem? (CO.D3) | Y/S/N |
| 13. Does your child make reasonable predictions? (CO.D4) | Y/S/N |
| 14. Does your child ask questions based on observations? (CO.E1) | Y/S/N |
| 15. Does your child share their conclusions? (CO.E2) | Y/S/N |
What cognitive skills do you want your child to learn?
Literacy Skills
Literacy skills involve prereading and reading.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | |
| --- | --- |
| 1. Does your child pay attention during reading time? (LI.A1) | |
| 2. Does your child understand writing direction? (LI.A2) | |
| 3. Does your child recognize printed words? (LI.A3) | |
| 4. Does your child say rhyming words? (LI.B1) | |
| 5. Does your child separate compound words? (LI.B2) | |
| 6. Does your child break words into syllables? (LI.B3) | |
| 7. Does your child break words into sounds? (LI.B4) | |
| 8. Does your child name several letters? (LI.C1) | |
| 9. Does your child describe pictures in books? (LI.D1) | |
| 10. Does your child retell stories? (LI.D2) | |
| 11. Does your child write and draw? (LI.E2) | |
| DATE 1:9/30/21 | |
| --- | --- |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N | |
| Y/S/N |
What literacy skills do you want your child to learn?
Math Skills
Math skills involve number recognition and manipulation.
| Name: Marcus Greene | |
|---|---|
| DIRECTIONS: Mark Y for yes, S for sometimes, and N for not yet. | DATE 1:9/30/21 |
| --- | --- |
| 1. Can your child count 3 items aloud? (MA.A1) | Y/S/N |
| 2. Can your child count 10 items aloud? (MA.A2) | Y/S/N |
| 3. Can your child count 20 items aloud? (MA.A3) | Y/S/N |
| 4. Can your child count by tens to 100? (MA.A4) | Y/S/N |
| 5. Can your child compare 2 small sets of items? (MA.B1) | Y/S/N |
| 6. Can your child compare 2 medium sets of items? (MA.B2) | Y/S/N |
| 7. Can your child compare 2 large sets of items? (MA.B3) | Y/S/N |
| 8. Can your child read and write numerals for up to 5 items? (MA.C1) | Y/S/N |
| 9. Can your child read and write numerals for 6 to 10 items? (MA.C2) | Y/S/N |
| 10. Can your child read and write numerals for 11 to 20 items? (MA.C3) | Y/S/N |
What math skills do you want your child to learn?
Intervention Priorities
Date: 9/30/21
- Getting dressed and undressed by himself
- Holding a pencil correctly
Date:
Date: