Parent Conversation Guide

Use these open-ended prompts to guide a relaxed conversation with parents. Feel free to adapt wording as needed and jot down notes below each question.

Section 1: Child & Family Background

1. Who lives in your home, and how does your child get along with each family member?
   
   
   
   
   
   
   
   
   

2. Can you share a typical weekday and weekend routine for your child?
   
   
   
   
   
   
   
   
   

3. What are your child’s favorite activities, hobbies, or strengths you’ve noticed recently?
   
   
   
   
   
   
   
   
   

4. Are there any cultural, linguistic, or family traditions that are important for us to know?
   
   
   
   
   
   
   
   
   

Section 2: Developmental & Health History

1. How was your child’s early development—anything you remember about milestones like crawling, walking, or talking?
   
   
   
   
   
   
   
   
   

2. Does your child have any ongoing medical conditions, allergies, or medications we should be aware of?
   
   
   
   
   
   
   
   
   

3. Have there been any recent health changes or concerns you’d like to discuss?
   
   
   
   
   
   
   
   
   

4. Is there anything from prenatal or birth history (e.g., full-term, complications) that might still affect your child today?
   
   
   
   
   
   
   
   
   

Section 3: Social & Emotional Context

1. How does your child interact with peers—at school, in the neighborhood, or other groups?
   
   
   
   
   
   
   
   
   

2. What have you noticed about your child’s mood or behavior at home versus other settings?
   
   
   
   
   
   
   
   
   

3. Are there any recent life changes or stressors (moves, losses, transitions) that impact your child?
   
   
   
   
   
   
   
   
   

4. What helps your child feel safe and supported when they’re experiencing stress or big emotions?
   
   
   
   
   
   
   
   
   

Parent Consent Form

Consent to Biopsychosocial Assessment

We value your input in helping us understand your child’s background, needs, and strengths. The information you provide will be kept strictly confidential and used only to develop personalized support plans at the Boys & Girls Club.

Confidentiality Statement:
All information gathered through this intake process is protected under confidentiality guidelines. Only authorized social workers and program staff will have access to your responses. Your details will not be shared outside of the Boys & Girls Club without your permission, except in cases where disclosure is required by law (e.g., risk of harm).

By signing below, you acknowledge that you have read and understood the above statement and agree to participate in the Biopsychosocial Assessment.

Child’s Full Name: ________________________________________

Parent/Guardian Name (Print): _______________________________

Signature of Parent/Guardian: _______________________________

Date (MM/DD/YYYY): _______________________________________

Action Plan Template

Instructions: Use this template to summarize agreed-upon next steps from today’s intake meeting. Assign each action to a responsible person, set a due date, and track the status and any additional notes.

1. Action Item:
   
   
   
   Responsible Person:
   
   
   
   Due Date:
   
   
   
   Status:
   
   
   
   Notes:
   
   
   
   
   
   

1. Action Item:
   
   
   
   Responsible Person:
   
   
   
   Due Date:
   
   
   
   Status:
   
   
   
   Notes:
   
   
   
   
   
   

1. Action Item:
   
   
   
   Responsible Person:
   
   
   
   Due Date:
   
   
   
   Status:
   
   
   
   Notes: