FY21 Big MS Support Assessment

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Match Party Details

Full Name

Nickname

Start of Match

Referral Follow Up Due

Referral Opportunity Link

Next Evaluation Due

Evaluation Link - SEL

Evaluation Link - SOR

Evaluation Link - SOR (SB)

Program Type

Date of Call

Support Assessment Type

Is this a needs-based call?

Call Notes

Minimum 1 sentence of context for everything checked off below.

ACTION PLANS

Big Action Plan

Immediate & Ongoing Goals + External Facing + Action-Based

Staff Action Plan

AUGUST 14TH 2023: AD filled out post closures with GU/L. L is not fully sure if he wants to get re-matched, worries about how it will affect post closure friendship with B. AD reiterated that friendship with B will continue even if he potentially gets rematched, told L to think and talk to GU about it and let AD know or let Rebecca know when she reaches out to match GUs younger son Collin in November 2023.
AUGUST 3rd 2023: B post closure filled out

Historical Match Info:
MAY 30th 2023: GU reported L is aware that B is moving, took it well and have discussed how to stay in touch. GU thinks L is interested in getting re-matched, match will stay open until July as will continue to meet and then will close match, confirm if L wants to get re-matched.
MARCH 2023: B accepted to Columbia U in NYC, moving July-August, is going to tell GU and ask how to best share info with L that he wants to close match but stay in touch independently.
Little has made tremendous strides in Emotional & Social Competence.
Big and MO schedule through Acuity, sometimes MO needs to reschedule.
L: can be shy on the phone but is having an easier time articulating himself, loves legos, roblox, nerf guns, swimming, playing pretend, playing board games, sour patch kids, Swedish Fish, stickers, monkey bars and playgrounds, running around, improv role playing, space/learning about space, nature, dinosaurs, building things and learning to use tools
B: Just moved to Downtown Crossing; Interests: Movies, NBA, running, sports, accepted to Columbia U in NYC, moving July-August and wants to close and stay in touch independently.
GU: very nice, engaged on the phone and open to discussions about PYD

Activity 1:

Status of Outing

Activity Type

PYD Explored (select all that apply)

ConnectionCaringCuriosityCharacter ConfidenceEmotional CompetenceSocial CompetenceN/ACONNECTION: communication, respect, trust, negotiation, compromise, expectations, stability ..... CARING: empathy, sympathy, compassion, kindness, social justice, advocacy, civic engagement, sharing with others ........... CURIOSITY: love of learning, critical thinking, persistence, creativity, problem solving, trying new things ............ CHARACTER: moral compass, responsibility, fairness, honesty, integrity, manners ........... CONFIDENCE: self-esteem, determination, self-worth, independent thinking ............ EMOTIONAL COMPETENCE: coping mechanisms, discussing feelings, asking for help ............... SOCIAL COMPETENCE: adaptation to environment, manners

Does this person need a needs-based call next month?

YesNo

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Supervising a Little	Public Places & Car Safety
Health, Medications & Allergies	Weapons & Firearms
Alcohol, Tobacco and Drugs	Physical Contact & Boundaries
Secrets & Confidences	Spending Time at a Big’s Home
Overnight Activities	Athletic Activities & Extreme Sports
Leaving a Little or Young Sibling Home Alone	Connecting Safely Online
Match Outing Costs & Gift Giving	Music, Movies, & Video Games
N/A

Supervising a Little	Following School Rules
Health, Medications & Allergies	Weapons & Firearms
Alcohol, Tobacco and Drugs	Physical Contact & Boundaries
Secrets & Confidences	Connecting Safely Online
Music, Movies, & Video Games	Appropriate Dress
Remaining on Site	Fighting Between Kids
Communicating with Your Little Outside School	N/A