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WVDHHR\BPH\OMCFH\WVBTT\INDIVIDUALIZED FAMILY SERVICE PLAN – rev.
Child outcomes are based on the changes the family wants to see in their child’s ability to successfully participate in the daily activities and routines that are i
mportant to them. (Use additional pages as needed.)
Outcome #
What routine or activity will be the focus for this child outcome?
Functional Outcome Statement (What we can accomplish in the next six months related to this routine or activity?)
Who
Will (do what)
Under what conditions
We will know this outcome has been achieved when:
:KDWDFWLYLWLHVVWUDWHJLHVZLOOWKHIDPLO\GRZLWKWKHLUFKLOGEHWZHHQYLVLWVWRDFKLHYHWKLVRXWFRPH"6WUDWHJLHVPD\FKDQJHRYHUWLPHDVQHHGHG
+RZZLOOWKHIDPLO\EHFRDFKHGWROHDUQWKHVHVWUDWHJLHV"

How will the team measure progress (observable actions and behaviors)?
☐ Intervention Activity notes
☐ Data Gathering
☐ Service Coordinator Activity Note
☐ Parent Report
☐ Ongoing Team Communication
☐ Other – Describe
WV BIRTH TO THREE
Office of Maternal, Child and Family Health
Bureau for Public Health
Department of Health and Human Resources
Child Last Name:
Child First Name: MI
DOB: ID#:
FOLDER: Date:
IFSP
Practitioner will model recommended strategies. Practitioner will provide written materials and answer questions.
Practitioner will support the family through guided practice with recommended strategies. Practitioner will design and teach family how to collect data, when appropriate.
Practitioner will observe child/family within the routine and provide feedback on use of recommended strategies.
Child Outcomes in Daily Routines
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Completed 27 June 2022

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