Home visit worksheet
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Older adult with functional limitations
Preparation for Home Visiting Worksheet
Population |
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Which population do you intend to choose for your home visiting client? ______ Older adult with functional limitations ______ MCH pregnant/postpartum family) |
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Provide a brief general description of this population. |
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Priority Public Health Concerns |
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Identify 3 priority public health concerns for your specified population (aging or MCH). These should be health concerns for which you can target an individual/family level intervention during your home visits. Describe why these are priority concerns. What public health-based strategies may help save future healthcare expenditure for these priority concerns? |
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Concern |
Description of concern and public health-based strategy |
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Policy Map |
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Using the Minnesota State University Mankato library database Policy Map, search your community on information that could be of concern for your home visiting client. For example, search information on quality of life, incomes, spending, and health. Describe resources and data that can impact your home visiting client. |
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Resources and Data |
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Focused Assessment Tools |
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Identify and describe 3 focused assessment tools (i.e. checklists, survey, etc.) that may be used with your chosen population to determine if your individual/family is at risk of your above specified priority public health concerns (use readings, referenced websites, and/or other sources). The focused assessment tools should be appropriate for use on an individual/family at your upcoming home visits. See sample assessment tools in D2L content area. |
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Focused Assessment Tool |
Description |
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Family Assessment Tools |
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Identify and describe a full or partial family assessment tool that may be used with your client/family. |

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