Family Care/Monitoring Form

Informações do Beneficiário(responsável familiar)

Social Identification Number (NIS) - No.

Nome do Responsável Familiar:

Family Code:

Inclusion of the family in the social assistance network

Is the family being assisted/accompanied by the CRAS? Is the family being assisted/followed by CREAS?
Yes No Yes No

If so, which CRAS? If so, what is the CREAS?

Is the family being assisted/followed by the POP Center? In the absence of CRAS or CREAS, the family is
attended/accompanied by which local technical team of the agency
Yes No manager of Social Assistance?

If so, what is the POP Center? Basic (If the family is not attended to/followed by CRAS)
Special (If the family is not served/followed by CREAS)

General information about service/follow-up

Identified situations:
(Report ALL situations identified in the family or environment, insert the situation codes according to the table attached to this form)

Activities of Social Assistance:

(Report ALL activities that the municipality will carry out with the family, insert the activity codes according to the table attached to this form)

Forwarding (optional):
(Report ALL referrals made with the family, insert the referral codes as per the table attached to this form)

General observations for the network (socio-assistance and/or intersectoral)

(If desired, include brief information about the service/follow-up. Confidential information should not be described here.)

Temporary interruption of the effects of non-compliance with conditionalities

Social assistance professionals responsible for the care/follow-up of the family may temporarily suspend the application of future effects.
resulting from the breach of conditions. This decision must be supported by an analysis of the family's situation, based on the identification of
vulnerabilities that it is facing and the strategies to overcome them. To trigger the Temporary Interruption, it is necessary for the family to have the registration of
active monitoring/attendance in Sicon. While in effect, the Temporary Interruption ensures that any non-compliance with conditions does not
effect (warning, blocking, suspension, or cancellation) for the family. If the service/support is terminated in Sicon, the Interruption
Temporary will also be terminated. The Temporary Suspension begins to take effect from the month following its activation and is valid for six months. However,
it can be extended or, still, cease before the end of the period, by command in Sicon, at the discretion of the social assistance team that attends/follows the
family.

Do you want to include the family in Interruption Yes No

Attention! If you want to renew or end the active temporary interruption, please register the justification below:

Information of the technician responsible for filling in the data

Nome do servidor: Server signature: Data:

This form should not be mailed to the Ministry of Citizenship, being for internal use only by the municipality. The coordinator/technician must enter the data of family assistance/follow-up in Sicon (online).
Evaluation of service/follow-up results
This assessment can be performed at any time, at the discretion of the responsible professional.
service/follow-up. However, it is recommended that the synthetic record of the evaluation of results be
filled out at least once every seven months during the period of service/support; and
mandatory, whenever the record of the family's assistance/follow-up is to be closed.

Como você classifica os resultados obtidos, até o presente momento, no que se refere à ampliação das condições de
confrontation or overcoming of vulnerabilities and/or social and personal risk that were affecting compliance with
conditionality, on the part of the family?

There has been a worsening in relation to the initial situation of the family.

The current situation is equivalent to the initial situation, with no identifiable advancements.

There has been progress/improvement in the conditions for facing or overcoming risks and vulnerabilities that
were affecting the fulfillment of the conditionalities

There has been significant progress/improvement in the conditions for coping with or overcoming risks and
vulnerabilities that were affecting compliance with the conditionalities, justifying the termination
of systematic service/follow-up (if this option is selected, the service/follow-up
must be closed in the Sicon)

The service/support was discontinued due to the family's difficulty in adhering (if this option is)
marked, the service/follow-up must be closed in Sicon)

The service/accompaniment was discontinued due to difficulty in providing services (if this option is
marked, the service/follow-up must be closed in Sicon

If desired, briefly record additional information about the evaluation of the service/monitoring.
Confidential information should not be described here.

Details of the technician responsible for filling in the data

Nome do servidor: Server signature: Data:

This form should not be sent by mail to the Ministry of Citizenship, and is for internal use of the municipality only. The coordinator/technician should enter the data of family assistance/follow-up in Sicon (online).
 Table of codes for inclusion in family care/follow-up
Identified situations:
Difficulty in family relationships
2. Intrafamily violence (physical, sexual, or psychological)
3. Negligence of parents or guardians
4. Use, abuse or dependence on alcohol or other drugs by family members
5. Violence in the school environment (discrimination, bullying, racism, etc)
6. Violence in the territory, preventing movement
7. Lack of interest of the child/adolescent in school
8. Family disinterest in the school
9. Adolescent in compliance with socio-educational measures in open air (LA or PSC)
10. Adolescent in compliance with restrictive or deprivation of liberty socio-educational measures
11. Child/adolescent in protective foster care measure
Child labor
13. Street trajectory of the child/adolescent
14. Street trajectory in the family
15. Child/adolescent responsible for the care of family members
16. Family affected by public calamities, natural or technological disasters (harsh winter,
17. Parents or guardians in the prison system
18. Non-existence or insufficiency of education service offerings
19. Non-existence or insufficiency of health service offerings
Child/adolescent or family member with a disability
21. Non-existence or difficulty of transportation or commuting to school
22. Non-existence or difficulty of transportation or movement to health services
23. Child and adolescent pregnancy

24. Death in the family

25. Child/Adolescent Disease

26. Family illness
27. Family abandonment by parent/guardian
28. Separation of parents or guardians
29. Change of the guardian or the primary responsible for the care of the child/adolescent
30. Unemployment of parents or guardians
31. Lack of necessary material resources to go to school (clothes, shoes, school supplies, etc.)
Psychological suffering of the child/adolescent
33. Psychological suffering of a family member
34. Family is unaware of the child's/adolescent's absences from school
35. Disagreement or disinterest of the family in vaccinating
36. Hospitalization for the health treatment of the child/adolescent or family member

37. Health treatment for the child/adolescent or family outside the municipality
38. Situation of food insecurity
39. Absence of civil documentation or vaccination card
40. Temporary housing of the family in the care service
41. Change of city
42. Other situations

Activities of Social Assistance:

Active Search (mark this item only if the family was located this way)
2. Family Welcome
3. Home Visit
4. Family/Individual Care
5. Inclusion of the family in the Protection and Comprehensive Care Service for Families - PAIF

6. Inclusion of the family Specialized Protection and Assistance Service for Families and Individuals - PAEFI

7. Inclusion of the family in group activities (meetings/talks/workshops)

8. Inclusion in the Emergency and Public Calamity Protection Service
9. Family or individual follow-up
10. Development of the Family or Individual Monitoring Plan
11. Inclusion in Basic Social Protection Service at home for people with disabilities and the elderly
12. Service Support for Adolescents Under a Protective Measure
Inclusion in the Special Social Protection Service for People with Disabilities, Elderly and their
14. Inclusion in the Specialized Service for People in Situations of Homelessness

15. Inclusion in other offers of the social assistance network (Programs, projects and services)

Forwarding:
1. For Reception Services
2. For Conviviality and Strengthening of Bonds Services aimed at children and adolescents
3. For Services of Coexistence and Strengthening of Bonds aimed at the elderly
4. For registration update in CadÚnico (Including when carried out in this very unit)
5. For inclusion in CadÚnico (including when carried out in this very unit)
6. For the INSS, aiming for access to the BPC

7. For the INSS, aiming for access to other rights, not just the BPC.

8. For access to Occasional Benefits

9. For access to civil documents (Birth Certificate, ID, Work Card, etc)
10. Referral from CRAS to CREAS (Exclusive scheduling for CRAS)
11. Referral from CREAS to CRAS (Exclusive appointment for CREAS)
12. Referral to other units/Social Protection Services Special
13. For Centro Pop
Day Center and Similar
15. For the Happy Child Program
16. For Oral Health Services (for example: Smiling Brazil)
17. For Mental Health Services
18. For Health Services aimed at access to orthoses and prostheses for people A21:A25with
19. For Family Health Units
20. For other services or units of the Unified Health System
21. For Health Services for people with disabilities and elderly persons (orthotics and prosthetics; habilitation
22. For Education - Daycare and Preschool (early childhood education)

23. For Education - Regular education network (elementary and high school)
24. For Youth and Adult Education (e.g. Brazil Literate)
25. For Services, Programs or Projects aimed at professional training
26. For Services, Programs or Projects aimed at generating work and income
27. For Services, Programs or Projects aimed at labor intermediation
28. For access to microcredit
29. For the BPC-Work program
30. For the housing program
31. For access to the Social Electricity Tariff
32. For equipment/projects and cultural actions
33. To the Guardianship Council

34. For the Judiciary

35. For Public Ministry
36. For Public Defender
37. For Police Stations (specialized or not)
38. For the Rights Council
39. For community and civil society organizations
40. Other Referrals