parenting assets and improvement review (p.a.i.r.) fileare welcome to copy and use this booklet, and...

Parenting Assets and Improvement Review

(P.A.I.R.)

INTAKE BOOKLET—PART I

For parents with more than one child together

R E V I S E D 1 0 - 0 6 - 0 8

Note to Professionals

We have prepared this Intake Booklet for our own use in working with separated, divorced, and never-married parents. Our goal, of course, is to help them create better futures for themselves and their children. Other professionals—such as guardians ad litem (GALs) and parent coordinators—are welcome to copy and use this Booklet, and we value their comments and suggested revisions. We encourage professionals to meet at least once with parents to explain this Booklet and the process they are involved in before assigning this work to the parents.

Charles A. Asher 224 West Jefferson Blvd., #400

South Bend, Indiana 46601 574-233-9341

[email protected]

mailto:[email protected]

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Introduction to Parents

As you fill out these pages, please keep the following things in mind.

1. A ―Parenting Assets and Improvement Review‖ (or P.A.I.R.) is different from other family evaluations you may have had or heard about. The preferred outcome of a P.A.I.R. is not to send recommendations to a court, but to help parents:

a. appreciate their children’s special needs, including their need for peace,

safety, predictability, and (if safe) cooperation between their parents. b. understand that their most important interests (such as protecting their

children by ending parent conflict) are ones they have in common. c. succeed as co-parents in raising healthy and happy children.

2. In reviewing your family’s present strengths and possibilities for improvement, I am

interested in how you and your children’s other parent (your ―co-parent‖) will be parenting well together in the future. I’ll hope you’ll think about the future at least as much as the past and the present.

3. I assume that you will work hard for your children’s benefit. This includes

completing this Intake Booklet and building good outcomes for your children. There are many hours of work involved for you, so please get started early and stay with it. (Use extra sheets of paper whenever necessary.)

4. Do this work on your own and without help from others. This is about your chance:

a. to achieve a better understanding of your true challenges. b. to succeed in meeting those challenges for the sake of your children and

yourself. (Contact me if you feel you need any help to complete this work.) Before filling out this Intake Booklet, do an excellent job on the website assigned to you. If you and your co-parent were (or are) married, use www.UpToParents.org. If you and your co-parent weren’t married to each other, use www.ProudToParent.org. Then, please complete this Intake Booklet and drop it off at my office by ________________________. Finally, the creators of these websites and this ―Parenting Assets and Improvement Review‖ will be interested in your thoughts about this experience. This is voluntary on your part, but you will have a chance, if you wish, to share your reactions to these resources by visiting www.PAIR-Feedback.com. I look forward to what you and your co-parent can achieve in giving your children what they need most at this difficult time for them.

http://www.uptoparents.org/

http://www.proudtoparent.org/

http://www.pair-feedback.com/

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A: Contact and background information 1. Your contact information:

A. Name and age: ________________________________________________ B. Address:______________________________________________________

C. Phone numbers: Home: _______________ Work: __________________

Cell: ________________ Pager: __________________

D. Email address: ________________________________________________ E. Occupation/employment: ________________________________________

2. Your co-parent’s contact information:

A. Name and age: ________________________________________________

B. Address: ______________________________________________________

C. Phone numbers: Home: ______________ Work: ___________________ Cell: _______________ Pager: ___________________

D. Email address: ________________________________________________

E. Occupation/employment: ________________________________________ 3. If you were (or are) married to your co-parent, state:

A. Date of marriage: ____________________________________________ B. Date of separation: ___________________________________________

C. Date of divorce filing: _________________________________________

D. Which parent filed for divorce: __________________________________

E. Date of divorce (if final): ________________________________________

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4. If you and your co-parent were never married to each other, describe the history of

your relationship (when you met, whether you ever lived together, how your relationship grew and came apart, etc.): ________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ __________________________________________________________________

5. Circle which website www.UpToParents.org (for divorcing or divorced parents) or

www.ProudToParent.org (for parents never married to each other) you completed. Give your:

A. Username (print carefully!): ______________________________________

B. Password (print carefully!): _______________________________________

6. How far do you and your co-parent live from each other? A. Approximate distance in miles: __________________________________

B. Approximate driving time: ______________________________________

7. Date you began filling out this Intake Booklet ______________________________



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8. Basic information about the children you have together.

9. Basic information about any other children involved (including any step-siblings, half-siblings, foster children, and others.):

Name of child _____________________________________________________ Age ___________ Sex/Gender _____ Date of birth _______________________ School ________________________________________ Grade ____________ Schedule for being with each parent___________________________________




Name ___________________________________________________________ Age ___________ Sex/Gender______ Date of birth _______________________ School ________________________________________ Grade_____________ Resides with __________ Relation to you or your co-parent ________________



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10. If you are divorced from any other person, give that person’s name, the years you were married, the names and ages of any children you have together, and a brief description of how you are getting along with this former spouse. (If you have had more than one divorce, give this information about all prior marriages and spouses.)___________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________

11. If you have children with anyone you were not married to, please give the names and ages of those children, the name of the other parent, and a description of how you are getting along with that parent today. _______________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _________________________________________________________________ __________________________________________________________________

________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 12. What was the highest grade/level of education you completed—and at what

school/university? When? a. Highest grade/level: ____________________________________________ b. Degree: _____________________________________________________ c. School/university: ______________________________________________ d. Year: _______________________________________________________

13. Give your employment history by listing the names of your employers, your jobs,






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your job duties, and dates of employment. (Start with your first job and go forward.)

14. How was the decision made to have this Parenting Assets and Improvement Review

(P.A.I.R.)? _________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________

15. Are you open to new ideas for improved co-parenting, instead of arguing the past or taking issues to court? Please explain.___________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

Employers Jobs Duties Dates

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B: Legal background

16. The judge or magistrate in your case. __________________________________ 17. Please provide the following information about your attorney:

Name: ____________________________________________________________ Address:___________________________________________________________ Telephone number: __________________________________________________ Email address: ______________________________________________________ How long has this attorney represented you? ______________________________ 18. What prior attorneys have you had on any of these family matters (and over what

periods of time)? ___________________________________________________ ________________________________________________________________

19. Please provide the following information about your co-parent’s attorney:

Name: ____________________________________________________________ Address:___________________________________________________________ Telephone number: __________________________________________________ Email address: ______________________________________________________ 20. What prior attorneys has your co-parent had on any of these family matters (and

over what periods of time)? __________________________________________ __________________________________________________________________

21. How many court hearings have you had? Please list all the issues that have been

taken to court or raised while you were in court. ____________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ 22. Do you believe going to court has helped or hurt the way you and your co-parent

relate and cooperate? Please explain. ___________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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23. Do you have an upcoming hearing? If so, please provide the date and explain the

reason for the hearing. _______________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ 24. Have you and your co-parent had any other reviews or evaluations (such as a

custody evaluation or a guardian ad litem review and report)? If so, please provide the name, address, and telephone number of the person who did the evaluations or reports. Be sure to attach copies of all reports to this Intake Booklet. ___________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

25. If you’ve had such a review or evaluation, do you believe the experience helped or hurt the way you and your co-parent relate and cooperate? Please explain. __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 26. What type of custody do you have? (Joint legal custody? Sole legal custody with

one parent? Joint physical custody? Primary physical custody with one parent?)__ __________________________________________________________________

27. What do you understand the law means by the custody label you have? _________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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C: Your co-parenting and your expectations

28. How do you and your co-parent share information about the important events and issues in your children’s lives? (If this is not going well, please state what changes need to be made.) ___________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

29. Describe how you and your co-parent make important child decisions. __________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

30. Regarding the discussions you and your co-parent have about your children’s

needs, issues, and problems in their lives: A. Where and how do you have these discussions (for example, in person away

from any children, in person at pick ups and drop offs, at a counselor’s office, through email, etc.)? ____________________________________________

_________________________________________________________________ __________________________________________________________________ __________________________________________________________________

B. How much time do you spend in these discussions in a typical month? _____ _________________________________________________________________

C. What topics have been the hardest, and what topics have been the easiest? _________________________________________________________________

__________________________________________________________________ __________________________________________________________________

D. Describe one discussion that went particularly well and state when it occurred. _____________________________________________________

_________________________________________________________________ __________________________________________________________________ __________________________________________________________________

31. Where do you and your co-parent get advice for problems in cooperating or in

raising your children? Do you get this advice together or separately? Does the advice help? _______________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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__________________________________________________________________ __________________________________________________________________

32. What schedule do you and your co-parent use to share time with your children?

__________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 33. What other childcare arrangements do you have, including time that your children

are with grandparents, with other family, or in paid childcare? __________________ __________________________________________________________________ __________________________________________________________________

___________________________________________________________________ 34. How easily do you and your co-parent make changes to your parenting schedule to

meet everyone’s needs? ______________________________________________ _________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

35. How well do you and your co-parent use the ―chance of first refusal‖? (The ―chance

of first refusal‖ means offering additional parenting time to the other parent when one of you cannot watch them.) ________________________________________ __________________________________________________________________ __________________________________________________________________

36. Be sure to finish all your website work before answering any more questions in this

Intake Booklet. If you need to add or change any of your responses to the written Exercises on the website, you can do so easily. Just log back on with your username and password, and click at the bottom of the page next to the Exercise you wish to work on.) Did you finish all the website work? _______

A. Did you fully answer all parts of Exercise A? _______ B. Did you fully answer all parts of Exercise B? _______ C. Did you write 10 good memories and compliments in Exercise C?_______ D. Did you fully answer all parts of Exercise D?_______

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In the Introduction to this Intake Booklet, I said a little about my hopes and expectations as an observer of your family. I would now like to know more about your hopes and expectations. 37. What do you think a judge can do to give your children better cooperation between

their parents? ______________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

38. What things could you and your co-parent do to give your children that gift?_______ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

39. Circle any of the following you are willing to do to build a better team with your co-parent for the sake of your children (and add any additional ones you think could help you do better for them):

A. Talk seriously with your co-parent about the Commitments you both chose

in your website work and how to carry through on those. B. Attend a half-day co-parenting class. C. Attend a twelve-week co-parenting class. D. Attend two to six counseling sessions with your co-parent. E. Other: _____________________________________________________ F. Other: _____________________________________________________ G. Other: _____________________________________________________

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D: Your children

40. Use the form at the end of this Intake Booklet to describe each of your children. 41. Describe what you want your children to be like as young adults.

a._________________________________________________________________ __________________________________________________________________ b.________________________________________________________________ __________________________________________________________________ c._________________________________________________________________ __________________________________________________________________ d.________________________________________________________________ __________________________________________________________________ e.________________________________________________________________ __________________________________________________________________

42. Describe some family activities your children most enjoyed when your family was

together. For example:

The children all used to like our trips to their grandparents, especially during the summer. My parents have a place on Fish Lake, and the children really loved our times swimming and hiking there.

They also liked simple things like our “pizza nights” at home about every week.

They liked that we went to their games together and out for a treat afterwards.

They liked to have friends over to spend time with their whole family. Etc.

a._________________________________________________________________ __________________________________________________________________ b.________________________________________________________________ __________________________________________________________________ c._________________________________________________________________ __________________________________________________________________ d.________________________________________________________________ __________________________________________________________________ e.________________________________________________________________ __________________________________________________________________

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43. Describe the major losses in your children’s lives. These should include any losses

related to your marriage and separation and also other losses they have suffered. For example:

All our children were shocked and hurt when we told them we wouldn’t be

a family under one roof together. I think they knew there were problems, but they (especially Crystal) have been devastated to now be like their friends whose parents are divorced.

They are both noticeably sad about not being able to live with both parents in one house.

Crystal has asked if we can be together “and be a family again.” Jason has a learning disability, and there are things he sees his sister

able to do that he can’t. We moved just a year ago, so both kids lost many friends, and I think

these losses have started piling up for them. Etc. a._________________________________________________________________ __________________________________________________________________ b.________________________________________________________________ __________________________________________________________________ c._________________________________________________________________ __________________________________________________________________ d.________________________________________________________________ __________________________________________________________________ e.________________________________________________________________ __________________________________________________________________ f._________________________________________________________________ __________________________________________________________________ g.________________________________________________________________ __________________________________________________________________ h._________________________________________________________________ __________________________________________________________________ i.________________________________________________________________ __________________________________________________________________ j.________________________________________________________________ __________________________________________________________________

44. How focused have you and your co-parent been on your children’s need for peace

and courtesy between their parents? Please explain. _______________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

45. Other children have divorced parents who:

consistently relate courteously speak well of each other support the children’s relationships with both parents. How concerned are you to give your children these same gifts? Please explain your answer. ___________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ What do you think will happen to your children if you do not give them these gifts?______________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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E: Past and future problem-solving

46. How did your parents handle their conflicts as you were growing up? ___________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 47. How did you feel about your parents’ way of handling their conflicts? What did you

do? ______________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 48. In what ways are you affected even today by the way your parents handled their

conflicts?___________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

49. Describe how and why, in your view, your marriage (or personal relationship) ran

into problems. _______________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________

50. If you are still married to each other, do you have an interest in saving your

marriage? Or, if you were never married, do you want to continue a personal, dating, or live-in relationship with your co-parent? Please explain your answer. ___ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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51. Describe what counseling you and your co-parent have had—whether together,

separately, in the past, or in the present. Be sure to include (a) the names of the counselors, (b) the periods of time of the counseling, (c) the approximate number of sessions, (d) the topics, and (e) the outcomes. _____________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

52. Describe what counseling your children have had, whether now or in the past.

Again, (a) give the counselors’ names, (b) the periods of time they used counseling, (c) the approximate number of sessions, (d) the topics, and (e) the outcomes. ____ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

53. Describe any additional counseling you think would benefit you or any members of

your family. This may include individual counseling or counseling between you and your co-parent, closure or divorce counseling to handle your divorce and co-parenting better, or counseling for children. ________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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54. Have you been to any co-parenting class(es)? If so, please give:

A. The name of the class(es): _______________________________________ B. The location(s): ________________________________________________ C. The approximate date(s): ________________________________________ D. The names of the instructors: _____________________________________ E. The number of sessions and total number of hours ____________________ F. The most important messages of the class(es): _______________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

55. In addition to the counseling you’ve mentioned in #51 and 52, what other problem-

solving tools have you and your co-parent used—separately or together—to create a better co-parenting partnership to meet your children’s needs? (This should include all co-parenting classes, mediation, and any other resources you’ve used.) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

56. What, if any, religious affiliation do you have, and how active is your religious

involvement? _______________________________________________________ __________________________________________________________________ 57. What social or volunteer organizations and activities do you participate in? _______

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

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F: Special issues

Note: As with all questions on this Intake Booklet, be sure to use extra paper if necessary.

58. If you are currently married or romantically involved with a new partner, give that

person’s name, describe your relationship, and describe how he or she is relating with your co-parent and with your children. ________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ 59. If your co-parent is currently married or romantically involved with a new partner,

give that person’s name and describe how well that person is relating with you and with your children. _________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ 60. Do you, or your does co-parent, have a problem with alcohol abuse or prescription

drug abuse or dependence? If so, please explain the problem, any treatment received, and any recovery fellowship or program used. ______________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

61. Have you, or has your co-parent, used any illegal drugs in the last five years? If so,

please explain the usage, any problems that have resulted, any treatment received, and any recovery fellowship or program used. ______________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

62. If there have been any protective orders, restraining orders, or no-contact orders

against you or your co-parent, please state the exact circumstances leading to them, when they were issued, and whether they are still in force. ______________ __________________________________________________________________ _________________________________________________________________

63. Have the police ever been called for any incident between you and your co-parent? If so, please explain the exact circumstances in each case. Be sure to carefully

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describe each incident, giving the date, exact events, and outcomes. __________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

64. Have you or your co-parent ever been prosecuted for any act against each other or

against any child? If so, please explain the circumstances. ___________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

65. At this time, are there any criminal investigations or charges against you or your co-

parent? If so, please explain. __________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

66. Has there been any domestic violence (physical, emotional, or otherwise) in your

family (whether against you, your co-parent, or any child)? If yes, please explain in detail. _____________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

67. Please describe any other arrests or convictions of you or your co-parent. Give the

dates and describe the facts and outcomes. _______________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

68. Do you feel safe in attempting to build cooperation with your co-parent and in

meeting with your co-parent? If you have any concerns about safety, please explain them in detail. _______________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

69. Has any agency (child protective services, the police, or any other agency)

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investigated anything involving either you or your co-parent? If so, please describe the circumstances, the investigation, and the outcome. _______________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

70. Is there any other reason you or your co-parent cannot be entrusted with caring for

your children? If so, please explain. ___________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

71. What issues do you and your co-parent have to resolve at this time? __________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

72. On a scale of 1–10, please rate your present level of cooperation with your co-parent (with 1 being ―very bad‖ and 10 being ―very cooperative‖). Please explain your answer. _______________________________________________________ _________________________________________________________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 73. On a scale of 1-10, please rate how well you think you and your co-parent are

capable of cooperatively co-parenting your children if you receive some good counseling or other help (with 1 being ―very poorly‖ and 10 being ―very successfully‖). Please explain your answer. ______________________________

_________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

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G: Final thoughts and quick action plan 74. Before answering this question, read carefully through the Commitments you chose

from www.UpToParents.org or www.ProudToParent.org. (There may be 40 or more of these.) Write out the three of those Commitments you believe will be making the most difference now that you will be observing them.

1. _______________________________________________________________

________________________________________________________________ ________________________________________________________________

2. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

3. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

75. Write here your 10 good memories and compliments about your co-parent that

you’ll be sharing with your children. (This is Exercise C on the website.) 1. _______________________________________________________________

________________________________________________________________ ________________________________________________________________

2. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

3. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

4. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

5. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

6. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

7. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

8. ________________________________________________________________ ________________________________________________________________



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________________________________________________________________ 9. ________________________________________________________________

________________________________________________________________ ________________________________________________________________

10. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

76. By this time, your website work and this Intake Booklet should have suggested

some ideas for better meeting your needs and your children’s needs. Regardless of

what your co-parent does, you now have the chance to do specific things that

can rescue you and your children today. Watch the video entitled ―8 Hidden Keys,‖ found in Step Two on the ―Parents Corner‖ link of www.UpToParents.org. Then circle the Keys you now promise to give to your children, starting today.

1. Observing the Child Safety Zone.

2. Keeping your children out of adult roles.

3. Sharing 10 good things about their other parent.

4. Celebrating what they get to do with their other parent.

5. Cheerfully encouraging calls to their other parent.

6. Promptly sharing child-related information.

7. Staying out of legal combat.

8. Enjoying and admiring your children.

77. Which of these Keys will require extra effort on your part? State what special effort you’ll be making (or special help you’ll be using) to succeed. __________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

78. (A) What specific changes would you like your co-parent to make to better respond

to your children’s needs? 1. ________________________________________________________________

________________________________________________________________ 2. ________________________________________________________________

________________________________________________________________ 3. ________________________________________________________________

________________________________________________________________ 4. ________________________________________________________________

_______________________________________________________________________


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(B) What specific changes could you make to better respond to your children’s needs?

1. ________________________________________________________________ ________________________________________________________________

2. ________________________________________________________________ ________________________________________________________________

3. ________________________________________________________________ ________________________________________________________________

4. ________________________________________________________________ ________________________________________________________________

79. Imagine your children at age 25 looking back on what is going on in their family

today. What do you think they would say they most wished you had done—or were most glad you did—at this time in their lives? _____________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

80. Is there anything else you would like the reviewer to know? __________________

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

81. How will you and your co-parent be sharing the expenses of this review (for

example, 50-50)? ___________________________________________________ ___________________________________________________________________

82. On what date did you finish this Intake? _________________________________ 83. Approximately how much time did you spend doing your website work (on

UpToParents.org or ProudtoParents.org) _______________________________ 84. Approximately how much time did you spend filling out this Intake Booklet? (Include

the time you spent filling out the attached ―Describing My Children‖ pages.) ____ ________________________________________________________________

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Describing My Children Note: Be sure to use a separate form for each child.

A. Name and age of your child ____________________________________________ B. How would you describe your child to a friend? Include your child’s personality,

interests, and special qualities.__________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

C. Describe (1) a time in the past when you and your co-parent became aware that your child had a problem (an illness, a personal or school problem, or a fear), (2) how you and your co-parent responded, and (3) how the situation ended. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

D. Describe your child’s reactions and problems from any past conflict between you and your co-parent. (Don’t describe the conflict, just your child’s reactions and problems from it.) ____________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

E. Describe any fears and problems your child has. For each of these, what do you think can be done to help your child? ____________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

__________________________________________________________________

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F. What school does your child attend school? What grade? How is your child doing

in school? Which subjects and activities does your child especially like, and which are a challenge for your child? __________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

G. Read the interactive article on the ―Parents Corner‖ of the website called ―Children’s Painful Thoughts.‖ Then circle all the thoughts you think your child would likely have over continuing conflict between you (the parents).

1. “I’m so ashamed. I’m humiliated. Other kids’ families aren’t like this.” 2. “I’m scared. I don’t know what will happen next.” 3. “I need to fix this. It’s dangerous if I don’t.” 4. “This is MY mom and dad. I must have the faults they point to in each other.” 5. “I need to figure out who’s right and who’s wrong.” 6. “I need to pick sides.” 7. “I need to tell people what they want to hear.” 8. “This parent will be angry (or hurt) if I want, need, or love my other parent.” 9. “If I weren’t here, this wouldn’t be happening.” 10. “I can’t do anything right. I deserve whatever bad happens to me.” 11. “I’d do anything to feel better or to fit in.” 12. “I don’t care anymore. It hurts too much to care. The world doesn’t care

about me—and I don’t care about the world.”

H. What specifically would your child want to be different about the way you and your co-parent relate to each other? (Don’t ask your child; answer from your own sense of what your child would like.) ________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

I. Do you think your child deserves these improvements in the way his/her parents relate? Do you think your child’s wish is reasonable?________________________ __________________________________________________________________ __________________________________________________________________

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__________________________________________________________________

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H. What specifically would your child want to be different about the way you and your co-parent relate to each other? (Don’t ask your child; answer from your own sense of what your child would like.) __________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________

I. Do you think your child deserves these improvements in the way his/her parents relate? Do you think your child’s wish is reasonable?________________________ __________________________________________________________________ ________________________________________________________________

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__________________________________________________________________

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I. Do you think your child deserves these improvements in the way his/her parents relate? Do you think your child’s wish is reasonable?________________________ __________________________________________________________________ ________________________________________________________________

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__________________________________________________________________

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I. Do you think your child deserves these improvements in the way his/her parents relate? Do you think your child’s wish is reasonable?________________________ __________________________________________________________________ __________________________________________________________________

parenting assets and improvement review (p.a.i.r.) fileare welcome to copy and use this booklet, and...

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