Early Help Assessment Part A



Download 132.11 Kb.
Date conversion13.12.2016
Size132.11 Kb.

Early Help Assessment



Part A

Section 1: Your family household


Details of all children or young people living in household

Name

DOB/

EDD

Gender

Ethnicity

Disability

Religion

Who has PR

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Family / other household members

Name

DOB/

EDD

Gender

Ethnicity

Disability

Religion

Relationship to child(ren)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Address

     

Postcode:      

Telephone:      


Other significant people not living in household

Name

DOB

Gender

Ethnicity

Disability

Religion

Rel'ship to child(ren)

Address

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Communication needs (including language) of any of the people to be included in this assessment

     


Details of other issues regarding the assessment i.e. access to the home, times, pets, conflict, domestic abuse

     

Section 2: Reasons and understanding about your assessment




Date the assessment started:

     

(Aim to be completed within 10 working days unless otherwise agreed)




Family member / practitioner completing form:

     

Mob /

tel no:

     

Family members who have contributed to the assessment:      


What are the reasons for starting this assessment?

     



Section 3: Your family support, history and safety


Services working with you and your family

Agency

Person supporting

Practitioner's name

Role

Contact details

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Relevant previous agency involvement and any completed assessments

Agency

Name of agency and assessments completed

For who?

When?

Education

     

     

     

Health

     

     

     

Housing

     

     

     

Domestic abuse

     

     

     

Mental health

     

     

     

Significant learning disability

     

     

     

Substance misuse

     

     

     

Offending

     

     

     

Social care

     

     

     

Other, family group conferencing, court

     

     

     

For list of possible assessments see Guidance for completing a Family EHA. Please ensure that information about current and previous agency involvement and relevant assessments findings are appropriately incorporated within Section 4: Your families profile and story.


Significant events and their impact (i.e. new baby, bereavement, separation/divorce, redundancy, experience of abuse or violence)

     


Your family's safety advice

Key safety issue

Yes

No

N/A

Are there working smoke alarms on each floor of the property?







Are the parents / family happy that in the case of a fire they could all escape safely? How?







Safe sleep arrangements







Don't shake your baby advice







Home safety







Safe storage of harmful substances







See DSCB website for Family Safety Advice guidance to aid completion of this section

www.derbyscb.org.uk or www.derbyshirescb.org.uk




Derbyshire schools only - Next Steps

Continue with early help assessment? (complete part B) Yes  No 

Other action, please specify with reasons:      


Part B

Section 4: Your family's profile and story


Child's profile and story Child/young person's development, physical and emotional health, learning and behavioural development, family and social relationships. Comment on each child and young person, their wishes and feelings and identify needs and strengths.

     


Parents and carers profile and how they look after the children parenting skills, basic care, guidance & boundaries, emotional warmth & stability whist ensuring safety. Note parents views, strengths and needs plus any attendance at parenting programmes.

     


Family, home, community and support networks family history & relationships, wider family, housing & finances, useful resources available in locality. Note strengths and needs.

     

Section 5: Child, family and practitioner's views




What does the child / young person think needs to stay the same, and why?

     

What does the child / young person think needs to change, and why?

     



What does the family think needs to stay the same, and why?

     

What does the family think needs to change, and why?

     



What does the practitioner think needs to stay the same, and why?

     

What does the practitioner think needs to change, and why?

     



Section 6: Practitioner's analysis


What are you / the family worried about (risks)?

     


What is the impact of these risks / behaviours on the child and family?

     


What is working well to address these worries (strengths)?

     


How will we know when the desired outcome has been achieved / when things are better?

     



Section 7: Identified actions from Early Help Assessment




What do we want to achieve?

How are we going to do it?

Who? (family member, extended family, friend, practitioner, other)

When by?

Date completed

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


Child / young person's views on the identified actions

     


Parents / carers views on the identified actions

     


Who has seen the children? When and where?

     


What might happen if this plan is not followed?

     




Date assessment completed:

     


Information sharing

I have had reasons for sharing information explained to me and I understand that information will only be stored and shared for the purpose of helping my family. Is there is anyone you do not want us to share information with? No  Yes  If so, please specify:



     




Signed on behalf of family:

     

Date:

     




Signed by practitioner completing form:

     

Date:

     




Role, organisation and contact details:

     


See also documents for Team Around the Family (TAF) meetings on www.derbyscb.org.uk and www.derbyshirescb.org.uk



Appendix 1
Derby City Early Help Assessment Monitoring Form

Once the assessment has been completed (this can be either before or after your first TAF), please complete all sections of this form and return to Locality Single Point of Access (SPA) Clerk. Include details of all children assessed.




Child's details

Name:      

Any other surname/s? If yes please note:

     


DOB / EDD

     


Gender

     


Ethnicity

     


Disabilities

     


Religion

     


Address:      

Postcode:      

Locality 1 & 5  Locality 2  Locality 3 & 4  Not known 

Unique pupil number, if known:      




Details of practitioner who completed the early help assessment

Name:      

Role:      

Agency:      

Address:      

Telephone number:      

Email:      



Details of Lead Professional, if different from above

Name:      

Role:      

Agency:      

Address:      

Telephone number:      

Email:      




Date Early Help Assessment started:

     

Was an Early Help Pre-assessment Checklist completed? Yes  No 




Signature:

     

Date:

     



Please return to Locality SPA Clerk via:
POST: marked private and confidential to the Locality Single Point of Access Clerk, CYPD, The Council House, Corporation Street, Derby, DE1 2FS or SECURE EMAIL ONLY to:


  • Locality 1 and 5 vcm1and5@derby.gov.uk

  • Locality 2 vcm2@derby.gov.uk

  • Locality 3 and 4 vcm3and4@derby.gov.uk




Appendix 2



Derby City Early Help Assessment Closure Monitoring Form

Once the assessment has been closed, the Lead Professional must complete all sections of this form and return to Locality Single Point of Access (SPA) Clerk. Include details of all children assessed.




Child's details

Name:      

Any other surname/s? If yes please note:

     


DOB / EDD

     


Gender

     


Ethnicity

     


Disabilities

     


Religion

     


Address:      

Postcode:      

Locality 1 & 5  Locality 2  Locality 3 & 4  Not known 

Unique pupil number, if known:      




Date Early Help Assessment started:

     




Date of closure:

     




Early Help Assessment Outcome



No further support required



Low level needs - needs met through assessing agency / family



Emerging needs - needs met through Team Around the Family meetings



Complex or serious needs - referral to disabled children's service /Lighthouse



Complex or serious needs - referral to Social Care



Child protection concerns – Referral to social Care



Referral to health / medical service



Other, please provide details below:



     




Details of Lead Professional, if different from above

Name:      

Role:      

Agency:      

Address:      

Telephone number:      

Email:      




Signature:

     

Date:

     


Please return to Locality SPA Clerk via:
POST: marked private and confidential to the Locality Single Point of Access Clerk, CYPD, The Council House, Corporation Street, Derby, DE1 2FS or SECURE EMAIL ONLY to:


  • Locality 1 and 5 vcm1and5@derby.gov.uk

  • Locality 2 vcm2@derby.gov.uk

  • Locality 3 and 4 vcm3and4@derby.gov.uk

April 2015 DSCB Page of



Version 2: please note this document replaces the March 2014 version


The database is protected by copyright ©dentisty.org 2016
send message

    Main page