Poole Early Help Assessment 2016

ID / Main
Address / Start Date /
Who is in the family home? /
Name (including AKA) / Date of Birth/ Estimated Delivery Date / Gender / Phone Number and email. Home address if different from above / Position in family/ relationship to child(ren)/ young person(s) / School/ Early Years/ College/ Employment / Details of any special needs or requirements – eg communication needs, interpreter required, mobility, access requirements etc / Wheel complete /
Who else is important to the family?

If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

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If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

Presenting issues: What has prompted you to start this assessment? /
Parent(s)/Carer(s) View / Child(ren)/Young Person(s) View / Practitioner View

If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

Practitioner completing this assessment /

If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

Organisation / Practitioner name / Job Title / Phone / e-mail / Office Address / Working with which Family Member(s): / Lead Prac-titioner / Currently
Involved / Contributed to this Form / Specialist Assessment /
Other practitioners/services working with any member(s) of the family - currently or in the past 12 months. Eg GP/Health Visitor, School contacts, Early Years provider, Adult Services, Social Worker, Youth Worker and Voluntary Sector. Please include contact details. /

If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

PEHA 2016

Poole Early Help Assessment 2016

If you identify an immediate safeguarding concern at any point during the assessment, speak to your line manager and follow LSCB Procedures

Continued:
Safety
Back to wheel /
·
Self-Care/ Living /
·
Money/ Housing /
·
Social/ Relation-ships
Back to wheel /
·
Drugs/ Alcohol /
·
Physical Health /
·
Emotional/ Mental Health
Back to wheel /
·
Behaviour /
·
Attending/ Engaging /
·
Being a Parent
Back to wheel /
·
Summary / Analysis
What have you told us about you/your family? / What have professionals told us about you/your family? /
What are the strengths and protective factors?
Who has identified these? / What are the needs? Are there any risk factors?
Who has identified these? /
Poole Early Help Assessment 2016
Action Plan (to be agreed with the family) The Lead Practitioner(s) will ensure this plan is monitored and reviewed /
Lead Practitioner(s) / Role / Phone / Plan Date /
What needs to change? / Why? / How?
Steps to be taken / Who will do this? / When? / Completed Date / Review Notes /
Signatures – to be signed by all family members who are involved in the action plan. Parents/carers can sign on behalf of children who are too young, or who aren’t able to understand. /
· I have read this form and agree that it is a fair assessment of my/my family’s strengths and needs.
· I agree to the action plan and understand that family members and professionals will work together to achieve the changes we have agreed.
· I give consent for this form to be shared with professionals who can offer support to help achieve the changes set out in the action plan. /
Name / Signature / Date / Name / Signature / Date /
Plan Complete (Lead Practitioner must notify the Hub when the plan is complete or when it is handed over to a new Lead)
Actions completed date: / Changes achieved and successes: / What happens next?