This form is to be used as an initial viability assessment of the applicant(s) undertaking a Connected Personsfostering or Special Guardianship assessment.

This form must not be used to assess applicants under Regulation 24 of The Care Planning, Placement and Case Review (England) Regulations 2010 (immediate and emergency placements). There is a separate form for this.

Parts Aand B are for the social worker to provide information about the situation and to present the views of the child, the parents, and anybody else with parental responsibility. All sections should be completed.

At the end of the document the social worker is asked to evaluate the proposed arrangement and the proposed carer will have the opportunity to give their comments.

Referrals to Family Placement Service: This form should be completed and sent along with a completed referral form to: or if you require further guidance please contact Zelma van Rhyn on 024 76831873.

Child(ren)’s details:

Name(s) / DoB/EDD / Gender / Religion / Ethnicity / Legal Status
Home Address (inc postcode & telephone number)

Applicant(s)

Name(s) / DOB / Gender / Religion / Ethnicity / Relationship to child
Home Address (inc postcode)
Telephone number (mobile and/or landline)

PART A– TO BE COMPLETED BY THE CHILD’S SOCIAL WORKER

Why is the child unable to live with a birth parent currently? What are the identified risks? What is required from the carer to keep the child safe from these risks?

What is the applicant’s understanding of the child(ren)’s circumstances and the local authority’s concerns?

Child care experience:Include information about parenting their own children, and confirm any previous involvement with Children’s Services with their own children.

Also cover their experience and views on contact issues for looked after children. Views re discipline, behaviour management etc.

Areas to potentially explore:

What are your views on corporal punishment? How would you implement discipline and behaviour management strategies etc?

What is your experience and a view on contact with the child’s other significant family members. How would you manage this?

How would you ensure a child remains safe from physical and sexual abuse in your network of family, friends and acquaintances and that they, in turn, remain safe from allegations?

How will the child be eased into your routines?

How would the 'rules of the house' be explained to them?

How would a child experience any religious/ spiritual customs in the home?

How would a child experience any cultural aspects of your life?

How would a child be accepted into your extended circle of family and friends?

What is the applicant’s motivation to care for this child(ren)?

Have you involved other people in your decision to care for this child(ren)?

What do you feel you can offer a child(ren) placed with you?

Applicants with a birth child/ren

Do you plan to have more children of your own in the future and, if so when and how many?

What do you feel are the issues that might be raised by having both birth children and another child(ren) in your family?

What information / documents have been given to the applicants. Please give details:

i.e any relevant court documents – Ensure that Data Protection Act Legislation is complied with, and relevant consents obtained before sharing of information / documents.

What is your assessment of the applicant(s) ability to meet the child(ren)’s needs and to provide a stable family environment that will promote secure attachments:

It is useful to ascertain whether the applicant can step into a child's shoes and see the world from a child's perspective?

Do you have any knowledge or experience of children who are looked after?

How might you expect a child to react to being separated from their parents or carers, and how would you deal with this?

How might you expect a child who has been abused in the past to behave in your home, and how would you deal with this?

If a child started to tell you about some abuse that had happened to them in the past, what would you do?

If a child(ren) have not had a good experience of attachment to their parents, how might this affect them?

Can you understand how some LAC are 'stuck' in their development and may act younger than their actual age?

How might you be able to help such children?

How might you communicate with very young children or those who function below their chronological age?

How would you encourage a child to join in play and activities?

How would you help a child to attend school?

How could you help a child who had no school place or has been excluded from school?

How could you help a child build up their self-esteem and make them more resilient?

How would you manage the differing needs if you had more than one child?

How would you ensure the needs of your own children were also met?

Might there be a conflict between the way you manage the behaviour of your own children and that of other cared for children?

Do you understand that, for some children who have been abused, punishments such as sending them to their room may not be appropriate?

Discuss safe caring issues and the impact of this on family life.

What is therelationship between the applicant and the child/ren’s parent/s like?

Have any members of the household been involved in any incidents of domestic abuse, or any other criminal behaviours (either as perpetrator or victim)?

Please give details.

Are the applicant(s) able to work in partnership with the local authority?

Has there been any significant events in the applicants life which could impact on their ability to care for the child(ren)

What support would the applicant/s need in order to maintain the placement?

Health:Do they have any health needs which may impact on their care of the child?

What efforts do you make to try to maintain a good level of health?

Do you now, or have you in the past suffered from any significant illnesses including any mental health difficulties?

Use of antidepressants? Has this been resolved? Exploration or alternative therapies?

If so, please give details and any ways in which this may affect your ability to care for a child.

What is your attitude to smoking and alcohol use?

Do you feel that you are a strong person emotionally?

How have you managed and responded to stressful episodes in your life? Give examples

Do you understand how physical or mental health issues can play a part in children needing to be looked after?

Do any children or other adults in the household have any health issues which could have an impact on the family?

Employment:

Do the applicant’s work? What hours? What is their employment and unemployment experiences, effects on caring fit in with their present commitments? Include National Insurance number.

How important is work to you?

What are your ambitions/plans for the future with regard to work?

How will your work commitments fit around your caring responsibilities? Have you discussed this with your employer?

Accommodation:

Standard of hygiene. Is the accommodation safe and suitable for the child in question? Description of bedroom, proposed sleeping arrangements,

Can you describe your accommodation and garden (if applicable?)

How long have you lived here?

Is it privately owned or rented?

If rented, how secure is the tenancy and is the landlord aware of your plan to care for the child(ren)?

In what ways is it suitable for looking after children?

Are there any alternations or adaptations you would need to make?

What space would be available solely for the child and what would be shared?

Have you any plans to renovate or alter the property in any way?

Have you any plans to move house in the future? If, where and when?

Pets: What pets do they have (include breed)?

Are immunisations up to date?

How does the pet interact with strangers /children etc?

Don’t forget to explain the following:
  • the process of assessment, including the need for references, the interviewing of ex-partner/s and older children, along with own child’s school, health professional, what happens next etc.
  • the role of a Special Guardian / Connected Persons foster carer
  • that withholding information may be seen negatively, particularly in relation to any criminal caution / conviction.
  • If Connected Person foster carer: that the child may/will become a Looked After Child and implications (Social Worker visits, Placement Reviews etc)
  • the role of child’s social worker, family placement service social workers, others
  • support available where required; expectations re visits, training etc
  • the legal process (where appropriate) – suggest need to seek ownlegal advice
  • attending meetings, medical appointments, parents evenings.
  • other options – Child arrangement order, Adoption

Please confirm that DBS checks have been initiated: YES NO

Date the DBS was processed:

Has an Adult Health medical form been given to the applicant: YES NO

Date medical arranged for if known:

Social worker’s evaluation and Signs of well - being assessment:

Does the applicant have the potential to meet the needs of the child/ren as laid down in the child’s plan? Is this the most suitable way of safeguarding and promoting the child’s welfare?

Worries/concerns: / Signs of Well-being
Complicating factors: / Strengths:

Carer/s comments on this assessment and recommendation, including any areas of disagreement, or reasons why the assessment has not been discussed.

Social worker analysis and recommendation(if the assessment is positive then Part C on the next pages needs to be completed and a referral should be made to the Family Placement Service by emailing this form and the completed referral form to )

Applicant(s) declaration
  • I/we undertake to be truthful and honest in providing full and accurate information for this assessment, both verbally and in writing. I/we understand that the Family Placement Service or social care may seek verification of any information that I/we have supplied or will supply, and that if any of this information is found to be false or misleading, this may result in fps deciding not to proceed with my/our application.
  • I/we understand that any information supplied by me/us in respect of this application may be held and/or processed in an electronic form and is subject to the relevant provisions in the Data Protection Act 1998 and other statutes. I/we understand that any information supplied will form part of the Fps services case record held in respect of this application to.caring for a child.

Applicant(s) consent
  • I/we give consent to Social Care undertaking a check with the Disclosure and Barring Service and agree to complete the appropriate forms to progress this.
  • I/we give consent to FPS contacting my/our home local authority and any previous local authority areas to undertake a check regarding my/our suitability to care for a child/children.
  • I/we give consent to the fps requesting a written report about my/our health from my/our GP and I/we agree to arrange and take part in a medical examination with that GP as part of the process. I/we understand that further enquiries may be required and that I/we may be asked to give specific consent to obtain further health information.
  • I/we give consent to the Family Placement Service seeking written and verbal references from personal referees where I/we have provided their details in my/our application form.

Signature (Applicant 1)
Date
Signature (Applicant 2)
Date
Name of social worker completing this form:
Signature and date:
Name of the child’s social worker (if different):
Neighbourhood Office and Telephone number:
Team Manager:
Signature and date:

We will try and complete this assessment within 10 weeks of receiving the referral unless advised otherwise.

Significant dates i.e Court timetable, Child Protection Conference or LAC review:

Date assessment to be completed by:

PART B– TO BE COMPLETED BY THE CHILD’S SOCIAL WORKER. THE INFORMATION YOU PROVIDE WILL BE USED AS PART OF THE FULL ASSESSMENT

Child 1(if more than one child please copy and paste relevant sections and complete for each child)

Name
Date of Birth

Physical Description and Personality

Please give a physical description of the child and include a current photo of the child
Please give describe the child’s personality, likes, dislikes and interests.

Chronology of the child’s care since birth3

Include any periods looked after by the local authority.

Age of Child (yrs & mths) / From / To / Placement details

Health

Describe the child’s health history, current needs and what is required to meet these.

Education

The child’s current school
Does the child have a statement of needs under the Education Act 1996?
Yes/No (if yes provide details)
Does the child require additional help in school?
Yes/No (if yes provide details
Describe the child’s educational needs and what is required to meet these

For SGO applications only - all school placements including playgroup and nursery provision with dates and the child’s educational achievements

From / To / Name of provider and address / Type of educational provision & achievements

Emotional and Behavioural Development

Describe the child’s emotional and behavioural development, their needs arising from this and what is required to meet those needs.

Identity

Describe the child’s identity and what is required to meet needs arising from this. Provide information about the child’s religious persuasion and including details of baptism, confirmation or equivalent ceremonies

Family and Social Relationships

Describe the child’s current and historical relationship with family members and others, including the applicant(s) and any other members of the household or the applicant’s family:
What are the current arrangements for contact between the child and family members and others who the local authority consider relevant? Who is responsible for arranging and supporting these arrangements?
What are the proposed future arrangements for contact between the child and family members and others who the local authority consider relevant? Who will be responsible for setting up and supporting these arrangements?

Social Presentation

Describe the child’s social presentation and what is required to meet any needs arising from this

Self Care Skills

What are the child’s self care skills and what is required to meet any needs arising from these?

Reasons for proposed placement

Why is the child unable to live with a birth parent currently? What are the identified risks? What is required from the carer to keep the child safe from these risks?

Wishes and feelings of the child

What are the child’s wishes and feelings in relation to any proposed plans including plans for contact (as set out above) and in relation to his religious and cultural upbringing. Please include the date on which the child’s wishes and feelings were ascertained.

Birth parents background and history

Birth Mother

Physical description including photograph where available.
Please describe the birth mother’s health history, including details of any serious physical or mental illness, any hereditary disease or disorder or disability
Please describe the birth mother’s educational history
Please describe the birth mother’s employment history
Please give a description of the birth mother’s personality and interests

Birth Father

Physical description including photograph where available.
Please describe the birth father’s health history, including details of any serious physical or mental illness, any hereditary disease or disorder or disability
Please describe the birth father’s educational history
Please describe the birth father’s employment history
Please give a description of the birth father’s personality and interests

Birth parents’ relationship

Please describe the past and present relationship between the birth parents

Parental responsibility

Provide details of whether the child’s parents married to each other at the time of the child’s birth or have they subsequently married?
Date of marriage
If the parents were not married, please indicate if birth father has parental responsibility and how this was acquired?
If the child’s parents have been previously or are currently married or civilly partnered to another person please give dates/details.
Is there any other person who holds parental responsibility for the child? (please include date acquired and details)

Views of the birth family