Family Details- Include Those Living in Family Home

Unique Family Number (For Office Use Only):
Child and Family Common Assessment Framework
The purpose of the family common assessment is to gather evidence to help the family members identify strengths and weaknesses which are helping or preventing the family achieving a safe and settled lifestyle.
1. Family Details- include those living in family home
Family Address
Postcode
Housing status (private rented, housing association etc):
Name of landlord (agency name if rented from agency):
Is family at risk of eviction? (Y/N) / Is family at risk of becoming homeless? (Y/N)
Family contact numbers:
One parent Household?:
Family Religion:

*Tip: Click last cell, choose ‘Table’ from Taskbar, choose ‘Insert’, choose ‘Insert Row Below’

Parents/ Carers
First Name / Surname / DOB (dd/mm/yyyy) / Gender
(M/F) / Disability (Y/N) and details / Ethnicity
(refer to ethnicity guidance in IWG) / Employed / Lives in family home? (Y/N)
Children
First Name / Surname / DOB/ EDD (estimated delivery date (dd/mm/yyyy) / Gender
(M/F) / Nursery/
school/
college attended / Disability
(Y/N) and details
(If yes please provide NHS number) / Ethnicity
(refer to ethnicity guidance in IWG) / Lives in family home? (Y/N)
Other Significant Family Members
R’ship / First name / Sur-
name / DOB
(dd/mm/yyyy) / Gender
(M/F) / Disability (Y/N) and details / Ethnicity
(refer to ethnicity guidance in IWG) / Employed
(Y/N) / Lives
in family home? (Y/N)

NB this form is intended for electronic use however if you wish to complete by hand you can increase the size of the boxes before printing off by clicking inside the relevant box and selecting the return button.

Current Family and Home Situation (e.g family structure, family trees)
2. Lead Professional
Name / Organisation
Role/Post / Contact no
Address inc postcode / E mail
Managers Name / Manager contact and e mail
3.Assessment Details
Reasons why the family is being assessed:
Reasons
-these are the big stresses on family life and can include health concerns, effects of poverty, family functioning, breakdown and stress, neglect and housing issues
Employment/ unemployment
Crime/ anti social behaviour
School attendance/ outcomes
Services working with the family- Health
GP / Health Visitor / Dentist
Name
Address
Contact No
Current Involvement with family
Services working with the family- Education
Nursery/ School/ College Name
Address
Contact number
Current involvement with family
Other Services Working with the Family
Service / Address and Contact Number / Current work ongoing with Family / Contributed to Assessment (Y/N)? / Invite to TAF Meeting (Y/N)?

Family History-Previous experiences the family have had working with services e.g. older referrals into social care or working with agencies such as probation or drug and alcohol teams. This should also include significant historical events such as domestic violence, abuse or neglect of parents.
Date / Detail / Outcome
4. Family Strengths and Resilience
This section is for the family to record all of those things which strengthen their ability to cope as a family and should include those family and individual activities which help them. Examples could be good school attendance or strong support from relatives, or work done with a particular agency or professional. Family strength and resilience (ability of family to cope with difficulties) factors will help the family achieve positive outcomes.
5. Child’s Assessment- please include all children in the family
Assessment comments form the basis of the action plan and MUST identify individual childrenfor example if a need is child specific please indicate this with the child’s name. Include evidence from agencies or family members. Comments should record strengths as well as needs and evidence indicators are given where appropriate.
Development of children –
Strengths and Needs
Health
General health
Conditions and; access to and use of dentist, GP, optician; immunisations, developmental checks, hospital admissions, accidents, health advice and information.
Physical development, speech, language and communication
Correct size and weight; activity; relaxation; vision and hearing; fine motor skills (drawing etc.); gross motor skills (mobility, playing games and sport etc); conversation, expression, questioning; games; stories and songs; listening; responding; understanding.
Alcohol and Drugs Misuse
Current and recent substance misuse; drugs and alcohol – frequency, management of substance misuse; agency support, attendance at treatment programmes.
Emotional and social development
Feeling special; early attachments; risking/actual self-harm; mental ill health; coping with stress; motivation, positive attitudes; confidence; relationships with others; feeling isolated and solitary; fears; often unhappy.
Behavioural development
Self control; behaviour with peers and others; anti-social behaviour; gang related intimidation/threats; sexual behaviour, violence/aggression; restless and overactive, easily distracted, attention span/ concentration.
Identity, relationships, self-esteem, self-image and self-care skills
View of self; knowledge of personal/family history; sense of belonging; experiences of discrimination due to race, religion, age, gender, sexuality and disability. Building stable relationships. Teenage pregnancy. Becoming independent – washing, dressing, feeding etc.
Learning
Participation in learning, education
and employment
Access and engagement; attendance, participation; adult support; access to appropriate resources; receiving education off site; young people not in education, employment or training.
Progress and achievement in learning
Progress in basic and key skills; available
opportunities; support with disruption to
education; particular educational needs; level of adult interest.
Ambition
Aspirations/ dreams; pupil’s confidence and view of progress; motivation, perseverance.
Social and community resources
Day care; places of worship; transport; shops; leisure facilities; crime, unemployment, anti-social behaviour in area; peer groups, social networks and relationships; religion.

Voice of the Child(ren): Views, wishes and feelings of the child(ren)– Do you agree/ disagree; are you happy with what has been written? How would you like things to change/ improve for you and your family?
Assessments undertaken on Children- e.g. health, education, social care, youth offending etc
Type of Assessment / Name of Child / Date Assessment Started / Author of Assessment and Contact No. / Consent to Share with Lead Professional (Y/N)
6. Summary
Conclusions: Strengths and Resilience- what are the family’s strengths to be built upon? See section 4.
Conclusions: Needs- what are the areas the family need support with to improve outcomes for all family members (must include those factors given as reason for the assessment being undertaken such as crime/anti-social behaviour, school attendance and unemployment)
General Assessment –
Strengths and Needs
Health
General health
Conditions; access to and use of dentist, GP, optician; hospital admissions, accidents, health advice and information; health conditions; disability and impact on family life. Detail adults with long term illnesses.
Emotional and Mental Health
Levels of confidence and self esteem; sources of strength; causes and effects of stress and anxiety; feelings of despair, self-harm; treatment; impact on parenting, family life, work and day to day functioning.
Parenting
Ability to provide a stable and loving family environment; praise and encouragement for children; provision of food, warmth, shelter; appropriate parenting – role model, discipline, support for positive activities, not overprotective; parenting difficulties – domestic violence, upheaval, debt etc.
Relationships and Family Functioning
Stability of relationships and effects on family life; illness, bereavement, domestic violence, substance misuse, relationship and family breakdown. Formal and informal support networks, wider caring roles and responsibilities.
Behaviour and Offending
Anti-social behaviour and sanctions; organised/ gang behaviour; involvement with police – no. of call outs; Involvement with criminal justice system; intervention from probation; relationship with community, effects on family; adults subject to Anti Social Behaviour sanctions and no. of breaches on last 6 months.
Alcohol and Drugs Misuse
Current and recent substance misuse; drugs and alcohol – frequency, addiction with prescription or illegal drugs; related criminal activity; impact on family; agency support; rehabilitation; attendance at treatment.
Housing and Social
Quality of housing; homelessness and reasons; at risk of eviction- any housing Anti Social Behaviour sanction; warm, safe and clean; adequate no. of bedrooms; rent arrears; maintenance issues; housing environment, social isolation of family; social and community resources, transport, local shops and services.
Employment, Education and Training
Current employment/ education/ training status; Qualifications and skills and ambitions; Length of unemployment periods; Access to and receipt of benefits; Involvement with employment agencies; Effects on family – debt, stress etc.

Adult’s comments on the assessment - Do you agree/ disagree; are you happy with what has been written? What should change to improve the future for you and your family?
Other Assessments undertaken on Adults –e.g. health, worklessness, offenders, housing needs etc
Type of assessment / Family members name / Date assessment started / Author of assessment and contact no / Consent to share with Lead Professional (Y/N)

8. Family Priorities
From the assessment, information available and discussions with the family identify the priority areas to be addressed within the Family Contract/ Team Around the Family (TAF) Meetings.
Provide details in relation to what needs to change in order for the family situation and functioning to improve.
(For Intensive Family Intervention Programme families: Priorities must include those relating to Crime/ Anti-Social behaviour, School Attendance and Unemployment).
Priority / What Needs to Change / How Will You Measure Success
e.g ImproveSchool Attendance / Poor morning routine needs to improve / Children will be prepared for school and ready to leave house by 8am
Signed for family: SIGNED COPYON FILE
Signed / Name / Date
Lead Professional’s signature:
Signed / Name / Date
Lead Professional's Manager’s signature:
Signed / Name / Date

9. Consent and Information Sharing
Information collected in this family plan assessment form will need to be shared with the agencies identified in the form to help us provide the services you need. If we need to share information with any other organisations later to offer you more help we will ask you about this before we do.
We will treat your information as confidential and we will not share it with any other organisation unless we are required to by law, or unless you or someone else will come to harm if we do not share it. In any case we will only ever share the minimum information we need to share.
In line with the Data Protection Act (1998) we require your consent to share and store the information in this form.
Information will be shared with the Wirral Safeguarding Children Board to allow it to test the effectiveness of safeguarding arrangements for children.
I understand the information that is recorded on this form and that it will be only be stored and shared for the purposes of providing services to me and my family.
I have had the reasons for information sharing explained to me and I understand them.
I agree to the sharing of information, as agreed, between all the services listed in this form.
I also agree to the sharing of information with the services/ organisations listed below:
x
I understand I may add to or withdraw consent at any time.
Signed by Adult(s) / Signature on File
Signed / Name / Date / Yes / No
Signed / Name / Date / Yes / No
Signed by each Child / Signature on file
Signed / Name / Date / Yes / No
Signed / Name / Date / Yes / No
Signed / Name / Date / Yes / No
Signed / Name / Date / Yes / No