Children's Court Clinic
Sydney Children’s Hospitals Network
Children’s Court of NSW
2 George St
Parramatta
Locked Bag 4001
Westmead NSW 2145
DX8257 PARRAMATTA
ASSESSMENT REPORT – CLIENT AND CLINICIAN DETAILS
CONFIDENTIALITY
Use of this document other than for the purpose of the proceedings referred to below, or the provision if it, or disclosure of its contents to any person or organisation without leave of the court, or other lawful excuse, may be a criminal offence.
Court:
CHILD/YOUNG PERSON
/Date of Birth
/Age
/Children’s Court Clinic
File No.
Report prepared by:
Signature: …………………………………………………… Date: …/…/...
Email:
Fax: 02 8688 1520
CHILDREN'S COURT CLINIC – CONFIDENTIALITY NOTICE
CHILD/YOUNG PERSON
/Date of Birth
/Age
/Children’s Court Clinic
File No.
It is the practice of the court to release the assessment report to all parties unless there are exceptional circumstances.
[ ] In my view there are no exceptional circumstances which should restrict the release of the assessment report or any part thereof to all the parties;
[ ] In my view there are exceptional circumstances, which indicate that the release of this assessment report or part thereof should be restricted. Restricting a report has serious implication, so consider calling the Director if you are thinking of checking this box.
The reasons for this view are:
Authorised Clinician’s Name: …..………………………………………………….
Authorised Clinician’s Signature: …..…………………………………………………. Date: …/…../….
FOR CHILDREN’S MAGISTRATE or JUDGE’S USE:
I order that this report may be made available to:
[ ] All parties and legal representatives, and the child’s medical practitioner or other health provider; or
[ ] All legal representatives only
[ ] The mother [ ] The father
[ ] The mother’s legal representative [ ] The father’s legal representative
[ ] The child [ ] Family and Community Services’ legal representative
[ ] The child’s legal representative
[ ] Other (e.g., medical practitioner or other health provider):…………………………………………….
This report is not to be disclosed to any other person without leave of the court.
Judicial Officer: ……………………………………………………..Date: …/…../…
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Children's Court Clinic
Sydney Children’s Hospitals Network
Children’s Court of NSW
2 George St
Parramatta
Locked Bag 4001
Westmead NSW 2145
DX8257 PARRAMATTA
CHILDREN'S COURT CLINIC ASSESSMENT REPORT
CONFIDENTIALITY
Use of this document other than for the purpose of the proceedings referred to below, or the provision if it, or disclosure of its contents, to any person or organisation without leave of the court, or other lawful excuse, may be a criminal offence.
Health practitioners and service providers to whom this report is released are bound by relevant privacy legislation, and required to observe confidentiality in relation to any personal information (particularly the Health Records and Information Privacy Act 2002), and names and identifying information in relation to children and young persons [s.105 of Children and Young Persons (Care and Protection) Act 1998] in this report. This report is not to be further released.
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CHILD/YOUNG PERSON
/Date of Birth
/Age
/Children’s Court Clinic
File No.
Executive Summary
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1.1
Assessment order/Referral details
2 …………. were referred for evaluation pursuant to an Assessment Order dated …………..made at ……………. Children’s Court, under s53 and s54 of the Children and Young Persons (Care and Protection) Act 1998, relating to the “care of the child/young person and to a person (or persons) with parental responsibility or seeking parental responsibility for the children to carry out that parental responsibility”.
Terms of assessment
3 The issues to be addressed as stated in the Assessment Order are as follows:
3.1
Declarations
4 At the beginning of the assessment process, all children who were of sufficient understanding to make an informed decision as to whether to participate in the assessment process, and all adult parties to the assessment, were informed of the nature, purpose and process of the interviews and other components of this assessment. They were also informed that any information given in the interviews or assessments may be included in the report to be sent to court. They then gave the Authorised Clinician their consent in writing. It is considered that this consent was validly given.
5 I have read and agree to be bound by the Uniform Civil Procedure Rules 2005 Schedule 7 Expert Witness Code of Conduct.
Sources of information
6 In undertaking this assessment report the documents listed below were perused:
6.1
Assessment contacts
7 The following contacts (e.g., phone calls, messages, faxes, letters, personal contacts) were made in order to arrange this assessment:
7.1
Assessment process, clinical interviews and observations
8 The clinical interviews and assessment procedures undertaken in relation to this assessment report are detailed below:
8.1
Relevant family/cultural background information, including Aboriginality
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Clinical findings
Observations /Interviews with parents/carers
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12
Adult test results (if any)
13
Observations/Interviews with children
14
Child test results (if any)
15
Parent/carer/child interaction observations
16
Collateral sources of information
17
Formulation/Summary
18
Issues to be addressed/terms of assessment
19 The results of the assessment in terms of the issues to be addressed in the Assessment Order are as follows:
19.1
Recommendations
20.1
(Signed)
Authorised Clinician
Date:
Note: I am available for attendance at court on (days of the week)
Email:
Fax: 02 8688 1520
Authorised Clinician’s Curriculum Vitae
CHECKLIST FOR SUBMISSION OF ASSESSMENT REPORTS
For AC’s use only - not to be included with the report
Before sending your assessment report, please check you have included the following:
[ ] Client and Clinician Details cover sheet (completed and signed by the AC)
[ ] Confidentiality Notice form (completed by AC)
[ ] Consent Limited Confidentiality in Assessments form (signed by the client/s).
[ ] Brief CV (as attachment to report)
[ ] Tax Invoice form (completed by the AC).
[X] Clinical Survey Form (currently not required)
[ ] Other relevant paperwork/receipts (e.g.: interpreter and travel receipts).
Send all Authorised Clinician’s reports by email (preferable), registered post, or facsimile.
Post Client Services Manager
Children’s Court Clinic
Locked Bag 4001
Westmead NSW 2145
Fax 02 8688 1520
Enquiries Client Services Manager on 8688 1515
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