Appendix 3

South Tyneside

Early Help Assessment and Plan

For children and young people with disabilities.

Name:

Date of Birth:

Date of Assessment:

Date of Plan:

To be completed with the child and or parent and carer.

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Personal Details

Full Name
I like to be called
Date of Birth
Home Address
Gender
Child Looked After / Name of Social Worker
Ethnicity/Religion
Home Language
Child’s/Young Person’s preferred method of communication/support required to participate
Parent/Carers Name(s)
Contact telephone number(s)
E-mail address
Describe Childs Disability
Early Help Worker co-ordinating this plan
Do you have a Statement / Education, Health and Care Plan (EHCP)?

Services involved with this child and family

Service/organisation / Contact details / Telephone / Consulted as part of this assessment? Please give date.
GP (family doctor)
Health Visitor or Midwife
Setting or school attended
Young Person’s Lead
Children’s Centre involved
Child and Adolescent Mental Health Service (CAMHS)
Special Educational Needs
Adult Mental Health Service
Youth Justice Service
Social Worker
Anti-Social Behaviour Unit
Police
Matrix
Children’s Social Care
Dental services/
Ophthalmology/Audiology
SALT / Occupational Therapy / Physiotherapy
Dietician
Other (add lines if needed)
Communication needs:
How do you communicate? Verbal? Non verbal? BSL, Makaton?
Does you use signs or symbols (for example, board maker, Picture Exchange Communication)?
If you communicate non-verbally, is body language, eye pointing, or other forms of communication significant? How do you communicate with the person who looks after you, and at school?
  1. Are you able to get around the house and elsewhere by yourself?
/ Not at all / With help / Without help
Is there anything else you want to tell us?:
  1. Are you able to feed yourself?
/ With help / Without help
Is there anything else you want to tell us?:
  1. Are you able to wash / dress yourself?
/ With help / Without help
Is there anything else you want to tell us?:
  1. Are you able to use the toilet by yourself?
/ With help / Without help
Is there anything else you want to tell us?:
What Support Services are accessing now?
please tell us about them:
What have you tried and has it worked for you and your family?
What types of support services are you interested in accessing?
What difference will this make to you and your family?
  1. Which times/days would be most helpful to receive support?

Daycare / Weekdays / Weekends / Full weeks
Yes / am / pm / Yes / Yes / Yes
No / am / pm / No / No / No
Other/comments:

Care Needs

Parents and carers

Ensure that this tells the story of this child’s family. Consider strengths and areas of concern for each question. Be specific about what needs to change.

What is effective about your family and your ability to parent this child/these children?
What do you consider the family’s strength’s to be and your strengths as a parent?
What is not so effective?
Do you need support in your own right? – if so, please ensure this is fully addressed in the conclusions
How do family members get along with each other?
Have you any problems that affect family life? Consider the likely impact of specific adult issues (substance misuse, domestic violence, mental health, debt, unemployment) on their ability to parent and the impact of the child’s/children’s issues on the parents/carers.
Do you get support from extended family, friends and neighbours? From whom? How reliable is this support?

Conclusions, solutions and actions: why issues have occurred and what needs to happen next
1) What are our conclusions? (agreed by family and lead professional conducting assessment)
Consent for information storage and sharing of information for Early Help
The information that is recorded on this assessment has been explained to me. I understand that it will be stored electronically and will be shared with other professionals where appropriate. I understand and agree that it will be used for the purpose of providing services to me and/or the child or young person for whom I am the parent/carer. This will usually be provided by a “Team Around the Child and Family” using a single Early Help Plan and a Review Record, which will also be stored electronically and which will also be shared with other appropriate professionals (unless listed below).
I understand that any safeguarding or child protection concerns which arise during this assessment or the life-time of the Early Help Plan will be referred to Children’s Social Care..
I have had the reasons for information sharing explained to me and I understand those reasons.
Yes No
I have had reasons why assessment information may have to be shared with Children’s Social Care (safeguarding or child protection) explained to me.
Yes No
I agree to the sharing of information, except with the services listed below
Yes No
What information may not be seen by which agencies?
Once signed, a copy of this assessment must be given to the parent/carer and the child/young person (if appropriate)
Child’s/young person’s signature (where possible to obtain)
Signature / Print name / Date
Parent’s/carer’s signature
Signature / Print name / Date
Assessor’s/Lead Professional’s signature
Signature / Print name / Date
Manager’s signature
Signature / Print name / Date
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My Early Help Plan - Outcomes for the next 12 months
To meet my key priorities, the following need to happen:
Outcome Required / What support is required to help meet my needs?
(This should be detailed, specific and be quantified) / How often will this happen? / Who will provide the support? / Who is responsible for this and will monitor it? / By when will this be achieved?
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Resource Information
The following information is required in relation to any funding or commissioned resource by the Council
Special Education Provision
Outcome / Provision / How Often? / Cost
(£) / Funding source
Personal budget
Total / £
Health Provision
Outcome / Provision / How Often? / Cost
(£) / Funding source
Personal budget
Total / £
Social Care Provision
Outcome / Provision / How Often? / Cost
(£) / Funding source
Personal budget
Total / £
Other Funding including Transport
Outcome / Provision / How Often? / Cost
(£) / Funding source
Personal budget
Total / £
Provision might include:
  • Education:appropriate facilities and equipment, staffing arrangements and curriculum, appropriate modifications to the application of the National curriculum, where relevant.
  • Health:Specialist support and therapies, nursing support, specialist medical equipment, wheelchairs, continence supplies.
  • Care:assistance at home, in travelling, adaptations to the home, short breaks, provision of meals, specialist equipment.

Outcome of Carer Needs - Assessment if appropriate

Agreeing the Plan

Date the Plan was completed:

Date by when the Plan will be reviewed:

Person responsible for calling the review meeting:

My Personal Budget

Is a personal budget requested?Yes/No

Is a personal budget agreed?Yes/No

If yes, who is managing the budget (notional/direct payment)?

The personal budget allocation is

Description of outcome and provision / Weekly cost
£ / Annual cost
£
Education:
Outcome
Provision
Health:
Outcome
Provision
Social Care:
Outcome
Provision
Other:
Outcome
Provision
Total

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