GIRFEC in Shetland: Assessment and Analysis Form (V4.5)

Named Person: / Job Title: / Contact Details:
Lead Professional: / Job Title: / Contact Details:
Start date of Assessment: / Click here to enter a date. / Date initial Assessment Completed: / Click here to enter a date. / Date of most recent review: / Click here to enter a date. /
Unique identifiers:
Name: / CHI: / SWIFT: / SEEMIS:
(NOTE: Enter child’s name in footer.)
Other names used: / Known as (if different):
Date of Birth: / Click here to enter a date. / Gender:
Address: / Whose address is this?
Phone/email: / Expected DoB: / Click here to enter a date. /
Ethnic Group: / Nationality:
What is the child’s preferred method of communication / language? / What arrangements are required? e.g. interpreter / advocate
Name and Address of School: / School Attendance:
Family Details (see Genogram tool if required)
Name / DoB / Relationship to child/young person / Parental responsibilities / rights (Y/N) / Residing at same address as child (Y). If no, provide address, including contact number
Click here to enter a date. /
Click here to enter a date. /
Click here to enter a date. /
Click here to enter a date. /
ASSESSMENT
Requested by: / Date completed: / Click here to enter a date. /
Reason for assessment:
Child/Young Person’s family background and history:
Child/Young Person’s unique profile (including development):
Current situation (for C/YP and family):
Assessment: (using National Practice Model and/or other Tools in Guidance - NB analysis is recorded in the Analysis section)
What are the views of those who have participated in the Assessment?
Child /Young Person’s view of current strengths and pressures:
Parents’/Carers’ view of current strengths and pressures:
ANALYSIS
Analysis: (of all the information you have available and what it is that needs addressed)
CONCLUSIONS & RECOMMENDATIONS
Views of child/young person and any other appropriate person (please record name and relationship to child young/person)
Name / View / Action taken in relation to view
And outcome

NOTE: Delete following sectionsif not relevant to the child or young person.

COMPULSORY MEASURES
Complete when: / *The Reporter has requested a report
*There is a referral to the Reporter
*There is a Children’s Hearing
Is there a recommendation that compulsory measures are required? Yes ☐ No☐
Why is the recommendation made?
Why is the Action Plan insufficient on a voluntary basis?
If compulsory measures are agreed, what specific conditions would support the Action Plan?
Why are these specific conditions recommended?
RISK SUMMARY / Date of Risk Summary: / Click here to enter a date. /
Risk Assessment Tools Used
What is the information telling me? (risk indicators for):
Insert Child’s Name:
Parent/Carer:
Family:
Wider World
What is the information telling me about the level of need/concern/risk?
LAC INFORMATION
Looked After or Accommodated Episodes:
Establishment / Address / Date From / Date To / Other details/reason
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Who should/should not have contact:
Name / Relationship / Should NOT / Date From / Other details/reason
☐ / Click here to enter a date. /
☐ / Click here to enter a date. /
☐ / Click here to enter a date. /
Health:
Health issue (including allergies) / Medication / Date From / Date To / Other details/reason
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Health Assessments:
Outstanding Appointments / With / Location / Date / Notes
Click here to enter a date. /
Click here to enter a date. /
Click here to enter a date. /
Diary of weekly events/activities (Child/Young Person’s Routine):
Event / Activity / With / Location / Day/Dates / Notes (e.g. transport)
RAS INFORMATION
For schools to complete using the support menu in section 5.2 5b4 of the Managing Inclusion Guidelines
Need / Low / Medium / High
  1. Personal Support

  1. Supervision

  1. Tuition

  1. Curriculum

  1. Transition

This assessment of resources is agreed by (tick all those that apply)
Head Teacher ☐ ASN Teacher ☐ASN Principal Teacher ☐
Other
Is this pupil LAC? Yes ☐ No☐
If yes, please enter last LAC Review date:
Is this person assessed disabled?Yes ☐ No☐ Or declared disabled?Yes ☐ No☐
By ☐Carers ☐Parents ☐Young Person
If assessed or declared disabled, will they require support as an adult? Yes ☐ No ☐N/A ☐
If they will require support as an adult, check all those that apply:
Support for independent living ☐Housing ☐ Life skills ☐Day care ☐ College ☐
Other:
Will they require transition planning? Yes ☐ No☐ If so, please give the date of the next transition:
Into pre-school provision / Click here to enter a date. / Returning to school following extended absence / Click here to enter a date. /
Nursery to P1 / Click here to enter a date. / Moving between schools / Click here to enter a date. /
P7 to S1 / Click here to enter a date. / Transition within a school / Click here to enter a date. /
Secondary to post-school provision / Click here to enter a date. / Transition as a result of school closure or new construction / Click here to enter a date. /
Returning to school following exclusion / Click here to enter a date. /
Other:
CHILD PROTECTION INFORMATION
Is the child currently on the Child Protection Register? Yes ☐ No☐
Registration Details
Start Date / End Date / Outcome of Registration
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Click here to enter a date. / Click here to enter a date. /
Is the Scottish Children's Reporter Administration involved? Yes ☐ No☐
Is the Child/Young Person Looked After? Yes ☐ No☐
Legal status(must record 'None' if there is no status) / Other (specify)
Previous legal status / Other (specify)
SIGNATURES (ON COMPLETION OF ASSESSMENT)
Name / Signature / location of signature on electric version / Date
Child / Young Person / Click here to enter a date. /
Parent / Carer / Click here to enter a date. /
Parent / Carer / Click here to enter a date. /
Lead Professional / Click here to enter a date. /

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