Identifying Details

Early Help

Completion of an Early Help Assessment is part of a continuing process to assess and meet the needs of children and young people. It is not a one-off application form for additional support. It is a record of a continuing process. In some cases where the need is a Special Educational Need and or Disability (SEND), the assessment and review may lead to a request for assessment for an Education, Health and Care Plan but equally may meet the needs of children and young people on its own. All Early Help materials can be found at

Date assessment started / Date
registered / Date coordinator changed / Date
Closed

Notes for use: If you are completing this form electronically, text boxes will expand to fit your text. Where there are tick boxes, please insert anX where applicable.

N.B In completing this assessment it will be useful to refer to and use tools that can support you decide what needs to happen. There is a range of tools on the Cumbria LSCB website such as: Early Help Supporting Documents, Services to Support Families, the Salford Graded Care Profile, Risk and Resilience Matrix and the CSE Risk Assessment

Identifying details

Details of Child/ren and all significant family members (e.g. siblings, unborn, parent/carers, grandparents etc.) include DOB of all family members including parents; their relationship to the child/yp, address and phone number:

If this is a SEND Assessment, please ensure that you highlight the child that this assessment is for.

Full name
(Enter all children first) / DOB
EDD2
ESSENTIAL / Sex / Family member?
e.g. mother, father, child / Ethnic origin / Nursery/
School/
College
(if applicable) / Is this child part of the assessment?
Y or N / Parental responsibility
Y/N / Address
Telephone number
(if different)
CHILD / n/a

Current family, home situation/support network

Tell us who is in the family network? E.g. family structure including siblings, other significant adults such as grandparents, neighbours and friends; tell us who lives with the child/young person or who does not live with the child or young person, but provides support to the family.

Are there any family members currently in prison? Yes☐No ☐If yes please, list below

Additional Information - Services supporting this child/ren or young person and familyAgencies involved: (GP, midwife, nursery, school, access and inclusion officer, youth provision, other)

Name / Agency / Role / Contact Details / Took part in assessment
(y/n) / Date Started / Date ended

Doesthe child/ren have an identified Special Educational Need or Disability? Yes ☐ No ☐If yes, please give further detail

Details of person(s) undertaking assessment:

Name: / Contact tel. no:
Address: / Postcode:
Role: / Organisation:
Email:

What has led to this assessment being undertaken?

Attendance at educational setting / ☐ / Domestic abuse / ☐ / Not in education, employment or training(parent or carer) / ☐ /
Behaviour at home/community / ☐ / Drug/alcohol issues (parent/carer) / ☐ / Parenting / ☐ /
Behaviour at school / ☐ / Drug/alcohol issues (young person) / ☐ / Parental disability / ☐ /
Child’s development/ learning / ☐ / Exclusion from educational setting / ☐ / Relationship difficulties at home / ☐ /
Child sexual exploitation (CSE) / ☐ / Housing/ financial issues / ☐ / Relationship difficulties at school / ☐ /
Child/YP disability / ☐ / Low level/ emerging neglect / ☐ / Risk taking behaviour / ☐ /
Concerns regarding emotional wellbeing (child/young person) / ☐ / Mental health (parent/carer) / ☐ / Teenage pregnancy / ☐ /
Crime, anti-social behaviour (child/young person) / ☐ / Not in education, employment or training (child/young person) / ☐ / SEND / ☐ /
Crime, anti-social behaviour (parents/carers) / ☐ / Other (please specify)