Knowsleyearlyhelpassessmentforchildren,Youngpeopleandfamilies

KnowsleyEarlyHelpAssessmentforChildren,YoungPeopleandFamilies

Section1
Dateassessmentstarted
Immediatefamilyinformation
Childrenand Young People
Name / Dateofbirth
(duedate) / GenderM/F / Ethnicity / Disability / Whohasparentalresponsibility
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
Parents/ Carersdetails
Name / Dateofbirth(duedate) / GenderM/F / Ethnicity / Disability / Whohasparentalresponsibility
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
MaleFemale / A1 - White BritishA2 - White IrishA3 - Any other white backgroundB1 - White and Black CaribbeanB2 - White and Black AfricanB3 - White and AsianB4 - Any other mixed backgroundC1 - IndianC2 - PakistaniC3 - BangladeshiC4 - Any other Asian backgroundD1 - CaribbeanD2 - AfricanD3 - Any other Black BackgroundE1 - Other Ethnic Group - ArabE2 - Any other Ethnic GroupE3 - Not stated/RefusedE4 - Undeclared/Not known
Primarylanguageinthefamily:
FamilyAddress(es):
Contacttelephonenumbers:
1.
2.
3.
4.
5.
Relevantinformationincludingimmediatefamilyand/orothersignificantadultsdetails:
Thosewhotookpartintheassessment-Includingfamily/widerfamily/professionals
EthnicityKey: WhiteBritish-WB;Caribbean–Ca;Indian–I;Whiteand Black Caribbean-WBC;Chinese–Ch;White Irish–WI; African–Af;Pakistani– Pa;WhiteandBlack African–WBA;Bangladeshi–Ba;WhiteandAsian-WA; Any other–pleasedescribe; Not given- NG
Practitionerdetails– Leadprofessioncompletingtheassessment
Name: / Job role andagency / Address / Contact details:
Telephone:
Mobile:
Email:
Name: / Job role andagency / Address / Contact details
Telephone:
Mobile:
Email:
Name: / Job role andagency / Address / Contact details
Telephone:
Mobile:
Email:
Whoelseis workingwith thefamily
PleaseincludeHealth,Educationandanyotheragenciescurrentlyinvolvedwiththefamily
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details
Agency / Main contact / Contact details

Additional services may include:School/College,GP,Dentist,HealthVisitor,Children’sCentre,Housingprovider,ChildDevelopmentTeam,Therapyservices,YouthOffendingService,Probation,Anti-SocialBehaviourUnit,KnowsleyWorks,JobCentrePlus,Youthservicesetc

Reasonforassessment
Section2
Child/YoungPerson’sName
Learning /Education /Employment – including attendance, aspirations / RAG
RedAmberGreen
PhysicalHealth / RAG
RedAmberGreen
Emotional and Mental Health / RAG
RedAmberGreen
Relationships –school,family, friends / RAG
RedAmberGreen
Crime &Anti-Social Behaviour / RAG
RedAmberGreen
Substance/Alcohol Misuse / RAG
RedAmberGreen
Use thespacebelowtonoteanythingelse you would like to include aboutyourchild(ren)?
How wouldyou describe yourchild’s /children’s strengths orthethings thattheydo well?
RAGRating Key: / R = RED–issues whichneedaddressingquickly; A= AMBER–issues youmay needhelpwith;G = GREEN–ositive/noissues
VoiceoftheChild / useappropriateageandabilityrelatedtoolstoensurethevoiceofthechild/youngpersoniscaptured
Whatareyourbiggest worries aboutyourfamily?
Whatthingsdoyourparentsor carers dowell?
Whatareyourhopesand wishes foryourself?
Whatareyourhopesand wishes foryourfamily?
Whatwould you like to changethemost?
Whatdo youfeel you can doto helpmake somepositive changes?
How will you knowthings have changedfor thebetter?
Section3
Parent/AdultName
Housing / LivingConditions / RAG
RedAmberGreen
PhysicalHealth / RAG
RedAmberGreen
Emotional and Mental Health / RAG
RedAmberGreen
Relationships –including domestic abuse / RAG
RedAmberGreen
ParentingSkills / RAG
RedAmberGreen
Employment / Training / Learning / RAG
RedAmberGreen
Crime &Anti-Social Behaviour / RAG
RedAmberGreen
Substance/Alcohol Misuse / RAG
RedAmberGreen
Finance /Debtissues / RAG
RedAmberGreen
RAGRating Key: / R = RED–issues whichneedaddressingquickly; A= AMBER–issues youmay needhelpwith;G = GREEN–positive / noissues
Parent/AdultVoice
Whatareyourbiggest worries aboutyourfamily?
Whatareyourhopesandgoalsforyourfamily?
Whathas worked well foryou as afamily in the past?
Whathas notworked well foryou asafamily in thepast?
Whatthingsas afamilywould you like tochangethemost?
What do youfeelyou can doasa parent/carer tohelp make some positive changes?
Whoelsecan support your familytomakesomechanges?
How will you knowthings have changedfor thebetter?
Section4
SummaryandAnalysis
Are thereanydangersor risks toyou and/oryourchild(ren)you needto dealwith? Ifsohowcan we help?
Summarise themost importantchangesfor yourfamily–whatneeds togo in yourfamilyplan?
Practitioner’sanalysis and conclusion
Section5
OurFamilyPlan
Howcan changehappen– whataction needstobe taken? / Who / When
Agreementto shareinformation
Iunderstandthat the information Igive will be used toget theservicesto help me andmyfamily.
Iunderstandthat theinformation I have providedmaybe sharedonlywhereit is necessaryandthelawallows it.Theinformationmaybe sharedwith other teamsandservices.
Theteamsandservicesthatwillhavemyfamily’sinformationwillbetheteamswhowillbehelpingandsupportingus.Theywillbenamed inmy/our assessmentandsupportplan.
Iunderstandthatundernocircumstanceswillyousharemy/ourpersonalinformationwiththirdpartiesfor commercial purposes.
Iunderstandthatinformation thatI give iskept safe andsecureandtreatedconfidentially.
Iunderstandthat my information will only be shared without mypermission to protect children orvulnerable adultsfromharm;or to aid theprevention anddetection ofcrime.
Below is the informationIwould notwantto be shared with any otherservice or team(unlessthelawallows or requires it)
Name: / Signature: / Date:
Name: / Signature: / Date: