· web viewthis early assessment is available to families who are residents of plymouth. please...

Version 1.1 January 2017

POD Plymouth Online Directory Early Help Postcode check *required

This early assessment is available to families who are residents of Plymouth. Please enter the family’s postcode to validate they are within the Plymouth City boundary.*Please enter a full postcode:Click here to enter text.

Safeguarding


POD Plymouth Online Directory Early Help *required*Is the child experiencing or at risk of significant harm?: ☐Yes ☐NoIf you have determined that a child or young person is at risk of, or is being harmed, abused or suffering neglect contact the Multi-Agency hub on 01752 305200 or email [email protected] In an emergency, please dial 999.

Consent for information sharing*required

mailto:[email protected]


POD Plymouth Online Directory Early Help In most circumstances the child or young person (if they are of an appropriate age and undertaking) or their parent of carer SHOULD BE PROVIDED WITH A COPY OF THIS ASSESSMENT FORM. Parents/Carers, children and young people must give their explicit consent for information to be shared with other agencies in order to support need and offer additional help.

The only exception to this is where you have child protection concerns and consent has been denied or seeking consent may jeopardise the welfare of the child or young person. If you are unsure about whether or not to seek consent for information sharing, please contact Gateway on 01752 668000 or email


POD Plymouth Online Directory Early Help [email protected]

I give my consent for Plymouth City Council, to request and share information regarding my family with internal and external agencies. I understand that this may include information to share where there are Safeguarding concerns or where there is a need to engage another agency to provide support for my family. I also understand that the information I share may be used for statistical and research purposes.*Information consent:☐Written ☐Verbal

mailto:[email protected]


POD Plymouth Online Directory Early Help


POD Plymouth Online Directory Early Help Person completing this form*required

*TitleChoose an item.

*RoleClick here to enter text.

*Organisation type

*Forename(s)Click here to enter text.

*SurnameClick here to enter text.

Organisation name


POD Plymouth Online Directory Early Help Choose an item.

*Tel contact numberClick here to enter text.

Click here to enter text.

*EmailClick here to enter text.

Assessment information*required


POD Plymouth Online Directory Early Help *Interpreter required ☐Yes ☐No If Yes please choose from below:

LanguageChoose an item.

Details of key person concern*required


POD Plymouth Online Directory Early Help *Forename(s)Click here to enter text.

*Date of birthClick here to enter a date.

*GenderChoose an item.

Male*SurnameClick here to enter text.

*EthnicityChoose an item.Choose an item.


POD Plymouth Online Directory Early Help Family address*required

*House/flat numberClick here to enter text.

*PostcodeClick here to enter text.

First line of addressClick here to enter text.Family details

*required



*RelationshipChoose an item.Choose an item.EthnicityChoose an item.

*At this address



Please enter details of the parent(s) or significant adult(s) with parental responsibilities as the first family member, followed by additional children involved in


POD Plymouth Online Directory Early Help ☐Yes ☐No the assessment.Please go to Appendix A to add details of any additional family members that are relevant to this assessment.

Who is already working with the family?AgencyChoose an item.

Family member

Agency contact nameClick here to enter text.

Contact number


POD Plymouth Online Directory Early Help Click here to enter text.

Support providedClick here to enter text.

Click here to enter text.

Present at assessment☐Yes ☐NoPlease go to Appendix B to add details of any additional Agencies that are already working with the family.

Reason for assessment


POD Plymouth Online Directory Early Help *required*Reason for assessment for key person of concernPlease give a brief overview of concerns. More detailed information will be requested in the next step of the assessment.Click here to enter text.

*Is the key person of concern already known to, or receiving support from, Plymouth City Council’s Special Educational Needs and Disabilities Service (SEND)?


POD Plymouth Online Directory Early Help ☐Yes ☐No*Is there a Team Around Me (TAM) for this child/young person/Family☐Yes ☐No ☐Unknown*Is the key person of concern a young carer (or have caring responsibilities)Definition of young carer. A young carer is someone aged up to 18 who provides unpaid care for a family member who has a long term physical health problem or disability, or a drug or alcohol dependency.☐Yes ☐No


POD Plymouth Online Directory Early Help What has already been tried/achieved with the family?DescriptionClick here to enter text.

OutcomeClick here to enter text.

Please go to Appendix C to add details of any additional support / interventions that are relevant to this assessment.


POD Plymouth Online Directory Early Help Children / Young person’s education


POD Plymouth Online Directory Early Help Level of needChoose an item.

For further information and guidance regarding the levels of need, please refer to the Plymouth Assessment Framework. A copy of which can be located at www.plymouth.gov.uk/documentlibrary/plymouthassessmentframework

ConcernsPlease select all the relevant concerns☐Not making expected progress in school ☐Poor or non-school attendance ☐Transition

http://www.plymouth.gov.uk/documentlibrary/plymouthassessmentframework


POD Plymouth Online Directory Early Help Child safety



ConcernsPlease select all the relevant concerns☐Child neglect ☐Parenting capacity or concerns ☐Lack of supervision or boundaries☐Child missing ☐Previous child protection / Child in need ☐Physical abuse☐Honour based issues / Forced marriage ☐Female Genital Mutilation ☐Other

Wider family concerns


POD Plymouth Online Directory Early Help Domestic abuse



ConcernsPlease select all the relevant concerns☐Incidences of domestic abuse in the past 6 months ☐Exposure to domestic abuse☐Historical domestic abuse ☐Other

Wider family concernsChoose an item.Choose an item.


POD Plymouth Online Directory Early Help Physical health



ConcernsPlease select all the relevant concerns☐Poor hygiene or presentation ☐Lack of access to health care ☐Poor diet or healthy lifestyle☐Sexual health concerns ☐Illness or injury ☐Problematic dental health☐Visual impairment ☐Teenage pregnancy ☐Other

Wider family concerns


POD Plymouth Online Directory Early Help Mental health



ConcernsPlease select all the relevant concerns☐Stress, anxiety or low self-esteem ☐Behavioural problems ☐Social isolation☐Self-harm ☐Other ☐Bereavement ☐Bullying ☐Eating and/or sleep disorder ☐Other

Wider family concernsChoose an item.


POD Plymouth Online Directory Early Help Substance misuse



ConcernsPlease select all the relevant concerns☐Drugs and / or alcohol misuse ☐Use of psycho-active substances ☐Solvent abuse ☐Other



POD Plymouth Online Directory Early Help SEN and disability



ConcernsPlease select all the relevant concerns☐Communications and interaction ☐Cognition and learning☐Social, emotional and mental health difficulties ☐Sensory and / or physical needs ☐Other



POD Plymouth Online Directory Early Help Anti-social behaviour



ConcernsPlease select all the relevant concerns☐Disregard for community and personal wellbeing ☐Mistreatment of others☐Environmental damage ☐Misuse of public places ☐Other



POD Plymouth Online Directory Early Help Offending



ConcernsPlease select all the relevant concerns☐Involvement in youth crime ☐Exposure to criminal behaviour☐Involvement in adult crime ☐Other



POD Plymouth Online Directory Early Help Early years



ConcernsPlease select all the relevant concerns☐Communication and language ☐Physical development☐Personal, social and emotional development ☐Literacy ☐Maths☐Understanding of the world ☐Expressive arts and design ☐Other



POD Plymouth Online Directory Early Help Housing



ConcernsPlease select all the relevant concerns☐Overcrowding ☐Unsuitable housing ☐Condition of home ☐Homeless or risk of ☐Other



POD Plymouth Online Directory Early Help Debt



ConcernsPlease select all the relevant concerns☐Low income / free school meals ☐Debt problems ☐Rent mortgage arrears☐Discrimination and social exclusion ☐Other



POD Plymouth Online Directory Early Help Young person / Adult employment, training, education



ConcernsPlease select all the relevant concerns☐Low income ☐Current job at risk ☐Free school meals☐NEET (Not in Education, Employment or Training) ☐ Adult currently not in employment of training ☐Other



POD Plymouth Online Directory Early Help Desired outcomes for: *required

Child/young personClick here to enter text.


POD Plymouth Online Directory Early Help FamilyClick here to enter text.

Lead professionalClick here to enter text.


POD Plymouth Online Directory Early Help Next steps

*required*Are you completing an outcome based support plan as part of/following this assessment?☐Yes ☐NoIf Yes -this should be completed within 2 to

Planned start date Click here to enter a date.

Date of review meeting Click here to enter a date.


POD Plymouth Online Directory Early Help 4 weeks of this plan.

If you are not completing one please state why?Click here to enter text.

Is this family engaged in a family group conference? ☐Yes ☐No

Would this family benefit from a family group conference? ☐Yes ☐No

Assessment consent


POD Plymouth Online Directory Early Help *required*Has the assessment been agreed by the child/young person/parent/carer? ☐Yes ☐No


POD Plymouth Online Directory Early Help APPENDIX AFAMILY DETAILS CONTINUED

Family details 1*required




*At this address





POD Plymouth Online Directory Early Help ☐Yes ☐No the assessment.





*At this address





POD Plymouth Online Directory Early Help Family details 3*required





Please enter details of the parent(s) or


POD Plymouth Online Directory Early Help *At this address☐Yes ☐No

significant adult(s) with parental responsibilities as the first family member, followed by additional children involved in the assessment.





*At this address





POD Plymouth Online Directory Early Help Family details 5*required


*RelationshipChoose an item.Choose an item.Ethnicity



Please enter details of the parent(s) or


POD Plymouth Online Directory Early Help *At this address☐Yes ☐No

significant adult(s) with parental responsibilities as the first family member, followed by additional children involved in the assessment.





*At this address





POD Plymouth Online Directory Early Help APPENDIX BWHO IS ALREADY WORKING WITH THE FAMILY? CONTINUED

Who is already working with the family? 1


POD Plymouth Online Directory Early Help AgencyChoose an item.

Family memberClick here to enter text.



Contact numberClick here to enter text.

Present at assessment☐Yes ☐No


POD Plymouth Online Directory Early Help APPENDIX CWHAT HAS ALREADY BEEN TRIED/ACHIEVED WITH THE FAMILY? CONTINUED

What has already been tried/achieved with the family? 1DescriptionClick here to enter text.

Outcome


POD Plymouth Online Directory Early Help What has already been tried/achieved with the family? 2DescriptionClick here to enter text.



POD Plymouth Online Directory Early Help What has already been tried/achieved with the family? 3DescriptionClick here to enter text.




What has already been tried/achieved with the family? 4Description

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