Surname(s) / First name(s)
Address (including postcode
Telephone number
Date of Birth / Gender / Ethnicity
Relationship to the child / Are you a carer* / If so, who for?
In employment/training?
GP details
Dentist details
Surname / First Name / D.O.B. / Ethnicity / Relationship to EHA subject
1
2
3
4
5
6
Details of other parent / carer if not living at this address
Name
Address
Other significant people connected to this family
who are important in providing a network of support: /
Name of Service / Worker name / Job Title / Contact Details / Family member being supported?
What could be better and why?
Think about what’s important to you and your family
This is where we record your worries & our worries.
Everyone deserves to be happy: what could be better? / What’s working well?
This is where you record the good stuff!
What makes you happy?
Think about what you’re good at; your successes.
Who makes up your support networks? / Score
1 - 10 / What needs to happen? The Plan.
What’s important for you and your family?
What would make you happy?
What are your goals?Actions needs to be set to help you and your family achieve them.
Home
Work
School/College
Social/Community
Health and Wellbeing
Please highlight what the next steps will be with the management of the case: / Single agency support: / Team Around the Family:
Signpost to other services: / EHA closed:
Refer into Early Help Hubs: / Other (please explain):

On a scale of 1-10, where ten is the best the situation could be, where do we rate each aspect? Use the key to score each area

CHANGE OF LEAD PROFESSIONAL

This section to be completed and returned to (stating change of Lead Professional in the subject line) when a new Lead professional is taking over as EHA Lead. It is important you complete and send this section to ensure we contact the correct lead professional for this case in future

Name of current LP / Agency / E-mail / Tel No
Name of new LP / Agency / E-mail / Tel No

EARLY HELP ASSESSMENT CLOSURE SECTION

Important – This section must be completed and returned to: (stating CLOSURE in the subject line) at the end of your intervention, when you are closing the EHA. Please send your completed EHA including copies of any review meetings and final outcome information.

We can then capture the good work you have done and highlight the issues affecting families in Manchester to help us tailor our interventions to better meet the needs of local children and families.

Date of closure: …………………..

EH OUTCOMES - REASONS FOR CLOSURE (Please Tick)

EHA support completed / Escalated to Children’s Services
Family moved out of area / Other (Please give details below)
Family disengaged (Please give details below)

EARLY HELP ASSESSMENT OVERALL SCORES

In this section we are asking you to give a score to show how you were feeling before EH support in the 5 areas and how you are feeling now on a scale of 1-10 where 10 is the best the situation could be and 1 being the worst

Family Self-assessment score / Before Early Help Support what did you score, how were you feeling in the five areas? (1-10) / How would you score how you are feeling in the 5 areas at the end of EH support? (1-10)
Home
Work
School / College
Social / Community
Health and Well Being
Adult / Child Comments
Practitioner comments