Peterborough Access to Support Panel & Joint Agency Support Panel

Peterborough Access to Support Panel & Joint Agency Support Panel

Resource Application Form

Please see accompanying guidance notes before completing this form for the first time.

Date of request:
Has case been to panel before? / - Select -NoYesNot Sure
Section 1: Details of Children/Young Person[s]:
Name / D.O.B/E.D.D / Age / Gender / LL/UPN/NHS Number:
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
- Select -femalemaleunborn
Section 2: Further Information Relating to Primary Children/Young People Referred
Ethnicity: / - Select - White BritishWhite IrishTraveller - Irish HeritageGypsy or RomaAny other white backgroundAsian BritishAsian IndianAsian PakistaniAsian BangladeshiAny other Asian backgroundBlack BritishBlack CarribbeanBlack AfricanAny other Black backgroundMixed: White and Black CaribbeanMixed: White and Black AfricanMixed: White and AsianAny other mixed backgroundNot Known / Religion:
First Language: / Interpreter Needed? / - Select -NoYes - alwaysYes - for complex or sensitive issuesNot known
Any additional information:
Disability: / - Select -NoneYesNot KnownN/A / Details:
Special Educational Needs: / - Select -NoneSchool ActionSchool Action +StatementOtherNot KnownN/A / Details:
Any Additional Information:
Parents/Carers/other relevant adults address & telephone:
School/Early Years
Other Education/Training:
Section 3: Child Protection Information
Are any of the children above subject to a child protection plan? / - Select -NoYes
If yes, please provide details:
Have CP Plans been in place previously and if so, when?
Section 4: Child Looked After & Legal Status Information
Are any of the children above currently looked after? / - Select -NoYes - Section 20Yes - Section 31Yes - Section 38Yes - Police ProtectionOther [provide details below]
Further details:
Name of Reviewing Officer:
Date of Next Review:
Summary of Care Plan:
Have any of the children above been looked after previously? / - Select -NoYesNot known
If Yes, please provide details:
Are there any court proceedings currently in progress? / - Select -NoYesnot sure
If Yes, please provide details:
Section 5: Brief Case Summary – Please provide brief overview of assessed needs, risks and protective factors and the impact of previous interventions. Please note that copies of recent assessments and review reports/minutes should be submitted with this application and it is not necessary to duplicate information contained within these.

Section 6: Services and Resources Currently in Place
Care/School/Health Placement: / - Select -NoneIn-house fosteringIFA FosteringConnected Persons placementPlaced with parentsSupported LodgingsSemi-IndependentShort breaks/shared careIndependent day schoolChildren's Home [attends external school]Children's Home including educationPrivate Fostering38 week/termly boarding school52 week Boarding SchoolFostering and Independent day schoolFostering and Residential Boarding SchoolSecure Children's HomeYOI/Secure Training CentreHospitalPlaced for AdoptionAdopted child / Cost:
Further details if ‘Other’:
Transport Costs / Details of Transport:
Direct Payments? / - Select -NoYes / If Yes, number of hours:
On-going S17 payments? / - Select -NoYes / If Yes, how much per week/month and what for?
Direct Intervention Service? / - Select -NoYes / If Yes, for how long?
High Level Family Support? / - Select -NoYes / If Yes, for how long?
Details of any other relevant family support services in place:

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Aims and Objectives of Family Support Work, and Impact to date:

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Details of relevant additional School/Educational support in place, including Learning Support Assistant Hours:

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Aims and Objectives of additional School/Educational Support, and Impact to date:

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Details of any relevant specialist health provision or additional health support:

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Aims and objectives of specialist health provision or additional health support and impact to date:

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Section 7: Resource Requests to Panel
Request 1: / - Select -New or changed Family Support PackageContinuation of existing family support packageFamily Group ConferenceIssue Care ProceedingsNEW care placement [i.e. not currently LAC]Continuation of care placement detailed aboveCHANGE of care placement detailed aboveAdditional Support to maintain a care placementAdditional support in SchoolNEW Independent School PlacementContinuation of Independent School Place as aboveCHANGE of Independent School PlaceSection 17 FundingNew or Changed Direct Payments RequestContinuation of Direct Payments packageNew or changed Short Breaks PackageContinuation Existing Short Breaks PackageNew or changed support for child or young personContinuation of support to child or young personSpecialist Assessment/sExceptional SGO/Adoption support packageContinuation of Placement post 18Other request / Estimated Cost:
Further details and brief reason for request and expected outcome for the child/young person and/or their family:

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Request 2: / - Select -New or changed Family Support PackageContinuation of existing family support packageFamily Group ConferenceIssue Care ProceedingsNEW care placement [i.e. not currently LAC]Continuation of care placement detailed aboveCHANGE of care placement detailed aboveAdditional Support to maintain a care placementAdditional support in SchoolNEW Independent School PlacementContinuation of Independent School Place as aboveCHANGE of Independent School PlaceSection 17 FundingNew or Changed Direct Payments RequestContinuation of Direct Payments packageNew or changed Short Breaks PackageContinuation Existing Short Breaks PackageNew or changed support for child or young personContinuation of support to child or young personSpecialist Assessment/sExceptional SGO/Adoption support packageContinuation of Placement post 18Other request / Estimated Cost:
Further details and brief reason for request and expected outcome for the child/young person and/or their family:

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Request 3: / - Select -New or changed Family Support PackageContinuation of existing family support packageFamily Group ConferenceIssue Care ProceedingsNEW care placement [i.e. not currently LAC]Continuation of care placement detailed aboveCHANGE of care placement detailed aboveAdditional Support to maintain a care placementAdditional support in SchoolNEW Independent School PlacementContinuation of Independent School Place as aboveCHANGE of Independent School PlaceSection 17 FundingNew or Changed Direct Payments RequestContinuation of Direct Payments packageNew or changed Short Breaks PackageContinuation Existing Short Breaks PackageNew or changed support for child or young personContinuation of support to child or young personSpecialist Assessment/sExceptional SGO/Adoption support packageContinuation of Placement post 18Other request / Estimated Cost:
Further details and brief reason for request and expected outcome for the child/young person and/or their family:

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Request 4: / - Select -New or changed Family Support PackageContinuation of existing family support packageFamily Group ConferenceIssue Care ProceedingsNEW care placement [i.e. not currently LAC]Continuation of care placement detailed aboveCHANGE of care placement detailed aboveAdditional Support to maintain a care placementAdditional support in SchoolNEW Independent School PlacementContinuation of Independent School Place as aboveCHANGE of Independent School PlaceSection 17 FundingNew or Changed Direct Payments RequestContinuation of Direct Payments packageNew or changed Short Breaks PackageContinuation Existing Short Breaks PackageNew or changed support for child or young personContinuation of support to child or young personSpecialist Assessment/sExceptional SGO/Adoption support packageContinuation of Placement post 18Other request / Estimated Cost:
Further details and brief reason for request and expected outcome for the child/young person and/or their family:

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Other Requests: / Estimated Cost:
Further details and brief reason for request and expected outcome for the child/young person and/or their family:

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Please detail below relevant views of the child/young person and or their family about the resources requested:

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Section 8: Key Practitioner Details
This form completed by [Name]: / Your Role:
Your Team/School etc: / Telephone:
Your email address [if not PCC]:
Your Manager’s Name:
Details of other key agencies involved including health, CAMH, School, Children’s Social Care, Special Educational Needs services and voluntary agencies. Please include the names of key practitioners:

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Section 9: QA and Approval
Social workers must obtain approval from their team manager and service manager before submitting this form. Please use this section to confirm that approval has been obtained.
Content approved by Team Manager? / Yes / No
Content approved by Head of Service? / Yes / No
Management Comments:
Section 10: Supporting Documentation
Please ensure that you submit a copy of all of the following where relevant along with this application:

Most recent Initial or Core Assessment, CAF or Statement of Special Educational Needs;
Child Protection Report and Plan;
Child in Need/Care and/or Pathway Plan and most recent review minutes;
Minutes of annual review of Statement;
Where a young person is in a residential care or education placement and the request is for continuation of the placement, a report from the placement provider detailing how they are delivering positive outcomes for the child/young person MUST be submitted with this application.

FORM SUBMISSION: The completed form must be submitted to the PASP inbox [ by the close of play on the WEDNESDAY before the panel date: Remember that your team manager and head of service need sufficient time prior to this to authorise the request.

Where a request is urgent, this form can be submitted through your Head of Service for an out of panel decision by the Director of Commissioning or Head of Commissioning [Specialist Services].

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