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Client Assessment/Monitoring (Young Father)

Name / Tel
Mob / Email
Address / Date of birth / NI number

Significant People / Other Members of Family

Name / Address / Age / Relationship / Telephone

Other professionals involved

Contact person / Agency / Address / Telephone

Fathering

Children
Name / M/F / DoBor
due date / Situation * / Mother’s name / Mother’s age / Child living
Withmother
/ other / Communication
with mother ** / Father
has PR***

* 1= dad-to-be; 2= birth dad living with; 3= birth dad living apart; 4=step dad; 5= 0ther (specify)

** 1= none at all; 2= some but v difficult; 3= with some difficulties; 4=good working relationship

*** 1=married to mum; 2=name on birth cert. after Dec 2003; 3=PR Agreement; 4=PR Order; 5=no PR

Fathering (cont)

Current fathering issues (mark those that are relevant)
1Non-resident father issues
.1 Contact, access .2 Legal info, advice, support .3 Relationship with child’s mum .4Relationship with “in-laws”
.5Child maintenance .6Social Services: support, advice .7 General support
2Parenting in general
.1 Help with children: (a) behaviour (b) health (c) education (d) c/care (e) other
.2Relationship with partner .3Social Services: support, advice .4 Parenting skills
.5 Benefits Information, advice .6 General support .7 Legal info, advice, support
3 Father-to-be issues
.1 Specific ante-natal info, advice .2 Explore thoughts, feelings about becoming father .3 Tell own parents
.4 Social Services: support, advice .5 General support .6 Benefits, Information, advice
.7 Other welfare advice, info .8Legal info, advice, support
.9Time off school/work for ante-natal/attend birth
Contact / parenting time (non-resident fathers)
Child’s name (complete separate entry for each child):
  • When, where and for how long was the last contact between father and this child?
  • Details of any legal reasons why contact should not take place or should be supervised? If supervised, who supervises – and where? How long has supervised contact been in place?
  • Perceived barriers to contact
  • Perceived contact-enablers

Client’s own view of current situation as a father

Partner, family, friends

Your current “home” family situation (mark as relevant):
.1 Living alone .2 Living alone with child .3 Living as couple without resident children .4 Living as couple with child(ren)
.5 Living with own parents/foster parents .6 Living with “in-laws” .7 Living with other adult(s)
.8 Carer .9 Other
Current partner
Tell us about your relationship with your girlfriend/wife (is this person the mother of your child/one of your children? How long have you been together? Do you live together? What are the strengths of this relationship? What challenges/difficulties are you experiencing as a couple? Is there ever physical violence between you? Do you ever feel afraid of your partner? Do you think she ever feels afraid of you?
Former / other partner where she is the mother(s) of (one of) your child(ren)
How long were you together? How well do you get on now? What improvements would you like to see in this relationship(s)?
Former / other partner where she is the mother of (one of) your child(ren):
How long were you together? How well do you get on now? What improvements would you like to see in this relationship?
Your own mother and father / important mother/father figures?
Describe the roles they play in helping or discouraging you from becoming the father you want to be. How did you experience their relationship with each other or with you, when you were younger? Have you lost any people who were important to you (even if you didn’t know them?) For example, did your father or mother die or move away? How would you describe your current relationships with your dad and mum, and any other important father/mother figures?
Your girlfriend’s/wife’s parents
Describe the roles they play in helping or discouraging you from becoming the father you want to be
Your mates
Describe the roles they play in helping or discouraging you from becoming the father you want to be. Are there gang membership issues?

Housing

Current housing situation (mark as relevant)
Homeless Friends/relatives LocalAuthtenant
Hous Ass tenant Foster care Residl/sheltred
Hostel Tied accom Institution
B & B hotel Licensee Owner occup
Roofless Traveller Unauthorised occupot Answered
Is client looking to move house? YES NO
Where to? (include size of house & who will be living there, area chosen and why)
Housing tenancy support
Making a Homeless application (has a homeless application been made or is one to be made? What documents are in place
- e.g. letter from parents?)
Attending interviews at the Housing Office
Applying for Community Care Grant or to Charitable Trusts
Sorting out income
Setting up utility bills
Accessing community resources / local services
Budgeting / Debts
Moving into new property
Decorating
Form filling
Reading / writing
Harassment
Other? Details:
Housing support from family and friends as well as people from agencies e.g. Connexions Adviser, Social Worker
Housing History – managing previous tenancies, periods of homelessness, reasons for moving

Money

INCOME
Current Income (per week or month)
Salary £
Income support £
Job Seekers Allowance £
Tax Credits £
Child Benefit £
Housing Benefit £
Care to Learn £
EMA £
Other £
______
TOTAL £
Additional benefits (including for partner if living together):
Healthy Start Vouchers YES NO
Maternity Grant YES NO
Community Care Grant YES NO
Other
Outgoings
Current outgoings (per week/month)
Debts £
Loans £
Fees (education etc.) £
Rent £
Services (heat, light, water, Council Tax) £
Child maintenance £
Transport £
General living £
Other
______
TOTAL £
If moving into a tenancy – financial plans for furnishing the property:
Anticipated income changes - e.g. when baby born
Referrals/additional support for money issues

Education / work / training

Current situation e.g. F/T, P/T education or employment, length of course
Your aspirations
Learning or other disabilities that might affect your educattion/employment
Caring responsibilities (including childcare) that night affect your education/employment
Difficulties with current employer/education or training provider
Employment history
Further information / referrals (e.g. to Connexions?) required /made

Health

Your own health
 Smoking – how many? ______
 Alcohol use – how much? ______
Substance use – which substances and how much? ______
______
 Medication ______
______
Diet – details ______
Diet - awareness ______
 Exercise – awareness ______
 Exercise – behaviour ______
Gambling – details / referral? ______
Your sexual health
Contraception (yes, no, what, when etc.)
Is more information on contraception required/being given?
STDs etc.
Is more information/referral on STDs required/being given?
Your own additional needs
.1 None .2 physical, moderate .3 physical, severe .4 visual impairment .5 hearing impairment
.6 speech impairment .7 learning disability .8 mental health* .9 long term sick
More details (e.g. adequate support for additional needs? Assessment required?)
* Anxiety and depression are very common among young fathers, but are rarely identified: referral for assessment may be useful. Please also identify and note strategies suggested to improve mood – e.g. medication, regular aerobic exercise etc.
Your child’s or child’s mothers’ health
List any health concerns relating to child(ren) or mother(s) of those children
Other household members: health/behaviour
List any serious health/behaviour concerns among other people with whom you live or who are very close to you (e.g. parents)
Contact/registration/experience with health professionals
Professional / Name / Tel / Address / Your experience of
GP
Specialist (for a particular
condition)
Mental health team
Maternity services (hospital)
Maternity services (midwife)
Health visitor
Optician
Dentist
Experience of maternity services
Service / Yes/No / Your experience of
Ante-natal classes
Scan
Birth
Post-natal support

Ethnicity

.1 whiteBritish .2 white Euro .3 other white .4 black British.5 black Euro .6 other black
.7 Asian British .8 Asian Euro .9 other Asian .10 mix race British .11 mix race Euro .12 other mix race
.13 Chinese .14 Japanese .15 traveller .16 other
Thank-you for your time.
This information will be used so that you and your adviser can make an Action Plan which will help to make sure that you get all the support and information that you need.
  • Confidentiality / Complaints leaflet given
  • Monitoring form completed
  • Consent form completed
Signed by Adviser:______
Signed by Client:______
Date:______

FOR ADVISER’S USE ONLY

Brief Summary of Initial Contact

Record of follow up contacts (include phone/text attempted contacts)

Date / by / Outcome

Targets, Action Plans

Target / By when (date) / Action

Other of our own services being accessed or required

How did he hear about our service/ referred by?