Early Help Family Assessment Form

Early Help Family Assessment Form

Basic Demographics

Early Help Module (EHM) ID:
Name: / DOB/EDD / Gender / Address / Relationship in family (if parent, do they have PR?) / Is person subject of this assessment

Current Family and Home Circumstances (including other relationships)

Current Family and Home Situation (e.g. family structure including other significant family members and adults living outside the household and extended family members)

Reason for Assessment

Background to referral: including reason and context; presenting difficulties; families’ feelings about referral and referrers expectations (to be populated from initial referral and edited by lead professional.)
Which of the following concerns are relevant to this child/young person/family at the point of referral? / Are any of the following reasons for the referral?
domestic violence – current and/or previous?
a member of this family in prison?
Anti-social behaviour – current and/or previous?
Low school attendance?

Services Involved and Contributions to Assessment

Name / Role / Service/Agency / Contributed to assessment Y/N / Details of contributions/reports provided.

Family History

Please provide a brief description of the family history, including significant events and family relationships.

Parent/Carer Profiles

Parent or Carer Profile - 1

Parent/carer name
Health and wellbeing, including physical and mental health:
Parenting capacity:
Housing, employment and financial considerations:
Social and community support network and resources:
Other significant information including their aspirations:
Adults view of what is happening and any comments about this assessment.

Child/Young Person Profiles

Child Profile - 1

Child/young person name:
General health and wellbeing, including physical and mental health:
Physical, social and emotional development:
Identity, self-esteem,
self-image
and social presentation:
Participation in education, employment or training:
Family, social and community relationships/support network:
Other significant information including their aspirations:
Child/young person’s view of what is happening and any comments about this assessment.

Teen/Family/Work Star

Will be a separate section within the assessment.

Identified Risks

Have any specialist risk assessments been completed e.g., Barnardos? If yes, which ones and where are they stored?
Have risk assessments been shared with family?
Date shared with family?

Analysis

Summary of lead professional’s views on the findings of the assessment including:what the information gathered during the assessment means for the child/young person/family – includes sifting/weighting and making sense of information and deciding upon the level and type of intervention required:
Date submitted by lead professional:
Name of authorising manager:
Date of authorisation: