Form 4: Child/Young Person S Action Plan

Form 4: Child/Young Person’s PlanPlan No: Date of Meeting:

Child/Young Person’s Name
Date of Birth
CHI Number
Date Plan Updated

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Purpose:

Legal Status / Education Establishment
(if applicable) / Stage of Intervention (if applicable) / Co-ordinated Support Plan
Click to select Section 22 Children (Scotland) Act 1995 Section 25 Children (Scotland) Act 1995 Section 29 Children (Scotland) Act 1995 Section 56(4)(b) Children (Scotland) Act 1995 Section 57 Children (Scotland) Act 1995 Section 70(1) Children (Scotland) Act 1995 Section 70(3) Children (Scotland) Act 1995 S80 Permanence Order S83 Permanence Order with Authority to Adopt Section 11 (Residence Order) Place of Safety Warrant Section 70(9) Children (Scotland) Act 1995 Section 75 Children (Scotland) Act 1995 Other (please specify) None / Yes
No

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Summary of Strengths, Issues and Concerns:

Desired Outcomes / How will we know this has been achieved / Actions required / By whom / Frequency/ Timescale / Progress made to date

Contingency Plan:

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Are Compulsory Measures required? YesNo

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If yes, please state the reasons for the decision and the type of order sought:

Views of the child/young person regarding the proposed plan (include areas of disagreement):

Child/Young Person’s Signature

Views of the parents/carers regarding the proposed plan (include areas of disagreement):

Parent/Carer’s Signature

Name / Agency / Address / Telephone Number & Email
Lead Professional
Named Person

Plan completed by: Designation: Date:

Copy given to (please list):

Date next plan review due: Signed:

This section only to be completed for Child Protection

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Concern(s) Identified / Comments
Domestic Abuse / YesNo
Parental Alcohol Misuse / YesNo
Parental Drug Misuse / YesNo
Non-Engaging Family / YesNo
Parental Mental Health Problems / YesNo
Child Placing Themselves at Risk / YesNo
Sexual Abuse / YesNo
Child Exploitation / YesNo
Physical Abuse / YesNo
Emotional Abuse / YesNo
Neglect / YesNo
Other Concern(s) / YesNo

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This section only to be completed for Throughcare/Aftercare

Lifestyle
Family and Friends
Health and Wellbeing
Learning and Working
Accommodation
Income/Finance
Rights and Legal Issues

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