If Possible, Please Complete This Form Electronically; the Text Boxes Will Expand to Fit

Review May 2014 GWPage 1 of 6

CAF Review Form
Before undertaking a CAF Review, contact to check what CAF records exist. If you have urgent safeguarding concerns, first discuss them with the Multi-Agency Safeguarding Hub
Team (MASH) Tel: 020 8649 0418/0419/0420 / Common Assessment Framework for children and young people
/

If possible, please complete this form electronically; the text boxes will expand to fit your text

Identifying Details (Details of unborn baby, infant, child or young person being assessed. If unborn, state name as ‘unborn baby’ and mother’s name, e.g. unborn baby of Ann Smith. The term ‘child’ is used throughout this form to include infant, child and young person).

First Name

Family Name

AKA1 /previous Name

Male (M)

Female (F) Unknown (U) /

Date of Birth (or expected date of delivery)

Unique Reference Number

Date CAF Review started / completed

Address / Date of CAF or last CAF Review
Postcode /

Contact Telephone/s

Has a Team Around The Child (TAC) / Child & Family Support (CFS) Meeting been held?

Does the child have a disability?

Yes

No

If yes, please

give details

Details of special requirements

(for child or parent)

Ethnicity

White British

White Irish

Traveller of Irish Heritage

Gypsy Roma

/ Any Other White Background
Black Caribbean /

Black African

Any other Black Background *

White & Black Caribbean

/ White & Black African

Indian

Pakistani

Bangladeshi

Chinese

/ Any Other Asian Background *

Any other Mixed Background *

Any other Ethnic Background

Refused to specify

*If other, please specify

Exceptional circumstances: significant harm to infant, child or young person

If at any time during the course of this assessment you feel that an infant, child or young person has been harmed or abused or is at risk of harm or abuse, you must follow your Local Safeguarding Children Board (LSCB) procedures as set out in the booklet What To Do If You Are Worried A Child Is Being Abused (2006):

If this CAF Review is being used to support a referral to Children’s Social Care in Sutton, it should be accompanied by the MASH Interagency Form and emailed (or sent by fax) to: Sutton MASH, 1st Floor Sutton Police Station, 6 Carshalton Road, Sutton, Surrey SM1 4RF. Tel: 020 8649 0418/0419/0420 Fax: 020 8649 0416

Secure email:

Out of hours Emergency Social Care Duty: (5pm – 9 am weekdays and all day weekends and public holidays):

Tel: 020 8770 5000 email: Fax: 020 8770 5900

1 AKA = Also Known As

Copy this form securely to child and family and all agencies involved, and email it to:

Details of Parents and/or Carers

Name / Address (if different to above)
Relationship to child / Contact Telephone (if different from above)/email (if known)
Name / Address (if different to above)
Relationship to child / Contact Telephone (if different from above)/email (if known)

Details of other family or household members, and significant people

First Name / Family Name / Date of Birth / Relationship to child / young person / Address (if different)

Details of Lead Professional

First Name / Family Name / Role / Organisation
Address / Telephone / Email address

Details of new Lead Professional (where this has changed)

First Name / Family Name / Role / Organisation
Address / Telephone / Email address

Services currently working with this child (including name of school or college and GP)

Service / Name of Contact / Address / Telephone / Email address
School
GP

Previous Situation (Please briefly summarise the situation when the CAF or last CAF Review was undertaken. What were the key issues?)

Current Situation (Please describe what has changed and what the situation is now. What new needs have been identified and/or what progress has been made?)

Review of the Previous Action Plan (Have the actions of the previous action plan changed, and if so why?)

What is your analysis of this child’s current needs and situation?

New Action Plan(in order of priority list the actions agreed as a result of this Review)

Desired Change (as agreed with child and/or family) / Action / Who will do this? / By When?
Can this CAF now be closed? / If not, when is the next agreed CAF Review Date?

Level of Need/Concern within the London Continuum of Need: (Stage 3 would indicate statutory Child in Need support; Stage 4 applies to children at the highest level of need, which is above the threshold for Common Assessment Framework)

Stage 1 / Stage 2 / Stage 3 / (Stage 4)

Child or young person’s comment on the assessment and actions identified(please note any comments on whether the child or young person feels they have made progress in particular areas – you can give their scores on the CAF Impact Tool on the next page as well as your own)

Parent or carer’s comment on the assessment and actions identified(please note any comments on whether the parent or carer feels progress has been made in particular areas – you can give their scores on the CAF Impact Tool on the next page as well as your own)

Consent for information storage and information and sharing

(please state if there are new restrictions about which services information can be shared with)

You are asked to consent to personal information about you / your child being shared with other agencies when it is appropriate to do so. Most agencies involved in providing services are required by law to co-operate to improve the well-being of children and young people, but require your consent to help do so.

Information already held or collected during an assessment and the provision of a service may be shared with others directly involved in caring for you/your child. This information may include details about your/your child’s health, welfare and development, home or family circumstances.

The purpose of sharing information is to enable suitable services to be provided through a better understanding of strengths and needs. It will also avoid you having to repeat the same information to several people or agencies.

** In some circumstances, information can be shared between agencies without consent, for example where sharing information might prevent a crime or safeguard the welfare of child or young person. Even in these circumstances, it is normal practice to obtain consent where possible.

If you have any concerns about particular information being shared with particular agencies, you should first discuss this with the Lead Professional or the professional who has completed the CAF.

A register of completed CAFs is held by the London Borough of Sutton. This holds only basic details of the child / young persona and their family, assessment and review dates and details of the professional involved. Assessment content will only be shred under the conditions described above.

I understand the information that is recorded on this form and that it will be stored and used for the purpose of providing services to:

Me
The infant, child or young person for whom I am a parent or carer

I have had the reasons for information sharing explained to me and I understand those reasons

I give my consent to the sharing of information as detailed above

**The signed copy of the CAF Review should be kept by the assessor who should state in this box that they hold a signed

copy on file. The signed copy should not be sent to the CAF office

Signature ** / Parent or Carer’s Name / Child/Young Person’s Name / Date

I specifically do not want the following information to be shared with the following agency/agencies

(please state if there are new restrictions to which services information can be shared with)

Assessor’s Name / Assessor’s Signature / Date

Please ensure you complete the CAF Impact Tool which is on the last page of this CAF Review Form

Common Assessment Framework (CAF) Impact Tool

1. ThisCAFImpact Tool will help you know when children, young people and families who you are supporting are experiencing improvements in their identified needs. It is aimed at ensuring that the right interventions are being provided and it will also allow you to demonstrate the impact on outcomes for children and young people. Guidance on how to score levels of need is given on If necessary, you can contact the CAF Co-ordinator: (020 8649 0413) for advice or guidance.

2.Please use this tool: a) at the time of the CAF assessment, and
b) at subsequent CAF Review or Team Around the Child (TAC/CFSM) meetings to record

progress since the CAF or last CAF Review was undertaken

3. Please submit this form with your CAF/CAF Review to CAF:

Child’s/Young person’s name:
FWI ID (if known):
Age when this IT completed (yrs + months): / Practitioner’s name:
Service:

Level on London Continuum of Need

(Stage 4 is not applicable to the CAF)

CAF CAF Review / Level
1 / Level
2 / Level
3
1. Development of the infant, child or young person
Health
General health
Physical development
Speech, language and communication
Emotional and social development
Behavioural development
Identity, self-esteem, self-image and social presentation
Family and social relationships
Self-care skills and independence
Sub-Total: Health
Learning
Understanding, reasoning and problem solving
Participation in learning, education and employment
Progress and achievement in learning
Aspirations
Sub-Total: Learning
2. Parents and carers
Basic care, ensuring safety and protection
Emotional warmth and stability
Guidance, boundaries and stimulation
Sub-Total: Parents & Carers
3. Family and environmental
Family history, functioning and wellbeing
Wider family
Housing, employment and financial considerations
Social and community elements and resources, including education
Sub-Total: Family & Environmental

(Total number of items in each column should be multiplied by 1, 2 or 3, as appropriate)

Total Level of Needs Score(out of 57) Date

For office use: SignedITFolderFWIS’sheet:RegisterFactorsIT