assessment update started
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Not sure of version number? Check with Common Processes Team0161 217 6160
If you are completing form electronically, boxes will expand to fit your text. Where ‘check boxes’ appears, insert an ‘X’ in those that apply
Identifying details of child
Record 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.
Given name(s) / Family name
Male / Female Unknown / AKA1/previous names
Address / Date of Birth or Estimated Due Date
(dd/mm/yyyy)
Contact tel. no.
Postcode
Ethnicity
Click to selectWhite: BritishWhite: IrishBlack AfricanBlack CaribbeanPakistaniIndianBangladeshiTraveller: Irish HeritageGypsy/RomaChineseMixed: White/CaribbeanMixed: White/Black AfricanMixed: White/AsianAny other White backgroundAny other Asian backgroundAny other Black backgroundMixed: Any other mixed backgroundAny other ethnic backgroundInfo not obtainedRefusedUnknown
Ethnicity Notes
*If other, please specify / Immigration status
Child’s first language / Parent’s first language
Is the child or young person disabled? / Yes / No
If ‘yes’ give details
Details of any special requirements
(for child and/or their parent) eg signing, interpretation or accessibility needs
Details of parents/carers
Name / Contact tel. no.
Date of Birth
Relationship to unborn baby, infant, child or young person
Address / Parental
responsibility?
Yes / No
Postcode:
Name / Contact tel. no.
Date of Birth
Relationship to unborn baby, infant, child or young person
Address / Parental responsibility?
Yes / No
Postcode:
Family and Living Arrangements (give details of siblings, relatives, other significant adults that live with the child and include significant people who donot live with the child)
Name and address / Date of Birth
dd/mm/yyyy / Relationship to child / Contact Details / Nursery/school/
college if applicable
Details of person(s) undertaking this assessment
Name / Contact tel. no.
Address / Role
Organisation
Postcode
Name of lead professional (where applicable)
.
If LP has changed give name and agency details (above) and contact details (below) and give reason why the change has been agreed / Please select reasonChange of practitioner within serviceAnother service more appropriate to leadParent/child has requested another lead pracStepped up to Social CareOther
Further detail:
Lead professional’s contact number
Lead professional’s email address
Assessment information
Family members & significant individuals presentat this assessment
Professionals present and supporting the assessment (name and service)
What has led to this unborn baby, infant, child or young person being assessed?
Services working with this infant, child or young person
Include details of GP, Health (HV, Midwife etc), early years, education, FE training provision.
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Service Name / Named Person / Contact Details
Page 1 of 14Common Processes 0161 217 6160
CAF assessment summary: strengths and needsConsider each of the elements to the extent they are appropriate in the circumstances. You do not need to comment on every element if you do not have relevant information.Base comments on evidence, not opinion, and indicate clearly what that evidence is and the source. If there are any major differences of opinion, these should be recorded clearly.
In each of the domains below, you will find prompts to help you provide evidence of strengths and needs. You should use the level of needs documentif you require further guidance. The titles in purplecorrespond with the codes in the action plan.
Please document the strengths and needs from across these domains in the strength and needs sections below.
1a. Health anddevelopment of unborn baby, infant, child or young person
1a(i) Health
Conditions and impairments; registered with and use of dentist, GP, optician; immunisations, developmental checks, hospital admissions, accidents, health advice and information
Physical development: Nourishment; activity; relaxation; vision and hearing; fine motor skills (drawing etc.); gross motor skills (mobility, playing games and sport etc.)
Speech, language and communication: Preferred communication/learning style, language, conversation, expression, questioning; games; participation in stories and songs; listening; responding; understanding appropriate to age
1a (ii) Emotional and Behavioural
Early attachment/strong attachment observations; risk taking/actual self-harm; phobias; psychological difficulties; coping with stress; motivation, positive attitudes; confidence; relationships with peers; age appropriate peers; feeling isolated and solitary; fears; often unhappy; bereavement; family breakdown (i.e. mother and father separate).Lifestyle, self-control, reckless or impulsive activity (lack of impulse control); behaviour with peers; substance misuse; anti-social behaviour; offending behaviour; pro-criminal friends/family ; violence and aggression; restless and overactive; easily distracted, attention span/concentration
1a(iii) Identity
Perception of self; knowledge of personal/family history; sense of identity and belonging; experiences of discrimination due to race, religion, age, gender, sexuality and disability.
1a(iv) Social Presentation
Has positive social presentation; has a wide range of interests and feels positive about self; is empathetic and shows consideration for others appropriate to age
1a(v) Family and social relationships
Building stable relationships with family, peers and wider community; age appropriate peers; helping others; friendships; levels of association for negative relationships; consistent, positive role models
1a(vi) Self-care skills
Becoming independent; boundaries, rules, asking for help, decision-making; changes to body; washing, dressing, feeding; positive separation from family; ability to travel independently (appropriate to age)
Evidence of Strengths / Evidence of Needs
1.b.Child’s learning
1b(i) Education
Understanding, reasoning and problem solving: Organising, making connections; being creative,exploring, experimenting; imaginative play andinteraction
Participation in learning, education and employment: Access and engagement; attendance (include % of attendance if available), exclusions,positive participation; adult support; access to appropriateresources
Progress and achievement in learning: Progress in basic and key skills; available opportunities; support with disruption to education; level of adult interest; Special Educational Need; extra educational provision
Aspirations: Ambition, confidence and attitude to learning;motivation, perseverance
Evidence of Strengths / Evidence of Needs
Has the child/young person ever gone Missing/Absent from Home? YesNoUnsure
If ‘yes’, please give number of incidents and detail (i.e. missing from family home) and action taken
2. Parents and carers
2(i) Basic care
Provision of food, drink, warmth, shelter, appropriate clothing; personal, dental hygiene; engagement with services
2(ii) Ensure Safety
Safe and healthy environment
2(iii) Emotional warmth and stimulation
Stable, affectionate, stimulating familyenvironment; praise and encouragement; secureattachments; support and encouragement of positive activities for child(ren) participation in positive leisure time activities
2(iv) Guidance and boundaries
Encouraging , displays self-control; modelling positive behaviour; effective and appropriate discipline; avoiding over-protection;
2(v) Stability
Stability of living arrangements (evidence of frequent house moves), school,employment status
Evidence of Strengths / Evidence of Needs
Has there been evidence of parental substance misuse?YesNoUnsure
If ‘yes’, please give details
3. Family and environmental factors
3(i) History and functioning
Illness, bereavement, violence, parental (or any significant others within the home) substancemisuse, criminality, anti-social behaviour; strong culture beliefs, diversity considerations,size and composition of household; absentparents, relationship breakdown; physical disabilityand mental health; abusive behaviour
3(ii) Wider family
Formal and informal support networks from extended family and others; wider caring and employment responsibilities eg childcare arrangements
3(iii) Housing,
Water/heating/sanitation facilities, sleeping arrangements; homelessness.
3(iv) Employment
Work andshifts; employment; volunteering opportunities and aspirations to move into the world of work.
3(v) Income
Income/benefits; effects ofhardship; long term out of work benefits
3(vi) Social Integration
Anti-socialbehaviour in area; peer groups, social networksand relationships
3(vii) Community Resources
Day care; places of worship; community involvement; transport; shops; leisure facilities; living in high crime area,
Evidence of Strengths / Evidence of Needs
Is there evidence of domestic abuse? YesNoUnsure
If ‘yes’, please give details if known
CAF Summary
Child or young person’s view on the assessment and key elements of what they feel needs to change
Parent or carer’s view on the assessment and key elements of what they feel needs to change
Conclusions, solutions and actions
Now the assessment is completed you need to provide a summary and agree the desired outcomes and what actions are required to achieve this. Work with the baby, child or young person and parent or carer, and take account of their ideas, solutions and goals.
What are your aims? (What are the key aims that the child, young person and family would like to address?)
How will you know when things have improved?
Team Around the Child (TAC) Plan: actions and desired outcomes (to bedeveloped and agreed alongside child, young person and/or family)
Action / Review
Domain
The codes belowcorrespond to the titles in purplefound in the CAF assessment summary: strengths and needs section. / What is neededand what needs to change? / How should this be met (Action)
(specific, measurable, achievable, realistic, time limited)
By when?
(date)
(Must be specific do not use ‘ongoing’) / Responsible Person / Agency (who is going to do it?) / What is Plan B if this action does not progress? / At review, the needs have:
(Please click and select relevant outcome) / Update on distance travelled for child and family (include positive progress or analysis if situation has deteriorated/stayed the same) / Actual Outcome (how did this help the child and/or family?)
To be completed once action has ended. / Date completed
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Click to select1a(i)1a(ii)1a(iii)1a(iv)1a(v)1a(vi)1b(i)2(i)2(ii)2(iii)2(iv)2(v)3(i)3(ii)3(iii)3(iv)3(v)3(vi)3(vii) / Click to selectNeeds increasedNeeds decreasedNeeds stayed the same
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Review TAC plan or organise a TAC Meeting? / Click to selectReview TAC PlanOrganise TAC Meeting / Date / (It is good practice to review and update the CAF Assessment and TAC Plan on a 6 weekly cycle (or earlier if necessary)
Has a formal TAC Meeting take place? / YesNo / Date of TAC Meeting
Attendance at TAC meeting / Important notes - brief bullet points discussed at TAC Meeting (which are not covered in updating the action plan or updating the needs in the CAF):
Were any agencies invited that were unable to attend?
Closure
Does this CAF episode require closure? / Yes No / Please select reason for closure: / Click to selectAll needs met (step down to universal)Family moved out of areaFamily refuses supportService unable to engage family in CAF processStep up to Social CareStep up to Social Care (child protection)Aged 18+OtherChild deceased
Date of Closure / If other is selected please specify:
‘By completing this section and ticking the ‘yes’ button you,the practitioner, confirm that you have received signed, written consent on the original copy of the CAF document and that the family, child or young person understand and agree that you will share the information with other agencies to maximise the support available to them? Yes
Consent statement for information storage and information sharing
“Information in this CAF document is collected so that we can understand your needs and offer appropriate support. If all of your needs cannot be addressed we may need to share this information with other agencies so that they can help us to provide the services that you need”
“We will keep your information secure and handle it fairly and lawfully. We will not share it unless it is in the child and family’s best interests to share, or if we are required to do so by law. If we believe that withholding information may result in you or your child coming to harm, we would need to share it with appropriate agencies. When we do share information we will only ever share the minimum information we need to.”
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
This infant, child or young person for whom I am a parent
This infant, child or young person for whom I am a carer
I have had the reasons for information sharing explained to me and I understand those reasons.
For children under 5 only: The child’s name, address and date of birth will be shared with the local Sure Start Children’s Centre, unless parent/carer indicates they don’t wish this to happen, by ticking this box:
I do not wish my child’s name, address and date of birth to be shared with the Children’s Centre
Parent or carer
Signed / Name / Date:
Young person (where appropriate)
Signed / Name / Date:
Practitioner’s signature
Signed / Name / Date:
Copy form securely to the child and family and all agencies involved and send a copy to:
Common Processes Team, using the most secure method:
Use Email: (password protect document) or Office Online [using return type ‘CAF Forms’] if you have a stockport.gov or stockport.sch.uk email address.
Use Gov Connect email: if you have a gov connect compliant email address e.g. nhs.net.
Post: Common Processes, Scanning Support Team, Lower Ground Floor, Stopford House, Piccadilly, Stockport SK1 3XE Tel: 0161 217 6160. If sending in the post please ensure, as a minimum that you mark the envelope private and confidential, with a return address on the back of the envelope and consider sending recorded delivery.
Exceptional circumstances: concerns about significant harm to infant, child or young person
If at any time during the course of this assessment you are concerned that an infant, child or young person has been harmed or abused or is at risk of being harmed or abused, you must follow your Local Safeguarding Children Board (LSCB) safeguarding children procedures. Visit to view the Stockport Safeguarding Children Policies and Procedures Handbook. The practice guidance What to do If you’re worried a child is being abused (HM Government, 2006) sets out the processes to be followed by all practitioners.
If youthink the child may be a child in need (under section 17 of the Children Act 1989) thenyou shouldalso consider referring the child to children's social care by contacting the Contact Centre on: 0161 217 6028. This referral process is included in the local safeguarding children procedures and isset out in Working Together to Safeguard Children(2013). You should seek the agreement of the child and family before making such a referral unless to do so would place the child at increased risk of significant harm.
The information provided will be used to update the Council’s records as well as for reporting and monitoring quality purposes.
Is this a notification of Child Protection to Children’s Social Care? (supporting information to confirm previous phone referral) Complete as many of the boxes as you are able to, ensuring you fully document the reasons for making the referral. If this has been an agreed Child Protection referral consent to send this form is not required if obtaining consent puts the child or young person at risk.
e-mail direct to: (password protected) or you have a gov connect compliant email address e.g. nhs.net
Page 1 of 14Common Processes 0161 217 6160