WESTERN ISLES CHILDREN’S SERVICES

CHILD ASSESSMENT AND PLAN DOCUMENT

Child’s name 1 Doc Ref

This Assessment & Plan belongs to:Name:

P:

Author of Report:

Date of Report:

Check boxes below to highlight sections completed

Section 1Child

☐Section 2

Chronology

☐Section 3

Assessment

☐Section 4

Plan

☐Section 5

CSP

☐

Section 6 Compulsory Measures

☐

Section 1 – ChildDate of this plan: Date of any previous plan: Date of next review: Date of last review:

Child/Young person detailsName:

Date of birth:

Age:

CHI:

CareFirst Number : (As appropriate)

Gender:

Level of ASN, 1 – 4:

First language:

Ethnicity: Has the child’s current address or any other information been withheld from this plan; ☐Yes ☐NoIf yes, detail what and why: Home address:

Postcode:

Current address (if different from home address):

Education/Early years establishment: Date of entry to current school:

Year group:

Public Health Nurse base:

Child and Family Team:

GP and Practice:

Level of school attendance:

Is the child/ young person on the Child Protection Register or subject to Child Protection measures

Lead Professional: Contact Details:

CSP Co-ordinator: Contact Details:

Named Person: Contact Details:

Child’s name 2 Doc Ref

☐In Draft ☐Final Version

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

Why does this child need an assessment and plan?Safe

☐Healthy

☐Achieving

☐Nurtured

☐Active

☐Respected & Responsible

☐Included

☐Please provide details:

Are there any statutory measures in place? Please provide details:

People living at the child’s home addressName DoB Relationship to child Parental

rights

☐☐☐☐☐☐

Other significant family members/peopleName Address Date of

BirthRelationship to child Parental

rights

☐☐☐☐☐

Please indicate whether you are in agreement with the information contained in this Child Assessment and Plan being shared with other services (please tick). If agreement given verbally or otherwise, then please detail when and to whom.

None Part All

Please detail if this includes all services assessed as requiring input into your child’s life or whether this is for certain services only, and if so which?   Name   Signature  

Name   Signature  

Date  

Child’s name 3 Doc Ref

☐Yes ☐No

Preferred language or form of communication and support required to attend meetings (Child and parents) (e.g. use BSL, needs interpreter, prefers contact by mobile phone, disabled access, supporter, etc.)

Partners to the assessment and plan (include child/young person, parents/carers and professionals)Name Role Address Telephone

Child’s name 4 Doc Ref

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

Section 2 - ChronologyDate of Entry Source Event Action (If any)

Child’s name 5 Doc Ref

Section 3 – Assessment

Family BackgroundDetails;

How I grow and develop – strengths and pressuresDetails;

What I need from those who look after me – strengths and pressuresDetails;

Child’s name 6 Doc Ref

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

My wider world – strengths and pressuresDetails;

Resilience Matrix

Resilience & Protective FactorsDetails;

Vulnerability & Adversity Details;

What has been/ are the impacts of these strengths and pressures and current risk needs analysis?Details;

Child’s name 7 Doc Ref

What has been tried so far to meet the child’s needs? (if review, include actions from any previous plan)Details;

Child/young persons’ view of current situationDetails;

Parents’/Carers’ view of current situationDetails;

Please indicate the overall calculation of risk that has to be managed?

Please indicate the level of commitment and engagement?

Please tick; Please tick; Low strength/ high concern Genuine CommitmentHigh concern/ high strength TokenismLow concern/ low strengths Compliance/ Approval SeekingLow concern/ high strengths Dissent/ AvoidanceComments; Comments;

Child’s name 8 Doc Ref

Section 4 – Child’s Plan

Desired Outcomes/Short, medium and long term targets

Actions/Methods By whom When

Outcome: We will know this has been achieved when:

Child/young person’s view of plan

Parents’/Carers’ view of plan

Is the child/ young person eligible for consideration of measures under the Self Directed Support Act

Child’s name 9 Doc Ref

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

Note and explain any disagreements with any areas of the plan between any partners to the plan (professional or child/family) and any further actions required

Contingency planning

Child’s name 10 Doc Ref

Section 5 – Co-ordinated Support Plan (CSP) Learning Plan

Profile

Factors giving rise to additional support needs

Educational objectives Additional support required Additional support provided by

Nominated school

Child’s name 11 Doc Ref

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

Name of school:

Address:

Telephone: Headteacher: Nature of placement:

The CSP Learning Plan is not authorised as a statutory part of the Plan unless this part is completed

Date: Next CSP review must be held by:

Authorised by:

Child’s name 12 Doc Ref

Section 1Child

Section 3Assessment

Section 4Plan

Section 5CSP

Section 2Chronology

Section 6Compulsory

Measures

Section 6 – Compulsory MeasuresThis section to be completed whenever: The Reporter has requested a report; or Referral is being made to the Reporter; or The child is coming to a Children’s Hearing.

Is the recommendation that compulsory measures are required?

Why is that recommendation made? What is the evidence that the plan can or cannot be achieved on a voluntary basis?

If compulsory measures are recommended, what specific conditions (if any) would support the Plan?

Why are those specific conditions recommended?

Report Completed by: Date

Date Sent to Reporter:

Counter Signed By: Title

Signature

Child’s name 13 Doc Ref

☐Yes ☐No