Thurrock CouncilCommon Assessment Framework (CAF)Section 1

Name of child      

Date of birth      

Phone number      

Gender      

Ethnicity      

Religion      

First language      

Interpreter required?      

Unique pupil number      

Section 2

For which purpose are you using this form?

As a CAF to assess a child's or young person's needs:

To refer a child or young person to the Multi-agency Safeguarding Hub (MASH)where concerns have been identified in respect of that child or young person:

Consent must be obtained for CAF to proceed, except:

a) where there are clear child protection concerns – that is, a child or young person has an injury or has made allegations against the parent or carer

b) when the referrer suspects that by attempting to get consent from the parents, the child or children or young person or adult victim could potentially be placed at risk of harm

c) when the referrer has sought consent but the parent or carer has refused permission – in this instance the referrer believes that by not sending the CAF to the MASH the identified concerns are likely to escalate and may place the child or children or young person at further potential risk of harm

The parent or carer HAS NOT consented to this CAF. My rationale for sharing information without consent is:

     

Where consent has been obtained please refer to section 10

Section 3

Person completing this CAF:

Name      

Job title      

Phone number      

Email address      

Lead professional, if different from above:

Name      

Job title      

Phone number      

Email address      

What has led to this child or young person or family being referred?

     

Dates:

Start date of assessment

     

Completion date of assessment

     

Names of those present during the assessment:

     

2 form version 30 June 2015

Section 4

Household members:

First and last names

Relationship to the child or young person

Gender Date of birth, or estimated due date

Address Ethnicity Parental responsibility

                                         

                                         

                                         

                                         

Significant others:

First and last names

Relationship to the child or young person

Gender Date of birth, or estimated due date

Address Ethnicity Parental responsibility

                                         

                                         

                                         

                                         

3 form version 30 June 2015

Is the child or young person living in a private fostering arrangement? Yes No

Definition of private fostering is:"when a child under the age of 16 (under 18 if disabled) is cared for by someone who is not their parent or a 'close relative'. This is a private arrangement made between a parent and a carer, for 28 days or more. Close relatives are defined as step-parents, grandparents, brothers, sisters, uncles or aunts (whether of full blood, half blood or marriage / affinity)."

If 'yes', please provide details (if known):

     

Is the child or young person a young carer? Yes No

Definition of young carers is:"children or young people under the age of 18 years of age who are regularly undertaking a significant caring role, including physical, practical and emotional support to a family member. The family member maybe disabled or mentally ill or have a substance misuse problem."

If 'yes', please provide details (if known):

     

Services currently working with the child or young person or family:

Service Key contact / professional

           

           

           

           

Case previously known to:

Children's social care Youth Offending Service

Troubled Families Police

Early Offer of Help Other –      

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Section 5

Presenting issues – child

At least one presenting issue must be selected. If multiple issues have been indentified, select all that are applicable:

Behaviour – please specify below Gangs

Substance misuse Missing from care or home

Disability Abuse and neglect

Private fostering Mental health

Child exploitation Special education needs / EHCP

Trafficking Missing education

UASC Other – please specify below

Where required, please specify:

     

Section 6

Is the family previously or currently known to Troubled Families? Yes No

Please tick all that apply:

Parents and children involved in crime or anti-social behaviour

Children who have not been attending school regularly

Children of all ages who need help are identified as in need or are subject to a child protection plan

Adults out of work or at risk of financial exclusions or young people at risk of worklessness

Families affected by domestic violence and abuse

Parents with children with a range of health problems

If you have ticked any of the above, please provide further information in the box below:

     

5 form version 30 June 2015

Section 7

Child's or young person's developmental needs –

To include: 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.

     

Presenting issues – parent

At least one presenting issue must be selected. If multiple issues have been indentified, select all that are applicable:

Mental health Domestic violence

Substance misuse Learning disability

Family dysfunction Housing

Ill health Other – please specify below

If other, please specify:

     

Education

Attendance at school:

0 to 30% 30% to 50% 50% to 80% 80% to 100%

Does the child or young person have a SEN / EHCP in place? Yes No

Has the child or young person had any fixed-term orpermanent exclusions in the last 12 months? Yes No

If yes, please provide details:

     

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Is Education Welfare involved? Yes No

If yes, please provide details:

     

Parenting capacity

Basic care, ensuring safety and protection, emotional warmth and stability, guidance, boundaries and stimulation:

Strengths:     

Needs:     

Impact upon child or young person:     

Family and environmental factors

Family history, functioning and well-being, wider family, housing, employment and financial considerations, social and community elements and resources, including education:

Strengths:     

Needs:     

Impact upon child or young person:     

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Section 8

What services and strategies have been put in place to support the child, young person or parents? What impact has this had?

     

What are the strengths and protective factors in the family?

     

Child's or young person's comments regarding this CAF, including wishes, feelings and aspirations, taking into consideration the child's or young person's age and stage of development:

     

8 form version 30 June 2015

Parent's or carer's views and comments regarding this CAF:

     

Goals and outcomes desired, next steps, what needs to change, how can this be achieved? Who can help?

     

Section 9

Threshold statement

I, the referrer, have reviewed the Thurrock threshold document for intervention of need and in my opinion I consider the child/young person/family to fall into the following category based on what I have assessed:

Tier 1 Tier 2 Tier 3 Tier 4

9 form version 30 June 2015

Consent for information storage and sharing of information between MASH, EoH and Troubled Families.

"I understand that the information recorded on this CAF will be stored electronically.

The information contained in this CAF will be used in order that the appropriate services are identified to support me / the child / young person that I am the parent of / carer to.

It has been explained to me that MASH, EoH and Troubled Families are a multi-agency team where information is shared by professionals. This is for the purpose of making decisions and to identify services which can provide support to me my child/young person that I am the parent of / carer to."

If it is determined that you will receive support from the Troubled Families programme, you should be aware that information will need to be shared with partner agencies, the voluntary sector, the Department of Communities and Local Government and their partner agencies.

The information will be shared with services involved with your support plan and to provide the Department of Communities and Local Government and their partner agencies with data and outcomes. Your personal information may be used, but at no time will personal data, your name(s), be published.

Information about the Troubled Families programme will be issued to the media to publicise the effectiveness of the scheme in Thurrock and success in reducing the number of families involved. At no time will personal information or names be given.

Information will be used to ensure support and consistency while your family is on the Troubled Families programme.

The reason for sharing information has been explained to me

Section 10

Child's or young person's signature:      

Date:      

Parent's or carer's signature:      

Date:      

Assessors signature:      

Date:      

A copy of this CAF has been provided to the child or young person: Yes No

A copy of this CAF has been provided to the parent or carer: Yes No

Multi-agency Safeguarding Hub (MASH): 01375 652 802 | thurrockmash@thurrock.gcsx.gov.uk

Children's Services, Thurrock Council, Civic Offices, New Road, Grays, RM17 6SL

10 form version 30 June 2015