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					                             Inter-Agency Child Protection Information Management System - FTR Forms
                                                                                 FOLLOW-UP FORM

SECTION 1 - CHILD'S PERSONAL DETAILS

Registration
                                                                                                          Other I/D Number
I/D Number

                   First Name                                                         Middle Name                                              Last Name

Child's Name



Other names &                                                                                                            Male
spellings child                                                                                           Sex                                           Age                                    years
is known by                                                                                                              Female




SECTION 2 - OUTCOME OF FOLLOW-UP VISIT

Was the child seen during the visit?                                                  Yes                 No


If not why not?

(visiting friends / relatives, at school, moved with family, moved to live with another caregiver, working, abducted, in detention, etc)


SECTION 3 - CURRENT CARE ARRANGEMENTS

Is the child still living with the same caregiver?                                    Yes                 No


If not give                  Death of caregiver                     Poverty                                 Relationship Breakdown                         Other
reasons for
change                Ill health of caregiver                       Education                                   Abuse & Exploitation
Note: To be determined by the programme

If not, give the type of current care                   Foster Family                                                  Street                              Interim Care Centre
arrangements?
                                                   Child Headed Household                           Orphanage                          Other


If not give        First Name                                                         Middle Name                                              Last Name
name and
address of
new caregiver
                   Country                                                      Admin Level 1                                          Admin Level 2




                   Admin Level 3                                                Admin Level 4                                          Village/Area/Physical Address - if not known enter landmarks e.g.
                                                                                                                                       hills, trees, names of schools or hospital etc.



NOTE: Each Admin level can be adapted to the specific address format of each country

Relationship of new caregiver to child                                                                                     Date new care arrangement started:
NOTE: To be determined by the programme


Explain the circumstances which
resulted in change of caregiver.



Are the child's current care/living circumstances satisfactory?                                           Yes                   No


If no, what action needs to be
taken? Is there a need for urgent
intervention?


SECTION 4 - ACTIVITIES
Is the child in school or training?                                 Yes                             No


If not, why not?                            Financial constraints                                   Lack of access                     Pregnancy/ children                    Have to help
                                                                                                                                                                              family/work
                                            lack of interest                                    Lack of infrastructure                    Early Marriage                              Other
NOTE: To be determined by the programme

If yes, what type of
                                                                                                         If relevant, what level have they achieved
education/training?
(early childhood, primary, secondary, non-formal, adult education/ literacy, vocational training, accelerated training, other)


Follow-Up Form                                                                              Page 1 of 5                                                                                          8/26/2012
NOTE: To be determined by the programme

What other community and / or livelihood   Unpaid                 Paid   Recreational      Livelihood
                                                                                                        Other
activities is the child involved in?        work                  work    activities       Activities

NOTE: To be determined by the programme
                                                                          please specify




Follow-Up Form                                      Page 2 of 5                                                 8/26/2012
SECTION 5 - CARE ASSESSMENT
Consider the opinions of the child, their family, their teachers, the community, etc plus your own observations.
Personal (general appearance and behaviour)
Guidance to assess personal well being: does the child have any particular worries? Does the child have sufficient clothing on? Does the child appear frightened/ withdrawn? Is
the child crying/ unhappy? Is the child unable to sleep (nightmares or screams in his/ her sleep)? Is the child's behaviour angry or aggressive? Is the child able to make and keep
friends? Has the child been involved in illegal activities? Does the child feel safe?

                                    Observations                                                     Action taken during visit                    Further action recommended




       Assessment:                 Urgent Intervention                            Ongoing Monitoring               No Further Action Needed


Family (family relationships and home setting)
Guidance for family assessment: does the child appear happy in the home? Does the child have problems with children or other family members? Is the child treated any
differently from the other children in the family? Does the child experience any anger or aggression in the home? How is the child disciplined? How is the child supported if upset?
Are parents/carers interested in child's well-being?

                                    Observations                                                     Action taken during visit                    Further action recommended




       Assessment:                 Urgent Intervention                            Ongoing Monitoring               No Further Action Needed


Community (acceptance, integration and participation)
Guidance for assessment: does the child mix with his/her peers and take part in the usual recreational and other activities? Is the child excluded from activities or groups in
the community? Does the child experience any discrimination? Does the child feel different or feel they are treated differently to their peers?

                                    Observations                                                     Action taken during visit                    Further action recommended




       Assessment:                 Urgent Intervention                            Ongoing Monitoring               No Further Action Needed


Education, Skills Training
Does the child attend regularly, participate in activities and perform satisfactorily? Does the child have the necessary uniform, equipment, materials and resources? Does the
child mix with others ? Does the child experience any discrimination , prejudice, bullying or ill-treatment

                                    Observations                                                     Action taken during visit                    Further action recommended




       Assessment:                 Urgent Intervention                            Ongoing Monitoring               No Further Action Needed

Health & Nutrition/ Overall Well being of the child
Guidance for health assessment: Is the child visibly malnourished? How many meals a day does the child have (is this the same as other children in the community)? Has the
child attended any kind of malnutrition (CTC or other) programme? Is the child frequently sick? What does the family/ guardian do when the child is sick: take to hospital, take to
country doctor, nothing? What kind of health care/nutritional services do the family have access to?


                                    Observations                                                     Action taken during visit                    Further action recommended




       Assessment:                 Urgent Intervention                            Ongoing Monitoring               No Further Action Needed
Economy & Livelihoods
Can the child's family provide for basic daily needs without assistance? Has the family's economic well being changed/suffered a shock due to conflict/natural disaster etc
and what has been the impact on the child/family members? Has a livelihoods assessment been carried out? Is referral to a specialist agency necessary for immediate relief
or further assessment?

                                    Observations                                                     Action taken during visit                    Further action recommended




Follow-Up Form                                                                         Page 3 of 5                                                                                8/26/2012
       Assessment:   Urgent Intervention   Ongoing Monitoring   No Further Action Needed




Follow-Up Form                                Page 4 of 5                                  8/26/2012
SECTION 6 - PROTECTION CONCERNS

Provide as much information as possible on all of the protection concerns identified in the Registration Form which still apply/have not been resolved. Please
include details of the concern/s, action required, action taken and any necessary follow up. Please include dates of any actions taken and highlight the need for any
immediate action.




       Assessment:                Urgent Intervention                      Ongoing Monitoring                    No Further Action Needed




SECTION 7 - FURTHER ACTION

Is there a need for further follow-up visit's)?                                                 Yes                                             No

If yes, when do you recommend the next visit to take place?                                   Date:                                                  DDMMYYYY

If not, do you recommend that the case be closed?                                               Yes                                             No
Explain your recommendations below




SECTION 8 - FORM COMPLETED BY

Name/Sign.                                                                                            Position

                                                                                  Date of
Agency
                                                                              interview/visit
                            Country                                       Admin Level 1                                         Admin Level 2


                            Admin Level 3                                 Admin Level 4                                         Village/Area/Physical Address - if not known enter
Location of Interview                                                                                                           landmarks e.g. hills, trees, names of schools or hospital
                                                                                                                                etc.




Follow-Up Form                                                                  Page 5 of 5                                                                                          8/26/2012

				
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