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					Every Child Matters
Change for Children

Bedfordshire Children and Young People’s Strategic Partnership

Common Assessment Framework and Multi Agency Referral Form
Where check boxes appear, insert an „X‟ in those that apply. Before completing a CAF, please contact the CAF administrator on 01234 276750, to establish the current situation of the child / young person This form is being used as : a) An Assessment Form And/or b) Multi Agency Referral Form Yes /No Yes /No e.g. MAAG, Single Agency

Identifying details
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. Name (first) : 2 Date of Birth or (Surname) EDD / : Gender (Female/Male/Unknown): Male /Female/Unknown Address (Surname) : / A.K.A / previous names :
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Phone Number : Date of Completion : Is this an Update? / Yes/No /

Has a CAF form already been completed on any biological / step sibling(s), if so what date / name: Yes/No Date: / / Name:

Ethnicity (Please indicate Yes)
White British Caribbean Indian White & Black Caribbean Chinese

White Irish

African

Pakistani

White & Black African

Any other ethnic group

Any other White background Any other Asian background *

Any other Black background Any other mixed background *

Bangladeshi

White & Asian

Not Given

*If other, please specify

Immigration Status Child‟s first language Parent‟s first language

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“Also known as” Expected date of delivery

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Does the child have a disability Yes /No If “Yes”, provide details?

Religion: Is an interpreter or signer required? Yes/No Has this been arranged? Yes/No

Details of any special requirements (for child and/or parent):

Details of parents / carers
Name (first) : (Surname) Contact telephone number : Address Parental Responsibility? Yes / No (Surname) : Relationship to unborn baby, infant, child or young person:

Name (first) :

(Surname) : Relationship to unborn baby, infant, child or young person: Parental Responsibility? Yes/No

(Surname) Contact telephone number : Address

Current family and home situation
(e.g. family structure including siblings, other significant adults etc; who lives with the child and who does not live with the child):

Details of person(s) completing common assessment form
Name : Email: Role : Lead professional name : Lead agency name : Organisation : Lead professional contact number : Lead agency contact number : Contact telephone number :

Assessment information People involved in assessment:

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Services working with this infant, child or young person
GP name (first) : Address (Surname) Contact Phone Number Office Telephone Number School, Nursery / Early Years or Education / Training provision Name : Address : (Surname) :

Other services
Service : Email : Service : Email : Service : Email : Service : Email : Service : Email : Contact Telephone Number : Contact Telephone Number : Contact Telephone Number : Contact Telephone Number : Contact Telephone Number :

CAF assessment summary: strengths and needs
What has led to this unborn baby, infant, child or young person being assessed? (Reason for referral)

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Consider each of the following elements to the extent they are appropriate in the circumstances. You do not need to comment on every element. Wherever possible, base comments on evidence, not just opinion, and indicate what your evidence is. 1. Development of unborn baby, infant, child or young person General health
Conditions and impairments; access to and use of dentist, GP, optician; immunisations, development 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, language, conversation, expression, questioning; games; stories and songs; listening; responding; understanding:

Emotional and social development
Feeling special; early attachments; risking/actual self-harm; phobias; psychological difficulties; coping with stress; motivation; positive attitudes; confidence; relationships with peers; feeling isolated and solitary; fears; often unhappy

Behavioural development
Lifestyle, self-control, reckless or impulsive activity; behaviour with peers; substance misuse; anti-social behaviour; sexual behaviour; offending; violence and aggression; restless and overactive; easily distracted; attention span/concentration

Identity, self-esteem, self-image and social presentation
Perceptions of self; knowledge of personal/family history; sense of belonging; experiences of discrimination due to race, religion, age, gender, sexuality and disability

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Family and social relationships
Building stable relationships with family, peers and wider community; helping others; friendships; levels of association for negative relationships

Self-care skills and independence
Becoming independent; boundaries, rules, asking for help, decision-making; changes to body; washing, dressing, feeding; positive separation from family

Learning Understanding, reasoning and problem solving
Organising, making connections; being creative, exploring, experimenting; imaginative play and interaction:

Participation in learning, education and employment
Access and engagement; attendance, participation; adult support; access to appropriate resources;

Progress and achievement in learning
Progress in basic and key skills; available opportunities; support with disruption to education; level of adult interest:

Aspirations
Ambition; pupil‟s confidence and view of progress; motivation, perseverance:

2. Parents and carers Basic care, ensuring safety and protection
Provision of food, drink, warmth, shelter, appropriate clothing; personal, dental hygiene; engagement with services; safe and healthy environment:

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Emotional warmth and stability
Stable, affectionate, stimulating family environment; praise and encouragement; secure attachments; frequency of house, school, employment moves:

Guidance, boundaries and stimulation
Encouraging self-control; modelling positive behaviour; effective and appropriate discipline; avoiding over-protection; support for positive activities:

3. Family and environmental Family history, functioning and well-being
Illness, bereavement, violence, parental substance misuse, criminality, anti-social behaviour; culture, size and composition of household; absent parents, relationship breakdown; physical disability and mental health; abusive behaviour:

Wider family
Formal and informal support networks from extended family and others; wider caring and employment roles and responsibilities:

Housing, employment and financial considerations
Water/heating/sanitation facilities, sleeping arrangements; reason for homelessness; work and shifts; employment; income/benefits; effects of hardship:

Social and community elements and resources, including education
Day care; places of worship; transport; shops; leisure facilities; crime, unemployment, anti-social behaviour in area; peer groups, social networks and relationships:

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Conclusions, solutions and actions
Now the assessment is completed you need to record conclusions, solutions and actions. Work with the baby, child or young person and/or parent or carer, and take account of their ideas, solutions and goals.

What are your conclusions?
(For example strengths, no additional needs, additional needs, complex needs, risk of harm to self or others)

What help/support does this child/family need?
What do you want MAAG? Single Agency to address?

Existing Action Plan (in order of priority)
What work is already in place/planned to support this child/family? Who will do this? By When: / /

What work is already in place/planned to support this child/family? Who will do this? By When: / /

What work is already in place/planned to support this child/family? Who will do this? By When: / /

What work is already in place/planned to support this child/family? Who will do this? By When: / /

AGREED REVIEW DATE

/

/

Lead Professional responsible for arranging review at 3 months initially & 6 monthly thereafter. Please update CAF admin using CAF Minute Form downloaded from www.bedfordshirelscb.org.uk

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How will you know when things have improved?

Child or young person‟s comment on the assessment and actions identified:

Parent or carer‟s comment on the assessment and actions identified:

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Consent for information storage and information sharing. (This section must be completed for all 3 outcomes below.
Please indicate whether consent is signed or verbal. The names of those giving and obtaining consent must be typed or clearly printed.)

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, the child/young person/family: I have had the reasons for information sharing explained to me and I understand those reasons

FOR MAAG REFERRALS:
Information will be shared with the Multi-Agency Allocation Group which the experience, skills and knowledge of a variety of services for the benefit of children and their families.

Signatures
/ /

Name - Young Person

Signed:

Dated

/

/

Name: - Parent Carer

Signed:

Dated

/

/

Name - Professional Completing Common Assessment Framework Form

Signed:

Dated

Additional Actions
If this is a CAF please indicate which of the following actions you have taken :Option 1 I have identified the service required and have used the CAF Form to refer.
Completed CAF to be sent to identified agency and CAF admin

Option 2 I have convened a local professional network meeting. No additional services required at this time.
Completed CAF to be sent to CAF admin, minutes of review meetings to be sent when complete (CAF Minute Form on LSCB website)

Option 3 I have sent the CAF Form to the Multi Agency Allocation Group (MAAG).
Completed CAF to be sent to CAF admin and relevant MAAG inbox

A copy of the completed CAF should be given to the parent/carer/young person. All completed CAF’s need to be sent to:- cafadmin@bedscc.gov.uk Tel: 01234 276750
If you are referring to MAAG please also send to the relevant MAAG inbox, area will be by address of Child/Young Person, as well as CAF admin. • maagnorth@bedscc.gov.uk • maagsouth@bedscc.gov.uk • maagmid@bedscc.gov.uk Further information on CAF/MAAG is available from www.bedfordshirelscb.org.uk 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’re worried a child is being abused (2006)” DFES download at www.everychildmatters.gov.uk

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