Nottinghamshire multi-agency action plan

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					        Nottinghamshire Multi-Agency Action Plan


This plan may be used to support work with a child
or young person, including an unborn baby or any child from birth.

Do we have enough information about the child’s or young person’s strengths, needs and
family situation?  YES / NO
 If NO, consider completing a Common Assessment Framework (CAF)

Child or young person: contact information
If unborn baby, write name as ‘unborn baby’ and mother’s name, e.g. ‘unborn baby of Ann Smith’
Name                                                          Also known as/previous names


Address                                                       Postcode

                                                              Contact phone number

Date of birth                                                 Gender
(or expected delivery date)                                   Male / Female / Unknown

Parents / carers: contact information
Name                                                          Also known as/previous names


Address (if different from above)                             Postcode (if different from above)

                                                              Contact phone number

Relationship to child or young person                         Parental responsibility? YES / NO

Name                                                          Also known as/previous names


Address (if different from above)                             Postcode (if different from above)

                                                              Contact phone number

Relationship to child or young person                         Parental responsibility? YES / NO


Accessibility information
If a family member needs additional support so that s/he can take part in action planning, please describe the support
needed. For example, a family member may need an interpreter, or may need meetings arranged in accessible premises, or
may need information presented in a non-written format or translated into a language other than English.




If additional support is needed, how will this be arranged?




  Nottinghamshire ISA                  Multi-Agency Action Plan             2007 FINAL VERSION                Page 1
              Overview / Review of Progress and Goals
       Describe the child’s or young person’s progress and their goals for the future
 If this is a review meeting, describe progress since last meeting, then review goals and restate or update them as needed.


Where child / young person is now                       Child’s / young person’s goals:
How well is the child/ young person progressing         What does the child or young person want to
towards these outcomes? (this may include               achieve?
progress made since last meeting)

 o Being Healthy




 o Staying Safe




                                                        Parent(s)’s / Carer(s)’s Goals:
                                                        (related to child / young person)
                                                        What do parents/carers want for their child?
 o Enjoying and Achieving




 o Making a Positive Contribution




                                                        Workers’ goals
 o Achieving economic well-being                        What are workers hoping to achieve by completing
                                                        this action plan?




  Nottinghamshire ISA                 Multi-Agency Action Plan               2007 FINAL VERSION                  Page 2
                                 Agreed Actions
Next steps      Agree what is most important to work on first. This should be agreed
between the child or young person, family and workers




Agreed Actions: what we need to do towards achieving agreed next steps
(actions may be for child/young person, parents, carers, workers or others)
                             Why are we doing this?
                            How does this relate to
What needs to be done?                                 Who will do this?      By when?
                            agreed goals and next
                            steps?




 Nottinghamshire ISA        Multi-Agency Action Plan    2007 FINAL VERSION          Page 3
How will we know when action has been successful? What will be different?




How and when will action be reviewed?




Child’s / young person’s comments




Parent(s)’s / carer(s)’s comments




Worker’s comments (any worker present may want to add additional comments)




Child / young person         Rate this completed form on a scale of 1 to 10 ( 1 = not at all, 10 = completely )

This form has captured what I have said              I understand and agree with the planned action

Signed ____________________          Name _____________________________ Date ________________


Parent / carer               Rate this completed form on a scale of 1 to 10 ( 1 = not at all, 10 = completely )

This form has captured what I have said              I understand and agree with the planned action

Signed ____________________          Name _____________________________ Date ________________

  Nottinghamshire ISA            Multi-Agency Action Plan            2007 FINAL VERSION                 Page 4
Lead Professional / Worker coordinating action planning

I agree that this is an accurate record of our discussion. I understand and agree with planned action.
I will take responsibility for coordinating planned action and arranging a review meeting.

Signed ____________________            Name _____________________________ Date ________________

Role _______________________________                 Organisation ___________________________________

People attending meeting
All people attending meeting will receive a copy of this action plan
Name                          Relationship to child     I agree with         Contact details: where should a copy of
                              or service/agency         the content of       this form be sent?
                                                        this action plan
                                                        (signature)




If anyone else needs a copy of this action plan, give name, contact details and reason a copy is needed




  Nottinghamshire ISA               Multi-Agency Action Plan               2007 FINAL VERSION              Page 5
         Consent for information sharing and information storage
              Complete either section 1a OR section 1b and then complete section 2.

1a.    I am the child / young person named in this form

I understand the information recorded in this form. I know that it will be stored and used for the purpose of
providing services to me. I understand that information may be stored in computer systems.

The reasons for information sharing have been explained to me. I understand those reasons.

I agree to the sharing of information between the services that will contribute to the delivery of this action
plan. These services are listed below:




I agree to the sharing of agreed information with these members of my family (for example, parents)




Signed ____________________            Name _____________________________ Date ________________


1b.    I am a parent / carer of the child / young person named in this form

I understand the information recorded in this form. I know that it will be stored and used for the purpose of
providing services to my child. I understand that information may be stored in computer systems.

The reasons for information sharing have been explained to me. I understand those reasons.

I agree to the sharing of information between the services that will contribute to the delivery of this action
plan. These services are listed below:




I agree to the sharing of agreed information with these members of my family (for example, partner/ex-partner)




Signed ____________________            Name _____________________________ Date ________________


2. Worker coordinating action plan

Signed ____________________            Name _____________________________ Date________________

Role _______________________________                Organisation ___________________________________

  Nottinghamshire ISA              Multi-Agency Action Plan           2007 FINAL VERSION               Page 6