Leeds Early Help Assessment of Needs Form This form is intended to gather information about a child/young person’s current situation from a professional’s point of view. PROFESSIONAL ONLY FORM Family Information Name of Child D.O.B Address Parents name Parents Telephone number School/setting Attendance % Practitioners details Name of practitioner Date completing form: Reason for Request for information Parent and Duty and Advice completing (please from Horsforth Carer Drop in request for Tick): Children’s Services Session PACs Cluster support Adult counselling Parenting Parent Course Identified Universal Universal Targeted Specialist level of needs (Support Plus (Cluster (CAMHS in school) (Targeted support CSWS) through Support in HCS school) &/or HCC) For PACs SEMH score SEMH score Consent form 0-10 post-session 0-10 completed use: Brief Outline of situation What support has already been put into place? List the support and the impact achieved or not achieved, with the reasons why.
Leeds Early Help Assessment of Needs Form This form is intended to gather information about a child/young person’s current situation from a professional’s point of view. PROFESSIONAL ONLY FORM Family Information Name of Child D.O.B Address Parents name Parents Telephone number School/setting Attendance % Practitioners details Name of practitioner completing form: Date Reason for completing (please Tick): Request for information from Horsforth Children’s Services Parent and Carer Drop in Session PACs Duty and Advice request for Cluster support Adult counselling Parenting Course Parent Identified level of needs Universal (Support in school) Universal Plus (Targeted Support in school) Targeted (Cluster support through HCS &/or HCC) Specialist (CAMHS CSWS) For PACs use: SEMH score 0-10 SEMH score post-session 0-10 Consent form completed Brief Outline of situation What support has already been put into place? List the support and the impact achieved or not achieved, with the reasons why.