Early Help Assessment and Action Plan Early Help Details Date Early Help Started Main reason for completing the Early Help Assessment Additional reasons/info Names, job role and service of those involved in the assessment or at Child Action Meeting List any questionnaires or tools you have used to help gather information for this assessment Child and Family Details Child(ren)’s Name Gender Date of Birth Primary Language Ethnicity Other languages spoken Primary Address Telephone Mobile Parent/Carer details Parent Parent Don’t forget to ask Name parents and/or check Relationship to child with the Integrated Address (if different to Working Team to find out above) if there’s already an Early Telephone (if different to Help Assessment in place. above) Tel No: 01204 331394/2. Do parents have any special requirements such Have you done this? as disability or language / communication difficulties? If so, explain clearly) Lead Professional Details Name Address Postcode Contact Tel: number Job Title Agency Email Assessment Information Development of the unborn child, child or young person Health Physical Development Speech, language and communication Identity, Emotional, Social Development, Relationships with friends, Self-Care skills Behaviour Learning including
Early Help Assessment and Action Plan Early Help Details Date Early Help Started Main reason for completing the Early Help Assessment Additional reasons/info Names, job role and service of those involved in the assessment or at Child Action Meeting List any questionnaires or tools you have used to help gather information for this assessment Child and Family Details Child(ren)’s Name Gender Date of Birth Primary Language Ethnicity Other languages spoken Primary Address Telephone Mobile Parent/Carer details Parent Parent Don’t forget to ask parents and/or check with the Integrated Working Team to find out if there’s already an Early Help Assessment in place. Tel No: 01204 331394/2. Have you done this? Name Relationship to child Address (if different to above) Telephone (if different to above) Do parents have any special requirements such as disability or language / communication difficulties? If so, explain clearly) Lead Professional Details Name Address Postcode Contact Tel: number Job Title Agency Email Assessment Information Development of the unborn child, child or young person Health Physical Development Speech, language and communication Identity, Emotional, Social Development, Relationships with friends, Self-Care skills Behaviour Learning including
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