Early Help Assessment and Plan (EHAP) Form

EHAP Registration No.
Early Help Assessment and Plan (EHAP) Form
This EHAP form replaces the Common Assessment Framework (CAF) form. The process for assessing the needs
of a child/young person/family and creating an action plan to address those needs - remains the same.
Before initiating use of an EHAP
1
Ensure there are NO immediate child protection concerns.
If at any time you are concerned about the welfare or safety of a child/young person – call the Ealing Children’s Integrated Response Service (ECIRS) to discuss your concerns and get advice. Appropriate
action will then be taken 020 8825 8000 (24hrs).
2
Consider whether a multi-agency approach is necessary - or whether a single organisation/service can
meet all the child/young person’s needs.
3
You must contact the Family Information Service (FIS) to find out if an EHAP is already in use for the
child/young person or a sibling. And to obtain the registration number and Lead Professional contact
details (for an existing EHAP) or register a new EHAP. Call 020 8825 5588 (Mon-Fri, 9am-5pm).
EHAP Initiator comment Use this space to explain why an EHAP is being initiated for
this child/young person giving a brief overview of possible needs. Include an overview of the home
situation and family structure.
EHAP Initiator’s details
Date EHAP initiated:
Full name:
Role:
Organisation/service:
Tel:
Email:
Identifying Details
EHAP No.
Child/young person’s details
Parent/carer (1)
If unborn baby state name as ‘unborn baby’ and mother’s full
name e.g. ‘unborn baby of Ann Smith’
First name:
First name:
Address: (if different from child/young person)
Surname:
Surname:
Previous name:
Postcode:
Date of birth or expected date of delivery:
Tel:
Gender: Male Female
Unknown
Address:
Relationship to child/young person:
Parental responsibility:
Yes
No
Parent’s first language:
Postcode:
Is an interpreter required for meetings? Tel:
Yes
No
Yes
No
Parent/carer (2)
Family’s religion:
First name:
Surname:
School (name and town):
Address: (if different from parent/carer 1)
GP name:
Postcode:
GP address:
Tel:
Relationship to child/young person:
Postcode:
Parental responsibility:
GP tel:
Parent’s first language:
NHS no. (if known)
Is an interpreter required for meetings? Sibling’s name Gender Date of birth Additional needs/disability/SEN
Does the child/young person have additional needs, special
educational needs or a disability?
Yes
No
Yes
No
School
Does anyone in the family have any accessibility requirements
for meetings?
Yes
No
If yes, give details:
If yes, give details:
Does the child/young person have a statement of special
educational needs?
Yes
No
Is this child/young person a young carer?
Yes
No
Uncertain
Ethnicity
EHAP No.
Asian or Asian British
Mixed
Indian
White & Black Caribbean
Pakistani
White & Black African
Bangladeshi
White & Asian
Any other Asian background*
Any other mixed background*
Black or Black British
White
Caribbean
White British
African
White Irish
Any other Black background*
Gypsy/Roma
Traveller of Irish heritage
Chinese or other ethnic group
Any other White background*
Chinese
Arab
*If other please specify:
Any other ethnic group*
Not given
Services already working with this child/young person and their family
Consent for information storage and information sharing
I understand the information recorded on this form. I give consent to my information being shared with the services indicated
with a tick below for the purpose of setting up the first Team Around the Family meeting to enable access to help and
support from these services.
3
Family Information Service
(for support and/or to
register this EHAP)
Children’s centres
Health
Childcare provider
Youth services
School
Police
ECIRS (Ealing Children’s Integrated
Response Service)
ESCAN (Ealing Service for Children
with Additional Needs)
Please be aware we will contact Social Services if at any time during the EHAP process the child/young person has been
harmed or is at risk of harm or abuse.
Full name (BLOCK CAPITALS):
Signature:
I am
the young person (aged 12-16),
Date:
the parent of the child/young person,
the carer of the child/young person.
Verbal consent to initiate an EHAP may be given by the young person (aged 12-16) and/or their parent/carer. However,
written consent must then be obtained at the very first opportunity and BEFORE any information can be shared or stored
electronically. For children under the age of 12, parental consent must be obtained before initiating an EHAP.
Verbal consent obtained from:
EHAP Initiator’s full name:
Date:
Signature:
Early Help Assessment
EHAP No.
Date of first TAF:
Child/young person’s full name: Date of birth:
Lead Professional:
Role:Organisation/service:
Tel:Email:
Attendee (full name) Role Organisation/service Development of unborn baby, child or young person:
Parents and carers:
Family and environment:
Is the child/young person involved in caring for a relative or sibling on a regular basis?
Analysis and summary of assessed needs:
Tel
Action Plan
Needs and desired result (Number in order of priority) EHAP No.
Planned actions (Indicate name/service) Desired
completion date
Family or young person’s comment on the action plan or anything else so far:
Consent for assessment, agreed actions and choice of Lead Professional
I understand and agree with the assessment and proposed action plan and choice of Lead Professional. I consent to my
information being shared with the services identified in the action plan for the purpose of accessing these services.
Full name (BLOCK CAPITALS):
Signature:
I am
the young person (aged 12-16)
Date:
the parent of the child/young person
the carer of the child/young person
Agreed date for next Team Around the Family meeting (review):
Lead Professional’s full name:Signature:
Lead Professional checklist
Ensure the security of this form and its contents both paper and electronic.
Notify the Family Information Service (FIS) of the first TAF meeting and planned review date, giving your contact details as
the Lead Professional.
Photocopy for additional reviews
Action Plan Review
EHAP No.
Date of review:
Child/young person’s full name: Date of birth:
Lead Professional: Tel:
Attendee (full name) Role Organisation/service Tel
Were actions effective in achieving desired results? (Number points in relation to action plan and use effectiveness rating below)
Ineffective: No noticeable/measurable outcome/improvement. Partly effective: Small noticeable/measurable outcome, but still much to do to achieve the desired result.
Mostly effective: Most of the desired result has been achieved. A little extra effort is needed to achieve/sustain all the desired results. Completely effective: Desired result
achieved and can be maintained without further support.
Continuing needs and desired result (Number in order of priority) Further actions (Indicate name/service) Desired completion date
Date of next review meeting:
Consent for agreed further actions (if applicable) or closure of the EHAP
I understand and agree with the proposed further action and consent to my information
being shared with the services identified for the purpose of accessing these services.
The desired results have been achieved and I consent to the EHAP closing.
I no longer wish to continue with the EHAP and ask for it to be closed.
EHAP closed by LP
as level of need has
escalated to Level 4/
statutory services.
Family comment on progress, agreed further actions or closure:
Full name (BLOCK CAPITALS):
I am
the young person (aged 12-16)
Signature:
the parent/carer of the child/young person
Date:
the Lead Professional