1.
Child/Young person's Name:
2.
Name of Parent:
3.
Do you know what the current plan is for your child/young person?
YES
NO
4.
Do you know what the long term plan is for your child/young person?
YES
NO
Do you feel the placement is meeting your child/young person's needs?
5.
Health
YES
NO
IF NO WHY?
6.
Education
YES
NO
IF NO WHY?
7.
Routines
Yes
No
IF NO WHY
8.
Sleeping
YES
NO
IF NO WHY?
9.
Eating
YES
NO
IF NO WHY?
10.
Behaviour
YES
NO
IF NO WHY?
11.
Activities
YES
NO
IF NO WHY?
12.
Friendships
YES
NO
IF NO WHY?
13.
Communication with you as parents
YES
NO
IF NO WHY?
14.
Current contact arrangements?
YES
NO
IF NO WHY?
15.
Are there any support services involved with your family?
YES
NO
16.
Tick which teams
Community Support Team (CST)
Drug & Alcohol Rapid Response Team (DARRT)
Cwlwm (Family group conference)
Parent Support Worker (PSW)
Action For Children
Other
Therapeutic Team
Sessional Support
Other (please state)
17.
Do you know why they are working with your family?
YES
NO
18.
Is the plan clear?
YES
NO
19.
Does your own family offer any support?
YES
NO
20.
Do you need any other support, help or advice?
YES
NO
IF YES WHAT?
21.
Do you know what is expected of you in the plan?
YES
NO
22.
If YES do you think these are realisitic?
YES
NO
IF NO WHY NOT?
23.
Do you understand what assessments are being completed and by whom?
YES
NO
24.
Do you wish to make a compliment or complaint about the service?
YES
NO
IF YES PLEASE GIVE DETAILS
25.
Do you wish to meet with the Independent Reviewing Officer before the meeting?
YES
NO
26.
Date completed (DD/MM/YY format):
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