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):