Fostering and Adoption Services

Leeds City Council Fostering and Adoption Services CC9

Referral Form and Pen Picture for Permanent Foster Placement (all placement types)

This form will be used for the purposes of matching children and families.It will also be shown to prospective carers to establish whether they feel they may be able to care for a child or not. In order to do this, they need a full picture / assessment of the child and access to all available information. Please forward copies of any other relevant reports / material which would be helpful eg assessments, inc. foster carer reports / school / medical / disruption meeting minutes / reviews etc.

Information on this form will need to be updated every six months. Please forward additional information to the Fostering and Adoption Section, Merrion House, Tel: 2474747.

Name of Child: D.o.b Social Worker: Tel No: Area Team: Team Manager:

Child’s present carer:

Address: Tel No:

Child’s Birth Family Composition:

Relationship Name D.o.b

Address:

All Child’s Previous Placements (including family members) (please give full names and addresses. This is helpful in case new carers need information from previous carers eg life story work)

Placement Date Reason for moving

Child’s current Legal situation (include details of why child is looked after / legal status)

Date of last Child Care Review : Contact Information ( please detail any expected / anticipated arrangements for referred child eg: birth family / sibs / regularity etc)

Child’s future placement requirements ( please include: race / culture / religion / geography of placement / family composition of placement )

Placement Support requirements (eg: therapeutic / respite / support groups / financial and any other practical support)

Child’s Pen Picture

( to be completed by the child’s current carer. It is the Social Worker’s responsibility to ensure this is completed and appropriate help given. It is important that potential carers have a clear picture of what the child is like to live with and what their future needs will be ).

Please include comments on all of the following 12 areas:

1 Physical Development 7 Behaviour (what helps to manage issues?) 2 Personality 8 Social Skills 3 Health 9 Education / Learning (inc. cognitive and intellectual development) 4 Attachment Capacity 10 Talents 5 Birth Family Background 11 Likes, Dislikes, Fears 6 Contact Issues 12 Daily Routines Child’s views on future placement

( please include details of any preparation for placement undertaken, including Life Story work)

Photograph(s) / Video

Please attach recent photograph of child (not photocopy) and video whenever possible

Date this form and pen picture completed:

Date sent to Fostering and Adoption Section: Signed:

Child’s Social Worker:

Team Manager:

Child’s present Foster Carer: