Edge of Care Panel Form

Revised March 2015 P L AC E M E N T P AN E L T E M P L AT E

Placement Panel Date: Last Placement Panel Review Date: Form Completed by: Team manager / Social Worker / Personal Include role Advisor / IRO name.

Name of Child/Young Person: CareFirst ID: Ethnicity: Date of Birth / Age: Disability: Religion: Number of Placements (including this Placement Start Date: one) Placement Address: (Include reason if placed outside 20 mile radius) Placement type (fostering / residential) Date last assessment completed: Assessment Type: Which professionals and family members are currently offering support and what does this involve? Entry to Care: - Edge of Care Legal Status: - LPM - Emergency Protection Date of last LAC review & Outcome What is the long term plan for the child?

How are the child’s identity needs being met? Include issues relating to ethnicity, gender, disability and sexuality. Health: Issues / recommendations Date of last Medical: identified at the Initial / Review Health Assessment?

Placement Panel Form - Revised March 2015 Page 1 of 3 Revised March 2015 Is the child in receipt of children’s Yes No Comments continuing health care funding (CHC) If ‘No’ – Has a referral to children’s Note: referrals must be Not continuing health care been made? Yes No Date of referral: made ahead of the panel Applicable If ‘Yes’ – Please provide details of the progress made, in the placement, in relation to the young person’s continuing health care needs Has a referral to CAMHS been made? Yes No Date of referral: Has a CAMHS consultation taken Date of Yes No place: Consultation Detail of CAMHS involvement

Current School Educational Issues: SEN / SEBD / disability / School attendance / Impact of interruption to education If recommending placement move will Yes No Details this require a change in school? Details of Pathway Plan

Details of PEP Date of last PEP meeting Plus any information relating to education provision / employment etc Child / young person’s views of the placement / plan:

Guardian’s Views:

Family's Views:

IRO/Court's Views:

Placement Panel Form - Revised March 2015 Page 2 of 3 Revised March 2015 Historical Information: Include:  family information  entry to care  historic safeguarding concerns

Current Situation Include:  what is working well  any concerns or worries  placement update

Recommendations to Panel: Include reasons for recommendations

Reasons for child needing to remain in care:

Plans for Independence / Permanence:

Current cost of placement: £ per week Children’s continuing care (health) funding £ per week Current cost of educational provision: £ per week Cost attached to any recommendations:: £ per week

Social Work Signature Date Team manager Signature Date Team Manager Comments if required:

Placement Panel Form - Revised March 2015 Page 3 of 3