<p> Request for Team Around The Family</p><p>For the child or young person who is the main focus for this request for service</p><p>Name Contact Phone Home: number(s) Mobile: Date of Birth Male or female Previous TAF Main address inc Assessment? postcode Ethnicity 1st Language Name of school or Special Education early years setting Needs Name of GP Name of Health Visitor</p><p>Consent from the family / child / young person is needed for the information on this form to be shared. Please make sure that the section to give consent on PAGE 7 is completed.</p><p>Key Family Members </p><p>(Please include details of parents / carers and also other family members such as siblings, carers, step siblings, or other significant people who visit the home)</p><p>First Name Surname Relationship D.O.B. Parental Present at Household to child Responsibility meeting member</p><p>Is a parent or carer contributing to this request? Is the child or young person contributing to this request? </p><p>Person(s) coordinating this request</p><p>1 Contact phone Name no.</p><p>Address</p><p>Job title/role Agency</p><p>Is there already a key worker? </p><p>Name, agency and contact details Is yes, who are they?</p><p>Agencies working with the family already Include all known agencies and key relevant points about the work done with the family or ongoing</p><p>Birth history and medical background (if appropriate) Include outline of development delay/disability concerns, physical/sensory difficulties/language development and play skills</p><p>2 Family Strengths and Needs</p><p>Please comment on every element and score the level of need as follows: </p><p>1 = no needs 2 = minor needs 3 = moderate needs 4 = significant needs 5 = critical / complex needs</p><p>If this request concerns more than one child or young person, indicate which strength or need relates to which child. Where possible, base your comments on evidence, not opinion. Highlight and source the information you use to support your evidence. If there are any major differences of view, for example between the carer, young person or practitioner(s), these should be recorded too. </p><p>Family Profile:</p><p>Element Strengths and needs Level of need (1-5) 1 Housing </p><p>2 Income, employment and finance</p><p>3 Family history, relationships and well-being</p><p>4 Social and community links / supports</p><p>3 Child or Young Person Profile</p><p>Element Strengths and needs Level of need (1-5)</p><p>5. General health </p><p>6. Physical </p><p> development 7. Speech, </p><p> language and communication 8. Emotional and social development </p><p>Health and 9. Behaviour Wellbeing </p><p>10. Identity, self esteem, self image </p><p> and social presentation 11. Family and social relationships </p><p>12. Self care skills and independence </p><p>13. Understanding, Learning reasoning and problem solving 14. Attendance and participation in </p><p> learning, education or work</p><p>15. Progress and </p><p> achievement </p><p>16. Aspirations </p><p>4 Parent or Carer Profile</p><p>Element Strengths and needs Level of need (1-5)</p><p>17 Basic care, </p><p> ensuring safety and protection</p><p>18 Setting routines and boundaries </p><p>19 Emotional warmth and stability </p><p>20 Physical health </p><p>21 Mental health and </p><p> emotional well-being</p><p>22 Drug and alcohol use </p><p>Key agencies who are also working with the child, young person or their family (if known) </p><p>5 Ag Contact Name Tel: en cy Ag Contact Name Tel: en cy Ag Contact Name Tel: en cy Ag Contact Name Tel: en cy</p><p>6 Summary</p><p>Please use this page to summarise the level of need for each domain. Doing so will help to identify what needs to change, where the family may need additional support, and to structure a Team around the Family plan. The information shown here can also be re-used to identify what progress has been made at subsequent Team around the Family (TAF) review meetings.</p><p>None Minor Moderate Significant Critical/ 1 2 3 4 Complex 5</p><p>Family Profile 1. Housing 2. Income, employment and finance 3. Family history, relationships and wellbeing 4. Social and community links / supports Child and Young Person Profile Health and Wellbeing 5. General health 6. Physical development 7. Speech, language and communication 8. Emotional and social development 9. Behaviour 10. Identity, self esteem, self image and social presentation 11. Family and social relationships 12. Self care skills and independence Learning 13. Understanding, reasoning and problem solving 14. Attendance and participation in learning, education or work 15. Progress and achievement 16. Aspirations Parent or Carer Profile 17. Basic care, ensuring safety and protection 18. Setting routines and boundaries 19. Emotional warmth and stability 20. Physical health 21. Mental health and emotional well-being 22. Drug or alcohol use </p><p>7 Consent We have collected information in this TAF form so that we can understand what help your family may need. If we cannot cover all of your needs we may need to share some of this information with the other organisations so that they can help us to provide the services required. We will treat your information as confidential and will not share it with any other organisation unless you have consented, or unless we are required by law to share it, or if you or any other person will come to some harm if we do not share it. In all cases we will only ever share the minimum information we need to share. I understand the information that is recorded on this form and that it will be stored and used for the purpose of providing services to: Me The child or young person for whom I am a parent The child or young person for whom I am a carer I have had the reasons for information sharing and information storage explained to me and I understand those reasons. I agree to the sharing of information.</p><p>I agree for a copy of this form to be sent to a TAF Panel if necessary Historical data may also be shared with relevant agencies in support of this TAF assessment if required</p><p>Child or young person’s views about the assessment</p><p>Parent or carer’s views about the assessment</p><p>Signed (Child/Young Person) Name Date</p><p>Signed (Parent/Carer) Name Date</p><p>8 Signed (key worker or other practitioner) Name and Agency Date</p><p>What to do next?</p><p>A copy of this form must be sent to the TAF Coordinator for your area within 5 working days of it being signed:</p><p>TAF Coordinator, London House, Alban Square, Aberaeron, Ceredigion, SA46 0AJ</p><p>Tel: (01545) 572649 Fax: (01545) 572634</p><p>E-mail: [email protected]</p><p>If you are unsure about any aspect of this process, what to do next, or whether you should refer this family to the Team around the Family Panel please discuss this with the TAF Lead for your organisation and/or the TAF Coordinator. </p><p>You can also refer to the Team around the Family Guidance about these processes available on line at </p><p>Exceptional circumstances: concerns about significant harm to a child or young person</p><p>If at any time you have reasonable concern that a child or young person may be at risk of harm you should follow the All Wales Child Protection Procedures and contact Children’s Social Services Tel: 01545 574000</p><p>9</p>