| Identifying the child |
Child ID |
Please enter the unique ID used in your Case Mgmt System |
ID no. |
12346 |
Integer |
Child initials along with string of numbers (4-6 numbers) |
At referral |
|
Local Identifier |
Whatever ID you use to refer to the child (e.g. initials). This is not used in the data analysis. |
Free text |
TR |
String |
Child initials, free text (initials of officer - not more than 4 strings allowed) |
At referral |
|
Is this a planned or emergency home search? |
Please specify whether or not this is an emergency search. |
Planned/Emergency |
Planned |
Boolean |
Dropdown options - Planned, Emergency |
At referral |
|
Latest date for placement to start by |
What date does the child need to find a home/be placed by? If no exact date specified, please add an approximate. |
Date |
30-Mar-24 |
Date |
Date format (DD/MM/YYYY) |
At referral |
|
Number of siblings to place with |
How many siblings does the child have to be placed together with? If child has no siblings/does not need to be placed with siblings, then input 0 |
Number |
2 |
Integer |
Free text (only whole numbers allowed) / Dropdown with options (0, 1, 2...) |
At referral |
| Location(s) of search |
Preferred location for home search |
Which area do we want to find a placement in? Free text for data entry for now, we will explore how to structure without creating excess work. |
Free text |
Taunton |
String |
Free text |
At referral |
|
Primary family location (postcode sector - e.g. GL71) |
Which area does the child's primary family reside in? (Leave blank if information unavailable/confidential) |
Postcode |
TA1 |
String |
Free text (plus postcode sector - optional) |
At referral |
|
Is it recommended to find a home close to the primary family location? |
Does the SW deem it appropriate for the child to be close to their primary family? In case they are required to visit the family very often etc. |
Y/N |
Yes |
Boolean |
Dropdown - Yes/No |
At referral |
|
Does child go to school currently? |
Does child currently attend school? If the child is not of school age, please select "Not applicable". |
Y/N/Not applicable |
Yes |
Categorical |
Dropdown - Y/N/Not applicable |
At referral |
|
School location (postcode sector - e.g. GL71) |
Which area is the child's current school located at? |
Postcode |
TA1 |
String |
Free text (plus postcode sector - optional) |
At referral |
|
Does the child need to continue to attend this school? |
Does the child need to continue to attend this school? |
Y/N |
Yes |
Boolean |
Dropdown - Yes/No |
At referral |
|
Are there other location(s) of importance for the child that the child needs to visit regularly? |
Does the child have other locations such as extracurricular activities, grandparents' house, etc., that they would require to visit regularly? |
Y/N |
Yes |
Boolean |
Dropdown - Yes/No |
At referral |
|
Please specify which location |
If applicable, please enter the detail of the location of importance |
Free text |
Football training |
String |
Free text |
At referral |
|
How often does the child need to go to other location of importance? |
Please enter how often the child needs to be at the location of importance |
"Options: daily, few times a week, weekly, every two weeks, monthly, other" |
Weekly |
Categorical |
Dropdown options |
At referral |
|
Are there any locations to avoid? |
Is there a risk to the child if they are in certain locations, or might they pose a risk to others by being in a certain location? |
Y/N/Not specified |
No |
Categorical |
Dropdown - Y/N/Not specified |
At referral |
|
Location(s) to avoid (leave blank if not applicable) |
If applicable, please enter the location to avoid |
Free text |
|
String |
Free text |
At referral |
| Provision requirement(s) |
Communication, language, and learning needs |
Does the child have any communication, language, or learning needs? |
Y/N/Not specified |
Yes |
Categorical |
Dropdown - Y/N/Not specified |
At referral |
|
Specific communication and language requirements |
Please enter all that apply, or none if not applicable. |
"Options: ESOL, BSL, Makaton, Other, None" |
BSL, Makaton |
Categorical |
Dropdown options |
At referral |
|
Adaptation to the home |
Are there any adaptations required to the home to accommodate the child's needs? |
Y/N |
Not required |
Boolean |
Dropdown - Yes/No |
At referral |
|
Cultural needs (e.g., place of worship) |
Any specific cultural needs that the home needs to be aware of? |
"Options: Required, Not required, Other" |
Not required |
Categorical |
Dropdown options |
At referral |
| Provision recommendation |
Who can the child be cared for alongside? |
Are there any restrictions on who else can live in the same home? |
"Options: Solo placement, With other children, Only with older children, Only with younger children, No preference" |
With other children recommended |
Categorical |
Dropdown options |
At referral |
|
Can child live with pets/animals? |
Can the child live in a home with pets or animals? |
Y/N/Don't know |
Yes |
Categorical |
Dropdown - Y/N/Don't know |
At referral |
|
Foster care suitability |
Is foster care the most preferred home for the child as deemed by the SW? |
"Options: Preferred, Suitable but not preferred, Unsuitable, Not specified" |
Preferred |
Categorical |
Dropdown options |
At referral |
|
Residential suitability |
Is residential care the most preferred home for the child? |
"Options: Preferred, Suitable but not preferred, Unsuitable, Not specified" |
Suitable but not preferred |
Categorical |
Dropdown options |
At referral |
|
Supported home suitability |
Is supported home care the most preferred home for the child? |
"Options: Preferred, Suitable but not preferred, Unsuitable, Not specified" |
Not specified |
Categorical |
Dropdown options |
At referral |
|
Minimum adult support ratio |
Please specify the minimum adult support ratio. |
"Options: 1:1, 2:1, >2:1, Standard ratio, Not specified, Not applicable" |
>2:1 |
Categorical |
Dropdown options |
At referral |
| Finance Information |
Total planned weekly cost |
What is the agreed cost of placing a child? (Excluding VAT) |
Free text |
£XX |
String |
Costs (integer values allowed) |
At placement |
| Form Information |
Name of officer filling form |
Please provide the initials of the officer filling the form |
Free text |
JM |
String |
Free text (initials of officer - not more than 4 characters allowed) |
At referral |
|
Date of form filling |
Date of when this form was completed |
Date |
09/04/2024 |
Date |
Date format (DD/MM/YYYY) |
At referral |