Shropshire County Council Needs Assessment (Adapted for Presentation)
Outreach Assessment Family support
Record Date Person recording information Contact details
Contact How contact was made Referral from agency Referral from family or neighbor Self-referral
Family Details Relatives/care providers Relationship to consumer Services provided Address and contact details
Health General health of consumer Physical development (child) Communication Mental health Family and social relationships
Parenting Basic care ensuring safety and protection Emotional warmth and stability Guidance boundaries and stimulation
Family and Environment Family history, functioning and well-being Larger family Housing, employment and financial considerations Social and community elements and resources
Actions Arising from Assessment Services that have been provided Involvement of individual in self-help Involvement of family, friends, community, or other service agencies Names, types of services, and contact information
Review Case reviewers involved Date to be reviewed Name and title of person preparing assessment