Parent Carer Assessment DateDo you live in County Durham? *Yes This form is for those based in Durham only. If you're looking for the Darlington mini site, please click here.Details of Registered Parent CarerFirst nameSurnameDate of birthRelationship to Child/renAddressPostcodeTelephone NumberEmailDetails of Other Parent/CarerFirst nameSurnameDate of birthRelationship to Child/renTelephone NumberEmailRelationship to the child/renYesNoDoes this person consent to register?YesNoAlready registeredChildren under 18yrs in the householdNumber of children under 18yrsChild/renName of childDate of birthAgeSchoolAdditional Need (brief details)Please list any other adults living in the household and their relationship to the child/renHousehold member/sNameAgeRelationship to child/renDoes the family have current support from a social worker or one point/family worker?YesNoState worker’s name:State worker’s team:Does the parent consent to PCNA being shared with worker named above?YesNoBackground of Caring rolePlease provide a description of your situation – consider the difference between the help and support your child needs over the support a similarly aged child without additional needs would be expected to need. Include your child’s diagnosis (if there is one), development and any issues with education. Outline the tasks you carry out and the extra support you provide to your child. If you have more than one caring role please give details.Practical Support Personal Care This includes any help you provide to your child/ren to maintain their personal hygiene and includes things like washing, bathing, tooth care, makeup, managing periods etc.Do you support, or can you continue to support your child/ren or young person with additional needs with their personal hygiene?They do not need help with thisI can continue to provide the support they need without helpI can continue to provide the support they need, but I have help to meet all their needsI cannot continue to provide this support without any helpI cannot continue to provide this supportIf you provide this support how often do you provide itConstantlyDailyWeeklyLess oftenAdditional questions on personal careDo you provide support to your child/ren or young person to get to the bathroom or toilet and if so how often do you help with this.Do you help with extra tasks at meal times, do you have to encourage or prompt them, do they make healthy meal choice, do they have any to be encouraged or prompted to eat or PEG fed.Do you have to support your child/ren or young person to live in and use the home safely such as moving between rooms, lifting in and out of chairs or beds, locking doors and windows etcYou and your Caring role Knowledge & SkillsPlease provide a brief description of any training or parenting programmes you have attended. If you attend any Peer Support Groups please list here. Do you receive any online support / information? Is there any training or education you would like to take part in?I feel I have the appropriate level of support from servicesStrongly DisagreeDisagreeAgreeStrongly AgreeI feel I can continue supporting my child/ren for as long as they needStrongly DisagreeDisagreeAgreeStrongly AgreeI feel I have enough knowledge and skills around my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeI feel I know I enough about the maze of services to make informed decisionsStrongly DisagreeDisagreeAgreeStrongly AgreeHealth and WellbeingDo your caring responsibilities affect your physical or emotional wellbeing – if so please provide details here.My caring responsibilities are impacting my physical healthStrongly DisagreeDisagreeAgreeStrongly AgreeMy caring role is impacting my mental healthStrongly DisagreeDisagreeAgreeStrongly AgreeI feel that I can cope with any emotional stress I have due to my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeI feel appreciated in my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeI feels I can solve problems within my caring role if I need toStrongly DisagreeDisagreeAgreeStrongly AgreeI feel I would have time to socialise and maintain friendships if I want toStrongly DisagreeDisagreeAgreeStrongly AgreeI get time for myself outside of my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeI feel safe within my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeThe person I care for is safeStrongly DisagreeDisagreeAgreeStrongly AgreeWork, Income & Living Conditions Please make a note of the suitability of home, such as living conditions, managing day to day tasks, risk of homelessness, number of house moves in last 2 years, any antisocial behaviour etc.Do you and any other adults in your household work? Is your household income made up of employment, benefits etc. Do you have any financial worries?I am satisfied with my employment/education levelStrongly DisagreeDisagreeAgreeStrongly AgreePlease make a note of your living conditionsUse this section to give details of yourself and other household members employment status/education level and how you are managing financially.ServicesDo you have any help from other services such as transport, community services, leisure facilities and extra curricula activities and are these suitable? (please make a note of any help you have from other people too)I feel that other services value my caring roleStrongly DisagreeDisagreeAgreeStrongly AgreeFamily & Personal RelationshipsConsider the relationship between you and your child/ren and extended family members. Are you able to maintain good family relationships. Do you have support from other family members?I feel I have a positive relationship with my child/ren with additional needsStrongly DisagreeDisagreeAgreeStrongly AgreeI have good support from family membersStrongly DisagreeDisagreeAgreeStrongly AgreeChoice & Community InvolvementIs your child able to attend activities, clubs or meet with others, with or without your support. Are you able to access public transport to get to places. Can you make choices about your own needs and wishes and those of the child/ren you are caring for. Do you feel you can access local amenities with ease?Details of any services (past or present) involved with the family.Families First (SW)CurrentClosedOne PointCurrentClosedTeam Around the FamilyCurrentClosedOccupational TherapyCurrentClosedPhysiotherapyCurrentClosedCAMHSCurrentClosedSCAT/Neurodevelopmental Assessment pathwayCurrentClosedPortageCurrentClosedPaediatricianCurrentClosedSpeech and Language TherapyCurrentClosedEducational PsychologyCurrentClosedENTCurrentClosedASD teamCurrentClosedDo you have a back-up plan for emergencies?Do you have a plan to ensure the person you look after would still get the help they depend upon if you were not able to provide that support?YesNoIs there anything else you would like to tell usIs there anyone else who helps/supports your child/ren i.e.. Grandparents, family member, adult siblings, friends?Send MessageSave as DraftPlease do not fill in this field.
