AT14 Home Conditions - Questionnaire Page 1 of 5 © Copyright

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Assessment Tool
www.significantharm.com
Home Conditions
What does it do?
A short assessment of the physical aspects of the home conditions and
their impact on the children who live there. The scoring sheet
concludes with an analysis, identification of new needs, decisions about
the level of concern, the child’s emotional and behavioural development
and follow up actions.
How do I use it?
The scale is scored from 0 – 3 for each item and includes an area to
make notes or record evidence. Mark the description that best
represents the conditions in the home and their impact on the child.
If there are different age children relate this to either the subject of
the assessment or the most vulnerable child. The impact will be
greater depending on the age and ability of the child (e.g. a badly
soiled floor will have a different impact on a child who is crawling
compared to an older child). Particular home conditions may prompt
actions (e.g. clearing of rubbish from home) and a subsequent review
would establish whether this improvement has been sustained.
Complete in the family home or office. This may be done in conjunction
with the parent/carer. Otherwise it should be shared with them when
appropriate. The scoring sheet can then be completed with the family
or separately.
The Graded Care Profile is a further assessment tool which can be
used to assess neglect, including home conditions. It provides a more
comprehensive assessment with greater levels of detail should this be
required.
Developed:
This has been developed by Dafydd Paul and Nia Price (Gwynedd ICS
Project) and Bruce Thornton (bruce-thornton.info )
Original source:
Adapted and developed from:
Family Pack of Questionnaires and Scales – The Stationary Office
Language available:
English and Welsh
How long does it takes?
30 to 45 minutes once information is gathered.
Is further guidance available?
Yes
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Home Conditions
Child’s Name
Date of Birth
Worker’s Name
Date Completed
Age
Parent/Carer Name
Client Number
Scale
Smell (e.g. mouldy/rotten food, urine)
1)
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Notes:
Kitchen floor dirty, covered in bits, crumbs, rubbish, animal
faeces etc.
2)
Notes:
Floor covering in any other room dirty, covered in bits, crumbs,
rubbish, animal faeces etc.
3)
Notes:
General decorative order poor – obviously in need of attention
(e.g. stained or damaged walls, broken doors or windows)
4)
Notes:
Kitchen sink, draining board, work surface, cooker, fridge or
cupboard doors dirty.
5)
Notes:
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Cooking implements, cutlery or crockery showing ingrained dirt
and or these items remain unwashed until they are needed again
6)
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Notes:
Toilet, bath or basin broken, dirty or showing ingrained dirt
7)
Notes:
Furnishings or furniture broken, dirty or stained
8)
Notes:
Parent’s or children’s clothing unwashed, smelling or hair dirty
or matted
9)
Notes:
Garden or yard uncared for, strewn with rubbish or containing
dangerous items (e.g. broken bottles or prams)
10)
Notes:
None or little food in cupboards/home
11)
Notes:
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No adequate seating/furnishing (e.g. no chairs or tables)
12)
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Notes:
None or little evidence of toys or play items for the children
13)
Notes:
No beds, mattresses or bed clothes on children’s bed
14)
Notes:
Exposed needles or other drug paraphernalia visible in the
house and/or within children’s reach
15)
Notes:
Rodents or rodent damage to property
16)
Notes:
Hazardous environment ( e.g. broken electrical sockets, no
smoke alarms, lack of safety gates or fire guards)
17)
Notes:
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No basic services (no water in house, no electricity or gas
supply, no heating)
18)
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Does not exist
0
Exists to some extent
1
Noticeable has some impact
2
Very apparent/serious impact
3
Notes:
Extreme clutter or hoarding (e.g. bin bags or clothing or toys
left everywhere, lack of space to play)
19)
Notes:
Pets or animal hazards (e.g. numbers of animals in house,
aggressive or threatening animals)
20)
Notes:
www.bruce-thornton.info
[email protected]