Blackburn with Darwen Child & Family (CAF) Closure & Evaluation form
Surname
Forename
Alias
DOB/EDD
Section 2: Details of person completing the CAF closure form
Name
Agency
Job title
Tel
Email
Section 3: Closure details
Closure date:
Yes □
No □
Are you the Lead Professional?
If not, please state your role in the CAF process:
Has a home visit been completed prior to closure?
Yes □
If yes, please provide the date of the last home
visit:
If not, then when was the last home visit
completed (date):
1
No □
Gender
Section 1: Details of child or young person
CAF ID
Please tick the reason for closure and then identify all unmet needs and risks and evidence how these have been
addressed within the closure summary
Plan completed: □
Please evidence: (ensure you highlight where you have signposted to other agencies and/or where the child/family continue to
access ongoing support via single or other agencies)
Step up to social care (referral accepted):
□
Name of allocated social worker:
Please evidence reason for step up to social care:
Withdrawn consent:
□
please confirm whether you have:
Stepped the case up to social care as a result of withdrawn consent
□
Yes □
Yes
Stepped the case down (signposted to other agencies) as a withdrawn consent
□
No □
No
Moved out of area □
Have the relevant professionals in the new area been notified that there is a CAF in place for this
child/young person?
Please evidence
Yes
□
No
□
Child Death □
Level of case on the Continuum of Need and Response at point of closure:
1□
2□
3□
4□
Section 4: Signatures
Lead Professional’s signature:
Date:
(LP) Manager’s signature:
Date:
Parent/carer/young person
signature:
Date:
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Section 5: Evaluation - we politely ask that you complete this evaluation form with the family; this is now a
mandatory field. Note for parents/carers/young people - The CAF team are always trying to improve and are looking for your
opinions and experiences. Please help us by completing the following questions:
My worker discussed with me the worries they had about my child(ren)
and asked me what I thought
We agreed a plan of action, that I thought would improve things for my
child and our family
I agreed who the information could be shared with
The detail of CAF/TAF consent was explained to me
Having a CAF made a difference
Not
Satisfied
Satisfied
Very
Satisfied
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Not
Satisfied
Satisfied
Very
Satisfied
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Additional comments:
Section 6: Young person’s feedback (please complete if applicable)
My worker kept me informed
I agreed who my information could be shared with
I agree with what was in the action plan
I was asked about what I thought the problem was and what would help
Having a CAF made a difference
Additional comments:
Safe information exchange and data protection is important to us: We no longer accept hand written closure forms, and request that closure
forms are sent to us electronically (PDF copies of hand written closure forms are not acceptable).
Please send your completed closure form to [email protected] if you wish to encrypt your email and are unsure about this process
please contact 01254 666913/666914 for advice
If you wish to use GCSX secure email; you will need to register your service with GCSX and then contact (01254) 666913/666914 for next steps.
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