1. Shropshire County Council
Needs Assessment
(Adapted for Presentation)

2. Outreach Assessment
Family support

3. Record
Date
Person recording information
Contact details

4. Contact How contact was made Referral from agency
Referral from family or neighbor
Self-referral

5. Family Details Relatives/care providers Relationship to consumer
Services provided
Address and contact details

6. Health General health of consumer Physical development (child)
Communication
Mental health
Family and social relationships

7. Parenting Basic care ensuring safety and protection
Emotional warmth and stability
Guidance boundaries and stimulation

8. Family and Environment
Family history, functioning and well-being
Larger family
Housing, employment and financial considerations
Social and community elements and resources

9. 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

10. Review Case reviewers involved Date to be reviewed
Name and title of person preparing assessment