Confidential Form B
NAME OF AGENCY: ******** Social Services
SOCIAL WORKER Jean ************
DETAILS OF CHILD NEEDING FAMILY PLACEMENT
(NB This form and the BAAF standard medical form are designed to compliment each other
Name (underline surname) **** *****
Known as (underline surname-include nickname)
Type of care (i.e.. children's home) Community Home From: 03/12/85
Address: The *******************
DOB: ********* Sex: Male Race: Caucasian
Legitimate XXXXXXXXXXXXXXXXXXXXXXXXXXXXX (delete) Legitimate
Has a religion been specified for child? XXX/No If yes what religion: N/A
Has child been baptized? Yes/No If yes date and place
Weight at birth (if known) N/A Time of Birth:
Legal status of care (delete)
XXXXXXXXXXXXXXXXXX/matrimonial Acts/XXXXXXXXXXXXXXXXXXX (state which and Act concerned/not in care
Section 43 Matrimonial Causes Act 1973 (23/12/87)
pen picture; brief description of child and his personality (Please attach recent photograph)
**** is an attractive child with blonde hair and blue eyes. he is quite bright and exhibits leadership qualities. he is extremely fastidious both in school work and domestic environment. he gets anxious if given a task that he cannot get exactly right. he has normal hobbies for a boy of his age i.e. he plays for the school football team (captain).
Type of placement needed:
XXXXXXXXXXFoster HomeXXXXXXXXX (delete)
Are sibling to be placed with the child? Yes/XX Sister **************
Are religious considerations involved? XXX/No
Are geographical considerations important Yes/XX
II SIBLINGS (mark x preceding name if to be placed with the child)
X Name Sex Date of birth Place and type of care
***** ******* female ******** **************
**** ****** female ******** ***************
III INFORMATION FROM CHILD'S SOCIAL HISTORY
1. Care of child since birth
Dates (excluding present placement) Type of care (i.e. with mother, foster home) Comment on quality of parenting and reason for move
1979 M & J cared for by paternal grandparents Good care - returned to mothers
11/04/80 - 24/04/80 Children RIC fostered XXXXXXXXXXXXXXXXXXXX
10/11/80 - 12/11/80 Children privately fostered XXXXXXXXXXXXXXXXXXXX
27/01/81 - 15/03/81 M only RIC Mother said beyond her control. fostered. XXXXXXXXXXXXXXXXXXXX
01/10/82 - 21/10/82 M & J RIC XXXXXXXXXXXXXXXXXXXX
24/04/85 M & J to XXXXXXXX XXXXXXXXXXXXXXXXXXXX
2. Relationship to caretakers
Sporadically still in contact with natural mother - needs to know she is alright. Likes the occasional visit to natural father. Unquestioning re non-possibility of joining fathers new family. Needs to keep in contact with paternal grandparents.
Denial/anger. M shows signs of introvert - takes some time before he allows his emotions to show but he is very good at illustrating feelings through body language. i.e. when mother visits he sits a long way away from her initially.
Full time placement XX XXXXXX Nursery, XXXXX XXXXXXX Primary School, XXXXXXXXXX Primary, XXXXX XXXXXXX Infants returning to XXXXX XXXXXX Primary School.
M is seen as having great potential. He is conscientious and very hard working. Very good at sports, particularly football.
No serious problems at all. Slight visual problem corrected by glasses
Quite likes the studious professional image his glasses project.
CHILD'S PROFILE (attach additional page if needed)
M was admitted to a children's home on the 3rd December, 1985, from his mother, who said he was beyond control.
M was fairly petite, blonde hair, blue eyes and very under-confident., doing all that was asked of him with no questions asked. m always 'bottled up' his feelings inside and was unable to show his true feelings.
Over a period of months it became apparent that m was a sneaky young lad who could hate to be found out about anything he had done wrong. thus we would end up having a long faced, sulky boy who would not speak. Over the years m has managed to control his moods, though we still get the sulking, but M now speaks up and sound his views. M still finds any form of criticism difficult to accept and often ends up in tears, though these moods do not last very long if he is left on his own.
M has a good sense of humour and enjoys a laugh and a joke. but on occasions can become over the top and does not know when to stop. he has a catchy laugh and can be quite funny at times.
M is a tidy lad who has all his drawers in order., neat and tidy. he loves his cuddly toys, but his heart is set on football, watching, reading and playing.
m is a bright lad who enjoys his comprehensive school, though at first he found that being a small boy in a large school difficult to cope with after leaving his much loved junior school. M mixes well and says he has quite a few friends, though he never brings any back to the home.
When amongst his peers M is quite nasty towards his sister, often hitting her, pushing or just calling her names. On a one to one basis M is the opposite, he will play with her, laugh with her and behave like a normal brother as there is no need for him to be anything but a brother who should enjoy hi sisters company.
A lot of time has been spent with M in the special room, with regards to 'carers responsibility, needs and relationships' within the family. M has found some of the work very painful, but has understood what we have been covering and why.
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