Confidential Form B



NAME OF AGENCY: ******** Social Services

ADDRESS: ***************

SOCIAL WORKER Jean ************


(NB This form and the BAAF standard medical form are designed to compliment each other


Factual Information

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

                                                                                                                          Nationality      British

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:


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                         ********                                      ***************



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

  • Indicate the quality of any important relationship to past caretakers, if known

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.

  • has any special pattern of reactions to separation been observed?

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.


3. Education

  • Number and types of schools attended in the past including pre-school experience

Full time placement XX XXXXXX Nursery, XXXXX XXXXXXX Primary School, XXXXXXXXXX Primary, XXXXX XXXXXXX Infants returning to XXXXX XXXXXX Primary School.

  • Indicate any special talents or problems presented at school

M is seen as having great potential. He is conscientious and very hard working. Very good at sports, particularly football.


4. health

  • has the child suffered from any handicap, disability, injury or serious health in the past? (include problems requiring child guidance , speech therapy, dentistry, eye treatment etc...)

No serious problems at all. Slight visual problem corrected by glasses

  • How did the child cope with this? (if known)

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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