Ala Mai Pasifika
Early Childhood Assessment & Plan Form
Assessor's Information
Assessor's Name
*
Child Information
Child's Name
*
Ethnic Group/s Family Identify with:
Date of Birth
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Month
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Day
Year
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Part 1
Family Foundation/History
Considerations: Place of family origin, key people in the family, where is the child’s place in the family? extended family, support networks etc.
Family Culture/Practices
Considerations: What is usual practice for the family? Do they follow their traditional practices? What are their values & beliefs?
Family Goals & Aspirations
Considerations: Identify goals & aspirations, identify barriers for achieving them, who would be involved? What would it involve? What would it mean for them? What are their goals for the child/children?
Family Environment
Considerations: Social, Economical, Educational, Health.
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Part 2
About
Name of Child
*
First Name
Last Name
Considerations: Current age, developmental stage, language, what they like/don’t like, how often child away from family? Who child close to etc.
Education
Considerations: Are they in an ECE? Have they attended an ECE before? How long? Did they enjoy it? Are they still attending? How often?
Health
Considerations: is there any health concerns? immunisations? Other health checks done? On any medications? Nutrition issues?
Social
Considerations: how does the child get on with other children? Their siblings/cousins etc, is child comfortable being away from Mum, Dad, people they familiar with?
Family’s Goals & Aspirations for their Child
Considerations: What do they want to happen so that their goals & aspirations for their child can be achieved? What supports do they need? Who can support them to achieve these? What can they do? What is within their means?
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Formulation: Assessment Outcome
Considerations: Family’s strengths, child’s strengths, identified barriers to achieving goals & aspirations:
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Plan:
Considerations: Family Education Plan (if applicable), Child Education Plan, Identify support pathways etc
Timeframe:
Reviews:
Outcome:
Brief Comment Below if "N" or "Partial":
Plan Achieved:
Yes
No
Partially Completed
Date:
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Month
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Day
Year
Staff Signature
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