About the person I provide care for MY PLAN

T his form is for you and your worker to complete together

We want to understand the caring that you do, how it affects you

We will make an action plan to help you with being a Young Carer

You might also have a CAF (common assessment framework) form – this form gives extra information about caring, and doesn’t replace the CAF.

ConfidentialityThe things written on this form are your personal information. You can decide who to share the information with. If Centre33 are worried that you are not safe, then we might have to share information to keep you safe, but we will always try and tell you first.

The person's What is their What is their Do they have Is their condition Who else helps to care Is anyone working with name relationship main condition? other staying the same, for this person this person (e.g. Nurse, to you conditions? getting better or (e.g. family, friends, Social Worker, GP, getting worse? neighbours)? Support Worker)?

My Name: Date:

Please read the jobs below and put a tick in the box to show how often you have done each of them in the last month.

The JOBS I doMultidimensional Assessment of Caring Activities – Young Carers (MACA-YC18)

Copyright © 2009 Fiona Becker, Saul Becker, Stephen Joseph & Steve Regel. All rights reserved. Developed for The Princess Royal Trust for Carers by Young Carers International Research and Evaluation, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD.

Below are some things young carers like you have said about what it feels like to look after someone.

Never Some of the time All of the time1 Because of caring I feel I am doing something good2 Because of caring I feel that I am helping3 Because of caring I feel closer to my family4 Because of caring I feel good about myself5 Because of caring I have to do things that make me upset6 Because of caring I feel stressed7 Because of caring I feel that I am learning useful things8 Because of caring my parents are proud of the kind of person I am9 Because of caring I feel like running away10 Because of caring I feel very lonely11 Because of caring I feel like I can’t cope12 Because of caring I can’t stop thinking about what I have to do13 Because of caring I feel so sad I can hardly stand it14 Because of caring I don’t think I matter15 Because of caring I like who I am16 Because of caring life doesn’t seem worth living17 Because of caring I have trouble staying awake18 Because of caring I feel I am better able to cope with problems

HOW CARING me Please read each statement and tick the box

to show how often this is true for you.

Positive and Negative Outcomes of Caring – Young Carers (PANOC-YC20)

Copyright © 2008 Stephen Joseph, Fiona Becker, Saul Becker & Steve Regel. All rights reserved. Developed for The Princess Royal Trust for Carers by Young Carers International Research and Evaluation, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD.

Affects

Sometimes Young Carers are proud to care, and enjoy being a carer...

About me and my caring

role

... and sometimes Young Carers can find caring difficult, and feel there is an impact on their life.

MEABOUT

What things do you like to do? Do you do these things as much as you would like to?

Are there some things you sometimes miss out on because of your caring role?

What do you like about caring?

What do you dislike about caring?

What is easy about caring?

What is hard about caring?

How is your physical health? (Sleep, exercise, diet )

How is your emotional health? (Stress, anxiety, self-harm)

schoolABOUT

Sometimes Young Carers can find things difficult in school: Do you ever get

teased, picked on or bullied?

Do you ever get into trouble at school? What for?

What extra help do you get in school?

What do you dislike about school?

How does caring affect your homework/coursework?

How does caring affect your school attendance (e.g. missed days, being late)?

What would you like to do when you are an adult ? College, university, work?

How caring affects me at school

What do you enjoy about school?

Do you get enough support from school?

Tirednesslosing concentration

Worrying about their family member

Being late

Not having time to do homework

Not having anyone to talk to

I am unwell very often and I don’t take good care of my health. I am unwell quite often and only occasionally take care of my health. I am as healthy as most people my age. I am not often unwell, and usually take care of my health. I am hardly ever unwell and I take good care of my health.

How i feel

HEALTH

ABOUT my

Which statement best describes your physical health?

Why did you choose that statement ?

I often feel low and I don’t take good care of my emotional health. I quite often feel low and only occasionally take care of my health. I feel as good as most people my age. I don’t often feel low, and usually take care of my health. I hardly ever feel low and I take good care of my health.

Which statement best describes your emotional health?

Why did you choose that statement ?

Workers notes:

I have many good friends who I can trust. I have some good friends who I can trust. I have only a few good friends who I can trust. I have no good friends who I can trust.

I often see my friends outside of school.I sometimes see my friends outside of school. I rarely see my friends outside of school. I never see my friends outside of school.

How I rate my friendships:

I am very well supported and have someone to go to with any problem.

I have good support and I have someone to go to with a problem.

I have some support and some people to go to if I have a problem.

I have little support and few people to talk to if I have a problem.

I have no support and no one to go to if I have a problem.

FRIENDSABOUT my

And Support

Why did you choose those statements?

Why did you choose that statement ?

How I rate the support I have:

Workers notes:

I have no ambitions for after school/college. I have a few ideas about what to do after school/college but don’t know how to achieve them I have some ideas about what to do after school/college and how to achieve them. I have ambitions for after school/college and need some help to achieve them I have ambitions for after school/college and I know what I need to do to achieve them.

Look back at what we’ve written together. Are there things you would like to change or need help with? You might think about help with caring, help at school, chances to try new things or have more social time.

ABOUT my Future

My hopes for the future

What do I want it to be like in future?

Why?

What could we do to make the change?

Whose help do I need?

What kind of help I might need

Do I give consent for The person that helps What they do to help me Contact details Centre 33 staff to share or the person I care for information with this personSupport the person I care for:

At school:

Keeping me safe:

Support me with my health:

My GP is:

Others (e.g. family/friends):

Are there any other things that make it difficult for

your family?Lack of money?

Lack of transport ?

Housing problems?

If ‘yes’, please explain why?

People who can help me

I am worried that….(e.g…) If this happens, this is the plan… (e.g…)

my WORRIES“I’m worried about what will happen if mum keeps drinking.” What's

the plan and who can help?

”I’m worried about

what will happen if

Dad falls when I’m not there.”

“I’m worried about who I can talk to when I start secondary school.”

“I’m worried about who will look after mum when I go to college/university/work.”

“I’m worried about money.”

I am worried that: If that happens my plan is:

more help and info

babble.carers.org

is a UK-wide online space where young carers can chat, share their experiences and access information and advice in a safe, fun and supportive environment There is a dedicated online support team

who are on hand to answer any questions and offer support and advice via e-mail or one-to-one

webchats. babble.carers.org

Like Babble,

matter.carers.org has been created to provide an online space

for young adult carers aged 16 – 25 to connect, share experiences and access support. The site brings

together young adult carers from across the UK, as well as those who work with young adult carers, via an online space which is safe, and fun. There is an online community team on hand to provide support as and

when needed, by messaging or email.

www.childline.org.uk is a private and confidential service

for children and young people up to the age of 19. You can contact a ChildLine counsellor about anything –

no problem is too big or too small. Call free on 0800 1111, have a 1-2-1 chat online or send an email. They also have a section

with lots of useful advice specifically for young carers.

If you think that a child or young person is at risk of serious harm call the

Social Care Contact Centre immediately. For Cambridgeshire call 0345 045 5203

(8am to 6pm Mon – Fri) Outside of these hours, you can contact the Emergency Duty Team

01733 234 724

www.youthoria.org is a website for young people in Cambridgeshire.

Here you’ll find information and advice when you need it, entertainment and activities when you feel

like having fun and a voice when you want to be heard.

www.samaritans.org provides a 24-hour phone service for anyone who wants to talk about how they are

feeling, day or night. You can talk for as long as you like, as many times as you like.

Call: 08457 90 90 90 You can also e-mail or text them. E-mail: jo@samaritans.org Text: 07725 909090

111999

111 is the NHS non-emergency number. It’s fast, easy and free way of getting advice if someone is unwell. They will ask you some questions to find out what would be the best medical care for you/

the person you care for. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones.

999 is the official emergency telephone number which allows you to contact emergency services (e.g. ambulance, fire brigade, police) for urgent assistance

Also - I’m not sure if this is possible at this stage, but would it be possible to add a table at the back of the document which will be for an action plan (columns would just be something like - what is to be done, who will do it, when will it be done by)? I think I mentioned it a while back so apologies if you’ve already got this on your radar.

my action planWhat is to be done Who will do it When will it be done by