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Thursday 19 October 2017
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West Yorkshire IOM - IOM Assessment

Version: Tk/EM/2/1.0
Author: West Yorkshire Integrated Offending Management

 

Section 1: Assessment Details

Client name: ........................................................................................................................................

  

DOB: ....................................................................................................................................................

 

West Yorkshire district of residence/NFA status: .................................................................................

 

Assessor details 

Name of Worker: .................................................................................................................................

 

Contact Number: .................................................................................................................................

  

Service: ...............................................................................................................................................

 

Designation/job role: ..........................................................................................................................

 

Location of assessment:

  • Community appointment/outreach

  • Police custody

  • Prison

 

Name of Service/Police Station/Prison: ...............................................................................................

 

Date of completion: ............................................................................................................................

 


 

 

Section 2: Current Criminal Justice Status

IOM   Yes ........  No ........                        PPO  Yes ........  No ........                       

                                                              

In prison    Yes ........  No ........   

 

If yes, Offence: ................................................................................................................................... 

 

Prison: ................................................................................................................................................

 

Prison number: ...................................................................................................................................

 

Status of prison detention:

  • Remanded

  • Remanded and convicted, pending sentence

  • Sentenced

 

If sentenced: Start date ..................  Finish date ..................  Total length of sentence: ..................

  

Arrested    Yes ........   No ........   

 

If yes, Offence: ...................................................................................................................................

 

Police Station: ....................................................................................................................................

 

In Community (Complete for individuals assessed both in police custody and in the community)

 

Subject to conditions in the community?   Yes ........  No ........  (If yes, complete below)

 

On court bail   Yes ........  No ........   If yes, Offence: ...........................................................................   

 

Note any conditions of court bail: .......................................................................................................

  

On police bail  Yes ........  No ........   If yes, Offence: ...........................................................................

  

Note any conditions of police bail: ......................................................................................................

  

Subject to community order    Yes ........  No ........   If yes, Offence: ...................................................

  

State community order and/or it condition if known i.e. Drug Rehabilitation Requirement (DRR) etc.

 

............................................................................................................................................................

  

On licence   Yes ........  No ........   If yes, Offence: ...............................................................................

  

Note any conditions of licence i.e. Home Detention Curfew (HDC) or residency at approved premises:

 

............................................................................................................................................................ 

 

Are you subject to any of the following?

  • Anti- social behaviour order (ASBO)

  • Possession hearing

  • Injunction

  • Restraining orders

  

If yes, give detail ................................................................................................................................

 

............................................................................................................................................................

 

............................................................................................................................................................

 

 

Contact with Probation/YOT/DIP services

 

Are you in contact with any of the following services:

 

Probation      Yes ........  No ........

 

If yes, contact details of service and case manager: .......................................................................... 

 

Youth Offending Team (YOT)      Yes ........  No ........

 

If yes, contact details of service and case manager: .......................................................................... 

 

DIP (Drug Intervention Programme)        Yes ........  No ........

 

If yes, contact details of service and case manager: ..........................................................................

 

  

If it is identified in this section that the arrested person has a current Probation Officer/ YOT case manager/DIP case manager – do not complete the remainder of the form as the individual is known to services and there is an existing assessment.

 

Please send sections 1-2 to the IOM Rehabilitation and Resettle hub for the district in which the offender resides in.

 


 

 

Section 3: Form Completion Details

Communication support requirements

 

Client’s first language:  English .......  Other .......  State: ........................................................................

 

Is interpreter required? Yes ........  No ........

 

Does client require any other communication support, eg sign language? Yes ........   No ........

 

If yes, specify ..........................................................................

 

Does the client require an appropriate adult? Yes ........   No ........

 

If yes, note name and contact details of the appropriate adult who is present during assessment:

 

Name: .............................................................................................................................................

 

Contact details: ................................................................................................................................

Confidentiality and consent to share

 

Has the IOM scheme been explained and understood by the client? Yes ........   No ........

 

Has the confidentiality policy and consent to share been explained to the client and understood?

Yes ........   No ........

 

Has the client agreed to the confidentiality policy? Yes ........  No ........

 

Has the client signed the consent to share?    Yes ........  No ........
 


 

 

Section 4: Client Details

First name(s): .........................................................   Surname: .........................................................

 

Alias/name usually known by: ..............................................................................................................

 

Date of birth: .................................... Age: .......................................

 

Gender:  Male ........   Female ........   Other ........

 

Address: ...........................................................................................................................................

 

Postcode: ...............................................   Is this address:   Permanent ........  Temporary ........ 

 

No fixed abode (NFA): ........ 

 

Contact telephone number(s): Home: ............................................ Mobile: ...........................................

 

Can we write to you at the address you have given? Yes ........   No ........

 

Can we leave messages on the telephone numbers you have given? Yes ........   No ........
 


 

 

Section 5: Next of Kin Contact

Would you like to provide details of a next of kin? We will only contact this person in case of an emergency. Yes ........ No ........

 

Name: ........................................................................  Relationship: .................................................

 

Full address: ......................................................................................................................................

 

Contact telephone number(s): ..............................................................................................................
 


 

 

Section 6: Housing

 

Where are you currently residing?   In the community .......  Custody .......  Residential facility .......

 

Do you have access to accommodation in the community?   Yes .......   No .......

 

What are your current accommodation arrangements in the community?

 

A) If No fixed abode (NFA) .......  and one of tick below

 

Sleep on streets .......  Use night shelter .......  Sleep on different friends floor each night .......

 

Other ....... - give details ........................................................................................................

 

B) If temporary .......

 

Staying with friends/family as a short term guest .......  B&B .......  Direct access short stay hostel .......

 

House of multiple occupancy .......  Squatting .......

 

Other ....... - give details ........................................................................................................

 

C) If settled .......

 

Local authority/RSL rented .......  Private rented .......  Approved premises ....... 

 

Supported housing/hostel .......  Caravan .......  Own property .......  Settled with family/friends .......  Other .......

 

 

Who are you living with in the community?

 

Partner .......  Family other than partner .......  Friends .......  Live alone .......  Landlord ....... 

 

Other ....... - give details ........................................................................................................

 

Who is responsible for paying the rent? ....................................................................................

 

Do you have any problems with your current housing situation?  If yes, give details below   Yes ....... No .......

(Consider quality of accommodation, rent or bill payment arrears, relationship with cohabitants, temporary, eviction)

 

 

 

 

Are you claiming housing benefit? Yes ....... No .......

 


 

 

Section 7: Financial Management and Income

General Income

What is your main source of income?

 

Employment .......   Benefits .......   Family or others close to you .......   Criminal activity .......       

 
Other .......   Give details ..................................................................................................................

 

Benefits

National Insurance Number if known: ...............................      Do you have a bank account? Yes ....... No .......

 

Are you receiving benefits? Yes ....... No .......

 

If yes, tick which ones below:

 

Job Seekers Allowance .......   Employment and support allowance .......   Income support .......  

 

Incapacity benefit .......   Disability Living Allowance .......   Carers allowance .......   State pension .......  

 

Industrial Injuries Disablement Benefit .......   Housing benefit .......  

 

Other .......  give detail .........................................................................................................................  

 

Job Centre Plus Office address: .............................................................................................................

 

Do you require any support regarding benefits? Yes ....... No .......

 

If yes, detail support required ...............................................................................................................

 

Debt

Are you in any financial debt? Consider rent/mortgage arrears, fines, loan repayments  Yes ....... No .......

 
If yes, give detail ..................................................................................................................................

 
Are there any financial issues that you are concerned about? Yes ....... No .......

 

If yes, give detail .................................................................................................................................

 

Budgeting

Do you find you usually have enough money to cover your living costs – your rent, bills and food costs?

Yes ....... No .......

 

If no, why do you think this is?
 

 

 


 

Section 8: Employment

What is your current employment situation? 

 

Regularly employed .......   Pupil/student .......   Economically Inactive .......   Unemployed .......  

 

Other .......   Not known .......  


Provide details of current employment situation or occupation ..................................................................

........................................................................................................................................................


If you have worked in the last 5 years what different job roles have you worked in? Give dates and lengths of employment if known: ........................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

 

Would you like any support with finding education, training and employment opportunities? Yes ....... No .......

 


 

Section 9: Education and Schooling

At what age did you leave education? ......................................................................................................

 

How would you describe your attendance to school during your schooling years? 

 

Regularly attended .......   Occasionally attended .......   Rarely attended  .......  

 

Do you have any educational or vocational qualifications?  Yes ....... No ....... 
 

If yes, detail qualifications and dates obtained if known

 

 

 

QUALIFICATION

                                 

 

SUBJECT

                                      

 

APPROXIMATE DATE

OBTAINED