Children and Family Services

Make a Referral

We passionately believe that every child and young person has the right to achieve their full potential, irrespective of their background or circumstances; we offer a variety of services to support families.

Whilst we put the child first in our service planning, we also recognise the importance of the parent/s and family circumstances.

Family Carers offers a range of expert services to children and families -

Expert Assessments of Children and Families
Family Assessment and Support Intervention
Contact between Children and Their Parents and Family
Work with Parents

Our Services Span the following range:

Children with disabilities, learning or physical.
Children with complex care needs
Families where the parent/s are living with long term or on-going health difficulties
Family Assessment
Family Group Conferences
Contact between children & parents/families
Direct Work with Parents or Children

Our philosophy embodies holistic and compassionate care. Our staff are expert practitioners who are rigorously checked for the quality of their expertise and the safety of their practice.

Make a Referral

Please complete this form to make a referral for our child contact/supervision services

We will contact you after assessing the form

Person who is completing this form)

Name

Role

Address and postcode

Telephone

Family Members
Details of all the family members

Total number of Family Members

First Family Member Name

Age

Date of Birth

Gender

Ethnicity

Second Family Member Name

Age

Date of Birth

Gender

Ethnicity

Third Family Member Name

Age

Date of Birth

Gender

Ethnicity

Fourth Family Member Name

Age

Date of Birth

Gender

Ethnicity

Fifth Family Member Name

Age

Date of Birth

Gender

Ethnicity

Family Details

Who does the child live with?

Who has parental responsibility?

Adult with Whom the Child Lives

Name

Relationship to child(ren):

Address

Postcode

Ethnicity

Telephone

Mobile

Does the adult with whom the child lives with have a live in partner? Please mention name if yes.

Adult with Whom the Child Does Not Live

Name

Relationship to child(ren):

Address

Postcode

Ethnicity

Telephone

Mobile

Does the adult with whom the child lives with have a live in partner? Please mention name if yes.

Has this referral been seen and approved by both parents? Please ensure it has when making a self referral or referral by a solicitor.

Signed Referrer:

Position

Choose Services

Indirect Contact

Indirect Contact post box Indirect Contact support (session with child) Indirect Contact support (session with parent with whom the child lives) Indirect Contact support (session with parent staying in touch with the child)

Direct Contact

Supervised Contact Supported Handover

Other Sessions

Preparation for Contact Children Preparation for Contact Parents Dispute Resolution work

Proposals for Sessions

Number of Sessions required

Frequency of Sessions

Preferred start date to commence

Who will bring/collect the child?

If the parents and other adults involved in the sessionsare not willing to meet please indicate why (court orders, domestic abuse etc).

Are any other adults and or child(ren) allowed to be in the contact sessions?

Names of adults:

Relationship to child(ren):

Names of child(ren):

Relationship to child(ren):

What is the overall aim of the contact?

Please comment on the following:

Adults’ views / expectationsof referral/any contact

Children’s views / expectations ofreferral/ any contact

Previous Contact

When and where did contact last take place?

Who was involved in this contact?

Why did it breakdown?

Has this family ever used another centre?

Yes No

Name of centre and dates used:

Why did the contact end at this centre?

Do any of the children or adults involved in the sessions have any special needs or requirements relating to illness, impairment, allergies, special needs or other?(please specify)

Children

Adults

Are there any specific diversity needs? Please specify if yes.

Will an interpreter be required?(Only professional interpreterscan be used)

Yes No

Language Spoken

Who will provide and pay for the interpreter?

Court orders
If there is a court order for this referral, please provide following information

Name(s) of child(ren) or adult(s) to whom the order relates:

Type of order (child arrangement, care, residence, contact, parental responsibility, specific issues, prohibited steps, injunctions or other), please specify:

Court making order

Date order made

Date of next court hearing

Previous Convictions / Findings of Fact
Please give full details of any offences or findings of fact involving children, domestic abuse, sexual offences, drugs, arson and firearms.

Name of adult to whom conviction relates

Nature of conviction

Details of conviction

Date of conviction

Local Authority Involvement
Does one or more local authority Children’s Services Departments know the family? Present or Historical involvement. Specify following if yes.

Name of authority

Name of worker

Child(ren) involved

Nature of involvement

Dates of involvement

Are any of the children involved in the sessions currently subject to a Child Protection Plan or other Local Authority involvement? Specify following if yes

Child(ren)’s name(s)

Children and Family Services

Family Carers offers a range of expert services to children and families -

Our Services Span the following range:

Our philosophy embodies holistic and compassionate care. Our staff are expert practitioners who are rigorously checked for the quality of their expertise and the safety of their practice.

Please complete this form to make a referral for our child contact/supervision services

We will contact you after assessing the form

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