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High Impact Families Programme Referral Form

Family Composition

Surname / First Name(s) / DOB / Ethnicity
(see below) / Parent / Child
Address(es) / Owner/Landlord
(Council/Social Housing) / Tenancy Status (i.e. secure/at risk/ rent arrears) and details
Name and National Insurance Number / Name and National Insurance Number
Contact Telephone Numbers / Contact Email Address

Reason for Referral

See criteria listed at the back of this form

Criteria: / Family Member / Comments (e.g. benefits in receipt of / exclusion details / offending / ASB / local criteria etc)
Parents and/or children involved in crime or anti-social behaviour
Children who have not been attending school regularly
Children who need help
Adults out of work or at risk of financial exclusion and young people at risk of worklessness
Families affected by domestic violence and abuse
Parents and children with a range of health problems
Organisations involved with Family / Name and Contact details
Doctor (GP)
Health visitor/Midwife
Mental Health Services
Probation Service
Youth Offending Service
Alcohol and/or Drugs Service
Academy / School Representative
Police
Housing
Employer
Local Authority(Include relevant department)
Benefits Agency
Citizens Advice Bureau
Voluntary Organisation
Other
Self defined Ethnicity Key
Please circle code
Description / Code / Description / Code
British / W1 / Indian / A1
Irish / W2 / Pakistan / A2
Any other White background / W9 / Bangladeshi / A3
White and Black Caribbean / M1 / Any other Asian background / A9
White and Black African / M2 / Caribbean / B1
White and Asian / M3 / African / B2
Any other Mixed background / M9 / Any other Black background / B9
Chinese / O1 / Not Stated / NS
Any other ethnic group / O9
Referrer Details
Name:
Position held:
Organisation/Agency/Department:
Contact:
Address:
Date:

Please return this referral and any supporting documents to:

You do not need to submit the following criteria list – this is for your information

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January 2017

High Impact Families – Indicators

1. Parents and Young People involved in crime or anti-social behaviour
Suggested Indicators / Suggested Information Source
Children (u18) who have committed a proven offence (including out of court disposals) in the last 12 months / Youth Offending Service Teams; Police
Children or adults who have received an anti-social behaviour intervention (or local equivalent measure) in the last 12 months / The Police; ASB Teams; Housing Providers
Prisoners who will have parenting responsibilities on release who are less than 12 months from the end of their sentence or those already subject to supervision following release / Probation Providers (National Probation Service and Community Rehabilitation Companies)
Adult offenders who have parenting responsibilities and currently serving community sentences / Probation providers
Parents or children referred by professionals because their offending behaviour is of equivalent concern to the indicators above. / Police; multi-agency gang units; probation providers; Senior Organised Crime Partnerships; Integrated Offender Management Teams; CHANNELL Co-ordinators
2. Children who have not been attending school regularly over the last year
Suggested Indicators / Suggested Information Source
Children who are persistently absent from school for the last 3 consecutive terms (currently measured as missing 15% of sessions. Threshold will reflect DofE metric) / Local school census data
Local alternative provision census data
Education Welfare Officers
Children with min. 3 fixed term exclusions in the last 3 consecutive terms
Children who have been permanently excluded from school in the last year
Children who are in alternative provision for behavioural problems
Children who are not on the school roll / Local education records (e.g. reconciling HMRC child benefit records with school rolls)
Children referred by education professionals as having school attendance problems of equivalent concern because they are not receiving a suitable full time education / Teachers; education welfare officers etc
3. Adults out of work or at risk of financial exclusion, and young people at high risk of worklessness
Suggested Indicators / Suggested Information Source
Pre-Universal Credit, an adult in receipt of out of work benefits. Under Universal Credit, an adult who is claiming UC and subject to work related conditions / Automated DWP information sharing system; information provided by Troubled Families Employment Advisors (subject to DWP’s continuation of these secondment arrangements)
\young people who are about to leave school, but have no / low qualifications and (at risk of being NEET) / Local information sources, including personal learner records, info collected for the alternative provision census and pupil level key stage 4 data
Young people who have just left school but are NEET (15,16,17 year olds) / DfE’s Client caseload Information System – young people identified as NEET, whose activities are ‘not known’ and who are not registered on the system; Automated DWP info sharing offer – 16 / 17 year olds claiming hardship loans
Parents and families referred by professionals as being at significant risk of financial exclusion (e.g. those with problematic debt; those with significant rent arrears) / Referrals from Citizens Advice Bureau; Money Advice Service; Job Centre Plus etc.
4. Families affected by domestic violence and abuse
Suggested Indicators / Suggested Information Source
Victims known to local services that are experiencing domestic violence, are at risk of domestic violence or have experienced / Referrals from local domestic violence services (e.g. CAADA; Women’s Aid; and IDVA’s); housing providers; health and YOT’s
Families where a members of the household has a history of perpetrating domestic violence in at least the last 12 months / Local Police data; local domestic services
Police call outs for domestic incidents in at least the last 12 months / Local Police data; MASH information; MARAC data
5. Children who need help
Suggested Indicators / Suggested Information Source
Children who have been identified as needing early help /
  • Children who fail to attend the early years foundation check / cross reference with the two / two and half year health checks
  • Children who do not take up the early years entitlement
  • Children identified in the School Census as having social / emotional mental health problems
  • Children who have been reported missing from home and identified as of concern (e.g. local information on ‘safe and well’ checks, Independent Return Interviews)

Children who have been assessed as needing early help /
  • Children repeatedly assessed by Children’s Services, but not deemed ‘in need’
  • Children referred to a multi-agency team who are assessed as requiring support
  • Children assessed using Early Help Assessments (or equivalent)
  • Children being assessed by a Team around the Child, a Team around the Family, or a Team around the School

Children in need under s.17, Children Act 1989; children who have been subject to a section 47 enquiry; and children subject to a Child Protection Plan /
  • Information and commissions from children’s social care. This does not replace the statutory responsibilities of social workers

Children referred by professionals as having problems of equivalent concern / Referrals could include schools, social workers, early years providers, health visitors, education psychologists, school SENCO’s Youth Offending Teams, Police
6. Parents and children with a range of health problems
Suggested Indicators / Suggested Information Source
Parents and children with mental health problems including where they are not receiving specialist treatment and children with conduct disorders / GP’s, Community Mental Health Services, Child and Adolescent Mental Health Services
Adults with drug and alcohol problems who have parenting responsibilities / National Drug Treatment Monitoring System (subject to DH data sharing protocol)
New mothers with problems. These should include mental health, substance misuse and other signs of poor parenting risks / Referrals from health visitors / midwifes, including mothers who are assessed as needing Universal Partnership Plus; Local Child Health Information System (subject to DH data sharing protocol)
Families referred by health professionals as having mental and physical health problems of equivalent concern. (e.g. unhealthy behaviours, resulting in problems like obesity, malnutrition, diabetes) / Referrals from GPs, midwives, health visitors, family nurses, school nurses, drug and alcohol workers, mental health workers etc.

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January 2017