You may wish to have a consultation with an Early Help Social Worker or Senior Primary Mental Health worker prior to making a referral for additional targeted support. To arrange a consultation ring 0345 678 9021.
Please send this completed form, with a Webstar Score and any other assessment to;Compass, Mt McKinley, Anchorage Avenue, Shrewsbury Business Park, Shrewsbury, SY2 6FG
Fields marked with an * are mandatory. Others may be left blank providing this information is included in the accompanying assessment
Date of referral*Name of Referrer / *Organisation / *Contact Details
*Name (of child/ren or young person/s) / *DOB/EDD / *Age
*Name of parents/carers
Address of parents/carers
(if different to child’s)
*Telephone Number
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1)*Please confirm there isconsent for information being shared and used for purposes of providing services to the child/young person and their family.
YesNo
2)*Please confirm who this referral has been discussed and agreed with.
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Parent
Young person
Child
Other (please specify):
Early Help Referral Form v6.2 Nov 151
Signature of child/young person/parent/carer (please indicate) ______
Print Name:______Date: ______
Please confirm that the signature has been obtained
3)*What current assessment information are you sending in to support this referral?
*A copy should be sent with this referral form if Compass has not already been sent one
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Family Webstar Assessment
Individual Webstar Assessment
Asset / Onset
Social Work Assessment
Self-Harm / Suicide Prevention or other SSCB approved assessment tool
Education, Health and Care Plan
Other, please state:
Early Help Referral Form v6.2 Nov 151
Whole Family Action Plan
Social Work Plan (LAC/CP/CiN)
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Please note all assessments should be accompanied with a webstar score
4)What is the reason for your referral (what do you hope to achieve for this child/youngperson)?
5)What do you want the outcome (goal) of the intervention to be for the child/young person and how will you know when it has been achieved?
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6)*Which specific targeted service provider are you requesting?
If you are unsure of the service you require then you MUST book a consultation slot with an Early Help Social Worker. A consultation is requested by calling 0345 678 9021.
If you know which specific service provider you are requesting – please tick the appropriate box
Information about these service providers is available on our website
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EnHance
Children’s Centres
Lifelines
Targeted Youth Support
ParentingPractitioners
**CAMHS
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**Please note if you are requesting a CAMHS Service you MUST have had a recent CAMHS consultation prior to making the request. Consultation is requested by calling 0345 678 9021
CAMHS Consultation Date:Further information on other services and support available can be found by contacting Shropshire Family Information Service 01743 250465
7) *Risk assessments:
You are only required to complete this section if the information is not already indicated on the assessment
Please advise if there are any known risks if a home visit was to be carried out.
Yes No Don’t Know
Details if known:
Please indicate which, if any, of the SSCB priorities/monitoring information this child/young person and family may currently be subject to:Domestic AbuseChild Sexual ExploitationSubstance Misuse
Mental Ill Health Neglect Self Harm:
Neuro-developmental Pathway
For Compass use only
AllocationAccepted by Agency: / Date:
Agency Allocation: / Date:
Allocated workers name
Rationale for allocation non-acceptance
Early Help Referral Form v6.3 April 20161