Ideally This Form Must Be Completed with Thefamily

Family Group Conference

Request form

Ideally this form must be completed with thefamily,

and they should always be given a copy of the completed form Yes

The purpose of a Family Group Conferenceis:

For the family to hear information from the service providers about the support and service they could offer the family

For the family to consider any concerns about the children/young people and the strengths which exist within their family

For the family to create an action plan that supports the children/young people

For the requesting professional to agree the families plan, and confirm that it does not place the children at risk

For the family to have the opportunity of a review Family Group Conference

The person requesting the service must agree to attend the Family group Conference

Send this request to the Early Help Hub

Please state the service you are requesting in the subject box of your email. This will assist in the triaging of your request.

Telephone enquiries: 01872 322277 Monday to Thursday 8.45am to 5.15pm

Friday 8.45am to 4.45pm

Or visit the website

1. Person requesting the Family Group Conference

Name / Job Title
Address & Postcode / Landline
Team / Agency
Mobile / Email

2. Children/Young People:

Name / DOB / Gender / Ethnicity/first language
Address & Postcode
Name / DOB / Gender / Ethnicity/first language
Address & Postcode
Name / DOB / Gender / Ethnicity/first language
Address & Postcode
Name / DOB / Gender / Ethnicity/first language
Address & Postcode

3.Carers/Family Members/Friends:

Name / Relationship to child / Address & Postcode / DOB / Ethnicity/first language / Tel Number & Email

4. Other Professionals involved:

Name / Job Title / Agency / Tel Number & Email

5. Are there any known risk factors (people, pets, property and location) that FGC Coordinators need to be aware of when visiting family members? Yes/No? If 'yes' please give details.

6. What are the child’s or young person’s wishes?

7. A brief description of the current situation

As part of the safety plan what ‘concerns’ would the FGC address

8. What is working well for the family and what do they hope the FGC will achieve?

9. What question(s) does the Family Group Conference need to address

Is there anything which could not be agreed in the family plan(bottom line)?

Are any of the Children/Young People;

SEN statement or pendingYesNo Subject to a CP PlanYes No

'Looked after' by the LA Yes No A Young CarerYes No

Subject to court proceedings Yes No Subject to a CAFYes No

Subject to a Chin Plan Yes No Early Help Services Yes No

If yes, please give details. Also please give details of any particular needs of anyone to be included.

Any Other Information:

Parent/carer / Parent/carer
Young person's
Person requestingFGC signature: / Print name: / Contact No:

Consent

Ensure consent is obtained from the family for a Request and for sensitive information to be shared with professionals in the Early Help Hub. Please note anybody over 13 years, who is deemed competent, can give their own consent. This may be with or without parental consent.

By ticking this box, you are confirming that the following verbal consent has been given: “I agree to this request and to my information being shared with agencies who are part of the Early Help Hub response”:

Name of person giving consent ______Date ______