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YOUNG VOICES SUFFOLK ADVOCACY REFERRAL FORM

(This page will be used as case file front sheet when a referral is actioned)

Case No (office use only):
Date Form completed:
NAME (of person being referred):
DOB: Sex: M/F Ethnicity:
Address:
Tel No:
School: Teacher: Class:
Parent/Carer:
Address (if different from referred person):
Name of Referrer (if not a self referral)
Contact Details:
Relationship to referred person:
Language/preferred communication methods:
Any Access Requirements:
RISKS TO PERSONAL SAFETY – Detail any information needed to ensure the safety of the advocate and the referred person, including risk management procedures in place: THE ADVOCATE IS UNABLE TO PROCEED WITH THE REFERRAL UNLESS THIS SECTION IS COMPLETED.

SELF-REFERRAL ONLY

NAME:
Please describe the issues you would like the advocate to work on with you:

THIRD PARTY REFERRALS ONLY

(Please ensure you have completed page 1 of this referral form)

PERSON REFERRED:
Is the referred person aware of the advocacy referral? Y / N
Has the referred person requested the referral for advocacy? Y / N
Contact details of key professionals working with the client. For example:
Social Worker:
Keyworker:
Connexions:
Psychiatrist:
Physiotherapist:
SALT:
Other:
See our attached ‘Guidelines for Referral’ and outline the reasons why you feel the referred person would benefit from an advocate at this time:
Signature: ______(Referrer)
Date:______
Signature of client:______
Date: ______
Please send or e-mail your completed referral form back to
VoiceAbilityYoung Voices
E-mail: Fax: 08452412577
Post: Young Voices Suffolk, VoiceAbility Advocacy Service, Claydon Court, Claydon, Suffolk, IP6 0AE.

Young Voices Suffolk, VoiceAbility Advocacy Service Referral Guidance

This is an information sheet for referrers to help clarify what the advocacy service can offer. Please take into account the following points when considering whether a referral is appropriate and to help when explaining advocacy to people you want to refer.

One-to-One Advocacy is….

 Empowerment – both the process and outcomes of advocacy seek to empower people to have greater control over their own lives. If someone is able to self-advocate then we will not undermine their ability to speak up for themselves and will support them to do this.

 Securing Rights – ensuring people know their rights and have these upheld.

 Giving people informed choices – “it’s this or nothing!” is not a choice.

 Issue-specific and time-limited – once the issue is resolved, the advocate ends the relationship so they can work with someone else.

 Independent of service provision – VoiceAbility is a voluntary organisation working to create positive choice for disabled people and people with mental ill-health through training, client involvement and advocacy projects.

One-to-One Advocacy is NOT….

 Taking Over an Issue – the advocate and service user together form a plan about how the particular issue is to be addressed. The advocate is also not there to replace other professionals.

 Telling someone what to do – advocates support people to make their own informed choices, given all the facts. They do not make any decisions for the person they are working with.

 Befriending or support work – advocates do not get involved just because someone wants someone to talk to, or to perform any care tasks.

 Just for people who can talk – people who do not verbally communicate also need advocacy. In these cases we either identify appropriate methods of communication or follow a Watching Brief approach.

 A mediation service – an advocate is independent but not impartial. We are overtly there to be on the side of the person we are representing.

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