Specific Agency Referral Form (Sarf) & Guidance Notes

SPECIFIC AGENCY REFERRAL FORM (SARF) & GUIDANCE NOTES

1. WHEN A SARF SHOULD BE USED

1.1 The SARF is used to access a single service. The services accessible via SARF are:

· Behaviour Support Service (BSS)

· Education other than at school – health related needs (EOTAS)

· Education Welfare Service (EWS)

· Educational Psychology Service (EPS)

· Ethnic Minority Achievement Service (EMAS)

· Integrated Youth Service (IYS)

· Specialist SEN Service (SSENS)

· Speech and Language Therapy Service (S&LTS)

· Spurgeons Young Carers in Wiltshire

· Traveller Education Service (TES)

1.2 The SARF should not be used if:

· A child is of pre-school age. The CAF should be used to access the Early Intervention Team for Under 5s and the wider Early Years Childcare Team.

· The child is of pre-school age and needs a referral to Speech and Language Therapy. Please follow the relevant links at http://wiltshirechildrensservices.co.uk/speech-language-therapy/information-for-referrers/support/request-criteria-speech-language-therapy/

· A child or young person has a mental health difficulty. PCAMHS provide a single point of access for routine referrals to all Child and Adolescent Mental Health Services via the Pathways website www.wiltshirepathways.org.uk

· The needs of the child or young person are not clear or well understood. Use the Common Assessment Framework (CAF) to explore all aspects of the issues of concern.

Please note that referral to the Sensory Impairment Service (SIS) by SARF is being considered. Referrals to SIS can only be made by health professionals.

If there are child protection concerns, the Wiltshire Safeguarding Children Board procedures should be followed immediately – view them at www.swcpp.org.uk.

2. CONSENT

2.1 Information should only be recorded on a SARF with the knowledge and permission of the parent/carer or the young person if appropriate. Children and young people should not sign a form if someone with parental responsibility has done so on their behalf.

2.2 Consent must be informed. The person giving the consent needs to understand why the information needs to be shared and with whom. In cases where it impossible to gain informed consent due to language barriers referring agencies should contact EMAS for advice on 01225 757901 or at

2.3 In most cases the form must be signed by the parent/carer or the young person if appropriate. This is not necessary if the case is a referral to Education Welfare Service.

2.4 Consent does not guarantee a service. If a service does not become involved, feedback will be given to the referrer to explain the reasons.

3. GUIDE TO COMPLETING DIFFERENT SECTIONS OF THE SARF

Child/Young Person’s Details - a SARF is a referral related to only one child or young person.

Is there a Child Protection Plan – children will have a child protection plan if there was a decision made by a multi-agency child protection conference that one was required.

‘Looked After’ - refers to whether the child/young person is being looked after by a Local Authority.

Other needs or information – is there anything else about the child/young person it is important for someone to know so they can work with them effectively, e.g. the child/young person has a disability or other languages are used at home.

Level of attainment – this field should be used to describe approximately what academic levels the child/young person is reaching in terms of thresholds and grades. You should include:

· National Curriculum levels/P levels in English and Maths.

· Reading and spelling age where available (name of test and date used).

· Information about their ability to write unaided.

School attendance – attendance at school either as a percentage or a description.

Reason for referral – put as much specific information in here as possible, including any:

· concerns about general health, including physical development and hearing and vision

· issues relating to concerns about emotional and social development, e.g. risking/actual self harm, coping with stress, motivation, confidence, relationships with peers

· barriers to inclusion or independence

For some services (e.g. the Speech & Language Therapy Service) further specific information is required in addition to the SARF (note, if the reason for referral is unclear the CAF process should be used). For all Speech and Language Therapy referrals please visit http://wiltshirechildrensservices.co.uk/speech-language-therapy/information-for-referrers/support/request-criteria-speech-language-therapy/ Details of additional information other services require can be found online at www.wiltshirepathways.org.uk and on the www.wiltshirelscb.org website.

What the parent/carer and child/young person expects – include both longer term expectation of outcomes and immediate expectations around the service’s involvement; if the parents/carers and child/young person expect different things make that clear.

What provision is in place and what actions have already been taken – provide as much information as possible about the current involvement of services and what help is already being provided. For example, some help may have been put in place by the school using delegated funding or Pupil Premium. You can refer to documents you are also sending in to accompany the SARF. Bullet points (with dates when possible) support clarity.

Consent – Please see section 2 on the previous page.

It is important that full information is provided on the SARF form and that additional documents are provided at the time the SARF is submitted. When services need to contact a referrer to seek additional information or clarify needs this may delay service delivery to children and young people. If you are uncertain about what to include please contact the relevant service direct. For Inclusion Service enquiries please contact 01225 718095.

DATE: Updated Jul 17 Page 6 of 6

SARF Version 14

WILTSHIRE SPECIFIC AGENCY REFERRAL FORM (SARF) v13

Please refer to guidance prior to completion - only fill out those sections that are applicable.

Referral to
(Name of Service)
Referrer’s Name
Referrer’s Position / Role
Referrer’s contact details
Signature of Referrer / Date
Child/Young Person’s Details
Surname / First Name / AKA / previous names
Male / Female / Date of Birth / Year Group / First language
Current address
Contact Tel. No.
Name(s) of parents/carers / Parents’/carers’ address (if different from above)
Who has Parental Responsibility? / GP Surgery
Tel No.
Is there a Child Protection Plan in place? / Is the child Looked After?
SEN status (none, school action, school action plus or statement of special educational needs, EHC plan)
Are there any other needs or information which we need to be aware of which might impact upon this referral?
School/Educational Setting
Name of school child attends
Levels of attainment
School attendance record
Reason for Referral:
Why is the referral being made?
What does the parent/carer and child/young person expect to happen as result of this referral?
What provision is in place and what actions have already been taken?
Please remember also to attach key information such as: IEPs/ provision maps, notes of meetings, attendance letters or medical reports with this SARF.
Other services child/young person has previously been referred to or is currently in contact with:
Service

Name of professional

Contact Details

Date Referred

/ Support offered/Outcome

Parental or Young Person Consent for information sharing to support this referral

u We/I understand the information that is recorded on this form and agree that it will be shared with the service named at the beginning of the form and used for the purpose of providing services to the child/young person / me.

u We/I give consent to the involvement of the identified service to share information with other professionals as listed above and to carry out assessment and intervention if appropriate.

Parent /Carer or Young Person’s Name
Parent/Carer or Young Person’s signature
Date

Please send this form plus relevant additional / requested documents to the Wiltshire Council DCE Coordination Team, County Hall, Trowbridge, Wiltshire BA14 8JN.

DATE: Updated Jul 17 Page 6 of 6

SARF Version 14