Standard Referral Form for Milton Keynes Children’s Contact Centre

Please note that the Contact Centre is staffed entirely by volunteers and is not therefore continually manned.

Administration address: / MKCCC, PO Box 1549, BEDFORD, MK43 6AX
Centre Address: / The Rowans, 13A Moorfoot, Fullers Slade, MK11 2BD

This referral form needs to be completed either by a:

  • Solicitor
/
  • Family mediator

  • CAFCASS officer
/
  • Parent

Please print clearly IN BLACK at all times.

Contact cannot be organised until this referral form has been completed in full and submitted to the Contact Centre Coordinator for processing. Following satisfactory processing and a risk assessment, arrangements will be confirmed by the Coordinator for contact to commence. All referrals are subject to the discretion of the Contact Centre Co-Ordinator.

All information received will be treated in the strictest confidence.

All information relating to the Milton Keynes Children’s Contact Centre is published on the Contact Centre’s web site whose address is mkcontactcentre.org

Only dates and times of attendance will be disclosed, unless it is felt than anyone using the contact centre or a volunteer/staff member is at risk of harm or in accordance with our policies.

A copy of the completed referral form should be signed and either sent:

  • by e-mail to the Contact Centre Coordinator on: , with a one off administration fee of £20 being paid by bank transfer to: Milton Keynes Children’s Contact Centre Sort Code 40:12:19 account number 41477420 with the reference of the Child(rens) surname, or alternatively,
  • by post to: The Contact Centre Coordinator, at the administration address above together with the one off £20 administration fee, made payable to “MKCCC”.

There is a charge for the visiting parent to use the Contact Centre at every session, payable, in cash, on arrival:

  • £15 per session if the visiting payment is in employment
  • £5 per session if the visiting parent is in receipt of benefits (proof required)
  • £5 per handover

The resident parent and child(ren) will be offered a pre-visit, 2 weeks before contact will start. This will enable the children to be aware of where contact with their absent parent will take place and hopefully reassure them and allay any fears or concerns they may have.

Places are offered on a “first come first served” basis; from time to time there is a waiting list.

It is vital for the smooth running of the contact centre that when a “place” is no longer required, the Contact Centre Coordinator is advised as soon as possible. Please note that the Contact Centre operates a “three strikes policy” – if a family (either party) miss three consecutive sessions their place will be removed and offered to another family. The family shall be warned after 2 missed sessions of the consequences. If after three missed sessions a place is still required a further referral, with admin fee, will be need to be made and a place will be offered only at the Contact Centre Co-Ordinators discretion.

The contact centre aims at all times to ensure a safe, happy and relaxed atmosphere at the centre, which will result in contact moving out of the centre when appropriate. The contact centre telephone number is 07591 928588. This is not continually monitored. However, all messages left will be responded to, but not necessarily immediately but within 10 days. Please note that the Contact Centre Co-Ordinator will not act as a “go between” for parents or families and will not pass messages on to others save if it relates to attendance on the day of a scheduled contact session in exceptional circumstances and always at the Co-Ordinators discretion.

Guidelines for Referrers

All communications should addressed to the Contact Centre Coordinator, and either be sent by e-mail to , or by post to Milton Keynes Children’s Contact Centre PO Box 1549, Bedford, MK43 6AX.

Full details of opening are published on the Contact Centre Web site on mkcontactcentre.org but are alternate Saturdays for morning and/or afternoon sessions depending upon availability.

1. Please do not refer a client without contacting the Child Contact Centre Co-ordinator first to check availability of space and time. All referrals are subject to the discretion of the Co-Ordinator – a Court Order naming our Centre will not guarantee a place will be made available as the referral will remain subject to risk assessment and the Centre’s discretion.

2. A completed referral form should be received by the Contact Centre Co-ordinator at least four weeks in advance of the date which your client would like contact to commence. Where a Centre has a waiting list, a completed referral form should still be sent, the centre will then notify you when a place becomes available.

3. Only people named on the referral form will be allowed admittance to the Child Contact Centre. This may be varied by written agreement by both parties provided approved by the Co-Ordinator.

4. Parents are responsible for their children at all times whilst they are at the Child Contact Centre.

5. Please ensure that both parents have read and understood the Child Contact Centre's information leaflet, which is included on the web site at mkcontactcentre.org in advance of contact starting.

6. To try and maintain a friendly, impartial and confidential environment, we would request that
you do not at any time ask to see your clients on our premises.

7. Only dates and times of a family's attendance will be disclosed unless it is felt that anyone
using the Centre or a volunteer or member of staff is at risk of harm. In the unlikely event of it
becoming necessary to quote the Contact Centre Co-ordinator in any written report, due to a Centre user, volunteer or member of staff being at risk of harm, the form of words used should be checked and agreed in writing with the Contact Centre Co-ordinator beforehand.

8. For a fee, payable in advance, a brief written overview of the contact may be provided by the Contact Centre Coordinator. In the event of either a dispute between the parents as to events when using the centre or where an outside agency (such as police and/or local authority) becomes involved due to events when using the centres services then, subject to any safeguarding or legal requirements, a summary of events may be prepared by the coordinator and distributed to the parties to family law proceedings relating to the children of the family subject to the approval and discretion of the Trustees.

9. Child Contact Centres providing Supported Contact will not knowingly accept a referral when
somebody involved has been convicted of any offence relating to a) physical or b) sexual
abuse of any child, unless there are exceptional circumstances and they have sought
appropriate professional advice

10. The Contact Centre Coordinator reserves the right to reduce or terminate contact if this action is felt to be in the best interest of the child. Parents should be informed, that because the welfare of the child is paramount, there may be times when contact cannot take place if the child is too upset, even if there is a contact order.

11. Referrers should make arrangements for the provision of an interpreter where English is not
the first language of the family involved and problems may arise with communication.

12. The Child Contact Centre should be viewed as a temporary facility to help establish contact. The Child Contact Centre will be asking for your assistance to review the family's progress after six months.

13. Please notify the Child Contact Centre Co-ordinator if the arrangements for contact are going
to change or if contact is going to cease, to free up places for other families. Please see the note above concerning the “three strikes” policy. The Contact Centre may, at their discretion, exclude people or families from the centre in accordance with their Exclusion policy.

14. The contact centre operates a policy of zero tolerance of any abusive behaviour towards staff and volunteers.

REFERRAL FORM

Wherever possible, this form needs to be seen and completed by both parties solicitors and any other professionals involved with the family
Contact cannot commence until this form has been completed in full and received by the Contact Centre Coordinator
All information will be treated in the strictest confidence
Please print details clearly in black ink / For Contact Centre Use Only
Referral
Date of pre-visit
Date of first contact
Dates reviewed
Contact ended
Admin fee received
1. Children
Full Name(s): / Date of Birth / Boy=B Girl =G
2. Adult requesting contact
Full Name:
Relationship to child(ren)
Address:
Postcode: / Email address:
Telephone: / Mobile: / Fax:
Length of time since: / They met child(ren)
They lived with Child(ren)
Solicitor’s name: / Solicitors Ref:
Name of Practice:
Address of Practice:
Postcode: / Email address:
Telephone: / Mobile: / Fax:
3. Adult with whom the child(ren) resides
Full Name:
Relationship to child(ren)
Address:
Postcode: / Email address:
Telephone: / Mobile: / Fax:
Solicitor’s name: / Solicitors Ref:
Name of Practice:
Address of Practice :
Postcode: / Email address:
Telephone: / Mobile: / Fax:
4. Referrer
Name: / Profession
Address:
Postcode: / Email address:
Telephone: / Mobile: / Fax:
5. CAFCASS, Contact Orders & Contact
Is there a CAFCASS officer? (Please circle) / Yes / No
If yes, please provide details:
Name of CAFCASS officer: Name of CAFCASS office:
Address:
Postcode: / Email address:
Telephone: / Mobile: / Fax:
Where and when did contact last take place:
Is there a court order relating to the contact? (please circle) / Yes / No
If yes, indicate what the court order specifies and provide a copy with this referral form
Are there any other Child Arrangement Orders in relation to the child(ren) or other Orders relating to them? If so please confirm what and when.
Can the child(ren) can be taken out of the contact centre (please circle) / Yes / No
What is the next court date (if any)
6. Arrival at the Contact Centre
Are the parents willing to meet?(please circle) / Yes / No
Will the parent with whom the child(ren) reside be bringing with them to and collecting them from the contact centre? (Please circle) / Yes / No
If No who will be bringing and collecting the child(ren) from the contact centre
Indicate whether a handover session is required
What is the preferred date of the first contact at the contact centre
How frequently will contact take place (please circle) / 2 weekly / 4 weekly
For how long will each visit last? (up to 2hrs 30 minutes)
Names of other people allowed to participate in contact at the contact centre (subject to the prior agreement of the Contact Centre Coordinator)
Name / Relationship to Child
7. Information relating to the safety of the Child(ren)
Are there any sexual/child abuse allegations made in this family? (please circle) If yes, please provide details below / Yes / No
Is the family known to Social Services? (please circle) ) If yes, please provide details below / Yes / No
Has any person who will be involved in the contact every been convicted of an offence against the child(ren) (please circle) If yes, please provide details below / Yes / No
Has there been or is likely to be a risk of abduction? (please circle) If yes, please provide details below / Yes / No
If yes, are procedures in place for holding passports (please circle) / Yes / No
Please details of any allegations, undertakings injunctions or convictions relating to violence involving either party, their respective families or the children.
8. Health and Medical Requirements
Do any of the child(ren) have any illness, allergy, disability, special needs or medical requirements? (please circle) / Yes / No
If yes please give details
Do any of the adults involved suffer from long-term physical/mental illness or disability (please circle) / Yes / No
If yes please give details
9. Additional Information
What language is spoke at home?
Is an interpreter required (please circle) / Yes / No
If yes, please give details of the interpreter being used (including the name and organisation if any)
Has the family ever used another Child Contact Centre? (please circle) / Yes / No
If yes, please give details (this other Centre may be contacted).
Name of Child Contact Centre:
Address:
Postcode: / Email address:
Telephone: / Fax:
Where did contact last take place:
When did contact last take place:
Additional background information (Please use separate sheet if necessary)

I have explained the rules of the Child Contact Centre to my client.

I have read the rules of the Child Contact Centre (delete as appropriate)

This form has been completed accurately and to the best of my knowledge.

Signed ………………………………………………………………………… Date……………………………….

(specify: Solicitor; Family mediator; CAFCASS officer; Parent )

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MILTON KEYNES CHILDREN’S CONTACT CENTRE

REFERRAL FORM (August 2017)