REFERRAL FORM
LEGAL GATEWAY
PART A
TO BE COMPLETED BY THE SOCIAL WORKER PRIOR TO THE MEETING
Social Worker:Service Manager:
Team Manager:
Name of Child: / DOB:
Ethnicity:
Schools:
Health:
Health Visitor:
Rainforest Ward:
Paediatrician:
Mother: / DOB:
Address:
Father: / DOB:
PR?
Any other person with Parental Responsibility:
Name/Address/DOB/Status
Orders/Residence Orders
- CASE SUMMARY
- FAMILY COMPOSITION
2.1Identify all relevant family members and their relationships to the child.
2.2Genogram
3.THRESHOLD
3.1.1Precipitating events
Major incidents in the last three months.
Why are we taking legal action now?
What are the consequences of these incidents for the children?
3.2Background circumstances
Summary of children’s services involvement cross-referenced to the chronology.
Previous court orders and emergency steps.
List any assessments undertaken.
3.3Summary of harm and / or likelihood of harm
Type of harm suffered or at risk of suffering –physical, emotional, sexual, neglect and cause of harm/risk of harm.
Factual evidence in support of case that child has suffered/is suffering harm.
4.PARENTING CAPACITY
Analytical summary of parental capacity to meet needs.
What steps parent/s have taken to date to make the changes expected of them.
Assessment of the prognosis for change.
Can the child’s parent provide a good enough standard of care for the child for the rest of their childhood?
Reference any assessments of other significant adults who may be / have been assessed as carers.
5.CHILD IMPACT
Wishes and feelings of the child(ren) –direct from your assessment.
Refer to hard evidence of physical, sexual, emotional or psychological injury.
Intended outcome for the child.
Timescale to achieve this.
6.EARLY PERMANENCE AND CONTACT
Proposed contact framework set out significant contacts for the child who she or he should continue to see or hear from (in brief –will be in care plan also).
Sibling relationships.
Any impact of changes in placement / circumstances.
7.CASE MANAGEMENT
What has been done to support?
Why has this failed?
Who made decision to issue proceedings and when?
What further evidence is proposed (if any)?
TEAM MANAGER COMMENTS:SIGNED: / DATE:
PART B –RECORD OF MEETING
TO BE COMPLETED BY PANEL ADMINISTRATOR AT THE MEETING
Date of Meeting:Present:
TEAM MANAGER:
SOCIAL WORKER:
LEGAL REPRESENTATIVE:
OTHER(S):
Are the threshold criteria satisfied? YES □ NO □
If so, how? (Give brief summary based on physical abuse / sexual abuse / neglect /
emotional abuse / any other)
Were / are there any previous proceedings (including criminal proceedings) / order / judgements / facts and reasons?
Are there any section 7 reports / section 37 reports / expert reports?
Is an expert required?
If so, which type? / YES □ NO □
Is an order necessary?
If so, why? / YES □ NO □
At what level of court should the case be heard? / FPC □ CC □ HC □
Is the official solicitor required? –Capacity / YES □ NO □
Could / Should the case be ‘fast-tracked’? / YES □ NO □
Any other relevant factors?
Immigration and Nationality
Interpreter
Split hearing
Paternity and DNA testing
Disclosure
Security
Should an application be made for CICA? / YES □ NO □
ADVICE from Lawyer?
DECISIONS OF MEETING
Are care proceedings to be commenced? YES □ NO □
Documents to be provided :-
Document Date to Legal
DSCT on behalf of DMBC –Social work evidence template
If NO provide reasons:
DATE OF PRE-ACTION MEETING (if appropriate):
Date / 05/04/18
Version / Legal Gateway Referral Form Ver 1