Youth Support Team Early Help Request Form
Complete the form and send to either:
- or
- Fast Track Team at 48 London Road, Gloucester GL1 3NZ
- If you wish to talk to someone about your referral you can call 01452 547540 however you will still need to complete a referral form to action a request.
If the concerns are of an urgent nature, i.e. a child appears to require immediate protection, contact:
- Children & Families Helpdesk (8am – 5pm) 01452 426565
- Emergency Duty Team (5pm – 8am)01452 614758
Young Persons Details
Name / Date of Birth (D.o.B) / Age / Religion
School/College/Training Provider / Language / Interpreter Required / Ethnicity
Yes / No
Disability/Special Needs: / Gender
Current Address:
Postcode: / Telephone No:
Family Composition
Name / Age/DoB / Relationship to Young Person / Ethnicity / Member of the Household / Telephone No. (parents)
Yes/No
Yes/No
Yes/No
Yes/No
Awareness and Consent
I understand and consent to this referral being made, on my behalf, to Gloucestershire Youth Support Team (YST).
I accept that, in order to support me, the YST will securely and confidentially hold my personal information.
This information may be shared with other services outside of the YST if the YST feel that there is another partnership agency (Social Care or Families First for example) that may be able to provide support if the YST are not able to.
I accept that the YST have a legal duty to share my information if there are concerns of harm from others towards me (safeguarding).
Please understand that the Youth Support will not contact a young person who is not willing to engage in this referral.
Is young person willing to engage with this referral process? / Yes / No / Don’t KnowYoung person signature
Young person’s full name
Is parent/carer aware of request / Yes / No / Don’t Know
Parent/Carer Signature if appropriate/required
Parent/Carer full name and contact number
If ‘No’ to any of the statements above, please state your reasons (i.e. Your decision made to override the need for consent):
Requestor Details
Name of Requestor: / Agency/Role:
Email Address: / Telephone:
Postal Address: / Current Date Submitted:
Other Agencies/Professionals and GP involved with the young person/family
Name / Agency (Are they the Lead Prof/Agency?) / Role / Contact Details
Referring Agency/Professional involvement with young person/family
Is this young person currently open to your service? / Open/Closed / Date of closure:
What continued support are you providing to the young person?
Reason for request
Reason for Referral (please tick all those which apply) stating the nature of concern or perceived risk.
Substance Misuse
Low Level CSE, Keep Safe, Emotional Resilience
Anti-Social Behaviour
Crime Prevention
What outcomes are you seeking for this young person in relation to the above?
All requests for a service and general enquires will go through the Fast Track Team. A request for service will be considered and we try to respond to the referrer within five working days. We may respond in any of the following ways:
- We will return any request for services without the young person’s consent or if the form is incomplete
- We may not feel we have a role to play in which case we will contact you and let you know why. We will only make contact with the young person and their family if we feel we have a role to play. Otherwise we expect the referrer to notify the young person and their family of the outcome of the request
- We may signpost you onto other services/organisations
- We may already be working with the young person in which case we will let you know who the worker is and share your request for a service with them
- We may agree to meet the young person and offer a triage at which point we will agree the next steps with the young person and their family and we will let you know what has been agreed
- If a young person is NEET (post year 11) we will allocate a NEET worker
CONTACT: Fast Track Team 01452 547540
Document owner:Kate Langley
Published on:02/11/2017
Version: 1.0