Business Information & Support Officer
Access to Resources Children’s Team
REFERRAL FORM
REFERRAL TO THE ACCESS TO RESOURCES PANEL / CHILDREN IN CARE PANEL / REQUEST FOR PLACEMENT
The core information in Section 1, Parts 1 – 4 must be completed for ALL referrals
Please indicate type of referral by selecting one of the boxes below.
Please complete the relevant parts as stated below
| |Section 1 |Complete Parts |
|[pic] |Placement Request for In-House Fostering |1, 2, 3, 4, 5, 7, 8, 9, 12 |
|[pic] |Request for Parent & Child (information required regarding Parent & Child) |1, 2, 3, 4, 5, 6, 7, 8, 9,10,11,12 (If external 17) |
|[pic] |Request for External Independent Fostering |1, 2, 3, 4, 5, 6, 7, 8, 9,12, 17 |
|[pic] |Request for External Residential |1, 2, 3, 4, 5, 7, 8, 9, 12, 17 |
| |Section 2 |Complete Parts |
|[pic] |Access to Resources Panel |1, 2, 3, 4, 5,15 |
|[pic] |Children in Care Placement Panel |1, 2, 3, 4, 5,16 |
| |Section 3 |Complete Parts |
|[pic] | |17 |
| |Authorisation from SCS Assistant Director for IFP or Residential Placement | |
Please email to: ARTChildrens@.uk
General enquiries: 0300 333 6331
Section 1
|Contract reference | |
|(only to be completed by ART) | |
Part 1 – Referrer Details
|Name of Referrer | | | |
|(if not allocated Social Worker) | | | |
| |Area |District |Team |
| | | | |
|Name of allocated Social Worker(s) | | | |
| |Telephone number |Mobile number |Email address |
| | | | |
| | | | |
|Name of Team Manager |Telephone number |Mobile number |Email address |
| | | | |
Part 2 – Child’s Details
|ICS ID |Name |Date of Birth |Age |Gender |
| | | | | |
|Ethnicity | |
|If other, please give details | |
|Religion | |
|If other, please give details | |
|Practising | |
|Main Language | |
|If other, please give details | |
| |
Does the child have a disability?
(Outline nature of disability)
|Home address | |
|Child’s Status / Legal Status |Date of Child in Need Plan |Date of Child Protection Plan |
| | | |
| | | |
|Category of Child Protection |Date of current core assessment/single |Is the child subject to PLO proceedings? |
| |assessment | |
| | | |
|Current Placement | |
|If other, please give details | |
| | |Must remain at current school |
|Statement of SEN |Date of SEN | |
| | | |
| | | |Year Group |
|Education Setting |Name of School |Address of School | |
| | | | |
Part 3 – Family Composition
|Name of Persons’ with parental responsibility | |
| | |Is there a requirement to place any | |
| | |of the siblings with this child | |
|Name |Relationship | |Address |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
If yes, you will be required to complete a referral form for each child.
Part 4 – Child’s Assessed Needs
| | | |
| | |What is the current Care Plan, also state if |
| |Describe immediate issues/difficulties/strengths)|parents are in agreement with Care Plan? |
|Childs primary needs | | |
| | | |
| | |
| | |
|What are the child/young person’s wishes and feelings and are they in |What other agencies are involved and how are they contributing to the |
|agreement with the plan? |plan? |
| | |
|Placement history (include any breakdowns and disruptions in foster | |
|care/residential/with extended family members) | |
| |Brief Intervention history of what has been tried |
| | |
| | |
| |Details including reasons for ending of previous care episodes (names of |
|Has there been previous care episodes |previous carers and dates of care episodes must be included) |
| | |
| | |
|Has there been more than 3 previous placement moves within the last 18 |Details including reasons for ending of previous placements |
|months | |
| | |
|Are there any equality and diversity issues and how have they been |What are the child/young person’s current and future educational needs |
|addressed e.g. specific diet, mobility, communication methods (sign |e.g. do they have a management plan, is the child receiving full time |
|language, PECS) etc? |education, excluded etc? |
| | |
|What are the child/young person’s current and future health needs e.g. do | |
|they have a diagnosis, allergies, medication, conditions etc? | |
|Does the child receive any therapy or any other medical intervention? If | |
|yes, please give details | |
|Are there any specific behavioural and emotional problems which prospective foster carers need to be aware of e.g. has a child/young person been |
|sexually abused, aggression towards adults/children? |
| |
| |
| |
|Give a brief description of the child, including strengths, attributes, likes, dislikes, activities and interests |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
|BACKGROUND |
|(Details of home/family situation) |
| |
| |
| |
Part 5 – Placement Requirements
Agreement for child/young person to be placed in care
| | |Signature | | |
|Service Manager | | | | |
| | | | |Date |
| | | | | |
|Date of request for placement/service |Date placement/service required |
| | |
|Reason for placement being requested |Anticipated length of placement |
| | |
|Type of placement | |
|Describe any specific skills required by the foster carers | |
|Outline any specific equipment requirements, e.g. hoist, ramps etc | |
Select categories in boxes below
|Category |Category |
| | |
Part 6 – Placement Category (IFP Placements only)
|Select one of the following (If Parent and Child or Residential Migration, this will be “Specialist”) |
|[pic] |Standard |
| |(The child/young person requires consistent boundaries and a highly managed structured environment) |
|[pic] |Complex |
| |(The child/young person requires enhanced risk management or intensive management approaches) |
|[pic] |Specialist |
| |(The child/young person requires additional specialist support in relation to multiple and profound disabilities, complex medical needs,|
| |profound mental health difficulties) |
Part 7– Matching Details
|Does this child need to be the youngest/oldest/same gender? | |
|Has the child experienced loss or change of primary carer in the first 5 | |
|years of life? If yes, please give details | |
|Do the parents/family members pose any risks that the Foster | |
|Carer/Residential Unit should be aware of? | |
Part 8 – Matching Requirements
|Requirements: |If Required: |Any additional information: |
|Placement in specific location (state location and reason) | | |
|Placement with no other children/solo placement | | |
|Placement with no younger children | | |
|Placement with no older children | | |
|Placement with siblings, can share bedroom | | |
|Placement with siblings, but not sharing bedroom | | |
|Placement in an emergency | | |
|Bridge to Adoption placement | | |
|Remand placement | | |
|Short Term placement | | |
|Placement with no pets | | |
|Carers/Residential Unit with experience of disabilities | | |
|Carers/Residential Unit with experience of children who have been | | |
|sexually abused | | |
|Carers/Residential Unit with experience with working with children who| | |
|have experienced sexual exploitation or trafficking | | |
|Contact frequency requirement (state) | | |
|Contact requirement location (state) | | |
|Contact travelling requirement (state) | | |
|Contact supervision requirement (state) | | |
|Carers/Residential Unit with experience of working with unaccompanied | | |
|asylum seeking children | | |
|Carers/Residential Unit who have experience of meeting the needs of | | |
|children with different cultural, religious and linguistic needs | | |
Part 9 - Outcomes
|Identify what outcomes should be achieved whilst the child is in placement| |
|e.g. rehabilitation home within 3 months, requires foster carer to work | |
|with all parties to get child/young person home | |
Part 10 – Parent & Child Placement
|Name of parent(s) who will be in placement | | | |
|with child | | | |
| |Gender |Date of Birth |Ethnicity |
| | | | |
| | | | |
| | |
|Parent(s) home address |Name of persons’ with parental responsibility for parent if child in care |
| | |
| | |
|Please outline reason for placement, include why they are unable to remain| |
|at home | |
|Purpose of placement request e.g. parenting capacity assessment | |
|Agreed duration of placement | |
|Are any other assessments being undertaken? Please give details e.g. | |
|psychological assessment ordered by court | |
|Is the parent(s) a child in care or a care leaver? If yes, please give | |
|details | |
|Describe any specific tasks required of the foster carer e.g. 24 hour | |
|supervision, other child care tasks | |
|Has either parent experienced significant loss or recent relationship | |
|breakdown? If yes, please give details | |
|Give a brief outline of the parent(s) needs, strengths and attributes | |
|Outline any specific physical, religious, cultural, diet, mobility, | |
|learning disability needs of parent(s) | |
|Do the parents/family members pose any risks that the Foster Carer should | |
|be aware of? | |
|Is the parent(s) receiving full time education, training or on any other | |
|programme? If yes, please give details | |
|Name of parent(s) school? (If applicable) | |
|If excluded, please give reasons and time period? (if applicable) | |
|Does either parent(s) require or receive any form of therapy or on-going | |
|treatment for mental health e.g. addictions? If yes, please give details | |
|Financial situation of parent(s) what benefits do they receive? | |
|Are the parent(s) in agreement with the care plan and proposed placement | |
|arrangements? | |
|Additional comments | |
Part 11 - Matching requirements for parents
Requirements If Required Any additional information
|Placement in specific location (state location and reason) | | |
|Placement of child and parent(s) as only placement | | |
|Carers who have experience of meeting the needs of children with | | |
|different cultural, religious and linguistic needs | | |
|Placement with no pets | | |
|Carers with experience of disabilities/learning disabilities | | |
|Carers with experience of children who have been sexually abused | | |
|Carers with experience with working with children who have experienced| | |
|sexual exploitation or trafficking | | |
|Outline any contact arrangements with any family members | |
Please complete the Risk Assessment Form (Part 12).
Part 12a – Risk Assessment
IDENTIFIED RISKS
|Risk: |Current: |Previous History: |Indicate Level of Risk |Brief Details (if applicable): |
| | | |(High, Medium, Low): | |
|Aggression/violence towards others | | | | |
|Criminal/offending behaviour | | | | |
|Any admissions to: | | | | |
|Special Hospital | | | | |
|Y.O.I. (Young Offenders Institution) | | | | |
|Psychiatric Hospital | | | | |
|Preoccupation/ obsession with weapons | | | | |
|Threats to harm others | | | | |
|Bullying | | | | |
|Sexual abusive behaviour to others / risk | | | | |
|to other children | | | | |
|Vulnerability to sexual exploitation | | | | |
|Self harming behaviour | | | | |
|Arson / fire setting | | | | |
|Problems with alcohol or substance misuse | | | | |
|An expression of concern from others about| | | | |
|the risk of violence | | | | |
|Racial abuse / discriminatory behaviour | | | | |
|Allegations against staff / carers | | | | |
|Threatening behaviour in the community | | | | |
|Absconding behaviour | | | | |
|Other | | | | |
|Are there any active factors that indicate an increased risk to others? | |
Part 12b - OTHER AGENCIES / WORKERS INVOLVED
| |
|Give details of involvement |
| |
| |
| |
|What is the child’s/young person’s view of their behaviour? |
| |
| |
| |
|In your professional judgement, is a detailed assessment of risk required? | |
If Yes complete DETAILED RISK ASSESSMENT (Part 12c).
Part 12c - DETAILED RISK ASSESSMENT
If more than one risk is evident complete for each risk
Areas of Risk
|Describe risk event or incident e.g. Where did it occur? Who suffered | |
|harm? Nature of any injuries/abuse? | |
|Approximate date e.g. recent or past event history | |
|Information sources for incident | |
|Context of event | |
|Any known precipitants e.g. motivation, stressors? (include client & | |
|others’ view) | |
|Known triggers | |
|Warning signs and/or settings that trigger risk and time of highest | |
|risk/patterns of behaviour | |
|Outcome of event | |
|What measures / types of intervention are to be put in place to reduce | |
|risk and their effectiveness from client & other’s viewpoint? (See Risk | |
|Management Plan) | |
|What is the likelihood of reoccurrence? | |
Risk Assessment completed by
|Name of Social Worker | |Social Worker’s Signature | |Date |
| | | | | |
|Part – 12d RISK MANAGEMENT PLAN | |
|Management Plan |
| |
|Consider: |
| |
|Nature and degree of risks identified; who is at risk? How likely is it to occur? |
| |
|Relationship between risk, current social circumstances or other contextual factors |
| |
|Factors increasing the risk and protective factors that reduce risk. Previous helpful interventions |
| |
|Client’s, carers’ and others’ views of risk |
| |
|Gaps in information. |
| |
| |
|Guidance for written Plan |
| |
|Location of interviews with child/family/carer |
|Number and status of staff to be present |
|Reporting back mechanisms |
|Who else needs to know about this risk management plan e.g. colleagues, in other parts of department / council / other agencies / carers? |
| |
|Be specific – who, what, when, where and MUST NOTS. |
| |
| |
| |
| |
| |
| |
Risk Management Plans must be reviewed every three months or after any significant incident, whichever is the sooner.
|Risk Assessment review date |
| |
|Completed by Social Worker | |Date |
| | | |
|Authorised by Team Manager | |Date |
| | | |
Part 13 – Placement Offer (ART Officer to complete in conjunction with the Social Worker when placement offered)
|Have the Social Workers for the children currently in placement been | |
|consulted? | |
In-House Fostering Placement
|Name of Foster Carer | |
|Address of Foster Carer | |
|Area in which Foster Carer lives | |
|Name of Supervising Social Worker for Foster Carers | |
IFP Placement
|Name of IFP Provider | |
|Address of IFP Provider | |
|Name of Foster Carer | |
|Address of Foster Carer | |
|Area in which Foster Carer lives | |
|Name of Supervising Social Worker for Foster Carers | |
Residential Placement
|Name of Residential Provider Organisation e.g. Head Office | |
|Address of Residential Provider Organisation | |
|Name of Residential Unit | |
|Address of Residential Unit | |
|Area of Residential Unit | |
Placement Details
|What is the weekly cost of the placement? |£ |
|Weekly costs of any additional services provided? |£ |
|Start date of placement | |
|Review date | |
|End date | |
Part 14 – Matching Requirements Met
|Requirements |Please indicate which requirements have been met by the placement offer |
| |and any additional comments |
|Placement in specific location (state location and reason) | | |
|Placement with no other children | | |
|Placement with no younger children | | |
|Placement with no older children | | |
|Placement with siblings, can share bedroom | | |
|Placement with siblings, but not sharing bedroom | | |
|Placement of child and parent(s) together | | |
|Placement of child and parent(s) as only placement | | |
|Placement in an emergency | | |
|Bridge to Adoption placement | | |
|Remand placement | | |
|Short Term placement e.g. care proceedings | | |
|Placement with no pets | | |
|Carers with experience of disabilities | | |
|Carers with experience of children who have been sexually abused | | |
|Carers with experience with working with children who have experienced sexual| | |
|exploitation or trafficking | | |
|Contact frequency requirement (state) | | |
|Contact requirement location (state) | | |
|Contact travelling requirement (state) | | |
|Contact supervision requirement (state) | | |
|Carers with experience of working with unaccompanied asylum seeking children | | |
|Carers who have experience of meeting the needs of children with different | | |
|cultural, religious and linguistic needs | | |
Please ensure that this section is completed in conjunction with the Social Worker to identify what matching requirements have been met.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- business operations support job description
- business support officer job description
- business it support services
- small business it support services
- small business computer support services
- information security officer job description
- bank information security officer duties
- bank information security officer role
- chief information security officer responsibilities
- chief information security officer requirements
- chief information security officer jobs
- project support officer job description