Details needed for referrals

The referral form covers a number of different areas. This helps us form an holistic impression of the relevant issues for each individual child or young person, to assess the level of risk and what support is currently in place, and to understand the associated difficulties that the child or young person might be facing. Forms with incomplete or limited details may lead to delays in us being able to process the referral, whilst we seek further information from the referrer.

Our referral form asks for information about the following areas:

  • Reason for referral
  • Family structure and circumstances
    (details of birth parents, siblings and current living arrangements)
  • Developmental history
    (e.g. milestones and childhood illness)
  • Educational history
    (including current circumstances)
  • Age of first gender dysphoric or cross-gender experiences and details of these
  • Co-morbidities
    (e.g. mood disorders, autistic spectrum and learning disabilities)
  • Incidents of self harm and suicide attempts
    (with dates, methods and consequences)
  • Other risk taking behaviours
    (e.g. drugs, alcohol)
  • Any known abuse - including domestic violence - and details of these
  • Family health and mental health
  • Significant family life events with dates
    (e.g. miscarriages, separations, bereavements or migration)
  • Experiences of bullying
  • Involvement of other agencies and contact details for these
    (e.g. GP, social services, CAMHS, voluntary sector, supports groups etc)

The form also requests demographic and contact details for the child or young person as well as an outline of your plan for your continued involvement.