Referral Download a referral form here or complete the form below. Date submitted Eligibility Criteria Please check that you can tick yes to all of the questions 1 – 5 below before you make a referral. 1. Are there children between 0-18 years old AND living in Camden? YesNo 2. There are no other key workers, social workers or lead professionals providing intensive support to the whole family YesNo 3. There are family support AND financial inclusion advice needs YesNo 4. The child/ren in the family have or have experienced at least one of the following problems. You must be able to tick at least one of the following: Behavioral problemsEmotional or mental health difficulties or at risk of deterioration of mental healthVictim of bullying, isolation or damaging family relationshipsDisability, long-term health problem, or special educational needsDisruption due to construction of High Speed 2 Rail Line 5. The parents/guardian in the family can be described as at least one of the following. You must be able to tick at least one of the following: Long-term or currently unemployedHaving a disability/learning difficulties/long-term mental or physical illnessHomeless, threatened with homelessness, or living in overcrowded housingSingle parent or recently separated familiesNewly arrived in UKRefugee, traveller and black/ethnic minority communitiesExperiencing or past drug and alcohol abuseExperiencing or past domestic violence Please note that we will not take referrals where we believe there is a need for statutory assessment, monitoring or casework where we think there are ongoing safeguarding concerns or risks or where children may be suffering or at risk of suffering significant harm (based on current thresholds criteria for Children’s Services – LB of Camden). We will carry out a risk assessment for all referrals received including requesting information from referrers. All casework will be conducted in accordance with those risk assessments and controls identified as well as ERC protocols for staff safety. Family details Parent / Guardian Surname First name Date of birth Address Post code Home phone Mobile phone Language(s) spoken Ethnicity Children Please enter details of the eldest child first First name Surname Date of birth Gender -+ Language(s) spoken Ethnicity/ies Any disabilities or support needs Referrer details (if this is a self-referral, please go to the next section) Contact name Job title Organisation name Address Post code Phone Mobile phone Email Referral details What is the reason for the referral? (Please include any strengths that the family has or particular concerns.) Is there any other support that you think that would benefit the family? Permission Has the parent given you permission to make the referral? YesNo Can we contact the family directly? YesNo Please sign Services We have several family support services at Elfrida Rathbone Camden. So we can best direct your referral, please tick the service most suited to your need. Parenting ProgrammesCreative TherapyFamilies Together Project (Family Support)Support for families affected by the High Speed 2 railway construction (Family Support) Δ
