Referral

Download a referral form here or complete the form below.

    Eligibility Criteria

    Please check that you can tick yes to all of the questions 1 – 5 below before you make a referral.


    YesNo


    YesNo


    YesNo


    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


    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

    Children

    Please enter details of the eldest child first


    Referrer details (if this is a self-referral, please go to the next section)

    Referral details

    Permission


    YesNo


    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)