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Referral to Childrens Social Care Services

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					                              HALTON BOROUGH COUNCIL
                              CHILDREN & YOUNG PEOPLE’S DIRECTORATE
                              REFERRAL & INITIAL INFORMATION RECORD

                              REFERRAL TO CHILDREN’S SOCIAL CARE SERVICES
(A) Child in Need Referral - the referral form must include the written consent of the person with parental responsibility for the
child/ren, for the sharing of information with other agencies.

(B) Child Protection Referral - All child protection referrals must be discussed with the Duty Officer, at the time the concerns
come to light. The referral form must be completed subsequently and sent to the Duty Officer within 48 hours of the verbal referral
having been made. The parents/carers consent should also be sought. However, if this should create or increase risk of immediate
harm to either child or referrer, consent should not be sought. If consent is refused the referral should be made anyway. This must
be discussed and agreed at point of telephone referral with Duty Officer. The exceptions to seeking consent will be any referral
where Sexual Abuse or Fabricated and Induced Illness is suspected, in this instance there should be no discussion with family
prior to referral to duty officer.

What is a child protection Referral?
Section 47(1) of the Children Act 1989 states that: Where a local authority have reasonable cause to suspect that a child who lives,
or is found, in their area is suffering, or is likely to suffer, significant harm, the authority shall make, or cause to be made, such
enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard or promote the
child’s welfare.

    Referral Details                                            CareFirst ID
    Referred by:                                                Agency/Relationship to child

    Address

    Post Code                            Tel No                     Mobile No                       Email

    Date of telephone Referral if applicable



    Child/Young Person’s Name and Address

    Family Name                                   Forename(s)                               DOB:                      M         F

    Address:

    Postcode                           Tel No                                  Responsible
                                                                               Local Authority

    Current address (if different from above)

    Postcode                                                               Tel No:




     Please complete all sections of this form, incomplete referrals will not be accepted/
        returned. Please contact the Duty Officer is you need to discuss the referral.




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  Child/Young Person’s Ethnicity, Nationality, Religion and Communication Needs

  Caribbean            Indian            African           Pakistani              White British            Not given

  White and            Chinese           Black             White and              White Irish              White and
  Black                                  African           Bangladeshi                                     Asian
  Caribbean

  Please specify if                                        Child’s first                        Parent’s first
  Other background                                         Language                             Language

  Nationality

  Muslim                  Christian             Hindu           Buddhist           Other (please specify)

  Is an interpreter/signer required?           Yes         No               Has this been arranged         Yes         No




  Child/Young Person’s Principal Carers
  Name                Relationship to child/young person                                           Parental Responsibility
                                                                                                           Yes       No

                                                                                                            Yes        No


  Other household members (including non-family members)
  Surname                       Forenames                   DOB                  Relationship            Also          CareFirst
                                                                                                       referred?
                                                                                                          Y/N




  Significant others who are not members of child’s household
  Name                          Relationship                Address                                                    Tel No




  Key Agencies (please tick if currently working with the family)
                Name                           Tel:                                  Name                        Tel
  GP                                                                   HV
  EWO                                                                  Nursery
  School                                                               Police
  School                                                               YOT
  Nurse
  CAMHS                                                                Com Paed
  Other                                                                Other


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Reason for Referral/Request for Children’s Social Care Services
Please use the following headings to structure your referral and identify how a referral to Children’s Social Care will
address the issues you have highlighted and lead to an improvement in the situation



1.Development of child - health, behaviour, family relationships, etc




2. Parents and Carers- safety and protection, emotional warm, stimulation




3.Family and environmental – functioning and well being




4. Please outline the services that have been provided, eg CAF to address these issues prior to this referral.




Summary of Reasons for Referral




Please confirm the person with parental responsibility signed the attached consent form?         Yes     No
(Exception to this being risk of immediate harm to child/adult, or were sexual abuse or fabricated/induced illness is
suspected.)

Have you discussed this referral with your line manager?                                           Yes      No

Name of Manager/Supervisor:




Signed:                                                       Date:


Referrers Name (PRINT)

    Please complete all sections of this form, incomplete referrals will not be accepted/
       returned. Please contact the Duty Officer is you need to discuss the referral.


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                                       HALTON BOROUGH COUNCIL
                                       CHILDREN AND YOUNG PEOPLE DIRECTORATE

                                       CONSENT FOR INFORMATION SHARING

Obtaining and sharing information from other agencies is an important part of the Assessment
Process, as it gives a fuller picture of your child’s circumstances and needs. In addition, other
professionals may be able to offer services and support.

To do this we normally need your agreement and the agencies we may need to contact are listed below:

Education Service                                                     Health Visitor
School                                                                Hospital Consultant
School Health                                                         Other Hospital Staff
Housing Directorate                                                   Child & Adolescent Mental Health Services
Probation                                                             Police
GP                                                                    DSS
Others (please list)                                                  Voluntary Organisations (please list)




Declaration

*I agree to the sharing of relevant information between any of the agencies referred to above for
the purposes of assessing my child/children’s needs or

* I agree to the sharing of relevant information between the agencies referred to above for the purpose of assessing my
child/children’s needs except

(Delete whichever does not apply)


Child’s Name                                                                          DOB:

Name of person with Parental Responsibility

                                                     Yes            No
Has Complaints Form been given?

Signed:                                                                               Date:

This consent applies until Social Services’ current involvement with your child/children ceases. If
during this time you wish to withdraw your consent of any agency, please inform your Social
Worker.

                                         Thank you for your co-operation




Version 1.3.1                                Page 4 of 7                                      May 2007
FOR COMPLETION BY CHILDREN’S SOCIAL CARE SERVICES
(this page must be sent to the referrer)


Child/Young Person’s Name and Address                      Referred by:

Family Name                                 Forename(s)                       DOB:              M   F

Address:

Postcode                               Tel No                Responsible LA

Current address (if different from above)

Postcode                                                     Tel No:

Outcome of Referral

Allocated to Social Worker/Support Worker:

Referred to other source:

Referred to Social Care Resource:

Referred for Common Assessment:



Services no longer required/appropriate

Reasons




If you require any further information in relation to this referral please contact the
allocated worker or the duty officer on 01928 704341




Version 1.3.1                                Page 5 of 7                             May 2007
FOR COMPLETION BY CHILDREN’S SOCIAL CARE SERVICES (part 2)

   Other Social Services cases associated with the child/young person
   Name                                                                CareFirst ID


   Name                                                                CareFirst ID




   Summarise detail of previous Children’s Services’ involvement


   Child/ren subject to Child Protection Registration?   Yes        No


   Child/ren previously on Child Protection Register?    Yes        No


   Child/ren previously Looked After?                    Yes        No


   Child/ren on Disability register?                     Yes        No




   Referral Details
   Referrers                                        Agency/Relationship to child
   name:

   Address


   Post Code                   Tel No                      Does referrer wish to remain anonymous   Yes   No

   Method of referral          Letter          Telephone           In person



   Reason for Referral/Request for Social Services




Name of staff member completing this referral                                            Team
Pass to manager for Decision for Action within 24 hours




Version 1.3.1                               Page 6 of 7                                  May 2007
Administration

   Decision for Action – Please note: ensure referral is collated with previous referrals or files
   Provision of             Yes          No                  No further action   Yes          No
   information/advice
   Referral to other agencies (please specify)

   Simple Service provision (please specify)

   Initial Assessment to be completed by

   Signature of Manager                                        Date:



Action to be taken
                                        Action                                                       By When




Allocation Details

Allocated to                                                 Team                          Status           SW
                                                                                                           CSW

Name of Manager                                              Date




Review Arrangements

The completed Assessment should be reported to the Manager within the indicated timescale.
The case will be audited and reviewed on a regular basis within Supervision arrangements established in the Social
Workers/Support Worker’s Supervision Contract.




Version 1.3.1                                  Page 7 of 7                               May 2007

				
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