Referrer Family Background Needs Additional Submitted

Submit Request for Involvement Record CONTINUE Requesting Agency/Organisation Request Date: Contact: Position: Agency/Org: Address 1: Address 2: Town: Barnsley Doncaster Huddersfield Rotherham Sheffield Wakefield Worksop County: South Yorkshire North Yorkshire West Yorkshire Nottinghamshire Postcode: Email: Tel: Mobile: Manager: Lead Practitioner (if different from above) Contact: Position: Agency/Org: Address 1: Address 2: Town: Barnsley Doncaster Huddersfield Rotherham Sheffield Wakefield Worksop County: South Yorkshire North Yorkshire West Yorkshire Nottinghamshire Postcode: Email: Tel: Mobile: NEXT Family Family Name: ADD FAMILY Address 1: Address 2: Town: Barnsley Doncaster Huddersfield Rotherham Sheffield Wakefield Worksop County: South Yorkshire North Yorkshire West Yorkshire Nottinghamshire Postcode: Reason for request: PREV NEXT Background Information History/Background: Other Agencies ADD AGENCY Housing Provider: CPP/CIN: PREV NEXT Family's Support Needs Housing: Keeping room / home safe, clean and tidy Past or present problems with neighbours Notices or evictions / Risk of homelessness Arranging repairs Rent arrears Finance: Paying rent Claiming benefits Paying bills Clearing debts Budget planning Support networks: Family links Friends Other social networks Isolation Domestic abuse Offending Behaviour management Getting support from other agencies Meaningful use of time: Training Education Employment Interests Literacy needs Help with language Accessing child care Diversity: Cultural needs Religious needs Personal preferences Health and well being: Getting a doctor Getting a dentist Carer for a family member Addictions Exercise Hygiene Diet Adult SEND needs Physical health Mental health Hoarding Bereavement Children and School: Educational Attendance CIN Involvement Behaviour CPP Involvement Exclusion Sleep routines SEND needs Meal routines CSE Concerns Morning routines CCE Concerns Misconduct: ASB Police Involvement Trauma: Domestic Abuse Asylum Seeker Sexual Abuse Refugee Physical Abuse Victim of modern slavery Emotional Abuse Are they pregnant? No Yes Due Date: PREV NEXT Impact of Request If you hadn't requested involvement for the family to The Family Works Programme, what would you have done to support the family? Family Engagement Do the family positively engage with services? No Yes Willing to engage with the support from The Family Works? No Yes Are you as the requester happy to facilitate a warm intro: No Yes Please note that if the answer is 'no' to any of the above questions, the request is unlikely to be accepted Risk Assessment In your professional opinion are there any issues / concerns we should know about concerning the household which may impact on the health & safety of our lone working staff and volunteers? Eg specific household members, pets, visitors to the household, known Police concern etc. Please note that if this is left blank we will not be able to work with the family Data Protection Has the family consented to this request? No Yes We are committed to protecting any personal information we hold about individuals. We will follow the principles outlined in the General Date Protection Regulations 2018 for processing that information in accordance with our Data Protection Policy. For more information please see our privacy policy on our www.thefamilyworks.co.uk website. General Notes PREV SUBMIT RIR Your Request for Involvement Record has been submitted SUBMIT A NEW RIR