Request Forfamily Innovation Fund (FIF) Early Help Services

Request forFamily Innovation Fund (FIF) Early Help Services

SouthEssex (Basildon, Brentwood, Castle Point, Rochford)

Version 3. September 2016

If you are working with a child, young person or family who need a little bit of extra help you don’t need to wait for things to get worse before considering other options because these FIF Early Help services have been commissioned by Essex County Council to respond to low level needs of children, young people and their parents and carers.

Most people’s needs are usually best supported by those who already work with them for example, children’s centres, schools and GPs but sometimes they may need a little bit of extra support when a difficulty occurs. When that happens you can make a request to FIF Early Help Services or, parents/carers and young people over 13 years can refer themselves.

The only people who can’t use FIF Early Help services are those already working with specialist support services such as for example the Emotional Wellbeing and Mental Health Service (EWMHS), Family Solutions or Social Care because that is exactly what FIF Early Help services are aiming to prevent happen.

Section 1 - Referrer details

Name of person completing this form
Organisation (if applicable)
If self-referring who told you about us
Contact Telephone
Contact Email
Best time to contact
Alternative contact

Section – 2 - Person being referred The main family contact needs to sign consent beside the person being referred, unless they are 13 or over in which case they can sign themselves (see section 4.)

First Name / Surname / Age / Date of Birth / Ethnicity / School/education or workplace / Consent (if over 13)
Name ofmain family contact
Relationship to person being referred
Signature of main family contact
Contact telephone numbers
Young person contact (only if over 13)
Family address:
Postcode:
Emailaddress:
Others family members
First Name / Surname / Age / Relationship orRole
Are there any disability of learning needs to be considered for the person being referred
Are there any heritage, cultural or religious needs (include language) to be considered for the person being referred

Section - 3 - Reason for referral and request being made

Please indicate the issue(s) causing you or the person(s) being referred and some details about those concerns
Risky behaviours
Aggressive behaviours
Challenging behaviours
Relationship breakdowns
Conflict within the family
Emotional distress
Social isolation
Other
Select just oneEarly Help service and when the form is complete email or fax securely to the service with the consent form / Tick / Desired Outcome(s)
Parenting Support
The Children’s Society
Tel: 01245 493311
Fax: 01245 491400

Counselling
Open Door
Tel: 01268 906230
Tel:01375 390040

Mediation
Open Door
Tel: 01268 906230
Text 01375 390040

Coaching(14+ & parents/carers)
Southend YMCA
Tel: 07552 350434

Mentoring(8+ & parents/carers)
Southend YMCA
Tel: 07552 350434

Young People Risky Behaviours
The Children’s Society
Tel: 01245 493311
Fax: 01245 491400

Please tell us what you or person referred has done to address this problem already
Please tell us about other help that is in place now or has been in the past to address the problem
Has any other help been requested for this problem (for example school, GP, health visitor, friend)
Record here the views of the person being referred and what they want toget from the help
Concerns and/orrisks:record here anyconcerns/riskswe should know about beforecontacting thefamily/individual:

Office use only

For declined or signposted requests

√

Comments

Help requested does not deliver against the need identified

Should be met by Level 1universal services

Should be met by level 3 intensive services

Should be met by level 4 intensive services

Signposted to (including other FIF Early Help services)

Other

Section – 4 - Consentto access and share information
Thissection should besigned bya family memberwith parental responsibility or a person overthe age of13.
Please read/notecarefully andthensignand datetheform.Ifyou have concerns pleasediscussthemwiththepersonworkingwith you. You can note any limit/restrictions in the box ifappropriate

Iagreethatto the person making or taking the referral that they may check with other services and professionals for information about me/my/our child(ren) that helps make a decision about this referral and that I/we receive the right support.
Iagreethat personalinformation aboutme/us/mychild(ren)maybe sharedwith Essex County Council, help evidence the effectiveness of the my/our involvement with this service, during and after my/our involvement.
IunderstandthatI have the righttorestrictwhatinformationmaybe shared and with whom.
IunderstandthatImaywithdrawmyconsenttoshare information atanytime but that might resultin a reduction ofservicesbeing available.

Information I do not want to be shared:
Signed Date
For the Referrer/Provider
Is the person able to understand why their information may be shared and are they able to make a consent decision on this basis? (Please tick and complete A or B or C below).
A ) YES and I have explained to the person/their representative:

Their right to withdraw consent at any time.
Why we may need to share information and their right to restrict that information
Who we may need to contract to check for information with – for example, School, GP, Social Care, EWHMS, Early Help Hub and other VCS providers.
That in some cases we may share information without consent in order to safeguard the vulnerable, to prevent crime and/or if ordered by a Court

B) I am unable to judge this and have referred this matter to
C) No, because

THIS SECTION TO BE LEFT WITH THE FAMILY

Section - 5 -FrequentlyAsked QuestionsaboutInformation Sharing

Why we share personalinformation - Sharing personal information helpsustowork togethertosupportchildren,young people andtheirfamilies and carers. But,itisimportanttorememberthat ifyou don’t letusshare yourinformation,thiscould delayor preventyoufromgettingthe help you need.

Ichoosewhat personalinformationisshared aboutme - Mostofthetime we will tell you whatinformation we mightneedto passonandwho we need to passit on to. Thetypesofinformationto beprocessedmayinclude:Name, DateofBirth,Gender,Address,and relevant informationto inform assessment.Ifthere issomething thatyou don’twantustopasson aboutyou then wewon’t.Please tell theperson working with you.

Sometimeswe have to share personal information aboutyou withoutasking yourpermission,forexample:

•Ifwe are worried aboutthe safetyofa child, young personorvulnerable adult;

•Ifwe think thatacrime may be prevented orfoundout bysharingit;or

•Ifa court orderismadein criminal orlegal cases

Isayno

•You can askusnottopassyourpersonal information toanyone else at anytime

•You can saynoatfirst.You can alwayschangeyourmind lateron

•Orifyou sayyesyou can also changeyourmind later on

The benefits of sharingyour personalinformation

•Itwill help usmake surethat you gettherightsortofhelp

•You canquicklyfind out aboutthe different typesofhelp available to you

•Youwon’tbe askedforthesameinformation lotsoftimes

Howwesharepersonalinformation - So thatwe can safelyshare yourpersonal information,someorganisationsin EssexsuchasEssexCounty Council,Health andthepolice have signed anagreementcalledWhole Essex Information Sharing Framework (WEISF). Thismeansthatallthe organisationsthat have signeditmustprotectyour personal information. Fordetails ofthe charterand the organisationsinvolved,ask thepersonthatisworking with you oryou canfind iton the internet at Essex partnership portal

You can see what is on you record - Ifyou wanttocheckyourown recordortalkto someoneabouthow safe andconfidential yourpersonal information is,you should talk tothepersonwho isworkingwith you.

Data Protection: Forindependent advice aboutdata protection, privacyand data sharing issues,you cancontactthe Information Commissioner’s Office,Wycliffe House,WaterLane,Wilmslow,Cheshire SK9 5AF. Tel: 01625 545745or 08456 306060Fax:01625 524510 Website:

1 | Page July 2015