Referral and Assessment: Youth and Families Worker – Family Relationship Service Program
Counsellor: Maire Barron, BSocSc
Social Futures - 16 Keen St Lismore.Ph: 02 66201 803 Mobile: 0429216841 Fax: 02 66201 899
Date of Referral:19/06/2016
Client Details:
Clients full name: Click here to enter text.DOB: type date or use calendar option
Address: street address, suburb and post code
Phone: mobile and homePermission to text ☐Email: Click here to enter text.
Emergency person and relationship: Name and relationship
Emergency person contact details: mobile, email, home phone
Who do they live with if different from emergency contact: name and relationship
Other organisations involved: organisation, contact persons details
Do you identify as Aboriginal ☐ Torres Strait Islander: ☐Culturally and Linguistically Diverse : ☐
Do you have any children and if yes what are their ages: Click here to enter text.
Additional Information:
Disabilities: ☐, Financial issues: ☐, Legal issues: ☐, Alcohol and Other Drugs☐,
Domestic and Family Violence: ☐, Mental Health Concerns: ☐, Relationship issues: ☐,
Emotional Wellbeing: ☐,
Additional informationfrom above checked boxes: Click here to enter text.
Information about current situation: Click here to enter text.
What are the reasons this client is wanting this service:Click here to enter text.
Referrers Details:
Referrers name: Click here to enter text.
Relationship with client: Click here to enter text.Organisation: Click here to enter text.
Main focus of your support: Click here to enter text.
Contact Details: mobile, email, work phone
Consent to refer: ☐
Outline of the Youth and Families Worker – Family Relationship Service Program
Who can apply? Anyone aged between 10 – 24 yrs and/or their families
How to Apply? Use this form and email: or fax 02 66201899
Info about the Sessions: the service is free and we aim for six sessions @ 50min each, although the amount of sessionsand duration of sessions can be extended in some circumstances.
What happens in a counselling session? The young person or family bring in an issue that they have been having some difficulty dealing with. This could be; anxiety, depression, drugs, abuse, anger, relationships, parenting, school, or feeling overwhelmed. Sometimes someonejust wants a safe space to talk.
The first session will be supporting you to tell your story and talk about what’s going on in your life. The following sessions you will be supported to explore what’s important to you, assist you to find other ways to feel, act and respond that are more helpful and healthy. We will support you to move closer to what’s important to you. The counsellor may offer referrals to other specialist agencies if necessary.
Funding is provided by the Federal Department of Social Services: Family Relationship Program
NRSDC acknowledges the Traditional Owners of the land where we live and work and their continuing connection to land, water, sea and community. We pay respects to Australia’s First Peoples, to their unique and diverse cultures, and to Elders past, present and future.