Referral for Practical Support

Practical support can be offered for those who have experienced a recent bereavement.

Support can be offered in a variety of ways as detailed below:

  • One to one support, with a maximum of 4 sessions available.
  • Guidance on how to access other local and national agencies for support.
  • Telephone Support
  • Access to bereavement group/s if applicable.

The Service is not able to offer support to individuals who have complex Mental Health issues.

Please complete the referral form(enclosed) and fax to 01905 760935, email to our secure email address or post it to Bereavement Support South Worcestershire, C/o St Richards Hospice, Wildwood Drive, Worcester, WR52QT. Our referral form is also available within the ‘Professionals’ tab on our website

On receipt of a referral each individual’s need/s will be assessed by the Service. Those requiring support will be offered up to a maximum of 4 sessions.

If you would like further information or clarification about the referral process, please do not hesitate to contact us on 01905 760934 or visit our website

Referral to the Bereavement Counsellor

Our Bereavement Counsellors can receive referrals from GP’s* for individuals experiencing complex grief responses who require one to one counselling. Referrals will be considered following receipt of the referral form on the basis that the counselling requested is at least 8-10 weeks post death and at least one of the following criteria applies:

  • Bereaved parents or guardians - after the death of a child.
  • Individuals suffering multiple bereavements within the same 5 year period.
  • Individuals affected by traumatic or sudden death.
  • Individuals experiencing complex grief responses.

The Service is not able to offer counselling to individuals who have complex Mental Health issues.

Please complete the referral form (enclosed) and fax to 01905 760935, email to our secure email address or post it to Bereavement Support South Worcestershire, C/o St Richards Hospice, Wildwood Drive, Worcester, WR5 2QT. Our referral form is also available within the ‘Professionals’ tab on our website

On receipt of a referral each individual’s need/s will be assessed by The Service. Those requiring counselling will be offered up to a maximum of 12 sessions.

If you would like further information or clarification about the referral process, please do not hesitate to contact us on 01905 760934 or visit our website

*People registered to a South Worcestershire GP Practice can self-refer into The Service

Referral to the Child and Family Support Practitioner

Bereavement Support South Worcestershire provides an opportunity for children, adolescents and families to share their feelings and develop strategies for managing their bereavement.

We can support children and adolescents on their own or as part of a group. Parents and guardians may wish to access individual support or advice on supporting a bereaved child. This is encouraged before we can embark upon support with the child or children.

This service is provided free of charge to anyChild, Adolescent or Family who:

  • Have experienced a sudden or traumatic death of a close family member or friend within the last five years
  • Require support in their grief only*
  • Parents/Carer’s are willing to engage with their grief to further support their child/children
  • Are registered with a GP Surgery in the South Worcestershire Clinical Commissioning Group (see to see if your GP is a member)

*We are able to provide bereavement support to families where other issues, apart from grief are present, as long as other support (e.g. Family Support Worker) is in place.

Professionals working with bereaved children and families can contact the Child and Family support practitioner for support and guidance in their work.

The Service is not able to offer support to individuals who have complex Mental Health issues.

Please complete the referral form (enclosed) and fax to 01905 760935, email to our secure email address or post it to Bereavement Support South Worcestershire, C/o St Richards Hospice, Wildwood Drive, Worcester, WR5 2QT. Our referral form is also available within the ‘Professionals’ tab on our website

On receipt of a referral, each individual will be invited foran assessment and appropriate support determined at this stage. We can offer up to a maximum of 10 sessions and/or group work where applicable.

If you would like further information or clarification about the referral process, please do not hesitate to contact us on 01905 760934 or visit our website

*People registered to a South Worcestershire GP Practice can self-refer into the Service

DATE: / /

REFERRAL FORM

CLIENT DETAILS
Name: / Date of Birth: / /
Address:
Postcode:
Preferred Contact Number: / Permission to leave message on voicemail or with another person?
YES / NO
Alternative Contact Number:
Ethnicity:
REFERRER DETAILS
Name: / Contact Number / email:
Organisation: / Relationship to Client:
Is client aware of the referral?
Yes / No / Have they made contact with the person being referred?
Yes / No
Date of Consent:
/ /
PLEASE NOTE - CONSENT FROM THE CLIENT TO BE REFERRED TO THIS SERVICE IS ESSENTIAL
NON-CONSENT WILL RESULT IN DELAYED OR NO SERVICE BEING PROVIDED.
G.P. DETAILS
Name: / Telephone Number:
Practice:
PRESENTING NEEDS
Deceased name: / Date of death:
COMMUNICATION:
Preferred Language: / Communication or Sensory impairments:
Yes / No
If YES please give details:
OTHER PROFESSIONALS:
Professionals Involved / Contact Details / Nature of Involvement
Social Worker
GP
Psychologist
Mental Health Services
CAB
Other

INTERNAL USE ONLY

REFERRAL ACCEPTED: YES / NO REFERRAL CODE