Please describe what has been going on for the young person? How long has this been happening? (i.e. weeks, months, years etc.) Are there any issues with alcohol or drugs? Yes No If YES, please provide further details: Do you currently feel you the young person is a risk to themselves? Yes No Do you currently feel the young person) are a risk to others? Yes No If YES, (to any of the above) please provide further details: Did the CYP consent to the referral? Yes No Parental consent? Yes No Is the CYP happy to receive communication? Letter email Email address: Medication (include dosage) Is the young person a cared for child (yes/no)? If applicable, name of social worker (please specify) Is a CAF (Common Assessment Framework) in place for the family (yes/no)? Is a Child Protection Plan (yes/no)? What other agencies are involved with the young person (please specify) ?
Please describe what has been going on for the young person? How long has this been happening? (i.e. weeks, months, years etc.) Are there any issues with alcohol or drugs? Yes No If YES, please provide further details: Do you currently feel you the young person is a risk to themselves? Yes No Do you currently feel the young person) are a risk to others? Yes No If YES, (to any of the above) please provide further details: Did the CYP consent to the referral? Parental consent? Yes Yes No No Is the CYP happy to receive communication? Letter email Email address: Medication (include dosage) Is the young person a cared for child (yes/no)? If applicable, name of social worker (please specify) Is a CAF (Common Assessment Framework) in place for the family (yes/no)? Is a Child Protection Plan (yes/no)? What other agencies are involved with the young person (please specify) ?