Current Accommodation Local authority general needs tenancy Prison Housing association general needs tenancy Approved Probation Hostel Private sector tenancy Children’s home/foster care Tied housing or rented with job Bed and breakfast Owner occupation (private) Short life housing Owner occupation (low cost home ownership) Living with family Supported housing Living with friends Direct access hostel Mobile Home/Caravan Women’s refuge Any other temp accommodation Foyer Home Office Asylum Support Housing for people Rough sleeping Residential care home Sofa Surfing Hospital Other (please specify) Significant History/Other: Training, Education, Employment and Income Income Education/ Employment Full Time Wage Paid Work Part Time Wage Voluntary Work JSA / ESA Full Time / Part Time Education DLA Training Pension No Education or Training or Employment OTHER OTHER Current income? £_______________ weekly/ fortnightly/ monthly Current debts? Housing Related Support Maximise income, including receipt of correct welfare Better manage physical health benefits Better manage mental health Reduce overall debt Better manage substance misuse issues Obtain paid work Assistive technology/aids and adaptations to help maintain Participate in training and/or education independence Participate in leisure /cultural / faith and /or informal Maintain and/or obtain accommodation and avoid eviction learning activities Comply with statutory orders /related processes in relation to Participate in work-like activities, (unpaid work/ experience offending behaviour /voluntary work) Better manage self harm Establish contact with external services /groups /friends Avoid causing harm to others /family Minimise harm / risk of harm from others Developing confidence and ability to have greater choice and / or control and / or involvement Substance Use - Past Alcohol Crack Cannabis Heroin Powder Cocaine Magic Mushrooms Methadone/ Subutex Amphetamine Ketamine Solvents Ecstasy Prescribed Medication Benzodiazipines highs’ Other ‘Legal Other details: Substance Use - Current
Current Accommodation Local authority general needs tenancy Housing association general needs tenancy Private sector tenancy Tied housing or rented with job Owner occupation (private) Owner occupation (low cost home ownership) Supported housing Direct access hostel Women’s refuge Foyer Housing for people Residential care home Hospital Prison Approved Probation Hostel Children’s home/foster care Bed and breakfast Short life housing Living with family Living with friends Mobile Home/Caravan Any other temp accommodation Home Office Asylum Support Rough sleeping Sofa Surfing Other (please specify) Significant History/Other: Training, Education, Employment and Income Income Full Time Wage Part Time Wage JSA / ESA DLA Pension OTHER Education/ Employment Paid Work Voluntary Work Full Time / Part Time Education Training No Education or Training or Employment OTHER Current income? £_______________ weekly/ fortnightly/ monthly Current debts? Housing Related Support Maximise income, including receipt of correct welfare benefits Reduce overall debt Obtain paid work Participate in training and/or education Participate in leisure /cultural / faith and /or informal learning activities Participate in work-like activities, (unpaid work/ experience /voluntary work) Establish contact with external services /groups /friends /family Developing confidence and ability to have greater choice and / or control and / or involvement Better manage physical health Better manage mental health Better manage substance misuse issues Assistive technology/aids and adaptations to help maintain independence Maintain and/or obtain accommodation and avoid eviction Comply with statutory orders /related processes in relation to offending behaviour Better manage self harm Avoid causing harm to others Minimise harm / risk of harm from others Substance Use - Past Alcohol Heroin Methadone/ Subutex Solvents Benzodiazipines Crack Powder Cocaine Amphetamine Ecstasy ‘Legal highs’ Cannabis Magic Mushrooms Ketamine Prescribed Medication Other Other details: Substance Use - Current
Sheffield_referral.docx