Physical/Health/Special needs Does the child: Receive support under the SEN Code of Practice 2001 Have a statement of special educational needs Is there a CAF in place with this child/family? Lead for the CAF and contact number Yes No Unsure CAF Other Agencies ((please include Social Worker, CPN, and Teacher etc.) Have you made referrals to any other services? Eg. Reach, Journeys, CAMHS, Compass etc. Other agencies involved GP Name Telephone No. Address Does the client have a history of: Y N Past/Present Details Self Harm (inc. suicide risk) Violent/Aggressive Behaviour Self neglect
Physical/Health/Special needs Does the child: Receive support under the SEN Code of Practice 2001 Have a statement of special educational needs Is there a CAF in place with this child/family? Yes No Unsure Lead for the CAF and contact number CAF Other Agencies ((please include Social Worker, CPN, and Teacher etc.) Have you made referrals to any other services? Eg. Reach, Journeys, CAMHS, Compass etc. Other agencies involved GP Name Telephone No. Address Does the client have a history of: Y N Past/Present Details Self Harm (inc. suicide risk) Violent/Aggressive Behaviour Self neglect
2018-Buddy-referral-form.docx