How to complete this form Please complete appendix 1 if you are making a referral for one of the following parenting programmes Mellow Mellow Parents Triple P Parents as partners (PAP) Prior to making a referral, please ensure families meet the different eligibility criteria for parenting programmes. Please also note that this form should be submitted in addition to the Early help form. If you would like to discuss your referral in more detail, please contact the Croydon Parenting and Relationship hub coordinator at For further information about Croydon’s parenting offer, please visit https://www.practitionerspacecroydon.co.uk/ PARENT(S) / MAIN CARER(S) DETAILS Parent/ Carer 1 Parent/ 2 (if applicable) Full Name: REFERRER’S DETAILS Job role: Full Name: Email: Contact number: Please indicate which parenting programme you are making a referral for: MELLOW BUMPS Please tick if Parent requires support Parent is at 20-30 Parent has consented to meeting eligibility around forming a secure gestation the referral criteria attachment with their baby Parent does not suffer Parent does not suffer There are currently no from a severe mental from an unmanaged removal orders in place for health issue, e.g. addiction the unborn child psychosis MELLOW PARENTS Parent has consented to the referral and to being filmed with their child. Please tick if Parent requires support Recordings will not be meeting eligibility Child is aged 0-3 around forming a secure shared with outside criteria attachment with their child agencies and only used for reflective practice as part of the course. Parent does not suffer Child is living with parent Parent does not suffer from a severe mental and/ or is able to attend the from an unmanaged health issue, e.g. children’s group that runs addiction psychosis. alongside the programme. TRIPLE P
How to complete this form Please complete appendix 1 if you are making a referral for one of the following parenting programmes Mellow Mellow Parents Triple P Parents as partners (PAP) Prior to making a referral, please ensure families meet the different eligibility criteria for parenting programmes. Please also note that this form should be submitted in addition to the Early help form. If you would like to discuss your referral in more detail, please contact the Croydon Parenting and Relationship hub coordinator at For further information about Croydon’s parenting offer, please visit https://www.practitionerspacecroydon.co.uk/ PARENT(S) / MAIN CARER(S) DETAILS Parent/ Carer 1 Parent/ 2 (if applicable) Full Name: REFERRER’S DETAILS Full Name: Job role: Contact number: Email: Please indicate which parenting programme you are making a referral for: MELLOW BUMPS Please tick if meeting eligibility criteria Parent is at 20-30 gestation Parent has consented to the referral Parent requires support around forming a secure attachment with their baby Parent does not suffer from an unmanaged addiction Parent does not suffer from a severe mental health issue, e.g. psychosis There are currently no removal orders in place for the unborn child MELLOW PARENTS Please tick if meeting eligibility criteria Child is aged 0-3 Parent has consented to the referral and to being filmed with their child. Recordings will not be shared with outside agencies and only used for reflective practice as part of the course. Parent requires support around forming a secure attachment with their child Parent does not suffer from an unmanaged addiction Parent does not suffer from a severe mental health issue, e.g. psychosis. Child is living with parent and/ or is able to attend the children’s group that runs alongside the programme. TRIPLE P
EH-appendix-referral-form-parenting-support.docx