Assessment and Referral

If you would like to make a referral please find

School to Complete Referral forms preferably with the parent/carer.
Person who knows the child best to complete the Strengths and Difficulties Questionnaire (SDQ)
Send referral forms and SDQ to Childs Way Therapy and meet to discuss the referral and expected outcomes. This will be also a time to discuss the length of the intervention depending on the referral.
Meeting, background information gathering with school and parent/carer.
Consent form obtained and agreed the timing, space and frequency of the sessions.
After week 8-9 of Play Therapy we meet again to review the children’s progress and complete the follow-up SDQ’s.
Play Therapy review meeting to discuss the possibilities.
Using all the information I will make a recommendation and we can meet again to decide if the sessions need to continue or if the therapeutic work is ready for ending.
Ending plan; preferably 4 weeks to prepare the therapeutic ending.

Please complete the form below.

You will be asked to check the details before it is sent to us. Fields marked with * are.

Where concerns relate to a specific Pupil/Student, please complete the following:

Pupil/Student Name *

DOB *

Gender *

School Name *

Current School Year *

School Address

Legal Status: (none, SGO, Residence Order, Adopted, Looked After)

Ethnicity

Does the Pupil/Student have a Statement or Education, Care and Health Plan or any other kind of Individual plan? (If yes please give details)

Nature of concern / Identified Need / Issue

What actions have been taken to address concerns/issues?

What have been the outcomes of these actions?

What do you hope to achieve as a result of the involvement from us?

Involvement of other agencies

Agency

Summary of Involvement

Date

Parent / Carer Views

Pupil / Student's Views

Parent / Carer Contact Details *

Please include Name, Address, E-mail and Phone No.

E-mail Address

Contact Phone Number

Parent / Carer 2 Name and Address (if different to above)

Completed By *

Designation *

Telephone *

Email *