CSPOA FORM

Referrals for SEND
Concerned about a child?
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About Us
- About us
  Brighter outcomesCompany valuesCompliments and complaintsConsultationContact us
  Corporate Social ResponsibilityHow we are governedImprovement journeyNews
  Our PartnersPolicies & ReportsSuppliers informationUsing this site
Young people’s zone
- Young people’s zone
  Activities & things to doBeing in careCare leaversElevate – careers service
  Mental health supportReachOUTReading Youth CouncilYoung carers
  Your voice mattersYouth service
For parents and carers
- For parents and carers
  Report concerns about
  a childChildren in employmentChildren’s social careEarly helpFamily activities
  Fostering and adoptionHoliday activities and food (HAF) programmeManaging your
  wellbeingMental Health Support Team (MHST)
  Our mascot Freddie
  FutureReconnect youth teamSafeguarding & domestic
  abuseSchools
  SENDUnder 5sYour viewsYouth Justice Service (formerly YOS)
Professionals
- Professionals
  Report concerns about a childBecoming a childminderCareers in childcareEarly help and prevention
  services
  From conflict to connectionPartnershipsPSHE one stop shopReading Inclusion Support in Education (RISE) service
  School Effectiveness servicesReading Partnership SEND impactTraded services
  Under 5s servicesVirtual school
Join us

Search

Referrals for SEND
Concerned about a child?
PUBLIC
PROFESSIONALS

About us
YOUNG PEOPLE’S ZONE
For parents and carers
Professionals
Join us

Search

Referrals for SEND
Concerned about a child?
PUBLIC
PROFESSIONALS

Home
CSPOA FORM

1. Consent
Have you informed the parent/carer that you are making this contact?
- Yes
- No
Have they given consent for this contact?
- Yes
- No
Do they have parental responsibility for all children in the household?
- Yes
- No
Who gave consent?
Consent given as
- Verbal
- Written
If no consent tell us why
Have you informed the child/young person that you are making contact?
- Yes
- No
Have they given consent for this contact?
- Yes
- No
Verbal consent?
- Yes
- No
If no consent tell us why
2. The children and young people in the family home
Section 2
Surname (other names)*
Forename*
Any other names used
Date of birth
Day
Month
Year
Ethnicity
Religion (if applicable)
Gender*

Male

Female
Language spoken at home
Interpreter required?

Yes

No
Does the child have a disability?

Yes

No
If yes, please provide details:
Present postcode*
Present address
Previous Address if from outside area or at present address less than 1 year:
GP details
NHS number
UPN
Present school/preschool/children's centre/nursery
Address
Present school/preschool/children's centre/nursery
Headteacher
Class/form teacher
Email address of designated/safeguarding contact
(Present school/preschool/children's centre/nursery)

Telephone number of designated/safeguarding contact
(Present school/preschool/children's centre/nursery)
3. Parent/carer’s details
Section 3
Surname (other names)*
Forename*
Any other names used
Date of Birth
Day
Month
Year
Gender*

Male

Female
Relationship to child/children
Parental responsibility*

Yes

No
Main carer for the child*

Yes

No
Religion (if Applicable)
Language Spoken at Home
Does the carer have a disability?*

Yes

No
If yes, please provide details:
Present Address (if different from child)
GP Details
NHS Number
Parent/carer's email address

Parent/carer's phone Number
Name of Workplace (if known)
4. Significant other people to the family e.g. grandparents, aunt, uncle, siblings not living in the same household
Section 4
Surname (other names)
Forename
Any other names used
Date of Birth
Day
Month
Year
Gender

Male

Female
Relationship to child/children
Religion (if something to consider with the family)
Ethnicity
Language Spoken at Home
Interpreter required

Yes

No
Email address

Phone Number
5. Previous support
Has there been previous social worker involvement
- Yes
- No
- Unknown
If yes, was this in Reading
- Yes
- No
Dates
Have early help arrangements been initiated for this family?
- Yes
- No
- Unknown
If yes, was this in Reading?
- Yes
- No
Are or were the following in place (tick all that apply)
- Select All
- Early Help assessment
- Team Around the Child/Family Plan
- Team Around the Child/Family group and meetings
- Lead professional/key worker
Name of lead professional/key worker
6. Agencies/organisations/services involved with the family
Section 5
Agency type
Name of agency/practitioner
Role
Address & postcode
Email address

Phone number
Details of Involvement
7. Risk factors
Risk Factors
Please tick all that apply
- Alcohol misuse by child/young person
- Alcohol misuse by parent/carer/adult in household
- Anti-social behaviour
- Child exploitation (sexual & criminal)
- Domestic Violence
- Drug misuse by child/young person
- Drug misuse by parent/carer/adult in household
- Emotional abuse
- Fabricated illness
- Family in acute stress
- Female genital mutilation
- Forced Marriage
- Offending
- Homeless young person
- Honour based violence
- Learning disability of child/young person
- Learning disability of parent/carer/adult in household
- Missing from home
- Missing from school/education
- Mental health of child/young person
- Mental health of parent/carer/adult in household
- Neglect
- Physical disability or illness of parent/carer/adult in household
- Physical abuse
- Physical disability or illness of child/young person
- Private Fostering
- Radicalisation
- Sexual abuse
- Self-harming
- Trafficking
- Unaccompanied Asylum-Seeking Child (UASC)
- Young Carer
Other risk factor
8. Tell us about what life is like for this child/children/young person and their family
Reason for referral. Why are you worried about this child/family?
Does the family share your worries? Please describe facts including frequency, severity and impact. What are the specific behaviours of the parents/child/young person that may pose a risk to their welfare or safety?
What is the impact on the child/young person?
How is this affecting the child’s health, development and wellbeing? What are you worried will happen if nothing changes?
What help or support has already been put in place for this family and what is the outcome?
Tell us about how you, other services or extended family have been supporting the family and the impact of this. Please describe the help, support and/or interventions, when they took place or if they are current and the impact or outcome.
What is working well for this child and the family?
What are the strengths/support systems within the family, the things they do well, the resources within the family that reduce the danger and the times where danger has been present, but the parents have been able to manage/reduce this danger?
What level of intervention in line with the Reading Threshold document do you think Brighter Futures for Children can help this family with?
9. Your details
Your name*
Organisation/agency of referral*
Your role*
Date

Day
Month
Year
Your phone number*
Your email*

A copy of the completed form details will be sent to this email.
Have you discussed this contact with your safeguarding lead or line manager?*
- Yes
- No
Their name (if relevant)
Their title
10. Confirmation of Threshold of Need
What is your assessment of the Threshold of Need that this referral meets?
- Level 3 – Children's Social Care
- Level 2b – Target Early Help services provided by Brighter Futures for Children
- Level 2a – Early Help, partnership support
- Level 1 – Universal services
If you have ticked Level 1 or 2a we will refer you to the partnership coordinator.

Brighter Futures for Children
Civic Offices
Bridge Street
Reading
RG1 2LU

0118 937 3641
info@brighterfuturesforchildren.org
Registration number 2502331

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Christmas opening hours (in Reading):

We will be running a reduced service over the Christmas period. To support children, young people and their families who require urgent assistance, essential services will operate as follows:

Urgent Support Only in office hours:  Friday 27, Monday 30 and Tuesday 31 December (from 9am-5pm) call 0118 937 3641 (Option 1)

Office Closed: 25, 26 December, and Wednesday 1 January

Out-of-Hours Service:  For urgent support outside office hours (before 9am and after 5pm), or at weekends or bank holidays (25, 26 December and 1 January), call 01344 351999

Any urgent matters outside normal office hours, weekends or bank holidays, members of the public should call 01344 351999.

All BFfC services will resume on Thursday 2 January 2025.

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CSPOA FORM

1. Consent

2. The children and young people in the family home

3. Parent/carer’s details

4. Significant other people to the family e.g. grandparents, aunt, uncle, siblings not living in the same household

5. Previous support

6. Agencies/organisations/services involved with the family

7. Risk factors

8. Tell us about what life is like for this child/children/young person and their family

9. Your details

10. Confirmation of Threshold of Need

Christmas opening hours (in Reading):