Referral Details

Submitted: 30 November 2018 - 12:51 pm

Status: Unassigned

Case Worker:  

Consent: Referer have Verbal Consent

GDPR: Agreed

Signature:

Last Update: 7 December 2018 - 4:40 pm

Referrer Organisation: One Academy School

Referrer: Mr James Brown

Phone: 11111111111

Address: Broadley Rd, Harlow, CM19 5RD

Parent/Carer: Mr Homer Simpson

Phone: 22222222222

Address: 18 Duarte Place, Grays, RM166PH

Client Name: Mr Bart Simpson

Email: 

Phone: 

DOB: 12/11/2004

Age: 12 - 16 years

Address: 22 Duarte Place, Grays, RM166PH

Client School: One Academy School

Year Group: Year 7

Background:

Some Background info on Bart from a few years ago

Safeguarding Issues:

Most defiantly there should be but he has slipped through the cracks to many times

Personal/Self

Anxiety - Depression - Sexuality Issues - Suicidal - Gender Identity - Self Esteem - Identity Issues - Stress

Health

Disability - Illness

Relationships – Family

Bereavement - Family Issues - Sibling Issues - Split family - Looked after children - Adoption - Behaviour at home - Separation Issues - Traumatic Event - Neglect - Psychological Abuse - Domestic Violence - Alcohol abuse - Drug use - Sexual Abuse

Relationships – Peers

Bereavement - Checkbox title 2 - Checkbox title 3 - Traumatic Event - Peer relationship issues - Psychological Abuse - Sexual Abuse - Physical Abuse

Behaviour

Being bullied - 1 - Cyber Bullying - Self-Harm - Criminal Activity - Drugs - Disordered Eating - Obsessive Compulsive - Alcohol - Immature - Anger outbursts - Tearfull - Acting Out - Attention needing behaviour - Sexualised behaviour - Perfectionism

School

Disaffection - Phobic - Poor Attendance - Transition issues
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