OCS Family Group Conference Referral Form

Referral Date*

DayMonthYear
Referral Source
If other, please outline below
Children and young people at risk of coming into to LA care within open case work or newly in to the serviceChildren and young people in the Public Law Outline
Is the Case PLO or Proceedings?*
YesNo
Date of Family Network meeting or reason it was not offered or did not go ahead*
Referrer's Name*

First NameLast Name
Referrer's Email:*
example@example.com
Mobile Number*
Team Name:*
Team Manager:*
Team Manager Mobile Number:*
Key Child's surname
Key child's surname

Submission Cancelled!

Please obtain PR consent before completing this form

Who is the FGC for? Child/Young persons' details (please scroll along and include all details for the child e.g. DoB etc:*

Do any of the children or adults have an Advocate? - if so please put their name and contact number below

Please list all parents below*

Network - Family members and/or significant friends (please include key people if possible. The coordinator will also be exploring the network

Professional Network - Anyone that should/could be invited to the FGC (with family consent)

Family Issue(s)

Rows	Yes/No	Give brief details of the person affected by this issue (include names)
Domestic Abuse
Special Educational Needs
Mental Health
Alcohol
Drugs
Disability
Criminal Convictions
Other

Main Language of family:*
Interpreter required or any other communication needs?
Level of Willingness by Family to have an FGC
Risk Assessment
Is there a history of physical assault or verbal aggression by family members on other family members (Y or N)*
If Yes, please give full details including names
Is there a history of physical assault or verbal aggression by family members on welfare staff (Y/N) *
If Yes, please give full details including names
Is it safe to visit family members alone? (Y/N)*
Do members of the referring team visit alone? (Y/N) *
Any other identified risks?

Family Information

This information is for the family when they attend the family meeting. Once the parents/carers agree, every attendee will be given a copy of the family information prior to or on the day of the meeting. Please write in family friendly language. The Coordinator will also discuss this with you during the referral meeting. This information may be added to during the FGC process.
What are the family Strengths?
Why are Children's services involved and what are they worried about
What Questions do you want the family to consider to resolve the concerns (these will form the basis of the family plan
What will happen if there is not a plan that addresses the concerns?
What resources are available from social care / other agencies to support the child/young person and the family
If you have completed all the relevant fields above, please send to

The Family Meeting Service by selecting the

"Please Submit Now" button below
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Family Group Conference Referral Form