Family Respect Project - Online Referral Form

Family Respect Project - Online Referral Form
Our Family Respect project focuses on working with children and young people who display any abusive behaviours towards their parents and carers and other people in their family. The work is being led by YMCA Trinity Group through collaboration with the Police and Crime Commissioner and Respect UK.

Abuse takes many forms, and the signs are often invisible to those on the outside of it. Child to parent abuse is particularly hidden and misunderstood which often results in parents and carers feeling isolated, without any support.

Perhaps a child or young person aged 10 to 16 years of age who you know is showing physical or violent behaviours towards other people in their home? Maybe they have caused damage to items in their home, or to items which belong to someone else? Have they used coercion and manipulation to control the freedom and choices of other people they live with? It could be that they use verbal insults or threats to other family members? Or perhaps the abuse focuses on stealing, demanding money or other people’s property?

For us to be able to accept a referral for a family we need to ensure that someone in the family has reached out to the police for support with the abusive behaviour and this might have been a phone call or by looking at information online. If a young person has engaged with youth offending services, this is another way we can accept a referral.

If you know someone between 10 and 16 years of age who needs support because of any abusive behaviours they are exhibiting towards their parents or carers, or towards other people in their home, this could be a well-suited programme for them to get involved with.

Please complete the following form to refer someone to the project.

If you have any questions, email familyrespect@ymcatrinity.org.uk.

1. Information about the referrer
Have you gained consent from parents, carers or those with legal parental responsibility for the child or young person, so that we can contact them about the support we can offer?*

YesNo
You can not proceed with the referral form without consent.
Your first name:*
Your last name:*
Your job title/role:*
Your email address:*
example@example.com
Your phone number:
How did you hear about our support?*

Directly from the Family Respect team (YMCA Trinity Group)From a colleague inside my organisationFrom a professional from another organisationFrom information on the internetOther

4. Other support being given to the child/young person
Does the family receive regular support from anyone else:*

YesNo
Full name of professional:*
Agency of professional:*
Are there any more professionals:*

YesNo
Full name of professional 2:*
Agency of professional 2: *
Before submitting this referral please ensure that you have gained the relevant consent from the family, as we will be contacting them to discuss the support we can provide.

By clicking submit you will receive a copy of the referral form you have completed to the email address you have supplied us with
Should be Empty:

Family Respect Project - Online Referral Form

1. Information about the referrer

2. Information about the child/young person

3. Information about other people in the family

4. Other support being given to the child/young person