Social Prescribing Referral Form

  • Social Prescribing Referral Form

  •  REFERRAL GUIDE

     

    What is the Social Prescribing Service?

    Social Prescribing is for adults who are aged 60+ and living in the Cowichan Valley.  They are self-motivated, but could use help connecting with community resources.

    Referrals are received from healthcare practitioners who will collaborate with the Community Connector to reach out to clients, develop a wellness plan, and access progress of the client. The Social Prescribing Program is a preventative measure, meant to support aging adults in maintaining independence.   

     

    Clients being referred should range between 1-4 on the clinical frailty scale.

    Please see link for further details.  

    https://bc.healthyagingcore.ca/resources/resource-clinical-frailty-scale-1

     That is:

    1.      People who are active, motivated, and energetic. They exercise regularly and are among the fittest for their age.

    2.      People who have no active disease symptoms but are less fit. They exercise  and are active occasionally, such as seasonally.

    3.      People whose medical problems are well controlled but are not regularly    active beyond routine walking.

    4.      People who are not dependent on others for daily help; activities are limited. Commonly feel slowed up or tired during the day.

     

    Referral Criteria

    Seniors in the Cowichan Region who are experiencing:

    • Social isolation or loneliness.
    • Worries over food security.
    • Sadness that stops you from staying connected.
    • Life changing events - retirement, bereavement, health decline.
    • Feeling a loss of independence.
    • Difficulty in making healthy lifestyle choices.
    • Limited access to physical activity.
    • Fatigue or stress associated with having a caregiver or being one.

     Social Prescribing is not for Aging Adults:

    • Under the age of 60.
    • Who fall in the  5-9 range on the frailty scale.
    • Who require daily medical services.
    • Who do not have a desire to engage a wellness plan.
    • Who who do not want to establish greater independence.

     

    The Community Connector is available for ongoing support, encouragement, and connection; however, active client engagement is essential.

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  • How to Access Services:

    Step 1:

    A health professional will talk with patients about how Social Prescribing services may help them and send a referral to the Community Connector using this online referral form.

    Step 2:

    The Community Connector receives the referral, assesses fitness, and will reach out to you with any further questions, or to confirm that they will proceed with the referral.

    Step 3:

    The Community Connector will explore what activities, services and local support could improve a patient’s health and wellbeing.

    Step 4:

    Together the Community Connector and patients will identify goals and co-create a personalized wellness plan.   Community Connector is available for support to encourage meeting milestones in the wellness plan.

    Step 5:

    The Community Connector will proceed with connecting patients to local services and activities that can enhance their wellbeing. Including Better at home services. 

    Step 6: Graduation!

    The Community Connector will remain available for support, however patients should have established a sense of independence with their wellness plan and no longer require support, except for occasional times of signifacant change.

    For any questions about referral please contact the Community Connector at Volunteer Cowichan: socialprescribing@volunteercowichan.bc.ca or 250-748-2133.

  • Thank you for your referral. The Community Connector will be in touch soon via your identified preferred method of contact. 
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