Connected Families – Professional Referral
Connected Families is a six-week early-intervention family wellbeing programme for younger children attending with a parent or carer. Sessions use play, creativity, sensory experiences, nature and shared activities to strengthen relationships, confidence, wellbeing and connection.
Place Allocation
A limited number of places are available free of charge to eligible families with children aged 2–8 years through funding from The National Lottery Community Fund. Connected Families can also be accessed through commissioned provision, which allows greater flexibility where a family may benefit from the approach but does not meet the eligibility criteria for a funded place. Suitability is considered individually. Connected Families is a small-group community wellbeing programme. It is not therapy, childcare or educational provision. Submission of a referral does not automatically confirm a place. Family Mental Fitness North East CIC reviews referrals to consider eligibility, suitability, programme availability and whether the programme can appropriately and safely meet the needs of the child and family.
Referrer Details
Name
*
First Name
Last Name
Organisation
*
Job Title / Role
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Child & Family Details
Child's Full Name
*
First Name
Last Name
Child's date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Would another child from the family be attending Connected Families?
Yes
No
Child 2 Full Name
First Name
Last Name
Child 2 Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/carer's full name
*
First Name
Last Name
Relationship to child
*
Reason for Referral
Please tell us briefly why you feel this family would benefit from Connected Families.
What would you hope the child and family might gain from taking part?
Supporting the Family to Participate
Please note: Children remain the responsibility of their accompanying parent/carer throughout Connected Families. Parents/carers remain responsible for their child's toileting and personal care throughout the programme.
Does either the parent or child have any known allergies, dietary requirements or medical needs that we should be aware of when considering this referral?
Yes
No
Unsure
If Yes please provide details
Does the child or parent/carer have any additional needs, communication needs, sensory needs, accessibility requirements or other circumstances we should be aware of when considering this referral?
Please tell us what would help them participate comfortably and successfully
Is there anything that could affect the child's or family's ability to participate safely in a small group environment?
Yes
No
Unsure
If yes: please provide details, including any known triggers, behaviours, risks or support strategies that would be helpful for us to know
Does the child usually require individual adult support to participate safely in group activities?
No
Sometimes
Yes
Unsure
If Yes/Sometimes; please provide details
Consent
Has the parent/carer agreed to this referral and to the information provided here being shared with Family Mental Fitness North East CIC for the purpose of considering and arranging their participation?
Yes
I confirm that, to the best of my knowledge, the information provided is accurate and relevant to this referral.
I confirm
I understand that submitting this form does not guarantee a place and that Family Mental Fitness North East CIC will review the referral before confirming participation
I understand
Referral Route
Our National Lottery Community Fund-funded places are available to eligible families with children aged 2–8. Commissioned Connected Families provision offers greater flexibility where a family may benefit from the approach but does not meet the eligibility criteria for a funded place. Suitability is considered individually.
I am referring this family for:
*
A National Lottery Community Fund-funded place – the child is aged 2–8 and I believe the family meets the eligibility criteria described above
I would like to discuss commissioned Connected Families provision for this family
Anything else you think it would be helpful for us to know?
Photography and Images
Family Mental Fitness North East CIC takes a privacy-conscious approach to photography. Where photography consent has been obtained directly from a parent/carer, any photographs used publicly will focus on the activity rather than the identity of the child- for example, hands at play, activities and creations, over-the-shoulder images or photographs taken from behind. We do not routinely publish full, front-facing photographs of children’s faces. Photography consent is obtained separately from the child’s parent/carer and is not part of the professional referral process.
Submit
Should be Empty: