Consent to Referral

Consent to refer to Ivison Trust

(Please note - if you answer ‘no’ to any of the questions below, we cannot accept the referral)

Does the parent/carer understand that this referral is being made to Ivison Trust?
Does the parent/carer understand that information shared with Ivison Trust may include any of the details they have disclosed within your discussion/s including details of any possible crime?
Has the parent/carer given explicit consent for Ivison Trust to contact them via telephone?

We can only accept referrals if we have consent from the parent. Please ensure you can answer "Yes" for all three questions above 

Parent

Parent Details

 

Gender
Disability?
Child

Child Details

Parent Detail Other

Parent Contact Details

Preferred Victim Contact Method(s)
Safe to leave a voicemail?
Referrer

Referrer Contact Details

Please enter the details of the person making the referral

Activity

CE Indicators

The following questions are with reference to the child not the parent

How many missing from home episodes? Are they frequent and for prolonged/short periods? Does the young person go missing from home but it is not reported? Have you got any information regarding locations? Possible reasons for going missing from home? Regular patterns of behaviours related to absences?
High/low attendance? Relationships with school staff? Does the child abscond from school without parent’s knowledge of their whereabouts? Has there been an escalation in young person’s behaviour within the school setting?
Where does the child they take them? How does the child fund it? Who with? Type / class of substance? Any drug paraphernalia found within the home?
Does the young person habitually associate with risky adults and/or peers? Is the Young person in contact with adults and/or peers that pose a risk? Do you have any information regarding associates? Has the child ever been the victim of violence? Has the child been known to carry a weapon?
Has the young person posted inappropriate language / information / sexual pictures when contacted by an adult / older peer / unknown person? Does the young person plan to meet, face to face, persons they only know online?  Is the child secretive with their devices? Is there any content related to illegal substances?
Has there been an escalation in concerning behaviours from the child? Are parent and child able to communicate effectively? Does the parent have appropriate safeguarding measures in place? Is the child displaying aggressive and violent behaviours towards family members?
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Other Professional

Other Professionals

Please add the name and contact details of any other professionals involved with the victim or wider family e.g. Social Worker, Police Officer, CAMHS, Education contacts, St Giles, etc.

Other Professional

Other Professional

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Other Professional (3)

Other Professional

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Other Professional (4)

Other Professional

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Other Professional (5)

Other Professional

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Other Professional (6)

Other Professional

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