Single Point of Contact (SPOC) Safeguarding Referral Form

Welcome to Croydon's Interagency Safeguarding Referral Form

Welcome to Croydon’s Multiagency Referral Form (MARF)

This form is only for professionals and should be used to refer a child and family for one of the two following services:

1.An Early Help Best Start Family Solutions service (intensive/targeted need), where you are concerned for a child’s wellbeing and the family has asked for support that cannot be addressed by one or more organisation.
2. A Children’s Social Care (CSC) service where you are worried about the safety of a child.

If you are a member of the public please call 0208 726 6400

If you are unsure about whether or not to make a referral, or which service will best help the family and safeguard the child, please refer to the Croydon Continuum of Need on the Croydon Children Safeguarding Children Board website and speak to your designated safeguarding lead within your organisation. If you are then still unsure you can telephone the CSC Single Point of Contact (SPOC) consultation line for a consultation with the social worker or early help consultant on the numbers below:

Daytime hours:

(Monday to Friday 9am to 5pm) 0208 726 6400 main council number
(Monday to Friday 9am to 5pm) 0208 255 2888 for urgent child protection matters that require the same day intervention from a SPOC social worker;

SPOC Consultation:

(Monday to Friday 9am to 5pm) 0208 726 6464 where professionals with safeguarding responsibilities can consult early help consultants or social workers in the SPOC for advice on non-urgent cases

Out of hours:

5pm - 9am Monday- Friday, 24 hours Saturday, Sunday and bank holidays 0208 726 6400

Please note: completing this form will take several minutes. You need to ensure you have the child and families details to hand before you start.

Please make sure you have consent prior to filling in this form unless it would increase the risk of significant harm to a child in doing so.

Please ensure you complete all the required fields and press SUBMIT once the form is complete. Once the form has been submitted you will receive a thank you message confirming we have received your referral

If this form is not working, please download the MARF word version available at the bottom of the following link: https://www.croydon.gov.uk/healthsocial/families/childproctsafe/childprotect

If you are concerned about a child’s immediate safety , please call 999. If you would like to contact the SPOC please call 020 8255 2888

If your referral concerns a child who is or may be at risk of exploitation you must complete the Child Exploitation Screening Tool

Please note:

This form cannot be saved and needs to be completed in one session. This form takes approximately 10- 15 minutes to complete
the details will be lost is the session is left idle for more than 15 minutes

Early Help Best Start Family Solutions Service Early Help Best Start Family Solutions service is an intensive/targeted need early help service (Croydon Continuum of Need) providing support to children and their families when they are experiencing multiple difficulties

Early Help or Children's social care service value is required

Those wishing to access Parenting Programmes only can tick below:

Children’s Social Care Service
Children’s Social Care service is statutory/ specialist need service (Croydon Continuum of Need) that assesses and provides services for children and families whose needs are complex and enduring and/or who are experiencing, or at risk of experiencing significant harm if they are not provided with statutory services

Early Help or Children's social care service value is required

About the Child

Consent
The referral must always be discussed with the child and their family and consent for the referral should always be sought from those with parental responsibility unless to do so would place the child at further risk of harm. If you are worried about a child and you are unable to contact the parents, this should not stop you from making a referral and you can discuss your concerns in the first instance with your organisation’s designated safeguarding lead and if needed the CSC Front Door Single Point of Contact (SPOC) for a consultation with a Social Worker.

Has consent been sought?

Consent is required

Please provide a reason why consent has not been sought

Consent Reason is required

First name

First name is required

Last name

Last name is required

Date of birth/Delivery date

Date of birth is required Expected format: dd/mm/yyyy Selected date is invalid Date is smaller than allowed Age should be less than 21 years

If DoB Unknown, please estimate the child's Age

Age is required

Gender

Gender is required

Ethnicity

Ethnicity is required

If Other selected in Ethnicity, please state here

Ethnicity Other details is required

Religion

Religion is required

If Other selected in Religion, please state here

Religion Other is required

Disability/SEN statement

Disability/SEN statement is required

Disability/SEN statement description for the condition or need

Disability statement description is required

Is an Interpreter Required?

Interpreter Required is required

If an Interpreter required, please state which language(including sign language)

Interpreter Language description is required

Enter the child's address

Contact number

Contact number is required Contact number should contain 11 digits

Educational setting/nursery/school details

Name:

Address:

Telephone:

Head Teacher:

Contact details:

nursery/ class/ form teacher:

Contact details:

Has an assessment or an outcome based plan been completed? (e.g. Early Help or Child and family wellbeing assessment)

Early Help Assessment Completed is required

If yes, please name the Lead Professional

Lead Professional is required

Lead professional contact number:

If yes, please attach assessment

Upload

Your document has been uploaded Please upload your document

If No, what has been done to support the family already?

Support The Family is required

If No, please attach support plan/professional summary

Upload

Your document has been uploaded Please upload your document

Have you discussed this already with a SPOC Social Worker or an Early Help Consultant?

Have Discussed With Mash is required

If yes, who did you speak to?

Who did you speak to is required

Any other Significant information

Croydon Children & Family Partnership

Details about the family. In this section please add parents/carers and all household members including siblings.

The parents/carers/household members (where Y/N please select)

#	First Name	Last Name	Relationship
{{$index + 1}}	{{item.FirstName}}	{{item.LastName}}	{{item.Relationship}}

First name

First name is required

Last name

Last name is required

Date of birth

Date of birth is required Expected format: dd/mm/yyyy Selected date is invalid Date is smaller than allowed Age should be less than 21 years

If DoB Unknown, please estimate the Age

Age is required

Gender

Gender is required

Is this person the primary care holder?

Primary care holder to child is required

Relationship to child

Relationship to child is required

Has parental responsibility?

Has parental responsibility is required

Ethnicity

Ethnicity is required

If Other selected in Ethnicity, please state here

Ethnicity Other details is required

Any special needs / disabilities

Interpreter Required

Parent/Carer First Language

NI Number

NI Number is required

Enter the address

Please tick if the same address as the child

Contact number

Contact number is required Contact number should contain 11 digits

Information about you - the professional completing this form

First name

First name is required

Last name

Last name is required

Name of Organisation

Organisation is required

Job title

Job title is required

Email Address

Agency email is required Agency email is not valid eg: @croydonhealth.nhs.uk or @met.police.uk

Contact number

Contact number is required Contact number should contain 11 digits

Relationship to the child/Your agency's Role or Service provided

Relationship to the child is required

Croydon Children & Family Partnership

Details of Professionals involved with Child or Family

Details of any other Professionals involved with Child or Family (including GP, School, Health, Worker/Family Worker, etc.)

#	Name	Organisation Name	Organisation	Relationship
{{$index + 1}}	{{item.FirstName + " " + item.LastName}}	{{item.Organisation}}	{{item.OrganisationType}}	{{item.Relationship}}

First name

First name is required

Last name

Last name is required

Organisation Type

Organisation Type is required

Name of Organisation

Organisation is required

Job title

Job title is required

Contact number

Contact number is required Contact number should contain 11 digits

Relationship to child

Relationship to the child is required

Reason for Concern

Reason for Concern (if your concern is about a vulnerable adult/carer we still need you to complete this section) or any other factors to take into consideration

Why are you concerned about the child? Reason for Referral. What are you and/or the child and family worried about?
Does the family share your worries? Please describe facts including frequency, severity and impact. What are the specific behaviours of the parent/child/young person that may pose a risk to their safety?

Your Concern is required

What is the impact on the child/young person?
How is this affecting the child’s health, development and well-being? Provide information in relation to the child’s Education (Attendance, Support, Attainment), Health (Emotional and Physical) and Social Development (Developing positive and healthy relationships) What are you worried will happen if nothing changes?

Impact on child is required

What is working well for this child and in this family?
What are the strengths/support systems within the family, the things they do well, the resources within the family, the resources within the family that reduce the risk and the times where risk has been present but the parents/carers have been able to manage/reduce this risk?

Working well for child is required

What do you want to happen next?
What needs to happen next to ensure the child is safer and ensure the parents/carers can keep the child safe?

Your Concern is required

Croydon Children & Family Partnership

Summary

Section 1 - About the child

Early Help Best Start Family Solutions Service: {{wizardObj.model.ChildInfo.Ehbhf}}

Children’s Social Care Service: {{wizardObj.model.ChildInfo.Cscs}}

Has consent been sought? {{wizardObj.model.ChildInfo.Consent}}

Please provide a reason why consent has not been sought: {{wizardObj.model.ChildInfo.ConsentReason}}

Parenting Program: {{wizardObj.model.ChildInfo.ParentingProgram}}

First Name: {{wizardObj.model.ChildInfo.FirstName}}

Last Name: {{wizardObj.model.ChildInfo.LastName}}

Address: {{wizardObj.model.ChildInfo.Address.addressLine1}} {{wizardObj.model.ChildInfo.Address.addressLine2}} {{wizardObj.model.ChildInfo.Address.addressLine3}} {{wizardObj.model.ChildInfo.Address.town}} {{wizardObj.model.ChildInfo.Address.postcode}}

Telephone Number: {{wizardObj.model.ChildInfo.ContactNumber}}

Date Of Birth or Expected Delivery Date: {{wizardObj.model.ChildInfo.DateOfBirth}}

If Unknown, please Estimate the child's Age: {{wizardObj.model.ChildInfo.Age}}

Gender: {{wizardObj.model.ChildInfo.Gender}}

Ethnicity: {{wizardObj.model.ChildInfo.Ethnicity}}

If Other, Please state here: {{wizardObj.model.ChildInfo.Ethnicity}}

Religion: {{wizardObj.model.ChildInfo.Religion}}

If Other, Please state here: {{wizardObj.model.ChildInfo.ReligionOther}}

Disabilities: {{wizardObj.model.ChildInfo.Disabilities}}

If Yes, please state: {{wizardObj.model.ChildInfo.DisabilityDetail}}

Is an Interpreter Required: {{wizardObj.model.ChildInfo.InterpreterRequired}}

If yes, please state which language(including sign language): {{wizardObj.model.ChildInfo.InterpreterLanguage}}

Croydon ICS No: {{wizardObj.model.ChildInfo.CroydonICSNo}}

Educational setting/nursery/school details

Name: {{wizardObj.model.ChildInfo.SettingName}}

Address: {{wizardObj.model.ChildInfo.SettingAddress.addressLine1}} {{wizardObj.model.ChildInfo.SettingAddress.addressLine2}} {{wizardObj.model.ChildInfo.SettingAddress.addressLine3}} {{wizardObj.model.ChildInfo.SettingAddress.town}} {{wizardObj.model.ChildInfo.SettingAddress.postcode}}

Telephone: {{wizardObj.model.ChildInfo.SettingTelNo}}

HeadTeacher: {{wizardObj.model.ChildInfo.HeadTeacher}}

HeadTeacher Contact: {{wizardObj.model.ChildInfo.HeadTeacherContact}}

Nursery Teacher: {{wizardObj.model.ChildInfo.NurseryTeacher}}

NurseryTeacher Contact: {{wizardObj.model.ChildInfo.NurseryTeacherContact}}

Has an early help assessment already been completed? {{wizardObj.model.ChildInfo.EarlyHelpAssessmentCompleted}}

If yes, please name the lead professional: {{wizardObj.model.ChildInfo.LeadProfessional}}

Lead professional number: {{wizardObj.model.ChildInfo.LeadProfessionalNumber}}

Document: [Attached]

If no, what has been done to support the family already? {{wizardObj.model.ChildInfo.SupportTheFamily}}

Document: [Attached]

Have you discussed this already with a SPOC Social Worker or an Early Help Consultant?: {{wizardObj.model.ChildInfo.HaveDiscussedWithMash}}

If yes, who did you speak to? {{wizardObj.model.ChildInfo.MashOfficer}}

Any other Significant information: {{wizardObj.model.ChildInfo.SignificantInfo}}

Section 2 - Details of the family - Father/Mother/other siblings or family members and/or significant others/adults (including perpetrator if applicable)

First name: {{item.FirstName}}

Last name: {{item.LastName}}

DoB/set.DoB/Age: {{item.DateOfBirth}}

Ethnicity: {{item.Ethnicity}}

Gender: {{item.Gender}}

Primary Care Holder: {{item.PrimaryCareHolder}}

Address {{item.Address.addressLine1}} {{item.Address.addressLine2}} {{item.Address.addressLine3}} {{item.Address.town}} {{item.Address.postcode}}

ContactNumber: {{item.ContactNumber}}

Relationship to child: {{item.Relationship}}

special needs / disabilities: {{item.SpecialNeeds}}

Interpreter Required: {{item.InterpreterRequired}}

Parent/Carer First Language: {{item.ParentCarerFirstLanguage}}

Has parental responsibility? {{item.ParentalResponsibility}}

If yes, please provide the parent/carer NI number if available: {{item.NINo}}

Section 3 - About You

First Name: {{wizardObj.model.YourInfo.FirstName}}

Last Name: {{wizardObj.model.YourInfo.LastName}}

Name of Organisation: {{wizardObj.model.YourInfo.Organisation}}

Job title: {{wizardObj.model.YourInfo.JobTitle}}

Email: {{wizardObj.model.YourInfo.Email}}

Telephone number: {{wizardObj.model.YourInfo.ContactNumber}}

Relationship to the Child/Your agency's Role or Service Provided: {{wizardObj.model.YourInfo.Relationship}}

Address: {{wizardObj.model.YourInfo.Address.addressLine1}} {{wizardObj.model.YourInfo.Address.addressLine2}} {{wizardObj.model.YourInfo.Address.addressLine3}} {{wizardObj.model.YourInfo.Address.town}} {{wizardObj.model.YourInfo.Address.postcode}}

Section 4 - Details of Professionals involved with the Child or Family (including GP, School, Health, Worker/Family Worker, etc.)

First name: {{item.FirstName}}

Last name: {{item.LastName}}

Organisation: {{item.OrganisationType}}

Organisation Name: {{item.Organisation}}

Relationship to Child: {{item.Relationship}}

ContactNumber: {{item.ContactNumber}}

Section 5 - Reason for Concern (if your concern is about a vulnerable adult/carer we still need you to complete this section) or any other factors to take into consideration

What are you and/or the child and family worried about? {{wizardObj.model.ReasonForConcern.WhyYouConcern}}

What is the impact on the child/young person? {{wizardObj.model.ReasonForConcern.ImpactonChild}}

What is working well for this child and in this family? {{wizardObj.model.ReasonForConcern.WorkingWellforChild}}

What do you want to happen next? {{wizardObj.model.ReasonForConcern.NextHappen}}

Is there suspected or a history of…

Alcohol misuse by child/young person {{wizardObj.model.MistreatmentDetails.AlcholMisusechild}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.AlcholMisusechildDetail}}

Alcohol misuse by parent/carer/adult in household {{wizardObj.model.MistreatmentDetails.AlcholMisusecarer}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.AlcholMisusecarerDetail}}

Anti-social behaviour {{wizardObj.model.MistreatmentDetails.Antisocialbehaviour}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.AntisocialbehaviourDetail}}

Child Exploitation (sexual or criminal) {{wizardObj.model.MistreatmentDetails.ChildSexualExploitation}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.ChildSexualExploitationDetail}}

Disability (SEN-D) {{wizardObj.model.MistreatmentDetails.Disability}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.DisabilityDetail}}

Domestic Violence {{wizardObj.model.MistreatmentDetails.DomesticViolence}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.DomesticViolenceDetail}}

Drug misuse by child/young person/criminal exploitation/county lines {{wizardObj.model.MistreatmentDetails.DrugMisusebyChild}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.DrugMisusebyChildDetail}}

Drug misuse by parent/carer/adult in household {{wizardObj.model.MistreatmentDetails.DrugMisusebyParent}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.DrugMisusebyParentDetail}}

Early Years SEN-D {{wizardObj.model.MistreatmentDetails.Earlyyearssendd}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.EarlyyearssenddDetail}}

Emotional abuse {{wizardObj.model.MistreatmentDetails.EmotionalAbuse}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.EmotionalAbuseDetail}}

Fabricated illness {{wizardObj.model.MistreatmentDetails.Fabricatedillness}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.FabricatedillnessDetail}}

Family in acute distress {{wizardObj.model.MistreatmentDetails.FamilyinacuteDistress}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.FamilyinacuteDistressDetail}}

Female genital mutilation {{wizardObj.model.MistreatmentDetails.FemalegenitalMutilation}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.FemalegenitalMutilationDetail}}

Forced Marriage {{wizardObj.model.MistreatmentDetails.ForcedMarriage}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.ForcedMarriageDetail}}

Gang affiliation and /or serious youth violence {{wizardObj.model.MistreatmentDetails.Gangaffiliation}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.GangaffiliationDetail}}

Homeless young person/ family at risk of homelessness {{wizardObj.model.MistreatmentDetails.Homeless}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.HomelessDetail}}

Honour based violence {{wizardObj.model.MistreatmentDetails.HonourBasedViolence}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.HonourBasedViolenceDetail}}

Learning disability of child/young person {{wizardObj.model.MistreatmentDetails.LearningDisability}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.LearningDisabilityDetail}}

Learning disability of parent/carer/adult in household {{wizardObj.model.MistreatmentDetails.LearningDisabilityParent}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.LearningDisabilityParentDetail}}

Missing from home {{wizardObj.model.MistreatmentDetails.MissingFromH}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.MissingFromHDetail}}

Missing from school/education {{wizardObj.model.MistreatmentDetails.MissingFromSorE}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.MissingFromSorEDetail}}

Mental health of child/young person, including bereavement {{wizardObj.model.MistreatmentDetails.MentalIllHealthChild}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.MentalIllHealthChildDetail}}

Mental health of parent/carer/adult in household {{wizardObj.model.MistreatmentDetails.MentalIllHealthParent}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.MentalIllHealthParentDetail}}

Neglect {{wizardObj.model.MistreatmentDetails.Neglect}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.NeglectDetail}}

No Recourse to Public Funds {{wizardObj.model.MistreatmentDetails.NoRecoursetoPublicFunds}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.NoRecoursetoPublicFundsDetail}}

Parenting {{wizardObj.model.MistreatmentDetails.Parenting}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.ParentingDetail}}

Physical disability or illness of parent/carer/adult in household {{wizardObj.model.MistreatmentDetails.PhysicalDisabilityParent}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.PhysicalDisabilityParentDetail}}

Physical abuse {{wizardObj.model.MistreatmentDetails.PhysicalAbuse}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.PhysicalAbuseDetail}}

Physical disability or illness of child/young person {{wizardObj.model.MistreatmentDetails.PhysicalDisabilityChild}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.PhysicalDisabilityChildDetail}}

Private Fostering {{wizardObj.model.MistreatmentDetails.PrivateFostering}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.PrivateFosteringDetail}}

Radicalisation {{wizardObj.model.MistreatmentDetails.Radicalisation}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.RadicalisationDetail}}

Special Educational Needs and Disability {{wizardObj.model.MistreatmentDetails.SpecialNeeds}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.SpecialNeedsDetail}}

Sexual abuse {{wizardObj.model.MistreatmentDetails.SexualAbuse}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.SexualAbuseDetail}}

School exclusion/multiple school moves {{wizardObj.model.MistreatmentDetails.Schoolexclusion}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.SchoolexclusionDetail}}

Self- harming {{wizardObj.model.MistreatmentDetails.SelfHarming}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.SelfHarmingDetail}}

Trafficking {{wizardObj.model.MistreatmentDetails.Trafficking}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.TraffickingDetail}}

Unaccompanied asylum seeker (UASC) {{wizardObj.model.MistreatmentDetails.Uasc}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.UascDetail}}

Young carer {{wizardObj.model.MistreatmentDetails.YoungCarer}}

Please Describe in Further Detail…: {{wizardObj.model.MistreatmentDetails.YoungCarerDetail}}

If the issue you are concerned about it not listed about please include below: {{wizardObj.model.MistreatmentDetails.NoneoftheaboveDetails}}

Please click here if you would like a copy of this referral emailed to you

Croydon Children & Family Partnership

Croydon's Interagency Safeguarding Referral Form

Thank you for submitting a Safeguarding Referral to Croydon’s Single Point of Contact (SPOC).

We will make a decision in relation to the status of this referral within one working day. You will be notified of our decision no later than three working days following the submission of your referral. We will contact you using the email address you have provided