Referral Form: My Future programme

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This form is part 1 of a 2 part referral form. Part 1 below will establish basic eligibility. Part 2 will ask for details about the family and how we may support them.

Our programmes support families with children who display challenging behaviour. Newly referred families, with a child meeting our behavioural threshold, are entitled to access: 
  • Children will receive 6 to 9 months of input from a Chance UK mentor. 
  • Families and mentors agree to adhere to Chance UK's policies around safe sessions during the Covid-19 pandemic. Children can have in-person 1:1 sessions in the community following guidelines if it's safe to do so, or remote 1:1 sessions if it's not. 
  • Parents and carers on the Explore & Empower programme will have 1:1 support and group options from our Family Support team.
  • With Chance UK’s support, children and mentors will identify the child’s strengths, use solution-focused tools, and make and complete goals. Families will review and support these changes and progress, have support to access group work from Chance UK as well as the option of accessing support from other organisations. 
  • After graduation, all contact between the family and the mentor will stop. 
ELIGIBILITY QUESTIONS




To work with Chance UK, families must agree and select YES to following this policy and treating all staff and volunteers fairly.

CHILD









REFERRER - YOUR DETAILS






Your own email address





SCHOOL OR OTHER PROFESSIONAL BEHAVIOURAL ASSESSMENT
Goodman Strengths and Difficulties Questionnaire (SDQ)
Copyright Robert Goodman 1997. Permission granted for use.
Please rate the child’s behaviour over the last six months, or over the last school year,
by selecting one answer in each row below.


Not True Somewhat True Certainly True
MAIN CARER BEHAVIOURAL ASSESSMENT
Goodman Strengths and Difficulties Questionnaire (SDQ)
Copyright Robert Goodman 1997. Permission granted for use.
Please rate the child’s behaviour over the last six months, or over the last school year,
by selecting one answer in each row below.


Not True Somewhat True Certainly True