Chance UK Referral Form

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

Referrals are OPEN for the Explore & Empower family service in Islington, and the My Future mentoring programme in Camden and Southwark. 

Please note, we have reached capacity for referrals with Autistic Spectrum Condition and cannot accept any more of these referrals in this intake.

This supports families with children who display challenging behaviour. Newly referred families, with a child meeting our behavioural threshold are entitled to access: 

Ÿ   Children will receive up to 9 months of input from a Chance UK mentor and staff. 
Ÿ   Children will begin sessions remotely during lockdown. Physical 1:1 sessions in the community is the aim for all mentoring relationships, but only once it is safe for all to do so.
Ÿ   Parents and carers will have 1:1 support and group options from our Family Support team (on the Explore & Empower programme only)
Ÿ   Chance UK Programme Managers will provide remote contact with the child before they can be matched with a mentor.
Ÿ   With Chance UK’s support, children and mentors will identify the child’s strengths, use solution-focused talking tools to improve issues, 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. 
Ÿ   Families will graduate from the programme in spring 2021. After this, all contact between the family and the mentor will stop after graduation. 


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











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