POCAR Referral Form

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Page 1

The overall aims of POCAR are:

Support parents to address drug and alcohol difficulties to achieve their parenting goals.
Enhance safety and stability for children.
To increase parents’ self-esteem and confidence.
Reduce isolation and build resilience.

Please note we aim to contact the parent within 2 weeks of receiving this referral.

Page 2

Referring service details

Source of referral

Other source of referral - details

BHCC Children's Services POD number

Referrer name

Phone

Have you spoken to the Partners in Change (PIC) team?

YesNo

Parent details (We will use these to contact the parent. Please complete a separate referral if referring more than one parent or carer – POCAR has separate programs for men and women)

First name

Last name

Date of birth (DD/MM/YYYY)

Phone

Email:

Address 1

Address 2

Town / City

County

Country

Postcode

Date moved in at this address (DD/MM/YYYY)

If the exact date is unknown, please give your best estimate.

In line with GDPR 2018 please confirm that you have discussed the referral with your client and they have agreed to it being made.

YesNo

Page 3

Children’s details (We need these to understand the family and for our safeguarding procedures. We will not contact the children or any carers without further discussion and consent)

Individual child

Full name

Date of birth (DD/MM/YYYY)

Legal status (if applicable)

Please help us build a picture of the family by providing the following information about current family circumstances:

Pen Picture for the children – briefly outline important information relevant to this referral.

What is their lived experience of their parent’s difficulties and their understanding of current family circumstances? What do they understand about their parent's substance misuse?

Who do they live with and, if they do not live with their parent, what are the contact arrangements for the children?

Do they access services at Young Oasis or other support?

Do they attend school or nursery, and if so how do they get on there?

Health Visitor contact details for Under 5's:

How do the parents and/or professionals describe their children and what is the relationship like?

Is there anything else that is important for us to know about the children?

Page 4

Pen Picture for the adults – please provide brief details as a starting point to help us understand the parent’s experiences leading to this referral. Guiding questions in Italics.

What is the primary substance being used?

Frequency of consumption

Substance use (drugs or alcohol) as currently understood

· What are the concerns? What is the impact on the family?

· How would the parents describe their history with substance or alcohol if they do not agree with your view?

· What changes are important to them?

Any learning or communication needs?

· What was their experience of school or other group settings?

· Are there any barriers to accessing service (financial, technological)?

Parenting Capacity

· Can you give an outline of your current view of parenting and parenting capacity?

· What is going well and what are the concerns?

Support Network – Brief outline of relevant Family, friends, professionals, and other support systems.

· Who is in the family network, ages, ethnicity, cultural background? Description of relationship or initials are ok if confidentiality is a concern.

· Where relevant who lives together?

· What professionals are important to the family network? Who do the family view as most useful or important?

· Any other support or networks that are important?

Relationships

· What relationship patterns are important to consider as part of the recovery journey for this parent?

Parental conflict and abuse are frequently identified in relationships where substance misuse is present. Is this a concern for this family and/or the professionals in the network?

Physical health

· What is important for us to know?

· How can we help them to access the service?

Emotional Wellbeing and Mental Health

· What is important for us to know?

· How can we help them to access the service?

Finances

· Do they have money for day-to-day living? Have you made referrals or given other assistance to help with day to day finances?

Employment/benefits etc

Housing

· Has a fire safety check been completed?

· Is the tenancy at risk?

· Is the housing suitable for the family or are there concerns about the impact on change and/or recovery?

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Briefly summarise what will help us start working effectively with this family, understand priorities and agree timeframes for goals.

Strengths

What needs to change? Where do we hope to see development?

What is the most important change at this stage? How will we recognise change has occurred?

Dates of upcoming meetings (Network Meetings, Child Protection Conferences , Court dates etc.)

Oasis will provide a report for conferences and other feedback as standard. Court reports carry an additional fee.

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