The Cart Shed: Agency Referral Form

PLEASE READ BEFORE SUBMITTING A REFERRAL TO ENSURE THAT THE CART SHED IS THE RIGHT SERVICE FOR THE PERSON YOU ARE WORKING WITH


Level of Support

We are charitable organisation providing a basic Tier 1 mental health service. We endeavour to support as many people as we can, and referrals are considered on an individual basis, however the nature of our environment, our staffing levels, the type of provision we offer, and the fact that our Young Cart Shed provision runs alongside our adult provision, means there are some individuals we are unable to work with.


Please be aware that we cannot work with:

 

·         Individuals that pose a risk to children or young people.

·         Individuals with a history of sexual offending.

·         Individuals that are aggressive or violent and pose a risk to our team or participants.


Referral for individuals that fall into the above categories will not be accepted.

 

Please be aware that for anyone that is being supported by Probation services, we require a full risk assessment from Probation at the point of referral so that we can make an informed decision as to the suitability of that individual for our service. We can only consider those that Probation has assessed as low risk to others. Without this risk assessment information, the referral will be rejected as incomplete. 

 

·         Individuals in mental health crisis, especially if they are not receiving support elsewhere. We are able to sign post and refer on but have limited capacity to provide ongoing 1:1 mental health support. The interventions we provide are predominantly activity and group-based with a focus on mental health promotion, so primary or specialist mental health support needs to be provided by a statutory or private service.


·         Individuals presenting with predominantly behavioural issues. Behaviours of any sort that cause distress to other participants or that are disruptive to service provision and that cannot be moderated effectively following intervention, will result in the placement being withdrawn. We need to ensure that we maintain a welcoming, safe, non-judgemental and therapeutic space for our service users.


·         Individuals requiring 1:1 support on site. Individuals need to be able to manage the site, facilities, tools and activities safely and with minimal support. We have a low staff to participant ratio, so our focus is on facilitating engagement in the activities on offer and we have limited capacity to provide individual support beyond this.


·         Individuals requiring ongoing support from a support worker or personal assistant on site. Beyond Taster Days and transitions periods where we can accommodate external 1:1 support to help get individuals started and settled with us, we cannot work with those that need this level of external 1:1 support on site on a longer-term basis. We need to manage numbers on site so that sessions are not too busy or overwhelming for participants. Regularly having additional people on site has a detrimental impact on the therapeutic group dynamic we aim to create.


Mobility

We are based outdoors in a woodland environment and as such the ground can be uneven, slippery and there can be trip hazards such as tree roots. Our environment may therefore not be suitable for those with poor mobility or poor balance, or those that need certain types of walking aids such as rollator frames. We have open fires on site, so are cautious about accepting referrals for individuals that experience falls or seizures. There is a walk of about 100m from the car park to the woodland site that individuals need to be able to manage.

 

There are composting toilets on site that are on raised platforms with four 6” steps to access, so individuals need to be able to manage steps independently in order to be able to use our toileting facilities.


Transport

We offer free transport from designated pick-up points in Hereford, Leominster and Kington only, so individuals need to be able to get to one of these pick-up points in order to be able to use our transport. They also need to be able to get on/off of the transport safely and independently.



Name and Date of Birth







Parent Contact Details









Address




Email and Phone




Preferred Method of Contact


GP Details



School Details



Transport Details

Emergency Contact Details






Background information of person being referred











Armed Forces and Blue Light Community



Reason for Referral

Relevant Background Information

Risk Assessment
The more information you can provide us with, the quicker and easier it is for us to screen the referral, incomplete information will mean that we will need to pass the referral back to you.

Please include information around:
Risk to self or others including children
Risk of self neglect
Risk of drug and/or alcohol misuse
Behaviour Issues 

Additional Documentation
Where relevant and possible please attach copies of EHCP’s, CPA’s, Crisis Plans, Care Plans and any other assessment or reports. 
Involvement with Agencies
Telling us about the services they've used or are currently using helps us get them started quickly. Rest assured, having used these services now or in the past does not disqualify them from attending. 











Referrer's Details










Address




Voluntary Contributions

Feedback consistently shows how highly valued our services are by everyone who takes part. As a charity, The Cart Shed relies on fundraising to support people who are not eligible for social care funding to attend our sessions.


We therefore invite participants, where they are able, to make a voluntary contribution towards the cost of their course. Any amount is welcome, and there is no expectation or requirement to contribute. If someone is unable to give, even a small amount, they are still very welcome to be referred and take part, access to our service is never dependent on making a donation.



After enrolment, participants will receive clear information on how they can contribute if they wish to do so. Please ensure this is shared with your client so it is understood in advance and comes as no surprise.

Data Protection
The information that is shared with The Cart Shed during the referral process is requested in order to enable provision of appropriate occupational therapy assessment and intervention.  It will not be utilised in any other form than for the purpose for which it is collected. If it should become beneficial or necessary to share information with other healthcare professionals, social or welfare organisations this will be done in compliance with the Information Commissioner’s Office GDPR Regulations 2018. All information collected will be held securely.

If you are having problems completing this form please contact us here