Multi Agency Referral

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Please consult the threshold guidance and the guide to making a referral before answering the next questions. If you require further information you can ring 0121 788 4300 to speak with a referral and advice officer. (Monday-Thursday 8.45am-5.20pm, Friday 8.45pm-4.30pm).

Please select the type of referral you wish to make and answer the accompanying questions.

Threshold Level 4 - Section 47 Significant Harm

You are making a referral of this type because the child is suffering or likely to suffer significant harm.

In the event of immediate danger call 999

If the threshold for significant harm is met the family’s agreement is not needed but do consider whether they should be informed and record your decision with your reasons.

Who have you discussed this referral with?

The Parent

The Competent child

Not discussed - because to do so could cause further harm to the child

Other

Solihull LSCP Multi-agency Safeguarding Procedures may provide assistance with the following question.

Briefly identify the type of significant harm you feel the child is suffering or likely to suffer This could be physical abuse, emotional abuse, sexual abuse or neglect.

You must attach any screening tools you have used in the uploads section at the bottom of this form - Exploitation screening tool, DASH, DVRIM, GCP2 etc.

Threshold Level 4 - Section 17 Child In Need

Are you making a referral because one of the following apply?

the child is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for them of services by a local authority

the child’s health or development is likely to be significantly impaired, or further impaired, without the provision for them of such services

the child is disabled

As the threshold for significant harm is not being met, the family will need to consent to this referral. Ideally consent will be gained from both the parent & child. There may be rare occasions where consent is only being gained from a competent child the reason for not gaining the parents’ consent will need to be explained, for example; the child may be 17 and estranged from their family, requiring a joint homelessness assessment.

To make a section 17 referral you must have consent from the parent or competent child. Do you have consent?

Parent consent

Please explain why you have not gained parent consent

Child consent

Solihull LSCP Multi-agency Safeguarding Procedures may provide assistance with the following question.

Good practice - please explain that the information will be shared between MASH agencies - there is a leaflet to explain MASH for parents/carers.

Briefly explain the main reason you are making this referral today This could be because an early help plan or an education, health & care plan is not progressing/requires statutory resource.

You must attach any screening tools you have used in the uploads section at the bottom of this form - Exploitation screening tool, DASH, DVRIM, GCP2 etc.

Threshold Level 3 - Early Help

This referral type is for instances when a problem has emerged or actions are needed to prevent a problem occurring for a child/family that cannot be met by your agency or multi-agency work following the LSCP early help guidance & procedures and require Children’s Services involvement.

As the threshold for significant ham is not being met, the family will need to consent to this referral. Ideally consent will be gained from both the parent & child. There may be rare occasions where consent is only being gained from a competent child the reason for not gaining the parents’ consent will need to be explained, and care should be taken not to raise a child’s hopes when effective change may not happen without parents agreement.

To make an early help referral you must have consent from the parent or competent child. Do you have consent?

Parent consent

Please explain why you have not gained parent consent

Child consent

Briefly explain the main reason you are making this referral today This could be because an early help plan is not progressing or requires statutory resource, or your agency does not have capacity/needs support to carry out a level 3 early help assessment.

You must attach an early help plan if not progressing, and any screening tools you have used in the uploads section at the bottom of this form - Exploitation screening tool, DASH, DVRIM, GCP2 etc.

Threshold Level 3 - Solihull Youth Offending Service

You can ring the Youth Offending Service for advice on 0121 788 4290 (Monday-Thursday 9.00am-5.00pm, Friday 9.00pm-4.30pm)

This referral type is for the YOS Prevention Service - support offered for young people aged 8-17 who are offending/engaging in anti-social behaviour but have not been arrested or charged.

You must have consent from both a parent & the child to make a referral to the prevention service. Do you have:

Parent consent

Child consent

Briefly explain the main reason you are making this referral today This should include a brief description of offending/anti-social behaviour, location and peers identified as positive/negative influences.

Serious Incident/Accident Notification A&E and emergency response staff only

You are making this notification as you do not believe there is enough information to suggest a child is suffering or likely to suffer significant harm for a S47 referral to be made.

This section must only be completed by A&E and Emergency response staff who are only in contact with the child/person because of an accident/incident. It should be completed when the member of staff does not believe the threshold for significant harm has been met, and the family do not require/wish to receive child in need or early help from Children’s Services. The family should be informed that the information is being shared to ensure that any possible safeguarding concerns can be identified. A response from children’s services should not be expected, but they will cross check records to see if there are any concerns.

Have you informed the parent/carer and/or child that you are sharing information with Children’s Services but that you are not making a request for a service?

Parent consent

Please explain why you have not gained parent consent

Child consent

Date of Incident/Accident

Time of Incident/Accident

What incident/accident occurred? Please include nature of event, who was present when it occurred, place/location of event etc.

What action was taken? Please include a brief summary of what action was taken by who and any other referrals made - who to/for what - and any information provided to the child/family/other professionals.

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	GP
	Nursery/School/College
	Health visiting/School nurse

Multi Agency Referral Form

Person completing the referral details

Child's details

Siblings/Other children in household/family

Parent/Carer details

Other agencies/professionals involved

What is the main reason for you making this referral today?

Threshold Level 4 - Section 47 Significant Harm

Threshold Level 4 - Section 17 Child In Need

Threshold Level 3 - Early Help

Threshold Level 3 - Solihull Youth Offending Service

Serious Incident/Accident Notification A&E and emergency response staff only

Supplementary questions

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