Hampshire Forensic CAMHS Referral Form

The Forensic Child and Adolescent Mental Health Service is a specialist service that covers Hampshire and the Isle of Wight, and falls within the wider Child and Adolescent Mental Health Services (CAMHS). This team is part of the Sussex Partnership Foundation Trust. The service primarily delivers consultation and assessment for children and adolescents under 18 who have both a mental health need, and who show high risk behaviours towards others. The young person may or may not be in contact with the Youth Justice System. In some instances, specialist intervention and treatment are offered for children with complex forensic mental health needs. The service has good relationships with other services in Hampshire and frequently works with them to help children and adolescents.

Referrals

We are a small team but welcome enquiries from any professional with concerns about a young person. When we receive initial enquiries, we can have a brief conversation about whether a formal referral to the team is advisable or not. If we advise making a referral, we will ask you to provide information about the young person via a referral form, and we may also seek clarification via phone or email. When you make a referral, we expect you to have discussed this with the young person and their family or carers and to have sought their consent. In some cases, where consent is not given but there are major concerns, a referral can be made on safeguarding grounds.

What happens when a referral has been made?

Referrals will be made by professionals working with young people following discussion with parents, carers or young people about contacting us.

Following referral, we will discuss things with you to check that services are helping in the best possible way. We will help clarify what is needed and who or what might provide this.

The way we work includes:

Offering advice
Offering ongoing support to professionals
Supporting or offering direct assessment or intervention
In this way, a professional working might come to us for advice about the best way to support a child or young person. Once we have had this discussion we may not need to be further involved.

In some cases (but not all) we may need to meet directly with the young person, their family or carers, and any professional with whom they are closely involved.

Hampshire Forensic CAMHS Referral Form

Person's Details

Person's Name: *

Date of Birth: Day*

Date of Birth: Month*

Date of Birth: Year*

NHS Number:

Age at referral: *

Gender: *

Male

Female

Other

Please Specify... *

Ethnicity: *

Religion: *

Address: *

Address at time of referral (if different):

Telephone Number: *

Is the person aware of the referral? *

Yes

Does the young person consent to the referral? *

Yes

Next of Kin / Carer Details

Next of Kin / Carer Name: *

Next of Kin / Carer Address:

Next of Kin / Carer Telephone Number:

Next of Kin / Carer aware of the referral? *

Yes

Next of Kin / Carer consent to the referral? *

Yes

GP Details

GP Name:

GP Address:

GP Telephone Number:

GP Aware of the referral? *

Yes

Referrer Details

Referrer Name: *

Referrer Job Title: *

Referrer Address: *

Referrer Telephone Number:

Referrer Email: *

YP / CYP Section

Other Agencies Involved

Person's Circumstances

Reasons for Referral

Risk (Select all that apply):

Violence/Aggression

Fire Setting

Sexually Harmful Behaviour

Second Opinion in Complex Case

Radicalisation

Criminal Justice

Other

Behaviours (if applicable): (Who was targeted, precipitants, severity, age on onset)

Violent Ideations/ Concerning Thoughts (if applicable): (Specific detail, How it Makes Them Feel, Frequency/ Duration, Triggers, Plans to Act)

Mental health concerns or diagnoses including Learning Disability, Autism and ADHD, Deliberate Self Harm/ Suicide:*

Relevant Information: (Intellectual functioning, Developmental delay, Neurological impairment, Offending history, Peer associates)*

Referrer's Anticipated Outcome*

Terms & Conditions

Consent and Information Sharing: -

Please note, by submitting this referral, you are confirming that you have followed your local consent policies. This includes gaining the relevant consent for referring to our service, and the sharing of appropriate information across agencies involved.

I have read and agree with the above terms and conditions.*