Referral Form | chatfieldhousing.co.uk

How to make a Referral

Chatfield Housing accepts referrals for Adults with support needs between the age of 25 - 65 years and ONLY accept referrals from the 'Homeless Services' in both Lambeth and Croydon Councils

We Do Not Accept Referrals for clients with Poor Mobility, who has Care Needs or self-referrals.

Chatfield Housing offers support to clients with a broad range of support needs which includes:

Ex-Offenders
Abuse sufferers
Recovering Addicts
Mild Mental illness
Learning Difficulties

At the assessment clients will be asked to provide the following:

Proof of identity
National Insurance number
Proof of Income
Evidence of leave to remain in the UK (if applicable)
Bank statements

Please also ensure that the client is eligible for UK benefits and they can provide proof that a claim has been made, has been awarded or being processed. Attention must be given to the client’s support needs section as you or the client will be required to supply additional evidence (e.g. medical

conditions/diagnoses, criminal convictions, victim support/DV etc.,) for our records. If necessary, you will need to obtain the person’s written consent to share such data with us under the DPA/GDPR protocols.

Wherever practicable, we will expect to see the applicant’s own description of the support they seek and an indication of their willingness to engage in the project. The information provided will form the basis of a bespoke support plan. Once we accept the application, you (the referrer) will be required to submit a copy of the completed referral form to our local authority for authentication.

The Referral Process

Clients from European Economic Area (EEA) who are not eligible for Housing Benefit (HB) will not be eligible for our supported housing schemes, so unfortunately, we cannot accept these referrals.

Client Criteria

Clients must have support needs in order to be accepted. Referrals without Support Needs will not be processed.

The assessment is a 3-stage process:

Stage 1. Telephone interview to assess suitability for our projects

Stage 2. Risk & Needs Review by a Senior Support Officer

Stage 3. Meeting with Chatfield Housing for assessment and viewing of vacancy.

At Stage 3 the client will be asked to provide:

Proof of identity
National Insurance number
Proof of Income
bank statements

Once the client has met the criteria and accepted, we will then provide Tenancy Related Support for up to one year after which a review will be done. if the client continues to meet all criteria and pays rent on time, a further 1 year license will be issued. During this time the client needs to be activiely seeking alternative move on accommodation. The client will be encouraged to save at the local Credit Union to cover their move on cost at the end of their tenancy. Chatfield Housing will only provide signpost support for the clients' move on to independent accommodation, as financial support is not given.

Fair Access

Our aim is to call the clients within 2 working days of agencies making a referral.

We will give priority to:

Clients with a disability Benefit ESA or PIP
Clients with a Local Connection
Councils and organisationson who are on our Referral Framework

There is no guarantee that clients will be offered Chatfield’s Supported Accommodation.

However, if you are on our Referral Portal then the client is more likely to be offered housing when a room becomes available.

Utilities/Rent Payment

All Clients on entering our housing is expected to pay £15.00 per week for rent/utilities payments. This MUST BE set up as a 'Direct Debit'. All Clients MUST ensure that this is done within the first week of moving in as if not paid this is deemed as anti-social behaviour and processes will be followed which can lead to an eviction.

Our Client utilities Account Bank Details:

Chatfield Housing bank details will be given to the client once they have moved in so that they can set up via their bank monthly/weekly payments.

Moving on Assistance

Chatfield will provide £30 to assist clients with their moving on, once they are ready to move out of a project and ALL MOVE ON PAPERWORK is completed, including a TESTIMONIAL.

If Clients are not prepared to complete paperwork and testimonial this will NOT be issued.

General Data Protection Regulation

Clients and Referral agents can see how Chatfield Housing will use and protect their data by viewing the Data Protection Policy , a request can be obtain by emailing us at info@chatfieldhousing.co.uk

Clients First Name *

Clients Last Name *

Client's NINO *

Current Address (if applicable) *

Client's DOB *

Client's Gender *

Client's Sexuality *

Client's Ethnic Origin *

Clients Email *

Client's Phone *

Next of Kin First Name *

Next of Kin Last Name *

Next of Kin Phone *

Current Address(if applicable) *

What circumstances made you homelessness *

Local Connection * *

Any potential Clients without a local connection on the list provided, will not be offered a face to face interview until a suitable local connection becomes available

Have the Client ever been housed by Chatfield Housing? * *

Yes

Is the client working more than 16hrs per week? * *

Yes

Is the client Eligible for welfare benefits and lived in UK or at least 5 years? * *

Has the Client got Proof of ID, NINO, Income and proof of residence? * *

Yes

we are helping the client to obtain these

Please tick which benefits the client receives * *

Referral Agency Details *

Agency Org Details - First Name (Agency Worker) *

Last Name (Agency Worker) *

Agency Phone * *

Agency Email *

Explain to us how the client would benefit from our Supported Accommodation and why did you chose our Service? * *

Risk Assessment Please use examples listed of risk areas to ensure that the assessment is as comprehensive as possible and no key risk areas are missed. Think broadly about risk and add new risk areas if needed. Please remember the risks that is associated with achieving the goals of the client as this can have a positive as well as a negative outcome. If a particular ‘Risk Area’ does not apply.... Please leave blank *

RISK OF HARM TO SELF *

RISK OF HARM TO SELF – Additional Information *

RISK OF HARM TO OTHER RESIDENTS *

RISK OF HARM TO OTHER RESIDENTS - Additional Information *

RISK OF HARM TO PROPERTY History of causing damage to hostel, others and own property *

Yes

RISK OF HARM TO PROPERTY -Additional Information *

LONE WORKING RISK RATING *

Are there any issues that may heighten Risk? *

In an Emergency Use this part of the plan to say what you would like to happen in the event of a crisis. The crisis could be linked to the risk areas identified above, or not. Please be aware that Chatfield Housing staff will have a responsibility to contact other professionals or emergency services if you are in an emergency or crisis situation. In an emergency how would you like staff and others to respond? *

Your Needs Assessment This section of the document outlines areas of needs and how Chatfield Housing can support you with these. By using this information, we can develop a simple plan for you to be reviewed in the next 3 months. If a particular ‘Need Area’ does not apply to you.... Please leave blank Housing: this will help us to understand the issues that you face, such as finding, transferring and maintaining a home, living with and around others and working towards moving on to your own settled/permanent accommodation. *

Housing I need some support with Housing *

Yes

HOUSING - Additional Information *

Finance: This helps us to assess and help you to understand any financial issues that is relevant to your needs such as, understanding your entitled benefits, managing your money well, payment of bills, and clearing any debts. FINANCE *

FINANCE- additional Information *

Meaningful use of time: This helps us to understand how you want to manage your time positively/effectively and how you would like to make better use of this e.g. Education, employment, training, interests, hobbies and improving on positive strength.

MEANINGFUL USE OF TIME I need some support with how I spend my time

MEANINGFUL USE OF TIME - Additional Information *

Physical Health and Wellbeing: this gives you an opportunity to inform us of any factors/issues that may affect your physical health and wellbeing, e.g. Diet, exercise, hygiene, any links to professionals or doctors. *

Yes

If yes, pls specify *

PHYSICAL HEALTH AND WELBEING I need some Support with my physical health and wellbeing *

PHYSICAL HEALTH and WELLBEING - Additional Information *

Diversity. Chatfield appreciates that every individual is unique and recognise individual differences. To ensure that we offer the appropriate support, we will work with you to identify specific needs to you e.g., cultural/religious needs and personal preferences. DIVERSITY I need some support with my cultural needs and personal preferences *

Yes

DIVERSITY- Additional Information *

Support Network: we will assess and understand what network (formal or informal) are currently in place (supporting you) and signpost if this is necessary. We will work with additional network according to any needs and risk that is identified. We will work with you to develop and improve all support connections SUPPORT NETWORK I need some support with my Support Network *

Yes

SUPPORT NETWORK - Additional Information *

Safeguarding: we will support you to identify vulnerability issues that you may face when dealing with particular people or situation and will offer support that is effective to help you to keep safe from harm. SAFEGUARDING I need some support around Safeguarding *

Yes

SAFEGUARDING- Additional Information *

Emotional Health and Wellbeing: We will take this opportunity to explore any significant issues that is a factor/can become a factor to your everyday wellbeing e.g. Depression, anxiety, any treatment, medication or therapy, any link with specialist support being received and/or we will offer to link you with specialist support as required. EMOTIONAL HEALTH AND WELBEING I need some support with my Emotional Health and Wellbeing *

Yes

EMOTIONAL HEALTH AND WELLBEING - Additional Information *

Substance Misuse: we will support you to address any areas around alcohol or substance use/abuse in the past or present. We will also work with you to identify any triggers and/or risks. We will work with you and record in detail your use and together, decide a plan of management, along with your support network. SUBSTANCE MISUSE I need some support with Substance Misuse *

Yes

SUBSTANCE MISUSE- Additional Information *

Offending Behaviour: this will help us to capture details of any previous or current convictions, cautions or warnings, court cases pending and most importantly details and roles of the professionals working with you. This will also help us to design along with other professionals a network package to ensure your continued engagement and support. OFFENDING BEHAVIOUR I need some support with Offending Behaviour *

Yes

OFFENDING BEHAVIOUR - Additional Information *

Violent/Aggressive Behaviour: Chatfield looks at any history or pattern of any behaviour that you may have and what is likely to, trigger this to violence. This will enable us to give you the support needed and to signpost you to external agencies that you may need to access. This will enable both the client and us to understand and identify appropriate support and safety planning. VIOLENCE OR AGGRESSIVE BEHAVIOUR I need some support with Violence or Aggressive Behaviour *

Yes

VIOLENCE AND AGGRESSIVE BEHAVIOUR - Additional Information *

Self-Harming: this will help both us and the client to explore any history, issues or circumstances where harm may take place and gives us a chance to understand any practical details that is needed to support you in identifying and managing risks. SELF HARMING I need some support with Self Harming *

Yes

SELF HARM- Additional Information *

Domestic Abuse: our aim is to understand any emotional and practical needs that you may have in relation to DV or any external support that is currently working with you in order to provide the best possible care and support needed. Domestic Violence I need some Support with Domestic Violence *

Yes

DOMESTIC ABUSE- Additional Information *

Legal Matters Not Relating to Offending Behaviour: this broad area will help us to understand and link with the appropriate support around issues such as divorce, visitations, asylum etc or other relevant information. LEGAL MATTERS I need some support with Legal Matters *

Yes

LEGAL MATTERS- Additional Information *

Disability Issues: this allows us to understand and to put in place any physical and learning support that may be needed, including risk management so reasonable adjustments can be made to promote access to our service. DISABILITY ISSUES I need some support with my Disability *

Yes

DISABILITY - Additional Information *

Personal Choice: the client will identify any wishes they would like to achieve e.g. Applications for birth certificates, passports, DLA etc PERSONAL CHOICE I need some support with Personal Choice *

Yes

PERSONAL CHOICE - Additional Information *

Agency Org * *

Confidentiality - Consent, Explanation and Exceptions I give my consent for the information that I have given to be shared internally and between Chatfield Housing and relevant agencies in order to access accommodation and services in relation to my identified needs. I also agree to the Chatfield Housing GDPR Policy (Link Above) * Yes - I give my consent It has been explained to me that this information will be held on a database, will remain confidential and will not be shared with any other agency without first seeking my permission * Yes I understand the only exception to this will be where Chatfield Housing has serious concerns about the personal safety of myself or others. Example of their concerns include if I am contemplating suicide or self-harm, if there is a genuine threat of violence against others, or where staff are summoned by a court order to give evidence. * Yes Referral forms can also be obtained if you call our main office on 020 8834 4704 and request a paper-based copy. If you are a part of the HMPS and do not have access of any internet service. Please bear in mind there is an administration cost of £40 to access this service. *

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