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- OXFORDSHIRE FAMILY MEDIATION 12 Spinners Court, 55 West End, Witney, Oxfordshire, OX28 1NT (T) 0844 8476658 (E) admin@ofm.org.uk
- Name: DOB
- Names: DOB: Living with: Do they wish to be seen
- Ethnicity*: Ethnicity*
- Referral parent Referral parent Reasons for referring child/ren to Children’s Voice
- Presenting issues / background information for child/ren being referred
- Are there, or have there been, any court proceedings regarding the child/ren If so, please provide details
- Is there, or has there been, any contact with the court welfare service regarding the child/ren If so, please provide details
- Is there, or has there been, any contact with Social Services regarding the child/ren If so, please provide details
- Are any child/ren in the family on the Child Protection Register
- Referrer’s contact details
- Accessing the Children’s Voice Service at OFM
- FOR OFFICE USE ONLY
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For office use only: CW Location Date received CS no. 
  
OXFORDSHIRE FAMILY MEDIATION 12 Spinners Court, 55 West End, Witney, Oxfordshire, OX28 1NT (T) 0844 8476658 (E) admin@ofm.org.uk CHILDREN’S VOICE REFERRAL FORM - CONFIDENTIAL Date of referral: CHILD/YOUNG PERSON’S DETAILS Name: DOB: Gender: Ethnicity*: Age: Living with: School: Any additional needs: Mobile Number: Email Address: SIBLINGS (INCLUDING HALF AND STEP SIBLINGS) – please continue below or on a separate sheet if needed Names: DOB: Living with: Do they wish to be seen? Parent 1 – Relationship to the child: Parent 2 - Relationship to the child: Name: Name: Address: Address: Postcode: Postcode: Ethnicity*: Ethnicity*: Tel: Tel: Email: Email: Any additional needs: Any additional needs: *Break down of ethnicity categories: White British, White Irish, Black or Black British African, Black or Black British Caribbean, Black or Black British Other, Asian or Asian British Indian, Asian or Asian British Pakistani, Asian or Asian British Bangladeshi, Chinese, Mixed White and Black Caribbean, Mixed White and Black African, Mixed White and Asian, Mixed Other, White Other, Asian or Asian British Other, Gypsy Roma, Other, Unknown Referral parent? Referral parent? Reasons for referring child/ren to Children’s Voice (please continue below / on a separate sheet if necessary): ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………… Presenting issues / background information for child/ren being referred (please continue below / on a separate sheet if necessary): ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Are there, or have there been, any court proceedings regarding the child/ren? If so, please provide details: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Is there, or has there been, any contact with the court welfare service regarding the child/ren? If so, please provide details: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Is there, or has there been, any contact with Social Services regarding the child/ren? If so, please provide details: …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Are any child/ren in the family on the Child Protection Register? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Referrer’s contact details (if different from above): Name: Address and postcode: Phone number and email address: THANK YOU FOR YOUR REFERRAL TO THE CHILDREN’S VOICE SERVICE AT OFM Accessing the Children’s Voice Service at OFM (Please take a moment to read the following information) The Children’s Voice service at OFM was set up to support children who have been affected by parental divorce or separation. It is important to note, that they are not a crisis intervention services, but offer a safe space where children and young people can access one-to-one therapeutic support with a specialist Support Worker. Each child or young person accessing either the Children’s Voice service is offered up to 6 sessions at one of our outposts across Oxfordshire. See our website for current charges.www.ofm.org.uk At OFM, we find that children benefit from the Children’s Voice service most, when Mediation between parents has taken place first. If the separation process or court proceedings are currently underway, we recommend waiting until things are more settled before making a referral. In some cases, Child Inclusive Mediation (CIM) may be a more suitable option. Depending on the age of the child or young person affected by parental separation, CIM encourages parents to ask their children for their opinion about the situation or the issues they may be facing as a result, with the guidance of an impartial third party (the Mediator). However, whilst children and young people may be being asked for their opinions, they are not asked to make final decisions, as this can make them feel responsible for changes in their family and may lead to a confusion of roles between parents and children and add unnecessary pressure. We advise that communication between parents should be handled very carefully, especially within earshot of their children. Conflict and criticism between parents can be very hard for their children to bear; they need both parents to allow them to have a loving relationship with the other parent. It is helpful for children and young people if they are not questioned about the other parent’s life, or asked to pass on messages. If children and young people are protected from such things, they will find it much easier to adjust to their new life. We know that divorce and separation can have a huge impact on the lives of everyone concerned; however, we believe it is important that children and young people’s needs remain central during this difficult time. If other agencies are working with the child and/or family being referred, please do let us to know. We may well ask for permission to contact these agencies so that we can work together to best support you. We also need to know if there are any child protection issues within the family, and if anyone in the family is on the Child Protection Register. Do not worry if you don’t know this information, we’ll still be happy to help. Please note - unless there are exceptional circumstances which we have been made aware of, we will need permission from both parents for child/ren under the age of 16 to be able to access the Children’s Voice Service at OFM. Young people over the age of 16 are welcome to self-refer for which they do not need to gain consent from either parent. However, we do recommend that they inform their parents about the service. When Children’s Voice sessions come to an end, we offer children the chance to give their parents feedback about how they are feeling via their Support Worker, or to tell their parents themselves. We find that many children want to pass on feedback to their parents, but respect their choice either way. It is important to recognise that all sessions for children and parents are confidential, apart from if safeguarding issues arise. We hope that you have found this useful. If you have any questions or would like more information, please contact the OFM office by ringing 0844 8476658 or emailing admin@ofm.org.uk. We also recommend that you visit the relevant pages of our website www.ofm.org.uk/page/childrens-voice. FOR OFFICE USE ONLY Approved by………………………………………………..Date…………………………..……… CS number………………………………. 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