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This form must be completed with the family, who should be given a copy of the completed form.
The Referrer must agree to attend the Family Group Conference to assist the process.
The purpose of a Family Group Conference is:
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For the family to hear information from the professionals about their contact with the family, and what support and services they could offer the family
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For the family to consider any concerns about the children and the strengths which exist within their family
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For the family to make decisions and come up with a plan that supports the needs of the children
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For the referring professional to agree the family’s plan, and confirm that it does not put the children at risk
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For the family to have the opportunity of a Review Family Group Conference if they feel this would help
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Information about the children
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Name of children
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Gender
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Date of birth
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Information about the family
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Ethnic origin: Family’s 1st language:
Any special needs: Any literacy support needed:
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Names, addresses and telephone numbers of extended family and significant others
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Name
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Relationship to the children
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Address, postcode & phone numbers
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Details of Referrer and Professionals involved with the children and their family
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Name, Job Title and Location of Referrer
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Contact Information
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Please state the name of your team.
Supervising Managers Names (Must Provide):
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(all 3 required)
Land Line:
Mobile:
Email:
Tel
Email:
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Name, Job Title and Location of other Professionals
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Phone and Email address
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Brief description of the current situation
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Signs of Safety – Overall how would you rate the safety for the child/children 0 (High) to 10 (None)
As part of the safety plan what ‘worries’ would the FGC help address?
What is working well for the family?
* Note – referrers must submit a family tree or genogram, that includes the extended family. A referral may not be accepted without this.
Are there any Health and Safety Issues that the Co-ordinator would need to bear in mind when meeting with the family (e.g. concerning dogs, risky behaviour, etc) ?
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What question(s) does the FGC need to address?
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What would you not agree to in the family plan? For example action that would put the child at risk or resources not available.
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Names, signatures & date
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We agree to take part in the FGC process and to support the plans and decisions agreed.
We consent to the information on this form being shared with those involved in the FGC process.
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Children
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Family Member
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Referrer
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Line Manager
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Sign
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Print name
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Date
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Referrals will not be accepted without the signature of a family member and the referrer. However, these can be sent separately in the post – an electronic referral will be accepted in the meantime to expedite the process.
Any questions on process can be directed to:
Gisella Thomas
FGC Champion for Reading Borough Council Referrals
Hamilton Centre,
135 Bulmershe Road
Reading, RG1 5SG
Phone: 0118 9373873
Email: eocs@reading.gov.uk
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Juliet Penley
FGC Champion for West Berks Referrals
Phone: 01635 519093
Email: jpenley@westberks.gov.uk
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Please return the completed form and family tree or genogram to:
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Family Group Conferences (Reading & West Berks)
c/o of Hamilton Centre,
135 Bulmershe Road,
Reading RG1 5SG
0118 9373873
Email: eocs@reading.gov.uk
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