Changing Minds & Changing Lives

New Referral Form

We accept clients, male and female, aged 25 years and over with local connections in the area where accommodation, care and support is available.

When a referral is received, if appropriate, an appointment will be offered for a comprehensive assessment. Once assessed, if the client meets our criteria and a vacancy exists, a unit of accommodation will be offered. If a vacancy does not exist, the client will be put on a waiting list for consideration for when a vacancy becomes available. We take referrals from several sources including the NHS, Local Authorities, Housing Organisations, Prisons, Probation, The Police, Drug & Alcohol agencies, Homeless shelters, Approved Premises, and Veterans. 

Self-Referral

Contact us or visit your local office and an appointment for an assessment will be offered. Details can be found in contact us

 3rd Party Referral

We accept referrals from agencies and organisations who wish to refer on behalf of their clients. You can refer using our online form or contact us directly.

Complete our online referral form

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Low RiskMedium RiskHigh Risk
Risk to children
Risk to self
Risk to other clients
Risk to staff
Risk to females
Arson
Risk of suicide
Risk of substance abuse/alcohol misuse
Risk of domestic abuse
Risk of sex offences
Risk of extreme anger and hostility
Risk Indicators - This information is required to allow support workers to prepare for the assessment fully. Please give as much detail as you are aware of especially where there may be concerns for lone working. Please note, if this referral is left blank or there is a lack of information, it may result in a delay of the referral being processed. * If you are making this referral for an individual that is not know to you and/or you do not consider it appropriate to complete this section, please tick here........ (please ensure the 'Network of Support/other agencies involved' details are completed in full as this will allow us to make the necessary enquiries regarding risk.
Immediate & OngoingRequired but not yet engagedNot required
Social Worker
CPN
Probation
Psychiatrist/Psychologist
ImmediateFutureNone
Access to local services Rough Sleeping
Becoming homeless/evicted (within 28 Days)
Risk of offending
Risk of self - harm
Risk of harm from others
Risk of long-term unemployment
Reduce social isolation
Risk of domestic abuse
Accessing drug & alcohol services
Access to health services
Ability to manage money better
Access voluntary services
Unplanned hospital admissions
Getting involved in activities
Developing problem solving skills
Frequent presentation to accident & emergency
Increased feelings of being less reliant
Ability to keep a home safe & secure
Ability to manage health & wellbeing
Ability to manage personal hygiene
Gaining or maintaining employment, education & training
Developing personal competence
Building personal competence
Ability to manage a healthy lifestyle
Developing interpersonal skills
Skills to eat healthily
Increase social & community networks
Deteriorating financial position
Ongoing health issues
Increased feelings of being more independent
Ability to manage ongoing health problems
Obtaining or maintaining a suitable home
Developing household skills
Reducing feelings of isolation
Developing self esteem
Increase confidence