AR1.4
YOUNG VOICES SUFFOLK ADVOCACY REFERRAL FORM
(This page will be used as case file front sheet when a referral is actioned)
Case No (office use only):
Date Form completed:
NAME (of person being referred):
DOB:
Sex: M / F
Ethnicity:
Address:
Tel No:
School:
Teacher:
Class:
Parent/Carer:
Address (if different from referred person):
Name of Referrer (if not a self referral)
Contact Details:
Relationship to referred person:
Language/preferred communication methods:
Any Access Requirements:
1
AR1.4
RISKS TO PERSONAL SAFETY – Detail any information needed to ensure the safety of the
advocate and the referred person, including risk management procedures in place: THE
ADVOCATE IS UNABLE TO PROCEED WITH THE REFERRAL UNLESS THIS SECTION IS
COMPLETED.
SELF-REFERRAL ONLY
NAME:
Please describe the issues you would like the advocate to work on with you:
2
AR1.4
THIRD PARTY REFERRALS ONLY
(Please ensure you have completed page 1 of this referral form)
PERSON REFERRED:
Is the referred person aware of the advocacy referral?
Has the referred person requested the referral for advocacy?
Y/N
Y/N
Contact details of key professionals working with the client. For example:
Social Worker:
Keyworker:
Connexions:
Psychiatrist:
Physiotherapist:
SALT:
Other:
3
AR1.4
See our attached ‘Guidelines for Referral’ and outline the reasons why you feel the referred
person would benefit from an advocate at this time:
Signature: ________________________________________________ (Referrer)
Date:_____________________________________________________
Signature of client:_________________________________________
Date: ____________________________________________________
Please send or e-mail your completed referral form back to
VoiceAbility Young Voices
E-mail: [email protected] Fax: 08452412577
Post: Young Voices Suffolk, VoiceAbility Advocacy Service, Claydon Court, Claydon,
Suffolk, IP6 0AE.
4
AR1.4
Young Voices Suffolk, VoiceAbility Advocacy Service Referral Guidance
This is an information sheet for referrers to help clarify what the advocacy service can offer. Please
take into account the following points when considering whether a referral is appropriate and to help
when explaining advocacy to people you want to refer.
One-to-One Advocacy is….
Supporting people who are going through a difficult time to speak up for
themselves or to get their views across to others
 Empowerment – both the process and outcomes of advocacy seek to empower people to have
greater control over their own lives. If someone is able to self-advocate then we will not
undermine their ability to speak up for themselves and will support them to do this.
 Securing Rights – ensuring people know their rights and have these upheld.
 Giving people informed choices – “it’s this or nothing!” is not a choice.
 Issue-specific and time-limited – once the issue is resolved, the advocate ends the relationship
so they can work with someone else.
 Independent of service provision – VoiceAbility is a voluntary organisation working to create
positive choice for disabled people and people with mental ill-health through training, client
involvement and advocacy projects.
One-to-One Advocacy is NOT….
 Taking Over an Issue – the advocate and service user together form a plan about how the
particular issue is to be addressed. The advocate is also not there to replace other
professionals.
 Telling someone what to do – advocates support people to make their own informed choices,
given all the facts. They do not make any decisions for the person they are working with.
 Befriending or support work – advocates do not get involved just because someone wants
someone to talk to, or to perform any care tasks.
 Just for people who can talk – people who do not verbally communicate also need advocacy. In
these cases we either identify appropriate methods of communication or follow a Watching Brief
approach.
 A mediation service – an advocate is independent but not impartial. We are overtly there to be on
the side of the person we are representing.
5