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"Talking Really Helps" Referral Form 

Details of Your Child or Young Person (CYP)

CDASS collects this information so that we have the main contact details of the CYP who is being referred to us. We will keep their details confidential and allocate a unique reference number (URN) once they are accepted onto TRH which will used to refer to the CYP once they attend TRH.

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We also ask the ethnicity and gender of your child to ensure that we are providing a fair and equal service to all children and young people regardless of background. 

What is your child's gender? Required
What is your child's ethnicity? Required
Details of Parent/Carer

CDASS is a charitable voluntary organisation which means that we do not have a direct accountability to any public or private agencies such as Children Services, Schools or the Police. CDASS requires your details to be able to contact you via email or a chosen social media platform. We keep your details confidential but if your child is known to be at risk of harm, CDASS will always contact you first to let you know the steps we have a duty to take in order to safeguard and protect your child and his/her family.

Talking Really Helps and Your Child (specific questions)

We ask a few questions about your child so that we have an idea of what they would like to happen before starting the TRH intervention programme.

Do you think your child will want to attend the TRH programme once or twice a week? Required
Do you think your child will consent to attending TRH? * Required
Do you think your child would prefer to attend the online TRH sessions at home or school? Required
Have they been received any previous help or support as a child victim of domestic abuse? Required
Contact Times

Due to being an online service and understanding that parents/carers have busy lives, CDASS would like to arrange a suitable time to contact you. However, as CDASS undertakes administrative and developmental work Monday to Thursday mornings, we are only available for meetings and TRH sessions in the afternoons/early evenings. We will also consider weekend TRH sessions if requested.  

What is your preferred social media platform for your child to access the TRH programme? Required
If you are employed or unemployed, what is the best time to contact you using the above chosen social media platform? Required
CDASS and Improvement

This helps CDASS to improve its marketing approach.

How did you hear about CDASS? Required
Your voice

Please feel free to add anything else that you or your child would like to say about CDASS or domestic abuse services for CYP.

What's next?

Please feel free to add anything else that you or your child would like to say about CDASS or domestic abuse services for CYP.

Thanks for your submission!

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