JOY
PROFESSIONAL REFERRAL

Please note – when referring into the JOY Project, we require ALL Mental Health Support Workers to make the initial appointment with a member of JOY staff and be able to attend the first appointment with their client. Unfortunately we will not be able to accept referrals unless the support worker or a support worker can do so. Patients who have been recently discharged from Mental Health Services who have been asked to self-refer into JOY will also be asked to attend with the Mental Health Worker who has been working with them. Please contact JoRae, JOY Project Manager on jorae@worcestercommunitytrust.org.uk if you would like to discuss further.

Please also note – JOY doesn’t currently have childcare facilities, but under 1’s can sometimes accompany their mum/carer to some of our sessions. Please ask for more information if this is applicable.

Referrer's Details

Name of agency

First Name *

Last Name *

Email Address

Phone

What is your preferred method of contact?

Can you attend the first session with the client?

Will you continue to work with this client?

Client's Details

First Name

Last Name

Email Address

Phone

What is their preferred method of contact?

Postcode

Date of birth

Is the client working?

If yes, what is their work pattern? What time of day would they prefer to access the JOY Project?

Does the client have children?

If yes, are there childcare arrangements in place so they can attend?

Is the client a single parent?

Is the client a named Carer?

Are there any other agencies working with the family?

If yes, please provide details

If you are referring a woman with current domestic abuse issues, have you first referred into the DAWN project for group, 1-2-1 and legal support or WMWA?

Are there any health conditions (mental health, neurodiversity, learning or specific physical conditions) that we need to know about?

If yes to any of these conditions – have appropriate referrals been made to meet their specific needs?

If yes, please provide details

Are there any ongoing conditions or restrictions in place with this client?

If yes, please give brief details which we will speak directly to you about.

What made you decide to refer your client to the JOY Project? (please tick all that apply)They are experiencing loneliness and/or isolationThey need support with their anxiety / mental health issuesThey need support with their confidence and/or resilienceThey've had previous experience of domestic abuseThey are currently experiencing domestic abuseThey need support with their physical wellbeingFor crafts and activitiesFor coursesFor skills and training opportunitiesFor volunteering opportunitiesOther (please provide details below)

What is the client hoping to achieve from accessing the JOY Project?

Please give any other information you feel the JOY Project would benefit from knowing, including any risk factors we should know about

Ethnic OriginWhite - English/Welsh/Scottish/Northern Irish/BritishWhite - IrishWhite - Gypsy or Irish TravellerWhite - PolishAny Other White BackgroundMixed/Multiple Ethnic Groups - White & Black CaribbeanMixed/Multiple Ethnic Groups - White & Black AfricanMixed/Multiple Ethnic Groups - White & AsianAny Other Mixed/Multiple Ethnic BackgroundAsian/Asian British - IndianAsian/Asian British - PakistaniAsian/Asian British - BangladeshiAsian/Asian British - ChineseAny Other Asian BackgroundBlack/African/Caribbean/Black British - CaribbeanBlack/African/Caribbean/Black British - AfricanAny other Black/African/Caribbean backgroundOther Ethnic Group - ArabAny Other Ethnic GroupPrefer not to sayIt would be really useful to receive details on cultural origin, religion and sexual orientation. All Information is strictly private, anonymous and confidential. This is not compulsory. Thank you for your help.

ReligionNo religionChristianBuddhistMuslimSikhOtherPrefer not to sayIt would be really useful to receive details on cultural origin, religion and sexual orientation. All Information is strictly private, anonymous and confidential. This is not compulsory. Thank you for your help.

Sexual OrientationAsexualBisexualHeterosexual/straightGayQueerUnsurePrefer not to sayIt would be really useful to receive details on cultural origin, religion and sexual orientation. All Information is strictly private, anonymous and confidential. This is not compulsory. Thank you for your help.

GenderFemaleTransIntersexPrefer not to sayIt would be really useful to receive details on cultural origin, religion and sexual orientation. All Information is strictly private, anonymous and confidential. This is not compulsory. Thank you for your help.

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Worcester Community Trust is a registered charity 1112342
Registered Company Number 04722577

Registered Office:
The Green Centre,
Gresham Road, Dines Green,
Worcester, WR2 5QS

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Referrer's Details

Client's Details

JOY
PROFESSIONAL REFERRAL