Placement Assessments with Support Package

Referral Submitted

Thank you - your Placement Assessment with Support Package referral has been received by the HAPii team.
We will be in touch within 2 working days to discuss scope, documents, support needs, and next steps.

Referral Details

Date of Referral *

Preferred Contact Method *

Level of Urgency *

Relevant Deadline / Review Date

Referring Person / Organisation

Name *

Position / Role *

Organisation / Agency *

Contact Phone *

Contact Email *

Service Requested

Full Placement Assessment with Support Package Assessment of the child's needs, placement strengths and pressures, with tailored support recommendations. Placement Stability Review & Support Package Focused review where a placement is under strain or needs additional therapeutic support. Pre-Placement Matching Consultation Support for matching, transition planning, and preparation before a placement begins. Post-Placement Therapeutic Support Package Bespoke support for carers and professionals following placement start or change.

Primary Purpose / Questions to Address *

Child / Young Person Details

Name, Date of Birth & Age *

Current / Proposed Placement *

Legal Status / Care Order

Communication, Disability, Cultural or Access Needs

Placement, Carers & Network

Current / Proposed Carer(s) *

Key Professionals Involved *

Birth Family / Siblings / Significant Relationships

Placement History

Placement Background & Current Concerns

Reason for Referral *

Child's Attachment, Trauma and Developmental Needs *

Current Placement Pressures / Risks *

Placement Strengths and Protective Factors

Support Package Needs

Areas Where Support Is Needed

Understanding attachment and trauma Therapeutic parenting / caring Emotional regulation Behaviour support Contact / access support Placement transitions Professional network consultation Other

Desired Support Package Outcomes *

Current Supports & Previous Assessments

Current Professional Supports

Previous Assessments / Interventions

Safeguarding & Legal Context

Immediate Risk / Safety Concerns? *

Court / Legal Proceedings Involved?

Risk / Safeguarding Details

Practical Arrangements

Location / Online Platform

Availability / Preferred Times

People to Be Included in Assessment / Support

Documents Available

Care Plan Placement Plan Fostering assessment / review Chronology Previous assessments / reports Court order / direction School / therapeutic reports Consent forms Other

If other, please specify

Preferred Consultant

Declaration

I confirm I have authority to make this referral and that consent, information-sharing permissions, and safeguarding arrangements are in place or will be clarified before the placement assessment and support package begins. I understand HAPii may request further information before confirming scope and suitability.

Additional Notes

Signature (Full Name) *

Date *

HAPii Placement Assessments with Support Package Form

Referral Submitted