How to complete this form Please complete appendix 1 if you are making a referral for one of the following parenting programmes Mellow Mellow Parents Triple P Parents as partners (PAP) Prior to making a referral, please ensure families meet the different eligibility criteria for parenting programmes. Please also note that this form should be submitted in addition to the Early help form. If you would like to discuss your referral in more detail, please contact the Croydon Parenting and Relationship hub coordinator at For further information about Croydon’s parenting offer, please visit https://www.practitionerspacecroydon.co.uk/ PARENT(S) / MAIN CARER(S) DETAILS Parent/ Carer 1 Parent/ 2 (if applicable) Full Name: REFERRER’S DETAILS Full Name: Job role: Contact number: Email: Please indicate which parenting programme you are making a referral for: MELLOW BUMPS Please tick if meeting eligibility criteria Parent is at 20-30 gestation Parent has consented to the referral Parent requires support around forming a secure attachment with their baby Parent does not suffer from an unmanaged addiction Parent does not suffer from a severe mental health issue, e.g. psychosis There are currently no removal orders in place for the unborn child MELLOW PARENTS Please tick if meeting eligibility criteria Child is aged 0-3 Parent has consented to the referral and to being filmed with their child. Recordings will not be shared with outside agencies and only used for reflective practice as part of the course. Parent requires support around forming a secure attachment with their child Parent does not suffer from an unmanaged addiction Parent does not suffer from a severe mental health issue, e.g. psychosis. Child is living with parent and/ or is able to attend the children’s group that runs alongside the programme. TRIPLE P
Please tick if meeting eligibility criteria Child is aged 0-12 Parent has consented to the referral Parent requires support to reinforce positive parenting practices and promote child development PARENTS AS PARTNERS (PAP) Please tick if meeting eligibility criteria At least one child is aged 0-11 Both parents have consented to the referral and are able to attend Parents require support around parent-parent relationship/ improving communication and practices Parents are currently not involved in family law/ care proceedings It is deemed safe for both parents to attend together (e.g. no ongoing/ high level domestic abuse) Where possible, we try to take accommodate parents’ location preferences. Please could you indicate parent’s preferred area for attending the parenting programme. Please tick. Planning Area 1 (Norbury, Upper Norwood, South Norwood, Bensham Manor, West Thornton, Thornton Heath) Planning Area 2 (Woodside, Ashburton, Addiscombe, Selhurst, Broad Green, Waddon, Croham, Fairfield, Shirley) Planning Area 3 (Heathfield, Fieldway, New Addington, Selsden and Ballards, Sanderstead, Kenley, Purley, Coulsdon East, Coulsdon West) Please let us know a time when the parent would most likely be available to attend the parenting course. Monday Tuesday Wednesday Thursday Friday AM PM AM PM AM PM AM PM AM PM Comments (e.g. only available weekends): Please submit this form alongside an Early Help Referral form or Early Help Assessment (CAF). By post or by hand Early Help Hub, Early Intervention Support Service, Department for Children Families and Learning, Floor 4 Zone C, Bernard Weatherill House, 8 Mint Walk, Croydon CR0 1EA By password protected Childreferrals@croydon.gov.uk By secure fax 020 8633 9436