Request School Health Nursing Support

Welcome to the Worcestershire School Health Nursing Service referral information, which is part of the Starting Well Partnership

Please read the below referral criteria carefully before submitting the form:

1. We accept electronic referrals from Schools, Parents, GPs and other professionals for school aged children, however if you need a word version, please email whcnhs.shnaccessandresponse@nhs.net
2. We can accept telephone contact from parents for initial advice or for further referral into the service through our 1 simple number: 01905 520032
3. We also have a confidential texting service for Parents via our Chat Health Parent Line (07312 263547)
4. Young People can self-refer or have a text chat with a school nurse via our ChatHealth confidential texting service (07507 331750). 
5. All referrals will be processed by our dedicated Access and Response Team and responses will be sent to the referrer received via email. Please ensure you add your contact email address to the referral form.  
6. You should expect to have a response to your referral within 14 days.

Referral Exclusion Criteria

• Health related school absence referrals

These referrals cannot be considered if they are not health related.

• Growth and nutrition

Monitoring height and weight for other professionals who are already planning care.

• Emotional health and wellbeing

If a child or young person is already under the care of another service provider (e.g. Children and Adolescent Mental Health Services (CAMHS), Specialist Counselling, Wellbeing and Emotional Support Team (WEST) etc.)

If a referral to CAMHS or Community Paediatrics is required, this should be completed by whichever professional first identifies a concern - this could include the GP or school.

If there are immediate concerns around serious self-harm, psychosis, or suicidal ideation, please seek emergency advice by dialing 999, 111 or attending your nearest at A&E department.

• Bereavement

If a child or young person has already been referred to or is under the care of a specialist service.

• “Behaviour”

School-based behaviour concerns need to be addressed by school following own procedures.

More information required

• If children/young people are already under the care of specialist health services and you need further information, this should be requested from the specialist service.
• If you have any safeguarding concerns, please do not refer to this service to investigate - follow your organisation’s individual safeguarding policies, and/or make a direct referral to Worcestershire’s Family Front Door
• Please ensure that you have gained and documented consent from young person 13+ prior to submitting a referral
• Please only add one child per referral form (Siblings require separate referral forms to be submitted).

School Health Nursing Referral

Note: Questions marked by * are mandatory

*This is a mandatory field. Referrer's Name

*This is a mandatory field. Referrer's Email Address:

*This is a mandatory field. Referrer's Phone Number:

*This is a mandatory field. Date of referral:

*This is a mandatory field. Relationship to child/young person:

*This is a mandatory field. Child/ Young Person's Name

*This is a mandatory field. Child/ Young Person's Date of Birth:

*This is a mandatory field. Child/ Young Person's Gender:

Please Select An Option MaleFemaleOtherTransgender MaleTransgender FemaleGender NeutralNon BinaryPrefer not to sayNot Known

Child/ Young Person's NHS Number (if known):

*This is a mandatory field. Name of School:

Form/Year Group:

*This is a mandatory field. Ethnicity:

Please Select An Option White - BritishWhite - IrishWhite - Any other White backgroundMixed - White and Black CaribbeanMixed - White and Black AfricanMixed - White and Black AsianMixed - Any other mixed backgroundAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiAsian or Asian British - Any other Asian backgroundBlack or Black British - CaribbeanBlack or Black British - AfricanBlack or Black British - Any other Black backgroundOther Ethnic Groups - ChineseOther Ethnic Groups - Any other ethnic groupPrefer not to say

Language spoken if not English or other Communication Needs:

Interpreters needed?

Yes
No

*This is a mandatory field. Parent/ Carer's Name:

*This is a mandatory field. Relationship to child/young person:

*This is a mandatory field. Parent/Carer's Contact Number:

*This is a mandatory field. Parent/ Carer's Address (including postcode):

GP/ Surgery Name:

GP/ Surgery Address:

	Supporting resilience and wellbeing (e.g., bullying issues, domestic abuse concerns, managing tasks in daily life- washing, dressing, hygiene, general advice for toileting issues, routines)	Improving health behaviours and reducing risk taking (e.g., social media concerns, friendship groups, alcohol or drug misuse, smoking, sexual health, relationships, behaviour issues, puberty advice and support, Parenting groups)	Supporting healthy lifestyles (e.g., diet, sleep, poor diet and physical inactivity, Oral health)	Promoting self-care and improving health literacy (concerns around bullying, puberty, sexual health, gender identity, sexual orientation, Parenting strategies and support, information on support groups, support available in community)
*This is a mandatory field. What are the specific health issues that the School Nurse may be able to address? Please select the main reason from the following list
Please select any other additional health issues that the School Nurse may be able to address from the list

Please elaborate on the concerns raised above What are the specific health issues that the School Health Nurse may be able to address? Please include any relevant information that you feel may be beneficial. Does the child have any medical conditions or are they under the care of any other professionals? Any current medication (if known)?

What strategies/services have already been implemented, and when, to support the child/young person in meeting their health needs? Can you identify if there has been any involvement from other partners/agencies such as Early Help, Parenting Support or Family Support?

Does this child/young person have an Early Help Assessment in place?

Yes
No

*This is a mandatory field. Has verbal consent been obtained from a parent/carer for children under the age of 13 or from the young person if over the age of 13?

Yes
No
N/A

*This is a mandatory field. Name of person giving consent:

*This is a mandatory field. Relationship to the child/young person

*This is a mandatory field. Contact Number:

*This is a mandatory field. Email Address:

If consent is from a young person - how you would like to be contacted?

Letter
Telephone
SMS/Text
Video Call (Webex or Teams)

Young person's contact number

Young person's email address (could be a school email address)

Social-Worker Details (if applicable)

Child Protection Plan

Child in Need

*This is a mandatory field. Referrer’s signature

Clear

Additional information for parents, children and young people that can offer help and support

• Parenting Support Groups on Starting Well Partnership Website
• ChatHealth, text 07507331750  - Health and well-being advice and support for young people, operated by the Worcestershire School Health Nurses 
• Young People support on Starting Well Partnership website
• Child and Adolescent Mental Health Services (CAMHS) (opens new window)
• CAMHS Reach4Wellbeing (opens new window) - Group interventions for children and young people with anxiety 
• Paediatric Occupational Therapy (opens new window) - Sensory processing problems resources (An Advice Line (0756436633) is available on Wednesdays from 10am-3pm.
• ChildLine - Support for children and young people (opens new window) telephone: 08001111
• Young Minds (opens new window)
• Worcestershire Young Carers (YSS) (opens new window)
• Sexual Health Outreach (opens new window)
• ERIC - support and advice line for continence (opens new window)