Before completing

Family Support Services Referral

Please select the type referral you would like to make *

Early Years Outreach ProgramLead Family WorkerSupported Playgroups

Select all that apply

Early Years Outreach Program referral information

The Program provides support to families to access Early Childhood Education services for children aged zero to five years, who live in the city of Port Phillip, and are experiencing challenges.

Eligibility

Families with children aged 0 to 5 in need of support around Early Childhood Education and Care ServicesFamilies that are not currently supported by another case management service.

Families that have been exposed to risk factors that may include: family violence, drug and alcohol, mental health, neglect or housing and situational stress.

Further information

If you have any questions, please contact:

Early Years Outreach Worker
Phone: 0466 954 111
Email: earlyyearsoutreach@portphillip.vic.gov.au

City of Port Phillip ASSIST
Phone: 9209 6777

Lead Family Worker referral information

Family Workers provide generalist family advice, referrals and support to families on topics such as:

Community connectedness
Family violence
Emotional support
Parenting strategies
General mental health

Eligibility

Families with children aged 0 to 8 who live, work or play in the City of Port Phillip
Families that are not currently supported by another case-management service (Orange Door).

Further information

If you have any questions, please contact:

Lead Family Worker
Phone: 0401 283 680 or 0421 483 149
Email: leadfamilyworker@portphillip.vic.gov.au

City of Port Phillip ASSIST
Phone: 9209 6777

Supported Playgroups referral information

Supported playgroups are facilitated by a Council worker and offer light-on parenting advice and strategies. Sessions follow the Smalltalk program’s structure, covering a different topic every week, including the below:

Tuning into children
Following your child's lead
Listening and talking more

Eligibility

A family member in the household holds a Health Care Card or equivalent
Families in which a family member identifies as Aboriginal and/or Torres Strait Islander
Families looking after children in kinship care arrangements (Out of Home Care)
Families referred from Child FIRST/Child Protection
Families referred from or participating in Enhanced Maternal and Child Health Services

Further information

Some parents are also eligible for In-Home Support. In-Home Support is provided by a qualified facilitator who visits a family in their own home fortnightly during school terms for approximately one and a half (1.5) hours each fortnight. During these home-based sessions, parents practice the smalltalk strategies. Parents participating in In-Home Support may also be attending a Supported Playgroup. In-Home Support may be used to engage eligible families who are initially reluctant to attend a Supported Playgroup.

If you have any questions, please contact:

Supported Playgroup Facilitator
Phone: 0412 514 421 (Mondays, Wednesdays and Thursdays only)
Email: supportedplaygroups@portphillip.vic.gov.au

City of Port Phillip ASSIST
Phone: 9209 6777

We will make contact within five working days to discuss how we can support the family around the support and service needs identified in this referral.

Please confirm who is completing this form *

Declaration

Consent has been obtained by the family to make this referral *

Consent has been obtained for the referrer and City of Port Phillip Family Support Services to exchange information in regards to this referral and relevant support needs *

Referrer details

First name *

Last name *

Agency or centre name(if applicable)

Contact number *

Email *

Parent or caregiver details

First name *

Last name *

Email *

Contact number *

Is it safe to leave a message? *

Is an interpreter required? *

Please state dialect *

Does anyone in the household hold a Health Care Card or equivalent visa category?

YesNo

Home address status *

Home address details *

Street address *

City *

State *

Postcode *

First Nations identity *

Country of birth *

Date of arrival to Australia

Add details for another parent or caregiver? *

YesNo

First name *

Last name *

Email *

Contact number *

Is it safe to leave a message? *

Is an interpreter required? *

Please state dialect *

First Nations identity *

Country of birth *

Date of arrival to Australia

Child details

Child's name *

Date of birth *

Are you up to date with your Maternal and Child health appointments? *

Support details

Early Years Outreach Program support details

What are the barriers to accessing Early Childhood Education and Care Services (ECECS)? *

What support is required from Early Years Outreach worker? *

Lead Family Worker support details

Area of support needs *Select all that apply

What support is required from a Lead Family Worker? *

Supported Playgroups details

Issues the parent/caregiver felt a supported playgroup may assist with *

Reasons for referral as identified by service provider *

Are there any medical issues the Supported Playgroup Facilitator should be aware of for parent or child/ren?

Have any other family support referrals been made for the family? *

Please list the other family support referrals *

Is the family currently working with any other services? *

Please list the current services *

Any further comments

Data privacy and collection

The personal information requested on this form is being collected by the City of Port Phillip (CoPP) and will be handled in accordance with the Privacy and Data Protection Act 2014. This information will be used solely by the council for that primary purpose or directly related purposes. It will be treated in compliance with the CoPP Information Privacy Policy and the Information Privacy Act.

Supported playgroups is funded by the Department of Families Fairness and Housing (the Department). The service agreement between the Department and the service provider delivering this playgroup requires the service provider to collect personal information about you and your child/ren using this form. This information enables (1) to register your child and provide targeted support to your child/ren, and (2) the Department to evaluate whether the playgroup meets outcomes required by the service agreement (the primary purposes).

The Department values the privacy of every person and may only collect and handle personal and health information consistent with Victorian privacy law. The Department will only use your personal and health information collected through this form for the primary purposes described above, or otherwise when permitted by law. Personal information will be de-identified and aggregated prior to being used for the purposes of reporting. Information collected may be disclosed to external entities for purposes of research, in which case any identifying information about you, your child or your family will be removed to ensure your personal information is protected.

Yes, I give permission for the City of Port Phillip to store and process my data. *

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