Make a Firststop referral below

Please complete this information about the professional completing this form.

Please complete this section about the young person being referred.

This form allows us to determine whether it is suitable for a young person and their parent’s/carers to access Firststop Family Mediation Service. If we feel that a placement will trigger or exacerbate any risk or support needs and have a detrimental effect on the young person or their parents/carers, we may not recommend they join the service. We will look at all referrals on a case-by-case basis.

The information collected via this referral form is being completed for the sole purpose of connecting young people and their families to the Firststop Family Mediation Service. All information will be held confidentially in accordance with Gloucestershire Nightstop’s Data and Confidentiality Policy and Family Mediation Policy. The Firststop Family Mediation project is funded by Tewkesbury Borough Council Housing Department as part of their prevention of youth homelessness work. If you are registered with their housing support services, summary information about the outcome of your Firststop journey will be shared with them. Added to this, anonymised information about those who use our service will be shared with the Tewkesbury Council Housing Department about the outcomes and effectiveness of the service to support funding applications for its continuation in the future. Accessing your personal information: Under General Data Protection Regulation, clients have a number of rights over the way we manage information. Right to be informed: we will not collect their information without their knowledge, and they have the right to be informed of what data we are processing, what for, how we obtained it and to whom it is released Right to access: subject to certain conditions, we will grant access to the information we hold related to the client Right to rectification: we will correct information that is wrong Right to erasure: we will erase client information (except in some circumstances) Right to restrict processing: we will stop using your information at client's request (in some circumstances) Personal information is gathered to allow us to assess whether Family Facilitation is the right service for you and your family, to enable us to make appropriate offers of other services and to safely manage those services. Data is also used to monitor the service for funding applications, but this does not include identifying information. On occasions, we use information for marketing and promotion purposes but this would only be with your consent. The full privacy policy is available in the footer of the Gloucestershire Nightstop website https://www.gloucestershirenightstop.org.uk/about-us/privacy-policy/ . If you wish to make any requests or have any questions about the handling of your data, the Data Controller Elaine Pearson can be contacted at our office via: Telephone: 01452 331330 Email: