This form is to be used when requesting support for a child or young person and their family at levels 2, 3 or 4 of the Hackney Child Wellbeing Framework from Hackney Council Children & Education Services. If you are unclear on whether to make a request for support, please contact the MASH by calling 020 8356 5500 and asking for a ‘consultation’.

The following information is needed to help provide a service for a child, young person and their family. This will allow us to provide the right support for them as quickly as possible. Please refer to the Hackney Child Wellbeing Framework and guidance document to help you complete this form. Referrers will be informed of the final decision following screening, unless it is deemed inappropriate to do so, in which case the reasons for this will be recorded on the Request for Support form.