Youth and family support service referral

Use this form to refer a young person (aged 10 to 17 years) and their family to our youth and family support service.

We can help young people who are at risk of breaking the law only if they live in or visit the Brisbane region.

To refer a young person and their family, answer the following questions and submit your referral online. Once we receive your referral, we will contact the family to set up a meeting and work out how we can best support them.

1. Can I make a referral?

   1. Are you or are you concerned about a young person aged 10 to 17 years? *

      • Yes
      • No
   2. Does the young person live in, or regularly visit, our service area? * View list of service areas in the greater Brisbane region (If you chose 'Yes' above)

      • Yes
      • No
   3. Does the young person have a youth justice caseworker? * (If you chose 'Yes' above)

      • Yes
      • No
   4. Do you think the young person is at risk of engaging in a criminal act? * (If you chose 'No' above)

      • Yes
      • No
2. Make your referral (If you chose 'Yes' above)

   1. The situation

      1. What are the issues the young person is experiencing? Select all that apply

         • Conflict
         • Suspension
         • Homelessness
         • Other
      2. What other issues is the young person facing? * (If you chose ‘Other’ above)
         
      3. Is the young person getting support from other agencies? *

         • Yes
         • No
      4. What other support is the young person getting? * (If you chose 'Yes' above)
   2. Young person's details

      1. Young person’s name

         1. Given name *
         2. Family name *
      2. Date of birth * dd/mm/yyyy
      3. Home address

         1. Address line 1 *
         2. Address line 2
         3. Address line 3
         4. 1. Town, city or suburb *
            2. State *
            3. Postcode *
         5. Country *
      4. Phone * Home, mobile or work number
      5. EmailExample: jane.smart@example.com
      6. Cultural background
      7. Have you received consent from the young person? *

         • Yes
         • No
      8. Does the young person need a translator? *

         • Yes
         • No
      9. What is the young person’s main language? * (If you chose ‘Yes’ above)
      10. Are you referring a second person from the same family? *

          • Yes
          • No
      11. Second young person (If you chose ‘Yes’ above)

          1. The situation

             1. What are the issues the young person is experiencing? Select all that apply

                • Conflict
                • Suspension
                • Homelessness
                • Other
             2. What other issues is the young person facing? * (If you chose ‘Other’ above)
             3. Is the young person getting support from other agencies? *

                • Yes
                • No
             4. What other support is the young person getting? * (If you chose 'Yes' above)
          2. Young person's details

             1. Young person’s name

                1. Given name *
                2. Family name *
             2. Date of birth * dd/mm/yyyy
             3. Home address

                1. Address line 1 *
                2. Address line 2
                3. Address line 3
                4. 1. Town, city or suburb *
                   2. State *
                   3. Postcode *
                5. Country *
             4. Phone * Home, mobile or work number
             5. Email Example: jane.smart@example.com
             6. Cultural background
             7. Have you received consent from the young person? *

                • Yes
                • No
             8. Does the young person need a translator? *

                • Yes
                • No
             9. What is the young person’s main language? * (If you chose ‘Yes’ above)
                
             10. Are you referring a third person from the same family? *

                 • Yes
                 • No
             11. Third young person (If you chose ‘Yes’ above)

                 1. The situation

                    1. What are the issues the young person is experiencing? Select all that apply

                       • Conflict
                       • Suspension
                       • Homelessness
                       • Other
                    2. What other issues is the young person facing? * (If you chose ‘Other’ above)
                    3. Is the young person getting support from other agencies? *

                       • Yes
                       • No
                    4. What other support is the young person getting? * (If you chose 'Yes' above)
                 2. Young person's details

                    1. 1. Given name *
                       2. Family name *
                    2. Date of birth * dd/mm/yyyy
                    3. Home address

                       1. Address line 1 *
                       2. Address line 2
                       3. Address line 3
                       4. 1. Town, city or suburb *
                          2. State *
                          3. Postcode *
                       5. Country *
                    4. Phone * Home, mobile or work number
                    5. Email Example: jane.smart@example.com
                    6. Cultural background
                    7. Have you received consent from the young person? *

                       • Yes
                       • No
                    8. Does the young person need a translator? *

                       • Yes
                       • No
                    9. What is the young person’s main language? * (If you chose ‘Yes’ above)
                       
   3. Parent / guardian details

      1. Parent’s / guardian’s name

         1. Given name *
         2. Family name *
      2. Address

         1. Address line 1 *
         2. Address line 2
         3. Address line 3
         4. 1. Town, city or suburb *
            2. State *
            3. Postcode *
         5. Country *
      3. Phone * Home, mobile or work number
      4. Email Example: jane.smart@example.com
      5. Cultural background
      6. Have you received consent from the parent/guardian? *

         • Yes
         • No
      7. Does the parent / guardian need a translator? *

         • Yes
         • No
      8. What is the parent’s / guardian’s main language? * (If you chose ‘Yes’ above)
         
   4. Referral details

      1. Referrer’s name

         1. Given name *
         2. Family name *
      2. Organisation *
      3. Phone * Home, mobile or work number
      4. Email Example: jane.smart@example.com

Our support service is only for young people aged 10 to 17 years and their family and support network.

The young person may be eligible for support from other services such as Kids Helpline, Parentsline, Child Safety regional intake, or Child Safety after hours service.

We can provide support services only in the Brisbane region.

The young person may be eligible for support from other services such as Kids Helpline, Parentsline, Child Safety regional intake, or Child Safety after hours service.

The support of the young person’s caseworker will overlap with the support we can provide. Our service would not be suitable for this young person at this time.

This support service is only for young people who have committed a crime, or who you think will commit a crime.

The young person may be eligible for support from other services such as Kids Helpline, Parentsline, Child Safety regional intake, or Child Safety after hours service.