This form is to help us understand your current situation and how we may be able to support you.
We will keep all information in line with our confidentiality policies.
Our programme accepts self-referrals and supported self-referrals (in other words, if you are making this on behalf of someone else, they will be completing this form with you).
What to do next
I am completing this form about myself
If you need help with completing the form, or if you have any questions, please call 0344 515 1615. Also, please tell us about any services who you are working with already. We won’t contact anyone without your permission.
I am being supported to make a self-referral by someone else
Please ensure that you put the details of the person supporting you on the form so that we can contact you both to discuss the referral.
If I am not with the person I’m referring
Please call the engagement team first on 0344 515 1615 to discuss. We can talk about the best way of making a referral with you.
Inspiring Change Manchester is a learning programme which aims to support existing services to work together, share information and ultimately provide the right support at the right time for people. Our main aim is to break down barriers that cause people with Multiple and Complex Needs to disengage, or feel disengaged from services.
We ask that this form is completed so that we can begin to understand as much as possible about the current situation right at the beginning. Understandably, there are bits of information that you may be concerned about putting in this form, but the more that you do feel able to include the better we are to be able to support you.
We will store all information about you in line with our confidentiality policies.
By completing this form, you begin the application process to our programme. From this point we will expect any service that has already been supporting you to continue to do so, and to contribute to any discussion in order to fully assess your current circumstances and create a plan of action with you. This may involve sharing support plans and also attending a meeting with other services.
Once submitted, the application will be considered.
A member of the team will then contact you and, where appropriate, other organisations that you have been involved with to agree a way forward.