Community Support Referrals

This form is intended for agencies or agency Staff only.

A separate survey has been prepared for service users to get their perspective on their referral journey. We encourage all workers making and receiving referrals to encourage tenants they refer to complete the Service User survey and to assist them if that is required.

These surveys are part of the Waterloo Human Services Collaborative's action plan, which explores the effectiveness of local referrals between agencies. We will use this feedback to investigate and inform how we can improve the service system for providers and residents. The Collaborative has agreed that we want to encourage active linking and feedback on referrals as part of our continuous improvements in local customer service. You can find further resources in a Customer Service Toolkit on the Collaborative’s website.

We are conducting this survey in September 2024, and if data like this has not already been collected, please consider collecting it for the month to inform your answers. If this is not possible, estimated totals are acceptable.

We appreciate your cooperation in completing this form and promoting the residents' survey to your service users. Your efforts will be valuable in our progress in this work.

Please exclude clinical or medical-related referrals. However, social prescriptions and social support-related referrals by clinicians to generalised services can be included in this survey.

Should you need more assistance or information on the background of this survey, visit the service access page of our website, www.waterloo2017.com or email wtrlhms@dcj.nsw.gov.au

About You

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1. Is this survey being filled out on behalf of:

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2. Concerning this data, how many staff are involved in making and accepting referrals?

Internal Referral's

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3. Does your service make / receive internal referrals to specialists/teams within your organisation?

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4. Where an external referral is transferred internally do you provides feedback to the original referrer?

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5. Where an onward referral is made, is the outcome of that referral tracked?

Referrals to your agency

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6. On average, how many referrals does your agency receive from other agencies in a month?

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7. How many of your clients are self-referring

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8. On Average, how many referrals you receive need to be referred on to another agency due to capacity, waitlist, complexity, incorrect referrals, not providing the service requested, etc

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9. Does your agency have any standards around response times?

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10. What is the average response time for responding to a referral?

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11. What percentage of referrals do clients withdraw or not progress?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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12. What percentage of referrals came with adequate information and consent?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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13. What percentage of referrals do you provide feedback to the referrer about their referral?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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14. What percentage of referrals you received were you able to accept?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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15. What percentage of referrals received were inappropriate?

0 100
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i We adjusted the number you entered based on the slider’s scale.
Referrals made to other agencies

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16. On average, how many referrals does your agency make in a month?
(Include those received from other agencies and onward referred counted earlier in Q8 above).

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17. What percentage of referrals you made to other agencies were accepted.

0 100
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i We adjusted the number you entered based on the slider’s scale.

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18. What percentage of referrals you made do clients withdraw or not progress

0 100
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i We adjusted the number you entered based on the slider’s scale.

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19. What percentage of referrals made to other agencies received no feedback?

0 100
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i We adjusted the number you entered based on the slider’s scale.

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20. What action is taken if feedback is not received from the other agency and client?

Information and informal Enquiries
(non-tracked)

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21. On average, how many enquiries do you receive monthly for information about services when there is no formal referral by your agency/unit and no standard tracking of outcomes?

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22. Do your staff use / recommend Service Seeker or Ask Izzy to find services?

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23. Any observations on how provisions of information on services can be improved?

Overall Observations

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24. How would you rate the effectiveness of the referral system in place for your agency?

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25. How would you rate the effectiveness of the referral system in place for the wider service system you refer people to?

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26. What are the biggest challenges you face when making referrals?

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27. What are the biggest challenges you face when receiving referrals?

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28. Can you share any insights from your agency on successes or good practice tips that you think others would benefit from?

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29. How do you think the referral system could be improved?

Contact Information (optional )

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30. Name and title of person completing the survey

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31. Name of Organisation

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33. What is the address of your organisation? (unit, outlet or service)

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34. can we contact you with any follow up questions

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35. Are you a current member of the Waterloo Collaborative or any of the working groups?

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