The Hub - F.A.S.H | Family Assessment Support Homicide

The HUB provides peer support and practical advice for families affected by homicide and culpable road deaths. Through this assessment form, we aim to identify your concerns and any additional needs so we can offer tailored support to you and your family.

The F.A.S.H form helps us gather essential information about your circumstances, ensuring we can provide the most relevant and effective assistance.

Once you complete the form, we’ll listen to your needs and provide the help that’s most relevant to you and your family members.

No one should have to suffer in silence.

1: Permission and Consent

To provide you with the best possible support, we may need to speak with third parties on your behalf (e.g. housing authorities, schools).

This form gives us the legal permission to act on your behalf regarding the areas you have identified in your assessment as needing support. Rest assured, we adhere strictly to the Confidentiality and GDPR Act 2018.

Your Name(Required)

First Name Surname

Signature(Required)

Todays Date(Required)

2: About the Incident

In order to offer the appropriate support, we need some basic information about the incident. Please provide the name of the victim and the date of the incident. If you were referred to The HUB, kindly let us know who referred you. This information will help us understand your situation and tailor our services to your specific needs.

Victim’s Name(Required)

Date of Incident(Required)

Referral Type(Required)

Referred

Self-Referral

Please provide the name of the person or organisation who referred you:(Required)

3: Situation Information

To better understand your family’s needs, we ask that you provide details about the circumstances that have led to The HUB’s involvement. This information will help us identify areas that require support, prioritise urgent concerns, and determine if external referrals are necessary.

Please provide details of the areas in need of support(Required)

This includes areas of concern to monitor, areas of priority, and needs that may require external referral.

4: Personal Details

In this section, we ask for your personal details to help us contact you and ensure we understand your circumstances better. The information you provide will remain confidential and will only be used to offer the most appropriate support. Please note that the last two questions regarding sexual orientation and ethnicity are entirely optional, and you may choose not to answer them.

Your Name(Required)

First Name Surname

Gender(Required)

Male

Female

Other

Prefer Not To Say

Date of birth(Required)

Do you have a disability?(Required)

Yes

No

Disability Details(Required)

Please provide details of the disability:

Address & Contact Details

Address(Required)

Street Address City County Postcode Country

Landline Telephone(Required)

Mobile Telephone(Required)

Email Address(Required)

Optional Questions

You do not have to answer the following questions if you do not wish to.

Sexual Orientation

Ethnicity

Please select the option that best describes your ethnic group or background

Asian or Asian British

Black, African, Caribbean, or Black British

Mixed or Multiple Ethnic Groups

Other Ethnic Group

White

Prefer Not To Say

5: OLLY Children’s Group

Would you like your child/children to become a member of our O.L.L.Y Group (Our Lost Love Years)? If so, please provide the following information for each child. You can add more children by pressing the “ + ” icon. Please note: you will be required to complete a separate O.L.L.Y enrolment form for each child.

Childs Details

Child’s Name

Relationship to you

Date of Birth

School/College

6: Affected Areas In Need Of Support

Please indicate any areas where you or your family require support. These can include issues affecting your mental health, physical wellbeing, or environmental circumstances. Identifying these areas will help us provide the most appropriate guidance and assistance.

Please tick all that apply(Required)

Any Extra Details?(Required)

This can include any services you prefer information not to be shared with.

Other Factors(Required)

Please specify any environmental factors that may require support.

7: Brief Outline of Your Tragedy Incident/Incidents

Please provide a brief outline of the incident or incidents that have brought you to The HUB. This information will help us better understand your circumstances and provide appropriate support.

Details(Required)

Please provide a brief outline of the incident or incidents that have brought you to The HUB.

Postcode of the cemetery where the victim has been laid to rest(Required)

Do you know which services may be able to provide the support you need?(Required)

Yes

No

Please provide details(Required)

Has the family agreed to accept support and participate in the F.A.S.H Assessment?(Required)

Yes

No

8: Agree and Consent

Once you have read this form, please sign below to agree to its terms and confirm your consent for The HUB to provide support, or to refer you to the appropriate agency qualified in their field. The HUB will monitor your journey, including peer support, to ensure you receive the best assistance possible. If needed, with your consent, we may refer you to other specialised organisations.

Member’s Signature(Required)

Today’s Date(Required)

For Admin Use Only

Assessor’s Signature

Assessor’s Name

First Name Surname

Today’s Date

The HUB is a ‘One Stop Shop’, open five days a week from 9.30am to 4pm. No appointments are necessary, and we also offer a 24-hour helpline for those moments when you need someone to listen. We’re here for you, even on days when keeping an appointment feels impossible.

Visit our main website for further information.

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Family Assessment Support Homicide (F.A.S.H)

No one should have to suffer in silence.

1: Permission and Consent

2: About the Incident

3: Situation Information

4: Personal Details

Address & Contact Details

Optional Questions

5: OLLY Children’s Group

6: Affected Areas In Need Of Support

7: Brief Outline of Your Tragedy Incident/Incidents

8: Agree and Consent

For Admin Use Only