[Skip to content]

Short breaks self referral form

Short breaks self referral form

Local Offer logo

Short breaks and respite care explained

Short Breaks provide children and young people with disabilities opportunities to spend time away from their parents and carers, relaxing and having fun with their friends. 

They also provide families with a break from their caring responsibilities and give parent and carers a chance to unwind, spend time with their other children or take part in leisure or training activities. 

Short breaks help families to spend time together, ensuring that there is support to make access possible. Short break activities are offered during the daytime, evening, weekend and school holidays.

Short breaks statement

We've produced a short breaks statement (PDF document) which goes into more detail about eligibility and the types of short breaks.

Children and young people will be considered for our Short Breaks service if they:

  • Are aged between 0 and their 18 birthday
  • Live in the Wokingham Borough
  • Have a recognised disability - that is, a physical or mental impairment, which has a substantial and long-term effect on their ability to carry out day-to-day activities and
  • As the result of their disability, they require support to participate fully in leisure or recreation activities

This may include:

  • A physical disability
  • A learning disability
  • A hearing impairment 
  • A visual impairment 
  • A communication disorder i.e. autism
  • Attention deficit hyperactivity disorder (ADHD) (where a child is unable to access any other type of mainstream provision, even with support)
  • A consciousness disorder i.e. epilepsy *
  • Children who have palliative care or a life-limiting or a life-threatening condition
  • A mental health condition *

* Where children or young people do not meet the children and young people's Continuing Care assessment for children with complex health care needs criteria, and are therefore not able to access short break support from health services.

If the eligibility criteria apply to you, complete the:    


Completing the self referral form will help us gain a better picture of your child’s needs and the level of service or support needed.

If you require support to complete the form please contact the Short Breaks Co-ordinator.

Email:  ShortBreaksCo-ordinator@wokingham.gov.uk

Return completed form

Please return your completed form to our duty triage team.

Email:  triage@wokingham.gov.uk

or by post to:

Duty Triage and Assessment Team

Ground Floor

Shute End


RG40 1BN

What happens next

After we receive your form a record for your child will be created on our system, if one does not already exist. The form will then be passed to the Short Breaks and Early Help Team for a decision. You will be contacted within 5 working days of receiving your form with the outome of your referral.

For further information please read our Short Breaks Statement (PDF document).

Don’t forget there are many services that can be directly accessed without the need for assessment. To find out more visit the Local Offer directory.

Help and support for other needs

If you need support with wider needs or would like support from a social worker please contact the duty triage team:

Who provides short breaks

Short breaks are provided by:

  • Wokingham Borough Council
  • Our preferred providers
  • Other public and private providers

Which types of short breaks are available

There are different types of short breaks available:

  • Day-time care in the homes of children with disabilities or elsewhere
  • Overnight care in the homes of children with disabilities or elsewhere
  • Educational or leisure activities for children with disabilities outside their homes
  • Services available to assist parents / carers in the evenings, at weekends and during the school holidays 

Find short breaks

Visit our short breaks and respite care services web page to find short break services.

Preferred-provider logo.jpg

We've put together a list of preferred short breaks providers which you can use for short breaks and respite care. This is a voluntary list and these providers have been vetted by us to ensure that they have experience in providing the service, with adequate staff, skills and knowledge. 

They are required to have specific insurances, as well as policies and procedures in place to guide the actions of the individuals involved in the service, such as safeguarding, safer recruitment and health and safety. The providers will undergo annual checks so that parents and carers can be assured that the provision is suitable to remain on the preferred providers list.

You can view the preferred providers in our service directory.

Getting your Short Breaks Direct Payment

The short breaks direct payment is the amount of money you get to pay for your short breaks. 

We'll set up a bank account for you and send you a bank card known as the 'Wokingham Card' which you can use to pay for the short breaks.

Read the assessment to receiving short break payments flowchart (PDF document) to find out more.

You can find out more about the card and how to activate it on the Pre-paid Financial Services website.

Direct payment guide

Read the Short Breaks Direct Payment guide (PDF document) for information on:

  • What is a Short Break Direct Payment? Who can get them? How do they work? 
  • How will the money be paid to me and how do I use the online Bank Account / ‘Wokingham card’?
  • What can I spend Short Break Direct Payments on?
  • How do I recruit and employ a Personal Assistant?
  • How do I use an agency, organisation or purchase a service?
  • What happens if I need support or there is a change in circumstances? 
  • What Records Do I need to Keep?
  • How are Short Break Direct Payments reviewed, suspended or stopped?

You can use your Short Break Direct Payments to employ a personal assistant, you will be responsible for the recruitment and employment process and managing the terms and conditions of their contract.

Read factsheet 4 of the Short Breaks Direct Payment guide (PDF document) to find out what this will involves.

The Skills for Care website also provides information on recruiting and employing a personal assistant.

Find a personal assistant service

Search the Local Offer directory for care agencies who offer personal assistant services.

If you require a personal assistant for someone aged 18 or over see our adult community directory for details of local personal assistants and care agencies.

If you are not eligible for short breaks from Wokingham Borough Council, we will ensure that our decision is clearly explained to you.

In most cases where a child has a disability, even if it is not substantial, there will be services available at the universal level that they can engage with. Information on these services can be found on the Local Offer directory. You do not require input from the Short Breaks and Early Help Team for your child to be able to access these, although our Short Break Co-ordinators can offer initial advice and signposting.

Further support

Our CAN Network Co-ordinator can offer support when looking for services and activities on our Local Offer.

Email: can.network@wokingham.gov.uk

Below are local services and organisations who might be able to help you:

Local Offer directory

The short breaks process and documents are continually being developed and evolving. We welcome your feedback to help us improve. Please send any feedback to SEND Voices Wokingham.

Give website feedback

Back to top