South Gloucestershire - Low-intensity Wellbeing Referral Form

This form is for professional use only. If you are worried about the safety of a child, please contact Access and Response on 01454 866000 Monday to Thursday 9.00 – 5.00, 4.30 on Friday, 01454 615165 out of hours and at weekends. If a child or young person is in immediate danger then please dial 999 and ask for police assistance.

We can only accept referrals from limited areas from South Gloucestershire: BS15, BS32, BS30. Please get in touch with us at [email protected] before making a referral outside of these areas.

We are low-intensity therapists, which means we will work with young people in a flexible way for a short length of time (6-12) sessions. We work with young people with mild to moderate mental health issues, as young people with a higher level of need require high-intensity therapy which we are not trained to deliver.

The lists below give an idea of the mental health difficulties that are and aren’t suitable for our roles. The list in not exhaustive, and is largely dependent on the severity and complexity of the difficulties the child or young person is experiencing. We can also help you when deciding on suitability, and suggest alternatives for the young person and signpost if we think a CWP is not suitable.

We can work with: low mood/depression, social anxiety, general anxiety, panic disorder (panic attacks), phobias (most but not all), sleep problems

We can sometimes work with: emotional regulation problems, obsessive compulsive disorder, self-harm (if low risk), health anxiety, difficult behaviours

We cannot offer support for: severe depression/anxiety, bi-polar disorder, eating disorders, post-traumatic stress disorder, current or historic abuse/violence, high-risk behaviour

Referrer’s Details

Young person’s details

We ask for the contact details of the young person (if possible) so we can arrange a pre-assessment call to understand what they hope to achieve during their one to one support.

Please note, we do not offer support with all of the above and this is for information purposes only

I understand that by completing this form, the details I have provided above will be taken, saved and stored by Creative Youth Network for data protection reasons, namely to provide one to one support to young people. I have been advised that if I want to know more detail about how Creative Youth Network deal with my information, I can ask to see the full Privacy Notice for Young People, Parents and Carers May 2018.