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Online referral Form

First name

Last name

Email

Phone Number

Post code

Intials of child(ren)/young person(s)

Is the child(ren)/young person(s) currently in receipt of any other therapeutic intervention? *

No

Yes

Status of referer *

Birth Parent

Foster Carer

Adopter

Special Guardian

Social Care Professional

DOB of child(ren)/young person(s) * required

Are there any safeguarding issues we should be made aware? *

No

Yes

If you answered yes to any of the above questions, please elaborate below

What therapeutic service did you require? *

DDP informed intervention

Theraplay Informed Intervention

Therapeutic Life Journey Work

Therapeutic Support Groups

Let's Do Project

Please indicate what training you would like to consider? *

N/A

Developing empathy in children: A practical guide for parents and carers

Self-harming behaviours:

Lying and stealing

The challenge of challenging children: A guide

Sexualised behaviours: Tips

Managing adult responses: A child's view

Talking to children with trauma and loss experiences

Wellbeing: Methods

PACE principles: A guide for interaction with children (2-day or 3 day course. Each session 3 hours)

PACE principles: A guide for interaction with adults (2-day or 3-day course)

Managing transitions

Controlling Behaviours

Skills to Foster (six evening or weekend courses

Allegation’s training

Men Who Foster

Foundations for attachment

Wellbeing: Methods

Skills to Foster (six evening or weekend courses

Responding vs reacting: A guide for parents and carers.

Life journey work

Safeguarding children

Sexualised behaviours: Tips

PACE principles: A guide for interaction with children

Adolescent’s training

Serious Case Review Training

Child Sexual Exploitation

Developmental trauma

Managing Siblings

Building Bonds With Play

Please expand on why you are making a referral for a service?

I declare that the info I’ve provided is accurate & complete

I have ensured that I have anonymised information regarding the person you are referring for a service

Thanks for submitting!

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