I'd Like to work with someone

If you are experiencing difficulties with your emotional wellbeing that have changed how you live your life, you might want to come and talk with us to see if there are tools and techniques to support you to make changes. 

CYP-AccEPT works to support young people and their families with guided self-help and, where needed, face to face work. The wellbeing practitioners are trained to support mild to moderate difficulties in low mood, worries or fears, and behaviour. They support young people and families with structured support materials over a course of up to 8 sessions.


If you have been struggling with your symptoms for a very long time, or your symptoms impact you to the extent that you are concerned about yours or others' safety, it is likely that a service who can see you more frequently and spend more time with you, would be more helpful. To help us find the best service for your needs, please could you answer the questions below and one of the team will be in touch.

Please be aware that we are not an 'out of hours' service, and most of the appointment times we have available will be within the working / school day. 


Please give as much detail as possible so that we can make a thorough initial assessment of your needs.  

A little about you

If you are aged 13 and over, you can ask to work with us without permission from your parents. However, If you are aged between 13 and 15,  it is important that your read our consent and confidentiality information as there are exceptional circumstances where we, in order to help keep you safe, may need to share information with your parents, or a responsible adult who can support you. 


 Please answer all of the questions below and a member of the team will be in contact with you. We aim to respond to all enquiries within 5 working days. 

If you are asking for support alongside your child under 13, please answer the questions together, where possible,  as a reflection of their experience also, and with their details (age etc.) 

We will need to write to you about your referral. Please tick below the ways in which we can write to you

Phone / text 


Post addressed to me 

A little about what is challenging you

This section helps us to understand more about your current difficulties. We won't be able to get your full experience in this section, but these questions help us to get a sense of whether we are the best service for your needs. 


Over the last two weeks, How bad have your difficulties been? The rating scale shows 10 to be not bad at all, to 100 being the worst possible 

From the last two weeks (14 days) how many days have you felt as bad as you rated in the question above? 

How many other / different times in your life have you experienced these same difficulties

little about the impact of your difficulties

When we experience difficulties in our mood, fears or behaviour they can often start to impact or change how we live our lives: With friends, with family, and at school. This section helps us to understand how your difficulties are impacting you

Where do your difficulties impact your life?

Please use the sliders to show how big an impact or change your difficulties have in each area of your life. As before, 10 represents not much impact, 100 represents a really big impact. 



With friends / socially

A little about your safety

Sometimes, we can feel so desperate about how our difficulties make us feel, and the impact that they have on our lives, that we can lose a sense of hope for the future, or a sense of connection with the world around us.

Some people cope with that by hurting themselves, and sometimes people have really difficult thoughts and ideas about how they might end their lives if they don't feel able to cope anymore.

It's really important that we understand whether your difficulties have impacted on you in this way, so that we can make sure to support your safety where we can, or help direct you to an alternative service who could offer more time and different ways of working with you. 

If you are answering this section as a parent of a young person aged 12 and under, try to answer this as far as possible from their experiences. 

Please note: if you tell us that you are currently taking actions towards ending your life, we have a duty of care to pass this information on to your GP to try and support your safety. 

Current Difficulties (within the last three months)
Past Difficulties (over three months ago)
Sense of safety from, or to, others. 

If you need immediate support around any of the issues you have told us about above, Please use our Accessing support page for other services that can help you. 

A little about what you want to change

CYP-AccEPT wellbeing practitioners will support you to make changes based on the goals you set. How effective you are in making these changes will be based on how able you are to put the tools and techniques into action. This section helps us to understand a little more about the change you want to see. 

How important is it to you that you make changes to how your feelings impact your life. 0 = not important, 100 = the most important thing

How motivated are you to use the tools and support materials to help you to make changes? 0 = not motivated, 100 = completely motivated. 

How Confident do you currently feel about being able to make these changes? 0 = not confident, 100 is completely confident. 

Thanks for taking the time to tell us about your difficulties.
Please check the box below, that you have read our confidentiality and consent policy and then click the submit button below to send your responses. We will aim to reply within ten working days 

I confirm that I am aged 13 or over, and have read the confidentiality and consent policy