Psychoeducational Support Form

Referral Submitted

Thank you - your Psychoeducational Support referral has been received by the HAPii team.
We will be in touch within 2 working days to discuss needs, format, and next steps.

Referral Details

Date of Referral *

Preferred Contact Method *

Level of Urgency *

Relevant Deadline / Target Date

Referring Person / Organisation

Name *

Position / Role *

Organisation / Agency *

Contact Phone *

Contact Email *

Who the Support Is For

Audience / Participants *

Child / young person Parent(s) Foster / kinship carer(s) Residential care team Professionals School / education staff Other

If other, please specify

Participant Names / Roles / Ages *

Support Requested

One-to-one Psychoeducation Individual support for a child, young person, parent, carer, or professional. Family / Carer Psychoeducation Support for parents, foster carers, kinship carers, or a caregiving network. Professional Consultation Case-focused consultation for social workers, GALs, education staff, or care teams. Group Session / Workshop Psychoeducational input for a team, foster carer group, family network, or professional group. Bespoke Support Package A tailored package combining psychoeducation, consultation, and practical recommendations.

Preferred Delivery *

Estimated Number of Sessions

Themes / Learning Goals

Key Themes Requested

Attachment Trauma Emotional regulation Therapeutic parenting / caring Play, connection and repair Contact / access support Life story / identity Transitions / placement stability Other

Specific Goals / Questions *

Background & Current Context

Reason for Referral *

Relevant Child / Family / Team Context *

Current Concerns / Presenting Needs

Strengths and What Is Already Helping

Safeguarding & Legal Context

Immediate Risk / Safety Concerns? *

Court / Legal Proceedings Involved?

Risk / Safeguarding Details

Practical Arrangements

Location / Online Platform

Availability / Preferred Times

Accessibility, Cultural or Communication Needs

Documents Available

Care Plan Assessment / report Placement / support plan School report Court order / direction Consent forms Other

If other, please specify

Preferred Consultant

Declaration

I confirm I have authority to make this referral and that consent, information-sharing permissions, and safeguarding arrangements are in place or will be clarified before support begins. I understand HAPii may request further information before confirming the scope of work.

Additional Notes

Signature (Full Name) *

Date *

HAPii Psychoeducational Support Form

Referral Submitted