Therapeutic Life Story Work Form

Referral Submitted

Thank you — your Therapeutic Life-story Work referral has been received by the HAPii team.
We will be in touch within 2 working days to discuss next steps, timelines, and a formal proposal.

Referral Details

Date of Referral *

Preferred Contact Method *

Referring Person / Organisation

Name *

Position / Role *

Organisation / Agency *

Contact Phone *

Contact Email *

Child's Details

Child's Name *

Age *

Gender *

Current Placement *

Estimated Number of Sessions

Type of Therapeutic Life-story Work Required

Full Therapeutic Life Story Intervention (including narrative development and emotional processing) Life Story Book Creation with therapeutic support Preparation for adoption or long-term permanence Support for identity, loss, and belonging issues Integrated Life Story Work combined with attachment/trauma processing Other (please specify below)

If other, please specify

Brief Background & Reason for Referral

Care History, Key Losses / Events, Current Emotional Needs & Goals *

Key Objectives / Outcomes Sought *

Preferred Consultant

Dr Lisa O'Reilly Founder & Director · Guardian ad Litem · Play Therapist · Attachment Researcher Dr Caroline Duignan Guardian ad Litem · Child & Youth Researcher · National Trainer Charlotte Lyne Child & Adolescent Psychotherapist · Play Therapist · Clinical Supervisor Dr Katie O'Donoghue Art Psychotherapist · Chartered Psychologist (BPS) Mel Shanley Guardian ad Litem · Medical Social Worker · Trauma Specialist Kevin Hutton Guardian ad Litem · Residential & Child Protection Specialist Steven Peet Guardian ad Litem · Complex Case Reviewer · Foster Carer No preference Please recommend the best match for this case

Additional Information

Court / Legal Proceedings Involved? *

Immediate Risk / Safety Concerns? *

If safety concerns, please describe

Documents Attached

Care Plan Previous Reports Chronology Other

If other, please specify

Declaration

I confirm I have authority to make this referral and consent for HAPii to contact the relevant parties as needed.

Signature (Full Name) *

Date *

HAPii Therapeutic Life-story Work

Referral Submitted