Under 18’s Self-Referral Form for Low Intensity Cognitive Behavioural Therapy (Li-CBT)

This form is not monitored 24 hours a day. If you are at immediate risk of harm, call 999. For urgent mental health support call NHS 111 and select the Mental Health option.

Who is this service for?

If you are under 18 and experiencing difficulties such as anxiety, low mood, stress, panic attacks, sleep problems, low confidence, social anxiety, or other emotional wellbeing concerns, our Children’s Wellbeing Practitioners (CWPs) may be able to support you.

CWPs provide Low-Intensity Cognitive Behavioural Therapy (LI-CBT), a short-term intervention usually lasting 6–8 sessions. Together with your practitioner, you will identify a goal that is important to you and work towards achieving it.

During your sessions, you may:

  • Learn more about your thoughts, feelings, and behaviours (psychoeducation)
  • Explore practical Cognitive Behavioural Therapy (CBT) techniques
  • Develop skills and strategies to use in everyday life
  • Receive guided self-help support
  • Build a toolkit of techniques to help you manage challenges and improve your wellbeing

Not sure if this is the right support for you? That’s okay. Complete the referral form and we will review your information to find the most appropriate support. We aim to contact you within 5 working days of receiving your referral.

Self-Referral Form

About you

Parent or carer details

Contact preferences

What would you like help with?

Support already in place

Safety questions

Why we ask these questions These questions help us understand how urgently you may need support and how to keep you safe. You can choose "prefer not to say" where shown.

Strengths and goals

What happens next?

Once we receive your referral, a member of our team will review the information provided. We will talk with you about what is going on and explore the best support options available. This may include one-to-one support, wellbeing activities, mentoring, groups, or specialist services. If our service is not the best fit for your needs, we will try to suggest other support options that may be more suitable.

Privacy and consent

We will keep what you tell us private wherever possible. If we are worried that you or somebody else is at risk of serious harm, or that a child or vulnerable person may not be safe, we may need to share information with other services to help keep people safe. Wherever possible, we will talk to you first and explain what information needs to be shared and why.