Wirral MHST- support with the transition to secondary school self-referral form :: Cheshire and Wirral Partnership NHS Foundation Trust

Wirral MHST - support with the transition to secondary school self-referral form

Online Support Intervention (OSI) is an online programme that helps parents and carers learn ways to support children with worries about transitioning to secondary school.

Wirral MHST is offering OSI to parents and carers of children in Year 6 at Wirral primary schools to help support the move from primary school to secondary school.

Please answer the questions below so we can learn more about your child and decide whether OSI would be helpful for you to support your child with their worries about transitioning to secondary school.

By completing this form, you are consenting to receive support from Wirral Mental Health Support Team.

A member of the team will contact you to arrange an appointment to talk about whether OSI is the right support for your child. During the initial discussion, the MHST practitioner may decide that your child would be more suited to a different type of support, which they will speak to you about.

We keep NHS electronic patient records, which can be seen by GPs. By asking for support from our service, you agree to us keeping a record of the support we provide.

Your child's primary school

Which school does your child attend? Please select from the list below. Please note: if your child's school is not on this list then we are unable to accept a referral for the OSI. Please speak to your child's school's mental health lead for advice. Required

Initial screening questions

Please confirm that you consent to the following before completing the rest of the form.

I am a parent/carer of a child in a Wirral primary school and I consent to this request for support Required

Yes

I consent for work to be carried out via video where required (eg via Microsoft Teams)? Required

Yes

I give my consent for the NHS Mental Health Support Team to contact the Mental Health Lead in my child’s education setting? Required

Yes

I give my consent for the NHS Mental Health Support Team to contact other agencies supporting my family if required Required

Yes

Please answer the following screening questions before completing the rest of the form.

Is your child’s primary difficulty worry related to the transition to secondary school? Required

Yes

Can you confirm that your child is not experiencing difficulties that could make this support unsuitable or less helpful, such as autism, a learning disability, thoughts of suicide, or repeated self-harm? Required

Yes

Are you aware that this is an online offer of support and do you have access to the internet to take part in the intervention? Required

Yes

Can you confirm that you do not have any learning difficulties or mental health problems that would make it hard for you to take part in the Online Support Intervention? Required

Yes

This intervention also requires parents/carers to complete work for an hour each week between sessions with the practitioner. Are you able to commit to this? Required

Yes

Please note: if you answered 'no' to any of the above initial screening questions, you do not need to fill in the rest of the form below as you / your child may require a different type of support. Please speak to your child’s School Mental Health Lead about this before completing the rest of the form.

If you have immediate concerns about the mental or emotional wellbeing of a child or young person, please contact the Wirral 24/7 Mental Health Crisis Line by calling NHS 111 and selecting option 2 for mental health.

If you answered 'yes' to all of the screening questions and would like to proceed with your request for support from the OSI, please complete the rest of the form and submit via the pink 'submit' button at the bottom of the page. Thank you.

About your child

First name Required

Surname Required

My child likes to be known as Required

Child's assigned sex at birth

Male

Female

Prefer not to say

Name of child's preferred contact at school

Full name of parent / carer Required

Relationship to child Required

Email address

Mobile number

Home address Required

Address 1

Address 2

City

Country

County

Postal Code

What is your preferred method of contact Required

Phone

Letter

Do you require any additional support to access this programme, such as an interpreter / translator? Required

Yes

If you answered yes to the above question, please detail the support you require

Why are you interested in OSI?

Parent/carer/next-of-kin's view: What is your child struggling with in relation to the move to secondary school that they would like to change? Please give details (eg brief example of a recent situation where they have experienced this difficulty) Required

Child's view: What would you like help with? If they are able to, they can type their thoughts here

What would you and your child like to be different as a result of receiving support? Please give examples (eg things your child would like to be able to do, things they would notice that would be different). Required

Goals are important to us so we will discuss this further when we meet with you and/ or your child.

Names of other services that have been accessed or are currently being accessed by you or your family. Please give name of service and type of support (eg counselling, early help, social care, CYPMHS)

Is there anything else you'd like to tell us?

What happens next?

Thank you for taking the time to complete the 'request for help' form for the OSI. Please make sure you submit your response via the pink 'submit' button below before leaving this page.

Someone from the Mental Health Support Team will contact you within 2 weeks to arrange a time when we can discuss your form and to hear more about how you are hoping the team can help your child.

Please note that this form should not be used if you need immediate help or support regarding your child’s emotional or mental wellbeing. If you require urgent help or support that is not indicated on this form, please call the 24/7 Mental Health Crisis Line by calling NHS 111 and selecting option 2 for mental health.

If no one has made contact with you within two weeks of submitting the form, please contact us at: cwp.wirralmhstreferrals@nhs.net

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Wirral MHST- support with the transition to secondary school self-referral form