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The In-mind approach

We try and get a good, early, understanding of the difficulties you've been experiencing, and for how long, so that we can match you with the right person from the start.

If you are looking for support for your child, please complete this form with them where possible. If they are 13 and over they can complete this form themselves. We often find that this gives us the best picture of what they would like support with. 

Providing mental health, ASD and ADHD support across the Oxfordshire area and beyond.

A little about 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 2 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 (name, age etc.) 

We will need to contact you about your referral. Please tick below how you would prefer to be contacted

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 it's a good start! 

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 

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

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

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. 

School / Work 


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, and get you the right package of care from the start. 

If you are answering this section as a parent of a young person aged 13 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. 

A little about what you want to change

Our clinicians will support you to make progress based on what you would like to change in your life. Some people feel really ready and motivated to make those changes, and others notice that their feelings really impact their confidence around change. The answers to the questions below help us to ensure that you work with the right person, for how you are feeling

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 and ready do you feel to be able to practice new skills to help with your feelings? 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 reply within two working days 

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