Sycamore Wellbeing - Professional Referral

Sycamore Wellbeing – Professional Referral

Sycamore Wellbeing is a six-week targeted early-intervention programme for children aged 5–8 who would benefit from additional support with their emotional wellbeing, regulation, confidence, participation and connection. Delivered from our Mongolian yurt and garden at The Lighthouse Project in Byker, Sycamore recognises that children engage, communicate and regulate in different ways. Sessions therefore draw on a range of approaches including therapeutic play, creativity, sensory regulation, therapeutic gaming, LEGO®-based activities, sandtray, gardening, books and storytelling, mindful movement, breathwork, nature connection and outdoor exploration. Sessions have a consistent and predictable structure while remaining responsive to each child's strengths, interests and individual support needs.
Sycamore takes its name from our Tree of Hope – a sapling grown from the felled Sycamore Gap tree and planted within The Lighthouse Project grounds. It provides a special symbol of growth, resilience and renewal at the heart of the programme.
Place Allocation

Funded places are available for eligible children aged 5–8 who live in Newcastle or Gateshead and are currently on a CNTW waiting list for mental health support or an assessment for neurodiversity. Sycamore is a therapeutic wellbeing intervention; it is not counselling, psychotherapy or a diagnostic service. It provides structured, child-centred therapeutic activities designed to support wellbeing, emotional regulation, confidence, participation and connection while a child is waiting for specialist support or assessment. Participation in Sycamore does not replace, affect or alter the specialist service or assessment the child is waiting for. Children may be supported individually or, where appropriate, within a carefully matched small group. Each referral is reviewed individually, taking account of the child’s needs, presenting concerns, support requirements, risk and suitability for the available provision. Places are limited and there may be a waiting period before provision can begin. Submission of a referral does not automatically confirm a place. Family Mental Fitness North East CIC will review the referral and contact the referrer regarding suitability, availability and next steps.
Referrer Details
Name

First NameLast Name
Organisation
Job Title / Role
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child Details
Child's Full Name

First NameLast Name
Child's date of birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Child's Home Postcode (Required for eligibility checks)
Name of School
Year Group
Parent/carer's full name

First NameLast Name
Parent/Carer email
example@example.com
Relationship to child
Reason for Referral
Please tell us why you are referring this child to Sycamore Wellbeing and what you hope they might gain from taking part.
Funded Place Eligibility

Funded places are available for eligible children aged 5–8 who live in Newcastle or Gateshead and are currently on a CNTW waiting list for mental health support or an assessment for neurodiversity.
Is the child currently on a CNTW waiting list for:
Please tell us which service/pathway the child is waiting for and approximately when they were referred.
Please upload evidence confirming that the child has been referred to, and is currently awaiting, the relevant CNTW mental health support or neurodevelopmental assessment pathway. This may include a referral acknowledgement, waiting-list confirmation, relevant professional correspondence or other documentation confirming the child's current pathway status. Please redact information relating to any other individuals that is not relevant to this referral. We are unable to confirm an NHS-funded Sycamore place without evidence of eligibility.

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Completing This Form

Sycamore is designed to support children with a wide range of needs and presentations. Please answer the following questions openly and candidly. A history of dysregulation, avoidance, leaving a supervised area, aggression or other behaviours of concern will not in itself prevent a child from accessing Sycamore. This information helps us understand the child and informs their individual support and risk planning, including the most appropriate delivery format, staffing level, environment, reasonable adjustments and any additional support that may be required. Accurate information is important for the child’s wellbeing and the safety of everyone taking part. Where essential safety information is not known, we may pause the referral while further information is obtained.
Supporting the Child to Participate Safely
Does the child have any known allergies, medical needs or health conditions that we should be aware of when considering this referral?
Does the child have any additional needs, communication needs, sensory needs or accessibility requirements that may affect their participation?
Please provide relevant details for any of the above, including allergies, medical or additional needs, communication or sensory requirements, accessibility needs, and anything that helps the child feel comfortable, regulate, communicate and participate successfully.
Supporting the Child to Participate Safely - further details
Toileting and personal care.
Family Mental Fitness North East CIC staff do not provide toileting, intimate care or personal care assistance during Sycamore sessions. Can the child manage their toileting and personal care independently during a Sycamore session?
If no, please describe what assistance or prompting is required.
Toileting and personal care - further details
Avoidance and engagement
Does the child display avoidant behaviour when anxious, overwhelmed or asked to participate in something they find difficult?
If yes, please describe what this typically looks like, any known triggers and what usually helps the child to re-engage.
Avoidance and engagement - further details
Leaving supervised areas / flight risk
Has the child ever attempted to leave or left a classroom, activity, building or supervised area without agreement?
If yes, please provide details, including how recently this has occurred, typical triggers or circumstances, what usually helps, and the level of supervision normally required.
Leaving supervised areas / flight risk - further details
Physical aggression and behaviour presenting risk
Has the child displayed physical aggression towards other children or peers?
Has the child displayed physical aggression towards school staff or other professionals?
To the best of your knowledge, has the child displayed physical aggression towards parents/carers or other family members?
Has the child displayed behaviour that has caused, or presented a significant risk of, physical harm to themselves?
Has the child caused significant damage to property when distressed or dysregulated?
If yes, please provide relevant details, including what the behaviour typically looks like, how recently it has occurred, known triggers, frequency or severity where relevant, and strategies currently used to reduce or manage risk.
Physical aggression and behaviour presenting risk - further details
Level of adult support
Does the child usually require individual adult support to participate safely in activities outside their usual classroom or familiar environment?
Are there any circumstances in which the child currently requires two adults to support them safely?
If Yes or Sometimes, please describe the level of support normally required and when it is needed.
Level of adult support - further details
School attendance and significant incidents
Has the child received a suspension from school within the last 12 months?
Is the child currently attending school on a reduced timetable, experiencing significant difficulties attending school, or regularly unable to access their usual classroom?
If yes to either of the above, please provide brief relevant details, including how recently this occurred and any support currently in place.
School attendance and significant incidents - further details
Consent
Has the parent/carer agreed to this referral and to the information provided here being shared with Family Mental Fitness North East CIC for the purpose of considering and arranging participation?
I confirm that, to the best of my knowledge, the information provided is accurate and relevant to this referral.
I understand that submitting this form does not guarantee a place and that Family Mental Fitness North East CIC will review the referral before confirming participation
Anything else you think it would be helpful for us to know?
Photography and Images

During Sycamore sessions we may take photographs to celebrate activities, record participation and share the work of the programme. Our approach is privacy-conscious: photographs of children are normally taken from behind, over the shoulder, or focused on hands, activities and creations rather than identifiable front-facing images. Some photographs may be published by Family Mental Fitness North East CIC, including on our website, social media or in programme and funding communications.
Does the child have appropriate consent in place for this type of photography and publication?
Should be Empty:

Sycamore Wellbeing – Professional Referral

Place Allocation

Referrer Details

Child Details

Reason for Referral

Funded Place Eligibility

Completing This Form

Supporting the Child to Participate Safely

Toileting and personal care.

Avoidance and engagement

Leaving supervised areas / flight risk

Physical aggression and behaviour presenting risk

Level of adult support

School attendance and significant incidents

Consent

Photography and Images