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	<title>WESTERN | ASCERT</title>
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	<title>WESTERN | ASCERT</title>
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		<title>School Counselling</title>
		<link>https://ascert.biz/project/school-counselling/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Wed, 21 Aug 2024 14:03:34 +0000</pubDate>
				<guid isPermaLink="false">https://www.ascert.biz/?post_type=project&#038;p=76535</guid>

					<description><![CDATA[HOPE Counselling Service for Post Primary Schools]]></description>
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				<div class="et_pb_text_inner"><h2><strong>Service Overview</strong></h2>
<p>Pupils today are faced with many pressures as they continue to develop their coping skills and preparation for the adult world. Pupils experiencing stress or emotional problems find it difficult to engage with the education process and to reach their full potential.</p>
<p>The Holistic Options for Promoting REsilience (HOPE) Independent School Counselling and Therapy Service is accessible to all post primary aged pupils in Northern Ireland. </p></div>
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				<div class="et_pb_text_inner"><h3><strong>Make a referral for counselling</strong></h3>
<p>The counselling service can be requested by a pupil, parent or the school. If you wish to request counselling for a pupil, click the button below.</p></div>
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				<div class="et_pb_text_inner">For more information you can contact us:</p>
<p>T: 0800 25 45 123        E: <span><a href="mailto:info@ascert.biz">hope@ascert.biz</a></span></p>
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<p><span>ASCERT is an organisational member of the British Association of Counselling and Psychotherapy. BACP Membership No. 00276694</span></p></div>
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				<div class="et_pb_text_inner"><h3><span style="color: #ffffff;">Find out if we provide counselling in your school.</span></h3></div>
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				<h5 class="et_pb_toggle_title">Schools available for counselling service from ASCERT</h5>
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				<h5 class="et_pb_toggle_title">List of schools</h5>
				<div class="et_pb_toggle_content clearfix"><p>Abbey Community College, Newtownabbey<br />Aughnacloy College, Aughnacloy<br />Belfast High School, Newtownabbey<br />Carrickfergus Academy, Carrickfergus<br />Carrickfergus Grammar School, Carrickfergus<br />Castlederg High School, Castlederg<br />Christian Brothers Grammar School, Omagh<br />Coleraine College, Coleraine<br />Coleraine Grammar, Coleraine<br />Cookstown High School, Cookstown<br />Devenish College, Enniskillen<br />Dominican College, Portstewart<br />Drumglass High School, Dungannon<br />Enniskillen Royal Grammar School, Enniskillen<br />Erne Integrated College, Enniskillen<br />Fivemiletown College, Fivemiletown<br />Holy Trinity College, Cookstown<br />Integrated College, Dungannon<br />Larne Grammar School, Larne<br />Larne High School, Larne<br />Limavady Grammar School, Limavady<br />Limavady High School, Limavady<br />Loreto College, Coleraine<br />Loreto Grammar School, Omagh<br />Mount Lourdes Grammar School, Enniskillen<br />North Coast Integrated College, Coleraine<br />Omagh Academy Grammar School, Omagh<br />Sacred Heart College, Omagh<br />St Aidan&#8217;s High School, Derrylin<br />St Conor&#8217;s College, Clady<br />St Fanchea&#8217;s College, Enniskillen<br />St John&#8217;s Business and Enterprise College, Dromore<br />St Joseph&#8217;s College, Coalisland<br />St Joseph&#8217;s College, Enniskillen<br />St Kevin&#8217;s College, Lisnaskea<br />St Killian&#8217;s College, Carnlough<br />St Mary&#8217;s College, Irvinestown<br />St Mary&#8217;s, Limavady<br />St Michael&#8217;s College, Enniskillen<br />St Patrick&#8217;s College, Dungannon<br />The Royal School, Dungannon<br />Ulidia Integrated College, Carrickfergus</p>
<p><strong>If your school is not on this list, contact us and we can direct you to the organisation that provides the counselling service to your school.</strong></p>
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<p><strong style="font-family: montserrat; font-size: 22px;">Some answers to questions pupils may have</strong></p>
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<p><strong>What’s counselling/therapy about?</strong><br />Sometimes we all have problems that are worrying. Think of a confusing jigsaw when all of the pieces are difficult to match together. Talking about a problem in counselling/therapy is like sorting out the pieces so that we can build a picture that makes more sense to us.</p>
<p><strong>What happens in counselling/therapy?</strong><br />Counselling/therapy gives you the opportunity to talk in private about anything which is worrying you. The counsellor/therapist will not take sides or tell you what to do or how to live your life, but they will help you to look at choices and encourage you to make your own decisions.</p>
<p><strong>Who is the Counsellor/therapists?</strong><br />They are a team of professionally qualified and experienced people who have experience working with children and pupils. Counsellor/therapists are trained to listen without judging and to help people sort out their thoughts and feelings about whatever is concerning them.</p>
<p><strong>Where will counselling/therapy take place?</strong><br />Counselling/therapy will take place in a room set aside by the school. This room will be a safe place where no one will be able to listen in to what you are telling the counsellor/therapist. Sessions can last up to 50 minutes and appointment times should be varied so that time is not lost from the same subject.</p>
<p><strong>When is counselling/therapy available?</strong><br />Your counsellor/therapist will be available on specific school days and sessions will be scheduled with you. There will also be designated times when you can just drop in without an appointment. </p>
<p><strong>How do I get to see the counsellor/therapist?</strong><br />You can see the counsellor/therapist by talking to one of your teachers, self-referring by using the post box in the reception Area or asking your parent or carer to arrange an appointment.</p>
<p><strong>Is counselling/therapy Confidential?</strong><br />What you say in counselling/therapy is not repeated to others without your permission, unless there are very serious concerns about your safety or another person’s safety. This will be explained to you at the initial meeting with the counsellor/therapist.</p>
<p><strong>Do my parents/carers need to know?</strong><br />Counselling/therapy works best when you are able to tell your parents/carers and they can support you. If you want to have counselling/therapy without your parents/carers knowing your school will decide if you can do this. This decision is based on how well you understand what counselling/therapy is about and the consequences of not telling your parents/carers. This is known as being ‘Gillick’ competent.</p>
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		<title>Self Help</title>
		<link>https://ascert.biz/project/self-help/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Fri, 28 Feb 2020 11:17:41 +0000</pubDate>
				<guid isPermaLink="false">http://www.ascert.biz/?post_type=project&#038;p=54568</guid>

					<description><![CDATA[Tools and resources you can use to support your wellbeing]]></description>
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<p>Self help materials are resources you can work through yourself to help you make changes in your life.  We understand that not everyone is in a place where they want to speak to a professional service. Also, some people may be getting support already but need a bit of extra help. </p>
<p>In our resource hub, we have booklets and online tools that you can use at your own pace to help you consider your situation and make changes that will be helpful to you. </div>
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				<div class="et_pb_text_inner"><h1><span style="color: #ffffff;">Visit our Self help section now</span></h1>
<h4><span style="color: #ffffff;">Get started now and use our self help resources.</span></h4></div>
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		<title>Engage</title>
		<link>https://ascert.biz/project/engage/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Wed, 07 Aug 2019 22:57:28 +0000</pubDate>
				<guid isPermaLink="false">http://www.ascert.biz/?post_type=project&#038;p=47943</guid>

					<description><![CDATA[Therapeutic support for families]]></description>
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<p>The Engage service provides a family therapy programme available to professionals working with families experiencing problems. We can support to strengthen the relationships and functioning within the family will help repair and stabilise relationships in order to reduce risks experienced by the persons of concern of full family breakdown. In addition to the direct therapy sessions, we provide further unscheduled support and partnership working to support the family.</p>
<p>Through systemic therapy we increase awareness and help families and individuals to make connections between systems/events that can sometimes appear unrelated. This issues or ‘problems’ would be broadened and reframed in order to help those who are stuck see issues in new way and therefore new solutions. By doing this individuals and families understand themselves and the others in their family better in their own context and are more capable to make sustainable positive changes that can avert crisis and breakdown.</p>
<h3>How to access this service:</h3>
<p>This is not a funded service. Professionals or agencies can purchase packages of support as they require it. To discuss how we can help you, contact Engage Service Manager Julie McNamara</p>
<p>T: 0800 2545 123<br />E:<span><a href="mailto:juliem@ascert.biz">juliem@ascert.biz</a></span></p></div>
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		<title>Steps To Cope</title>
		<link>https://ascert.biz/project/steps-to-cope-2/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Wed, 07 Aug 2019 21:32:47 +0000</pubDate>
				<guid isPermaLink="false">http://www.ascert.biz/?post_type=project&#038;p=47890</guid>

					<description><![CDATA[For young people living with alcohol, substance use or mental health issues in their family.]]></description>
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							>An online information resource designed to support young people living with the presence of Alcohol misuse, substance misuse or mental health in their family. 
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							>Support For Individuals. 
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				<div class="et_pb_text_inner"><h2><strong>Steps to Cope Service Overview</strong></h2>
<p>The Steps to Cope Service provides support to young people aged 11-25 who are experiencing or who have lived with another family member’s alcohol or substance use or mental health difficulties. </p>
<p>The service is available across Northern Ireland and offers direct support for young people and parents. We also have information and an online self-care tool for young people in the Steps to Cope section of this website. If you are a young person seeking help, or you want to refer a young person to the Steps to Cope service you can make a referral online using the form at the bottom of this page or just click the button below.   </p>
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				<div class="et_pb_text_inner"><h3><strong>Information on Steps to Cope for young people</strong></h3>
<p>Steps to Cope has been developed specifically for young people who have experienced parental alcohol or drug issues or mental health issues in their family. It can be difficult to understand what is going on in your family, discuss it with others or know how to cope with things. <span style="font-size: 14px;">You cant change what is happening in your family but you can learn how to be more resilient to these challenges.</span></p>
<p>You can get support from one of the Steps to Cope team, who will work directly with you either face to face or virtually. If you would like to discuss direct support you can use the online form below, or call us on 0800 2545 123 or contact us using our online referral form. </p></div>
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				<a class="et_pb_button et_pb_button_1 et_pb_bg_layout_light" href="#stc-form">Make a referral online</a>
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				<div class="et_pb_text_inner"><p>We also have online information and a self care programme you can work through. These have been developed with the help of other young people that have experienced these issues too and include things that they found helpful. You can have a look at the information and online support tool in the <strong><a href="https://ascert.biz/stc-home/">Steps to Cope</a></strong> area of our website.</p></div>
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				<a class="et_pb_button et_pb_button_2 et_pb_bg_layout_light" href="https://ascert.biz/stc-home/">Take me to the Steps to Cope online support</a>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="393" height="289" src="https://ascert.biz/wp-content/uploads/2019/08/kids.png" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/08/kids.png 393w, https://ascert.biz/wp-content/uploads/2019/08/kids-300x221.png 300w" sizes="(max-width: 393px) 100vw, 393px" class="wp-image-47896" /></span>
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				<div class="et_pb_text_inner"><p>Whether it is face to face support from our service or you choose to use the online support<span style="font-size: 14px;"> programme you will be guided through 5 simple steps that can help you. These are</span><span style="font-size: 14px;">:</span></p>
<p>1) looking at <strong>what life has been like for you</strong> living with these issues.</p>
<p>2) Giving <strong>information</strong> on alcohol and drug use, addiction and mental health to help you understand more about the situation</p>
<p>3) Looking at <strong>coping</strong> and what methods of coping are helpful or unhelpful and what else you can do</p>
<p>4) Identifying the <strong>support</strong> you have available and who else you could reach out to</p>
<p>5) Looking at <strong>further help</strong> you may require</p></div>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="1183" height="947" src="https://ascert.biz/wp-content/uploads/2019/08/family.png" alt="" title="family" srcset="https://ascert.biz/wp-content/uploads/2019/08/family.png 1183w, https://ascert.biz/wp-content/uploads/2019/08/family-600x480.png 600w, https://ascert.biz/wp-content/uploads/2019/08/family-300x240.png 300w, https://ascert.biz/wp-content/uploads/2019/08/family-768x615.png 768w, https://ascert.biz/wp-content/uploads/2019/08/family-1024x820.png 1024w, https://ascert.biz/wp-content/uploads/2019/08/family-1080x865.png 1080w" sizes="(max-width: 1183px) 100vw, 1183px" class="wp-image-47945" /></span>
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				<div class="et_pb_text_inner"><h3><strong>Information on Steps to Cope for parents or carers</strong></h3>
<p>When there are issues like alcohol, substance use or mental ill-health difficulties in a family, children can struggle to understand what is going on, feel they are to blame or having difficulty coping. They cant change what is happening in their family but they can learn how to make them selves more resilient to these challenges. If your family is experiencing these issues then Steps to Cope can be of help to your children. </p>
<p>If your child or young person has questions, whether it be about alcohol use, drugs, mental health or associated issues, it may help reduce their anxiety to have answers and develop their understanding. They can also look at how they cope and what supports they can use to help them.</p>
<p>If you think your child would benefit from face to face support, then our Steps to Cope service for young people can help. Just complete the online form below or give us a call on 0800 2545 123.</p>
<p>Or your children <span style="background-color: #c88bda; font-size: 14px;">get information from the <a href="https://ascert.biz/stc-home/"><strong>Steps to Cope</strong></a> area of our website or use the online self care tool to help them.</span></p></div>
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				<div class="et_pb_text_inner"><h3><span style="color: #ffffff;"><strong>Information for Referral Agents </strong></span></h3>
<p><span style="color: #ffffff;">If you are working with a family where there are parental drugs, alcohol or mental health problems, you can refer a young person for one to one support or signpost the young person to the <strong><a href="https://ascert.biz/stc-home/" style="color: #ffffff;">Steps to Cope</a></strong> area of our website where they can get helpful information and find a self care tool that they can work through themselves.</span></p>
<p> If <span style="font-size: 14px;">you wish to refer them for face to face support you can make a referral using the online form below. </span>There is also a practitioners area on the site where you can get information resources that may be useful to you.</p>
<p>For more information contact us:</p>
<p>T: 0800 2545 123<br />E: stc@ascert.biz</p></div>
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				<div class="et_pb_text_inner"><h1 style="text-align: center;">Make an online referral to Steps To Cope</h1></div>
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								<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='I would like a confirmation of this referral via the above email'  id='choice_18_69_1'   />
								<label for='choice_18_69_1' id='label_18_69_1'>I would like a confirmation of this referral via the above email</label>
							</li></ul></div></li><li id="field_18_56"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_56"><label class='gfield_label' for='input_18_56' >Trust area you live in<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_56' id='input_18_56' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Belfast' >Belfast</option><option value='South Eastern' >South Eastern</option><option value='Southern' >Southern</option><option value='Western' >Western</option><option value='Northern' >Northern</option><option value='Don&#039;t Know / Other' >Don&#039;t Know / Other</option></select></div></li><li id="field_18_62"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_62"><label class='gfield_label gfield_label_before_complex'  >Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_18_62'><li class='gchoice gchoice_18_62_1'>
								<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='I confirm that the person being referred is aware of the referral and has agreed to being contacted by ASCERT'  id='choice_18_62_1'   />
								<label for='choice_18_62_1' id='label_18_62_1'>I confirm that the person being referred is aware of the referral and has agreed to being contacted by ASCERT</label>
							</li></ul></div></li><li id="field_18_49"  class="gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_49"><label class='gfield_label' for='input_18_49' >GP / GP practice name</label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_18_49' type='text' value='' class='medium'      aria-invalid="false"   /> </div></li><li id="field_18_50"  class="gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_50"><label class='gfield_label' for='input_18_50' >GP practice telephone number</label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_18_50' type='text' value='' class='medium'      aria-invalid="false"   /> </div></li><li id="field_18_51"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_51"><label class='gfield_label gfield_label_before_complex'  >Address</label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_18_51' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_18_51_1_container' >
                                        <input type='text' name='input_51.1' id='input_18_51_1' value=''    aria-required='false'    />
                                        <label for='input_18_51_1' id='input_18_51_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_18_51_3_container' >
                                    <input type='text' name='input_51.3' id='input_18_51_3' value=''    aria-required='false'    />
                                    <label for='input_18_51_3' id='input_18_51_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_51.4' id='input_18_51_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_18_51_5_container' >
                                    <input type='text' name='input_51.5' id='input_18_51_5' value=''    aria-required='false'    />
                                    <label for='input_18_51_5' id='input_18_51_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_51.6' id='input_18_51_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_18_9"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_9"><h2 class="gsection_title">Reason for referral</h2></li><li id="field_18_57"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_57"><label class='gfield_label' for='input_18_57' >Reason for referral (optional)</label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_18_57' type='text' value='' class='medium' maxlength='500'     aria-invalid="false"   /> </div></li><li id="field_18_11"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_11"><h2 class="gsection_title">Parent / legal guardian details</h2></li><li id="field_18_12"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_12"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_12'>
                            
                            <span id='input_18_12_3_container' class='name_first' >
                                                    <input type='text' name='input_12.3' id='input_18_12_3' value=''   aria-required='true'     />
                                                    <label for='input_18_12_3' >First</label>
                                                </span>
                            
                            <span id='input_18_12_6_container' class='name_last' >
                                                    <input type='text' name='input_12.6' id='input_18_12_6' value=''   aria-required='true'     />
                                                    <label for='input_18_12_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_18_13"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_13"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_18_13' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_18_13_1_container' >
                                        <input type='text' name='input_13.1' id='input_18_13_1' value=''    aria-required='true'    />
                                        <label for='input_18_13_1' id='input_18_13_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_18_13_3_container' >
                                    <input type='text' name='input_13.3' id='input_18_13_3' value=''    aria-required='true'    />
                                    <label for='input_18_13_3' id='input_18_13_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_13.4' id='input_18_13_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_18_13_5_container' >
                                    <input type='text' name='input_13.5' id='input_18_13_5' value=''    aria-required='true'    />
                                    <label for='input_18_13_5' id='input_18_13_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_18_13_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_18_14"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_14"><label class='gfield_label' for='input_18_14' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_18_14' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_18_52"  class="gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_52"><label class='gfield_label' for='input_18_52' >Email</label><div class='ginput_container ginput_container_email'>
                            <input name='input_52' id='input_18_52' type='text' value='' class='medium'     aria-invalid="false"  />
                        </div></li><li id="field_18_55"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_55"><label class='gfield_label' for='input_18_55' >Is the parent or guardian aware of this referral?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_18_55' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_18_58"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_58"><label class='gfield_label' for='input_18_58' >We can provide advice and structured support for family members. Is this needed?</label><div class='ginput_container ginput_container_select'><select name='input_58' id='input_18_58' class='medium gfield_select'     aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_18_70"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_70"><h2 class="gsection_title">Support for other family members</h2></li><li id="field_18_72"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_72"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_72'>
                            
                            <span id='input_18_72_3_container' class='name_first' >
                                                    <input type='text' name='input_72.3' id='input_18_72_3' value=''   aria-required='true'     />
                                                    <label for='input_18_72_3' >First</label>
                                                </span>
                            
                            <span id='input_18_72_6_container' class='name_last' >
                                                    <input type='text' name='input_72.6' id='input_18_72_6' value=''   aria-required='true'     />
                                                    <label for='input_18_72_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_18_73"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_73"><label class='gfield_label' for='input_18_73' >Date of birth<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_date'>
                            <input name='input_73' id='input_18_73' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm/dd/yyyy' aria-describedby="input_18_73_date_format" aria-invalid="false" aria-required="true"/>
                            <span id='input_18_73_date_format' class='screen-reader-text'>MM slash DD slash YYYY</span>
                        </div>
                        <input type='hidden' id='gforms_calendar_icon_input_18_73' class='gform_hidden' value='https://ascert.biz/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg'/></li><li id="field_18_74"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_74"><label class='gfield_label' for='input_18_74' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_74' id='input_18_74' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_18_75"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_75"><label class='gfield_label gfield_label_before_complex'  >Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_consent'><input name='input_75.1' id='input_18_75_1' type='checkbox' value='1'   aria-required="true" aria-invalid="false"   /> <label class="gfield_consent_label" for='input_18_75_1' >I confirm that this person has given their consent to be contacted by ASCERT.</label><input type='hidden' name='input_75.2' value='I confirm that this person has given their consent to be contacted by ASCERT.' class='gform_hidden' /><input type='hidden' name='input_75.3' value='12' class='gform_hidden' /></div></li><li id="field_18_16"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_16"><h2 class="gsection_title">Referral agent details</h2><div class='gsection_description' id='gfield_description_18_16'>If you are a professional who wishes to refer someone into the DAISY service, please input your details below. </div></li><li id="field_18_17"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_17"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_17'>
                            
                            <span id='input_18_17_3_container' class='name_first' >
                                                    <input type='text' name='input_17.3' id='input_18_17_3' value=''   aria-required='true'     />
                                                    <label for='input_18_17_3' >First</label>
                                                </span>
                            
                            <span id='input_18_17_6_container' class='name_last' >
                                                    <input type='text' name='input_17.6' id='input_18_17_6' value=''   aria-required='true'     />
                                                    <label for='input_18_17_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_18_18"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_18"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_18_18' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_18_18_1_container' >
                                        <input type='text' name='input_18.1' id='input_18_18_1' value=''    aria-required='true'    />
                                        <label for='input_18_18_1' id='input_18_18_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_18_18_3_container' >
                                    <input type='text' name='input_18.3' id='input_18_18_3' value=''    aria-required='true'    />
                                    <label for='input_18_18_3' id='input_18_18_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_18_18_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_18_18_5_container' >
                                    <input type='text' name='input_18.5' id='input_18_18_5' value=''    aria-required='true'    />
                                    <label for='input_18_18_5' id='input_18_18_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_18_18_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_18_23"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_23"><label class='gfield_label' for='input_18_23' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_18_23' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_18_21"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_21"><label class='gfield_label' for='input_18_21' >Profession<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_18_21' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_18_22"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_22"><label class='gfield_label' for='input_18_22' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
                            <input name='input_22' id='input_18_22' type='text' value='' class='medium'    aria-required="true" aria-invalid="false"  />
                        </div></li><li id="field_18_24"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_24"><label class='gfield_label' for='input_18_24' >Are you the main contact?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_24' id='input_18_24' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_18_25"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_25"><label class='gfield_label gfield_label_before_complex'  >Details of main contact<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_18_25'>
                            
                            <span id='input_18_25_3_container' class='name_first' >
                                                    <input type='text' name='input_25.3' id='input_18_25_3' value=''   aria-required='true'     />
                                                    <label for='input_18_25_3' >First</label>
                                                </span>
                            
                            <span id='input_18_25_6_container' class='name_last' >
                                                    <input type='text' name='input_25.6' id='input_18_25_6' value=''   aria-required='true'     />
                                                    <label for='input_18_25_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_18_59"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_59"><label class='gfield_label' for='input_18_59' >Main contact email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_18_59' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_18_26"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_26"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_18_26' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_18_26_1_container' >
                                        <input type='text' name='input_26.1' id='input_18_26_1' value=''    aria-required='true'    />
                                        <label for='input_18_26_1' id='input_18_26_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_18_26_3_container' >
                                    <input type='text' name='input_26.3' id='input_18_26_3' value=''    aria-required='true'    />
                                    <label for='input_18_26_3' id='input_18_26_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_26.4' id='input_18_26_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_18_26_5_container' >
                                    <input type='text' name='input_26.5' id='input_18_26_5' value=''    aria-required='true'    />
                                    <label for='input_18_26_5' id='input_18_26_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_18_26_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_18_27"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_27"><label class='gfield_label' for='input_18_27' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_18_27' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_18_28"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_28"><label class='gfield_label' for='input_18_28' >Profession<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_18_28' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_18_33"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_33"><label class='gfield_label' for='input_18_33' >Is this client currently engaged with another service<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_18_33' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_18_34"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_18_34"><label class='gfield_label' for='input_18_34' >Please provide details<span 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			</item>
		<item>
		<title>DAISY</title>
		<link>https://ascert.biz/project/daisy-belfast/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Mon, 17 Jun 2019 20:22:12 +0000</pubDate>
				<guid isPermaLink="false">http://www.ascert.biz/?post_type=project&#038;p=47408</guid>

					<description><![CDATA[Drug &#038; Alcohol Intervention Service for Youth]]></description>
										<content:encoded><![CDATA[<p><div class="et_pb_section et_pb_section_17 et_section_regular" >
				
				
				
				
				
				
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="1110" height="676" src="https://ascert.biz/wp-content/uploads/2019/06/DAISY.jpg" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/06/DAISY.jpg 1110w, https://ascert.biz/wp-content/uploads/2019/06/DAISY-980x597.jpg 980w, https://ascert.biz/wp-content/uploads/2019/06/DAISY-480x292.jpg 480w" sizes="(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1110px, 100vw" class="wp-image-50351" /></span>
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				<div class="et_pb_video_box"><iframe loading="lazy" title="Daisy -  Video 2" src="https://player.vimeo.com/video/368548416?dnt=1&amp;app_id=122963" width="1080" height="608" frameborder="0" allow="autoplay; fullscreen; picture-in-picture; clipboard-write; encrypted-media; web-share" referrerpolicy="strict-origin-when-cross-origin"></iframe></div>
				
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				<div class="et_pb_text_inner"><h2><strong>Service Overview</strong></h2>
<p>The Drug and Alcohol Intervention Service for Youth (DAISY)  provides support for young people and young adults experiencing problems from their alcohol or substance use. DAISY is available to young people aged 11 – 25 years and also to the young person&#8217;s parents or other family members.</p>
<p>We provide confidential service and each young person or family will be offered support based on their particular needs. This can be provided through one to one sessions or in groups. </p>
<p>DAISY is a partnership between ASCERT and Start360 and operates in, Belfast, Northern, South Eastern, and the Western Trust Health and Social Care Trust areas.</p>
<p>We accept referrals from young people, their families or friends, and a range of professionals.</div>
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				<div class="et_pb_text_inner"><h3><strong>How to refer into the service</strong></h3>
<p>You can refer yourself or someone else into DAISY by completing the online form below.</p>
<p>You can also <a href="https://ascert.biz/wp-content/uploads/2020/03/DAISY_Referral_Form_revised_Feb_2016.docx">download</a> a referral form and send it to us if you prefer.</p></div>
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				<a class="et_pb_button et_pb_button_5 et_pb_bg_layout_light" href="#daisy-form">             Make a referral  online            </a>
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				<div class="et_pb_text_inner">For more information you can contact us:</p>
<p>T: 0800 25 45 123<br />
E: <span><a href="mailto:daisy@ascert.biz">daisy@ascert.biz</a></span></div>
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				<div class="et_pb_text_inner"><h3><strong>Information on DAISY for young people </strong></h3>
<p>If you are 11 to 25 and are concerned that your drinking or drug use is causing problems, DAISY can help you work out how to deal with this. We offer confidential advice and support. We will never judge you or tell you what to do, but we will work alongside you to discuss what is happening and what things would help you get to where you want to be. </p>
<p>If you want help from DAISY, you can contact us using the online form below or call or email us. We will arrange to meet with you in one of our offices or somewhere near where you live to discuss things. We will decide with you what the best way we can support you and how that will happen. We understand that life is complicated and there are often other things going on that influence a persons alcohol or drug use. We will help you look at these things and what you can do to make things better and keep yourself safe and what other supports you may need to do this.</p>
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					<div class="et_pb_testimonial_description_inner"><div class="et_pb_testimonial_content"><p><span class="OYPEnA text-decoration-none text-strikethrough-none">I feel like DAISY are the first people to actually listen to me and hear me, without putting words into my mouth. Everyone is friendly and actually willing to help. You guys are amazing. </span></p></div></div>
					<span class="et_pb_testimonial_author">Young person supported by DAISY</span>
					<p class="et_pb_testimonial_meta"></p>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="1698" height="1131" src="https://ascert.biz/wp-content/uploads/2020/02/counselling.jpg" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2020/02/counselling.jpg 1698w, https://ascert.biz/wp-content/uploads/2020/02/counselling-1280x853.jpg 1280w, https://ascert.biz/wp-content/uploads/2020/02/counselling-980x653.jpg 980w, https://ascert.biz/wp-content/uploads/2020/02/counselling-480x320.jpg 480w" sizes="(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 1698px, 100vw" class="wp-image-54228" /></span>
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				<div style="background-image:url(https://ascert.biz/wp-content/uploads/2023/08/14.png)" class="et_pb_testimonial_portrait"></div>
				<div class="et_pb_testimonial_description">
					<div class="et_pb_testimonial_description_inner"><div class="et_pb_testimonial_content"><p class="cvGsUA direction-ltr align-start para-style-body"><span class="OYPEnA text-decoration-none text-strikethrough-none">I am proud that I am taking better care of myself and have a better relationship with my family.</span></p></div></div>
					<span class="et_pb_testimonial_author">Young person supported by DAISY</span>
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				<div class="et_pb_text_inner"><h3><strong>Information on DAISY for parents or carers </strong></h3>
<p>The DAISY service can support young people to help them reduce their alcohol or substance use or make changes that will reduce the impact or harm it has for them. This is a voluntary service, so the young person has to have agreed to be referred and willing to engage with us. We can also provide advice and support to family members, even if the young person is not willing to accept help.</p>
<p>DAISY provides the space for the young person to talk confidentially about how to cope and deal with their substance and alcohol use. Within the working relationship with our practitioners they will be able to explore how they are feeling and understand why they are using. They will receive support on how to reduce their use, and also to reduce the risk to themselves. The therapies offered are client led, which means we support the young person based on where they are in life, we work collaboratively with them to agree what changes they want to happen and what support them need to do this.  </p>
<p>Family is an extremely important source of support for the young person, and also how things are in the family can be an influence on the young person&#8217;s alcohol or substance use. We know that parents, siblings or other family members like grandparents are also often impacted by the young person&#8217;s behaviours and can struggle to deal with what is happening.  </p>
<p>DAISY offers informal advice or more structured support to family members to help understand and manage things. There are options for therapeutic family support which creates a space to gain understanding around substance / alcohol use, help support and repair relationships and have better connected family .</p>
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				<div class="et_pb_text_inner"><h2><span style="color: #ffffff;"><strong>Information for referral agents </strong></span></h2>
<p><span style="color: #ffffff;">If you are working with a young person or young adult aged 11 to 25 where drugs and alcohol are present the DAISY may be able to help support this individual and their family.</span></p>
<p><span style="color: #ffffff;">This service supports young people and young adults aged 11-25 and their family.</span></strong></p>
<p><span style="color: #ffffff;">We offer a variety of approaches which include, brief intervention, therapeutic one to one counselling, mentoring, group work (therapeutic and educational), and family therapy.  </span></p>
<p><span style="color: #ffffff;">We will work collaboratively with you as the referrer and other professionals to ensure a co-ordinated and integrated support for the young person and their family.</p>
<p><span style="color: #ffffff;">The person being referred should have consented for the referral to be made. You can make a referral using the online form or download a referral form and send to us. You can give us a call to discuss the case in the first instance before you make a referral. Once we it we will contact you for any further information we need and discuss how we will deal with it.</div>
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				<span class="et_pb_image_wrap "><img decoding="async" src="https://ascert.biz/wp-content/uploads/2019/09/ballpen-blur-close-up-461077.jpg" alt="" title="" /></span>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="434" height="316" src="https://ascert.biz/wp-content/uploads/2019/08/Daisy_white.jpg" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/08/Daisy_white.jpg 434w, https://ascert.biz/wp-content/uploads/2019/08/Daisy_white-300x218.jpg 300w" sizes="(max-width: 434px) 100vw, 434px" class="wp-image-47887" /></span>
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				<div class="et_pb_text_inner"><h4><strong>DAISY is delivered in partnership between ASCERT and Start360 </strong></h4>
<p><strong>      </strong></p></div>
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			</div><div id="daisy-form" class="et_pb_section et_pb_section_24 et_pb_with_background et_section_regular" >
				
				
				
				
				
				
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				<div class="et_pb_text_inner"><h1 style="text-align: center;">Make an online referral to DAISY</h1></div>
			</div><div class="et_pb_module et_pb_code et_pb_code_2">
				
				
				
				
				<div class="et_pb_code_inner">
                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_1' style='display:none'><div id='gf_1' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_1' id='gform_1'  action='/project_category/westernyouth/feed/#gf_1' >
                        <div class='gform_body gform-body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id="field_1_3"  class="gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_3">All fields marked with a * are required to be filled in</li><li id="field_1_4"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_4"><label class='gfield_label' for='input_1_4' >Person requesting referral<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_1_4' class='medium gfield_select'  aria-describedby="gfield_description_1_4"  aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Myself' >Myself</option><option value='Parent / Legal Guardian' >Parent / Legal Guardian</option><option value='Referral Agent' >Referral Agent</option></select></div><div class='gfield_description' id='gfield_description_1_4'>The DAISY service can accept direct referrals from young people themselves (between the ages of 11-25), or from a parent/legal guardian or a professional referral ‘agent’ who is working in some way with the young person (e.g. a GP, social worker, youth worker, probation officer etc.). </div></li><li id="field_1_5"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_5"><h2 class="gsection_title">Client details</h2><div class='gsection_description' id='gfield_description_1_5'>If you are asking us to support you, then input your details here. If you are referring someone else for support, then input their details</div></li><li id="field_1_6"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_6"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_6'>
                            
                            <span id='input_1_6_3_container' class='name_first' >
                                                    <input type='text' name='input_6.3' id='input_1_6_3' value=''   aria-required='true'     />
                                                    <label for='input_1_6_3' >First</label>
                                                </span>
                            
                            <span id='input_1_6_6_container' class='name_last' >
                                                    <input type='text' name='input_6.6' id='input_1_6_6' value=''   aria-required='true'     />
                                                    <label for='input_1_6_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_1_61"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_61"><label class='gfield_label' for='input_1_61' >Gender<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_61' id='input_1_61' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='Please select' >Please select</option><option value='Male' >Male</option><option value='Female' >Female</option><option value='Prefer not to say' >Prefer not to say</option><option value='Other' >Other</option></select></div></li><li id="field_1_63"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_63"><label class='gfield_label' for='input_1_63' >Please Specify<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_1_63' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_53"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_53"><label class='gfield_label' for='input_1_53' >Date of birth<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_date'>
                            <input name='input_53' id='input_1_53' type='text' value='' class='datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd/mm/yyyy' aria-describedby="input_1_53_date_format" aria-invalid="false" aria-required="true"/>
                            <span id='input_1_53_date_format' class='screen-reader-text'>DD slash MM slash YYYY</span>
                        </div>
                        <input type='hidden' id='gforms_calendar_icon_input_1_53' class='gform_hidden' value='https://ascert.biz/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg'/></li><li id="field_1_8"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_8"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_1_8' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_8_1_container' >
                                        <input type='text' name='input_8.1' id='input_1_8_1' value=''    aria-required='true'    />
                                        <label for='input_1_8_1' id='input_1_8_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_1_8_3_container' >
                                    <input type='text' name='input_8.3' id='input_1_8_3' value=''    aria-required='true'    />
                                    <label for='input_1_8_3' id='input_1_8_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_8.4' id='input_1_8_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_1_8_5_container' >
                                    <input type='text' name='input_8.5' id='input_1_8_5' value=''    aria-required='true'    />
                                    <label for='input_1_8_5' id='input_1_8_5_label' >Post Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_1_8_6' value='United Kingdom' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_1_48"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_48"><label class='gfield_label' for='input_1_48' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_48' id='input_1_48' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_1_66"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_66"><label class='gfield_label' for='input_1_66' >Email</label><div class='ginput_container ginput_container_email'>
                            <input name='input_66' id='input_1_66' type='text' value='' class='medium'     aria-invalid="false"  />
                        </div></li><li id="field_1_69"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_69"><label class='gfield_label screen-reader-text gfield_label_before_complex'  ></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_69'><li class='gchoice gchoice_1_69_1'>
								<input class='gfield-choice-input' name='input_69.1' type='checkbox'  value='I would like a confirmation of this referral via the above email'  id='choice_1_69_1'   />
								<label for='choice_1_69_1' id='label_1_69_1'>I would like a confirmation of this referral via the above email</label>
							</li></ul></div></li><li id="field_1_56"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_56"><label class='gfield_label' for='input_1_56' >Trust area you live in<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_56' id='input_1_56' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Belfast' >Belfast</option><option value='South Eastern' >South Eastern</option><option value='Southern' >Southern</option><option value='Western' >Western</option><option value='Northern' >Northern</option><option value='Don&#039;t Know / Other' >Don&#039;t Know / Other</option></select></div></li><li id="field_1_62"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_62"><label class='gfield_label gfield_label_before_complex'  >Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_62'><li class='gchoice gchoice_1_62_1'>
								<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='I confirm that the person being referred is aware of the referral and has agreed to being contacted by ASCERT'  id='choice_1_62_1'   />
								<label for='choice_1_62_1' id='label_1_62_1'>I confirm that the person being referred is aware of the referral and has agreed to being contacted by ASCERT</label>
							</li></ul></div></li><li id="field_1_49"  class="gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_49"><label class='gfield_label' for='input_1_49' >GP / GP practice name</label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_1_49' type='text' value='' class='medium'      aria-invalid="false"   /> </div></li><li id="field_1_50"  class="gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_50"><label class='gfield_label' for='input_1_50' >GP practice telephone number</label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_1_50' type='text' value='' class='medium'      aria-invalid="false"   /> </div></li><li id="field_1_51"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_51"><label class='gfield_label gfield_label_before_complex'  >Address</label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_1_51' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_51_1_container' >
                                        <input type='text' name='input_51.1' id='input_1_51_1' value=''    aria-required='false'    />
                                        <label for='input_1_51_1' id='input_1_51_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_1_51_3_container' >
                                    <input type='text' name='input_51.3' id='input_1_51_3' value=''    aria-required='false'    />
                                    <label for='input_1_51_3' id='input_1_51_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_51.4' id='input_1_51_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_1_51_5_container' >
                                    <input type='text' name='input_51.5' id='input_1_51_5' value=''    aria-required='false'    />
                                    <label for='input_1_51_5' id='input_1_51_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_51.6' id='input_1_51_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_1_9"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_9"><h2 class="gsection_title">Reason for referral</h2></li><li id="field_1_10"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_10"><label class='gfield_label' for='input_1_10' >Help With<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_1_10' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Drug use' >Drug use</option><option value='Alcohol use' >Alcohol use</option><option value='Drug &amp; alcohol use' >Drug &amp; alcohol use</option><option value='Someone else&#039;s use of substances' >Someone else&#039;s use of substances</option></select></div></li><li id="field_1_57"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_57"><label class='gfield_label' for='input_1_57' >Reason for referral (optional)</label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_1_57' type='text' value='' class='medium'      aria-invalid="false"   /> </div></li><li id="field_1_11"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_11"><h2 class="gsection_title">Parent / legal guardian details</h2></li><li id="field_1_12"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_12"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_12'>
                            
                            <span id='input_1_12_3_container' class='name_first' >
                                                    <input type='text' name='input_12.3' id='input_1_12_3' value=''   aria-required='true'     />
                                                    <label for='input_1_12_3' >First</label>
                                                </span>
                            
                            <span id='input_1_12_6_container' class='name_last' >
                                                    <input type='text' name='input_12.6' id='input_1_12_6' value=''   aria-required='true'     />
                                                    <label for='input_1_12_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_1_13"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_13"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_1_13' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_13_1_container' >
                                        <input type='text' name='input_13.1' id='input_1_13_1' value=''    aria-required='true'    />
                                        <label for='input_1_13_1' id='input_1_13_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_1_13_3_container' >
                                    <input type='text' name='input_13.3' id='input_1_13_3' value=''    aria-required='true'    />
                                    <label for='input_1_13_3' id='input_1_13_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_13.4' id='input_1_13_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_1_13_5_container' >
                                    <input type='text' name='input_13.5' id='input_1_13_5' value=''    aria-required='true'    />
                                    <label for='input_1_13_5' id='input_1_13_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_13.6' id='input_1_13_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_1_14"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_14"><label class='gfield_label' for='input_1_14' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_14' id='input_1_14' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_1_52"  class="gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_52"><label class='gfield_label' for='input_1_52' >Email</label><div class='ginput_container ginput_container_email'>
                            <input name='input_52' id='input_1_52' type='text' value='' class='medium'     aria-invalid="false"  />
                        </div></li><li id="field_1_55"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_55"><label class='gfield_label' for='input_1_55' >Is the parent or guardian aware of this referral?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_1_55' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_58"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_58"><label class='gfield_label' for='input_1_58' >We can provide advice and structured support for family members. Is this needed?</label><div class='ginput_container ginput_container_select'><select name='input_58' id='input_1_58' class='medium gfield_select'     aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_70"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_70"><h2 class="gsection_title">Support for other family members</h2></li><li id="field_1_72"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_72"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_72'>
                            
                            <span id='input_1_72_3_container' class='name_first' >
                                                    <input type='text' name='input_72.3' id='input_1_72_3' value=''   aria-required='true'     />
                                                    <label for='input_1_72_3' >First</label>
                                                </span>
                            
                            <span id='input_1_72_6_container' class='name_last' >
                                                    <input type='text' name='input_72.6' id='input_1_72_6' value=''   aria-required='true'     />
                                                    <label for='input_1_72_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_1_73"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_73"><label class='gfield_label' for='input_1_73' >Date of birth<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_date'>
                            <input name='input_73' id='input_1_73' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm/dd/yyyy' aria-describedby="input_1_73_date_format" aria-invalid="false" aria-required="true"/>
                            <span id='input_1_73_date_format' class='screen-reader-text'>MM slash DD slash YYYY</span>
                        </div>
                        <input type='hidden' id='gforms_calendar_icon_input_1_73' class='gform_hidden' value='https://ascert.biz/wp-content/plugins/gravityforms/images/datepicker/datepicker.svg'/></li><li id="field_1_74"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_74"><label class='gfield_label' for='input_1_74' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_74' id='input_1_74' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_1_75"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_75"><label class='gfield_label gfield_label_before_complex'  >Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_consent'><input name='input_75.1' id='input_1_75_1' type='checkbox' value='1'   aria-required="true" aria-invalid="false"   /> <label class="gfield_consent_label" for='input_1_75_1' >I confirm that this person has given their consent to be contacted by ASCERT.</label><input type='hidden' name='input_75.2' value='I confirm that this person has given their consent to be contacted by ASCERT.' class='gform_hidden' /><input type='hidden' name='input_75.3' value='6' class='gform_hidden' /></div></li><li id="field_1_16"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_16"><h2 class="gsection_title">Referral agent details</h2><div class='gsection_description' id='gfield_description_1_16'>If you are a professional who wishes to refer someone into the DAISY service, please input your details below. </div></li><li id="field_1_17"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_17"><label class='gfield_label gfield_label_before_complex'  >Name<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_17'>
                            
                            <span id='input_1_17_3_container' class='name_first' >
                                                    <input type='text' name='input_17.3' id='input_1_17_3' value=''   aria-required='true'     />
                                                    <label for='input_1_17_3' >First</label>
                                                </span>
                            
                            <span id='input_1_17_6_container' class='name_last' >
                                                    <input type='text' name='input_17.6' id='input_1_17_6' value=''   aria-required='true'     />
                                                    <label for='input_1_17_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_1_18"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_18"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_1_18' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_18_1_container' >
                                        <input type='text' name='input_18.1' id='input_1_18_1' value=''    aria-required='true'    />
                                        <label for='input_1_18_1' id='input_1_18_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_1_18_3_container' >
                                    <input type='text' name='input_18.3' id='input_1_18_3' value=''    aria-required='true'    />
                                    <label for='input_1_18_3' id='input_1_18_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_18.4' id='input_1_18_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_1_18_5_container' >
                                    <input type='text' name='input_18.5' id='input_1_18_5' value=''    aria-required='true'    />
                                    <label for='input_1_18_5' id='input_1_18_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_18.6' id='input_1_18_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_1_23"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_23"><label class='gfield_label' for='input_1_23' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_1_23' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_1_21"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_21"><label class='gfield_label' for='input_1_21' >Profession<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_1_21' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_22"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_22"><label class='gfield_label' for='input_1_22' >Email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_email'>
                            <input name='input_22' id='input_1_22' type='text' value='' class='medium'    aria-required="true" aria-invalid="false"  />
                        </div></li><li id="field_1_24"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_24"><label class='gfield_label' for='input_1_24' >Are you the main contact?<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_24' id='input_1_24' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_25"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_25"><label class='gfield_label gfield_label_before_complex'  >Details of main contact<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name' id='input_1_25'>
                            
                            <span id='input_1_25_3_container' class='name_first' >
                                                    <input type='text' name='input_25.3' id='input_1_25_3' value=''   aria-required='true'     />
                                                    <label for='input_1_25_3' >First</label>
                                                </span>
                            
                            <span id='input_1_25_6_container' class='name_last' >
                                                    <input type='text' name='input_25.6' id='input_1_25_6' value=''   aria-required='true'     />
                                                    <label for='input_1_25_6' >Last</label>
                                                </span>
                            
                        </div></li><li id="field_1_59"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_59"><label class='gfield_label' for='input_1_59' >Main contact email<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_1_59' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_26"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_26"><label class='gfield_label gfield_label_before_complex'  >Address<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>    
                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address' id='input_1_26' >
                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_1_26_1_container' >
                                        <input type='text' name='input_26.1' id='input_1_26_1' value=''    aria-required='true'    />
                                        <label for='input_1_26_1' id='input_1_26_1_label' >Street Address</label>
                                    </span><span class='ginput_left address_city ginput_address_city' id='input_1_26_3_container' >
                                    <input type='text' name='input_26.3' id='input_1_26_3' value=''    aria-required='true'    />
                                    <label for='input_1_26_3' id='input_1_26_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_26.4' id='input_1_26_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_1_26_5_container' >
                                    <input type='text' name='input_26.5' id='input_1_26_5' value=''    aria-required='true'    />
                                    <label for='input_1_26_5' id='input_1_26_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_26.6' id='input_1_26_6' value='' />
                    <div class='gf_clear gf_clear_complex'></div>
                </div></li><li id="field_1_27"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_27"><label class='gfield_label' for='input_1_27' >Phone<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_phone'><input name='input_27' id='input_1_27' type='text' value='' class='medium'   aria-required="true" aria-invalid="false"   /></div></li><li id="field_1_28"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_28"><label class='gfield_label' for='input_1_28' >Profession<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_1_28' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_33"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_33"><label class='gfield_label' for='input_1_33' >Is this client currently engaged with another service<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_1_33' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_34"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_34"><label class='gfield_label' for='input_1_34' >Please provide details<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_1_34' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_35"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_35"><label class='gfield_label' for='input_1_35' >Are you aware of any literacy difficulties<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_35' id='input_1_35' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_36"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_36"><label class='gfield_label' for='input_1_36' >Please provide details<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_1_36' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_37"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_37"><label class='gfield_label' for='input_1_37' >Is english the young person’s first language<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_1_37' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_38"  class="gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_38"><label class='gfield_label' for='input_1_38' >Please specify preferred language<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_1_38' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_39"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_39"><label class='gfield_label' for='input_1_39' >Does the young person have a disability<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_39' id='input_1_39' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_40"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_40"><label class='gfield_label' for='input_1_40' >Please specify details<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_1_40' type='text' value='' class='medium'     aria-required="true" aria-invalid="false"   /> </div></li><li id="field_1_41"  class="gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_41"><label class='gfield_label' for='input_1_41' >Are there any risks identified (such as suicidal behaviour, self-harm, aggression etc)<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_select'><select name='input_41' id='input_1_41' class='medium gfield_select'    aria-required="true" aria-invalid="false" ><option value='' >Please select</option><option value='Yes' >Yes</option><option value='No' >No</option></select></div></li><li id="field_1_65"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_65"><label class='gfield_label' for='input_1_65' >Please specify details<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_textarea'><textarea name='input_65' id='input_1_65' class='textarea medium'     aria-required="true" aria-invalid="false"   rows='10' cols='50'></textarea></div></li><li id="field_1_43"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_43"><label class='gfield_label' for='input_1_43' >Additional information</label><div class='ginput_container ginput_container_textarea'><textarea name='input_43' id='input_1_43' class='textarea medium'    placeholder='Please provide any other relevant information in relation to the client you are referring to enable appropriate and adequate services to be identified.'  aria-invalid="false"   rows='10' cols='50'></textarea></div></li><li id="field_1_64"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_64"><label class='gfield_label screen-reader-text gfield_label_before_complex'  ></label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_64'><li class='gchoice gchoice_1_64_1'>
								<input class='gfield-choice-input' name='input_64.1' type='checkbox'  value='I would like a copy of this referral emailed to myself'  id='choice_1_64_1'   />
								<label for='choice_1_64_1' id='label_1_64_1'>I would like a copy of this referral emailed to myself</label>
							</li></ul></div></li><li id="field_1_44"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_44"><h2 class="gsection_title">Preferences</h2></li><li id="field_1_45"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_45"><label class='gfield_label gfield_label_before_complex'  >Data Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_consent'><input name='input_45.1' id='input_1_45_1' type='checkbox' value='1'  aria-describedby="gfield_consent_description_1_45 gfield_description_1_45" aria-required="true" aria-invalid="false"   /> <label class="gfield_consent_label" for='input_1_45_1' >I agree</label><input type='hidden' name='input_45.2' value='I agree' class='gform_hidden' /><input type='hidden' name='input_45.3' value='6' class='gform_hidden' /></div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_1_45'>In compliance with UK Data Protection Law, ASCERT requires your consent to keep a record of your details submitted in this form to process this referral. Please check this box to indicate you have given consent for your personal data to be utilised in this way. Visit the <a href="http://www.ascert.biz/privacy-cookies-2/">Privacy Policy</a> section of this website to read more about how we process your data.</div></li><li id="field_1_47"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_1_47"><label class='gfield_label gfield_label_before_complex'  >Marketing Consent</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_1_47'><li class='gchoice gchoice_select_all'>
						<input class='gfield-choice-input' type='checkbox' id='choice_47_select_all'   onclick='gformToggleCheckboxes( this )' onkeypress='gformToggleCheckboxes( this )' />
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		<title>Targeted Life Skills</title>
		<link>https://ascert.biz/project/lifeskills/</link>
		
		<dc:creator><![CDATA[Fiona McCann]]></dc:creator>
		<pubDate>Fri, 10 May 2019 12:29:32 +0000</pubDate>
				<guid isPermaLink="false">http://www.ascert.biz/?post_type=project&#038;p=46998</guid>

					<description><![CDATA[A group programme for young people.]]></description>
										<content:encoded><![CDATA[<p><div class="et_pb_section et_pb_section_25 et_section_regular" >
				
				
				
				
				
				
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="2157" height="1916" src="https://ascert.biz/wp-content/uploads/2019/08/lifeskills.jpg" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/08/lifeskills.jpg 2157w, https://ascert.biz/wp-content/uploads/2019/08/lifeskills-600x533.jpg 600w, https://ascert.biz/wp-content/uploads/2019/08/lifeskills-300x266.jpg 300w, https://ascert.biz/wp-content/uploads/2019/08/lifeskills-768x682.jpg 768w, https://ascert.biz/wp-content/uploads/2019/08/lifeskills-1024x910.jpg 1024w, https://ascert.biz/wp-content/uploads/2019/08/lifeskills-1080x959.jpg 1080w" sizes="(max-width: 2157px) 100vw, 2157px" class="wp-image-47919" /></span>
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				<div class="et_pb_video_box"><iframe loading="lazy" title="Targeted Life Skills -  Video 1" src="https://player.vimeo.com/video/368547518?dnt=1&amp;app_id=122963" width="1080" height="608" frameborder="0" allow="autoplay; fullscreen; picture-in-picture; clipboard-write; encrypted-media; web-share" referrerpolicy="strict-origin-when-cross-origin"></iframe></div>
				
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				<div class="et_pb_text_inner"><h2><strong>Service Overview</strong></h2>
<p>Just telling teenagers about the dangers of drugs doesn’t work, nor does trying to scare them with horrendous imagery or the telling of horror stories. Risk is inevitable and teens will engage in risk taking behaviour regardless. They are built for it, experimenting and risk taking is all part of their growth.</p>
<p>Targeted Lifeskills Service offers an age appropriate lifeskills and harm reduction programme for groups of young people age 11-21 that are at risk of alcohol or drug use. ASCERT provide this service in the Western Trust area and in a partnership with Start360 in the Northern Trust area. It is available to organisations or services working with existing groups of young people that they consider are have a higher risk of alcohol or drug use problems than young people generally. They may be at risk because of their behaviours, their personal circumstances, where they live, or there may be evidence that they are already experimenting with substances.</p>
<p>The Targeted LIfeskills Service engages the young people in a structured programme tailored to the needs of the group and delivered over a number of sessions. These sessions will focus on lifeskills that strengthen the young person&#8217;s skills in managing the choices they make and risks they take, such as communication, dealing with emotions or decision making. These can be supplemented with harm reduction sessions focusing on particular types of substances that may be a particular risk or relevance for that group.</p>
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				<div class="et_pb_text_inner"><h3><strong>Information for group referrers</strong></h3>
<p>The Targeted Life Skills Service is for young people aged 11-21 years, who are deemed at risk of using drugs and/or alcohol. We can deliver to young people in a variety of statutory or community settings. We don&#8217;t normally deliver in schools unless there are identified groups about which there is a specific concern. The programme is normally 4 – 8 sessions, which are interactive and designed to cater the needs of the young people, taking into account their age and learning ability. The programme will normally be delivered in your venue.</p>
<p>If you are working with a group of young people you think would benefit from a programme, you can complete the online referral form below or give us a call to discuss it.</p>
<p>For further information contact us:</p>
<p>T: 0800 2545123<br />E:<span style="color: #ffffff;"> <a style="color: #ffffff;" href="mailto:TLSreferrals@ascert.biz">TLSreferrals@ascert.biz</a></span></p></div>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="1487" height="1171" src="https://ascert.biz/wp-content/uploads/2019/10/belle.png" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/10/belle.png 1487w, https://ascert.biz/wp-content/uploads/2019/10/belle-1280x1008.png 1280w, https://ascert.biz/wp-content/uploads/2019/10/belle-980x772.png 980w, https://ascert.biz/wp-content/uploads/2019/10/belle-480x378.png 480w" sizes="(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) and (max-width: 1280px) 1280px, (min-width: 1281px) 1487px, 100vw" class="wp-image-50626" /></span>
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				<span class="et_pb_image_wrap "><img loading="lazy" decoding="async" width="349" height="193" src="https://ascert.biz/wp-content/uploads/2019/08/targeted_lifeskills1.png" alt="" title="" srcset="https://ascert.biz/wp-content/uploads/2019/08/targeted_lifeskills1.png 349w, https://ascert.biz/wp-content/uploads/2019/08/targeted_lifeskills1-300x166.png 300w" sizes="(max-width: 349px) 100vw, 349px" class="wp-image-47918" /></span>
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				<div class="et_pb_text_inner"><h4><strong>Delivered in partnership between ASCERT and Start360 </strong></h4>
<p><strong>         </strong></div>
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				<div class="et_pb_text_inner"><h1 style="text-align: center;">Make an online referral to Targeted Lifeskills</h1></div>
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                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_4' ><div id='gf_4' class='gform_anchor' tabindex='-1'></div><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_4' id='gform_4'  action='/project_category/westernyouth/feed/#gf_4' >
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                                                    <input type='text' name='input_4.3' id='input_4_4_3' value=''   aria-required='false'     />
                                                    <label for='input_4_4_3' >First</label>
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                            <span id='input_4_4_6_container' class='name_last' >
                                                    <input type='text' name='input_4.6' id='input_4_4_6' value=''   aria-required='false'     />
                                                    <label for='input_4_4_6' >Last</label>
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                                        <label for='input_4_5_1' id='input_4_5_1_label' >Street Address</label>
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                                    <input type='text' name='input_5.3' id='input_4_5_3' value=''    aria-required='false'    />
                                    <label for='input_4_5_3' id='input_4_5_3_label' >City</label>
                                 </span><input type='hidden' class='gform_hidden' name='input_5.4' id='input_4_5_4' value=''/><span class='ginput_right address_zip ginput_address_zip' id='input_4_5_5_container' >
                                    <input type='text' name='input_5.5' id='input_4_5_5' value=''    aria-required='false'    />
                                    <label for='input_4_5_5' id='input_4_5_5_label' >ZIP / Postal Code</label>
                                </span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_4_5_6' value='' />
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                            <input name='input_8' id='input_4_8' type='text' value='' class='medium'     aria-invalid="false"  />
                        </div></li><li id="field_4_10"  class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_4_10"><h2 class="gsection_title">The Participants</h2></li><li id="field_4_11"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_4_11"><label class='gfield_label' for='input_4_11' >Please Indicate the Age Range of the Identified Participants for the Training</label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_4_11' class='medium gfield_select'     aria-invalid="false" ><option value='11-13' >11-13</option><option value='14-15' >14-15</option><option value='16-21' >16-21</option></select></div></li><li id="field_4_12"  class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_4_12"><label class='gfield_label gfield_label_before_complex'  >Data Consent<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class='ginput_container ginput_container_consent'><input name='input_12.1' id='input_4_12_1' type='checkbox' value='1'  aria-describedby="gfield_consent_description_4_12 gfield_description_4_12" aria-required="true" aria-invalid="false"   /> <label class="gfield_consent_label" for='input_4_12_1' >I agree</label><input type='hidden' name='input_12.2' value='I agree' class='gform_hidden' /><input type='hidden' name='input_12.3' value='9' class='gform_hidden' /></div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_4_12'>In compliance with UK Data Protection Law, ASCERT requires your consent to keep a record of your details submitted in this form to administer to process this referral. Please check this box to indicate you have given consent for your personal data to be utilised in this way. Visit the <a href="http://www.ascert.biz/privacy-cookies-2/">Privacy Policy</a> section of this website to read more about how we process your data.</div></li><li id="field_4_13"  class="gfield field_sublabel_below field_description_below gfield_visibility_visible"  data-js-reload="field_4_13"><label class='gfield_label gfield_label_before_complex'  >Marketing Consent</label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_4_13'><li class='gchoice gchoice_select_all'>
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