2. In the referral form
• Name, address, contact
details, programme/course
details (integrates with
SITS/ICON)
• 9 Protected characteristics of
the Equality Act 2010
• What the student wants
support with (multiple choice
of a maximum 22 choices,
e.g. academic stress, low
mood, anxiety, etc.)
• How the issues impact on
their life
• What has worked in the past
• What hasn’t helped
• Previous mental health
professional support history
• GAD7, PHQ-9, WSAS
• Pre-CIAO
• C-SSRS
4. End of the intervention
• Post-CIAO
• Student experience of the practitioner and the service (10
statements with a simple Likert Scale – Strongly Agree, Agree,
Disagree, Strongly Disagree)
• Open text box of what was worked well
• Open text box of what could be improved
• Open text box of any additional comments