Who is this referral for?
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Me
Someone else
What is your relationship with the client?
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Professional
Friend / family / third party
Source of referral
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CJS: courts
CJS: other
CJS: police
Education Services
Health: GP
Health: IAPT
Health: mental health services
Health: other
Housing
Local authority: adult services
Local authority: children's services
Local authority: other
SARC services
Self
Northumbria Victim and Witness Service
Voluntary sector
Women's sector: DV
Women's sector: other RC
Women's sector: other
Other
Health, state which:
Housing, state which:
CJS, state which:
Local authority, state which department:
Women's sector, state which:
Other, state which:
State which (e.g. Youth services):
Continuing to work with client
Referrer's name
Referrer's phone
Referrer's email
Referrer's address
Referrer's relationship with client
Permission to make referral
First name
Last name
Service(s) you / they would like:
Counselling
Group Work
ISVA Service (Independent Sexual Violence Advisors)
If you select more than 1 service you will be added to a separate waiting list for each service. If you are unsure which service you would like to access please contact the admin team on
enquiries@rctn.org.uk
or
0191 222 0272
.
Counselling
- A counselling referral will offer up to 12 sessions of trauma-informed counselling that can be accessed either face to face, online or over the telephone. Your counselling will always be delivered by a woman. Accessing counselling is based on needs, risk and therapeutic assessment. If we are not able to offer you counselling at this stage we will guide you to find more appropriate support to help you in preparation for future counselling.
Group Work
- A referral will mean that you, or the person you’re referring, will be contacted by our Group Worker to discuss joining a group. We offer a number of different groups and brief descriptions can be found on our Group Work page on the RCTN website. Our groups offer weekly sessions from between 4-8 weeks. We also offer an Ongoing Monthly Peer Support Group. Before joining a group you will be invited to a pre-group one-to-one meeting to discuss groups and complete a risk assessment. Group support can be accessed either face to face or online. RCTN groups are for those that have experienced sexual violence at any point in their lives and feel like a woman only space is right for them.
ISVA Service (Independent Sexual Violence Advisors)
-
The ISVA (Independent Sexual Violence Advisor) service is here to support you if you have experienced sexual violence or sexual abuse, no matter when it happened. We can support you to understand your options and provide emotional and practical support, including supporting you through the criminal justice process if you choose to report to the police. We can also help you access and navigate other services such as health care and specialist support. You remain in control of the decisions you make, and your ISVA will be alongside you to support your choices and ensure you feel safe.
Living in area
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Gateshead
Newcastle
North Tyneside
Northumberland
South Tyneside
Sunderland
Out of area
Working in area
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Gateshead
Newcastle
North Tyneside
Northumberland
South Tyneside
Sunderland
Out of area
Not known
Which educational establishment studying at
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Newcastle University
Northumbria University
Newcastle College
Sunderland University
Other (please state below)
Prefer not to say
Other establishment
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Street
City
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Can we write to this address
Mobile Phone
Can call mobile
Can leave message on mobile
Can text to mobile
Email
Can email
Preferred method of communication
Other information about making contact
Support / communication needs for accessing the services
Date of birth (dd/mm/yyyy)
Sexual orientation
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Bisexual
Gay / lesbian
Heterosexual / straight
Other
Prefer not to say
Gender
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Woman
Non-binary
Transwoman
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Disability
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Yes
No
Prefer not to say
Additional learning needs
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Yes
No
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Additional mental health needs
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Yes
No
Prefer not to say
Ethnic origin
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Asian / British Asian (including Chinese, Indian, Pakistani, Bangladeshi and any other Asian background)
Black / African / Caribbean / Black British
Mixed / Multiple Ethnic Groups (White and Black Caribbean, White and Black African, White and Asian, Any other mixed / multiple ethnic background)
White (English, Welsh, Scottish, Northern Irish, Irish, Gypsy, Irish Traveller, Any other White background)
Other ethnic group (including Arab and any other ethnic group)
Prefer not to say
Reported to police
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Yes - the only incident / all the incidents
Yes - some, but not all of the incidents
No
Recent
child
rape / sexual assault
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Yes
No
Recent rape / sexual assault
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Yes
No
Historic rape / sexual assault
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Yes
No
Historic
child
sexual assault
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Yes
No
Other form of sexual violence
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Yes
No
Preferred counselling base
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Gateshead
Newcastle Central
North Tyneside
Northumberland
South Tyneside
Sunderland
Contact Information