Who is this referral for?
Please select...
Me
Someone else
What is your relationship with the client?
Please select...
Professional
Friend / family / third party
Source of referral
Please select...
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 service is here to support survivors of sexual violence who:
Are thinking of reporting their experience of sexual violence to the police but would like to discuss this first OR
Have reported their experience of sexual violence to the police and there is an active police case or Criminal Court proceedings; OR
Have been told by the police or the CPS (Crown Prosecution Service)
within the last 3 months
that they will be taking no further action on their case, and would like to discuss their options. I
f your needs fall outside of the above, then our ISVA service will not be the right service for you at this time but we would encourage you to explore our other services including our Helpline which you can use without a formal referral to our organisation. We can also provide you with signposting to other services that may meet your needs. You can contact our Helpline or enquiries to request this information.
Living in area
Please select...
Gateshead
Newcastle
North Tyneside
Northumberland
South Tyneside
Sunderland
Out of area
Working in area
Please select...
Gateshead
Newcastle
North Tyneside
Northumberland
South Tyneside
Sunderland
Out of area
Not known
Which educational establishment studying at
Please select...
Newcastle University
Northumbria University
Newcastle College
Sunderland University
Other (please state below)
Prefer not to say
Other establishment
Contact options - text of onscreen error message
You must enter at least an email address, phone number or address.
Contact options - validation
Street
City
Postcode
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
Please select...
Bisexual
Gay / lesbian
Heterosexual / straight
Other
Prefer not to say
Gender
Please select...
Woman
Non-binary
Transwoman
Prefer not to say
Disability
Please select...
Yes
No
Prefer not to say
Additional learning needs
Please select...
Yes
No
Prefer not to say
Additional mental health needs
Please select...
Yes
No
Prefer not to say
Ethnic origin
Please select...
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
Please select...
Yes - the only incident / all the incidents
Yes - some, but not all of the incidents
No
Recent
child
rape / sexual assault
Please select...
Yes
No
Recent rape / sexual assault
Please select...
Yes
No
Historic rape / sexual assault
Please select...
Yes
No
Historic
child
sexual assault
Please select...
Yes
No
Other form of sexual violence
Please select...
Yes
No
Preferred counselling base
Please select...
Gateshead
Newcastle Central
North Tyneside
Northumberland
South Tyneside
Sunderland
Contact Information