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
CJS: probation
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
Victims First Northumbria
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
Practical and Emotional Support (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 20 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. Please take a look at our criteria page on our website. 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.
Practical and Emotional Support
- Practical and Emotional Support referral provides a flexible combination of practical, emotional, advocacy or ISVA support via face-to-face appointments, phone calls, email or online. If you are considering reporting/have reported sexual violence to the police, we can act as your Independent Sexual Violence Adviser (ISVA) to help you through the process. We have specialist ISVA’s working with people with different learning needs, under 25’s and people living in rural areas. You will not be able to tell your ISVA about any of the details of the incident being investigated, as this will be seen as ‘contaminating’ your evidence. Emotional support is a safe space for you to talk and receive reassurance and encouragement, if you want therapy we can refer you to the Counselling service. There may be some things that are not appropriate for us to advise you on (e.g. legal advice) in which case we will support you to access the most appropriate service.
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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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
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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
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Gender
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Woman
Non-binary
Transwoman
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Disability
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Yes
No
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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
Newcastle West End
North Tyneside
Northumberland
South Tyneside
Sunderland
Prison
Contact Information