Childrens Referral

Professional Referral - Children (0-17 Years)

Please note, we are unable to offer support to children if their experience of sexual harm has not been referred to social care or the police. This form should be used where a child is in need of therapeutic or wellbeing support. If the child is, or is considering, pursuing a formal complaint, you should make a referral on our ISVA referral form. The disclosure will need to be reported in any event. Please contact us if you have any queries on 01226 320140.

Disclosure reported(Required)
Consent to Referral(Required)

Child's Details

Child's Date of Birth(Required)
Parental Responsiblity
Communication Preferences(Required)
It is important that we are able to make direct contact with the child's primary caregivers, please let us know how they are happy for us to communicate with them. Please note that calls from us tend to be on a withheld number and letters on headed paper.
Please tell us anything you think we need to know when making contact with the child or heir caregiver i.e. they require an interpreter, large text or a request that we call at a certain time of day

Referrer Details

Please let us know what support you have, or are, providing to the child you are referring.

Referral Detail

Detail here the outcome of any police investigation/ criminal trial

Support Mapping

Please detail any current or planned assessment, as well as history of social care and early help involvement
Please select all factors present
Please provide more detail of your assessment of strengths and risks

Monitoring Information