Childrens Referral Form


RASA Merseyside is a specialist service, adhering to Rape Crisis National Standards. We are a survivor focused organisation and, as such, we do not accept referrals for anyone who is subject (the suspect) to an ongoing police investigation for sexual offences, convicted of any sexual offences, or for anyone who may pose a risk of sexual harm to others.

RASA Merseyside provides support to anyone impacted by sexual violence. We have a counselling service which provides one to one support to work through the impacts of sexual abuse. We also have an ISVA service for anyone who has an ongoing police investigation regarding a sexual offence.

RASA Merseyside only accepts referrals made by professionals with the children’s parent/guardian’s knowledge and agreement.

Confidentiality

  • RASA Merseyside Services are confidential, unless there are concerns about safeguarding, immediate risk of harm to self or others, or issues of legality.
  • RASA Merseyside may only disclose information to the referrer about the service user’s attendance with informed consent from all parties.
  • RASA Merseyside will not disclose issues discussed within counselling.
  • RASA Merseyside adhere to confidentiality, Data Protection, and Safeguarding Policies – Available on request

How to make a referral Please complete and submit the form below with as much information as possible. We must be informed by the referrer of the service user’s involvement with other agencies, for example, Social Services or Mental Health services. Required fields are shown with a *

Upon receipt of this referral, we aim to contact the service user within 7 working days.

Referrer Details

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Essential Details

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Service Details

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Service criteria /explanation of services (Click here to show/hide details)
Client Contact Details

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Parent/Guardian details

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Additional Details

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Social care involvement and level of intervention, e.g. EHAT or Child in need.

Assault Details (if known)

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(CSA means 'Childhood Sexual Abuse')

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Please tick box to show consent given from parent/guardian for referral to support services.*


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