Children's Referral

Eligibility Criteria: Child / young person 0 to the end of their 17th year who is resident in Barnsley, who has experienced sexual abuse, where the abuse has been reported and / or investigated by the police / social care and where any criminal proceedings have concluded*. We also accept referrals for children / young people who have been impacted by sexual abuse.

Our children’s specialist therapeutic service is two-fold and comprises our Therapeutic Wellbeing Service and Therapy. At BSARCS we recognise that children and young people are not always immediately ready or in a stable enough environment to access therapy and process their trauma. Therefore, we offer therapeutic wellbeing support to those children and young people who’re unable to access specialist therapy at the time they’re referred. The information contained below is screened to identify appropriate referrals and which service best meets the child / young person’s needs.

*BSARCS provides a separate support service for children and young people who are currently involved in court proceedings.

* Denotes a required field

Referrer Details

Name *

Contact Number *

Email *

Where possible, signed authority MUST be sought from child/ young person and/or parents/carers. As an organisation, we understand that this is not always practical, however, EXPLICIT CONSENT to the referral must ALWAYS be sought from the individual concerned.

GDPR – We record and retain the personal information submitted on this form for the purpose of referral management, please tick this box to confirm that you understand and agree to us retaining your data for this purpose. You can request, at any time, that we remove your personal information from our records.

Childs Details

Name of child/young person *

Date of birth (DD/MM/YYYY) *

Age

Child / Young persons telephone number

Disability (Physical and /or learning)

Religion

Ethnicity

Any medical needs?

Parent / Carer Details

Name

Email address

Address

Contact number

Relationship to child

Parental Responsibility

Yes

Referral Details

Reason for referral including age of child / young person at time of abuse, details of abuse etc.

Name of perpetrator

DOB / Age

Address if known

Relationship to child / young person

Police / Social care investigation

Yes

Police / Social care investigation details

Outcome of criminal trial

Is there any current direct / indirect contact with the perpetrator or any person connected to the perpetrator? (if yes please give details):

Child Support System

Please detail names / contact number/ relationship of the child / young persons support network include family / friends / key professionals including school/collage.

Assessments / Plans

If the child / young person currently subject to any assessments or plans?

e.g Child Protection Plan, CIN (Children in Need plan), EHA (Early Help Assessment), EHCP (Education, Health & Childcare Plan)

Yes

If yes, please provide breif details, including the start dates of the assessments / plans

Is there a significant history of involvement from Social Care / Early Help services?

Yes

If yes, please provide breif details

Strengths

Does the child / young person have a stable home environment?

Yes

Are they engaging with education?

Yes

Do they have a positive peer group?

Yes

Do they any hobbies / attend any activities?

Yes

Risks

Does the child / young person misuse substances?

Yes

Is the child / young person being sexually or criminally exploited?

Yes

Have they ever gone missing?

Yes

Any self harm or suicidal thoughts or acts?

Yes

Sexually harmful behaviour?

Yes

Any violence towards adults or peers?

Yes

Any eating disorders?

Yes

Any parental risks? DV / substance misuse etc

Yes

Please provide further details if you've answered yes to any of the risk factors

Once you have submitted this form we will add you to our system and one of our team will be in touch soon.

RCEW Helpline 0808 802 9999 (women and girls)
Safeline 0808 800 5005 (men)
Samaritans 116 123

In an Emergency call 999