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Eligibility questionnaire
Question 1 of 10
Has the person being referred provided informed consent to this specific referral being made on their behalf? If under 18 has someone with parental responsibility consented to this referral?
*
Yes
No
Please ensure consent has been sought for this referral.
Question 2 of 10
Is the person being referred under investigation for or been convicted of sexual or domestic abuse?
Yes
No
Safety Net is a survivor focused service. We do not knowingly work with anyone who is under investigation for or has been convicted of sexual or domestic abuse.
Question 3 of 10
Is the person being referred experiencing a mental health crisis? Has the person being referred survived a suicide attempt in the last three months?
Yes
No
For now, the person being referred is not eligible for service because we are a recovery service, rather than crisis support. If the person is in mental health crisis, they can call NHS
111
and select option 2 for urgent mental health support. If they live in Cumbria and need urgent help with their mental health right, with their consent, contact Cumbria Crisis Support on
0800 652 2865
. In addition, consider contacting their GP.
Question 4 of 10
Has the person being referred been living with, or have they been in a relationship with an alleged perpetrator within the last three months?
Yes
No
For now, the person being referred is not eligible for service because we are a recovery service and do not provide immediate safety support to people who are experiencing domestic abuse now. If you are a professional working with someone who is currently at risk of domestic abuse, you are required to complete a domestic abuse risk assessment (DASH) with this person. This can be found at:
https://safelives.org.uk/resources-for-professionals/dash-resources
. Please ensure all high-risk cases are referred to Cumbria MARAC and the IDVA service, which in Cumbria is provided by Victim Support. Victim Support Cumbria can be contacted on
0300 303 0157
.
Email Address
*
Question 5 of 10
Has the person being referred experienced sexual abuse or a sexual assault within the last three months?
Yes
No
For now, the person being referred is not eligible for service because we are a recovery service and do not provide immediate safety support to people who are experiencing sexual abuse now. If you are a professional working with someone who has experienced a sexual assault immediate support can be accessed through The Bridgeway (SARC). The ISVA service in Cumbria is Victim Support and they can be contacted on
0300 303 0157
.
Question 6 of 10
Does the person being referred have a substance use disorder or dependency involving alcohol or drugs and is not engaging in support for this?
Yes
No
If the person being referred is not engaging in dependency recovery services, we request they get support regarding this prior to being referred into support at Safety Net. Please consider referring them to CADAS by calling
0800 254 5658
. In addition, Recovery Steps can be contacted on
01900 512300
or emailed on
referrals@recoverystepscumbria.org.uk
.
Question 7 of 10
Is the person currently homeless, sofa surfing, or living in unsafe accommodation?
Yes
No
Immediate housing needs should be addressed prior to referring someone for recovery support. Immediate accommodation and support for someone who is a victim of domestic abuse can be accessed by contacting Cumberland Housing teams: Allerdale Office hours:
01900 702660
Out of hours:
0300 373 3730
Email:
Homelessness1@cumberland.gov.uk
Carlisle Office hours:
01228 817428
Out of hours:
01228 817373
or
01228 817386
Email:
Homelessness2@cumberland.gov.uk
Copeland Telephone:
01946 598300
Email:
Homelessness3@cumberland.gov.uk
Safety Net are commissioned to provide support to individuals and families affected by domestic abuse residing in various forms of supported accommodation. This includes refuges, specialist safe accommodations, dispersed accommodations, sanctuary scheme properties, second-stage/move-on accommodations, and other emergency domestic abuse housing. Eligibility for these services applies from one month after leaving the abusive relationship, instead of the usual three months. Please contact us on
office@safetynetuk.org
or by phoning
01228 515859
in office hours to discuss the suitability of our support for this person, before making a referral and request an appointment with one of our triage team.
Question 8 of 10
Is the person currently engaged in therapy, or have they completed therapy in the past six months?
Yes
No
We will not accept referrals for people who are currently working with another therapist, as it is not recommended to engage in different therapeutic interventions at the same time. In addition, we request that people being referred have a period of six months between therapeutic interventions, to apply the tools/techniques learnt from therapy, prior to engaging in a new therapeutic relationship.
Question 9 of 10
Is the person being referred a refugee or a person seeking asylum?
Yes
No
Safety Net is able to accept referrals for people who are refugees or seeking asylum and have experienced rape, domestic abuse or sexual abuse. In addition, we can provide support if they have experienced any other abuse as a result of being a refugee, for example physical abuse or imprisonment. Please
complete a referral form online
or
download
, complete and email to:
office@safetynetuk.org
. Referral forms must be signed. Referrals which are incomplete or which do not provide supporting information where prompted to do so will not be accepted and returned to the referrer. Please contact us on
office@safetynetuk.org
or by phoning
01228 515859
in office hours to discuss the suitability of our support for this person, before making a referral and request an appointment with one of our triage team.
Question 10 of 10
Your client may be eligible for our support. Please
complete a referral form online.
Referrals which are incomplete or which do not provide supporting information where prompted to do so will not be accepted and returned to the referrer. Please contact us on
office@safetynetuk.org
or by phoning
01228 515859
in office hours to discuss the suitability of our support for this person, before making a referral and request an appointment with one of our triage team.
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Student placements
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Overview of our services
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Who we support
Support for domestic abuse
Support for sexual abuse
Support for childhood sexual abuse
Support for refugees
Work in schools
Out of hours support
Make a self-referral
Self-help resources
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Our services for professionals
Is your service user ready for recovery?
Make a professional referral
The trauma-informed approach
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Overview of our services
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Who we support
Support for domestic abuse
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Support for childhood sexual abuse
Support for refugees
Work in schools
Out of hours support
Make a self-referral
Self-help resources
Resources for young people
Professionals
Our services for professionals
Is your service user ready for recovery?
Make a professional referral
The trauma-informed approach
Resources for professionals
Training
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