Refer To Us - Alongside

Adults client referral

The Liberty Project provides holistic recovery support to women aged 18+ involved in opportunistic street sex work in Stockton and Middlesbrough.

The Adult Sexual Exploitation Partnership (ASEP, formerly STAGE) provides holistic recovery support to women aged 18+ who have been sexually exploited or groomed across Cleveland.

We can also work with women aged 18+ in Middlesbrough and Redcar & Cleveland who are facing challenges in at least two of the following areas: homelessness or acute housing need, substance or alcohol misuse, domestic abuse, mental health and repeated contact with the criminal justice system, as well as either on street sex work to meet their basic needs or previous or current experience of sexual exploitation.

This short referral requests the initial information required to allocate a Project Worker and provide the most appropriate support. Obtain the client’s consent to the referral and to use the contact details marked safe. Further history will be obtained at the client’s initial meeting.

Client consent

Date of referral *

Does the client consent to this referral? *

Does the client consent to contact using the details marked safe on this form? *

Does the client consent to A Way Out holding their details in a secure database in accordance with GDPR and the Data Protection Act? *

Client details

Full name *

Date of birth *

Contact telephone number

Telephone safe to use?

Email address

Email safe to use?

Contact address

Address safe to use?

Care of address?

On street homeless?

Sofa-surfing or staying with a friend temporarily?

Current issues

Key challenges and other important information relevant to the referral

Other organisational involvement

Organisations or agencies involved

For each agency, include its name, the key or support worker’s name and contact number, and whether the client consents to us contacting them to share information.

Referrer details

Full name *

Job title

Agency and contact address

Contact telephone number *

Email address *

Risk posed by client (to self or others)

Assess risk using evidence, history and current circumstances. Low: no significant or current indicators of harm. Medium: identifiable indicators, but harm is unlikely unless circumstances change. High: serious harm could occur at any time. Very high: serious harm is imminent. Everyone must have at least a low risk assessment.

Risk to self *

Risk to staff *

Risk to a known adult *

Known adult: who and nature of relationship

Risk to children *

Risk to the public *

Evidence and context for risk assessment

Information on this form is sensitive. Submit it only through a site and mailbox configured for confidential referrals. Fields marked * are required.

Adults client referral

Blossom referral