Lamplight API response

First name

Last name

Address 1

Address 2

Address 3

Address 4

Address 5

Postcode

Email address

Mobile phone

Phone number

We would like to contact you/your client about our services from time to time. You/they can opt out whenever you/they like, and we won't share your/their contact details with any other organisations. Are you happy for us to contact you/them:

By post

By email

By mobile

By text message

Other information

Referral Information

The ECPAT UK Programme offers support for children and young people. It is child-centred, rights-based, and trauma-informed.

We provide tailored support for young people in a safe environment to enable them to learn valuable life skills, access peer support, ease their trauma, understand their rights, and have their voices heard in order to develop new skills.

The Youth Programme accepts referrals for young people aged 15-25 who may have been trafficked or exploited or who present with indicators of trafficking.

We acknowledge that young people might be age disputed or not within the age range mentioned above. To discuss the young person's eligibility, please do contact the youth team for clarification.

We provide tailored support for children and young people based on their individual needs. This can include advocacy work, risk assessments and needs' assessments, one-to-one support and/or signposting.

Our principle offer is ensuring the rights and entitlements of the children and young people we are supporting are met, including they are being looked after in appropriate accommodation.

Referral procedure

1. Referral to ECPAT UK completed

2. Meeting/phone call with the referrer

3. Introductory meeting with the child or young person (if appropriate)

Young Person's Further Details

Young person's WhatsApp number (if different from phone no.)

Date of Birth

Date of Birth (as given by the child or young person at the point of referral)

Is the young person's age disputed?

If the young persons age is disputed please provide as much detail as possible. If known and applicable, what is the DOB currently used by the Home Office and/or local authority children's services?

Gender

Accommodation

Current accommodation type

Current accommodation type (other)

Previous address 1

Was previous address 1 a Home Office commissioned children or adults hotel?

Previous address 2

Was previous address 2 a Home Office commissioned children or adults hotel?

Personal Details

Country of origin

Languages spoken

Afrikaans

Aja-Gbe

Akan

Afar

Albanian

Amazigh

Amharic

Anii

Arabic

Armenian

Assamese

Aymara

Azerbaijani

Balanta

Bambara

Bariba

Bassari

Bedik

Belarusian

Bengali

Berber

Biali

Bislama

Boko

Bomu

Bosnian

Bozo

British Sign Language

Buduma

Bulgarian

Burmese

Cantonese

Catalan

Chichewa

Chinese, Mandarin

Chirbawe (Sena)

Comorian

Croatian

Czech

Dagaare

Dagbani

Dangme

Danish

Dari

Dendi

Dhivehi

Dioula

Dogon

Dutch

Dzongkha

English

Estonian

Ewe-Gbe

Fijian

Filipino

Finnish

Fon-Gbe

Foodo

French

Fula

Gbe

Gen-Gbe

Georgian

German

Gonja

Gourmanché

Greek

Guaraní

Gujarati

Gàidhlig

Haitian Creole

Hassaniya

Hausa

Hebrew

Hindi

Hiri Motu

Hungarian

Icelandic

Igbo

Indonesian

Irish

Italian

Japanese

Jola

Kabye

Kalanga

Kanuri

Kasem

Kazakh

Khmer

Khoisan

Kinyarwanda

Kirundi

Kissi

Korean

Kpelle

Kurdish

Kyrgyz

Lao

Latin

Latvian

Lithuanian

Lukpa

Luxembourgish

Macedonian

Malagasy

Malay

Malinke

Maltese

Mamara

Manding (Mandinka, Malinke)

Mandinka

Mandjak

Mankanya

Manx Gaelic

Maori

Marshallese

Mbelime

Moldovan

Mongolian

Montenegrin

Mossi

Nambya

Nateni

Nauruan

Ndau

Ndebele (Northern)

Ndebele (Southern)

Nepali

New Zealand Sign Language

Noon

North Korean

Northern Sotho

Norwegian

Nzema

Oniyan

Oromo

Ossetian

Palauan

Papiamento

Pashto

Persian

Polish

Portuguese

Quechua

Romanian

Romansh

Russian

Safen

Samoa

Sango

Sena

Serbian

Serer

Seychellois Creole

Shona

Sinhala

Slovak

Slovene

Somali

Songhay-Zarma

Soninke

Sotho

Spanish

Susu

Swahili

Swati

Swedish

Syenara

Tagalog

Tajik

Tamasheq

Tamil

Tammari

Tasawaq

Tebu

Telugu

Tetum

Thai

Tigrinya

Tok Pisin

Toma

Tonga

Tongan

Tsonga

Tswana

Turkish

Turkmen

Tuvaluan

Ukrainian

Urdu

Uzbek

Venda

Vietnamese

Waama

Waci-Gbe

Wamey

Welsh

Wolof

Xhosa

Xwela-Gbe

Yobe

Yom

Yoruba

Zimbabwean sign language

Zulu

Does the child/young person require an interpreter?

If the child/young person does require an interpreter what language is required?

Interpreter gender preference

Religious belief (if known/ and if practising)

Are there any known or potential special educational needs

Please give details of any SEN assessments (if applicable)

ESOL level (if applicable)

Pre-Entry Level Entry 1 Entry 2 Entry 3 Level 1 Level 2

Pre-Entry Level

Entry 1

Entry 2

Entry 3

Level 1

Level 2

Immigration status/welfare support status and entitlements

Is the child/young person British born/do they hold British citizenship?

If they don't hold British Citizenship what is their immigration status?

Asylum Seeker Refugee Refused Other form of leave Deemed 'inadmissible' In appeal process Other

Asylum Seeker

Refugee

Refused

Other form of leave

Deemed 'inadmissible'

In appeal process

Other

Date of arrival in the UK (if applicable)

Port reference/ Home Office reference number (If applicable)

Does the child/young person have an immigration solicitor?

Please provide further information about their immigration status if known

Has the young person attended/been invited to a substantive asylum interview?

Did the young person arrive in the UK under the age of 18 (including if age disputed)?

Has the child/young person been referred to the local authority children's services with safeguarding responsibility?

When was the child referred to the responsible local authority?

Current responsible local authority children's services

Further relevant details regarding local authority involvement, if relevant e.g. if there have been delays in a local authority accepting responsibility due to age disputes, placements in hotels etc.

Welfare support status and entitlements

Child's legal status (under the Children Act 1989)

Child in need (CIN)

Looked after child (LAC)

Care leaver

s20 voluntary accommodation

s31 Care Order

Child protection plan

Other (please state)

Child's legal status (other)

If a care leaver please choose a category

Has the child or young person been moved under the National Transfer Scheme (NTS)

Trafficking/Trafficking Indicators

Please provide as much detail as possible and if you need clarification on the definition of child trafficking and exploitation please refer to

https://www.ecpat.org.uk/definition-child-trafficking-exploitation-and-slavery

What are the concerns for child trafficking/modern slavery?

What type of exploitation do the concerns relate to?

Is there a concern the child/young person is in contact with trafficker/s?

Are there concerns around risk of child/young person being re-trafficked or going missing? Please give as much detail as you can

Has a referral been made to the National Referral Mechanism (NRM)?

If an NRM referral has been made please provide the full name, agency and role of person who made the NRM referral including contact details if known.

Please provide a date the NRM referral was made

Professional contact details

Please provide contact details of any professionals involved in the child/young person's life.

Statutory social worker/personal advisor (name, local authority, email, phone no.)

Key-worker/support worker (name, organisation, email, phone no.)

School/College contact (name, email, phone no., location)

Immigration solicitor (legal firm, name, email, phone no

Welfare/Public Law solicitor (legal firm, email, phone no.)

Criminal Solicitor (Name, Email, Phone No.)

GP (Surgery Name, Email, Phone No.)

Other agencies involved (e.g. mental health, police, VOS, health, education) (name, role, email, phone no.)

Parent/Guardian/Carer details (if applicable)

Full name of Parent/Guardian/Carer

Type of carer (foster, relative, supported accommodation provider, etc)

Address of Parent/Guardian/Carer

Mobile number of Parent/Guardian/Carer

Email address of Parent/Guardian/Carer

Details of referral

Referrer Details

Referrer name

Organisation

Job title

Referrer email address

Referrer contact number

Referrer's role in relation to the young person

Is the young person aware of the referral?

Risk Assessment

Please answer Yes or No. If yes, Please add more details.

Do they have any physical health issues? (e.g. Mobility, allergies, chronic illness, injuries.)

Details on physical health issues

Are they experiencing any mental health issues? (e.g. depression anxiety, PTSD)

Details on mental health issues

Are you aware of any current or historic self-harm or suicidal thoughts/attempts?

Details on self-harm or suicidal thoughts/attempts

Is there a known history or concern around substance use?

Details on substance use

Has the child/young experienced/witnessed violence or abuse (please consider different forms, for example including domestic abuse; armed conflict, kidnapping, torture)?

Details on experiences/witnessing of violence or abuse

Experiences of separation and loss

Please share any known detail about family history including any significant relationships and losses

Have there ever been concerns about the child or young person using violence or aggression?

Details of violence and aggression

Have there ever been concerns of offending behaviour and any convictions?

Details of offending behaviour and convictions

Are there any areas in London/UK that the young person may be at risk in?

Please provide exact locations the young person may be at risk in

Is there anything else you feel that is important for us to know?

Thank you for completing this form.

You can contact the Youth Team at:

Sophia Benedict,Youth Programme Manager and Therapeutic Lead, Mobile: 07S32790328, Email: s.benedict@ecpat.org.uk

By clicking "Submit your referral" below you consent that we may store the information you have provided for the purposes explained above. Please see our privacy policy for more information.

You can read our privacy policy here

Youth Programme Referral Form