INDEPENDENT STALKING ADVOCACY CASEWORKER: ISAC

Referral Form: Gloucestershire

Referrer information

Referrer name and job title

Referrer contact number

Referring organisation

Referrer Email Address

Referral Details

First Name

Last Name

Address 1

Address 2

Town

Post Code

Date of Birth

SAFE Phone Number

Email Address

PLEASE FLAG IF YOU HAVE ANY CONCERNS ABOUT ONLINE/ DIGITAL STALKING THAT MIGHT MAKE CONTACT UNSAFE!

Digital Concerns

Suspect Details

First Name

Last Name

Address 1

Address 2

Town

Post Code

Date of Birth

Description of Suspect

Child(ren) information

Child 1

Child Full Name

Child Date of Birth

School

Please detail any social care involvement

Child 2

Child Full Name

Child Date of Birth

School

Please detail any social care involvement

Child 3

Child Full Name

Child Date of Birth

School

Please detail any social care involvement

BACKGROUND INFORMATION: PLEASE PROVIDE AS MUCH INFO AS POSSIBLE

How the client met the suspect:

How long ago did the relationship with the ex-partner end:

Has the suspect tried to get near to the client:

Has the suspect made threats to the client:

Has the suspect got into the client’s house:

Has the suspect damaged any of the client’s property:

Has the suspect ignored a police warning/breached a court order:

Does the suspect have ongoing contact with the client:

Does the suspect have a previous history of stalking or harassment:

Does the suspect have a history of sexual or physical violence:

Does the suspect seem to have a major mental health problem:

Does the suspect seem to have problems with substance abuse:

How scared is the client:

Any other information that might be useful to know:

Information For Referrers:

This is a specialist service for high risk stalking victims in Gloucestershire, who are over the age of 16.

The service is funded by the OPCC for Gloucestershire.

Our usual working hours are 8:30am-4pm.

We aim to respond to referrals within 48 hours.

We aim to keep the referrer updated with progress on the case.

Information About ISAC Role:

Gloucestershire’s Stalking Hub aims to ensure the effective management of high risk stalking cases in Gloucestershire.
Stalking Hub has access to specialists in police, CPS, probation, Mental Health and other agencies.
ISAC represents victims at the multi-agency Stalking Clinic meetings chaired by Gloucestershire Constabulary.
If a referral is appropriate, ISAC can refer a case into Stalking Clinic.

Gloucestershire’s ISAC team is:
Safe Lives IDVA qualified: https://safelives.org.uk/
Trained in Stalking Risk Profile: https://www.stalkingriskprofile.com/
Accredited by University of Brighton (Paladin): https://paladinservice.co.uk/

FearFree Helpdesk: 01225 775 276

ISAC Inbox: isac@fear-free.org.uk.cjsm.net

If this person’s situation changes or if the support is no longer needed, please inform us on spa@fearfree.org.uk or 01225 775 276