Application toBlue Knot Health Professionals Referral Database.

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Have you been referred by COTWA?

NoYes

Personal Details

Title

Last Name

First Name

Gender

This information will be used by Blue Knot Foundation to contact you:

Email

Phone Number

Mobile Phone

Address

City

State

Post Code

Practice details

This information will be provided to Blue Knot Helpline and Redress Support Service clients when your name is provided for a possible referral:

Practice Name

Phone number

Email

Alternate phone number

Address

City

State

Post Code

Website

Do you provide your service online that is accessible to anyone in Australia?

Where did you find out about applying for the Blue Knot Referral Database?

Other, please specify

Knowledge of trauma-specific therapy

Health practitioners applying for listing on the Blue Knot Referral Database need to demonstrate knowledge of and ability to work effectively with adults who experienced inter-person complex childhood trauma as opposed to 'single incident' trauma. Blue Knot has released a number of guidelines which present the principles and approaches to this work. These can be purchased in soft or hard copy formats at https://professionals.blueknot.org.au/resources/publications/

It also provides extensive professional development training opportunities to build knowledge and skills for this work at https://professionals.blueknot.org.au/professional-development-training/

General therapeutic approach

Describe your general therapeutic approach to working with adults who have experienced complex trauma. Specifically comment on how you integrate trauma-specific clinical work with core trauma-informed principles and respect for cultural and other forms of diversity. (Maximum 500 words)

Considerations when working with clients with experiences of complex trauma from childhood
Outline what you see as specific issues related to childhood trauma experiences. What adjustments, if any, do you make to your therapy with adults who have experienced complex childhood trauma? (Maximum 500 words)

Referral considerations

Outline the circumstances in which you might consider referring a complex trauma client on. What network would you access to support your clients with a suitable referral? (Maximum 300 words)

Further information

Is there anything else you would like to tell us that is relevant to your application for inclusion on the Blue Knot Referral Database? (Maximum 300 words)

Declaration

Please review the following information carefully.

I understand that Blue Knot Foundation reserves the right to solely make decisions about all listings on the Blue Knot Referral Database, including but not limited to additions to, renewals and removals of listings from it. While Blue Knot Foundation will endeavor to provide a reason, it is under no legal or other obligation to do so, and any decision made is final.

I understand that Blue Knot Foundation will require me to renew each year which includes provision of updated practicing certificate/s.

I understand that a listing on the Blue Knot Referral Database does not guarantee how often my details may be provided to Blue Knot Helpline and Redress Support Service clients, nor how often I may be contacted with an enquiry about my services.

I understand that because of the nature of the service, Blue Knot counsellors have limited engagement with clients and are only able to undertake basic needs assessment and that it is solely my responsibility to assess the suitability of every referral made to me.

I confirm that I will advise Blue Knot Foundation in writing if:

Any of my practice contact details change I resign from or fail to renew any of the professional memberships or affiliations included in this application Any other practice-related matters change that are relevant to my listing on the Referral database.

I understand that Blue Knot Foundation is not able to investigate or determine any complaints made by a client against me and that clients will be referred by Blue Knot Foundation to the relevant complaints body for such purposes.

I confirm that I will advise Blue Knot Foundation in writing if:

Any professional body with which I am registered, or a relevant complaints body commences an investigation related to a client complaint Any of the professional memberships or affiliations included in this application are cancelled and/or are suspended and/or my clinical practice is restricted by an accrediting body

I understand that Blue Knot Foundation will suspend the listing of a Health Professional from the Blue Knot Foundation Referral database under any of the above circumstances, and also if Blue Knot Foundation is notified in writing by another party that a complaint against a practitioner listed on the Referral Database has been submitted to a relevant complaints body. At such time as the Health Professional’s registration is fully reinstated and/or a complaint is finalised with no impact to their clinical registration/s, the Health Professional can accordingly advise the Blue Knot Referral Database Team on referraldatabase@blueknot.org.au and request their listing be reactivated on the Referral database.

I,

confirm I have reviewed and understood all the information included in this application,

YesNo

confirm that the information I have provided is true and accurate.

YesNo

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