POETIC is an in-community after-care program for girls (12-24) who have experienced child maltreatment, commercial sexual exploitation (CSE) or domestic minor sex trafficking (DMST).  

Through evidence-based therapeutic interventions, creative arts therapy, an on-site school and mentorship, POETIC equips girls to find their voices, reclaim their narratives and persist forward. POETIC serves the Dallas community at no cost to youth and families.

This referral form is only for Dallas County Juvenile Department.  If you or your agency is interested in referring a youth, please email: referrals@iampoetic.org


Once submitted, you will receive a response within 48 hours. 

If youth is accepted, please email the following to referrals@iampoetic.org

  1. Previous psychological evaluation(s) (PSAS)
  2. Probation report
  3. Educational records

REFERRAL QUESTIONS

Name of youth being referred *
Name of youth being referred
Date of birth *
Date of birth
Past or current history of CPS placement *
Does youth have history of child maltreatment *
Neglect, sexual, physical, emotional abuse, exposure to domestic violence
Does youth have a history of Commercial Sexual Exploitation (CSEC)? *
History or suspicion of sexual activity in exchange of anything of value such as housing, food, drugs, promise of safety, etc
Does youth have a history of Sex Trafficking? *
History or suspicion of sexual activity in exchange of anything of value where a third party profits such as a trafficker, recruiter, "boyfriend," family member, etc
POETIC services referring to (you may select multiple) *
School grade last completed
Does youth have an IEP/504plan?
Is youth aware you are making the referral?
Guardian Name (if applicable)
Guardian Name (if applicable)
Is guardian Spanish-speaking?
Guardian Phone Number (if applicable)
Guardian Phone Number (if applicable)
Address youth will likely return to post-adjudication
Address youth will likely return to post-adjudication
Probation Officer (PO), Therapist, Case Manager's Name *
Probation Officer (PO), Therapist, Case Manager's Name
PO, Therapist, Case Manager's Phone *
PO, Therapist, Case Manager's Phone
Date Probation Ends or Ended *
Date Probation Ends or Ended
Where is the youth at the present time? *
If in placement, estimate date of discharge
If in placement, estimate date of discharge