Redbridge e-forms Domestic Abuse MARAC Risk Indicator & Referral Form For professional use only. Step 1 of 9 - Overview 11% Overview This is the London Borough of Redbridge's Online MARAC Risk Indicator & Referral Form. Please continue if you would like to refer an individual to the Redbridge MARAC (Multi-Agency Risk Assessment Conference). We all have a duty of care to report any children or vulnerable adults who may be affected by domestic abuse. Referrals should be completed to the following services if there is a safeguarding concern: Adult social care (opens in new window) Children's social care (opens in new window) Before completing this form for the first time we recommend that you read the full MARAC Referral Guidance and Frequently Asked Questions and Answers We recommend that you complete the risk indicator checklist prior to completing the victim’s details as only high-risk cases can be referred to MARAC. A high-risk case is identified by 14 'yes' responses on the risk indicator checklist.If there are less than 14 ‘yes’ responses you should only refer to MARAC if:There is potential Escalation: the number of police callouts to the victim as a result of domestic violence in the past 12 months. This can be used to identify cases where there is not a positive identification of a majority of the risk factors on the list, but where abuse appears to be escalating and where it is appropriate to assess the situation more fully by sharing information at MARAC. It is common practice to start with 3 or more police callouts in a 12 month period. This will be reviewed depending on local volume and level of police reporting in Redbridge.It is a Honour Based Violence, Forced Marriage, Female Genital Mutilation, Teenage Pregnancy.In your Professional Judgement the case needs to be discussed at MARAC. Please state the reason why on referral form within practitioner’s notes.The case has previously been discussed at MARAC in the last 12 months and a repeat incident has occurred.A Clare’s Law disclosure request.Continue to complete the remainder of the MARAC referral form if the victim fulfils the MARAC Criteria.If you do refer a client, you will be invited to attend the next MARAC in order to present why you deem the client to be high risk. Information Sharing: It is always preferable to obtain the clients consent to take a case to MARAC and due to the new GDPR guidelines it is essential for our advocacy service to be able to make contact if previously unknown.Emergency MARAC: If you think an Emergency MARAC should be called then please contact the MARAC Coordinator on telephone number 0208 708 5082 immediately. For further queries contact: MARAC@redbridge.gov.uk If you have a client which is NOT deemed high risk but wishes to receive support, please complete the Reach Out referral form. Please continue to complete the London Borough of Redbridge MARAC Risk Indicator & Referral Form Victim Consent The victim needs to be aware that the MARAC referral is being made unless it is unsafe to do so. Victim consent is preferred, however, MARAC referrals can be made without the consent of the victim. If the victim has NOT consented to the referral, the following sections must be completed for the referral to be accepted.Is the victim AWARE of the MARAC referral?(Required) Yes No Please state your reason why not.(Required)Has victim CONSENT been given?(Required) Yes No Date consent obtained(Required)How did you obtain the consent ?(Required)Lawful basis for sharing information(Required) Vital interest Legitimate interest For more information on either of these, please see the links below: Vital interest (opens in a new window) Legitimate interest (opens in a new window) Please confirm you have taken into account the following:(Required) The information is relevant The information is adequate and necessary to achieve purpose The information is proportionate Sharing this information will not significantly increase risk to the client/family What are legal grounds for referring to MARAC without victim consent?(Required) Child Protection Act 2004 s.115 Crime & Disorder Act 1998 Pt.3 Schedule 8 Data Protection Act 2018 Human Rights Act 2004 Common Law The Care Act 2014 Your detailsYour Agency Category(Required) Police IDVA Children's Social Care Primary Care Service Secondary Care/ Acute trust Education Housing Mental Health Probation Voluntary Sector Substance Misuse Adult Social Care MASH Other Agency name(Required)Contact name(Required)When this form is submitted a copy of this referral form with all submitted fields will be sent to the email address provided in the question below.Email(Required) Telephone number(Required) Victims/Survivors detailsName(Required) First Last Date of birth(Required)Address (Client must live in Redbridge, otherwise a referral needs to be made to the MARAC in which they reside)(Required)Find addressSelected address Telephone Number(Required)Is this number safe to call ?(Required) Yes No Unknown At certain times Is it safe to leave a voicemail/ send a text message?(Required) Yes No Unknown Safe times(Required) Add RemoveEmail address only if safe to send email to victim's email address GP DetailsIs the client a Social Housing Tenant with a Housing Association?(Required) Yes No Unsure Please state the housing association so a request for housing support can be made if appropriate(Required)Please selectA2DominionAbbeyfieldAnchorASRAEast Thames GroupEstuary Housing Association LtdGenesis Housing AssociationHome Group LtdHousing 21Industrial Dwellings Society (1885) LimitedLondon & Quadrant GroupMetropolitan Housing TrustNewlon Housing TrustPeabodyPlaces for PeopleSanctuary HousingSanctuaryStadiumSwan Housing GroupOtherPlease specify(Required) Victim/Survivor Diversity dataInterpreter required?(Required) Yes No LanguageEthnicity(Required)Please SelectABAN - Bangladeshi (Asian/Asian British)AIND - Indian (Asian/Asian British)AOTH - Any Other Asian Background (Asian/Asian British)APKN - Pakistani (Asian/Asian British)BAFR - African (Black/Black British)BCRB - Caribbean (Black/Black British)BOTH - Any Other Black Background (Black/Black British)CHNE - ChineseMOTH - Any Other Mixed Background (Mixed)MWAS - White & Asian (Mixed)MWBA - White & Black African (Mixed)MWBC - White & Black Caribbean (Mixed)OOTH - Any Other Ethnic GroupWBRI - White British (White)WIRI - White Irish (White)WIRT - Traveller of Irish Heritage (White)WOTH - Any Other White Background (White)REFU - RefusedNOBT - Information Not Yet ObtainedGender(Required)Please SelectMaleFemaleNon - BinaryTransgenderOtherPrefer not to sayUnknownSexuality(Required)Please SelectHeterosexual/StraightGay or LesbianBisexualPansexualOtherPrefer not to sayUnknownReligion(Required)Please SelectNo religionChristian (including Church of England, Catholic, Protestant and all other Christian denominations)BuddhistHinduJewishMuslimSikhOtherPrefer not to sayUnknownPlease specify ethnicity(Required)Please specify gender(Required)Please specify sexuality(Required)Please specify religion(Required)Disabilities (including Mental Health)(Required) Physical Sensory Mental health condition Learning disabilities No disabilities Unknown All clients should have an IDVA in addition to other support from agencies unless the client declines or contact is not possible. Has this client been referred to a specialist domestic abuse support service (Independent Domestic Violence Advocate IDVA service)?(Required) Yes No, an IDVA needs to be allocated No, Client declined IDVA support No, not able to contact client to offer IDVA support Not applicable - I am from the IDVA service that the client is open and being supported by Agencies referred to(Required) Reach Out Victim Support Aanchal Women's Aid Refuge Eastern European Service Other Please specify(Required)Does the client have access/recourse to public funds?(Required) Yes, the client can access public funds No, the client has no recourse to public funds Unknown Perpetrator details Relationship to victim(Required)Please selectPartnerEx-partnerMotherFatherSiblingAdult sonAdult daughterAdolescent sonAdolescent daughterOtherUnknownDo you know the perpetrator's details ?(Required) Yes No Perpetrators first name(Required)Perpetrators last name(Required)Perpetrators date of birth(Required)Is the perpetrator's address the same as the victim's address?(Required) Yes No Perpetrator's Address(Required) Street Address Address Line 2 City AberdeenshireAngus/ForfarshireArgyllshireAyrshireBanffshireBedfordshireBerkshireBerwickshireBlaenau GwentBridgendBuckinghamshireButeshireCaerphillyCaithnessCambridgeshireCardiffCarmarthenshireCeredigionCheshireClackmannanshireConwyCornwallCromartyshireCumberlandDenbighshireDerbyshireDevonDorsetDumfriesshireDunbartonshire/DumbartonshireDurhamEast Lothian/HaddingtonshireEssexFifeFlintshireGloucestershireGwyneddHampshireHerefordshireHertfordshireHuntingdonshireInverness-shireIsle of AngleseyKentKincardineshireKinross-shireKirkcudbrightshireLanarkshireLancashireLeicestershireLincolnshireLondonMerthyr TydfilMiddlesexMidlothian/EdinburghshireMonmouthshireMorayshireNairnshireNeath Port TalbotNewportNorfolkNorthamptonshireNorthumberlandNottinghamshireOrkneyOxfordshirePeeblesshirePembrokeshirePerthshirePowysRenfrewshireRhondda Cynon TaffRoss-shireRoxburghshireRutlandSelkirkshireShetlandShropshireSomersetStaffordshireStirlingshireSuffolkSurreySussexSutherlandSwanseaTorfaenVale of GlamorganWarwickshireWest Lothian/LinlithgowshireWestmorlandWigtownshireWiltshireWorcestershireWrexhamYorkshire County Postcode If 'Other' please specify(Required) Child(ren) details Are any children impacted (e.g. does the client or alleged perpetrator have any children under 18 years old, or are there are children living at the address of the client or alleged perpetrator)(Required) Yes No Unknown Please confirm you have made a referral to Children’s Social Care(Required) Yes No Please state reason for not making a children's social care referral(Required)Please provide details of children if any. Childs first name Childs last name Date of birth Relationship to victim Relationship to perpetrator Same address as the client? Address (if different to the victims) School (if known) Does the victim have parental responsibility? Actions Edit Delete There are no Entries. Add Child Maximum number of entries reached. Referral detailsPlease highlight for what reason you are referring this case to MARAC.(Required) Professional judgement Visible high risk (14 ticks or more on DASH RIC) Potential escalation (3 or more incidents reported to the Police in the past 12 months) MARAC repeat (further incident identified within twelve months from the date of the last referral) Reason for Referral(Required)Please provide a brief overview of client’s current situation and recent incidents that triggered the referral. Please highlight the current risk factors that need addressing. The risk must be current and not historical. You can include any relevant history with approximate dates where possible, but please keep this brief. What are the Victims Greatest Priorities/ What do you hope you get out of MARAC?(Required)e.g. Assist with Civil Remedies such as non- molestation orders/legal advice. General Support/Advice of options around keeping safe. HousingAre there any other factors to be considered for the victim?(Required) Yes No What are these factors?(Required) Mental Health Issues Learning/ Physical disability Substance Misuse Honor Based Violence (HBV) Female Genital Mutilation (FGM) Forced Marriage Other Please specify(Required)Are there any other factors to be considered for the perpetrator?(Required) Yes No What are these factors?(Required) Mental Health Issues Learning/Physical disability Substance Misuse Other Please specify(Required)Has the victim been heard at the Redbridge MARAC or another MARAC in the last 12 month?(Required) Yes No Unsure Which MARAC were they heard at and at what date?(Required) Notice! Cases referred to MARAC currently take up to 4 weeks to be heard at the next available meeting. If you believe a case should be prioritised and heard sooner, please clearly state your reasons on the MARAC referral form. If you believe an Emergency MARAC may be required (where a single-agency safeguarding response is insufficient and an urgent multi-agency response is necessary), please complete this referral form as usual and immediately contact the MARAC Coordinator on 0208 708 5082, explaining the reasons for urgency. Please note that Emergency MARACs are held at the discretion of the MARAC Chairs. Risk Assessment Please state which risk assessment you have completed with the client and ensure you add the responses to the form. If you have not completed a risk assessment please state the reason.Which risk assessment have you completed ?(Required) DASH RIC DARA (Police use only) Risk assessment not completed DASHRICPlease add entry by clicking "add responses" button. Entry must be added. 1. Has the current incident resulted in injury? 2. Are you very frightened? 3. What are you afraid of? Is it further injury or violence? 4. Do you feel isolated from family/friends? Actions Edit Delete There are no Entries. Add Responses Maximum number of entries reached. DARAPlease add entry by clicking "add responses" button. Entry must be added. How often does (...) make threats to harm you or things you care about such as people, pets or property ? Comment How often does (...) call you names humiliate or degrade you ? Comment Actions Edit Delete There are no Entries. Add Responses Maximum number of entries reached. State the reason for not completing.(Required)
