MARAC Risk Indicator & Referral Form

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

Victims/Survivors details

Name(Required)

First Last

Date of birth(Required)

Address(Required)

Find 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)

Email address only if safe to send email to victim's email address

GP Details

Perpetrator details

Do 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 County Postcode

Relationship to victim(Required)

If 'Other' please specify(Required)

Child(ren) details

Are any children impacted ?(Required)

Yes

No

Unknown

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

There are no Entries.

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

DASHRIC

Please 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?	5. Are you feeling depressed or having suicidal thoughts?	6. Have you separated or tried to separate from [name of abuser(s)] within the past year?	7. Is there conflict over child contact?	8. Does [name of abuser(s)] constantly text, call, contact, follow, stalk or harass you?	9. Are you pregnant or have you recently had a baby (within the last 18 months)?	10. Is the abuse happening more often?	11. Is the abuse getting worse?	12. Does [name of abuser(s)] try to control everything you do and/or are they excessively jealous?	13. Has [name of abuser(s)] ever used weapons or objects to hurt you?	14. Has [name of abuser(s)] ever threatened to kill you or someone else and you believed them?	15. Has [name of abuser(s)] ever attempted to strangle / choke / suffocate / drown you?	16. Does [name of abuser(s)] do or say things of a sexual nature that make you feel bad or that physically hurt you or someone else?	17. Is there any other person who has threatened you or who you are afraid of?	18. Do you know if [name of abuser(s)] has hurt anyone else?	19. Has [name of abuser(s)] ever mistreated an animal or the family pet?	20. Are there any financial issues?	21. .Has [name of abuser(s)] had problems in the past year with drugs (prescription or other), alcohol or mental health leading to problems in leading a normal life?	22. Has [name of abuser(s)] ever threatened or attempted suicide?	23. Has [name of abuser(s)] ever broken bail/an injunction and/or formal agreement for when they can see you and/or the children?	24. Do you know if [name of abuser(s)] has ever been in trouble with the police or has a criminal history?	Total 'yes' responses	Actions

There are no Entries.

DARA

Please 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	How often does (...) control your daily activites such as how you dress or how you perform your household tasks ?	Comment	How often does (…) deny you access to money or control what you can spend it on?	Comment	How often does (…) make you account for where you have been or monitor your phone, email or social media to check up on you?	Comment	How often does (…) follow or stalk you, or try to contact you when you do not want them to?	Comment	How often do you feel isolated or like you have no one to turn to for support?	Comment	How often does (…) use physical violence towards you such as pushing, slapping, punching or kicking?	Comment	How often does (…) strangle you or attempt to choke, suffocate, or drown you?	Comment	How often does (…) use or threaten to use weapons such as household items, knives or guns to hurt you?	Comment	How often does (…) threaten or attempt suicide?	Comment	Have you recently separated from (...) or do you plan to separate from them?	Comment	Has this/will this put you in danger?	Comment	Is the abuse you are experiencing from (…) getting worse?	Comment	Has (…) ever threatened to kill you and you believed they were capable of doing it?	Comment	Has (…) ever hurt the children?	Comment	Does (…) use child contact arrangements to control you or continue to abuse you?	Comment	Are you pregnant or have you recently had a baby?	Comment	On a scale of 0 to 10, where ‘0’ is not at all likely and ‘10’ is very likely, how likely do you think it is that (…) will seriously injure you in the future?	Actions

There are no Entries.

State the reason for not completing.(Required)

MARAC Risk Indicator & Referral Form

Overview

Victim Consent

Your details

Victims/Survivors details

Victim/Survivor Diversity data

Perpetrator details

Child(ren) details

Referral details

Risk Assessment