LOGO

(Insert name of agency) Individual Management Review for

CONFIDENTIAL This document is strictly confidential and should not be shared without the explicit consent of the author and/or permission of the Serious Case Review Panel

Page 1 of 6 Author Title Date This page must be completed by the IMR Author and Chief Officer/Chief Executive/Director of your agency, prior to submission to the Executive Serious Case Review Panel or Serious Case Review Panel.

Name of Child (ren) subject of SCR:

Date of Birth:

Date of Death:

Agency providing the report:

IMR Author:

Evaluation statement on behalf of agency:

. The IMR conforms to the LSCB IMR Report template . The IMR takes into account the specific Terms of Reference for the SCR . The IMR has been checked against Ofsted descriptors . The IMR is: o Comprehensive o Well-structured o Includes good analysis of the information o Provides explanations for any practice which may be of concern o Places emphasis on key findings and lessons o Has sound and SMART recommendations

Signed………………………………………………………Date………………..

Name……………………………………………………….

Role in agency……………………………………………………………………

IMR Author responsible for writing IMR report.

I have read this report and confirm that I have approved it as my agency’s IMR report to the Serious Case Review Panel.

Signed:………………………………………………………Date………………

Name……………………………………………………………………………….

Title…………………………………………………………………………..

Agency……………………………………………………………………….

Page 2 of 6 Chief Officer/Chief Executive/Director responsible for signing off the IMR report.

Contents Contents...... 2 1 Introduction...... 3 2 Circumstances of Child’s Death...... 3 3 Individual Management Review Process...... 3 3.1 Terms of Reference (author should refer to Terms of Reference agreed by the Serious Case Review Panel.)...... 3 3.2 List of reviewers...... 3 3.3 Methodology...... 3 4 Family Circumstances...... 3 4.1 Genogram or full list of family composition...... 3 4.2 List of significant others...... 4 4.3 Household composition (if different)...... 4 4.4 Current address of family and any significant others...... 4 5 Background to agency Involvement...... 4 6 Agency Involvement with family...... 4 6.1 Summary of decisions, services offered and actions taken...... 4 6.2 Case analysis...... 4 7 Lessons to be Learned...... 4 7.1 Organisational safeguarding...... 4 7.2 Good practice examples...... 4 7.3 Implications for practice...... 4 8 Conclusions...... 4 9 Recommendations...... 4 10 Internal Agency Action Plan...... 5

Page 3 of 6 1 Introduction

1.1.1

2 Circumstances of Child’s Death

2.1.1

3 Individual Management Review Process

3.1 Terms of Reference (author should refer to Terms of Reference agreed by the Serious Case Review Panel.)

3.1.1

3.2 List of reviewers

3.2.1

3.3 Methodology

3.3.1

4 Family Circumstances

4.1 Genogram or full list of family composition

Page 4 of 6 4.2 List of significant others

4.3 Household composition (if different)

4.4 Current address of family and any significant others

5 Background to agency Involvement

5.1.1

6 Agency Involvement with family

6.1 Summary of decisions, services offered and actions taken

6.1.1

6.2 Case analysis

6.2.1

7 Lessons to be Learned

7.1 Organisational safeguarding

7.1.1

7.2 Good practice examples

7.2.1

7.3 Implications for practice

7.3.1

8 Conclusions

8.1.1

9 Recommendations

9.1.1

Page 5 of 6 10 Internal Agency Action Plan

RECOMMENDATIONS ACTIVITIES TIMESCALE RESOURCES LEAD PERFORMANCE

Page 6 of 6