CONFIDENTIAL
Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
This form should be completed every time domestic abuse is identified
Domestic Abuse Referral Pathway
If you identify domestic abuse during contact with an adult, child or family
Complete the Risk Indicator Check List (CAADA-DASH page 2 – 6). Always try and complete this with the victim and from the information you take from the victim/or already have
Address the immediate safety needs of the victim e.g. emergency accommodation or police involvement if required (see also Domestic Violence & Abuse Service Directory) Contact a MARAC champion for advice if needed (see page 10)
If there are 14 ticks or more on the Risk Indicator Checklist or you are aware of a previous incident of DVA or you believe there is a high risk of murder or serious injury to this victim?
For cases involving forced NB this relates to the likelihood of marriage, phone the Police a life-threatening or traumatic on 101 for advice or 999 in YES NO incident occurring imminently. an emergency, in addition to Use the domestic abuse Risk these guidelines Indicator Checklist and your professional judgement to help with this decision
Identify the needs of the victim and their family to find out what Complete the MARAC Referral Form (pg 7-9) additional support is required and refer to appropriate agency – and upload all 12 pages of this document to see pg 12 and/or Domestic Violence & Abuse Service Directory SharePoint. This will lead to an automatic www.theburydirectory.co.uk/domesticviolence or, contact a referral to an IDVA within 24 hrs. If you do not MARAC champion for advice (see pg 10). Always complete a have access to SharePoint, contact a MARAC Single Agency Support Doc (Pre CAF) when children and young Champion who will upload the document for people are involved. Supporting docs and information is avail you (see pg 10) at: www.bury.gov.uk/index.aspx?articleid=3370 or, contact CAF Consultants on 0161 253 5200 for advice
ALWAYS FOLLOW THE RELEVANT SAFEGUARDING CHILDREN AND ADULTS AT RISK POLICY GUIDELINES Referrals for adults (18 years and over) can be made to the Safeguarding Adults Team on 0161 253 5151. Referrals for children (including 16/17 year olds) can be made to the MASH Team via [email protected] 0161 253 5678 or the emergency out of hours duty team on 253 6606
RISK INDICATOR CHECKLIST (CAADA-DASH)
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
The risk information gathered from the following checklist will help you identify high risk cases of domestic abuse, stalking and ‘honour’-based violence. Use this information to help you decide which cases should be referred to MARAC and what other support may be required. A completed form becomes an active record that can be referred to in future.
Please explain that the purpose of asking these questions is for the safety and protection of the individual concerned. Always make sure that the victim can talk safely, and always ensure that interviews are conducted in the absence of the alleged perpetrator.
Please add comments where indicated. It is assumed that your main source of information is the victim. If this is not the case please provide details in the column on the far right-hand side.
The boxes will expand as you type text into them and there is space at the end of the form for additional information, where appropriate.
1. Visible High Risk: the number of ‘ticks’ on this checklist. If you have ticked 14 or more ‘yes’ boxes the case would normally meet the MARAC referral criteria.
2. Professional judgement: if a professional believes that a victim or their family is at significant risk of harm, they should refer the case to MARAC (see pages 7 – 9). There will be occasions where the particular context of a case gives rise to serious concerns even if the victim has been unable to disclose the information that might highlight their risk more clearly. This could reflect extreme levels of fear, cultural barriers to disclosure, immigration issues or language barriers particularly in cases of ‘honour’-based violence. This judgement would be based on the professional’s experience and/or the victim’s perception of their risk even if they do not meet the criteria in point 1 above. Professional judgement could also include cases where there hasn’t been a recent incident of domestic abuse, for example because the perpetrator has been in prison or out of the country, but where there is a serious threat to the victim.
3. Potential Escalation: the number of police callouts to the victim as a result of domestic violence in the past 12 months. This criterion 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 callouts in a 12 month period but this will need to be reviewed depending on your local volume and your level of police reporting.
This form is not a full risk assessment for children but it will provide valuable information about the risks that children are living with. The presence of children increases the wider risks of domestic violence and stepchildren are particularly at risk. If risk towards children is highlighted you should consider what referral you need to make to obtain a full assessment of the children’s situation.
SOURCE OF DON’T YES NO INFORMATION IF KNOW NOT VICTIM CURRENT SITUATION
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
SOURCE OF DON’T YES NO INFORMATION IF KNOW NOT VICTIM 1. Has the current incident resulted in injury? (Please state what and whether this is the first injury) Comment:
2. Are you very frightened? Comment:
3. What are you afraid of? Is it further injury or violence? (Please give an indication of what you think the abuser might do and to whom, including children).
KILL (specify self, children or other)
FURTHER INJURY AND VIOLENCE (specify self, children or other) Comment:
4. Do you feel isolated from family/friends i.e. does the abuser try to stop you from seeing friends/family/doctor or others? Comment:
5. Are you feeling depressed or having suicidal thoughts? Comment:
6. Have you separated or tried to separate from the abuser within the past year? Comment:
7. Is there conflict over child contact? (Please state the nature of the conflict) Comment:
8. Does the abuser constantly text, call, contact, follow, stalk or harass you? (Please expand to identify what and whether you believe that this is done deliberately to intimidate you? Consider the context and behaviour of what is being done. This question is relevant even if the parties are living together) Comment:
CHILDREN/DEPENDANTS 9. Are you pregnant or have you recently had a baby (within the last 18 months)? DOMESTIC VIOLENCE HISTORY 10. Is the abuse happening more often?
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
SOURCE OF DON’T YES NO INFORMATION IF KNOW NOT VICTIM Comment:
11. Is the abuse getting worse? Comment:
12. Does the abuser try to control everything you do and/or is he/she excessively jealous? Comment:
13. Has the abuser ever used weapons or objects to hurt you? Comment:
14. Has the abuser ever threatened to kill you or someone else and you believed them? Comment:
15. Has the abuser ever attempted to strangle/choke/suffocate/drown you? Comment:
16. Does the abuser do or say things of a sexual nature that make you feel bad or that physically hurt you or someone else? (Please specify who and what) Comment:
17. Is there any other person who has threatened you or of whom you are afraid? (Consider extended family if honour based violence and please specify who) Comment:
18. Do you know if the abuser has hurt anybody else? (Children, siblings, elderly relative, stranger, other partners – consider honour based violence and please specify who) Comment:
19. Has the abuser ever mistreated an animal or the family pet?
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
SOURCE OF DON’T YES NO INFORMATION IF KNOW NOT VICTIM Comment:
ABUSER 20. Are there any financial issues? For example, are you dependent on the abuser for money? Has the abuser recently lost his/her job? Are there any other financial issues? (Please specify what) Comment:
21. Has the abuser had problems in the past year with drugs (prescription or other), alcohol or mental health issues that has created problems in leading a normal life? Drugs Alcohol Mental Health Comment:
22. Has the abuser ever threatened or attempted suicide? Comment:
23. Has the abuser ever breached bail/an injunction and/or any agreement for when they can see you and/or the children? Please specify what: Bail Conditions Non molestation/civil order Child contact arrangements Forced Marriage Protection Order Other Comment:
24. Do you know if the abuser has ever been in trouble with the police or has a criminal history? (If yes, please specify) Comment:
PLEASE CALCULATE THE NUMBER OF “YES” RESPONSES and enter in the box to the right
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
For consideration by professional: Is there any other relevant information (from a victim or professional), which may increase risk levels? Consider victim’s situation in relation to vulnerability, disability, substance misuse, mental health issues, cultural/language barriers, ‘honour’-based systems and minimisation. Are they willing to engage with your service? Describe:
Consider abuser’s occupation/interests – could this give them unique access to weapons? e.g. ex-military, police, pest control etc Describe:
Is there anything else you would like to add to this? e.g. if the victim has refused to answer any questions Comment:
Officer name: Date:
AUTHORITY TO DISCLOSE:
I agree that this organisation may share the information I have provided in this assessment and referral form with other relevant services/organisations, for example adult and childcare services, health related services, housing services, police and probation services, in order to assist me. This organisation may also obtain information about me from other organisations to protect my vital interests.
I also agree that the information I have provided may be used by the organisation to aid monitoring and future decision making.
Signed by the customer: ……………………………………………………………………………………....
Dated: …………………………….
NAME AND ADDRESS OF CUSTOMER:
......
......
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
GREATER MANCHESTER MARAC REFERRAL FORM Only complete the fields below (page 7-9) if you are making a referral to MARAC - Use the Risk Indicator Checklist beginning on page 2 to guide your decision ALL INFORMATION ON THIS FORM SHOULD BE COMPLETED AS FULLY AS POSSIBLE Date of most recent Date of Referral DV incident Referring Agency
Contact Name(s) Please indicate the 14 ticks on RIC Escalation Repeat Victimisation Professional Judgement reason for referral If the reason for referral is professional judgement please outline the reason here Is this a repeat referral If Yes, date when (within the last 12 Yes No last at MARAC? months)? Victim Details
Name:
DOB: Gender: Sexual Ethnicity: Religion orientation Address (if this address is temporary please give details of victims last permanent address): Contact Number(s) Safe time to call:
GP details (if known): Relationship to perpetrator: Who is the victim afraid of? (please include all potential threats and not just primary perpetrator) Additional risk factors (e.g. vulnerable due to mental health/physical disability, old age, learning disability) Do you consider that there are grounds for Yes No Referral completed: Y/N If no please state reason: referring the victim to safeguarding?
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
Consent
If ‘no’, are there Has the victim’s grounds to share Yes No Yes No consent been obtained? information without consent? Nationality Immigration status: (e.g. asylum seeker, refugee, spousal visa with NRPF, ILR)
Alleged Perpetrator
Name and DOB:
Ethnicity:
Address: Alcohol or drugs Alcohol Drugs Details: involved? Any additional health or care needs? E.g. dementia, learning disability or mental health problems
Children
Relationship to Relationship to Children DOB Sex Address School victim perpetrator
GP details: Does the child/children ordinarily reside at the address? Did the child/children witness the incident? Injuries sustained? Give details Disabilities: Do you consider that there are grounds for Yes No Referral completed: Y/N If no please state reason: referring the child/children to safeguarding?
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
Additional information:
Other associated adults within the household (Please use the space below to tell us about other adults that live in the household who may be in need of specialist support by reason of mental or other disability, age or illness).
MARAC Administrators/Champions
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
Victim Support Ruth Wilson – [email protected] - 01204 374327
Housing Assessment Team Gail Sutcliffe - [email protected] 253 7164 Angela Murphy– [email protected] – 253 7713 Lorraine Blake – [email protected] – 253 5554
Six Town Housing Susan Hadcroft – [email protected] Jenny Dyson - [email protected] – 686 8096/8000
Pennine Foundation Trust - Safeguarding Petra Hayes-Bower - [email protected] – 0161 762 7338
Early Break Ray Jones - [email protected] – 0161 723 3880
One Recovery Bury Anita McWilliam - [email protected] 0161 253 7778
Probation Mark Newton – [email protected] -03000 477921
Children’s Social Worker Gill Price – [email protected] – 0161 253 5476
Adults Social Worker Denise Wilcock – [email protected] - 0161 253 5450
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
Glossary and Acronyms
Adult at risk - people over 18 who are, or may be in need of community care services by reason of mental health, age or illness, and who are – or may be unable to take care of themselves, or protect themselves against significant harm or exploitation.
Child at risk – children under 18 who are, or may be in need of community care services by reason of mental health, age or illness, and who are – or may be unable to take care of themselves, or protect themselves against significant harm or exploitation.
IDVA’s (Independent Domestic Violence Advisors). They are trained specialists who provide holistic support to the most at risk adults and families.
MARAC is a Multi Agency Risk Assessment Conference – the purpose of which is to share information about the adults and families most at risk of murder or serious harm due to domestic abuse, and work to minimise any risks posed.
Bury Safeguarding Adults Board – a multi-agency partnership created to ensure that all organisations providing or commissioning services for adults in Bury work in a co-ordinated way that promotes health and well being, safeguarding and the protection of adults from abuse in Bury.
Bury Safeguarding Children Board - a statutory organisation whose main objective is to co- ordinate and ensure the effectiveness of work that is done in safeguarding and promoting the welfare of children and young people under the age of 18 in Bury.
SARC - Sexual Assault Referral Centre based at St Mary’s Hospital. It provides a counseling and aftercare service to victims of rape or sexual assault, current or historic.
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Bury Partnership - Domestic Abuse Risk Assessment and Referral Form
Always address the immediate safety needs of the victim - dial 999 in an emergency or for more information go to www.endthefear.co.uk
Greater Manchester Police 101 or 999 in an emergency Independent Domestic Abuse Support for victims who are at high risk of serious 0161 856 2256 Advisors (IDVA) harm. Victim Support Provides practical and emotional support and advice 0161 200 1950 to all victims, families and witnesses of crime. Women’s Housing Action Group Support for men and women experiencing and or 01706 718 180 WHAG fleeing domestic abuse. Provides housing related support including help with budgeting, rent arrears, income maximisation Central Access Point and other housing issues (referral agency for 0161 253 5940 WHAG).
Help for families with multiple needs including SCIL 0161 253 6757 those experiencing or at risk of domestic abuse. Women’s Domestic Abuse Advice and support for women. Also in Urdu & 0161 636 7525 Helpline Punjabi. Mon to Fri 10 – 4, Tues until 7. Email: [email protected] Advice and support to any woman (age 16 and over) who is being abused, has been abused or is Free Phone - in fear of being forced into marriage. This includes National 24 hr DVA Helpline 0808 2000 247 partners, husband, ex-partners and family members, and women in same sex relationships.
Men’s Advice Line Helpline for male victims experiencing and or at 0808 801 0327 risk of domestic abuse - Mon to Fri 10 - 1 & 2 - 5 Respect Helpline for perpetrators of domestic abuse Mon to 0808 802 4040 Fri 10 - 1 & 2 - 5 Manchester Rape Crisis Advice and support for women and girls who have been sexually abused Mon to Fri 10 - 4, Weds & 0161 273 4500 Thurs 6 - 9 St. Mary’s Sexual Assault 24 hr advice, support & forensic service for people 0161 276 6515 Referral Centre who have experienced rape or sexual assault Forced Marriage Unit Helpline providing information about forced 020 7008 0151 marriage. Target hardening for victims and their families 0800 555815 where there is a threat of or potential for arson. Fire & Rescue Service (letterbox blanks, smoke alarms, escape plans etc). Bury Asians Women’s Centre Advice and support for vulnerable women from 0161 280 2270 BME communities. Jewish Women’s Aid Advice and support for Jewish women and their Free Helpline children who have experienced or are experiencing 0808 801 0500 domestic abuse. One Recovery Bury (support for Support for individuals and families to address 0161 253 6488 drug and alcohol misuse) substance misuse and dependency in Bury. Adullam Homes (Gateway) Accommodation for offenders leaving prison. 0161 764 7038 Early Break (Gateway) Support for offenders and their families. 0161 723 3880
Witness Care Unit Guidance and support for individuals through the 0161 856 3700 criminal justice process. Citizens Advice Bureau Independent advice including benefit advice, 0844 826 9320 housing and legal issues. Single point of access for all referrals into mental 0300 2003440 Bury Access and Crisis Team health services.
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