<p> LOGO</p><p>(Insert name of agency) Individual Management Review for</p><p>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</p><p>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.</p><p>Name of Child (ren) subject of SCR:</p><p>Date of Birth:</p><p>Date of Death:</p><p>Agency providing the report:</p><p>IMR Author:</p><p>Evaluation statement on behalf of agency:</p><p>. 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</p><p>Signed………………………………………………………Date………………..</p><p>Name……………………………………………………….</p><p>Role in agency……………………………………………………………………</p><p>IMR Author responsible for writing IMR report.</p><p>I have read this report and confirm that I have approved it as my agency’s IMR report to the Serious Case Review Panel.</p><p>Signed:………………………………………………………Date……………… </p><p>Name……………………………………………………………………………….</p><p>Title…………………………………………………………………………..</p><p>Agency……………………………………………………………………….</p><p>Page 2 of 6 Chief Officer/Chief Executive/Director responsible for signing off the IMR report.</p><p>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</p><p>Page 3 of 6 1 Introduction</p><p>1.1.1</p><p>2 Circumstances of Child’s Death</p><p>2.1.1</p><p>3 Individual Management Review Process</p><p>3.1 Terms of Reference (author should refer to Terms of Reference agreed by the Serious Case Review Panel.)</p><p>3.1.1</p><p>3.2 List of reviewers</p><p>3.2.1</p><p>3.3 Methodology</p><p>3.3.1</p><p>4 Family Circumstances</p><p>4.1 Genogram or full list of family composition</p><p>Page 4 of 6 4.2 List of significant others</p><p>4.3 Household composition (if different)</p><p>4.4 Current address of family and any significant others</p><p>5 Background to agency Involvement</p><p>5.1.1</p><p>6 Agency Involvement with family</p><p>6.1 Summary of decisions, services offered and actions taken</p><p>6.1.1</p><p>6.2 Case analysis</p><p>6.2.1</p><p>7 Lessons to be Learned</p><p>7.1 Organisational safeguarding</p><p>7.1.1</p><p>7.2 Good practice examples</p><p>7.2.1</p><p>7.3 Implications for practice</p><p>7.3.1</p><p>8 Conclusions</p><p>8.1.1</p><p>9 Recommendations</p><p>9.1.1</p><p>Page 5 of 6 10 Internal Agency Action Plan</p><p>RECOMMENDATIONS ACTIVITIES TIMESCALE RESOURCES LEAD PERFORMANCE</p><p>Page 6 of 6</p>