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:

Before completing this form for the first time we recommend that you read the full MARAC Referral Guidance and Frequently Asked Questions and Answers (opens in new window)

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

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)

Please visit the Information Commissioner's Office for more information on Vital interest (opens in new window) or Legitimate interest (opens in new window)

Lawful basis for sharing information(Required)

Vital interest

Legitimate interest

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 contact details

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.

Name of contact(Required)

First name Last name

Email(Required)

Telephone number(Required)

Victim/Survivors details

Name(Required)

First name Last name

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 address

Victim/Survivors contact details

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

Interpreter required?(Required)

Yes

No

Language

Victim/Survivors ethnicity

Ethnicity(Required)

Please specify ethnicity(Required)

Victim/Survivors gender(Required)

Please specify gender(Required)

Victim/Survivors sexuality(Required)

Straight or heterosexual

Gay or lesbian

Bisexual

Pansexual

Asexual

Queer

Other

Prefer not to say

Unknown

Please specify sexuality(Required)

Victim/Survivors disabilities (including Mental Health)(Required)

Physical

Sensory

Mental health condition

Learning disabilities

No disabilities

Unknown

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

Do you know the perpetrator's details ?(Required)

Yes

No

Perpetrator's first name(Required)

Perpetrator's last name(Required)

Perpetrator's date of birth(Required)

Perpetrator's address details

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

Child(ren) details

Are any children impacted?(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	Actions

There are no Entries.

Referral details

Please 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. Housing

Other factors about the victim to be considered

Are 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)

Other factors about the perpetrator to be considered

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)

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?	Actions

There are no Entries.

DARA

Please add entry by clicking "add responses" button. Entry must be added.

How often does the abuser(s) make threats to harm you or things you care about such as people, pets or property ?	Comment	How often does the abuser(s) call you names humiliate or degrade you ?	Comment	How often does the abuser(s) control your daily activites such as how you dress or how you perform your household tasks ?	Comment	Actions

There are no Entries.

State the reason for not completing.(Required)

MARAC Risk Indicator & Referral Form

Overview

Agency details

Your contact details

Victim/Survivors details

Victim/Survivors contact details

Victim/Survivors ethnicity

Specialist service/agency referral details

Perpetrator details

Perpetrator's address details

Child(ren) details

Referral details

Other factors about the victim to be considered

Other factors about the perpetrator to be considered

Risk Assessment