Risk Enablement Forum for complex or high risk cases

The Risk Enablement Forum (REF) provides a framework for Darlington Safeguarding Partnership partner agencies, working with people who have care and support needs, who have the mental capacity to make unwise choices and who are at risk of serious harm or death through self-neglect as a result of those choices.

The REF is collaboratively owned by participating agencies operating in Darlington. It will be administered on behalf of the participating agencies by Darlington Safeguarding Partnership and chaired by a nominated senior officer.

The REF will consider case presentations for situations which have already been considered within partner agencies risk assessment processes and/or the self-neglect multi-disciplinary meeting and significant risk remains. Reasons for referring to the Risk Enablement Forum may include:

• Lack of progress identified at the multi-disciplinary 6 weeks review meeting
• Public safety remains a concern
• Lack of partnership engagement
• Disagreement on deployment of resources

Partner agencies will remain responsible for delivering services to the people with whom they are in contact. This is not a means of handing over responsibility or closing down a case. To access the Risk Enablement Forum, complete and send by e mail the referral form, the risk assessment and plan as part of the referral to  DSP@darlington.gov.uk

Additional information on Terms of Reference and Referral Process for the Risk Enablement Forum (REF), including referral form, flowchart and guidance on meetings are outlined below.

Risk Enablement Forum (REF) Guidance and Terms of Reference

Introduction

This guidance has been developed to create a framework for decision making in complex high-risk cases where there is potential for real harm to the adult.  The Risk Enablement Forum (REF) will provide an opportunity for multi-agency partners to consider significant risks which remain unresolved.   

Purpose

The purpose of the Forum is to work in collaboration with a core group of multi-agency professionals and extended members to reduce/remove or manage the risk of harm to those vulnerable individuals who are identified as being complex and at high risk of harm.  

It is expected that interim measures will have already been considered by the referring team to minimise risk.  Referrals will only be made when other multi-agency processes have not been successful in reducing risk of harm and where a strategic approach to case oversight is required.

The forum will consider operational issues, share information/knowledge and experience to remove barriers to Safeguarding in order to promote the safety and wellbeing of those individuals identified to be at high risk of harm. Collectively develop individual risk management plans which will be monitored with the aim to improve their outcomes and remove system barriers. Information will be shared in accordance with Darlington Safeguarding Partnership Information Sharing Protocol.

In line with the Mental Capacity Act 2005 an individual who has the mental capacity to make a decision and chooses to live with a level of risk is entitled to do so. 

Criteria for Risk Enablement Forum Referrals

• An adult has eligible care and support needs and a significant risk has been identified.
• Any agency can present/refer a case to the Risk Enablement Forum where they identify a complex or challenging concern of risk for an individual which cannot be resolved.

• Prior to a referral being made to The Risk Enablement Forum, all conventional safeguarding methods/interventions (including multi-agency meetings) must have been held to look at the risks and how these risks can be minimised. Minutes of these meetings will be required and provided with the referral to the risk enablement forum.
• There must be an up-to-date assessment, care and support plan and risk plan, these need to identify the current situation and risks.   
• A Senior Manager from the agency making the referral should be made aware and in agreement with the referral being made.
• Legal advice should be sought where appropriate

REFERRAL PROCESS

When the above criteria are met the completed Risk Enablement Forum Referral Form [Word Document] and relevant documentation, including MDT minutes should be sent electronically DSP inbox dsp@darlington.gov.uk

Darlington Safeguarding Partnership needs as much information as possible to enable members to make a proportionate decision as to how to respond to the referral.

Darlington Safeguarding Partnership will acknowledge receipt of referral and notify Head of Service for Adult Social Care and/or Head of Practice and Quality within 1 working day (escalate to Assistant Director, Adult Social Care should both Heads of Service be away from the office).  The Head of Service and/or Head of Practice and Quality will arrange a meeting within 7-10 working days with Darlington Safeguarding Partnership Business Manager and Designated Nurse Safeguarding Adults, North East and North Cumbria Integrated Care Board.

At the meeting, documents will be reviewed, and a decision will be made whether or not the case meets the criteria for the Risk Enablement Forum.  For any cases which do not meet the criteria a rationale will be given.

The REF meetings will be scheduled monthly with the option to hold extraordinary meetings if necessary. 

Feedback will be made to the referring agency within 5 working days.

Managers Checklist (Stage 1) - Authorising Submission of Risk Enablement Forum Referral

• Have you checked the referral against the flowchart?
• Has safeguarding been considered?
• Has multi-agency work taken place?
• Have you checked your internal case management system to ensure all relevant single agency actions have been completed? e.g. frequent visits, case escalation within your agency.
• Have you challenged the referrer on any areas of concern?
• Have you checked if the individual is aware of the referral and if their wishes are evidenced in the referral?
• Is the purpose of the referral clear, with clarity about what your agency wishes to achieve by making this referral?
• Have you considered staff support required in the management of this case – think about vicarious trauma and the support mechanisms that you can put in place for the referrer.
• Have you considered other referrals that may be appropriate such as MARAC (Multi-Agency Risk Assessment Conference) and MAPPA (Multi-Agency Public Protection Arrangements).

The Risk Enablement Forum (REF) Meeting

If agreed, the criteria for Risk Enablement Forum has been met, a meeting will be scheduled and all relevant agencies will be invited.

The Forum will be chaired by a Head of Service, Adult Social Care. Others attending the meeting will include the caseworker and the Team Manager and other professionals involved in the case.

Membership - Core Attendees:

• Acute Health Trust
• Adult Social Care (Chair)
• Community Safety
• Domestic Abuse Lead / Domestic Abuse Commissioned Service
• Integrated Care Board / General Practitioner
• Local Authority Housing / Homeless Team
• Legal
• Police
• Fire and Rescue
• Probation
• Public Health
• Referrer / Referring Agency
• Substance Misuse
• Tees Esk & Wear Valleys NHS Foundation Trust

Additional agencies may be invited on case-by-case basis.

The attendance of the individual at the REF meeting will be decided on a case-by-case basis and following a discussion. If an individual is not invited to the meeting a clear rationale as to why this decision was made must be recorded.

Frequency of Meetings

The REF meetings will be scheduled monthly with the option to hold extraordinary meetings if necessary and will be coordinated by Darlington Borough Council Adult Social Care.   

Meeting process

The Risk Enablement representatives are expected to take a person centred and strength-based approach to cases discussed, considering risks and protective factors in each case.

The Risk Enablement representatives will be accountable and responsible for agreeing actions with clearly defined timescales and for nominating leads to undertake actions in a timely and proportionate manner.

The Risk Enablement representatives will be responsible for making balanced and informed decisions on individual cases for closure to the Risk Enablement safeguarding process. This will be done appropriately considering all views and a clear rationale documented when this arises (this will be based on a majority vote).

Following the Risk Enablement Forum

The DSP Business Unit will circulate meeting minutes and actions agreed within 5 working days of the Forum.

The Risk Enablement representatives will be responsible for recording the relevant information on the information systems that they operate and for sharing actions agreed with any operational practitioners who are involved with the case.

The Risk Enablement representatives will ensure their agency/organisation completes the designated actions within the required timescales agreed at the forum meeting.

Where the case is to return to the following Risk Enablement Forum, agency/organisation representatives are accountable and responsible for ensuring that feedback is provided to the meeting at least 5 working days prior to scheduled meeting.

Management of Ongoing Cases

The DSP Business Unit will ensure that cases remaining in the Risk Enablement Forum safeguarding process are scheduled for discussion at future meetings.