Multi Agency Public Protection Arrangements (MAPPA) Referral for Level 2/3 Management ALL referrals must demonstrate what the benefit of active multi-agency management would be Is the Offender already subject to MAPPA? Yes Category 1 Category 2 No Not Known IF YES: Please consult with the Police Risk Management Officer (Category 1) or Lead Agency - Probation, YOT, Mental Health, (Category 2) who is currently managing the offender to discuss the reason for the referral and state the name of the person consulted and the date. Lead Agency Name Date Comments following consultation 1. Offender Information Complete in all Cases Family name: First name: Alias: Date of birth: Ethnicity: Gender: Disability/diversity considerations: Crams number: ViSOR number: NHS number: Last known address: Current address, including prison, hospital etc Proposed release address Page 1 of 7
2. Reason for Referral Complete in all Cases Reason for referral: What inter-agency work has been undertaken so far? How will active multi-agency management add value to the management of the risk(s) of serious harm? Who is identified as being at risk? What is the nature of the risk? What is the likelihood of further offending of this type? Imminency of the risk? (please include any evidence to suggest the offender is taking active steps to make it happen) Any potential disclosure issues? Page 2 of 7
Any accommodation issues? 3 Risk Assessment complete if currently subject to MAPPA and the referral is being submitted by lead agency IF NOT go to Section 5 If Category 1 offender Offence and relevant sentence/caution date. Please provide details of offence(s) Risk Matrix 2000 Level (include date assessment completed) Comments: (include overall risk level managed at) If Category 2 offender specify Lead - Probation Mental Health YOT Offence and relevant sentence dates including any current Community Order/Resettlement details. Please provide details of offence(s) Risk Assessment Tool used OASys SARA ASSET OTHER (please specify) Please provide copy of risk assessment tool except OASys Assessed Level of Risk of Harm as determined by the Risk Assessment Page 3 of 7
4 Risk Management Case managed by the Police Has a risk management plan been completed? Yes/No Date of plan Level of home visiting: Summary of risk management plan: Risk Management Officer: Case Managed by Probation Has a risk management plan been completed? Yes/No Date of plan Summary of risk management plan: Offender Manager: Case Managed by YOT Has a risk management plan been completed? Yes/No Date of plan: Summary of risk management plan: Case Manager: Case managed by Mental Health Has a risk management plan been completed Yes/No Date of plan: Details of plan: Case Manager: Legal status: Inpatient/current hospital: Page 4 of 7
Next tribunal date: Next Care Plan Approach date: 5 Victim Concerns Outline any concerns about the victim of the index offence or potential victims: Has the victim taken up the Victim Liaison Service? If YES: Give contact details of VLO Are there any domestic abuse concerns? If YES, answer questions a to e below. a. What are they? b. Has the victim been referred to MARAC? c. Has a MARAC meeting been held/is a meeting due to be held? d. Date of MARAC meeting (if known) e. Actions from MARAC 6 Safeguarding Complete if relevant Child Protection Concerns (continue an additional sheet if required) Are there any child protection concerns? If YES, answer questions a to d below. a. What are they?. b. Has your agency submitted a child concern notification. c. Is there an allocated Social Worker? If so, please give details. Page 5 of 7
d. Is the child or children currently subject to a Child Protection Plan? Vulnerable Adult Concerns (continue on additional sheet if required) Are there any vulnerable adult concerns? IF YES, answer questions a to g below a. Has your agency submitted a vulnerable adult notification: b. c. Date of birth: d. Gender: e. Does this person live with the offender? f. Relationship to offender: g. Name of Social Worker (if relevant): 7 Additional MAPPA invitees Are there any agencies/named individuals that can contribute to the risk assessment/management that need to be invited to the meeting. Invitee 1 Invitee 2 Page 6 of 7
Invitee 3 Referring Agency Information Date sent to Line Manager: Are you completing this referral on behalf of another agency? Yes No If YES provide details of agency Endorsement by Line Manager Grade: Date signed by Line Manager: Line Manager s comments: Please send it via secure e-mail to ntawnt.mappa@nhs.net, for the attention of the Safeguarding MAPPA Practitioner Lead (NTW) Date sent: Page 7 of 7