CHILDREN’S SERVICES Multi Agency Request for Services Form (MARF)
This form should be used to make a referral/request for services to Nottingham City Council Children’s Services for safeguarding or support services.(Where you believe there is immediate risk of significant harm please contact the Police.
For urgent safeguarding concerns please make the referral by telephone to 0115 8764800 and submit the MARF (within 24 hours)
Send the MARF to Nottingham City Council Children’s Services by secure email:
CONSENT AND CONFIDENTIALITY (NB when seeking consent please ensure that parents/carers understand that the information will be shared with services where considered appropriate to do so)
Is this a safeguarding referral? / Yes
DETAILS of the child/young person you are making the referal/request about
FAMILY NAME / Birch / FIRST NAME (S) / N/A
DOB / AGE/EDD / EDD 27/08.2016 / GENDER / N/A
ETHNICITY / N/A / RELIGION / N/A
FIRST LANGUAGE / N/A / INTERPRETER NEEDED / No
Disability / If you are aware that the child has a diagnosed disability, please provide detailsincluding any Education, Health and Care Plan (EHCP).
NHS No / N/A
ADDRESS / 49 Morley Street
Clifton
Nottingham
NG7 412
HOME TELEPHONE / 0115 879897 / MOBILE No. / Not Known
GP ADDRESS / Dr Smith
Aston Medical Centre
43 Ripply Street
Nottingham
NG1 1FX0115 976 542 / Health Visitor, School Nurse, Family Nurse Practitioner / N/A
NURSERY / SCHOOL / CHILDREN CENTRE / N/A
Has this referra/request been discussed with the parent/carer ? / Yes
Has the parent given consent to the referral/request being made? / No
What are the parents/carers views about your concerns and this referral/request? What is the family/individual hoping to achieve?
I have spoken with Claire Birch about this referal and about why I am worried about the safety of her unborn baby. Claire did not give consent to the referal as she does not agree that her unborn baby is at risk from domestic abuse from her partner Leon Carnell. I have not been able to talk with Leon Carnell as I have have only met him once and this was at an antenatal session and Claire was present. At the time I was worried about Claire’s presentation (she seemed withdrawn and would not maintain eye contact and appeared to look to Leon for reassurance when being asked questions). I was concerned that if I discussed the referral with Leon at this time it would put Claire and the baby at risk.
Has this referral/request been discussed with the child/young person? / N/A
What are the child/young person’s views about your concerns and this referral/request? What is the Child/Young Person hoping to achieve?
N/A
If the answer is ‘no’ to any of the above please state reason why. NB Requests for support services need parent consent.
Please see above
Is there any information contained in this referral/request that needs to remain confidential from the child or family? If yes please outline specific information to remain confidential and why.
NB DETAILS OF THE REFERRER, A PROFESSIONAL, CANNOT REMAIN CONFIDENTIAL UNLESS THERE ARE EXCEPTIONAL CIRCUMSTANCES.
Name of person completing referral/request / Maria Goldfinch
Relationship to child / Community Midwife
Date / 20.02.2016
Telephone number / 0115 976 542
Secure email
Address / Aston Medical Centre
43 Ripply Street
Nottingham
NG1 1FX
FAMILY COMPOSITION AND HOUSEHOLD MEMBERS
NAME / M/F / DOB / Relation to child / Ethnicity / Language
Claire Birch
49 Morley Street
Clifton
Nottingham
NG7 412 / F / 01.10.1984 / Mother / White British / English
Leon Carnell
49 Morley Street
Clifton
Nottingham
NG7 412 / M / 24.04 1980 / Father / White British / English
SIGNIFICANT OTHERS – NOT IN THE HOUSEHOLD.
NAME & Contact Details if known / M/F / DOB / Relation to child / Ethnicity / Language
Carole Birch / F / N/K / Maternal Grandmother / White British / English
Rebecca Birch / F / N/K / Maternal Aunt / White British / English
Have you initiated or completed a CAF/ Priority Families Assessment?
If yes please submit CAF/ Priority families Assessment with this form. / I have spoken to Claire about a CAF on a number of occasions but she has said no that this is not something that she wants or needs.
Name and contact details of Lead Worker: / N/A
Presenting issues in the family household at the time of this referral. This information will be used to pre-check eligibility for Priority Families.
Parents & children involved in crime or anti-social behaviour
Children have not been attending school regularly
Children who need help
Adults out of work or have serious debt issues Young people at risk of worklessness.
Domestic violence and abuse
Parents and children with health problems / Yes x No Not Known
Yes xNo Not Known
Yes No x Not Known
x Yes No Not Known
Yes No x Not Known
x Yes No Not Known
Yes No x Not Known
DETAILS OF THE REFERRAL/REQUEST—(Harm/Need Statement) What are you worried about?
Provide reasons for the referral; describe the (significant) harm that has already happened/ likely to happen to the child/unborn. Include how those responsible for the child were involved.
If this is a request for support services please state why additional support is needed.
Claire Birch has disclosed that she is pregnant. Claire is currently in a relationship with Leon Carnell, it is believed that this is a violent relationship. Leon has had previous Children’s Social Care involvement with his children from a past relationship.
During her appointment at the Health Centre today, Claire presented with a swollen lip and grazed face when asked how the injuries were sustained she reported that she had walked into a door. Claire smelt strongly of alcohol and when asked about this she denied that she had been drinking.
There is a concern that Claire Birch will remain in this violent relationship throughout her pregnancy. I have spoken with Claire regarding support from WAIS however she has said there is no point as she will be staying in a relationship with Leon Carnell. Claire says that she and Leon argue over stupid things and they end up shouting at each other but Leon has not hit her. I am worried that Claire does not appear to acknowledge or understand the impact her current relationship can have on her unborn child.
I am worried should the violence continue the unborn child will be at risk of harm. The evidence for this is based on conversations with Claire Birch who has presented at the Health Centre with injuries. Despite Claire saying her injuries were due to her walking into a door I am concerned that the injuries were a result of domestic incident between the couple.
Claire Birch has also told me that that Leon Carnell’s children from a previous relationship have had involvement with Children’s Social Care due to the domestic abuse within that relationship. Leon no longer has contact with these children. I am also concerned that Claire may be drinking alcohol as she smelt strongly of it today and at our last meeting, because of this and her history of alcohol misuse I am worried that her baby’s health and development may be affected by Claire’s alcohol use.
I have discussed WAIS with Claire but she has confirmed that she does not intend to end the relationship and would not consent to a referral being made. I have also talked to Claire about alcohol use and pregnancy, but Claire has denied that she is drinking and said she did not need to see the substance misuse midwife.
What do you know about this family, why are you involved?
I am the Community Midwife for Claire Birch I met her during her booking appointment on the June 5th 2015. Since my involvement I have observed a change in Claire’s presentation. When I first met Claire she was well presented, was chatty and engaging. However during a meeting last month which Leon Carnell also attended I observed that she was more withdrawn, smelt strongly of alcohol, would not maintain eye contact and appeared to look to Leon for reassurance when being asked questions.
Claire Birch has a history of involvement with Children’s Social Care Services, her previous child Donna Birch was removed from her care and adopted in 2009 at the age of 18 months. At the time Claire was in a violent relationship which she refused to end and was drinking heavily. It is believed that Claire was in care as a teenager due to family breakdown.
Leon Carnell is known to the Police in relation to the domestic abuse incidents which have involved past partners and Claire Birch. The Police report that they have been called to the house on a number of occasions and that alcohol is usually involved, and an argument ensues. At the last call out in March 2015 Leon had punched Claire in the face. Claire later retracted the statement that she made.
I am aware that Leon has children from a previous relationship and that they had Children’s Social Care involvement due to domestic violence therefore there may be concerns regarding his parenting.
Should Claire remain in this relationship I would have concerns regarding her ability to keep the baby safe.
What’s Working Well? - What contributes to the child’s general wellbeing?
Claire has attended all her antenatal appointments with the exception of one, but she called beforehand to tell me that she was not able to come and came to the next arranged appointment.
Claire is very excited about the baby’s birth and told me that she wants to keep this baby saying things will be different this time. Claire seems to take on advice given and has talked about all the things that she has bought for the baby. There are currently no concerns with the pregnancy Claire is in good health.
Claire has openly talked about Leon’s history and about her daughter being adopted.
In the past Claire has reported Leon Carnell to the Police when he has been violent towards her.
What’s Working Well? Existing Safety -Describe actions taken by parents/caring adults that are proven to help meet the child/young person’s needs or reduce the danger /risk when it occurs – give examples of how and when this happened.
I am not aware of anything that is currently protecting the unborn baby from domestic abuse, that whilst Claire has called the police in the past she later retracted her statement and I believe that Leon caused Claire’s recent injuries despite Claire’s denials. The baby will be experiencing these incidents and any stresses within the home which will impact of the baby’s wellbeing.
There are no safe levels of alcohol use in pregnancy therefore given Claire’s history and at the last two appointments she smelt strongly of alcohol which she denied, I do not feel able to say that the baby is safe from the potential harm alcohol can cause.
DANGER/WORRY STATEMENT: If things carry on without change, what are you worried will happen in the immediate future, medium and long term. Be specific and base your thinking on research and professional expertise.
Outline what you are worried the parent/carer may do or not do or will happen in the future and the possible impact of these actions on the child/ren. Which are the most significant for the child and describe the likely impact on their safety or well-being if there needs remain unmet?
I am worried because of the past history of domestic violence by Leon Carnell towards Claire and other partners I am concerned if Claire Birch stays in a relationship with Leon Carnell that he will be physically abusive towards Claire again and the baby could get physically hurt. I am worried that the domestic abuse could become more violent and happen more often and that Claire could suffer a miscarriage or the baby to be born early, be of low weight or even be born still born. I am also worried that that the unborn baby will hear what is happening and will become stressed and frightened in the womb.
I am worried about the safety and welfare of the baby when he or she is born. Leon might physically hurt Claire when the baby is there and that the baby could be physically hurt or be very frightened by this, become distressed, not be able to sleep of feed properly.
I am also worried Claire does not want to accept support that has been offered. I have concerns regarding Claire’s insight into the impact that domestic violence can have on her unborn child.
I am also worried that Claire may be drinking high levels of alcohol and because of her being in a violent relationship and her history of drinking heavily that her drinking will increase which may seriously affect the unborn baby’s health and development. This could result in miscarriage, stillbirth, premature birth, small birth weight, and Foetal Alcohol Spectrum Disorder (FASD). I am worried because research shows the more you drink the greater the risk to the baby’s health. A baby's liver is one of the last organs to develop and doesn't mature until the latter stages of pregnancy and therefore the baby finds it difficult to process alcohol. Drinking after three months of pregnancy carries risks of affecting your baby after they're born. The risks are greater the more you drink. The effects include learning difficulties and behavioural problems.
I am worried that if Claire keeps drinking that she won’t be able to look after the baby properly like feeding it, cuddling it and keeping it safe.
Having thought about what you’re worried about and what is working well, rate how worried you are about ______today and why ?
Where on a scale of 0-10. Where 10 means that everything that needs to happen for the child to be safe and well is happening and no extra professional involvement is needed 0 means things are so bad the child is no longer able to live at home.
Based on everything that you currently know please provide your safety/wellbeing scale along with the reason why to help us understand your level of worries about the situation.
Given the past and current worries that I have about previous Children’s Social Care involvement, domestic abuse, alcohol misuse and the potential impact on the unborn baby I am really worried about the unborn baby’s safety and wellbeing and would scale the current situation as a 2.
What needs to happen? SAFETY /WELLBEING GOALS. Describe precisely what outcomes you need to see to be satisfied that ______is safe and their needs are being. This must directly relate to the Danger/worry Statement.
What needs to change in order to make the situation safer and healthier for the child? What would indicate that progress is being made? What would you need to see to say this problem was really sorted?
I would need to see Claire Birch and Leon Carnell working with a network of family, friends, and professionals to show everyone that:
• Claire and Leon will find other ways of sorting out their problems that do not result in them drinking alcohol or shouting at each other, or Leon hitting Claire.
• Claire will reduce her drinking to less harmful levels.
• Claire and Leon are making sure the baby is getting the food, nourishment, cuddles and play she/he needs to stay at a healthy weight and to reach his/her developmental milestones.
• The baby is always cared for by an adult who is not under the influence of alcohol. If Leon and Claire are going to drink alcohol or be with people who are they will make sure the baby is cared for by a safe, sober adult.
ACTION. What do you expect to happen next? (be specific about support being requested and focus for any assessment and who you think should contribute to that assessment)
The information provided here and above will help determine the urgency and nature of any action required, particularly the need for statutory intervention. Please consider whether the child’s primary need is for protection and requires urgent statutory intervention.
I think there needs to be a multi pre- birth assessment to understand the risks posed to the unborn baby from Claire’s alcohol use and the domestic violence. This should include the circumstances of the adoption of Claire’s previous child and Children’s Social Care involvement with Leon Carnell’s children.
I think the substance misuse midwife should be involved and with Claire’s agreement her mother and sister.
Please detail any special needs or circumstances of any family member, which may affect this referral or communication and understanding between the family and professional agencies.
N/A
DETAILS OF OTHER AGENCIES INVOLVED WITH THE FAMILY/CHILD (REN): The form also allows for other agencies to be listed. Details of agencies involved allows for easier sharing of information and therefore more effective provision of service/support. Please list all agencies,
working with the family
Agency / Names / Address and tel. no. / Current involvement
ANY FURTHER RELEVANT INFORMATION
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