This Is a Guide: Professional Judgement Should Also Be Used
FAMILY SAFETY FRAMEWORK
RISK ASSESSMENT FORM
This is a Guide: Professional judgement should also be used
Appendix 1: FSF Risk Assessment Form
HIGH RISK FACTORS—someone is at risk of dying or suffering serious harm
(Total the number for each applicable risk factor)
Victim Perception / Past Month / Past 6 MonthsVictim believes the offender could kill victim/children / 10
Victim is terrified of the offender / 3
Victim is afraid of offender / 2
Child/ren is afraid of the offender / 2
Directed Violence to Family Member (Victim/Children) / total:
Offender has/attempted to strangle or choke victim on this occasion or in the past / 10
Offender has used sexual violence or coerced victim in to unwanted sexual practices / 5
Offender has assaulted victim or children in the past / 5
History of violence and the level/frequency of the violence has increased / 5
Offender assaulted victim/children during most recent incident / 5
Offender assaults the victim outside the home / 3
Threatened Violence to Family Member / total:
Offender has threatened to kill the victim/children in the most recent incident / 10
Children are present/witnessed/threatened during family violence incident / 5
Offender has access/possession of weapons/firearms / 5
Offender has used/threatened to use weapons/firearms / 5
Offender has threatened to harm the victim/children in past / 2
Directed Violence Towards Others / total:
Offender has history of violence against non-family members / 5
Controlling Behaviour / total:
Offender is increasingly or has socially isolated the victim/child from society/friends / 10
Offender is obsessed with/dependent upon/stalked the victim during this/past incident / 5
Offender has threatened or attempted suicide / 5
Offender has killed or harmed a family animal / 5
Offender has threatened to kill or harm a family animal / 3
Offender is jealous, bitter or hostile towards victim or children / 2
Other Vulnerability Factors / total:
There has been a recent separation and/or offender knows the victim is trying to leave the relationship / 10
Drug and/or alcohol misuse/dependency present / 5
Offender has easy access to victim and children or other family members / 5
Offender has recently been denied custody or access to his children / 5
Offender breached an Intervention Order during this incident or in past incidents / 3
There is a pregnancy/new birth in the relationship (child under 12 months) / 3
Child/ren are refusing to take access to the offender because they are afraid / 3
There is a child from another relationship within the home / 3
Offender has prior arrest for murder/manslaughter/rape or sexual assault / 3
Offender has demonstrated a sudden change in personality or behaviour / 3
Offender was abused as child in their ‘family of origin’ / 2
Offender is unemployed / 2
Offender/relationship is suffering financial problems / 2
Offender/Victim (please highlight) suffers depression or has other mental health
issues / 2
Offender is not taking prescribed medication / 2
Victim is more highly educated than the offender / 2
The relationship is affected by cultural issues / 2
The relationship is affected by disability issues / 2
total:
Total score of incidents in past month only :
FAMILY SAFETY FRAMEWORK
RISK ASSESSMENT FORM
This is a Guide: Professional judgement should also be used
IMMINENCY FOR THE REFERRAL AND SHARING OF INFORMATION TO A FSMDefining the Threat / TICK / REFERRAL
Likelihood
CURRENTLY OCCURRING / The serious threat to life or health is currently occurring and needs to be prevented or lessened immediately / FSM
ALMOST CERTAIN / The serious threat to life or health will occur if not prevented or lessened immediately / FSM
NOT LIKELY (standard or medium risk) / The serious threat to life or health is not likely and risk can be managed by agencies usual processes / Non FSM
Standard / 0 - 23
Medium / 24 - 44
High / 45 + / If you have ticked this box please consider the QUESTION OF IMMINENCY required for referring to a Family Safety Meeting
An assessment of STANDARD or MEDIUM risk DOES NOT negate your responsibility for positive action. You should address the victim/children’s needs as per your agencies mandate. Please keep this form in your records.
Please fill out the FSM Referral Form first giving consideration to the following examples of when to refer the matter:
The victim and children (if any) are safe for now but the victim is intending in the very near future to return to live or place themselves back into a high risk situation
The victim and children (if any) are not safe and the victim is still continuing to live with the offender
The victim is in a high risk category and the offender knows the victim’s whereabouts or is currently seeking to locate the victim and children (if any)
URGENT – CONFIDENTIAL
FSM REFERRAL FORM
ATTENTION:
OFFICER IN CHARGE OF FAMILY VIOLENCE INVESTIGATION SECTION
SAPOL Tel: Date:
Victim: Name and Date of Birth:Phone no:
Address of Victim:
Offender: Name and Date of Birth:
Address of Offender:
Children: Names and Dates of Birth:
Address of Children:
Risk Assessment Score:
*(Attach completed FSF Risk Assessment Form)
Reasons for Referral:
Background and Risk Issues:
Is the person referred aware of the FSM referral? Yes/No
Has consent been given for referral? If not, why not?
Referring worker and agency:
Contact Details: Telephone
Mobile:
Email:
Address:
DISCLAIMER: “The information contained in this email is confidential and may also be the subject of legal, professional privilege or public interest immunity. If you are not the intended recipient, any use, disclosure or copying of this document and or its attachments is unauthorised. Please advise us by reply and then delete it from your system.
FAMILY SAFETY MEETING
INFORMATION REQUEST FORM FOR NEW REFERRAL
STRICTLY PRIVATE AND CONFIDENTIAL
Your name:Tel:
Email:
1. Research all information, files and databases using NAME, DOB OR/AND ADDRESSES of ALL individuals concerned. Confirm basic contact information, ages of all concerned and number of children.
Perpetrator / Victim / Child / Child
Name
DOB
Address
Any other information, including extra Children: ______
2. Contact all relevant officers or support/key workers in your team and request current, accurate information and their professional opinion about the individuals concerned. Record this here.
3. Note records of last sightings, meetings or phone calls
4. Note recent attitude, behaviour and demeanour, including changes:
5. Highlight any relevant information that relates to any of the risk indicators on the completed Risk Assessment Form
6. Identify any other concerns your agency may have about the victim. Clarify any areas of discrepancy or inaccuracies of information on the agenda and or referral (e.g. information missing, more than one individual/alias names, conflicting information, more/less children than on agenda)
Domestic Violence is a crime that can include assault, sexual assault, harassment, injury and damage to property. It is a crime that our community takes very seriously. It is a policy of this agency to take positive action whenever possible in response to domestic violence.
What is a Family Safety Meeting?
A Family Safety Meeting is a multi agency response to high risk cases of domestic and family violence. These meetings are held regularly and bring together selected agencies who meet to address any issues in relation to the immediate safety of victims of domestic violence. It is important that you know that information shared at a Family Safety Meeting will be in confidence and will NOT be shared with the offender. This is done with your safety in mind. Also, information shared will only be in relation to issues of your risk and safety and that of children in your care.
Why are you being referred?
Your case is being referred to enable agencies to discuss the risks posed to your safety and to assist in increasing your safety and wellbeing. The referral may also assist your access to relevant support.
Who attends a Family Safety Meeting?
Professional workers from the following agencies regularly attend Family Safety Meetings:
South Australia Police
Victim Support Service
Correctional Services
Health Services
Families SA / Child Protection Services
Women’s Domestic Violence Services
School representatives
Mental Health Services
Drug and Alcohol Services
Housing SA
Do you have to attend the Family Safety Meeting?
No. You and your family are not expected to attend a Family Safety Meeting. The meeting is for workers only.
What can you expect out of the process?
With every case referred to a Family Safety Meeting, an Action Plan is developed at the meeting. This is a plan indicating what agencies can and will do to support you and your family around the risks to your safety. It may also involve actions from those agencies that are in contact with the perpetrator of violence towards you.
Where possible decisions that are made at the Family Safety Meeting will be reported back to you, if it is safe to do so, by the worker that you have initially had contact with.
Your rights
You may not want your case referred to a Family Safety Meeting. Some people are worried that this could make their situation worse. You can let the workers involved know if you do not agree to a referral. As part of our duty of care when life is at serious risk, our agency may still need to go ahead with a referral but we can indicate that you have not given your consent and state what concerns you have on the referral form.
Who can you talk to for further information?
If there are any issues and concerns you have about being involved in a Family Safety Meeting then you can talk to workers at this agency.