Making an ERF referral

The LSAB Exceptional Risk Forum can provide advice and recommendations in relation to circumstances where there is someone aged 18 or over, 

• who requires assistance with aspects of day to day living as a result of a physical or mental impairment or illness (including a mental health condition or substance misuse) and                                                                      
• who is experiencing an exceptional risk to themselves despite the best efforts of individual agencies and multi-agency approaches to mitigate those risks.

The Forum is not a replacement for good professional practice, multi-agency working, risk assessment and planning. There is an expectation that prior to making a referral to the Forum, that agencies will have explored the available options to respond to and mitigate the risks that the person experiences. It is only where these approaches have been tried and been unsuccessful in mitigating risk, that a referral to the Forum should be considered.

Before making a referral to the Exceptional Risk Forum please reflect on the following issues; and consider if there are further actions for yourself and partners to take first.

A. The person at risk 

• Do you know and understand the person’s views, wishes and desired outcomes? Does your approach take these into account?
• Is the person in need of representation of a friend, relative, or advocate to facilitate their involvement? 
• Have you provided for the person's communication and support needs to enable them to engage with support arrangements? 
• Have you recognised the person's personal and cultural background? Does your approach actively take these into consideration?

B. Are the right people and services involved?

• Are all key services engaged? 
• Is there an agreed lead person/agency to coordinate actions? 
• Where an agency is not involved, have you sought to escalate our concerns to gain involvement? 
• If there are differences of views, have you actively sought to resolve disagreements?
• Have you considered engaging with the person's relatives, do you have the consent of the person at risk, is it proportional to do so even without the person's consent?
• Have you considered involving an agency or service that has a role that enables them to befriend and get alongside the person, for example a community group or specialist service?

C. Is a multi-agency approach being followed?

• Has there been a multi-agency meeting about these concerns?
• Has there been a multi-agency risk assessment?
• Has a multi-agency plan for intervention been tried?
• Has there been a review of this multi-agency approach? Are there other approaches you can try?

D. Is the person declining support with essential services?

• Have you sought to build relationships? You may need to build relationships and trust before the person is gradually able to accept support. This can take time.
• Have you sought to understand and find the person behind the behaviours you are concerned about? Do you know why they decline support, and what is important to them?
• Have you tried to develop plans alongside the person, starting where they are and with what is important to them?
• Have you sought to be creative, addressing their particular needs, issues and concerns?
• Are you working with the person's strengths, at their pace?
• Have you considered if further interventions are proportionate to the risk, and in accordance with Article 8 of the Human Rights Act 1998 (Respect for Private and Family Life)?

E. Have legal options been considered?

• Is your practice in accordance with the Mental Capacity Act 2005; consider the principles. Is there evidence to indicate an assessment of Mental Capacity is required? Has this been undertaken?
• Has there been consideration of seeking legal advice? 
• Have legal powers of intervention been considered? 

F. Is there also a risk to others?

• If there is a risk to a child, have you informed Leeds City Council Children  Services of your concerns?
• If there is a risk to other adults, have you considered how to manage those risks? 

G. How would the Exceptional Risk Forum assist you?

• Have you considered specifically, why you are making a referral to the Exceptional Risk Forum? 
• What advice do you want from the forum that you do not currently have? What outcome(s) are you aiming to achieve for the person at risk

Agree with your partners/colleagues on the need to make an ERF referral. Then make an Exceptional Risk Forum referral using complete the attached form. This will need to be approved by a senior lead within your organisation. If your organisation is a member of the forum, you will need your forum member to approve the referral.

This plain text version can also be used

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