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While considering, 'what's my role in safeguarding adults?', you may start to consider the roles of the wider safeguarding network, and where you can go to access advice and guidance when previous interventions have been unsuccessful or insufficient to manage risk. In these cases, the Multi-Agency Risk Management (MARM) subgroup may be able to assist you.
The Multi-Agency Risk Management (MARM) subgroup considers cases of adults who remain at high risk of harm despite previous intervention efforts. The purpose of the subgroup is to ensure that multi-agency communication and information sharing takes place on a regular basis, and to support professionals and their managers in managing the most challenging and concerning cases.
The MARM subgroup will consider and advise on individual cases where:
The MARM subgroup will:
Read on below for some thoughts from our MARM subgroup members, about their role in safeguarding and the impact of the MARM subgroup.
"I work for a district council and my role is to support staff with safeguarding concerns that they may have for children's or adult's safeguarding. In considering the services that the council offers, such as housing advice to prevent homelessness, or the processing of benefits, there are some departments that have a front line role working with members of the public.
Mental health decline and suicide disclosures are the highest category of concerns that staff report, but it does not always mean that it would meet the threshold for safeguarding criteria under the Care Act 2014. In my discussions with staff about concerns and risks that remain, despite best efforts to engage and reduce harm, the MARM process is always considered.
Since the MARM was established, we as a council have made regular referrals, many of which have been triaged and discussed as a case. This gives the professional an opportunity to get advice and eyes from other partner agencies, at a time when we may feel stuck with next steps, or how to engage and ultimately reduce the risk and harm."
"The MARM provides an important function for Adults’ Services practitioners in the management of risk and complex cases, for which all avenues up to that point have been explored and exhausted. The opportunity to discuss cases with relevant partners with different professional disciplines, and to explore their perspectives and ideas for improving outcomes for the person, is invaluable in developing risk management and enablement plans, as well as identifying new ways to deliver social care support.
In addition to the case specific support that is available, the MARM also acts to provide practitioners with feedback in relation to how the case has been managed to that point, and so can be developmental in terms of the opportunities and avenues for case management that are available. It also enables the forum for the creation and growth of multi-disciplinary partnerships that last beyond the meeting and which can be brought to bear in future cases."
"MARM has provided an opportunity for a Multi-Disciplinary Team (MDT) approach to working with some of the most complex cases, bringing statutory and voluntary agencies together, using a strength-based approach, and reducing the risk to vulnerable clients.
In bringing agencies together in this way on an equal playing field we erode any barriers between agencies and create positive relationships, learning from and influencing each other, and bringing additional resources to vulnerable adults in West Sussex.
Turning Tides are able to represent the voluntary sector and bring knowledge and learning to the MARM, particularly around working with complex cases where homelessness, substance misuse, complex needs, and self-neglect are a common feature in our work.
MARM has been able to bring about positive change in a number of high-risk cases, with much of the work taking place outside of the meetings, where agencies come together, pooling resources and skills, to make a real difference in vulnerable adults’ lives.
I am proud to be the co-chair of the MARM, and am proud of the work we do, creating an opportunity for growth and learning for myself and others. Most importantly, it has allowed me to influence the system and the way we work with complex cases, and helped in raising the profile of homelessness.
The culture of MARM is such that it supports and provides solutions for other professionals who present cases, which could be daunting if it was not managed so effectively."
"As part of our aim to eliminate fire deaths and injuries in the home, West Sussex Fire & Rescue Service (WSFRS) offers the Safe and Well Visit. Working closely with intelligence-led information from our multi-agency partners, we can target and assist those individuals most at risk within our communities. Safe and Well Visits are delivered with consent from the person, where we offer home fire safety advice combined with a health and wellbeing conversation. At every visit we will ensure the home has a working smoke detector and, where appropriate, we will look at carbon monoxide monitoring devices. If the customer meets our criteria, we can also offer further equipment such as deaf alarms, fire retardant bedding/blankets, and retardant spray.
Last year, WSFRS delivered a total of 5,484 Safe and Well Visits for people who were identified and consented to a visit. With complex cases of concern that are brought to MARM, the person may not be engaging or may not give consent for the Fire Service to make a visit, even when the risks are evident to the practitioner. Through MARM and other Team-Around-the-Person approaches, where there is no consent, we have been able to liaise on a joined-up approach to risk. In some cases, practitioners have been enabled to install smoke detection in the home, and for others the practitioner has been able to invite the Fire Service into the home at a time when the person is ready.
The MARM approach can make an alert where there is a concern by agencies for risk, and a property can be highlighted with the local fire station while under case management. In response, the local Fire Station may liaise with the practitioner to increase the Safe and Well Events and leaflets in the area to increase awareness and availability of the home fire safety offer."
"Sussex Partnership NHS Foundation Trust (SPFT) supports the West Sussex MARM and provides a representative at the meetings. The meetings are always focussed on the adult at risk, with cases presented by a key worker who knows them well and has made the request for a MARM discussion. The multi-agency forum enables each agency to share information about their involvement and commit to actions to move the situation forward and reduce the risk of harm.
The criteria for referral to the MARM is applied robustly, which means that other processes for resolving the situation will have been pursued first. This ensures that only those cases that require the MARM are considered. This is important as it prevents duplication of work and escalation of casework where it is not required, and makes best use of everyone's time. The MARM is managed and chaired efficiently by the local authority, which is appreciated by SPFT. The MARM provides a specific resource for reducing the risk of harm to people living at high risk of serious harm; it is a valuable resource for SPFT who work with people who can fit this profile."
If you are working with an adult with care and support needs, and feel that the MARM subgroup may be able to help you, please refer to the MARM referral documents.
Key documents:
