Common Monitoring Form
Multi- agency Guidelines for the Completion of the Domestic Violence Common Monitoring Form
The information on this form will be stored and retrieved by the Domestic Violence Co- ordinator. Please ensure that all staff read these guidelines before completing the Domestic Violence Common Monitoring Form.
Aim of exercise:
To standardise the collection of information on domestic violence for monitoring purposes.
Objectives:
General points to consider
Please be sensitive to the client's immediate needs in relation to domestic violence and give reassurance that the form will facilitate your ability to meet those needs.
Please stress the confidential nature of the form, and in order to enable clients to feel some control over this process please complete the form in the presence of the client where possible and respect the client's choice to leave questions blank. Please note that all sections of the form refer to the victim and not the perpetrator.
The form largely refers to adults regardless of whether or not a child is the agency's primary client. However there may be circumstances in which the form needs to be completed on an adult and a young person in the same family i.e. where mother and daughter are being abused. And thus should be recorded as a separate person.
Page One.
Total number assisted:
This is new cases, not including ones counted from the previous quarter as they have already been counted.
Reported Before:
In order to avoid duplication of the entire form it is important to ask this before continuing. Providing information regarding which agency was involved will minimise the tome spent tracking cases.
Page Two:
Ethnicity/ religion:
Please allow clients to self identify ethnic origin and religious background. If the category does not correspond to any of those on the form then use 'other'.
Age group of victim / number of children per household.
Please fill this section as accurately as possible by asking the client for all the details. Children are classed as such up to the age of 18.
Relationship with abuser:
Please ensure this section is filled in as accurately as possible
Disability/ Other needs:
It may not be possible to ascertain all the information in a first interview. Please complete as much as possible
Page Three:
Level of Violence/ risk and which of the following have applied?:
Please complete as far as possible.
This section is relevant to all incidents in the history of the current abusive relationship and not just the latest incident.
When completing the box on repeat incidents please apply the police definition of repeat victim i.e. more than one incident in the last twelve months. A victim may have been beaten on numerous other occasions prior to this but for the purposes of consistent data collection this definition must be adhered to.
Recourse to public funds:
Please identify yes or no
Forms to be sent to emma.gray@lbbd.gov.uk
Please contact me with any queries on 020 8 227 2809
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Contact
Emma Gray
Domestic Violence Co-ordinator
Community Protection Unit
Health and Consumer Services Division
London Borough of Barking and Dagenham
First Floor Roycraft House
15 Linton Road
Barking
Essex IG11 8HE
Tel: 020 8227 2809
Fax: 020 8227 5699
Mobile: 07971 111 681
Email: emma.gray@lbbd.gov.uk
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