Domestic Abuse Advisory Hub Submission Form Step 1 of 2 50% NOTE: ALL INFORMATION RELATING TO THE FAMILY MUST BE ANONYMISED FOR THE PURPOSE OF DISCUSSION WITH EXTERNAL PROFESSIONALS. ANY SUBMISSIONS THAT CONTAIN PERSONAL IDENTIFIABLE INFORMATION WILL BE REJECTED.First Name* Surname* Email* Phone*Role* CSC Team* Team Manager invited and agreed to attend?*YesNoTeam Manager's Name* Team Manager's Email: (Please note that your Team Manager will be invited to the Hub and recommendations emailed to them after)* Child Protection Chair invited and agreed to attend?*YesNoChild Protection Chair's Name* Child Protection Chair's Email* LCS Number*I agree by attending the Domestic Abuse Advisory Hub that anything discussed will remain confidential unless we are worried about aspects of the case or that you, or someone close to, is at risk of harm. I also agree that all case information has been anonymised for the purpose of discussion with external professionals:Consent* I agree to the above Case Summary(please copy and paste from the LCS Case Summary Form but ensure that the information is anonymised)Child’s living arrangements and legal status*Date and reason for most recent involvement and outcome*What are we worried about?*What is working well?*Key difficulties and mitigating factors in family*Important historical information*What are you hoping to gain by presenting the case to the Domestic Abuse Advisory Hub?*Select Date*15th July - 10.30 - 11.3015th July - 11.30 - 12.3015th July - 1.30 - 2.3015th July - 2.30 - 3.3012th August - 10.30 - 11.3012th August - 1.30 - 2.3012th August - 2.30 - 3.302nd September 10.30 - 11.302nd September 11.30 - 12.302nd September 1.30 - 2.302nd September 2.30 - 3.3016th September - 10.30 - 11.3016th September - 11.30 - 12.3016th September - 1.30 - 2.3016th September - 2.30 - 3.3014th October - 10.30 - 11.3014th October - 11.30 - 12.3014th October - 1.30 - 2.3014th October - 2.30 - 3.3018th November - 10.30 - 11.3018th November - 11.30 - 12.3018th November - 1.30 - 2.3018th November - 2.30 - 3.3016th December - 10.30 - 11.3016th December - 11.30 - 12.3016th December - 1.30 - 2.3016th December - 2.30 - 3.30Disclaimer* I agree by attending the Domestic Abuse Advisory Hub that anything discussed will remain confidential unless we are worried about aspects of the case or that you, or someone close to, is at risk of harmCommentsThis field is for validation purposes and should be left unchanged.
