SAFECHAIN™ RESPONSE TO MARAC REVIEWS
High-Risk Visibility Failure™
Why High-Risk Victims Continue to Fall Through Systems Designed to Protect Them
External Evidence Response Series™ (EERS)
Version: 1.0
Author: Samantha Avril-Andreassen FRSA
Organisation: SAFECHAINN Ltd
Executive Summary
Multi-Agency Risk Assessment Conferences (MARACs) represent one of the most significant safeguarding interventions within domestic abuse response systems.
The purpose of MARAC is clear:
To identify high-risk victims of domestic abuse and coordinate multi-agency action to improve safety.
Police.
Health services.
Housing providers.
Children's services.
Domestic abuse specialists.
Probation.
Local authorities.
All come together around a shared objective:
Prevent Serious Harm.
The MARAC model reflects an important truth.
No single agency possesses a complete understanding of risk.
Risk becomes visible only when information is combined.
The challenge is that despite the existence of MARACs, Domestic Homicide Reviews, Safeguarding Adult Reviews and Serious Case Reviews continue to reveal recurring failures.
Victims known to multiple agencies continue to experience:
serious harm;
repeat victimisation;
homelessness;
economic abuse;
coercive control;
homicide.
This raises a critical question.
How can individuals be known to multiple agencies and still remain insufficiently protected?
SAFECHAIN™ identifies this challenge as:
High-Risk Visibility Failure™
A condition in which risk becomes visible across institutions but fails to generate sufficient continuity, accountability or intervention to prevent harm.
This paper argues that MARACs have significantly improved safeguarding coordination but that future progress requires infrastructure capable of maintaining visibility beyond individual meetings and institutional boundaries.
Part I
What MARAC Was Designed To Achieve
MARAC was established to address a fundamental safeguarding challenge.
Domestic abuse risk rarely sits within a single organisation.
Police may see incidents.
Health services may see injuries.
Housing providers may see instability.
Schools may see impacts on children.
Specialist services may see coercive control.
Each agency sees a fragment.
MARAC attempts to create:
Shared Visibility
Risk Coordination
Joint Decision-Making
Safety Planning
Accountability
The model remains one of the strongest examples of multi-agency safeguarding practice.
Part II
The High-Risk Visibility Paradox™
The existence of MARAC creates a paradox.
A victim may become recognised as high risk.
Multiple agencies may discuss the case.
Actions may be agreed.
Yet harm may still occur.
SAFECHAIN™ identifies this phenomenon as:
The High-Risk Visibility Paradox™
The condition whereby risk becomes visible without achieving sufficient continuity to prevent future harm.
Visibility alone does not guarantee protection.
Part III
High-Risk Visibility Failure™
The central SAFECHAIN™ concept emerging from MARAC analysis is:
High-Risk Visibility Failure™
This occurs when:
risk is known;
agencies are aware;
safeguarding concerns are documented;
yet systems remain unable to sustain coordinated protective action over time.
The challenge is not awareness.
The challenge is continuity.
Part IV
The Meeting Dependency Problem™
MARAC is fundamentally structured around meetings.
Meetings provide valuable coordination.
However meetings are events.
Risk is continuous.
SAFECHAIN™ identifies a recurring challenge.
The Meeting Dependency Problem™
The tendency for safeguarding visibility to peak during formal review processes and diminish afterwards.
Risk does not disappear when meetings end.
Yet institutional visibility frequently does.
Part V
Risk Fragmentation™
A recurring finding within reviews is that agencies often hold different components of risk.
Examples include:
Police
Incident history.
Health
Trauma indicators.
Housing
Safety concerns.
Social Care
Family vulnerability.
Specialist Services
Coercive control indicators.
The challenge is that risk remains distributed.
SAFECHAIN™ identifies this as:
Risk Fragmentation™
The separation of risk intelligence across multiple institutions without continuous integration.
Part VI
Why High-Risk Cases Remain Vulnerable
Several recurring challenges emerge.
Information Decay
Relevant information loses visibility over time.
Staff Turnover
Context leaves with individuals.
Referral Reliance
Actions depend upon successful handoffs.
Resource Pressures
High caseloads affect continuity.
Time-Limited Reviews
Risk continues after formal processes conclude.
The result is variability in protection.
Part VII
The Known-To-The-System Problem™
Many Domestic Homicide Reviews reveal a recurring phrase.
"Known to multiple agencies."
This phrase appears repeatedly.
SAFECHAIN™ identifies this as:
The Known-To-The-System Problem™
A condition in which institutional awareness exists but collective protection remains insufficient.
This concept directly connects:
EERS-018 Institutional Recognition Failure™
EERS-022 Safeguarding Without Interoperability™
EERS-023 High-Risk Visibility Failure™
Together they form a critical safeguarding architecture.
Part VIII
The SAFECHAIN™ Analysis
MARAC demonstrates that safeguarding systems already understand the importance of coordination.
The challenge is sustaining visibility.
SAFECHAIN™ argues that future safeguarding effectiveness depends upon:
Continuous Visibility
Verification
Accountability
Continuity
rather than episodic coordination alone.
Part IX
SAFECHAIN™ Infrastructure Response
National Vulnerability Verification Infrastructure™
Maintains vulnerability visibility across systems.
High-Risk Continuity Record™
Ensures risk indicators remain visible over time.
Safeguarding Continuity Architecture™
Supports cross-agency continuity.
Vulnerability Verification™
Provides structured recognition of risk.
Accountability Traceability Framework™
Tracks actions, responses and outcomes.
Risk Escalation Monitoring™
Identifies emerging deterioration.
Early Intervention Governance™
Supports proactive safeguarding.
Part X
New SAFECHAIN™ Architecture
This paper introduces:
High-Risk Visibility Failure™
High-Risk Visibility Paradox™
Meeting Dependency Problem™
Risk Fragmentation™
Known-To-The-System Problem™
High-Risk Continuity Record™
Risk Escalation Monitoring™
Continuous Safeguarding Visibility™
These concepts significantly strengthen SAFECHAIN™ safeguarding and vulnerability architecture.
Part XI
Policy Implications
The findings have implications for:
MARAC Partnerships
Police
NHS
Housing Providers
Local Authorities
Domestic Abuse Services
Safeguarding Partnerships
Government Departments
The challenge is no longer recognising high-risk victims.
The challenge is maintaining continuous protection.
The SAFECHAIN™ Position
MARAC remains one of the most important safeguarding innovations within domestic abuse response systems.
However coordination alone cannot guarantee safety.
SAFECHAIN™ argues that future safeguarding systems require:
continuity;
verification;
accountability;
visibility.
The objective is not replacing MARAC.
The objective is extending its effectiveness beyond individual meetings through continuity infrastructure.
Conclusion
The MARAC model demonstrates that multi-agency safeguarding can significantly improve risk recognition.
Yet serious harm continues to occur.
SAFECHAIN™ identifies this challenge as High-Risk Visibility Failure™.
The future of safeguarding therefore depends not simply upon identifying high-risk individuals but upon maintaining continuous visibility, accountability and coordinated action around them.
SAFECHAIN™ provides a framework for achieving that objective.
COPYRIGHT NOTICE
© 2026 Samantha Avril-Andreassen. All rights reserved.
SAFECHAINN Ltd (Company No. 12038453).
SAFECHAIN™, External Evidence Response Series™ (EERS™), SAFECHAIN™ Response to MARAC Reviews™, High-Risk Visibility Failure™, High-Risk Visibility Paradox™, Meeting Dependency Problem™, Risk Fragmentation™, Known-To-The-System Problem™, High-Risk Continuity Record™, Risk Escalation Monitoring™, Continuous Safeguarding Visibility™, National Vulnerability Verification Infrastructure™, Safeguarding Continuity Architecture™, Vulnerability Verification™, Accountability Traceability Framework™ and all associated methodologies, governance frameworks, implementation architectures, safeguarding systems, interoperability infrastructures and intellectual constructs are proprietary intellectual property authored and developed by Samantha Avril-Andreassen.
No reproduction, implementation, adaptation, deployment, AI training, commercialisation, derivative development or institutional adoption may occur without prior written permission from Samantha Avril-Andreassen and SAFECHAINN Ltd.
coordination around high-risk domestic abuse cases, yet serious harm continues to occur. This SAFECHAIN™ response examines why visibility does not always translate into protection and introduces High-Risk Visibility Failure™ as a critical safeguarding challenge.