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Safeguarding Adults P1 - Protection

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1 Safeguarding Adults P1 - Protection
Practitioner Level February 2015 ALL RESOURCES FROM TODAY CAN BE FOUND AT THE LINK – this is also on your inviting you to training welcome and introduction to course Welcome Practitioner safeguarding – follow on from alerter – also MCA course available – different expectations of you to alerters Ensure that between people sign in and state whether or not they have completed the pre-work For those arriving late they will be given the laminated ground rules card. The agreed cut off for arriving late and leaving early is 10% of the course which means that generally if people miss 35 mins or more they will not be able to stay / get a certificate. scwd/scwd-safeguarding-adults.htm

2 Mobile Phones / Devices
Housekeeping Fire Procedure Smoking Toilets Trainer to locate toilets and tell attendees where they are Familiarise yourself with the fire procedure and assembly point Smoking – ensure that you are familiar with the requirements of the venue and that the attendees are encouraged to adhere to them. E-cigarettes are to be smoked during breaks only Mobile Phones / Devices – Not to on unless an emergency / on-call. May need to labour the issue and remind people after lunch Breaks minutes am and pm. 45 minutes lunch. Please return promptly so that the day can stay on track Finishing time – including completion of evaluation forms etc Breaks Finishing Time Mobile Phones / Devices

3 Training Transfer Getting learning into practice
“50% of learning fails to transfer to the workplace” (Sak, 2002) “The ultimate test of effective training is whether it benefits service users” (Horwath and Morrison, 1999) Lots of research shows that learning fails to transfer to the workplace Lectures – only 10% stays So much going on in our lives We need this to transfer in safeguarding That’s why we recommend that people undertake the e-learning Three things have significant impact YOU and how you learn WORKPLACE and their commitment to learning and development TRAINING and how delivered

4 Ground Rules Safeguarding is a dynamic world and we continue to learn about how to prevent people from being harmed on both a strategic / organisational level and as individual practitioners. Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable. Respectful discussions about other disciplines / agencies – SA is not about a culture of blame. Easy to state that it’s the fault of X professional X organisation but all agencies and people take responsibility It is essential that we have an open mind regarding safeguarding REFLECTION

5 Ground Rules Confidentiality within the group will be respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will usually be discussed with you first. ground rules Confidentiality – individual comments are not passed on. SA issues will be highlighted – trainers responsibility to alert – will discuss with person. Recurring themes are passed on. Anything else anyone would like to add? Just ask the question. Also check for physical as well as emotional comfort at this time

6 Place and nature of work
Introductions Name Place and nature of work What do you want to know by the end of today’s session? 9.40 – introductions Name, Place and nature of work / role – try and establish specifically what their role in A is Pre-read - are there any areas that you are unsure of? Any questions? Anything you want to get out of today generally, questions, challenges and so on. Find one thing from each person to discuss / reflect back to them etc to start to develop a confidence in contributing to group discussions

7 At the end of the session you will:
be aware of the legal framework ask the ‘right’ questions and gather initial information in order to undertake an initial risk assessment take any required protective action to promote the safety and well being of the person take or make appropriate safeguarding referrals recognise when other agencies may need to be involved e.g. the Police, CQC, and refer to other sources of investigation where required (preservation of evidence) have reflected on your practice in safeguarding be clear about your role in the safeguarding process

8 Care Act Comes into force on the 1st April 2015
Revokes, repeals and cancels many laws and guidance including No Secrets Clarifies and consolidates good practice Not just about health or social care – promotes wider partnership working and responsibilities Promotes - Prevent, Reduce, Delay Many chapters relevant to SA Agenda Chapter 14 in resource bag Set context to changes All good practice is embedded in the Act so whilst some subtle changes it’s ‘business as usual’ in terms of how people are supported

9 14. Adult safeguarding This chapter covers:
13/04/2017 This chapter covers: •• Adult safeguarding – what it is and why it matters; •• Abuse and neglect: •• Understanding what they are and spotting the signs; •• Reporting and responding to abuse and neglect; •• Carers and adult safeguarding; •• Adult safeguarding procedures; •• Local authority’s role and multi-agency working; •• Criminal offences and adult safeguarding; •• Safeguarding enquiries; •• Safeguarding Adults Boards; •• Safeguarding Adults Reviews; •• Information sharing, confidentiality and record keeping; •• Roles, responsibilities and training in local authorities, the NHS and other agencies This chapter provides guidance on: Sections of the Care Act 2014 and Reinforce the fact that this in integral not stand alone PREVENT, REDUCE, DELAY

10 13/04/2017 Key Changes /points It changes the language of safeguarding adults – NOT Vulnerable The guidance repeatedly highlights the importance of person centred practice, the Mental Capacity Act and Advocacy in individual cases. It also emphasises strategies for prevention at both operational and inter agency strategic levels of working. Commitment to ‘Making Safeguarding Personal’ and Making Every Adult Matter Changing the language in turns changes approach language – less procedural This new guidance is now the main essential national source document for Safeguarding Adults and should be understood by anyone with a specialist or leadership role in Safeguarding Adults, in any organisation. The previous No Secrets guidance no longer applies as national standard guidance but it may still inform local safeguarding procedures where it supports compliance with the Care Act and its new guidance from Investigations and Safeguarding Adults processes to Safeguarding Adults Enquiries, and from Serious Case Reviews to Safeguarding Adults Reviews. Our current Policy Procedures and Guidance and our publicly accessible leaflets and web based information and training will need to be reviewed and updated to bring it fully in line with the new national terminology for Safeguarding Adults.

11 Key Changes /points Includes more detailed and explicit references to carers, including the risks that they can face and support they may need as well as the risks that they can present. Roles and responsibilities of partner organisations Serious case reviews become Serious Roles and responsibilities of SA Board members and Safeguarding Adults Boards

12 13/04/2017 Safeguarding Duties The safeguarding duties apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect. (14.2) and (14.6) No major change in good practice Duty to enquire, consider, advise, support if person as capacity Care Act 14.20

13 Safeguarding Duties Local authority statutory adult safeguarding duties apply equally to those adults with care and support needs regardless of whether those needs are being met, regardless of whether the adult lacks mental capacity or not, and regardless of setting, other than prisons and approved premises 14.9. Safeguarding is not a substitute for: •• providers’ responsibilities to provide safe and high quality care and support; •• commissioners regularly assuring themselves of the safety and effectiveness of commissioned services; •• the Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action; and •• the core duties of the police to prevent and detect crime and protect life and property Care Act 14.60

14 Make Enquiry Adult safeguarding means protecting a person’s right to live in safety, free from abuse and neglect. The Care Act requires that each local authority must: make enquiries, or ensure others do so, if it believes an adult is, or is at risk of, abuse or neglect (see paragraphs to 14.75). An enquiry should establish whether any action needs to be taken to stop prevent abuse or neglect, and if so, by whom; Carrying out enquiries Local authorities must make enquiries, or ensure others do so, if it reasonably suspects an adult who has care and support needs and is, or is at risk of, being abused or neglected and unable to protect themself against the abuse or neglect or risk of it because of those needs. An enquiry is the action taken or instigated by the local authority in response to a concern that abuse or neglect may be taking place. These duties apply in relation to any person who is aged 18 or over and at risk of abuse or neglect because of their needs for care and support. Where someone is over 18 but still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with as a matter of course by the adult safeguarding team. Where appropriate, they should involve the local authority’s’ children’s safeguarding colleagues as well as any relevant partners (e.g. police or NHS) or other persons relevant to the case. The level of needs is not relevant, and the adult does not need to have eligible needs for care and support, or be receiving any particular service from the local authority, in order for the safeguarding duties to apply. Mr A Care Act 14.10

15 Categories of abuse Physical abuse Domestic violence Sexual abuse
Psychological abuse Financial or material abuse Modern slavery – encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment. Domestic violence – including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence. Sexual abuse – including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting. Psychological abuse – including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks. Financial or material abuse – including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. Modern slavery – encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment. Care Act 14.17

16 Categories of abuse Discriminatory abuse
Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. Neglect and acts of omission Self-neglect – this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding Discriminatory abuse – including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion.182 Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation. Neglect and acts of omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating Self-neglect – this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding DCC HAS PLOICY BUT WIL BE REVIEWED. NOTE POWERS OF ACCESS Care Act 14.17

17 Patterns of abuse vary and include:
serial abusing in which the perpetrator seeks out and ‘grooms’ individuals. long-term abuse in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse; opportunistic abuse such as theft occurring because money or jewellery has been left lying around. serial abusing in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse; long-term abuse in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse; opportunistic abuse such as theft occurring because money or jewelry has been left lying around.

18 Six key principles underpin all adult safeguarding work
Empowerment “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.” Prevention “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.” Proportionality “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.” Protection “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.” Partnership “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.” Accountability “I understand the role of everyone involved in my life and so do they.” Empowerment – People being supported and encouraged to make their own decisions and informed consent. “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.” Prevention – It is better to take action before harm occurs. “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.” Proportionality – The least intrusive response appropriate to the risk presented. I am sure that the professionals will work for my best interests, as I see them and they will only get involved as much as needed.” Protection – Support and representation for those in greatest need. “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.” Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.” Accountability – Accountability and transparency in delivering safeguarding. “I understand the role of everyone involved in my life and so do they.”

19 Empowerment Prevention Proportionality Protection Partnership Accountability What outcomes should individuals experience from the safeguarding process? What can YOU do? Cards in folder for exercise Notes in file

20 Because you said something...
DVD in bag Notes on folder May have seen this before BUT we will use differently and it will be the basis for discussion throughout the session.

21 Small Group Discussion
In groups have a look at the following scenarios :- The man in the park The two brothers The couple in the conservatory What did you actually observe What’s the worst case scenario or possible least harmful scenario? What could / should / might be done (immediate short/long term)? Split group into three smaller groups and ask them to focus on one of the areas Initially you will only take information regarding the MAN IN THE PARK

22 Feedback – the man in the park
ask group one to feedback on the man in the park. What’s happening? What might be done? You are looking for them to recognise the discrimination aspects of the young peoples behaviour hate / mate crime dealing with the issue before it grows People in packs or groups behave differently – consider a hen night / stag night of ordinary people Could challenge Consider own safety Safety of others No expectation to challenge – personal choice Could speak to him School - NEED FOR EDUCATION Care direct Police 101 /999 roles and responsibilities Even if you can’t change anything for him you could change things for the next person

23 Hate Crime “Any criminal offence, which is perceived, by the victim or any other person, to be motivated by hostility or prejudice based on a person’s difference or perceived difference.” CPS Police also record incidents which are not crimes. FROM ACT Everyone is entitled to the protection of the law and access to justice. Behaviour which amounts to abuse and neglect, for example physical or sexual assault or rape, psychological abuse or hate crime, wilful neglect, unlawful imprisonment, theft and fraud and certain forms of discrimination also often constitute specific criminal offences under various pieces of legislation. Although the local authority has the lead role in making enquiries, where criminal activity is suspected, then the early involvement of the police is likely to have benefits in many cases. Act Discriminatory abuse – including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion.182 Case study Miss Y Page 253 IN FOLDER – from Care Act Hate crime may also be motivated by: Race, religion or belief, sexuality, transgender, age In greater Manchester – hate crimes are also recorded against groups from alternative subcultures following murder of goth sophie lancaster (Gender, pregnancy and maternity, civil partnership and marriage) Care Act 14.70

24 Disability Hate Crime Better understanding of disability hate crime
and of impact on victims Offender(s) often known to victim Likely to increase in severity or frequency EHRC / DoH / Home Office / Regional projects Neighbourhood harm register Enhanced sentencing Previously recognised race, religion, sexuality Now greater a understanding of disability hate crime and the impact on the victims - discuss Fiona / Francesca Pilkington and David Askew. Recognised as a potential and increasing risk – now on par with all other inequality (Equality Act) race, religion etc. Police more pro-active – recommendations from pilkington/askew SCRs / July 2013: Bijan Ebrahimi – suffering racist and disablist abuse from community. Told to collect photographic evidence. Community complained of pictures-> accused of being paedophile. Beaten to death and body set alight. James received min 18 years – known domestic abuser. Scope Report: 90% of LD have experienced incidents. xxxxxxx on daily or weekly basis – under reported as think its normal and supporters say ‘just ignore it’, ‘go a different route’ Figures backed up by mencap, autistic society, EHRC MIND/victim support study – people with severe mental health problems 3x more likely to be a victim of crime, 5x more likely to be victim of assault, women 10x more likely to be victim of assault; 7 x more likely to experience 3 or more crimes in a year; Those surveyed felt not treated fairly/taken seriously vulnerability screening on all calls = protected characteristics, victimisation, repeat crimes Neighbourhood harm register /– called to a premises more than 3 times in 3 months must be reviewed / consider and if apt investigated / referrals' DoH / Home Office projects – to educate / promote awareness Devon Hate crime strategy Devon hate crime strategy. South west coalition against LD hate crime A crime is a crime using the word abuse may on occasions reduce the impact / peoples views

25 “When someone befriends a vulnerable person in order to exploit them.”
Mate Crime “When someone befriends a vulnerable person in order to exploit them.” Why do people groom others? To Sexually abuse them (big prevalence LD/MH) To Financially abuse them e.g. mate crime, mail scams e.g. Lotteries/Clairvoyants, loan sharks, rogue traders, cuckooing Power/control – slavery, prostitution, drug trafficking, terrorism Forced marriage – asylum claims = mate crime Miss Y

26 Grooming Process Choose a vulnerable adult with whom they have (or can manipulate) a relationship of authority Develop a special relationship with the adult Get the victim’s support network to trust them or isolate the victim (threat, inducement, deception) Slowly introduce low level behaviour in order to desensitise or normalise Introduce the target behaviour mate crime/grooming Often specifically targetted - they may be lonely or isolated – LD/MH/Dementia Jimmy Saville enquiry – groom a whole nation – manipulate ISA report – warning signs DL – physical assault, stopping visitors, pressure to sign house over, pressure to go into care Inherent jurisdiction – undue influence, constraint – not free will.

27 Forced Marriage www.forcedtomarry.com
TK v. SY re asylum (forced marriage/lack capacity) SEE NOTES in folder Link with modern slavery

28 Radicalisation to Support or Commit Terrorism
Nicky Reilly attempted to detonate an improvised explosive device at a restaurant in Exeter in May Was radicalised through contact with people on the internet. Known to have mental health issues and learning difficulties. Building Partnerships, Staying Safe The health sector contribution to the Prevent strategy: guidance for healthcare organisations radicalisation – not just islamic extremists but also threats from far right, Ireland Possible other example of grooming. Changes in a persons behaviour may be a sign that they are being radicalised however there may be no obvious indications. Use your judgement to determine the significance of any signs. Raise concerns in accordance with Safeguarding Policies and Procedures - PREVENT agenda. Signs might include: changes in friendships, unusual actions or requests for assistance accessing extremist material on the internet use of extremist or hate terms to exclude others or incite violence writing or artwork promoting violent extremism LINKS with MAPPA and usual police systems BUT person can still be vulnerable Ways will be found to help individuals who may be at risk of being radicalised to support terrorism. E.g Bristol project: Prevent strategy 2011 The Prevent strategy has been re-focused following a review. The strategy now contains three objectives: to respond to the ideological challenge of terrorism and the threat from those who promote it; to prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support; and to work with sectors and institutions where there are risks of radicalisation that we need to address. It is guided by a number of key principles These include: Prevent will remain an integral part of the government’s counter-terrorism strategy, CONTEST Prevent will address all forms of terrorism, including the extreme right wing. However, it is clear that Prevent work must be targeted against those forms of terrorism that pose the greatest risk to our national security. Currently, the greatest threat comes from Al Qa’ida, its affiliates and like-minded groups Prevent will tackle non-violent extremism where it creates an environment conducive to terrorism and popularises ideas that are espoused by terrorist groups Prevent will make a clearer distinction between our counter-terrorist work and our integration strategy. Prevent depends on the success of that strategy. But the two cannot be confused or merged together. Failure to appreciate the distinction risks securitising integration and reducing the chances of our success Prevent must do much better in evaluating and monitoring progress against a common set of objectives. Money has been wasted. That must stop. public money will not be provided to extremist organisations who do not support the values of democracy, human rights, the rule of law and mutual respect and tolerance of different faith groups. Police found weapons and explosives at the home of Michael Piggin. He has Asperger syndrome and had been repeatedly bullied at school. He had become involved with a far right extremist group, the EDL.

29 Police involvement 101 OR 999 http://www.devon-cornwall.police.uk/
PCSO’s Police officers Neighbourhood beat managers Specialist officers – public protection unit various roles of police Vulnerability screening: Repeat offence; getting worse; impact; safety; harrassment; others affected; support available; equality/hate. Neighbourhood harm register – called to a premises more than 3 times in 3 months must be reviewed / consider and if apt investigated / referrals Use web site to find out who PCSO’s are Hate crime reporting online True Vision – mencap also have own line

30 13/04/2017 Making Every Adult Matter MEAM Project is also creating ways of improving multi agency assessment and support provided to people with complex needs and chaotic life styles at risk from self neglect and other types of harm. Self neglect FROM DCC Our current Policy Procedures and Guidance on Self Neglect already allow for multi-agency safeguarding processes to be used to help asses and manage risk in these cases. However this policy and our publicly accessible leaflets and web based information and training will need to be reviewed and updated to bring it fully in line with the new national guidance on enquiries into Self Neglect. MEAM Our vision is simple… That in every local area people experiencing multiple needs are: Supported by effective, coordinated services Empowered to tackle their problems, reach their full potential and contribute to their communities. Making Every Adult Matter (MEAM) is a coalition of four national charities – Clinks, DrugScope, Homeless Link and Mind – formed to influence policy and services for adults facing multiple needs and exclusions. Together the charities represent over 1600 frontline organisations working in the criminal justice, drug and drug treatment, homelessness and mental health sectors.

31 Scams www.thinkjessica.com www.stoploansharks.org.uk 1
Jessica received over 30,000 scam letters and sent off thousands of pounds. She was hounded by calls, including one from a clairvoyant who told her, when she could no longer pay his fees that there was an evil spirit lurking on a higher plain. She ended up in debt, stopped buying food so she could pay the scammers, having panic attacks and palpitations and was afraid of going upstairs. Her family believe these scams killed her. = financial abuse/mail scams; pressure to buy; trade descriptions loan sharks - criminal

32 Trading Standards May be able to help:
If you’ve been misled by the trader into buying something you wouldn’t have bought if you had been given all the information beforehand If the trader has made false claims about goods or services which you have found out not to be true If you’ve been sold fake or counterfeit goods If the trader has used aggressive selling techniques or persuaded you to buy something you wouldn't necessarily have bought if you had a free choice Trading standards Show newsletter Trading standards have strong enforcement and prosecution powers

33 Feedback – the two brothers
Ask group 2 to feedback on what they through was happening and what could be done The facts Simons view Capacity – fear? Situational capacity? Power imbalance Could be poor communication, interpersonal skills, lack of knowledge, unkindness. Could be cruel and considered abuse that has been happening for a long time Protective factors may be needed to be put in place Work with them on assertiveness skills Try and guide them to establishing protective factors Coercion could play a major part in this The family dynamics could also influence any outcome. It would be essential to focus on what Simon wanted. It may be that support would be the best way forward in this situation or that it could be criminal – care would need to be taken regarding any investigation Check if they had considered the previous few slides. Would they change their actions in line with this? In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised; and the case study below helps illustrate this. Two brothers with mild learning disabilities lived in their family home, where they had remained following the death of their parents some time previously. Large amounts of rubbish had accumulated both in the garden and inside the house, with cleanliness and self-neglect also an issue. They had been targeted by fraudsters, resulting in criminal investigation and conviction of those responsible, but the brothers had refused subsequent services from adult social care and their case had been closed. hey had, however, had a good relationship with their social worker, and as concerns about their health and wellbeing continued it was decided that the social worker would maintain contact, calling in every couple of weeks to see how they were, and offer any help needed, on their terms. After almost a year, through the gradual building of trust and understanding, the brothers asked to be considered for supported housing; with the social worker’s help they improved the state of their house enough to sell it, and moved to a living environment in which practical support could be provided. Miss P

34 Domestic Abuse Incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse... by someone who is or has been an intimate partner or family member regardless of gender or sexuality Includes: psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence; Female Genital Mutilation; forced marriage The Home Office 2013 May not define the couple in the conservatory as domestic abuse/may be situational? Wider definition than previously. Also includes ‘honour crime’ and FGM. MARAC for high risk cases = remember to make SA alert if vulnerable adult = SCR D IDVA service Adva for other cases STATS in folder re DV and people with disability In 2013, the Home Office announced changes to the definition of domestic abuse: •• Incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse... by someone who is or has been an intimate partner or family member regardless of gender or sexuality •• Includes: psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence; Female Genital Mutilation; forced marriage. •• Age range extended down to 16. Many people think that domestic abuse is about intimate partners, but it is clear that other family members are included and that much safeguarding work (that meets the criteria set out in paragraph 14.2) that occurs at home is, in fact is concerned with domestic abuse. This confirms that domestic abuse approaches and legislation can be considered safeguarding responses in appropriate cases.183

35 Devon Domestic Abuse Support Services
CAADA DASH Risk Identification Checklist and Risk Management Pathways in Devon - See more at: Devon’s Domestic Violence and Abuse Helpline: Adva has set up a new ‘one number’ domestic violence helpline for Devon. The aim is to keep it simple for victims to seek help – one number diverts straight through to Devon’s specialist domestic abuse services. It also makes it easier in awareness and publicity campaigns. Crucially, the helpline links the caller to Devon’s three specialist services: Domestic Violence and Abuse Service in South and West Devon; North Devon Against Domestic Abuse in North Devon and Torridge and Stop Abuse for Everyone in Exeter, East and Mid Devon. Please let all your colleagues know this number: The following, more commonly-occurring scenarios, will now be classified as domestic incidents: • An assault between siblings aged 16 and 17 years • A parental assault on a 16/17 year old child • A 16/17 year old child assault on a parent or other 16+ years family member

36 Feedback – the couple in the conservatory
Ask group two to feedback on what they through was happening and what they would do? Carer possibly very tired or has been previously abusive Assess Talk to both people Take to others involved Facts Capacity Any current support Request an assessment Comm care and carers Protective action may be requir4d to help carer understand how tired they are Work them on safe way forward Preventing things from getting worse would be important Do not pre-judge and assume that she is behaving in that manner because of her dementia consider all options If she lacks capacity then best interest would be important not just her husband’s view What if he’d hit her? What if she’d hit him? crime Leads on to the fact that raising a concern may not be an alert but even if not action can still be taken. If left it could be SA

37 Carers and Safeguarding
Carers are more likely to perpetrate abuse (intentional or not) if the carer: Has unmet or unrecognised needs Is themselves vulnerable Has unwillingly had to change his or her lifestyle or feels unappreciated or exploited Is being abused by the vulnerable person Has little insight or understanding of the person’s condition or needs Is feeling isolated, undervalued or stigmatised Has other responsibilities ADASS (July 2011) FROM ACT Carers and safeguarding Circumstances in which a carer (for example, a family member or friend) could be involved in a situation that may require a safeguarding response include: •• a carer may witness or speak up about abuse or neglect; •• a carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals and organisations they are in contact with; or, •• a carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others. Assessment of both the carer and the adult they care for must include consideration of both their wellbeing. Section 1 of the Care Act includes protection from abuse and neglect as part of the definition of wellbeing. As such, a needs or carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing it. If a carer speaks up about abuse or neglect, it is essential that they are listened to and that where appropriate a safeguarding enquiry is undertaken and other agencies are involved as appropriate.

38 Woman in the hospital & woman in the care home
What might be happening (best Case Scenario / worst scenario)? What could / might be done (short/long term)? whole group recap on role of practitioner = gather info/risk assess/protective action/consent?/alert Facts Capacity Fear may be stopping her from disclosing – Fear from the perpetrator, fear of retribution, fear of others views, that she wouldn’t be believed, that she has such low self esteem she thinks that this is just the norm. She has no ability to communicate what is happening. It might be that others can’t possibly believe that a colleague would ‘do something like that’ so don’t follow up any disclosures properly. Don’t jump to conclusions the nurse may have been doing something legitimate Protective – may mean removing nurse Criminal – call police – don’t interview the victim Should come back with Ask question – possible contact others Assessment of Risk Appropriate protective action Factors that may have influenced consent / capacity

39 Advocacy arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review where the adult has ‘substantial difficulty’ in being involved in the process and where there is no

40 New Statutory Advocacy
13/04/2017 The Act requires local authorities to involve people in assessments, care and support planning, and reviews. In order to facilitate the involvement and engagement of people who would otherwise have difficulty, it introduces a new requirement to arrange independent advocacy for people… A) who have substantial difficulty in being involved/ engaged in these processes and B) where there is no one available to help facilitate this involvement and engagement. Judging ‘substantial difficulty’ in being involvedBoth the Care Act and the Mental Capacity Act recognise the same 4 areas of difficulty (in any one of which a substantial difficulty might be found), and both require a person with these difficulties to be supported and represented, either by family or friends, or by an advocate in order to communicate their views, wishes and feelings. Four Areas of Difficulty As with MCA the assessors ability to communicate in a manner that works for the person is imperative ONUS ON METHODS, STYLES, PACE as with MCA Understanding relevant information Retaining information long enough to be able to weigh up options and make decisions Using or weighing the information as part of the process of engaging (A person must be able to weigh up information, in order to participate fully and be involved in the process) Communicating their views, wishes and feelings - Within this context, it is the person’s ability to communicate their views, wishes and feelings which is fundamental to their involvement rather than the diagnosis or specific condition

41 Substantial difficulty
13/04/2017 Substantial difficulty Where a person has substantial difficulty in engaging with the assessment process – Is there anyone appropriate who can support the person be fully involved? Maybe a carer (who is not professionally engaged or remunerated), a family member or friend. If there is no one appropriate, then the local authority must arrange for an independent advocate. An appropriate individual to facilitate the person’s involvement: First, it cannot be someone who is already providing the person with care or treatment in a professional capacity or on a paid basis (regardless of who employs or pays for them). That means it cannot be, for example, the person’s GP, nurse, key worker or care and support worker. Second the person’s wish not to be supported by that individual should be respected. Third, the appropriate individual is expected to support and represent the person and to facilitate their involvement in the processes. For instance a family member who lives at a distance and who only has occasional contact with the person, a spouse who also finds it difficult to understand the local authority processes, a friend who expresses strong opinions of her own prior to finding out those of the individual concerned, or a housebound parent are unlikely to be ideal. It is not sufficient to know the person well or to love them deeply; the role of the appropriate individual is to support the person’s active involvement with the local authority processes (see chapter 6). Advocates must have: •• a suitable level of appropriate experience: this may, for example, be in non-instructed advocacy or in working with those groups of people who may have substantial difficulty in engaging with assessments and care and support planning; •• appropriate training: this may, for example, initially be training in advocacy (non-instructed and instructed) or dementia, or working with people with learning disabilities. Once appointed, all independent advocates should be expected to work towards the National Qualification in Independent Advocacy (level 3) within a year of being appointed, and to achieve it in a reasonable amount of time; •• competency in the task: this will require the advocacy organisation assuring itself that the advocates who work for it are all competent and have regular training and assessments; •• integrity and good character: this might be assessed through: interview and selection processes; seeking and scrutinising references prior to employment and on-going DBS checks; •• the ability to work independently of the local authority or body carrying out assessments, planning or reviews on the local authority’s behalf: this would include the ability to make a judgement about what a person is communicating and what is in a person’s best interests, as opposed to in a local authority’s best interests, and to act accordingly to represent this; •• arrangements for regular supervision: this will require that the person meets regularly and sufficiently frequently with a person with a good understanding of independent advocacy who is able to guide their practice and develop their competence.

42 What is the purpose of making an alert?
To support the person to keep them safe now and in the future and to lead the life of their choice To share information about risk so that others can decide on the next actions that might be needed To collect national information / data making/taking an alert Data is used to show trends and to compare different local authorities – you can look at Devon’s performance in the annual report available on SAB website

43 Observation of/information received about poor practice or abuse
Practitioner’s Role Observation of/information received about poor practice or abuse Gather Information Take Action Assess risk Approx gather info/investigate - your role as a practitioner/not an alerter – this is different Responding in a regulated service 14.56

44 When should an enquiry take place?
Local authorities must make enquiries, or cause another agency to do so, whenever abuse or neglect are suspected in relation to an adult and the local authority thinks it necessary to enable it to decide what (if any) action is needed to help and protect the adult. The scope of that enquiry, who leads it and its nature, and how long it takes, will depend on the particular circumstances. It will usually start with asking the adult their view and wishes which will often determine what next steps to take. Everyone involved in an enquiry must focus on improving the adult’s well-being and work together to that shared aim. At this stage, the local authority also has a duty to consider whether the adult requires an independent advocate to represent and support the adult in the enquiry. The decision making tree at (see annex) highlights appropriate pauses for reflection, consideration and professional judgment and reflects the different routes and actions that might be taken. Objectives of an enquiry The objectives of an enquiry into abuse or neglect are to: •• establish facts; •• ascertain the adult’s views and wishes; •• assess the needs of the adult for protection, support and redress and how they might be met; •• protect from the abuse and neglect, in accordance with the wishes of the adult; •• make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect; and •• enable the adult to achieve resolution and recovery. The first priority should always be to ensure the safety and well-being of the adult. The adult should experience the safeguarding process as empowering and supportive. Practitioners should wherever practicable seek the consent of the adult before taking action. However, there may be circumstances when consent cannot be obtained because the adult lacks the capacity to give it, but it is in their best interests to undertake an enquiry. Whether or not the adult has capacity to give consent, action may need to be taken if others are or will be put at risk if nothing is done or where it is in the public interest to take action because a criminal offence has occurred. It is the responsibility of all staff and members of the public to act on any suspicion or evidence of abuse or neglect and to pass on their concerns to a responsible person or agency.

45 Asking the right questions
Open Closed Specific Probing Hypothetical Reflective Leading questions v. TED Need to be careful not to lead people. Tell me Explain Describe Generally we ask open questions – what, where, when, who, how, how often/how much/how many (why) We may need to ask specific questions to establish the ‘gist’ of what is happening - as professionals we do this on a day to day basis. If you suspect a criminal offence, you should not ask further questions. TED

46 Gaining Consent You should seek consent to share
Information unless doing so would: Place a child at increased risk of significant harm Place and adult at increased risk of serious harm Prejudice the prevention, detection or prosecution of a serious crime Lead to unjustified delay in making enquiries about significant harm or serious harm The first priority should always be to ensure the safety and well-being of the adult. The adult should experience the safeguarding process as empowering and supportive. Practitioners should wherever practicable seek the consent of the adult before taking action. However, there may be circumstances when consent cannot be obtained because the adult lacks the capacity to give it, but it is in their best interests to undertake an enquiry. Whether or not the adult has capacity to give consent, action may need to be taken if others are or will be put at risk if nothing is done or where it is in the public interest to take action because a criminal offence has occurred. It is the responsibility of all staff and members of the public to act on any suspicion or evidence of abuse or neglect and to pass on their concerns to a responsible person or agency.

47 Gaining Consent You can share information without consent:
In the best interest of a person lacking capacity (to understand the risks they face or capacity to understand the safeguarding process) In the public interest (You are trying to balance a person’s right to privacy with their right to life, right to be free from torture, inhuman and degrading treatment, right to liberty and right to autonomy.) consent to safeguarding process The public interest test implies that if the risk of harm is significant (right to life; freedom from torture, inhumane & degrading treatment; right to liberty; right to a private and family life), you can share without consent - the public would expect you to do this in the circumstances In small groups carry out the next two steps Decide what to do – is it Safeguarding? Consider significant harm and the potential for this if not addressed Gain consent – you may choose to act without consent in some situations – we will look in more detail at this. Encourage a discussion regarding the issues of balancing protection / rights/ capacity etc CONSENT AND CONFIDENTIALITY – refer to DCC Confidentiality and information sharing policy – have copies of them available.

48 Objectives of an enquiry
The objectives of an enquiry into abuse or neglect are to: •• establish facts; •• ascertain the adult’s views and wishes; •• assess the needs of the adult for protection, support and redress and how they might be met; •• protect from the abuse and neglect, in accordance with the wishes of the adult; •• make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect; and •• enable the adult to achieve resolution and recovery.

49 When should an enquiry take place?
Local authorities must make enquiries, or cause another agency to do so, whenever abuse or neglect are suspected in relation to an adult and the local authority thinks it necessary to enable it to decide what (if any) action is needed to help and protect the adult. The scope of that enquiry, who leads it and its nature, and how long it takes, will depend on the particular circumstances. It will usually start with asking the adult their view and wishes which will often determine what next steps to take. Everyone involved in an enquiry must focus on improving the adult’s well-being and work together to that shared aim. At this stage, the local authority also has a duty to consider whether the adult requires an independent advocate to represent and support the adult in the enquiry. The decision making tree at (see annex) highlights appropriate pauses for reflection, consideration and professional judgment and reflects the different routes and actions that might be taken.

50 Multi-agency Process Devon Care Direct on Torbay Single Point of Contact on or Plymouth Adult Protection Team on or Strategy meeting – you may be asked to attend – what would you need to bring? Investigation Case conference Review meeting anonymous referrals – possible but may not be able to act on information Out of area – dealt with by team where abuse happens In devon a request for support can be made to care direct. In Torbay a request for support, ie. MDT referral should be placed with the appropriate zone, ie. Torquay North & South / Paignton / Brixham.  Customer Services Centre (CSC) on and they will signpost/redirect or transfer the call to the correct team.

51 Process The Care Act becomes law on the 1st April 2015
Until advised otherwise by the safeguarding adults board all processes remain the same

52 Child Protection www.devon.gov.uk/childprotection
If you are concerned about a child or young person in Devon contact the MASH on or and give as much information as you can. 1 think family Increased risks where abuse takes place – people don’t necessarily differentiate between children/adults

53 Prevention is Better Than Cure
Keep the course in context. Whilst there are some very worrying situations occurring everyday there is also good practice. Remember to vigilant and deal with things at the earliest opportunity. Doing nothing isn’t an option. What will you do now? as a summary excerise If time ‘’What pro-active methods do we have available to us to ensure that the risk of abuse is reduced and that people aren’t placed at avoidable risk?’’. Also remind them that abuse can happen in all types of care environment but also so can good practice Large groups to flip chart fast and punchy positive end exercise Should come up with Good planning of care (covered later) Robust monitoring of care – Audit CQC / internal / care mgt etc Response to complaints / concerns / alerts Induction / training / ongoing Supervisions / appraisal / communication / team meetings Good shift patters / staff who are rested etc Strong value based leadership Sufficient focused resources etc etc etc LEAST restrictive options

54 Reference Sources www.devon.gov.uk
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366104/43380_ _Care_Act_Book.pdf

55 Final Questions? Questions, Evaluation forms Feedback, Finish


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