Presentation on theme: "AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES"— Presentation transcript:
1AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES North Ayrshire Council, East Ayrshire Council,South Ayrshire Council, NHS Ayrshire & ArranStrathclyde Police
2Objectives To explore the support and protection of adults at risk. To clarify operational duties and processes.To identify best practice and areas of development.Introduce Interim pan-Ayrshire & Arran ASP Procedures.To consider the range of legal options.Familiarise staff with procedure to be followed when it is suspected that harm has occurred.Identify the roles and responsibilities of the agencies involved.Explain and set out objectives for the sessionIntroduce and show group the Policy & Guidelines. That they should made available on request from managers and that they are on NHS Intranet
3Learning Outcomes: You Will Know …. Harm happens.What it is, where it happens and how it happens.What to do and how to progress concerns.The systems in place.Health Board, Local Authority and Strathclyde Police responsibilities, duties and powers.The legislative basis; ‘the toolbox’Borders enquiry; learnings to apply here.Ms A; Justice Denied.Refer to title and explain that by the end of the 1/2-day they will know the following outcomes.Briefly talk around each one
4Introduction – historical context Growing public awareness of abuse/media coverage of incidents and public enquiries.Increasing older population of potential adults at risk.Procedures introduced from 2000, updated 2008.National policy; Law Commission 1997, Borders Inquiry, SG consultation 2005, ASP Bill.AWI & MHA left gaps re ‘vulnerable adult’ and ‘adult at risk’.Adult Support and Protection (Scotland) Act 2007Refer to title, then explain that the following are fundamentally why we need a formal approach to awareness.Then reveal each point in turn and briefly talk around themHighlight that although abuse has always taken place :The first book published in UK “Old Age Abuse”, By Mervyn Eastman, 1984.No Secrets DOH 2000, England & WalesIn Safe Hands, Northern Ireland, 2000Scotland,Bill still progressing through Parliament
5Introduction - purpose Prevention – always the first priorityProcedures – the structureAction where harm has occurredPartnership across all sectorsAbuse; an actionHarm; the outcomeSelf explanatory
6Abuse; group exercise Definitions; what is abuse Examples; from professional experienceSigns; what to look forWho abuses; ??Context; where, when, howDiscuss in groups and feedback
7What is Abuse?An action.A violation of an individual’s human and civil rights by any other person.The wrongful application of power by someone in a dominant position.Includes aggressive, subtle and non-intentional acts, deficiency of care and treatment, exploitation, harm.Others …. ‘the martini approach’ ??Explain that it is difficult to get agreement on a definition due to differences such as culture, attitudes & individual standardsHowever, there are agreed principles of what constitutes abuse.
8Abuse: examples Physical Emotional/Psychological Deprivation of …. IsolationFinancial/MaterialSexualHuman RightsInstitutionalMalpracticeVerbalNeglectSelf NeglectRacial Abuse/DiscriminationRandom ViolenceDomestic AbuseAgeismInformation AbuseMedicationThis slide can be used to get the group involved.Refer to titleAsk group to to name the different types of abuseThe flip chart can be used to record their responsesReveal the bullet points in turn & discuss comparisons
9Some Signs Unusual or suspicious injuries. Unusual or unexplained behaviour.Allegations of abuse.Adult found alone in a situation of risk.Frequent/inappropriate contact with agencies.Interval between injury/illness and contact.Living with known perpetrator.Misuse of medication.Physical deterioration.Increases in confusion.Demonstration of fearof another person.Others.Refer to titleAsk group to to name some signsThe flip chart can be used to record their responsesReveal & discuss comparisons
10Abuser? ANYONE Staff member. Professional. Volunteer. Another person receiving the service.Spouse, relative, member of social network.Neighbour, member of public, stranger.A person who targets vulnerable people.Refer to title. Inform group that potentially any one can be an abuserAsk group for examples.The flip chart can be used to record their responsesReveal and compare
11Abuse: Context Own home. A carer’s home. Residential/nursing care. Work setting.Educational setting.Hospital.Social situations/public place.Hostel/temporary accommodation.Accommodation with support.Refer to title. Inform group that abuse can occur anytime,any place, any where.Ask group for examples.The flip chart can be used to record their responsesReveal and compare
12Borders Report; factsA woman with learning disability taken to hospital with multiple injuries from physical assault and sexual assault. Police investigation revealed a catalogue of abuse and assaults over previous weeks and longer. Three men were convicted of the assaults in 2002.Over many years events and statements were taken by social work, health services and Police that raised serious concerns.Others were receiving care under the same circumstances, with varying degree of learning disability, physical disabilities and mental health needs, which were largely neglected.They were neglected, lived in unsuitable and unsanitary conditions and were financially and sexually exploited.The next 3 slides are closely linked.They are about informing the group about the Border Report.Give out handouts to support the slides and the Borders Analysis.Reveal each slide in turn and talk around the point
13Borders Report; Some Findings Failure to investigate appropriately serious allegations of abuse.Acceptance of poor conditions in which the people lived.Lack of comprehensive needs assessments.Lack of risk assessments.Lack of information sharing and co-ordination.Disagreements between agencies at the front line.Un-sustained contact with the individuals concerned.Poor case recordings.Lack of care planning.Failure to consider statutory intervention.Lack of compliance with VA procedures.Poor supervision.Lack of senior management and leadership.Lack of clarity of role.
14Borders Report; Recommendations Review all cases of adults with learning disability to assess level of risk and quality of service.Review of LD services.Guidance of staff on complex cases.Vulnerable adult procedures.Comply with SSSC codes of practice.Improve training for MHOs.Acute discharge protocols.Develop better risk assessment methods.Improve case recording and review mechanisms.Introduce random case monitoring processes.Monitor the effectiveness of case transfer arrangements.Share information more effectively.
15Borders; learnings Is about people Key messages: Attitudes (they live this way!)Fragmentation of service response (who had the whole picture?)Identifying risk at key times.Communication and transfer of information.Audit/recording/monitoring.Resolving differing views (two tribes).Poor consideration of statutory powers.Reveal and compare with the feedback on flip chart
16Borders Report; A Check List Allocated worker with necessary skills and experience.All relevant information been gathered?Chronology of events and implications of these events understood?Comprehensive assessment, including risk?Care and protection plan?Statutory intervention considered?Individual seen on regular basis?Good communication and collaboration?Case been reviewed in accordance with procedure?Case been subject to oversight by line manager?NB this slide brings together the salient points regarding the Borders Report:Reveal & discuss in turn.Give hand out at the end
17Underpinning Principles Every adult has a right to be protected from all forms of abuse, neglect and exploitation that result in harmThe adult’s welfare takes primacySelf-determinationIf self-determination over-ridden, must be proportionate and be least disruptive responseASP, AWI & MHA all take into account;Privacy, dignity, safety, choice, respect, empowerment, equal consideration, preferences, participation, benefit, minimum interventionRefer to titleAsk which groups of people are most vulnerableThe flip chart can be used to record their responsesReveal & discuss comparisons
18Adults Have RightsAdults have the right to make their own decisions in relation to their safety, security and behaviours:And can only be overturned by lawCan the person understand the nature and consequences of the risks they may be subject toCan the person consent to any intervention that may be proposedDoes the person have the capacity to make informed decisions to accept or refuse assistanceRefer to title and inform group that as practioners/carers/professionals there are 2 basic rights to be considered in respect vulnerable adults.Reveal 1st point ask group for their opinion.Reveal rider to the above and discuss.Reveal 2nd point ask group their opinion.Reveal rider to the above and discuss
19Consider…. CONSENT CAPACITY RISK Consider; context, degree, frequency, outcome, effectRefer to title. Inform the group that with regard to the previous slide, the following are points to consider when dealing with someone who is suspected of being abused.Reveal and ask regarding personal experiences
20Dilemmas Intruding on someone’s liberty vs protecting this person. Acting vs not acting.Respecting the victim’s pride and fear of recrimination vs taking action.Dealing with tyranny vs respecting individual choice and control.Respecting vs intruding on confidentiality.Criminality vs confidentiality and fearRefer to title. Inform the group that “ it may not be abuse “ and with regards to the previous slides, the following are dilemmas that may not be uncommonReveal and ask regarding personal experiences
21Ms A – Justice Denied Mental Welfare Commission Report – April 2008 67 year old woman with a learning disability and in care of local authority since age 8Repeated sexual assaults by more than one man over a prolonged period of timeThe protective supports now in place amount to a severe restriction of libertyEmphasis on all that has gone before.. The responsibility to act, but in such a way that protects people, respects their rights, taking the initiative but consulting and involving others, engaging people and maintaining the working relationship…This reflects the previous slides and discussions… it’s important to re-emphasise the responsibility we ALL have…Final slide of session 1…..
22Ms ANo prosecutionPeople with a learning disability should have equal access to justice (UN Convention on Rights of People with a Disability)“... the responses of health, social care and criminal justice services combined to deny Ms A access to justice” (MWC report)Attitudes of professionals towards people with a learning disability affected their responses – different standards appliedAgain, round the table for a brief discussion.. .get some feedback, there will be debate.. Some might say, eg, that children always come first in preference to a vulnerable adult.. .reality is, any abusive situation must be dealt with.. .Adults have rights too,, to be protected, no less, no more, than any other person in society….Point 3; duty of care, inventive ways of working based around relationship skills….
23Ms A - findingsStaff in agencies were confused about their professional responsibilities in reporting a crimeKnowledge of relevant legislation and procedures lackingNo consensus on whether Ms A had the capacity to consent to sexual activityAssessment of her competence as a witness did not include people who knew her wellNo consideration on support and means of preparing Ms A to act as witnessPF left with little option than to abandon any actionSelf explanatoryGive out handout of slides
24Ms A; small group discussion Consider the facts and findings in the case of Ms AWhat changes would you bring into placeWhat recommendations would you makeCould this happen hereRefer to title and inform that frameworks are required because of certain fundamental principles ……Reveal each slide in turn.
25Ms A; selected recommendations APC to coordinate multi-agency training on capacity and consent to sexual activity and vulnerable witnessesAPC to ensure procedures include reference to vulnerable adult witness supportAPC to ensure procedures allow for appropriate sharing of informationClarify role of MHO in adult protection case conferencesRefer to title and inform that this legislation exists because of the previous agreed principlesReveal while explaining that these are possible measures which can be brought into force to protect the person. Ask group about their experiences.NB the first 2 examples are taken a bit further on the next 2 slides
26Ms ARefer to title and inform that this Act came into force October 2005Reveal and explain. Ask about personal experiencesNB inform the group that this is to increase awareness and the their manger can arrange specific training
27AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES North Ayrshire Council, East Ayrshire Council,South Ayrshire Council, NHS Ayrshire & ArranStrathclyde Police
28Inter-agency responsibilities Common responsibilitiesAll staff must be capable of recognising and acting on concerns for the safety of adults (and children)Are familiar with the inter-agency procedures to support and protect adults at riskCan take immediate action in an emergencyCooperation across partner agenciesSharing of information for the purposes of inquiries and protection planningBe alert to child protection concerns where a child is present where an adult is at risk of harmExplain that the following 2 slides are the 2 most commonly used Acts.Reveal and explainNB inform the group that this is to increase awareness and the their manger can arrange specific training
29WhistleblowingGuidelines, protection and reassurances to encourage disclosures of suspected or actual malpractice.Staff have the right to raise concerns and have them heard in an open and sensitive manner.Staff should be aware of procedures for whistleblowing, harassment policies, disciplinary procedures, complaints.Refer to title:- ask group their thoughts on whistleblowingReveal & talk around each pointNB everyone has a duty of care to report their concernsOur policy is a Zero Tolerance Policy
30Framework for Assessment and Intervention All partner agencies must ensure staff have an awareness of adult protection issues and a working knowledge of systems and practiceSocial work is lead agencyReferrals require full referral informationPrinciples appliedReferral to police if it is believed a criminal offence may have been committedRefer to full proceduresReveal title: explain that one law does not fit all cases.Reveal and ask which legislation could apply.Then as an example discuss the following:Different types of abuse require different powers of legislation: For example Domestic Abuse;Criminal LawCivil LawCommon LawMental Health ActNational Assistance ActDoes not matter which, if any , law is relevant, WE HAVE A DUTY TO REPORT AND RECORD
31Your Initial Practical Responsibilities You witness, suspect or receive information about abuse:Talk to victim seek consent to take action.Where person does not give consent for action, discuss with line manager.Emergency - contact appropriate emergency service.Consult with line manager/supervisor (if unavailable an alternative manager):To refer to local authority social work department.To refer to police where indications of a criminal offence (referral discussion to decide on appropriate action if victim does not wish to make complaint).Refer to to the title and point out that our response depends upon where we are in the organizationThis slide is about ensuring that the attendees are fully aware of their responsibilitiesReveal each point and inform them of their responsibilitiesNB. It is important to remind everyone of the importance of Confidentiality with the media
32Referral processRefer to the community care team for the area in which the adult livesEnquiry and Information TeamPrestwick, Kyle St, Riverside/Holmston, MayboleOr, if known to a specialist teamAdult mental health, elderly mental health, learning disability, physical disability, sensory impairmentYoung adults; disability, throughcareInitial inquiries; check with appropriate others, eg, NHSSSW/DepMan consider information and determine ASP or other action, eg, care managementSelf explanatory.32
33Referral process – young adults In addition to the referral routes listed previously, if a young adult of 16/17 is at risk of harmEstablish if an order under children’s legislation is in placeIf so, refer to the relevant C&F teamIf not or not known, refer to relevant community care teamInitial inquiries; check with appropriate others, eg, NHSSSW/DepMan consider information and determine ASP or other action, eg, care managementSelf explanatory.33
34Initial Actions SSW/DepMan decide on level of investigation and plan Consider; consent, capacity, risk, servicesSafeguard the adultProfessional judgement of recorded factsContext, degree, frequency, effect, outcomesExtent of harm, impact, a pattern, intent, legality, urgencyCouncil Officer investigative roleInvestigation visit within 24 hours – council officer along with other appropriate personCase conference within 10 working days.For information, as many people attending the briefings will be font-line staff who need to know what they must do immediately and what they must do next…. Ie report it up the line….But it’s always useful to know where the info goes, who will deal with it and the possible outcomes…Yes, it’s the good old local authority that has responsibility… again.
35Case conference Purpose to make decisions about support and protection Multi-agency; shared responsibilitiesConvened by SSW/DepManConsiders;risk management and protection plan (JIT docs)Inclusion of the adultLegal optionsSelf explanatory.
36Final pub quiz Describe definitions; Of an adult at risk of harm The 3 point testDefine the principlesWhat do we mean by ‘consent’, ‘capacity’ and ‘risk’Answer the ‘martini’ questionDescribe some of the ways an adult might be harmedWhat protection orders are availableWhat other laws are relevantWho are the partner agenciesWho can carry out inquiriesRefer to title. Inform that Bill is currently progressing through the Scottish Parliament, ….Reveal & talk around then points
37Good practice in ASP Don’t promise to keep secrets. Don’t place yourself at riskExplain what you are going to doProtect peopleAccept responsibilityWork in partnershipShare and record informationBe tenaciousRefer to title and explain that there are certain things we should not do…Reveal, talk around the slides & ask for comments from group.
38AYRSHIRE ADULT SUPPORT & PROTECTION PROCEDURES NHS Ayrshire & ArranNorth Ayrshire Council, East Ayrshire Council,South Ayrshire Council, Strathclyde Police