National Award in the Safeguarding of Vulnerable Adults AOFAQ Level 2 National Award in the Safeguarding of Vulnerable Adults

Student Introductions Course register Health & Safety HOUSEKEEPING Trainer Introduction Student Introductions Course register Health & Safety Assessment process and format Student manuals Toilets Tea/coffee Time keeping Meals Mutual respect Smoking Mobile phones Breaks Special Requests

AIM The aim of the course is to provide you with the underpinning knowledge to support you and your organisation in your responsibilities to protect vulnerable adults in the health and social care setting.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: Describe the term “safeguarding” State who is vulnerable from abuse State reasons where abuse could happen Define the term “dignity” State the role of the Disclosure and Barring Service

FOR YOUR INFORMATION All images contained in this presentation have been undertaken by trained actors and actresses. Due to the sensitivity of this subject, if you feel upset at any point, please feel free to leave the room

Introduction to abuse in health and social care Session 1 Introduction to abuse in health and social care

AIM The aim of the course is to provide you with the underpinning knowledge to support you and your organisation in your responsibilities to protect vulnerable adults in the health and social care setting.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: Describe the term “safeguarding” State who is vulnerable from abuse State reasons where abuse could happen Define the term “dignity” State the role of the Disclosure and Barring Service

Abuse may be a single or repeated event Abuse destroys lives 1.1 INTRODUCTION TO ABUSE Abuse is real Between April 2010 and March 2011, there were 96,000 reported cases of alleged abuse in England (source: BBC) Abuse may be a single or repeated event Abuse destroys lives Abuse is illegal

1.1 INTRODUCTION TO ABUSE

1.1 WHAT IS A ‘VULNERABLE ADULT’? ‘No Secrets’ (DOH, 2000) describes them as any person aged 18 years & over who: “..is or may be in need of community care services by reason of mental or other disability, age or illness; and who is unable to take care of himself or herself, or unable to protect him or herself against significant harm or exploitation”.

There is no definitive term for safeguarding 1.1 WHAT IS SAFEGUARDING? There is no definitive term for safeguarding It is generally considered as an overarching term which comprises of prevention, response to concerns and allegations and disclosures of abuse Some organisations refer to safeguarding as “adult protection”

People are more vulnerable if: 1.1 WHO ARE VULNERABLE? People are more vulnerable if: They are isolated from friends and family Do not have much contact with neighbours They have memory problems They have difficulty in communicating with others They do not get on with their carer They are addicted to alcohol and/or drugs They have a disability They are frail They have a mental health condition

In a residential or nursing home In a hospital In the workplace 1.1 WHERE CAN ABUSE HAPPEN? In a person’s own home In a residential or nursing home In a hospital In the workplace At a day centre or educational establishment In supported housing In the street It can happen in any place and at any time

A paid carer in a residential home or from a home care service 1.1 WHO MAY BE THE ABUSER? The person responsible for the abuse is often well known to the person being abused, and could be: A paid carer in a residential home or from a home care service A social care worker, health worker, nurse, doctor or therapist A relative, friend, or neighbour Another resident or person in a shared care setting Someone providing a support service A person employed directly by someone in their own home as a carer or a personal assistant Deceptive people who try to ‘befriend’ or impersonate a utility provider or respectable business

1.1 DIGNITY IN SAFEGUARDING If someone's dignity is not respected and poor care is given (weather purposely or not intentionally), it could result in a person being abused or neglected Dignity in care is essential and this must be preserved at all times You must ensure that:

1.1 DIGNITY IN SAFEGUARDING There is a zero tolerance approach towards abuse Do not stereotype or label any person Respect a persons privacy Treat people as an individual Treat people with respect Involve people in decisions which effect them Take the time to communicate Don't use any jargon

1.2 DEFINITION OF ABUSE Abuse is defined as: “Abuse is a violation of an individual’s human and civil rights by any other person or persons.” (No Secrets 2000)

1.2 DEFINITION OF SIGNIFICANT HARM/HARM There is no definition of “harm” in law which relates to adults. No Secrets (2000) states that it is: “Harm should be taken to include not only ill treatment (including sexual, and other forms of ill treatment that are not physical), but also the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioural development”

1.2 DEFINITION OF SIGNIFICANT HARM/HARM Section 120 of the Adoption and Children Act 2002 provides a definition for ‘harm’ as: “including for example, impairment suffered from seeing or hearing the ill-treatment of another”

1.3 SITUATIONS WHEN VULNERABLE ADULTS MAY BE ABUSED AT HOME Carers have had to change their lifestyle to suit the needs of the client unwillingly The client has communication issues The client has mental health issues No support is available from family or other carers Carers have alcohol and/or drug problems Carers have no privacy The client is often difficult or inconsiderate to the support provided by the carer

1.3 SITUATIONS WHEN ABUSE COULD HAPPEN IN A CARE SETTING Staff are poorly trained or untrained Staff work in isolations situations There is inadequate numbers of staff to cope with demands and pressures from service users There is little or no management/supervision

The checks available include 1.4 THE ROLE OF THE DISCLOSURE AND BARRING SERVICE On 1 December 2012 the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA) merged to become the Disclosure and Barring Service (DBS). The role is to help employers with recruitment by preventing unsuitable people from working with vulnerable children and adults. Criminal records and barring records are checked and passed on to the employer. The checks available include

There are three types of DBS checks: Standard disclosure 1.4 THE ROLE OF THE DISCLOSURE AND BARRING SERVICE There are three types of DBS checks: Standard disclosure Enhanced disclosure Enhanced with list checks

The check is made against the police national computer. 1.4 THE ROLE OF THE DISCLOSURE AND BARRING SERVICE Standard disclosure: It is primarily for people who will work with vulnerable adults and children on a regular basis. It can be used for other professions who high levels of responsibility e.g. accountants, magistrates etc. The check is made against the police national computer. It will reveal details of any conviction, caution, reprimand and/or final warnings issued.

The police will decide what additional information will be disclosed. 1.4 THE ROLE OF THE DISCLOSURE AND BARRING SERVICE Enhanced disclosure: In general, this check is for those who are regularly involved in caring for, supervising, training or being in the sole charge of vulnerable adults Examples include carers, teachers, youth workers, dentists, nurses etc. It checks as required for the standard check as well as with the police for any investigations which have taken place that have not led to a criminal record. The police will decide what additional information will be disclosed.

Enhanced with list checks: 1.4 THE ROLE OF THE DISCLOSURE AND BARRING SERVICE Enhanced with list checks: This includes the same as the enhanced check plus checks of the barred lists

SUMMARY: STOPPING ABUSE To stop abuse, the following is needed: Believe that abuse does happen Recognise the signs of abuse Understand that anyone can abuse Know the policies and procedures in your workplace for handling abuse Follow the individuals care plan (if applicable) Report any concerns or suspicions

AIM The aim of the course is to provide you with the underpinning knowledge to support you and your organisation in your responsibilities to protect vulnerable adults in the health and social care setting.

Abuse may be a single or repeated event Abuse destroys lives 1.1 INTRODUCTION TO ABUSE Abuse is real Between April 2010 and March 2011, there were 96,000 reported cases of alleged abuse in England (source: BBC) Abuse may be a single or repeated event Abuse destroys lives Abuse is illegal

The different types of abuse Session 2 The different types of abuse

AIM The aim of the session is to provide you with the underpinning knowledge to recognise the different types of abuse in health and social care.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: State the different types of abuse List the possible indicators of each type of abuse

Physical Sexual Emotional Financial Neglect Institutional 2.1 TYPES OF ABUSE Physical Sexual Emotional Financial Neglect Institutional Discriminatory

2.1 DEFINITION OF PHYSICAL ABUSE ‘No Secrets’ (2000) define it as: “including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions.”

2.1 EXAMPLES OF PHYSICAL ABUSE INCLUDE Pushing Shaking Pinching Slapping Kicking Force feeding Punching Inappropriate manual handling Restraint Denial of medication (prescribed) Forced confinement Unjustifiable physical discomfort

2.1 POSSIBLE INDICATORS OF PHYSICAL ABUSE Injuries that are consistent with physical abuse A person discloses they are being abused There are unexplained injuries Skin infections Change of behaviour Self-harm Unexplained weight changes Behaviour that indicates that the person is afraid of the perpetrator Injuries at different stages of the healing process

2.1 DEFINITION OF SEXUAL ABUSE ‘No Secrets’ (2000) define it as: “including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting.”

2.1 EXAMPLES OF SEXUAL ABUSE Rape Sexual assault Sexual acts which a vulnerable adult has not consented Being forced or coerced into being photographed or videoed to allow others to look at their body and/or sexual acts

2.1 SEXUAL ABUSE A sexual relationship between a care worker and a person with a mental disorder (learning disability or mental illness) is abuse and is an offence under the Sexual Offences Act 2003.

2.1 POSSIBLE INDICATORS OF SEXUAL ABUSE A disclosure is made Urinary tract infections, sexually transmitted diseases or vaginal infections that are not otherwise explained Significant change in sexual behaviour or outlook Clothing is torn, stained or bloody Pregnancy Soreness when sitting

2.1 DEFINITION OF EMOTIONAL ABUSE ‘No Secrets’ (2000) define it as: “including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks”

2.1 EXAMPLES OF EMOTIONAL ABUSE Threats of harm or abandonment Humiliation Intimidation Harassment Verbal abuse Isolation Ignoring Hostility Withdrawal from supportive networks

A person can suffer multiple types of abuse 2.1 EMOTIONAL ABUSE Be aware that emotional abuse will almost inevitably be involved in every other category of abuse. A person can suffer multiple types of abuse

2.1 POSSIBLE INDICATORS OF EMOTIONAL ABUSE Frightened/anxious Withdrawn in the presence of a particular person Low self esteem Changes in behaviour e.g. Continence or sleep problems Humiliation Instilling fear Verbal abuse Denial of access to family and friends

2.1 DEFINITION OF FINANCIAL ABUSE ‘No Secrets’ (2000) define it as: “including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.”

2.1 EXAMPLES OF FINANCIAL ABUSE Theft Fraud Wills Inheritance Exploitation Misuse or misappropriation of property Withholding money Improper use of a persons money

2.1 POSSIBLE INDICATORS OF FINANCIAL ABUSE Lack of money Removal of personal possessions Inadequate explanations for withdrawal of money Inability to pay bills Power of Attorney obtained when a service user lacks the capacity to make an informed decision Insufficient food Sudden loss of assets

‘No Secrets’ (2000) define it as: 2.1 DEFINITION OF NEGLECT ‘No Secrets’ (2000) define it as: “Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.” Neglect is the deliberate withholding or unintentional failure to provide the support and help that is expected to support a vulnerable adult Neglect also includes the failure to take action in any situation that is dangerous

Ignoring a service users medical or physical needs 2.1 EXAMPLES OF NEGLECT Ignoring a service users medical or physical needs Withholding necessities of life e.g. Medication, nutrition, hydration, heating etc Failure to provide access to social care Failure to provide access to educational services

2.1 POSSIBLE INDICATORS OF NEGLECT Inadequate heating and lighting Malnourished Cannot access appropriate medical care (including medication) Not afforded appropriate privacy or dignity Visitors are refused access to the service user Service user is exposed to an unacceptable risk Inadequate or inappropriate clothing Lack of personal care e.g. Rashes and sores

2.1 DEFINITION OF INSTITUTIONAL ABUSE ‘No Secrets’ (2000) define it as: “This may be in the form of isolated incidents of poor or unsatisfactory professional practice, at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems” Institutional abuse is often linked with other categories of abuse e.g. neglect

2.1 EXAMPLES OF INSTITUTIONAL ABUSE Lack of flexibility, choice and options Lack of dignity Staff not available Entering rooms without knocking Staff having an overly controlling relationship with service users Inappropriate restraint Lack of privacy e.g. Intercepting mail Skin sores and skin tears Public discussion on personal matters

2.1 DEFINITION OF DISCRIMINATORY ABUSE Discriminatory abuse is unwanted conduct which is based on a persons social identity e.g. Race, disability, age, culture, religion, sexual orientation, nationality or any other personal characteristic of the individual The conduct affects the dignity of the service user It could be a one off incident or persistent conduct The actions or comments are perceived as demeaning and unacceptable by the recipient

2.1 EXAMPLES OF DISCRIMINATORY ABUSE Name calling Bullying Harassment Denial of access to religious or cultural services Discriminatory abuse can lead to any other type of abuse

AIM The aim of the session is to provide you with the underpinning knowledge to recognise the different types of abuse in health and social care.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: State the different types of abuse List the possible indicators of each type of abuse

Alerting and reporting suspected abuse Session 3 Alerting and reporting suspected abuse

AIM The aim of the session is to provide you with underpinning knowledge to respond to suspected abuse appropriately.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: State the reasons that abuse come to light List the responsibilities of employees in dealing with suspected abuse Define the term ‘whistle blowing’ State the key features for making a referral

3.1 REASONS THAT ABUSE COME TO LIGHT A service user makes a disclosure to a member of staff stating that they are being abused You may have clear evidence that abuse or neglect is taking place You may have concerns or suspicions, but there is no direct evidence A person or agency suspects abuse is taken place or has evidence that it is taking place

3.1 EMPLOYEE RESPONSIBILITIES Anyone can abuse, regardless of their role It is the moral responsibility of every member of staff to report abuse You must follow your workplace policies and procedures The law will protect you for making a referral- this is a term called ‘whistle blowing’

You cannot be victimised for ‘whistle blowing’ An Act of Parliament called the Public Interest Disclosure Act (1998) protects you This Act encourages people to ‘blow the whistle’ about malpractice in the workplace and is designed to ensure that organisations respond by acting on the message rather than punishing the messenger It is important that you familiarise yourself with your workplace ‘whistle blowing policy’

It applies even if the information is confidential 3.2 WHISTLE BLOWING This Act applies to employees reporting crime, civil offences, miscarriage of justice, danger to health and safety or the environment and the covering up of any of these It applies even if the information is confidential The Act means that your employer cannot take any action against you because you have reported genuine concerns

Inform your line manager 3.3 MAKING A REFERRAL Inform your line manager If the vulnerable adult is in immediate physical danger or medical care is needed, then this will need to be dealt with as priority If there is evidence of any criminal activity taking place, then the police will need to be informed Once the abuse has been reported to your manager, the responsibility for action will not lie with you, but with your manager

3.3 RESPONDING TO A DISCLOSURE - THE DO’S Stay calm Listen carefully Be sympathetic If you need to ask for more information, confine your questions to TED: Tell me Explain Describe

3.3 RESPONDING TO A DISCLOSURE - THE DO’S Tell the person They did the right thing to tell you You are treating this information seriously It was not their fault You must inform your manager The manager will contact social services (with their consent) If their is criminal activity then it will be reported to the police If appropriate, the service/agency will take steps to support and protect them Write down as soon as possible the information you have gathered Use a body chart to record locations of any injuries (if appropriate) Ensure the information is noted in the case file

3.3 RESPONDING TO A DISCLOSURE - THE DONT’S Keep concerns, allegations or disclosures to yourself Stop someone who is recalling the events Ask leading questions e.g. Did they hit you? Promise to keep secrets Make promises that you cant keep Contact the alleged abuser Be judgemental e.g. It was your fault Jump to conclusions or make any assumptions Gossip with other members of staff

3.3 RESPONDING TO A DISCLOSURE Do not undertake an investigation yourself Protect and preserve any evidence If the alleged perpetrator contacts you, you must not provide them with any information about the incident Do not discuss the case with the relatives or carers of the abused person or any other worker at the time of investigation

3.3 FINAL NOTE: “If abuse is not acknowledged people cannot be protected, or given support to recover, and, in those cases where other adults may be at risk, they too are left exposed to further abuses, hence a failure to acknowledge abuse may lead to failures in prevention as well as in response” (Hilary Brown, 1998)

AIM The aim of the session is to provide you with underpinning knowledge to respond to suspected abuse appropriately.

By the end of the session, you will be able to: LEARNING OUTCOMES By the end of the session, you will be able to: State the reasons that abuse come to light List the responsibilities of employees in dealing with suspected abuse Define the term ‘whistle blowing’ State the key features for making a referral