1. Sunshine Care Training Sarah Yorwerth & Tara Hollinshead Safeguarding of Vulnerable Adults Sunshine Care1

2. Safeguarding Adults Safeguarding Adults can include any work or activity which aims to support adults at risk to retain independence, well-being and choice and to be able to live a life that is free from abuse and neglect. Sunshine Care2

3. What are YOUR rights? Everyone has the rights to live their life free from violence, fear and abuse The right to be respected The right to make choices about their lives The right to live in safety. Regardless of your age, disability or illness independence Dignity equality Choice Privacy Respect Sunshine Care3

4. Roles & Responsibilities Sunshine Care4

5. An Adult at Risk “ Abuse is a violation of an Individual’s human and civil rights by any other person or persons ” Department of Health, 2000, ‘No Secrets’ Guidelines. In brief the definition of an ‘Adult at Risk’ is: Aged 18 Years or 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 or may be unable to take care of him or herself, or unable to protect him or herself significant harm or exploitation. Sunshine Care5

6. The 3 forms DELIBERATE ABUSE: The abuser knows they are abusing. It is usually pre-planned or systematic. SPONTANEOUS ABUSE: An isolated incident without pre-meditation UNINTENTIONAL ABUSE: This can arise through neglect or poor practice. Inadequate resources or lack of training. Sunshine Care6

7. WHAT CONSTITUTES HARM? PHYSICAL ABUSE NEGLECT PSYCHOLOGICAL SEXUAL ABUSE FINANCIAL ABUSE INSTITUTIONAL ABUSE DISCRIMINATORY ABUSE Sunshine Care7

8. RESTRICTIVE PRACTICES Restrictive practices are any type of support or practice that limits the rights or freedom of movement of a person with disability.  Seclusion  Chemical  Mechanical  Physical  Environmental  Psycho-social Sunshine Care8

9. Physical Abuse Hitting someone Slapping Rough Handling Inappropriate Restraint or Sanctions Misuse of Medication. 5,961,568 number of abuse cases in 2010 15.7 % is physical Sunshine Care9

10. Indicators of Physical Abuse Broken Bones, Bed Sores, Burns, Misuse of Medication (overuse or altered) Self-Injurous activity, Appeasing behaviour, Bruises (unexplained, unusual, patterns/staged) Aggression Withdrawn Violence, Weight loss, Sleeping patterns Sunshine Care10

11. Neglect and Acts of Omission Ignoring Medical or Physical Care Needs Failure to provide access to appropriate health, social care or educational services Withholding of the necessities of life such as medication, food and drink and heating Sunshine Care11

12. Indicators of Neglect Dirty/Unkempt. Weight loss/gain. Injuries not receive medical attention, No external input, Poor Skin Viability, Failing to Act upon a Persons needs, Self Neglect, Malnutrition/Dehydration, Sunshine Care12

13. Psychological and Emotional Abuse Threats of harm or Abandonment Deprivation of contact or communication. Humiliation, Blaming or Controlling, Intimidation, Coercion or Harassment, Isolation or Withdrawal of Services or Support, Malicious gossip or Break a Duty of Confidence. Sunshine Care13

14. Indicators of Psychological Abuse Poor appearance Low self esteem Blackmail Aggression Fear, Seeking approval/attention seeking, Withdrawn, Apathetic, Increased levels of confusion, Self Harm/Injurous Ligature/Suicide watch, ‘Copy Cat’ behaviour. Sunshine Care14

15. Sexual Abuse Rape or Sexual assault, Contact or non-contact sexual acts to which the vulnerable adult has not consented, or could not consent, or was pressurised into consenting. Inappropriate Touching, Exploitation, Being videoed or photographed, Sunshine Care15

16. Indicators of Sexual Abuse. Bruising in the Genital/Anal area, Bruising on thighs/shoulders, Excessive Masturbation, Sexual Explicit behaviour, STI/UTI, Promiscuous Behaviour, Withdrawn, Obsessive Behaviour, Stockholm Syndrome, Self Neglect, Attention Seeking, Staff Behaviour Sunshine Care16

17. Institutional Abuse Rigid/ Long-standing Routines “We have always done it that way” Repeated instances of unsatisfactory professional practice, Pervasive ill-treatment, Gross Mis-conduct indicating an abusive Climate, Practice carried out for the convenience of the staff, Sunshine Care17

18. Indicators of Institutional Abuse Lack of Management/Support, Staffing Levels Rigid Routines/Inflexible Structures, Lack of Informed choices, Staff Morale, Lack of Training, Poor Training, Lack of External input/ openness, Lack of Stimulation, Poor Reserves. Sunshine Care18

19. Financial Abuse Theft Fraud Exploitation and Pressure, in connection with wills, property and inheritance, or financial transactions, Misuse or Misappropriation of Property, Possessions or Benefits. Sunshine Care19

20. Indicators Of Financial Abuse Lack of Funds, Lack of Food, Loss of Assets, Visitors on Benefits Day, Misuse of Reward/ Loyalty cards, Overly concerned about money/ funds, Financial Obsession, Assuming Default, Fraud, Unusual Transactions. Sunshine Care20

21. Discriminatory abuse Slurs or Similar treatment and other types of harassment that are based on a Person. Ethnic Origin, Religion, Language, Age, Sexuality, Gender or Disability. This covers Victimisation, Prejudice or Insults. It is against the law to discriminate against anyone because of: o Age, o Being or becoming a transsexual person, o Being married or in a civil partnership, o Being pregnant or having a child, o A disability, o Race including colour, nationality, ethnic or national origin, o Religion, belief or lack of religion/belief, o Sex, o Sexual orientation. Sunshine Care21

22. Indicators of Discriminatory Abuse Lack of Skill Development, Exaggerated Faith/ Religion, Tries to be more like other, Negative Slurs, Low Self Esteem/ Worth, Self Harm, Lack of Training, Lack of Equipment/ aids, Isolation, Denial of Cultural Inclusion. Sunshine Care22

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24. In an individual’s own home it is easier for an abuser to hide their actions from others. Institutional abuse is more likely to happen when standards are poor and routines are planned to fit around a rota or workers feel unsupported by their management. This can lead to a way of working that everyone begins to see as acceptable. They do not try to challenge the situation because they are afraid of speaking about what is being accepted by the majority. Any workplace where individuals display difficult or challenging behaviour that workers are not trained or supported to deal with. Particular vulnerabilities in the individual such as a sensory impairment, a mental health issue, dementia or a learning disability. A reaction could be taken as a symptom of their condition rather than an attempt to tell someone what is happening to them. Sunshine Care24

25. This term refers to actions that may need to be used such as physical restraint or use of devices, medication or seclusion. Restrictive practice must always be legally and ethically justified and must be absolutely necessary to prevent serious harm. If used inappropriately, restrictive practices have the potential to infringe human rights. Restrictive Practices Sunshine Care25

26. Serious Case Reviews Any abuse that takes place is wrong and has consequences for those involved; it can change the victims life and prevents them from being able to live as they wish. Sometimes abuse leads to serious harm or even death. When this happens a serious case review is carried out by the Local Safeguarding Adults Board. This looks at what has happened to find out why, what could have been done differently and how this can be prevented from happening again. Sunshine Care26

27. Some factors that have been featured in adult abuse and neglect such as: Lack of mental capacity Low self esteem Increasing age Physical dependency Social isolation Lack of access Environment Sunshine Care27

28. Basic Principles Empowerment Protection Prevention Proportionate Partnership Accountability. Sunshine Care28

29. Promoting dignity and rights. It is important to make sure that they care environment promotes people’s dignity and rights. Lines of communication between individuals and workers are always open. Relationship are based on trust Individuals play an active part in decisions about their care and support. Individuals are aware that they can share their concerns or complain and that they will be taken seriously. Individuals are supported to be as independent as possible to reduce their reliance on others who may take advantage of them Individuals known their rights and understand how they can expect to be treated. Sunshine Care29

30. Person centered careActive participationManaging risk Working together to plan care Being able to take part in activities Choice, assess and take risks Meeting unique needsActive partnerUnderstand the consequences Reduces negative or unfair treatment. Correct equipmentMaking safer choices. Choice and control.Correct resources Sunshine Care30

31. Multi-agency Safeguarding The Care Act 2014 makes it a legal requirements for local authorities to create multi-agency Safeguarding Adults Boards from April 2015. These boards set out the ways in which safeguarding procedures are put into practice in your local area. Promote information sharing between workers and organisations. Managers make decisions by following what is agreed locally and for their workplace as their threshold. Sunshine Care31

32. Local and National context No Secrets guidelines Vetting and barring scheme Office of Public Guardian National Framework Sunshine Care32

33. Complaints It is important that people receiving care and support feel able to challenge poor standards of care. The should know how to complain. An open and honest culture can encourage individuals to raise concerns before they come to harm. You should do what is appropriate in your role to try and resolve any concerns. If someone is still unhappy you must tell them how to complain. There should be a recorded process with agreed timescales Sunshine Care33

34. Responding to Abuse. (Remember you are NOT investigating) Stay calm and try not to react in such a way as to cause anxiety to the individual i.e. Shocked, appalled, hesitant. Tell the person that: They did the right thing in telling you, you are treating the information seriously and its not their fault Listen very carefully. Be empathetic Be aware of the possibility that medical evident might be needed Explain that you must tell your manager and the manager will contact social services, health and police. Sunshine Care34

35. Do NOT: Press the person for more details Promise to keep secrets (you can never keep this kind of information confidential) Pass on information to anyone other than those with a legitimate ‘need to know’ most likely to be your manager. Contact the alleged abuser Be judgemental e.g. ‘why didn’t you run away’ Gossip about abuse Stop someone when they are telling you what has happened to them as they may never tell you again. Sunshine Care35

36. Do you suspect an adult at risk is being abused? Are they in immediate physical danger? Yes Ring 999 Ensure immediate safety No Inform your line manager as soon as possible Sunshine Care36

37. Sunshine Care Training Sarah Yorwerth & Tara Hollinshead Safeguarding Children Sunshine Care37

38. Child Protection Is everyone’s responsibility; it is not only child care workers that have a duty to promote the welfare of children and protect them from harm Safeguarding is preventative and involves promoting the welfare of children by protecting them from harm and recognising the risks to their safety and security. Sunshine Care38

39. What is child abuse? Physical Abuse: This is any abuse where a child is physically harmed, for example hitting, biting, and burning. Signs and symptoms might be unexplained wounds, bruises or broken bones. The child might make up stories to explain injuries or try to cover them up. Emotional Abuse: This means a child’s emotional needs are not being met. This could include being made to feel inadequate or not feeling loved and secure. A parent or carer may not be talking to them enough or given them the attention they need. Typical signs and symptoms could include delays in development, speech disorders or a fear of making mistakes or overreacting to them. Sunshine Care39

40. Sexual abuse: This could involved children or young people being involved in sexual acts, being made to watch sexual acts or being showed pornography. Child sexual exploitation (CSE) means that children are manipulated sexually for the abusers benefit. Typical signs and symptoms include awareness and knowledge of sexual activities beyond what would be expected at their age as well as genital or anal pain or itching or sexually transmitted diseases. Neglect: This is a form of abuse where a child’s basic needs are not met, for example, through a lack of food, medical attention or access to education or poor clothing, housing, hygiene and parenting. Neglect could sometimes be happening as a result of a child being the carer of a family member. Typical signs an symptoms may include always being hungry, poor personal hygiene, delays in development, tiredness and looking ill. Sunshine Care40

41. Radicalisation: This is where children and young people are taught extreme, often violent, ideas based on political, social or religious beliefs. Signs of exposure to radicalisation could be behaviour changes, changes in the way they speak with others or having a new circle of friends use of extremist terminology, reading material or messages. Child trafficking: This means recruiting, moving or receiving a child through force, trickery or intimidation to take advantage of them. Signs and symptoms could be a domineering adult accompanying the child all the time and speaking for them. The child could appear withdrawn, compliant and unkempt, or should little or not use of the English language Sunshine Care41

42. FGM: Means to remove, constrict or otherwise disfigure a girl’s labia or clitoris for non-medical reasons, in most cases before they reach the age of 8. Some communities may use religious or cultural reasons to justify FGM, but it is a form of abuse. Signs and symptoms could range from severe pain and bleeding and chronic infections to psychological, mental health and sexual problems or damage to the reproductive system and infertility, All forms of abuse are likely to create a change in behaviour to the victim. It is important to know that not all children will display the same symptoms and that usually there is more than one type of abuse happening, for example, physical and emotional abuse Sunshine Care42

43. Impact of parent/carer’s physical and mental health To grow up happy and safe, children need parents or carer’s who love, protect and care for them in a stable, safe and secure home. Physical care and daily routines are important for development so anything that upsets routines can be unhelpful. If a parent or carer’s physical or mental health is poor, this could be a risk to the wellbeing of their child. It is important to remember that a parent/carer’s health might affect their ability to safeguard. Sunshine Care43

44. Examples of possible harm Examples of possible harm:  A parent/carer with mental health issues might feel unable to build attachments with their child, possibly causing emotional harm; or the child might be forced into decision making that they are not ready for.  A child with a parent/carer who is blind or deaf may be at increased risk of physical harm as they might not be fully able to judge dangerous situations. Seeing or hearing acts of domestic violence can have a similar effect on children as being emotionally abused. There could be a likelihood of feeling helpless or becoming aggressive. Sunshine Care44

45. Children’s rights The Human Rights Act 1999 gives a number of fundamental rights to every person living in the UK.  The right to life  Freedom from torture or degrading treatment  The right to education  The right to liberty and security.  Protection from discrimination. Some of the rights relating to child protection:  The right to life  The right to live a healthy life  The right to not be separated from their parents unless they are at risk of harm  The right of protection from drugs, sexual abuse or any harm to their development. Sunshine Care45

46. Concerns of suspected or alleged abuse  Report your concerns to your manager immediately  Make a record of your concerns  If you feel that this process is taking too long, call 999 and call the police; they can quickly remove a child to somewhere safe  Follow your organization's safeguarding policies and procedure. Sunshine Care46

47. Internet & Social networking The internet, with its endless access to information, is a valuable tool but also a potential risk to safety and security. It is important to monitor of be aware of what a child sees and shares, or could become exposed to. There is a high risk of being exposed to sexual predators, pornography and radicalisation. Over 1/3 of young people have been affected at least once. Sunshine Care47

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