safeguarding adults - preventing abuse and responding to poor practice
DESCRIPTION
Safeguarding Adults - Preventing Abuse and Responding to Poor Practice. Practitioner Level. Housekeeping. Fire Procedure. Smoking. Toilets. Breaks. Finishing Time. Mobile Phones / Devices. Training Transfer. Getting learning into practice - PowerPoint PPT PresentationTRANSCRIPT
Including
Safeguarding Adults - Preventing Abuse and
Responding to Poor Practice
Practitioner Level
Including
Toilets Fire ProcedureSmoking
Mobile Phones / Devices
Finishing Time
Breaks
Housekeeping
Including
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)
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Training Transfer
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Introductions
• Name
• Place and nature of work
• What do you want to know by the end of today’s session?
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OutcomesBy the end of the session you will:• Understand your responsibilities
• Be able to recognise and respond to poor practice and know who else to involve
• Recognise missed opportunities through learning from Serious Case Reviews
• Have a greater awareness of the legislative framework, regulation and guidance that contribute to the prevention agenda
• Identify opportunities for intervention through the assessment, care or treatment planning and review processes
• Recognise the role of person-centred support in preventing abuse
• Be able to consider the ongoing balance between prevention, protection and a person's right to choice
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Ground RulesConfidentiality 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 normally be discussed with you first.
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.
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Underpinning message for session
• Positive approach – promotion of good practice and early intervention to avoid harm
• The rule of optimism - maintaining healthy scepticism and respectful uncertainty
“It could happen here.”
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Setting The Scene
Where does our learning about Safeguarding come from?
• Serious Case Reviews/Complaints/Near misses• Research/Surveys/Data Analysis• Practice Experience/Theory/Reflection
www.devonsafeguarding.org
www.scie.org.uk
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Six Safeguarding Adults Principles
• Empowerment
• Protection
• Prevention
• Proportionality
• Partnership
• Accountability
‘Adult Safeguarding: Statement of Government Policy’ 2011
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‘Prevention in Adult Safeguarding’
“It does not mean being over-protective or risk-averse. Prevention needs to take place
in the context of person-centred support and personalisation, with individuals
empowered to make choices and supported to manage risks.”
Report 41, SCIE, 2011
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Vulnerability
What does the term ‘vulnerable’ mean?
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The Traditional Model• Risk factors for being abused – poor
communication skills, low self esteem, challenging behaviour, cognitive difficulties, lack of education/experience, loneliness
• Risk factors for carers abusing - isolation, stress, lack of knowledge of condition, substance misuse, lack of support
• Risk factors for services – poor management, high turnover of staff, low pay, lack of staff
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The Social Model of Vulnerability• A way of thinking about vulnerability that is not
patronising or impairment specific because the vulnerability is outside the person
• Vulnerable groups tend to be – placed in, or left in, situations of higher risk than would be tolerated
for others– Not heard, believed or taken notice of when they make complaints– Not helped to recover or recompensed
• Because of these situations vulnerable groups risk being seen as “easy targets”
(Prof. Hilary Brown)
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‘Constellations of Abuse’
Exclusion from mainstream service provisionDiscrimination in health, education, housing, employment , justice and welfare Unable to access public places and spacesDenied legal advocacy and routes for challengeInvisible or stigmatised in media
breaches of professional boundaries by
arrogant grandiose and unaccountable staff
resentful, down-trodden and hard-done-by staff
Family violence,
neglect or negligence partner violence
between parent and adult child
between adult child and older parent
more distant relativesParasitic, exploitative “mate” crime
rigid de-personalised regimes
neglectful care
staff out of their depth or not available
cruel, humiliating individuals
hate crimes
predatory crimes
sexual and financial
Unethical, unjustified and/ or unauthorised practice in response to challenging needs
Targeted abuse Institutional abuseProfessional abuseDomestic abuse
Unethical practice
Systemic abuse and social exclusion
Prof. Hilary Brown, 2012
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PCS Analysis
Neil Thompson
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Opportunities for intervention
• Assessment & Planning
• Care, Support or Treatment
• Review
• Service monitoring/Complaints
What are your responsibilities?
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Prevention: Your Responsibilities• people being informed of the right to be free from abuse; and
supported to exercise these rights, including having access to advocacy
• thorough needs assessments supported by risk assessments where required to inform people’s choices
• access to good universal services targeted at older and disabled people that can reduce the risk of people experiencing abuse, for example community safety services or services that increase people’s access to advice or maintain informal support networks
• a well informed, competent and properly vetted workforce operating in a culture of zero tolerance of abuse
• a sound framework for confidentiality and information sharing across agencies (CSCI, 2008)
Including
ISA Report“Safeguarding in the Workplace: What are the lessons to be
learned from cases referred to the Independent Safeguarding Authority?” March 2012
General indicators• carelessness, breaches of policy, attitudinal problems,
emotional detachment and persistent non-attendance, portrayal of a close personal relationship with the victim
Financial indicators• talking about money worries, seeking advances or
requesting overtime, failure to complete documentation and protocols regarding the handling of money
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Creating Safer Organisations• Recruitment - VBI• CRB/ISA Checks and References• Induction and Probation• Policies and Procedures• Setting Standards and Professional Boundaries• Training• Supervision• Performance Management
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Serious Case ReviewsTake place where a vulnerable adult has:• died, suffered serious sexual abuse, a potentially life-
threatening injury or serious and permanent impairment of health or development or when serious abuse takes place in an institution or multiple abusers are involved
AND
• the case gives rise to concerns about the way in which local professionals and services work together to safeguard vulnerable adults
OR
• where it is believed to be in the public interest to conduct such a review.
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Serious Case Reviews aim to:
• Establish whether there are lessons to be learnt about the way in which local professionals and agencies work together to safeguard vulnerable adults
• Improve practice by acting on learning
NB: The purpose of having a serious case review is not to reinvestigate or to apportion blame. They consider individual actions as well as the systems and processes within which individuals operate.
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Serious Case Reviews – recurring national themes
• Inter-agency communication• No lead agency• Training needed• Threshold issue • Assumptions
Jill Manthorpe and Stephen Martineau, 2009
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Devon SCRs
A: High number of deaths raised by CSCIPoor care standards not previously picked
up by many and various professionals
B: 2 falls resulting in deaths raised by PALSEnvironmental risks not previously picked
up by many and various professionals
H: Resident murdered by another on respitePoor transfer of risk information from
hospital to care home
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Devon SCRs – combined learning
• Duty on all health and social care professionals to record and act upon, any concerns about health, safety or wellbeing. This should include possible risks that are not necessarily the main focus of their contact.
• Ensure that a Service Provider is fully aware and able to safely meet someone’s needs. Other important considerations such as accessibility, peoples preferences, resource pressures and cost, should not compromise the primacy of ensuring safe care/support arrangements.
Including
Common Safeguarding Challenges (care homes)• Maladministration of
medication• Pressure sores• Falls• Rough treatment,
being rushed, shouted at or ignored
• Poor nutritional care
• Lack of social inclusion
• Institutionalised care• Physical abuse
between residents• Financial abuse
www.scie.org.uk
Including
Health and Social Care Act, 2008• Single registration system acts
as a “licence to provide services”
• Established Care Quality Commission to:
Regulate the quality of health care and adult social care
Look after the interests of people detained under the Mental Health Act
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Health and Social Care Act 2008
• Focused on outcomes rather than policies, systems and processes (inputs)
• CQC to monitor compliance – risk register
• New enforcement powers for CQC
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Snap!
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Behind Closed Doors
Area of Concern / Poor Practice
Watch the DVD
Complete the FIRST column ONLY
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Behind Closed Doors
Area of Concern/ Poor Practice
Which CQC outcomes does this relate to?
Complete the SECOND column ONLY
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Behind Closed Doors
Area of Concern / poor practice
Which CQC outcomes does this relate to?
What might you see, hear or smell?
Consider the indictors and signs that there might be if you hadn’t actually observed the behaviours
Complete the THIRD column ONLY
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What might you see?• Empty hours, bored residents• Empty and scrappy staff rotas (turnover, absences and
not enough staff)• Erratic medication charts• Dirty rooms• Dirty linen• No training or “going through the motions”• Policy documents and care plans kept in the drawer• Rushed staff• Dirty, untidy and unlooked after clothes
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What might you smell?
• Urine
• Faeces
• Stale food
• Body Odour
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What might you hear?• Dehumanising: “they” - people are lumped together – “they
eat like animals”, “the doubles”• Sexualising: “they’re at it like rabbits”, “she’s gagging for it”• Blaming:“he knows what he’s doing,” “she’s manipulative”,
“he’s winding me up”• Punitive: “they’ve got it coming”, “she needs to be taught a
lesson”, “if he thinks he can treat me like that”• Discrediting: “he doesn’t notice”, “they don’t care” “they
are zombies”
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Barriers to addressing poor practice• Lack of a tangible sense of what is wrong• Lack of certainty that your concerns are
reasonable or proportionate• Lack of “evidence” to back up concerns• Fear of immediate reprisals or long term
detrimental consequences• Fear that concern or complaint will not be
handled well so that their intervention will be in vain
Professor Hilary Brown
Including
How do you verbalise ‘gut instincts’?
Hull University: ‘Abuse in Care?’ (http://www2.hull.ac.uk/fass/care/safeguardingadults.aspx)
• A practical guide to protecting people with learning disabilities from abuse in residential services
• A practical guide to protecting people with dementia from abuse in residential services
Including
Service Monitoring Checklist 1. Leadership and Management
2. Staff behaviours and attitudes
3. Behaviours and interactions of residents
4. Isolation and lack of openness
5. Service design, delivery and make up
6. Environment and basics of care
Adapted from ‘Abuse in Care?’
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Practitioners’ Role
If you suspect a criminal offence, do not ask any further questions.
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Behind Closed Doors
Area of Concern / poor practice
If you hadn’t observed it what other indicators might there be?
What might you see, hear or smell?
What information do you need to gather? Where/ who from?
Complete column FOUR
What questions might you need to ask to establish the facts of the situation?
Be specific!
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What to do with concerns about poor practice
• Discuss with the professional concerned• Discuss with the service manager• Discuss with your manager immediately, in supervision
or at a team meeting• Discuss directly with the person, family, organisation.
Once discussed then back up in writing - SMART. • Record in Mr Manager if appropriate • Discuss with co-workers or Safeguarding Adults team • Encourage people to use the complaints process • Discuss with procurement / contracts team• Discuss with CQC
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Feelings / Emotional Responses
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Communication
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Neil Thompson
What is a problem?
‘....a problem is anything that either brings about negative ...or blocks positives or a mixture of the two.’
Neil Thompson
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An Elegant Challenge
Being constructive in challenging unacceptable behaviour or language
Collusion / Elegant Aggressive
no challenging challenge challenge
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Practice• Choose one of the scenarios from the film
(or your own) and make ‘an elegant challenge’ to your partner.
• Partners – What did it feel like? What could be done differently?
• Swap over.
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Any Questions?
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Prevention is Better Than Cure
Keep the course in context. Whilst there are some very worrying situations occurring everyday there is also good practice in all care environments
Remember to vigilant and deal with things at the earliest opportunity.
Whether it’s poor practice or abuse doing nothing isn’t an option.
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Resources
Dementia care mapping
www.bradford.ac.uk
CQC observation tools
www.cqc.org.uk/information-our staff/observation-tools
SCRs
www.devonsafeguarding.org
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Resources Social care governance – audit tool
Common Safeguarding Challenges
Minimising the Use of Restraint
www.scie.org.uk
Good Ideas!
www.kissingitbetter.co.uk/
www.myhomelifemovement.org/