Safeguarding.

Recognising And Responding To Abuse And Neglect.

Learning Objectives.

At the end of this session you will:• Understand who are ‘vulnerable adults’.• Understand what is meant by the term

‘abuse’.• Understand the legal framework behind

safegurding.• Have identified indicators of abuse.• Know what is ‘institutional abuse’?• Understand why people do not report

abuse.• Know who you should report concerns to.

But First.

What Is “Safeguarding.”

Safeguarding is about empowering staff to :-.• prevent, respond to or stop abuse;• to report, question and challenge abuse; and.• to work within the criminal justice system to

bring to justice those who take advantage of vulnerable people to abuse them.

Who Are “Vulnerable People.”

Activity 1

Take a moment to think about and make a list of adults you would see as being the ''most vulnerable'' in our society?

A Vulnerable Adult ;

Is defined as ;- a person 18 years of age or older whose ability

to perform the normal activities of daily living or to provide for his or her own care or protection is impaired due to a mental, emotional, long-term physical, or learning disability, or dysfunction, or brain damage, or the infirmities of aging.

What Is Abuse ?

What Is Abuse ?

Activity 2• Think about all the words and phrases that

come into your mind when you think of ''abuse'' and then try to form a brief definition

What Do We Mean By Abuse ?

• It is not easy to identify abuse because it is often inflicted subtly by the abuser, but it is very important to look for and recognise abuse as early as possible and to take effective action to keep your residents safe.

• It has also been discovered that if a person is suffering from one type of abuse there is a likelihood of other ‘abuses’ taking place.

Abuse Can :-.

• Be Intentional or unintentional.• Result from neglect or failure to act.• include depriving someone of services,

treatment .– misuse of medication ( Over or under dosing ).– not providing sufficient food and drink.– not providing warmth, comfort or support.

• consist of a single act or repeated acts.

Abuse Can :-.

• Occur when a vulnerable person is persuaded to enter into a financial transaction or sexual act to which they have not consented or cannot consent .

• occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.

Some Facts And Figures.

Where does abuse occur?• Action on elder abuse discovered that:-.– 66% of abuse occurred in the victim's own home.– 11% in nursing homes.– 10% was in residential homes.– 5% in hospitals and.– 4.2% in sheltered housing.

More facts and figures.

• Who are reported as victims of abuse?• There is a predominance of victims who are

men in the age range 79 - 90 and women age range 70 - 84. It was found that the older people got the more abuse occurred.

• Although the majority are older people, action on elder abuse also receive calls from other client groups, especially people with learning disabilities.

More facts and figures.

Who were the abusers?• Relatives or friends are the most frequent abusers,• 30% of abusers in the victim's own home were workers.• Only 8% of families abused when the victim was in care.• 70% of abusers in care settings were nurses or care workers.

People who abuse are paid staff or volunteers, family members, neighbours, friends or others in the vulnerable adult's network, other service users and strangers –

Anyone in any society can be capable of abusing another person.

More facts and figures.

Were there any differences in the gender of abusers or people abused? .

• 29% of people being abused were men and 71% women.

• 55% of abusers were men and 45% women - this figure might surprise you as men are often seen as being the only abusers.

More facts and figures.

How were cases dealt with?

The seriousness of the abuse reported can be seen by the fact that 20% went to case conference and involved a protection plan and about 20% had police involvement.

More facts and figures.

Who reports?30% of cases were reported by paid workers,

47% by relatives and 12% by friends or neighbours and 2% by carers. Note that almost a third of reports came from paid workers and so far only 2% by carers however with increased training and understanding concerning abuse and whistleblowing this figure is rising.

Safeguarding

And The Law.

What Does The Law Say ?

You will not be surprised to learn that there is a very extensive and robust legal framework

around the whole issue of safeguarding.

This next section is intended to help you become more aware of key legislation in relation to

abuse and neglect.

The Law.

• As a social care worker you will need to be aware of key legislation in relation to abuse and neglect.

• There have been cases in the media where vulnerable adults have been harmed in situations when they should have been protected by either social care workers in care settings or by family members in their own homes.

Legal Requirements.

• Standards of care have been raised through the introduction of training standards and this is a good way to protect vulnerable adults who have been harmed or abused through a social care workers lack of knowledge or skill.

• The government has taken action to ensure that vulnerable adults are protected from abuse with the creation of the Criminal Records Bureau (CRB) and with other initiatives such as “No Secrets”.

What Is The Criminal Records Bureau (CRB)?

• The criminal records bureau was conceived under part V of the police act of 1997.

• It provides organisations with access to criminal record information on known abusers.

• These checks are required as part of good recruitment practice.

• News Article

What is a CRB check?

• All successful job applicants are asked to apply to the bureau for an “Enhanced Disclosure”.

• This will contain all spent and unspent criminal convictions as well as cautions, reprimands and warnings. No disclosure can be issued without the consent of the individual applicant, and the information contained is always provided to individual applicants so that they can check that the information held is correct.

• These checks enable employers to make safer and more informed recruitment decisions which is very important for positions involving trust of any sort.

The CRB access information via the:

– Protection of Children Act list– Protection of Vulnerable Adults list– Information held under Section 142 of the

Education Act 2002

Independent Safeguarding Authority

(ISA) • The Independent Safeguarding Authority

(ISA) has been created to help prevent unsuitable people from working with vulnerable adults or children - ISA manage the POVA list.

• Information about how the referral process works can be found on the ISA’s website:www.isa-gov.org.uk

The ISA Role

• On 12th October 2009 ISA introduced a new list for people who have been vetted by ISA and are considered suitable to work with children or vulnerable adults - This new process is known as the Vetting and Barring Scheme.

What Will ISA Mean ?

• The safeguarding vulnerable groups act 2006 defines regulated activities involving working with children or vulnerable adults. Broadly, this is any activity that involves contact with children or vulnerable adults, or work in specific places such as schools, care homes, or hospitals.

• Any person undertaking a regulated activity must be registered on the ISA list. This will be a legal requirement. It will be the employer’s responsibility to enroll someone who is not on the list, or check an entry of someone who claims they are already on the list.

7 Categories Of 'Abuse.'

• Physical abuse:• Sexual Abuse:• Psychological Abuse:• Financial Abuse:• Neglect, self neglect or

self harm:• Discrimination: • Institutional

More facts and figures.

Types of abuse .55% was physical abuse,28% was financial abuse,22% psychological abuse,17% was neglect and,5.5% was sexual abuse.Discrimination and institutional abuse have been the

added as a category of abuse to be included in the new procedures, as yet very few figures have been gathered relating to these types of abuse.

Physical abuse:

• This occurs when injuries are inflicted, or the health and development of a person is severely impaired :-– when someone hits, slaps or physically hurts a

vulnerable adult. – When a person is given too much medication causing

drowsiness

Sexual Abuse

• This occurs when the person is involved in sexual activities to which they have not consented, or, if they are in a confused state and therefore do not fully understand what is happening to them.– An example: When a person is touched

inappropriately

Psychological Abuse:

• Where there is a denial of a person’s basic rights such as.– Not being given choices, or.– When their opinions are not being heard or.– When they are not given any privacy.

• Where the person is being over-protected and kept back, not enabling someone to live a normal life and to ‘develop’.

Psychological abuse frequently occurs prior to or concurrently with physical or sexual abuse.

Examples Of Psychological Abuse:

• Punishing a resident for being incontinent.• Threatening the physical health of the victim.• Controlling the victim’s freedom.• Acting to destabilize or isolate the victim.

Financial Abuse:

• People who are housebound, confused and/ or have physical or mental disabilities are seen as the most vulnerable and at risk.An example: – Someone cashes pension/benefits on behalf of a

vulnerable adult and does not give it to the person it belongs to, but keeps it for their own use.

– Someone takes a vulnerable adult shopping and keeps the change, two for ones or loyalty card points.

Neglect.

• To pay too little or no attention to a person, • To fail to take proper care of the person, • To omit to do or be remiss about something. • Neglect can be both physically and

psychologically abusive .

Examples Of Neglect.

• where the person does not receive proper food and drink resulting in malnutrition or dehydration.

• Where the person is not acknowledged and treated as though they are invisible .

• Where the person is not changed frequently enough to prevent smells or sore skin.

• Where a person is not given appropriate care for preventing pressure sores or infection.

Discrimination:

• Choices given to a person are not based on their ability or needs but made in relation to their race, sex or a person’s disability.

Activity 3

• Think about each of the six types of abuse and list the sorts of indicators, which might make you think that abuse was taking place. Take about five minutes for each type of abuse. (Physical, Sexual, Psychological, Financial, Neglect, Discrimination)

Behaviour As Communication

• The following types of behaviours could be displayed by the person and could alert you to something being wrong.

• Any of these behaviours could be as a result of any of the above types of abuse.

• The important thing to look out for and to question is - is there a change in a person's behaviour - what is the cause?

Behaviour That Might Result From Abuse.

• Slight or marked change in behaviour or inappropriate attachments.

• Fear, combined with a sense of hopelessness.

• Depression, total compliance, passive, low self-esteem.

• Acceptance of incidents as part of being old or vulnerable.

• Withdrawal from activity/ participation/communication.

• Feelings of powerlessness.• Mental confusion.

• Anger and physical/verbal outbursts.

• Seeking attention/protection often from numerous sources which may be unlikely.

• Insomnia/deprivation of sleep or need for excessive sleep.

• Change in appetite unusual weight gain/loss.

• Weepiness/unusual bouts of sobbing/crying.

• Unexplained paranoia, excessive fear or anxiety..

What Is “Institutional Abuse” ?

• Institutional abuse occurs when services develop ways of working that meet the needs of the staff group and the organisation rather than the individual service user. These practices often enhance the smooth running of the service but in themselves they can become abusive if they deny or limit the choices, dignity or privacy to those receiving the service

Avoiding Institutional Abuse.

When providing a service the guiding principles should be:• Actively promote the empowerment and well being of

vulnerable adults through the service.• Act in a way which supports the rights of the person to lead

an independent life based on self-determination and choice.• Recognise people who are unable to take their own decisions

and/or protect themselves, their assets and bodily integrity.• Recognise that the right to self determination can involve risk

and ensure that such risk is recognised and understood by all concerned and minimised whenever possible).

Why don‘t incidents of abuse get reported ?

• Although there is a steady increase of incidents of abuse being reported now, it is probably still only the tip of the iceberg. So if incidents of abuse are occurring or there are bad practices still going on why don't people report it/what are the barriers to reporting abuse

• Take a few minutes to think about and write up how many reasons you can think of why a vulnerable adult would not report abuse

Why don‘t incidents of abuse get reported ?

• Activity:If you are a staff member and you see poor work practices/abusive behaviour being carried out towards vulnerable adults, what might prevent you from reporting/what are the barriers to reporting?

Reporting Abuse.

• Since July 2005 all organisations providing social care services have been required By CQC to have policies and procedures on protection or as it is now called “Safeguarding of vulnerable adults”

SOVA.

Responding

To Suspected Abuse.

Abuse.

We have already mentioned that vulnerable adults may be abused by a wide range of people including:– Relatives and family members– Professional staff, e.g. Doctors or nurses– Social care workers– Volunteers– Other service users– Friends or neighbours– Strangers– People who deliberately target vulnerable adults

Abuse.

We have also said that abuse can take place in any context. It may be when a person:– Lives alone– Lives with relatives– Within a nursing, residential or day care setting– In hospital– Public places– In places previously assumed safe

Abuse.

• Because of the above It is very difficult to know when or where you might come across someone who is being abused and needing to tell someone about it - it could happen at any time.

• When someone is opening up and telling you that they have been abused, it is called “disclosure”.

Disclosure

• Someone in the act of disclosure may not be able to openly say how they feel, or be able to express their feelings very clearly in words. Sometimes the person may try to hide their feelings or be unable to face certain feelings. However, the listener should be able to pick up clues about a person's emotional state in other ways:

In This Session We Will Be Considering:

• What are the different ways in which vulnerable and distressed people signal that they are being abused ?

• What clues are there for you to identify poor practice or inadequate care ?

• What would some of these signs and symptoms look like in the context in which you work ?

• How should you respond to these ?

Objectives:- You Will.

• Know how to enable someone to tell you that abuse has occurred.

• Understand the issues of confidentiality and consent.• Know how to deal with disclosure and immediate

incidents.• Know how to look after the vulnerable adult and

assure their safety.• Know how to preserve evidence.• Know how to write a report of an incident.• Understand your rights under the ‘public interest

disclosure act’ “whistleblowing”.

Enable Someone To Tell You That Abuse Has

Occurred • As you can imagine, it would be very difficult for

someone to tell you that they are being or have been abused.

• How can you enable service users to tell you what has happened.

• One of the main skills we need is to be good at listening. We would all say that we are 'good at listening' but are we? What does 'good listening' mean? Watch someone who you think is a good listener and watch what they do - this is a skill which we can all develop further?

Enable someone to tell you that abuse has

occurred • Take a few moments to think and write down?

''What makes a person a good listener'' - what is it they do?

Clues That Suggest A Person Is Distressed

When working with a client the following might lead you to think that something is wrong:-.

• how they express themselves: in their tone/pitch of voice and rate of speaking. In the times when pauses and sighs seem to be significant. If it is a sensitive or difficult thing the person wants to say then they could change the subject or distance themselves away from their feelings and rather than say 'I feel' would say 'people may feel', 'one may feel', or 'you may feel'.

Clues That Suggest A Person Is Distressed

When working with a client the following might lead you to think that something is wrong:-.

• Through silences: in what they do not say. Even when people are quiet you can often sense there is something not quite right.

Clues That Suggest A Person Is Distressed

• When working with a client the following might lead you to think that something is wrong:-.

• The questions they ask: instead of sharing how they feel they might ask questions about the situation. It is important for the listener to pick up on the feeling behind the questions, they may say for example: if you knew something was wrong would you tell anyone.

Clues That Suggest A Person Is Distressed

• When working with a client the following might lead you to think that something is wrong:-.

• In his or her behaviour different: if someone is frustrated and agitated they may lash out at someone and become aggressive. If they are fearful or anxious they may withdraw into themselves and be unable to communicate.

Confidentiality and Consent

• The principles of confidentiality and consent are a central theme running through adult protection procedures. Good practice states 'that all confidential information about a service user should be rigorously safeguarded and although normally information about a service user can only be shared with their consent, in the case of adult abuse, consent from the service user can be overridden'.

Confidentiality And Consent

• You will need to tell the service user who wants to tell you a secret that you cannot keep information to yourself where you know they are being hurt or someone else is being hurt. You will need to pass that information on to the line manager and to no one else. Obviously if the manager is the person abusing the service user then the information needs to be passed on to the local social services office or in the case of a residential /nursing home to the social services/health service inspectors.

Confidentiality And Consent

• After explaining the bounds of confidentiality if they refuse to tell you anymore then you will need to report what has happened to your Line Manager. At some later stage the person may be ready to share the information but staff need to be on the alert to monitor exactly what is happening. It is very important that information you receive about the abuse of a vulnerable adult should only be shared on a 'need to know' basis - only those Staff such as the Line Manager should be informed

Confidentiality And Consent

• Service users should be advised why and with whom information relating to them has been shared and they also have a right to see information written about them. Information given to you by a service user should only be used for the purpose for which it was given - in adult abuse, report to line manager in the first instance who in turn contacts either the local social services office or the social services or health service inspectors if it is a residential/nursing home

How To Deal With Disclosure And

Immediate Incidents• Disclosure means that someone is telling you

that they have been or are being abused and this needs the worker to be very sensitive and empathic. The 0next slide will give a list of 'Do's and Don'ts' when someone is 'disclosing' to you

'Do's and Don'ts'

• Do remain calm and try not to show any shock or disbelief.• Do take what you have been told seriously - even if the person is confused.• Do demonstrate an empathic approach by trying to think what it might feel like to

be in their present position. You can never really know what it will feel like to that person but empathy is trying to do that.

• Do talk to the service user some more without interrogating him/her• Do say that they have done the right thing by sharing the information with you.• Do say that the abuse is not their fault (if the information is being shared by the

person who is being abused).• Do be aware of the possibility of 'forensic evidence' if the disclosure refers to a

recent abuse.• Do observe the person and take note of their body language.• Do say that you are treating the information seriously.

'Do's And Don'ts'

• Do remind the service user about the bounds of confidentiality but explain that you are required to share the information only with your manager.

• Do ascertain the facts - what has happened and when.• Do ask the client what s/he wants to do.• Do reassure the person, that any further investigation will be conducted sensitively

and with their full involvement, wherever possible.• Do make sure that the person who is being abused is safe and secure - this is

paramount but recognise their choice.• Do reassure the person that the service will take steps to support and where

appropriate protect them in the future.• Do report the information to your line manager at the earliest opportunity.• Do make a written record of what people have told you - preferably in their own

words.

'Do's And Don'ts'

• Don't stop anyone who is freely recalling significant events; allow them to share whatever is important to them.

• Don't ask questions or press the person for more details.• Don't promise to keep secrets, or make any promises you are unable

to keep.• Don't contact the alleged 'abuser' or alleged 'victim.'• Don't be judgmental, e.g. 'Why didn't you try and stop them?'• Don't break the confidentially agreed between the person disclosing

the information, yourself and your line manager.• Don't laugh or joke about what has been said.• Don't ignore what you have been told or dismiss what you have

heard.• Don't change the subject.• Don't say things like: 'come off it', 'stop messing about', 'that's

ridiculous', 'don't be stupid', 'S/he wouldn't do that'.

Preservation Of Evidence

If a sexual/physical offence has been committed then the police need to be called immediately and you will have to do the following in order to preserve the evidence for their examination:– Try to keep the person calm and quiet until the police arrive - do not

change their clothes, bath them or give them a drink - it will only be a short wait.

– Do not disturb the room.– Keep bedding, clothing and so on intact.– Put any tissues, condoms or bloody items in a clean envelope or glass.– Do not let other people go into the room until the police arrive.– Do keep the 'victim' and the 'abuser' apart -each should have a

different staff member. Do not let one worker look after both people as this may contaminate evidence.

– Do tell hospital staff what you think has happened as it may affect the way they treat the person, i.e. The importance of not bathing them or giving them a drink until the police arrive.

Dealing with emergencies

• Call an ambulance.• Contact the police - they will make arrangements for a

medical examination by a police surgeon.• Ask police and/or approved social worker to remove the

person alleged responsible either in relation to an assault or other crime or under Mental Health legislation.

• If there is no other way of ensuring their safety, arrange for the person who has been abused, to go to a safe environment.

• Arrange for the provision of immediate care services and/or respite care.

• Access emergency medical treatment and/or contraception

Guidance For Staff On Making A Written Record

It is very important to record what has happened, with sensitivity to the abused person, the precise factual details of the alleged abuse:

• Make a note of the date, time and setting in which the allegation was made of the incident of abuse.

• Make a note of anyone else who was there at the time, i.e. witness/es.• Write down what was said using the person's own words.• Separate out factual information from any opinions expressed - state exactly what

you saw or what was said. If you do include your own opinion you need to say that it is your opinion.

• Date and sign the report.• Use pen or ballpoint with black ink if you can.• To make sure your writing is legible.• To remember that your report may be required as part of any legal action or

disciplinary proceedings.• To keep a copy of what you have written for future reference.

Guidance For Staff On Making A Written Record

• Please note that if you write any rough notes just after the event to help you in putting your report /account together it is extremely important that you keep all these notes/messages etc. However illegible or rough you think they are in the appropriate file. These may be needed later for a court hearing or a disciplinary hearing. Also to write your report/account as soon as possible after the incident as leaving it a day or two could cause you to forget something vital.

Whistle Blowing - Reporting Suspected

Bad Practice • When you report a suspected incident of abuse or suspected

bad practice this should be made initially through your line manager. Unless, the line manager is carrying out the suspected abuse or bad practice then you report directly to the local office of social services department or the health service/social services inspectors if it is a residential/nursing home.

Alongside the report, workers should follow their own companies procedures for whistle blowing or reporting suspected bad practice. Whistle blowers are given protection under the public interest disclosure act, which became law in July 1998

The Public Interest Disclosure Act

Amends the employment rights act 1996 by extending employment protection rights to staff who reveal confidential information during their employment. If an employee reports on:– A criminal offence or a miscarriage of justice.– A safety hazard or risk.– An environmental hazard or evidence of environmental

damage.– A lack of compliance with a legal obligation.

And suffers a detriment as a direct consequence this could form the grounds of a complaint to an industrial tribunal.

Forms Of Detriment Include

• dismissal or redundancy• a demotion• a lack of promotion• withholding a pay rise or bonus• a termination of a fixed term contract

Public Interest Disclosure Act 1998

• One of the problems concerns the accuracy of the disclosure. However, if the person making the disclosure reasonably believes in the accuracy of the information and makes the disclosure in good faith, e.g. to his or her employer but not for personal gain - this situation is covered by the Public Interest Disclosure Act 1998

The Mental Capacity Act 2005

• has changed the legal framework since No secrets was published. It has introduced a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity. And, more importantly, it has introduced in law five simple but powerful principles which challenge us to create a new person-centred,empowerment-focused framework in which everyone must operate – and in which to locate safeguarding work.