Safeguarding Adults in Social Work

Andy Mantell, Terry Scragg, Andy Mantell, Terry Scragg

• Publisher: Learning Matters
• Year: 2011
• Print ISBN:
  9780857254016
• Edition: 2
• eBook ISBN:
  9780857254023
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This fully-revised Second Edition looks at how practitioners and students can achieve best-practice when working with vulnerable adults.

The first part of the book explores the evolution of concepts and policies for safeguarding adults, with particular reference to the Human Rights Act 1998 and the Capacity Act 2005. In the second section the focus shifts to good practice in empowering vulnerable adults. The final section focuses on developing effective professional and inter-professional practice.

PART 1
THE POLICY FRAMEWORK

Chapter 1
Policy to practice

David Gaylard

ACHIEVING A SOCIAL WORK DEGREE

This chapter will help you to meet the following National Occupational Standards.

Key Role 1: Prepare for, and work with, individuals, families, carers, groups and communities and other professionals.

• Address behaviour which presents risk to individuals, families, carers, groups and communities.

Key Role 3: Support individuals to represent their views and circumstances.

Key Role 4: Assess and manage risk to individuals, families, carers, groups and communities.

Key Role 5: Manage and be accountable, with supervision and support, for your own social work practice within your organisation.

• Work within multi-disciplinary and multi-organisational teams, networks and systems.

Key Role 6: Demonstrate professional competence in social work practice.

• Research, analyse, evaluate and use current knowledge of best social work practice.
• Review and update your own knowledge of legal, policy and procedural frameworks.
• Manage complex ethical issues, dilemmas and conflicts.
• Contribute to the promotion of best social work practice.

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Introduction

This revised chapter examines legislation and social policy in England, Wales and Northern Ireland (see Chapter 4 for discussion of Scottish law) with regard to safeguarding adults at risk (formerly known as ‘vulnerable adults’). It critically reviews key social policy that has influenced evolving safeguarding adult practice. It starts by defining key concepts before exploring how policy in practice has been incorporated into current procedural guidance and concludes with a consideration of the challenges which exist within empowering practice. Although currently there is no single consolidating piece of legislation in England, Wales and Northern Ireland, there are numerous pieces of legislation supplemented by policy aimed at detecting and preventing abuse.

What do we mean by abuse?

Where there are regional variations in definitions of abuse, No secrets (Department of Health, 2000) provides the following definitions:

Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or failure to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot give consent.

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

Physical, sexual, financial, emotional, discriminatory or psychological violation or neglect of a person unable to protect him/herself to prevent abuse from happening or to remove him/herself from the abuse or potential abuse by others.

a violation of individuals’ human and civil rights by another person or persons. (p9)

Key concepts in adult abuse

No secrets (2000) and other policies concerned with safeguarding adults have developed a number of terms and concepts that will aid your understanding of this complex field.

‘Vulnerable adult’ (now referred to as ‘adult at risk’) refers to:

any person aged 18 years and over who is or may be in need of community care services including services due to their role as carer by reason of mental or other disability, age, illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or serious exploitation.

(Lord Chancellor’s Department, 1997)

‘Vulnerability’ is a broader concept which may apply to a wide range of disabilities and situations including those adults at risk because of their caring or dependent role or family responsibilities. Vulnerability is a contentious concept and there are often conflicting views concerning an individual’s capacity and social situation. Therefore, this terminology has consequently been replaced by ‘adult at risk’ in revised multi-agency safeguarding adults policy and procedures. The UK prevalence survey (Comic Relief and Department of Health, 2007) highlights that it is often an individual’s context that makes them more vulnerable to abuse. Therefore, you have to be careful not to locate the cause of the abuse with the victim rather than the perpetrator.

This book seeks to acknowledge the range of situations and relationships in which people suffer abuse, but particularly focuses on the empowerment of adults:

who are or may be eligible for community care services to retain independence, well-being and choice and have access to their human rights to live a life that is free from abuse and neglect.

(ADSS, 2005 p5).

This definition specifically includes individuals assessed as being able to purchase all or part of their own care services, plus those deemed eligible for local authority commissioned community care services (e.g. low, moderate, substantial or critical need index of the Fair Access to Care eligibility criteria). This may include a need to access mainstream services, e.g. the police, trading standards, legal advice, in relation to a safeguarding issue.

‘Significant harm’ is a key concept within safeguarding adults work which helps practitioners to determine how serious or extensive abuse must be to warrant intervention.

Harm should be taken to include not only ill-treatment (including sexual abuse and forms of ill treatment that are not physical); the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, emotional, social or behavioural development or the impairment of health.

(Lord Chancellor’s Department, 1997)

The Law Commission Review of Adult Social Care Law Consultation (2010) added ‘unlawful conduct’ which appropriates or adversely affects property, rights or interests (e.g. theft, fraud, embezzlement or extortion) to help determine how serious or extensive harm must be to justify intervention.

‘Proportionality’ remains a fundamental concept since the implementation of the Human Rights Act 1998. The Act places a duty upon public authorities to intervene to protect the rights of the citizen, but requires that intervention must not be excessive in comparison with the risk posed (see Chapter 2).

‘Capacity to consent’. The Mental Capacity Act 2005 enshrines a presumption of capacity. Individuals are assumed to have capacity to make informed decisions, unless there is clear evidence to the contrary. This is often a critical issue when deciding whether a person has been abused or not and is discussed in detail in Chapter 3.

Categories of adult abuse

In highlighting the forms of abuse experienced by adults it is important to acknowledge their limitations. Such definitions cannot fully convey the impact upon the individual and their families. The Comic Relief and Department of Health UK prevalence survey (O’Keefe et al., 2007) conveys the complexity of abuse, with people sometimes being subject to multiple forms, overlapping or incremental abuse.

Physical abuse has been defined as the non-accidental infliction of physical force that results in bodily injury, pain or impairment (Stein, 1991, quoted in McCreadie, 1994). Practice examples include falls and injuries without satisfactory explanation or that are not conducive to present injuries. Other examples include pinching, scalding, slapping, pushing, hitting, kicking or hair pulling. Inadvertent physical abuse sometimes originates from poor practice, e.g. inappropriate application of outdated moving and handling techniques, involuntary isolation or confinement and the misuse of prescribed medication.

Sexual abuse is the involvement of adults in sexual activities without informed or valid consent, e.g. where the individual may have insufficient mental capacity to have full understanding and appreciation of the activity. This form of abuse includes coercion into the activity due to the other person being in a position of trust, power or authority. Practice examples of non-contact activity can include exposure to pornography, voyeurism, exhibitionism, innuendo, harassment, teasing, and photography. Contact examples include touching of breasts, genitals, anus, mouth, masturbation, attempted penetration to full sexual intercourse (Brown and Turk, 1994).

Psychological and emotional abuse can involve fear through threats of force, intimidation, humiliation or emotional blackmail, bullying, swearing and any other form of mental cruelty or manipulation or exploitation that results in mental or physical distress. Practice examples involve threatening an individual in a manner that is inappropriate to their age or cultural background, blaming, swearing, harassing, ‘cold-shouldering’, intentional isolation or confinement. It also includes the denial of basic rights, e.g. choice, dignity, privacy, self-expression and individuality.

Neglect is the repeated withholding of adequate care to achieve important daily activities of living which can be either intentional or unintentional. It also involves acts of omission, e.g. the failure within the context of a duty of care intervention to prevent harm of an individual, who may be considered not to have sufficient capacity to appreciate risk, poor or outdated manual handling techniques. Practice examples sometimes involve failure to provide food, heating, medical care, basic hygiene, appropriate personal and mouth care, basic pressure-area care, clothing, inappropriate use of prescribed medication.

Self-neglect alone may not necessarily warrant adult protection investigation unless the situation involves a significant act of omission by someone else with established responsibility for caring. Care management assessments and review procedures (including risk assessments) may often be a more appropriate response and intervention to consider in regard to situations of self-neglect. However, if an individual is mentally incapacitated, under the Mental Capacity Act there is a duty to intervene.

Financial abuse is the denial of access of the individual to money, property, possessions, valuables or inheritance, improper or unauthorised use of funds via omission, exploitation or extortion through threats. Perpetrators of financial abuse frequently hold positions of trust, confidence or power (see the research summary in this chapter). Practice examples include forcing sudden changes to a will, stealing, preventing access to or misappropriating money.

Institutional abuse occurs in care settings when individual service users’ needs and wishes are sacrificed in favour of the organisation’s agenda, staff regime or externally imposed performance targets. Practice examples can include arbitrary monetary limits to care plans waived as soon as there is a complaint, inflexible routines established around the needs of care staff rather than individual service users. Examples include fixed menus with no alternatives or choices offered, having to eat together at set times, rigidly enforced bedtime or toilet regimes, limited bathing times designated to suit staffing levels, no doors on toilets. Behaviour is generally cultural in origin and not specific to certain members of staff and is often as a consequence of inadequate leadership, poor management and staff training (see Chapter 10).

Discriminato...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Editors and contributors
• Series Editors’ Preface
• Acknowledgements
• Introduction
• Part 1: The policy framework
• Part 2: Empowering practice
• Part 3: Effective practice
• Conclusion
• Appendix: Subject benchmark for social work
• References
• Index