Topic outline

  • 1. The Importance of Prevention

    Safeguarding Adults encompasses a range of activities, including the prevention and reduction in abuse and neglect. The Local Authority must also co-operate with such other agencies or bodies as it considers appropriate in the exercise of its adult safeguarding functions. All agencies should stress the need for preventing abuse and neglect wherever possible. Observant professionals and other staff making early, positive interventions with individuals and families can make a huge difference to their lives, preventing the deterioration of a situation or breakdown of a support network.

    Agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adult procedures. Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk through timely information sharing and targeted multi-agency intervention.

    • 2. Where Does Abuse and Neglect Happen?

      People can be at risk of abuse and/or neglect in a range of settings throughout the community ranging from their own homes to care service settings as well as in the wider community.

      • 3. Patterns of Abuse

        Patterns of abuse vary and include:

        • Serial abusing in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
        • Long-term abuse in the context of an ongoing family relationship such as domestic abuse/violence between spouses or generations or persistent psychological abuse; or
        • Opportunistic abuse such as theft occurring because money or jewellery has been left lying around.

        • 4. Risk Factors

          There are certain situations or factors that may place people at increased risk of being abused or neglected. The presence of one or more of these factors does not automatically imply that abuse or neglect will occur, but they are important to note as they may increase the likelihood. The following factors may be relevant to any adult who may be at risk of abuse & neglect, whether living in a domestic home, care home or receiving care, support or services in hospital or any community setting. They include:

          • An unequal power relationship or control, whether physical, emotional or financial, generally exists between the abused and the abuser;
          • Living in the same household as a known abuser;
          • A personal or family history of violent behaviour, alcohol or substance misuse or mental illness;
          • Adults living with other family members who are financially dependent on them;
          • Financial difficulties often leading to substandard living conditions;
          • Certain personal needs may present more opportunity for abuse. For example, where a person needs assistance to bathe or use the toilet;
          • Role reversal and need for intimate personal assistance. For example, a son or daughter providing personal assistance for a parent;
          • A member of the household or family experiencing emotional trauma or isolation;
          • Differences in communication or a breakdown in communication;
          • A change in lifestyle of a member of the household or family, such as illness, unemployment or employment;
          • Dangerous or inappropriate physical or emotional environment, such as lack of space or privacy;
          • Carers not in receipt of any practical and/or emotional support from other family members or professionals.

          It might also be the case that an individual's own behaviour or condition places him or herself at greater risk of harm. For example, due to the state of a person's mental ill health or learning disability, he or she might exhibit behaviour that suggests to others a willingness to be drawn into a situation that might pose them some degree of risk.

          The move away from protection towards safeguarding means that there does not need to be a specific incident causing concern but rather that the concern can centre around a general level of risk. By alerting and raising a concern in these circumstances, the safeguarding process can be used to prevent or reduce the possibility of abuse or neglect occurring, particularly if the concern is raised at the earliest opportunity to enable risk factors to be reduced.

          • 5. Who may be an Abuser?

            Anyone can carry out abuse or neglect, including:

            • Spouses/partners;
            • Other family members;
            • Neighbours;
            • Friends;
            • Acquaintances;
            • Local residents;
            • People who deliberately exploit adults they perceive as vulnerable to abuse;
            • Paid staff or professionals; and
            • Volunteers and strangers.

            While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for the abuse or neglect is known to the adult and is in a position of trust and power.

            • 6. Staff, Care Workers and Managers

              Research shows that a significant number of abuse and neglect incidents involve professionals, care workers and managers - i.e. people paid to care for and advise Adults at Risk.

              This fact places a responsibility both on staff and care workers, and those responsible for the practice of paid staff and care workers - in terms of management and supervision - to ensure that they are safe to work with Adults at Risk. This means that all the processes and checks surrounding who works with Adults at Risk and how they work must incorporate the avoidance of abuse including:

              • Robust recruitment procedures;
              • The policies and procedures staff/carers work to;
              • How staff/carers are inducted and trained, especially concerning professional standards, policy and procedures and the possibility of abuse;
              • How staff/carers are supervised and supported;
              • Appropriate disciplinary procedures to deal with unsuitable staff/carers;
              • Appropriate referrals to the Disclosure and Barring Service, (formally known as the Criminal Records Bureau/Independent Safeguarding Authority) where staff/carers are considered unsuitable to work with Adults at Risk or to professional bodies;
              • Whistle-blowing policy and procedures.

              See also Section 16 of Legal Framework Procedure

              Many professions also have a code of conduct, or similarly named documents, which set out good practice for the profession. Some examples of these are those for doctors, nurses, solicitors, occupational therapists and social care workers.  By definition, action in default of the code of conduct involving an Adult at Risk may constitute abuse or neglect. Professional bodies also have the authority to strike staff from the register in certain circumstances.

              It is the responsibility of managers and agencies to monitor performance and to intervene if risks exist. If, however, managers do not take this responsibility seriously, then it is the responsibility of peers and others involved to take action using agencies' whistle blowing and abuse polices.

              • 7. Allegations of Abuse between Service Users

                It is important to ensure that service users are aware of the danger of abuse, the warning signs and indicators, and how they can get advice and help when needed. It is not always necessary for every instance where one service user abuses another to be investigated formally using the Safeguarding Adults process. It is however, important that such instances are recognised and dealt with appropriately and efficiently by the organisation caring for the individuals. In some cases it may be appropriate and necessary to convene a Strategy Discussion / Meeting, for example if the alleged abuse also constitutes a criminal act or if the matter is particularly complex or requires further investigation. It may also be the case if there have been more than one incident involving the same perpetrator or victim (Alerted in the past). In other instances it may be that the situation can be dealt with by implementing internal procedures, reviewing care plans, requesting re-assessments or altering service provision. However, it is important that, even if the incident is dealt with internally, the Safeguarding Adults Team is alerted by completing a Safeguarding Adult Concern (SAC) form (available from the Information for Professionals and Volunteers link on the Sunderland City Council website) and returning it to the Safeguarding Adults Team as soon as possible after the incident has occurred or concern has been raised.

                Where there are allegations of abuse and the alleged perpetrator in an adult at risk, it is important to consider whether lessons can be learned from the decisions and actions that were taken in the handling of any concern.

                It might be useful to ask:

                • Could this incident have been avoided?
                • Have we reviewed management and practice to protect vulnerable people in the future?
                • Were other vulnerable service users or staff at risk?
                • Did we take the appropriate action at the right time?
                • Did we receive the support we needed? If not, what can we do to ensure that we receive it in the future?
                • Have the appropriate risk assessments or risk management plans been undertaken?
                • Did we consider the needs, rights, views and opinions of both victim and perpetrator?
                • Have we recorded the actions taken appropriately?
                • Have we revised care plans and set reviews?
                • Have we applied the Safeguarding Threshold Risk Assessment Guidance to guide decision making?
                • Have we informed the Safeguarding Adults Team by completing the Safeguarding Adult Concern Form?
                • Have we identified to safeguarding measures / action taken to safeguard the individual(s)?
                • What have we learnt and what would we do differently next time?

                The following points might assist in considering a post abuse care plan or Safeguarding Plan for actions or support work that may be required.

                For the Victim

                • Practical: home / community support services, closer oversight / monitoring, alternative accommodation, day care, short breaks, residential / nursing care, adaptations or aids, advocacy, medical treatment;
                • Emotional: victim support, psychology, counselling, therapy, psychiatric assessment/treatment;
                • Legal / Financial: money advice, legal advice re criminal/civil injury compensation, preparation for court;
                • Educational: training to cover key areas:
                  • Assertiveness;
                  • Sexuality and relationships;
                  • Social skills;
                  • Understanding what abuse is and safeguarding measures for the future, to enable them to protect themselves;
                  • Understand the implications of making unfounded accusations / allegations.

                For the Perpetrator

                • Practical: home / community support services, short breaks or day care, longer term residential care, additional / closer monitoring and/or supervision, alternative accommodation, adaptations / aids, help with housing;
                • Emotional: group support, counselling, advocacy, psychiatric / psychological input;
                • Legal / Financial: legal advice, money advice / debt counselling;
                • Educational: training to cover key areas:
                  • Sexuality and relationships;
                  • Understanding about issues of abuse;
                  • Support to develop social skills.

                • 8. Carers

                  It is important to ensure that carers are made fully aware of the danger of abuse and neglect, the warning signs and indicators, and how they can get advice and help when needed.

                  A starting point for all carers will be ensuring that they are made aware of these Sunderland Safeguarding Adults Procedures and any provider organisation's policy and procedures.

                  In instances where a carer presents a risk to an Adult at Risk, it is the responsibility of assessors and provider organisations to do whatever is needed to reduce the risk to ensure the safety of the Adult at Risk, including where appropriate raising a Concern under the procedure in Chapter 3: Managing Individual Cases - Procedures Relating to all Cases. Documenting discussion with the Adult at Risk concerning their wishes is imperative.

                  See also Involvement of Carers in the Safeguarding Adult Process.

                  • 9. Adults whose Circumstances make them At Risk of Abuse or Neglect

                    Although adults will vary in their ability to understand risk, most can be helped to greater awareness of what abuse and neglect is, how abusers operate and how to protect themselves and benefit from help.

                    There are many ways in which these adults can be helped to reduce the risks they may face, including:

                    • Increased awareness of the fact of adult abuse and neglect, how and where it may happen and who can be an abuser;
                    • Understanding and being given the skills related to how to avoid potentially abusive situations;
                    • Knowledge of what to do if an abusive situation arises: how to get help; how to report concern.

                    Helping these adults to protect themselves to their maximum ability should be a high priority activity for both care workers and carers.

                    • 10. The Public

                      Members of the public have a vital role in Safeguarding Adults at Risk through the prevention and detection of abuse and neglect. Consequently it is the responsibility of all agencies and professionals to play their part in ensuring that there is a good level of public awareness of adult abuse and neglect, and how concerns can and should be reported.

                      • 11. Transitions

                        Robust joint working arrangements between Children's and Adult Social Care Services need to be put in place to ensure that the medical, psychosocial and vocational needs of children leaving care, children with mental health problems, children with physical disabilities or children with learning disabilities or autism are addressed as they move to adulthood.

                        The care needs of the young person should be at the forefront of any support planning and require a co-ordinated multi-agency approach. Assessment of care needs at this stage should include issues of safeguarding and risk. Care planning needs to ensure that the young adult's safety is not put at risk through delays in providing the services to maintain their independence and well-being and choice.

                        Good practice includes:

                        • Having policies and procedures which support effective transition processes;
                        • Shifting the general view of risk as a potential danger for a child, to one of potential opportunity but acknowledging potential risks for an adult;
                        • Managing risks as a phased process with awareness of the psychological and emotional issues;
                        • Managing family expectations (being clear about the level of support and resources available);
                        • Taking time to get to know the young person and their family, especially if they have communication difficulties;
                        • Acknowledging the rights of adults to take more responsibility for their decisions.

                        See also: In Sunderland, a Multi-Agency Preparing for Adulthood Protocol and Pathway has been developed to address the transition to adulthood of children and young people with Special Educational Needs and Disabilities (SEND).