Research team: Martin Stevens, Caroline Norrie, Katherine Graham, Shereen Hussein, Jo Moriarty, & Jill Manthorpe.

Local approaches to safeguarding adults at risk:

Overview of research

Acknowledgement and Disclaimer

• This presentation presents independent research funded by the NIHR (National Institute for Health Research) School for Social Care Research.

• The views expressed in this presentation are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health

• We would like to thank all participants in the study

Introduction

• Adult safeguarding background • Messages from the literature • Specialism • Decision-making and thresholds • Multiagency working • Models of Safeguarding - aims and methods • Models of Safeguarding • Safeguarding referral outcomes • Feedback on safeguarding • Priorities for training

Adult safeguarding in England

• Protecting adults at risk from mistreatment and neglect through processes of referral, investigation, protection plans and monitoring (also known as elder abuse, adult protection).

• Local Authorities continue to be the lead agencies (since 2000)

• The Care Act 2014 created a duty on local authorities (for the first time) to: – ‘make enquiries, or ensure others do so, if it believes

an adult is, or is at risk of, abuse or neglect.’ (Care Act Statutory Guidance, 2014 p192)

• However, still no prescription on how Local authorities (LAs) organise adult safeguarding

Specialism

• A ‘continuum of specialism’ from fully integrated into everyday social work practice to completely specialised (Parsons, 2006)

• Development of Adult Protection Coordinator as specialist practitioners (Cambridge & Parkes, 2006)

• Parallel development in Health and the Police (White & Lawry, 2009)

Benefits and problems of specialism

Benefits • Increase objectivity

(Manthorpe & Jones, 2002) • Create ‘organisational

memory’ (Owen, 2008) • Facilitate good working

relationships with providers (Fyson & Kitson, 2012)

• More investigations in institutional cases (Cambridge, et al, 2011)

• Higher likelihood of substantiating alleged abuse (Cambridge, et al, 2011)

Problems • Sometimes create conflict with

operational social workers (Parsons, 2006)

• Reduce continuity (Fyson & Kitson, 2010)

• Deskill non specialist social workers (Cambridge & Parkes, 2006)

Decision-making and thresholds

• More senior managers in decision making are less likely to allocate alert as safeguarding (Thacker, 2011)

• Likelihood of substantiated allegations (Johnson, 2012)

• Impact on the organisation (McCreadie et al, 2008)

• Blurred definitions of abuse - ‘cognitive masks’ (Ash, 2010, 2013)

Multagency working

• Central to policy since 2000 • Definitional challenges • Lack of resources to develop

partnerships • Lack of clarity about different

professionals’ roles • Care Act 2014 requirements

perceived as good driver • Shared development of policies and

procedures are reportedly beneficial • Some improved communication with

co-location and the development of Multi Agency Safeguarding Hubs

Models of Safeguarding

• This multi-phased and mixed-method study aimed to answer the following questions: – How have models of adult

safeguarding been addressed in the literature and other documentary evidence?

– What distinct different organisational models of safeguarding can be identified?

– What are the key variables between any different models?

– What outcomes are linked to different models of safeguarding?

Methods • Phase 1

– Literature review – Interviews with adult

safeguarding managers

• Phase 2 – Five sites – Staff survey – Secondary statistical analysis of Abuse of Vulnerable Adults

Returns (Now Safeguarding Adults Returns) and Adult Social Care Survey

• Phase 3 – Same five sites – Interviews with safeguarding practitioners and managers – Feedback interviews with care home managers, housing staff,

IMCAS and LA solicitors

Models of Safeguarding

Four models were identified in phase 1: • Dispersed-Generic – safeguarding referrals

managed and undertaken by operational social work teams

• Dispersed-Specialist – safeguarding enquiries managed and undertaken by a mix of locally based specialists and operational social work teams.

• Partly Centralised-Specialist- some high risk referrals managed or undertaken by central specialist team

• Fully Centralised-Specialist – Most safeguarding work undertaken by a central specialist safeguarding team

Implications of models • Staff in less specialist sites perceived themselves to

have more knowledge of particular groups • Specialist staff valued the increased knowledge of

safeguarding processes, law and procedures including multi agency working

• In more specialist sites, mainstream social workers had less confidence in their safeguarding practice

• Prioritising work more challenging for social workers in less specialist models

• Some tensions over allocation of safeguarding work in more specialist sites

• More specialist safeguarding involvement means more ‘handovers’ and thereby less continuity

Safeguarding referral outcomes

• Odds of substantiating referrals highest in Dispersed-Specialist sites

• Overall staff felt positive about their level of effectiveness in safeguarding

• Model had little impact on social workers’ views of effectiveness

• Good relationships with other teams and good support from managers related to higher views of effectiveness of safeguarding

Care home managers valued:

• Positive: – The importance of a properly functioning

MASH – Knowledgeable and professional social workers – Supportive approach of social workers – Access to LA training for care home staff

• Critical – Social workers with high caseloads – Lack of access or involvement with social

workers – Inconsistent knowledge of the Mental Capacity

Act (2005)

Priorities for training • Social care law particularly

the Mental Capacity Act 2005

• Deprivation of Liberty Safeguards

• Safeguarding implications of the Care Act 2014.

• Court work (less of a priority for the Centralised Specialist site)

Conclusions

• Model of safeguarding less important than expected • Highlights the importance of

– Supportive management styles – Fostering good relationships between and within teams – Developing a rational and acceptable means of allocating safeguarding

work between specialists and mainstream social workers – Ongoing training

• Choice of model may be linked more to local factors such as stability of population and workforce (where less stable populations require the development of specialist approaches)

Thanks for listening

Research Team:

• Martin Stevens (martin.stevens@kcl.ac.uk)

• Caroline Norrie (caroline.norrie@kcl.ac.uk)

• Katherine Graham (katherine.graham@york.ac.uk)

• Jill Manthorpe (jill.manthorpe@kcl.ac.uk)

• Jo Moriarty (jo.moriarty@kcl.ac.uk)

• Shereen Hussein (shereen.hussein@kcl.ac.uk)