By the end of the session you will; Objectives By the end of the session you will; Know how to recognise the signs and symptoms of abuse Know how to respond to disclosed or suspected abuse Understand the national and local context of safeguarding and protection policies and procedures Understand ways to reduce the likelihood of abuse Know how to recognise and report unsafe practice

Revision Quiz

Working in small groups define the term ‘Vulnerable Adult’ TASK 1 Working in small groups define the term ‘Vulnerable Adult’ Five Minutes

Vulnerable Adult? A‘vulnerable adult’ is someone who: Click for more A‘vulnerable adult’ is someone who: “has attained the age of 18; is in residential care or is in sheltered accommodation or receives domiciliary care or receives any form of health care and has any form of disability” (Safeguarding Vulnerable Groups Act 2006) “is or may be in need of community care services by reason of mental or other disability, age or 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 exploitation.” (No Secrets 2000)

Who is a vulnerable adult? TASK 2 Working in small groups answer the question Who is a vulnerable adult? Five Minutes

Who is a vulnerable adult? Abuse can affect any vulnerable adult, but particularly someone who is, or may be, unable to protect themselves against significant harm or exploitation, for example: Older people People with mental health problems People with physical disabilities People with learning difficulties or disabilities People with acquired brain damage People who misuse substances

Other vulnerable adults may be: People who are isolated and lack contact with other people People with memory problems or difficulty communicating People who don't get on with their carer People with carers addicted to drugs or alcohol People with financially and emotionally dependent carers

What kind of person abuses vulnerable people? TASK 3 As a whole group discuss the following question What kind of person abuses vulnerable people?

Who abuses? Anyone can be an abuser, often it can be the person you least expect, such as: Spouse/partner Carers and Care Workers Family member/relative Friend Neighbour Volunteer helper Someone not known to the person.

Winterbourne View

Types of Abuse Physical abuse Sexual abuse Emotional/psychological abuse Financial abuse Institutional abuse Self neglect Neglect by others

Working in small groups define the following: TASK 4 Working in small groups define the following: Group A Physical abuse Sexual abuse Emotional/psychological abuse Group B Financial abuse Institutional abuse Self neglect Neglect by others

Types of abuse; some definitions Physical: including hitting, shaking, biting, grabbing, withholding food or drink, force-feeding, wrongly administering medicine, unnecessary restraint, failing to provide physical care and aids to living Sexual: including sexual assault, rape, inappropriate touching/molesting, pressurising someone into sexual acts they don't understand or feel powerless to refuse Emotional or psychological: including verbal abuse, shouting, swearing, threatening abandonment or harm, isolating, taking away privacy or other rights, bullying/intimidation, blaming, controlling or humiliation

Financial or material: including withholding money or possessions, theft of money or property, fraud, intentionally mismanaging finances, borrowing money and not repaying. Neglect: including withholding food, drink, heating and clothing, failing to provide access to health, social and educational services, ignoring physical care needs, exposing a person to unacceptable risk, or failing to ensure adequate supervision. Discriminatory abuse: including slurs, harassment and maltreatment due to a person's race, gender, disability, age, faith, culture or sexual orientation. Institutional abuse: including the use of systems and routines which neglect a person receiving care. This can happen in any setting where formal care is provided.

Signs and Symptoms of Abuse TASK 5 Signs and Symptoms of Abuse What might we notice about a service-user who is experiencing the following? Physical abuse Sexual abuse Emotional/psychological abuse Financial abuse Institutional abuse Self neglect Neglect by others

Signs and Symptoms of Abuse Things we might notice about a service-user Physical Abuse When an individual is physically harmed by those who have a responsibility for their care. Examples may include: slapping, being restrained in a chair, or given too much medication Signs: Unexplained cuts, bruises, burns or other marks Unexplained injuries of any nature Exhibiting fear reactions when approached

Sexual Abuse Any form of abuse of a sexual nature including exploitation. Being involved in a sexual act that was unwanted or not agreed to, such as: rape, indecent assault, watching pornography etc. Signs: Unexplained injury to genital or other private areas Genital or anal soreness or infection Apparent fear or avoidance of physical contact Overtly sexualised behaviour or language

Emotional or Psychological Abuse When an individual is treated in a way that causes emotional or psychological harm that causes distress. Examples may include : constant criticism, disrespect or overt rudeness from carers or others, who may bully or undermine the service-user Signs: Obsessive,Compulsive behaviour Service-user may appear overly anxious to please Service-user may become withdrawn Service-user may exhibit lack of concentration Service-user may experience difficulty in focussing Service-user may exhibit loss of skills or abilities

Financial Abuse Any form of abuse which adversely affects the financial welfare of an individual. This may include theft by friends, family, acquaintances or carers; or threats to gain access to someone's money, or to get them to change their will Signs: Unexplained lack of money Sudden loss of assets Objects missing from the home Bills not being paid Being excessively or unusually protective of possessions Being excessively or unusually careful with money

Institutional abuse Any form of abuse which is created or sanctioned by the systems, policies and procedures of an organisation. This may involve any or all of the other forms of abuse Signs: Inadequate (or absence of) care or support plan Shared possessions in a residential setting Frequent admissions to hospital Many different carers (High staff turnover) Lack of consistency in the quality of care Inadequate equipment to support care giving

Self Neglect When an individual harms him or herself or fails to take adequate care of him or herself. Signs: Unexplained or inappropriate weight loss Hunger or thirst Unexplained cuts, marks or other injuries Dehydration Lack of personal care Dirty or unkempt appearance Medication not taken or taken incorrectly Missed medical appointments

Neglect by others When an individual is neglected by those who have responsibility for his or her care. Signs: Unexplained or inappropriate weight loss Hunger or thirst Unexplained cuts, marks or other injuries Dehydration Lack of personal care Dirty or unkempt appearance Medication not taken or taken incorrectly Missed medical appointments Failing health

Legislation and policy associated with safeguarding 'No Secrets' 2000 Safeguarding Adults - Consultation of the Review of the 'No Secrets' Guidance 2009 Human Rights Act 1998 CQC (CSCI) Safeguarding Adults Protocol and Guidance 2007 CQC Safeguarding Statement 2009 Mental Capacity Act Code of Practice 2005 Deprivation of Liberty Safeguards Code of Practice 2009 Safeguarding Vulnerable Groups 2006 Bichard Inquiry Report 2009 The Equality Act 2010

Local Policy LCC Multi-agency policy and procedure- Offers step by step guidance on the reporting of abuse, local safeguarding procedures and appropriate practices LCC Safeguarding adults policy (2010) Guidance to ensure all agencies work within a standard set of guidelines. Ensuring people are safe, free from violence, harm and abuse. Organisational policy – All settings are required to publish their own policies and procedures Click the book to visit LCC website

TASK 6 Working in small groups and using the resources available to you online and on paper, identify the correct procedures for dealing with incidents of abuse or incidents where abuse may be suspected.

What if I suspect abuse? The correct actions to take if abuse is suspected may include: Follow organisational procedures Report immediately to the correct person Record exactly what is suspected and why, Record injuries or marks on a body chart if appropriate Do not tell the person suspected of abusing the individual Do not discuss with anyone other than the correct person

What if someone tells me he or she has been abused? if an individual discloses abuse, the social care worker should take the appropriate actions listed on the previous slide. In addition he or she should: Reassure the individual Tell them you believe them Do not ask leading questions Tell the individual what you are doing and why Preserve any evidence

Preserving Evidence In the case of abuse- anything could be evidence; Remember: Don’t move or touch anything at the scene of event Where possible, leave things as and where they are. If anything has to be handled, keep this to a minimum. Do not clean up. Do not touch what you do not have to. Do not wash anything or in any way remove fibres, blood etc . Preserve the clothing and footwear of the victim. Handle these as little as possible to avoid cross contamination.

Preserve anything used to comfort or warm a victim – e.g. a blanket. Note in writing the state of the clothing of both alleged victim and alleged perpetrator. Note injuries in writing. Make full written notes on the conditions and attitudes of the people involved in the incident. Note and preserve any obvious evidence such as footprints or fingerprints.

Dealing with Abuse or Suspected Abuse It is important to recognise that abusive or unsafe practice may be found anywhere and involve anyone. Social care workers have a responsibility to take action in all cases. Duties include: Inform managers Report to police or other agency Challenge individual whose practice is not safe Take immediate action to protect any individual at risk Avoid cover ups or collusion Avoid aggressive challenges Demonstrate good practice in accordance with national and local legislation and policy

What if I report abuse to my line manager and nothing is done? Consider the following options: Whistle blowing: reporting your concerns to a higher authority such as the Care Quality Commission, the local authority safeguarding board, the police. Seeking further training and development for yourself and for other members of staff. Carefully record your concerns and seek advice from organisations such as the local authority safeguarding board, social services or other supportive organisations. Most importantly do not give up.

Organisations with a Role in Safeguarding Lancashire Adult and Community Services Directorate (Social Workers) Police Independent Social Care Providers inc. Supporting People Probation Service Safeguarding Children representative Medical professionals CQC Your organisations Criminal Records Bureau (CRB)

Who does what in safeguarding adults Police: Investigate crimes Will take action to prosecute if sufficient evidence is found Can arrange support for victims of crime. Medical Professionals: Examine and treat injuries, illness and medical conditions Can gather evidence to support police investigation into suspected abuse Can be used as expert witness to indicate likely causes of injury.

Social Worker: Assessment of need and access to a variety of services that can support and protect individuals. Regulatory Body: Regulatory bodies register and inspect agencies and care providers, and can require changes to practice to protect individuals. Criminal Records Bureau: CRB checks undertaken to inform prospective employers and organisations of previous convictions

Reducing the likelihood of abuse Person-Centred Care Person-Centred Care ensures that the service-user plays a central role in ensuring the quality of his or her care. The delivery of care becomes a partnership between the carers and the service-user. Person centred care can help an individual be more likely to protest about or report any safeguarding concerns, because he or she is a stakeholder in the care partnership and will feel more confident in expressing his or her concerns.

Reducing the likelihood of abuse Active Participation Individuals who are actively involved in their care are less likely to be victims of abuse as they have an opportunity to decide what they require and how it will be delivered. It also helps to ensure that carers see the individual as a partner rather than a passive recipient, which can ensure a more equitable balance of power.

Reducing the likelihood of abuse An effective and easy to use complaints procedure All organisations need a complaints procedure which is easy to understand and use. Individuals are more likely to make complaints about abusive situations if the system is simple and transparent. The complaint must be dealt with promptly with recorded outcomes.

Where do I go if I need guidance and support? Senior or more experienced staff Local joint working training sessions Relevant websites, books or leaflets (See below) Specialist workers in other agencies

LCC Multi-agency policy and procedure- Offers step by step guidance on the reporting of abuse, local safeguarding procedures and appropriate practices LCC Safeguarding adults policy (2010) Guidance to ensure all agencies work within a standard set of guidelines. Ensuring people are safe, free from violence, harm and abuse. Organisational policy http://www.lancashire.gov.uk/acs/sites/safeguarding/

Guidance and Advice Click on the picture to go to Lancashire County Council Safeguarding website for more information Click on the picture to visit the Social Care Institute for Excellence (SCIE) website.

Click on the picture to visit the Care Quality Commission (CQC) website Click on the picture to visit the NHS Vulnerable People website

QUIZ ANSWERS 1. Direct discrimination refers to treating a person less favourably than another person based on stereotypes, beliefs or prejudices. 2. Indirect discrimination refers to situations where it seems that people are treated equally but the requirements will have a particular impact on one group rather than another. 3. Diversity is recognition that each person is unique. Each person has their own heritage. Within larger groups there are differences (e.g. it is not acceptable to assume that everyone with a mental health problem has the same needs and same way of living their life)

4. Equality does not mean treating everyone the same 4. Equality does not mean treating everyone the same. It is linked to opportunities and fairness, so each individual has an opportunity to achieve his or her full potential and is not treated differently based on assumptions and stereotypes. 5. Inclusion is about working in a way that involves individuals. This may be in assessments, decisions about their care and how it will be delivered and reviews. Ensuring that any information is accessible to all using different formats if necessary. Accepting difference and choices that you may disagree with.

6. Examples of effective ways of challenging discriminatory practice may include: Report and record Whistle blowing Supervision Change systems Training and workforce development Individual coaching and mentoring Slide 3