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Learning Outcome 1
Understand the factors that contribute to the incidence of abuse and harm of self and others
1.1 – Explain why particular individuals and groups may be vulnerable to abuse and/or harm to self and others
1.2 – Review risk factors which may lead to incidence of abuse and/or harm to self and others
1.3 – Analyse the impact of social and cultural factors on different types of abuse and/or harm to self and others
Abuse is defined as a violation of an individual’s human and civil rights by any other person or persons. A Vulnerable adult is a person who 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.” (Adult Social Care Statistics Team, 2013).
One of the most vulnerable groups in British society are individuals with intellectual disability. Amid an ever-increasing population, it is estimated that 1,198,000 people in England have a learning disability (2% of the general population) (Holland, 2011). It is well documented that adults at risk have more exposure to opportunities for abuse, yet there is little definitive research indicating who is currently most likely to abuse someone with a learning disability. Some studies indicate that abuse is likely to come from other service users or from those with a family connection (Enable Scotland, 2009). This was recently highlighted in the serious case review of Winterbourne View which identified the exploitation of adults with learning disabilities and autism by hospital staff.
There are specific factors which may contribute to the abuse and neglect of vulnerable adults. Bruder and Kroese (2005), in their research review refer to authors who identify the following risk factors:
- Poor social skills
- Poor communication skills
- Physical dependence – (for example help with personal care, mobility, nutrition).
- Lack of education about appropriate sexual behaviour,
- Lack of awareness about how protect themselves.
Individuals with learning disability, autism or dementia often have additional, secondary medical conditions which further limit their capability to safeguard themselves against abuse and neglect. This can impact upon the ability to:
- Live independently
- Successfully make autonomous decisions
- Retain information
- Understand social situations or information being presented to them
The requirement for care and support immediately puts vulnerable adults at more risk than the rest of the general populace. Those providing care to a person who relies on them for support are in a position of power which has the potential to be either directly or indirectly abused. The probability of this is exacerbated in residential or nursing settings where groups of individuals have varying degrees of need. Turk and Brown (1993), identified that most victims of sexual abuse with a learning disability are women, and that the perpetrators are usually men who are known to the victim, and who typically go on to abuse again.
One crucial element in the safeguarding of adults is ensuring that there are enough employees on duty at any one time to provide adequate support. One in five nursing homes does not have enough staff on duty to provide safe care, the Care Quality Commission has found (McNicoll, 2014). When this occurs and staffing is not appropriate to the number of individuals needing provision, the scope for accidents and incidents is broadened. Abuse such as institutionalisation can occur when the needs of the organisation take priority over the needs of the client. Instead the setting operates systematically with poor practice as standard. This power based form of abuse disempowers the individual, and has the capacity to restrict all free thinking and choice, and can also be the reason for decline in physical and mental health. Organisations who provide support in this way often have poor management systems in place and an adverse work-place culture. The influence of this upon individuals is always negative with a complete absence of person-centred models of care. Indications of institutional abuse include the individual “not being addressed by their name (name calling), an unkempt appearance or obvious lack of adequate physical care, and an unquestioning adherence to inflexible systems or routines” (Tameside Metropolian Borough, 2017). These factors make it far more likely that an individual will be at risk of neglect and acts of omission with their basic needs not being met.
Furthermore, there is likewise a high risk of emotional/psychological abuse. Clients may be made to feel shame or guilt for exercising personal choice when the care staff have so many other people to attend to. This habitual blaming and scapegoating from staff towards the vulnerable individual can reinforce negative organisational culture, reduce client opportunities for complaint, and be the source of self-harm, sudden changes in mood and low self esteem/depression.
Mental health conditions in particular demonstrate a disparity in the abuse occurring between the gender of those diagnosed and “differentially affect the power and control men and women have over their socioeconomic determinants, their access to resources, and their status, roles, options and treatment in society” (Department of Mental Health and Subtance Dependence, undated). Individuals with poor mental health are four times more likely to be victims of physical violence (BBC News, 2012), and those who are female are especially vulnerable to sexual abuse. Statistics from the World Health Organisation show that 1 in 5 of these women are victims of rape or attempted rape. Risk factors include:
- Not having access to safe, affordable housing
- Previous exposure to physical, emotional, sexual and verbal abuse.
- Lack of available care and support or rejection of support.
- Marginalisation and Isolation occurring through a lack of understanding from communities and society
- A lack of family and peer relationships
Indications of sexual abuse include frequent bruising, often in hidden places such as the thighs, breasts and buttocks, unexplained pregnancy in someone who is unable to give consent, sexually transmitted diseases or infections, fear of being alone with certain people and reluctance to accept help with personal care.
Abusers may covertly initiate exploitation and create a scenario in which it may appear the vulnerable adult is to blame. Flirtation, speaking sexually with the intent to arouse, and exposing oneself are examples of this (Emotional Abuse Answers, 2017).
The individual may feel they will be punished or chastised if they report what has happened or may not have the communication skills or understanding to fully comprehend what has occurred. “Disclosures of abuse are more likely to be ignored and seen as less credible when made by individuals with disabilities (Disabled Persons Protection Commission, 2017). If the actions of the abuser cause a decline in health and well-being, and medical advice is sought, symptoms may be attributed to the behaviour and learning disability of the individual rather than the cause. This is termed “Diagnostic Overshadowing” and consequently, appropriate investigations may not be undertaken (Bowness, 2014). An abusive person is often very aware of this power disparity between them and the individual and will take every opportunity to pervert time spent with the vulnerable adult, thus creating a “behind closed doors” environment in which the individual is oppressed with no way to break the cycle of abuse. Consequently, adults with poor mental health or learning disability are at further risk of psychological and emotional, physical , financial, material and sexual harm, primarily all forms of exploitation (Keenan, 2011)
The social and cultural factors which contribute towards the abuse of vulnerable adults are multifaceted, but identifying some of these core features can support in detecting who may be most at risk, and why. The sexual and physical abuse of adults at risk is are subjects that nobody wants to admit exist, but social service departments, media and serious case reviews demonstrate that this is a very real theme that is not restricted by borders. Abuse of individuals can have a historical component, and may have occurred since childhood within the family dynamic thus forming the mindset that sexual violation and domestic violence are acceptable and normal parts of every-day life.
People with learning disabilities who are dependent upon parental or family care, have less control and power over their own lives, which can result in them not accessing, or not being known by the wider community, consequently creating an ideal environment for abuse to occur.
Outsiders may describe a family as “keeping to themselves”, strengthening the concept that nothing inappropriate could be happening within the household setting. The introduction of The Care Act 2014 placed a duty of care with local authorities to provide an assessment to anybody who identifies as having care and support needs. However, it should be considered that in the past there were no such responsibilities placed upon establishments, and in an age of no social media, internet or mobile phones, the opportunity to address abuse was limited, meaning the exploitation of adults often went unreported. “It was not until the last third of the 20th century that child abuse was identified as a problem” (Bilston, 2006) and individuals born prior to that era faced the risk of slipping through the net and being unnoticed by services due to all of their immediate care needs being met by family members. In current society, although legislation aims to prevent exploitation happening, “it can be argued that such practice predominately focuses on pursuing effective responses to abuse that has already happened, rather than preventing the onset of abuse” (Marsland, Oakes, & White, 2007).
Sexual abuse early in life has the potential to make individuals additionally susceptible as they grow and mature. The development of psychological problems related to early trauma only increases the probability that an adult will be dependent upon care and support. A study by Borgman, Dyer & Feldman (2015) from the Journal of Child Sexual Abuse, identified that “those who had been exposed to childhood sexual abuse often developed negative emotional states as adults”. Diagnoses of post-traumatic stress disorder and borderline personality disorder were common features of the people on which the research was based. Psychological disorders that are rooted in abuse make it more likely that an individual will be open to being emotionally, physically and sexually abused. This status quo is enforced if those providing the care have been victims of sexual or physical abuse themselves. The Individual with learning disabilities might not comprehend that sexual abuse is exploitation, subsequently they may see no need to inform anybody about it. This vulnerability is what gives the abuser the scope to continue abusing.
Sexual and physical abuse occur regardless of the social stratification of individuals. Poverty, while not a determinant in this type of abuse, “tends to contribute to negative patterns of family functioning by interacting with other risk factors such as depression, substance abuse, and social isolation to increase the likelihood of abuse” (Antai, Braithwaite, & Clerk, 2016). It must be assumed then that the more factors an individual has within their family dynamic, the higher the potential is for abuse.
Most cultures view sexual exploitation as something that is abhorrent. However, the philosophies, customs and social behaviour of other nations, especially those that consider women, the disabled, and children to be second class citizens, often results in them having a completely different viewpoint to the UK. The subject of sexual abuse is “still a taboo in India. There is a conspiracy of silence around the subject… Part of the reason lies in a traditional conservative family and community structure that does not talk about sex and sexuality at all” (Anshu, Chacko, Mathur, & Pratibha, 2016). Understandably, such a sensitive subject is difficult to acknowledge, but values like that of India embody an ideology that would make it almost impossible for any individual to disclose that they have been a victim of abuse. Having considered this, it is equally important to note that if Indian culture is not acknowledging the concept of sexual abuse, how then are they making their vulnerable family members and children aware that it exists? The 2009 WHO report on changing the social and cultural norms that support violence documented socially acceptable standards from around the world and issued the following facts:
- Sexual activity (including rape) is a marker of masculinity (some parts of South Africa).
- Girls are responsible for controlling a man’s sexual urges (Sudan).
- Sexual violence is an acceptable way of putting women in their place or punishing them (South Africa).
- A man has a right to assert power over a woman and is socially superior (India, Nigeria, Ghana).
- Female children are valued less in society than males (Peru, where female children are considered to have less social and economic potential).
- Children have a low status in society and within the family (Guatemala).
- A woman’s freedom should be restricted (Pakistan).(World Health Organisation, 2009)
The Public Health definition of sexual violence includes the sexual abuse of mentally and physically disabled people and the sexual abuse of children (Bhugra, Craig, & Bhui, 2010)
The United Kingdom has many diverse communities, all with their own “cultural norms”, some of which support physical and sexual violence in addition to holding restrictive and antiquated views on women and children. Principles like these clearly have the potential to be at the root of abuse. Some cultures may refuse services for care and support, because their cultural ideology dictates that strangers should not access the confines of the family unit. This can be especially worrying when there is a vulnerable person at risk and has the capacity to effectively prevent abuse being detected. Families who arrive in the UK and are part of an ethnic minority often have additional factors which can put vulnerable adults further at risk of sexual abuse, such as:
- A mindset that people with disabilities are inferior
- Disinterest in services
- Being an illegal immigrant
- Unknown previous criminal convictions
- Differing views on how vulnerable adults should be treated
- Societal values that are outdated and unacceptable.
Self-harm is described as a way to express something that an individual may not be able to put into words, to avoid disturbing memories, or to gain a sense of control over one’s life. It can also be used to create a sense of consistency or to transfer emotional pain into physical pain (Mind, 2013). There are various ways an individual could use self-harm including over or under eating, poisoning, over-dosing on medication, cutting or scratching and hitting oneself. The driving forces behind self-harm are often complex, but there are social and cultural determinants which form a common theme. According to Fliege Herbert et al. (2009), deliberate self-harm may occur at all ages, yet adolescents and young adults are at a higher risk. There is strong evidence that anxiety, depression and violence have links to self-harm, as does a previous history of sexual abuse. In addition to this, the study found that people who self-harm often have low self-esteem and limited coping mechanism’s. Subsequent social factors include “bullying, a dysfunctional family setting” (Harrington, 2001), while in older people, isolation, living alone and poor health were common determinants (Dennis, 2007). Poor outcome from self-harm may be influenced by further complex socio-economic factors such as poor housing and poverty, or may be culturally specific (Bergen, et al., 2010). Those living in deprived geographical areas have limited choices in how they socially interact, thus impacting on the opportunity to access interests or to form new relationships. This can only increase the frustration and anxiety felt by those who self-harm.
The three-city cohort study on self-harm in 2010 looked at the ethnic/cultural differences in the rates and characteristics of self-harm in individuals aged between 16-64. Research concluded that rates of self-harm were highest in young Black females (16–34 years) in all three cities. The most common form of injury self-harming black females presented with at A&E departments was self-poison using non-ingestible substances. Black and minority ethnic groups were less likely to receive a psychiatric assessment or to re-present at hospital with self-harm (Bergen, et al., 2010). Consequently, ethnic minority individuals are unlikely to seek further help at hospital after initially presenting for self- injury therefore not accessing referrals and outpatient appointments for assessment. This places the already vulnerable adult at further risk of:
- Continued psychiatric issues.
- Sustained injuries from self-harm.
- Remaining unknown to services.
- Non-resolution of the source of problems.
Black females, especially those who have moved to the UK from deprived countries, may be more vulnerable because of their cultural understanding and expectations of support surrounding self-harm. Doku & Read (2012) describe mental health as a neglected area in health care in Ghana. With few clinicians and trained researchers in the field, research has been limited both in quantity and quality. This type of previous experience increases the probability that care and support services will be avoided, thus adding vulnerability to an already marginalised group.
The current global refugee crisis is placing massive demand on authorities who are already stretched to capacity and unskilled in the diverse needs of migrants and asylum seekers. “In the first 6 months of 2015, more than 220,000 people were detected crossing the Mediterranean to Europe. Many of these are fleeing the conflict in Syria” (Prime Minister’s Office et al., 2015). There are various reasons why people are choosing to seek asylum, including fleeing from war, political and social conflict, oppression and sometimes torture in their country of origin. Individuals within this group are one of the most susceptible groups within our society, with often intricate health and social care needs. Within this group individuals become increasingly more vulnerable, including women in all stages of pregnancy, lone children and people with substantial mental health problems or disabilities (Haroon, 2008). Arriving in the United Kingdom and being placed in camps, groups already have many complex issues which may put them or others at risk. These include but are not limited to:
- Breakdown of the family unit
- Inability to exercise rights/being unaware of rights
- Cultural differences
- Lack of identification paperwork
- Not understanding the English language
- Unknown health needs or learning disabilities
- Unknown previous criminal history
- Emotional trauma
- Being a victim of violence or rape and other types of abuse
- Lack of safety, security and privacy
- Lack of care and support
- Inadequate housing
- Lack of essential commodities such as clean water, nutritious food and warmth.
Individuals who travel to England as asylum seekers and refugees have often had no choice other than to leave their own country, and are forced into new surroundings of which they may have no understanding. In addition to this, a lack of comprehension about the law, health services, social behaviour and culture of the United Kingdom can be a cause of further isolation. Barriers to effective communication, such as a lack of appropriate translators, poor health or learning disability can equate to vital information being missed, and opportunities for safeguarding measures lost.
For those who have already been exploited in their home country, the additional trauma of moving thousands of miles can exacerbate any vulnerabilities, making the possibility of abuse more likely. The Report on Immigration Removal Centres in England highlighted that being a refugee or asylum seeker has a profound effect on mental health and well-being. Its research into the effect of this has emphasised that the “longer an individual spends in detention camps the more severe the impact becomes upon their mental health, with depression, post-traumatic stress disorder, and anxiety being the most common mental health problems” (Boardman, Durcan, & Stubbs, 2017).
In refugee detention centres, many different cultures may be thrust together at one time within the confines of an environment that is both alien and restricted. Although human rights are protected under UK law, there is a high probability that these are not exercised due to being unfamiliar with legislation. The scope for abuse is widened in detainee centres when:
- There is a lack of understanding of the customs or values of individuals
- Racism is present
- There are cultural values present which promote the degrading and violence of women and children
- There is intolerance or discrimination of those with learning disabilities
- The religious views of individuals or groups impact upon those of others
- There are refugees from opposing enemy countries placed together
- Those with criminal records are placed within centres
The safety of adults with intellectual difficulties would be severely compromised in an environment with so many additional risk factors present. Individuals and groups with learning disabilities would be highly at risk of multiple types of abuse due to a lack of appropriate care and support. The added influence of not understanding the language and customs of others increases the prospect of confusion, and misinterpreting social cues. Capacity to understand the sexually motivated behaviour of others may be impacted leading to single or multiple episodes of abuse. Cultures that view those with learning difficulties as inferior may subject individuals to “scapegoating”, in which the individual is singled out, blamed and treated negatively. This has the potential to continue, as someone with restricted understanding may not realise they are being abused. There may also be a willingness to unnecessarily accept the blame.
In the UK the Human Rights Act 1998 extends to refugees and asylum seekers. The government and immigraton officials are under an obligation to treat individuals with fairness, equality, dignity and respect. Alongside this the 1951 Refugee Convention provides an extra source of protection for asylum seekers (British Institute of Human Rights, 2006). However, this guideline is outdated and doesn’t take into consideration present social and cultural issues. It is only in the past 30 years that abuse has been highlighted as a worldwide problem and historically, prior to this, there was little legislation in place to support the safety of an individual. To rectify this, current asylum conventions and national policies need to be consolidated and clear with defined abuse prevention and safeguarding procedures. Policy should additionally incorporate more thorough screening strategies to better identify those at risk of abuse.
Cultures who hold radical religious views, or archaic and abusive values surrounding women, children and those with disabilities, should be strictly monitored and undergo therapeutic measures to ensure the safety of others. It would be beneficial if Individuals with significant vulnerability were not be subjected to the refugee custody process and instead provided with suitable care and support away from areas of risk, as this will immediately lessen the opportunity for abuse.
Stronger measures are needed in order to identify those who are suspected of violent crimes in their own country. Having this information prior to detention would mean that an incident doesn’t have to occur before a criminal past is exposed. The support requirements of asylum seekers and refugees should not be met by social service departments, but by dedicated, specific teams with a realistic budget. The assessment process should include constant feedback and conferencing with refugees in order to endorse the best standards of safety for those who are vulnerable.
“In the 1970s resettling Ugandan Asians, the government took the unprecedented step of creating no-go areas. The incomers were dispersed around the country to “green” areas where public hostility against them was likely to be low” (Refuge Week, 2003). By today’s standards, this action would be considered politically incorrect and leaning towards promoting both exclusion and discrimination. However, a benefit to this is that it has encouraged the growth and expansion of ethnic minority communities, reducing isolation in the process and enabling cultures who share the same values to be in close proximity to one another. It is widely documented that abuse is less likely to go unreported in societies that interact with each other, and, undeniably, those who are part of a neighbourhood who relate to each other and embrace similar principles are more likely to have better mental health and happier relationships. This system does appear to have empowered individuals whilst permitting them to securely rebuild their lives.
It is equally important to note the limitations of historical strategies, and discuss how their implementation today would not be possible. Under modern UK legislation the utlisation of no-go areas would not be endorsed, as it would be considered an infringment of The Human Rights Act, and of the Equality Act. In addition to this the population of England has grown exponentially since the 1970s and documented cases of abuse have risen drastically. The current crisis in care and housing means that there are less resources to house vulnerable families, and more safeguarding instances than social service departments are safely able to manage. The Care Act 2014 demonstrated that personalisation, partnership and best practice are successful in limiting the occurrence of abuse, but conversely this is only able to be implemented for people already accessing health and social care services. For refugees currently residing in camps, the opportunities for abuse and violence due to vulnerability remain a genuine, daily concern.
SAFEGUARDING IN HEALTH AND SOCIAL CARE LEARNING OUTCOME 3
3.1 – Explain existing working practices and strategies designed to minimise abuse in health and social care contexts
3.2 – Evaluate the effectiveness of working practices and strategies used to minimise abuse in health and social care contexts
3.3 – Discuss possible improvements to working practices and strategies to minimise abuse in health and social care contexts.
The organisation implements numerous systems and strategies which lessen the scope for abuse. These are reviewed on a regular basis to ensure they are still relevant, and still practicable in the delivery of care and support.
Monthly outcome Review
The monthly outcome review is a document that is used to record health and well-being outcomes on a monthly basis. This includes outcomes which have been chosen by the individual, and monitors whether they have been achieved or not. Health appointments are also logged onto the document, so that staff can see at a glance the last time the client saw a particular medical professional, and when their next appointment is. Monitoring the achievement of outcomes is vital within a health and social care setting, as it allows the organisation to demonstrate that they are adopting person-centred practice with clients, and in line with national legislation and codes of practice. This also provides an audit trail at a macro level, enabling the organisation to define which counties are achieving, and which are not.
Examination of monthly file review documentation enables care staff and management to recognise if outcomes are accomplished, and to highlight which particular outcomes may need more direct support in order to be achieved. Thus, client choices which are not obtained are quickly identified. The organisation acknowledges that person-centred practice reduces the possibility of abuse and neglect and understands that “prevention involves delivering high quality person-centred services in safe environments. All adults have a right to holistic care that is focused on their individual needs, including their need to be kept safe” (British Medical Association, 2011). To improve and continue plotting health and wellbeing outcomes effectively, the form should stay up to date with current ways of working and with any changes to legislation to ensure the latest practice is being adhered to.
When working with clients that have learning disabilities there is the possibility for miscommunication and misinterpretation. There is the potential for care staff to be accused of abuse or poor treatment falsely Reduced intellectual capacity is a cause of vulnerability in those accessing health and social care services, and exploitation can occur without systems and strategies in place to safeguard against this. Having an empowering and safe culture within the organisation ensures that confusion is kept to a minimum. This is demonstrated by:
- the provision of easy read and picture documents which promote client understanding
- An open door policy which encourages clients to speak about anything, at any time.
- Ascertaining how much an individual knows and understands about abuse and its prevention
- Working in non-discriminatory, and anti-oppressive ways
- Empowerment through consultation – Individuals are involved and consulted about their opinions about service delivery, and as a result changes are implemented.
Promoting power and control through person centred practice is the main factor in reducing opportunity for abuse, and additionally recognising that the framework of assessment is ongoing and fluid rather than set in stone.
“Assessment is increasingly acknowledged to be a continuous process” (Hepworth, Rooney, & Larsen, 1997) and identifies that changes will occur in the life of an individual which can impact upon the type and amount of support they require.
Having user group-specific information to support in the identification and prediction of risk factors can support an organisation in safeguarding their clients. “Perceptions of risk and views on what might constitute acceptable practice in appraising and assessing potential risks are likely to differ between different groups of professionals and the support they provide to different groups of service users and informal carers in areas such as, mental health, disability and older age” (Glendinning & Mitchell, 2007).
Currently within the organisation information is freely available in differing formats for both care staff and supported individuals. This promotes education and awareness that people with learning disabilities are at risk of multiple types of abuse, including:
- Sexual abuse and exploitation
- Financial abuse
- Emotional/psychological abuse
- Physical abuse
- Deprivation of liberty
- Verbal abuse
Training for staff members, and continued education or qualification allows employees to develop an understanding of why learning disability makes individuals more vulnerable, and this is then incorporated into practice resulting in improved delivery of care.
The use of an intranet system within the agency is a huge benefit. It enables staff members to access policies and procedures at any time – even if away from the service and out in the community with a client. Information, safeguarded through a secure database can be shared effectively, providing up to date changes to client needs. This is especially useful for those staff members that lone work at a service, and who may rely on information that has been handed-over in note form. There are also opportunities for professionals in joint-working relationships to exchange information and reports. This can lessen the timescale for important information relating to clients to be relayed.
An equally significant aspect of the utilisation of ICT is its ability to educate and include individuals having support. Children as young as 3 in nursery education are, at a basic level, using the internet, digital cameras and computer art software as gateways to learning and development, and yet some of the most vulnerable adults, particularly those individuals with learning disabilities, do not and cannot access ICT. Additionally, there is often a philosophy that adults at risk have no interest or need to take advantage of this technology. Consequently, “recent policy statements and guidance from the UK government have underlined the importance of ICT for adults with learning disabilities specifically, as well as for the population in general, through the potential it offers for social inclusion” (Daniels, Parsons, Porter, & Robertson, 2005).
Adults at risk are a user group who rarely have input into creating ICT devices which are safe and easy for them to use. This absence of inclusion toward such a large part of the population is responsible for the gap in who can utilise ICT, and who cannot. Goggin and Newell (2003) clarify how individuals with disabilities are rarely in the position of power required to make decisions on Internet policy and remain “systematically excluded from interactive digital communications even while receiving consolatory attention in policy discussion”. Supporting adults at risk to have safe access to the internet can support in:
- Broadening educational prospects
- Accessing peer groups
- Maintaining relationships with friends and family members
- Identifying information which helps minimise abuse
All of which are key factors in inclusion, safety, and person centred care. The National outcome framework for vulnerable adults follows the Department of Health’s defining standards for the support of those at risk, and is used within all services providing care. The underpinning themes that any organisation must achieve for the clients they support are as follows:
- I am happy with the quality of my care and support and I know that the person giving me care and support will treat me with dignity and respect
- I am supported to maintain my independence for as long as possible
- I understand how care and support works, and what my entitlements are
- I am in control of my care and support
- I feel safe and secure
- I have as much social contact as I want with people I like (Department of Health, 2014).
These are achieved through effective assessment and planning, implementing person centred values and care, and the incorporation of a positive safety culture within the organisation. To improve upon the delivery of the above 6 standards, support staff could incorporate them into the monthly file audit, and consult each month with clients to see if they feel the principles are being achieved
Joint working relationships are key in ensuring the safety and wellbeing of supported clients. This collaborative way of working not only achieves government objectives, but also allows for a better and safer package of care and support for the individual. Each stakeholder may have specific expertise, be adhering to different codes of practice, or performance indicators, but the outcome of the entire team will be focused on the health and wellbeing of the person. Within the organisation, partnership working is usually delivered within a multidisciplinary capacity with support staff, social services, day service staff, mental health services and occupational therapy. Individual viewpoint, joint advice and treatment is implemented into the care and support of the individual.
Having additional professionals involved with the individual decreases the possibility for abuse and neglect, as poor treatment is less likely to be missed. Working in teams with individuals, allows information to be shared faster and identifies gaps in provision more effectively. This, alongside a healthy communication ethos and strong understanding of confidentiality policy result in only necessary information being shared with outside agencies, thus safeguarding the individual and promoting privacy.
Delivering a successful result via partnership working is dependent upon the competence of the collaboration as a whole. Barriers, such as ethical issues, unforeseen situations or perceived disinterest of services can have a damaging effect on all participants. Similarly, unstable teams with constantly shifting partners, especially in the role of social care workers’ or relief professionals, can induce trepidation, lack of trust and a delay in providing services, ultimately resulting in poor partnership working. There is a possibility of the differing geographical areas of stakeholders creating problems within the team. Agencies may be operating in more than one county, each county having its own legal responsibilities and priorities. There is also the risk of duplicating work, which means outcomes for the individual could be slowed down. Collaboration generally works extremely well within the organisation, with the exception that limits to budgets often curtail what can be realistically delivered to the client. To improve upon this, stakeholders must be transparent about this from the onset of the joint working relationship to promote clarity. This will ensure that all members of the partnership have a clear idea of the limits imposed by each stakeholder, therefore providing a clearer picture of how best to safeguard individuals from harm.
Mental capacity and decision making processes
Having mental capacity implies that an individual is able to make autonomous decisions. The law (Mental Capacity Act 2005) defines that an individual is unable to make decisions if any of the following four statements apply to them:
- Comprehend information that is given to them
- Retain or hold on to information long enough to make the decision
- Evaluate available information to make a decision
- Communicate their decision – by whatever method the individual uses, this could be facial gesture, sign language, Makaton or talking (Office of the Public Guardian, 2009)
Sometimes best interests’ decisions must be made to safeguard an individual from harm and exploitation, but these must never be based purely upon the basis of disability. Just because an individual is vulnerable does not mean they do not have the capacity to understand, or to be supported to make a decision. When supporting a client with a learning disability to make a decision, the organisation must make sure that the individual has all available information at hand and presented to them in the easiest possible way for them to understand. The process should occur at a time and place where the client feels most at ease, and with minimal disruption. Advocates or family members are able to support in this procedure. The Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DOLS), which were developed in 2009 provide a legal framework to avoid unlawful deprivation of liberty happening. The safeguards defend adults at risk who lack the capacity to agree to plans made for their care or treatment but who need to be deprived of their liberty in their own best interests to protect them from harm. Primary care trusts (PCTs), local authorities, hospitals and care homes have a statutory responsibility for administering and delivering the MCA DOLS at a local level (Office of the Public Guardian, 2009).