Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

Abstract

PurposeThe purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available from this data set of reviews to propose a model of good practice that can be used as the basis for subsequent SARs.Design/methodology/approachFurther published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been performed from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further SARs where self-neglect is in focus.FindingsFamiliar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where SARs are commissioned.Research limitations/implicationsThe national database of reviews commissioned by SABs is incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice.Practical implicationsAnswering the question “why” is a significant challenge for SARs. A framework is presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process.Originality/valueThe paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to SARs by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.