Adult Protection Practice Research Articles

Positive risk taking: debating the research agenda in the context of adult protection and COVID

PurposeThe purpose of this paper is to present the case for examining the concept of positive risk taking (PRT) in the context of adult protection. The paper argues there is a need for empirical research to understand the application of and attitudes to PRT to explore whether the concept has moved beyond a principle to make an identifiable difference to service users.Design/methodology/approachBy investigating evidence from policy, literature and professional opinion, this paper presents the ethical tensions for professional practice in adult protection between respecting a service user’s freedom to make choices to enhance their independence while preserving safety for service users and society. This is considered in the context of risk in health and social care and the recent changes in society resulting from COVID-19.FindingsInherent tensions are apparent in the evidence in health and social care between attitudes propounding safety first and those arguing for the benefits of risk taking. This indicates not only a need for a paradigm shift in attitudes but also a research agenda that promotes empirical studies of the implications of PRT from service user and professional perspectives.Originality/valueThis paper draws attention to the relatively limited research into both professionals’ and service user’s perspectives and experiences of PRT in practice.

Adult protection in Scotland in 1857 and in 2015: what have we learned?

Purpose – The purpose of this paper is to compare recent developments in adult protection legislation, policy and practice in Scotland in 2015 with the first attempts at protection of adults at risk of harm, in 1857-1862, with a particular focus on people with learning disabilities. Design/methodology/approach – The paper uses comparative historical research, drawing on primary archive material from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers. Findings – Growing public awareness of the extent of neglect and abuse, and the need for overarching legislation were common factors in the development of both the “The Lunacy Act” of 1857 and the Adult Support and Protection (Scotland) Act of 2007. Both pieces of legislation also had the common aim of “asylum”, and shared some other objectives. Practical implications – Total prevention of abuse of vulnerable adults is an aspiration in law and in policy. There is an evidence base of effectiveness, however, in protecting adults at risk of harm from abuse. Some ecological factors recur as challenges to effective safeguarding activity. These include problems of definition, uncovering abuse, enforcing legislation, evaluating impact and protection of people who are not a risk of harm to others. Originality/value – This paper compares common themes and common challenges in two separate time periods to investigate what can be learned about the development of legislation and practice in adult protection.

Paternalism or proportionality? Experiences and outcomes of the Adult Support and Protection (Scotland) Act 2007

Purpose – The purpose of this paper is to report the findings from research into the outcomes of adult protection in Scotland, with particular focus on how service users, family members and service delivery professionals perceive the effectiveness of the protection orders in the Adult Support and Protection (Scotland) Act 2007. Design/methodology/approach – The study comprised analysis of Adult Protection Committee biennial reports on implementation of the 2007 Act to the Scottish Government, key informant interviews and workshops with professionals involved in adult protection leadership and practice, and case study interviews with service users, family members and practitioners. Findings – Concerns about the potential for paternalistic practice and excessive use of the protection orders within the 2007 Act have not materialised. The principle of proportionality appears to be firmly embedded in adult protection practice. Service delivery professionals, service users and family members remain acutely aware of the tensions between autonomy and protection but point to beneficial outcomes for adults at risk from the careful use of protection orders, especially banning orders. Research limitations/implications – Only ten case studies were able to be included in the study. However, the use of mixed methods enabled triangulation of the findings. Common themes emerge from across the data sources. The findings also resonate with conclusions drawn by other researchers. Practical implications – The paper identifies outcomes and challenges in respect of protecting adults at risk in Scotland. Strengths and limitations of the 2007 Act are identified. Originality/value – The paper offers a formal evaluation of the outcome of protection orders for adults at risk in Scotland. The findings are of wider policy relevance given the debates on how to legislate for adult safeguarding in England and Wales.

Finding the words to work together: developing a research design to explore risk and adult protection in co‐produced research

Accessible Summary SummaryAlthough co‐production of research with people who access support services is increasingly common, details about how people who access support services can take more of an assertive role in developing research proposals and method design remains sketchy. This article reflects on the development of a research project on adult protection practice in Scotland. We start by giving an overview of what the policy on adult protection is in Scotland, how we did our research on this topic and what people who may be affected told us they wanted. Then, we examine how our team talked through key words used in adult protection, namely, ‘risk’ and ‘abuse’. Coming to a shared understanding of the words and the concerns around them meant thinking about how words are used in many ways, from decisions about which words were used, to how these words were part of relating experience in stories, to how these stories fit into the work we were doing and how all of this shaped how we present our research to those who make and carry out services. Through doing a literature review together, we have gained a better understanding of how words are used as tools. We conclude that those who make, carry out and research services should consider using a wider range of tools than just words to help people have a say in how work to help people is done.

Safeguarding adults: perspectives from primary care trusts in Kent and Medway

Adult protection has been a relatively recent concept for staff working within the health economy. Priorities have focused on raising awareness, developing an understanding of safeguarding responsibilities, challenging established practices and attitudes and embedding the concept within the culture of NHS organizations and the daily work of staff at all levels. Although social services have the lead for safeguarding activities (Department of Health, 2000), statutory health bodies have now begun to integrate their adult protection activities more effectively and positively with social services and the police. This paper reviews the journey undertaken by the three primary care trusts (PCTs) in Kent and Medway in developing adult protection expertise and sharing multi‐agency adult protection practice with both social services and the police. The three safeguarding vulnerable adults leads from the PCTs have joined together to look at how far we have come and what we still need to achieve.

Managers' and Staff Experiences of Adult Protection Allegations in Mental Health and Learning Disability Residential Services: A Qualitative Study

Adult protection policy slowly developed in England and Wales during the 1990s. In the same decade specialist residential services expanded for people with mental health problems and with learning disabilities, some of which were secure or semi-secure in status. Many referrals to adult protection systems emanate from this sector but few result in conclusive outcomes. This article reports on and considers adult protection workings in these settings. Data from interviews with 13 residential unit managers and 10 care workers, who were suspended following an allegation but later exonerated, are presented. Perceptions of the development of adult protection practice, policy and legislation were that these have generally led to positive outcomes. However, these data reveal other outcomes including service disruption, stress for residents, staff and managers. Service managers commented particularly on how the application of policy and practice enhances but also upsets the services they provide. Multi-agency collaboration, transparency of practice, training, reflective practice, and effective supervision of frontline staff, appeared to assist managers and care workers in negotiating the positive and negative experiences of the implementation of adult protection systems.

Voices from the frontline: social work practitioners' perceptions of multi‐agency working in adult protection in England and Wales

This article reports on the views of 92 social workers about their practice in adult protection in England and Wales as part of a wider study of adult protection working and regulation that took place between 2004‐2007 in 26 sample local authorities. The article explores social workers' reported experiences of partnership or multiagency working and how this, along with overarching regulatory frameworks, affected their practice within and across agencies. Among findings from the study were that social workers considered that sharing information and responsibilities led to positive outcomes for service users and that the incorporation of different agency perspectives supplemented sharing of best practice.

Safeguarding Adults: some experiences from safeguarding managers who are at the forefront of the safeguarding plan (case conference)

As Safeguarding Adults, the national framework of standards of good practice in adult protection, begins to take root in the language and culture of organisations, the need for an evidence base for best practice becomes increasingly important. This article examines the practice data currently generated in three safeguarding adults partnership areas with specific regard to the Safeguarding Adults plan. This process, prior to the clarification of language by Safeguarding Adults, may have been referred to as the ‘case conference’ or ‘review’. Data was gathered from focus groups of safeguarding managers from local unitary authorities. Themes emerged across the groups and, via the use of grounded theory (Strauss & Corbin, 1998), the themes were analysed to highlight the key issues and pressures for those operating within this role.

Evidencing good practice in adult protection: informing the protection of people with learning disabilities from abuse

The importance and challenges in providing a good practice evidence base for adult protection are outlined. The literature search, review and mapping exercise that formed part of the Abuse of Adults with Learning Disabilities: Policy, Practice and Educational Implications in Wales research study is detailed. The article presents examples from this evidence mapping exercise and considers the importance of adult protection research to the future development of policy and practice.

Cosmetic surgery for people with learning disabilities: considerations for adult protection practice

This paper explores the ethical issues surrounding the use of cosmetic surgery for and by people with learning disabilities. Although such interventions are less common in Britain than in the US, there is a growing interest in the use of cosmetic surgery to correct perceived defects in appearance and speech impairment. However, the assumed potential of cosmetic surgery brings adult protection concerns into stark relief.

A personal touch: managing the risks of abuse during intimate and personal care

This paper identifies considerations for managing the risks of abuse during intimate and personal care for people with learning disabilities and complex needs. Drawing on insights gleaned from research involving interviews with staff, policies and procedures in specialist day and residential services, and the development of a staff training resource, the paper identifies a framework for adult protection practice in this critical area of support.