Adult Safeguarding Research Articles

Exploring adult safeguarding data in England: mapping vulnerability and understanding trends

Purpose The purpose of this study is to explore and map Safeguarding Adults England data for 2022–2023 by local authority to enable identification and exploration of any differences between local authorities. Design/methodology/approach Colour symbology maps were produced to enable visual analysis of safeguarding concerns and Section 42 enquiries per 100,000 of the population, as well as the conversion of safeguarding concerns to Section 42 enquiries. Statistical hotspots were calculated using the Getis-Ord Gi* for Section 42 enquiries per 100,000 of the population across age classes. Findings Findings show regional differences across England in terms of the number of documented concerns, Section 42’s and conversion rates. Some regions had statistically higher or lower Section 42 enquiries per 100,000 of population across age classes compared to their bordering geographical neighbours. Reflections on these findings lead to a series of recommendations. Originality/value This paper addresses a need to explore further and analyse adult safeguarding data to inform practice, through choropleth mapping.

Physical abuse by staff and co-residents of older people and people with intellectual disabilities

Summary Physical abuse in care settings is a social problem with detrimental effects for residents, but effective prevention is dependent on staff reporting. In Sweden, designated officials, commonly social workers, are required to investigate reports of mistreatment. The aim of this study was to analyze what designated officials considered serious in reported incidents of physical abuse in two different care settings: care for older people and care for people with intellectual disabilities. Similar cases of physical abuse were chosen to demonstrate differences between judgments and provide a picture of how designated officials judge the relative seriousness of abusive situations. Interpretative content analysis and analytic induction were used to analyze reports of staff-to-resident abuse and resident-to-resident abuse in the two care areas. Findings There were no differences between incidents described as serious and those described as non-serious. Resident-to-resident abuse was the most commonly reported incident, particularly in dementia care and care for people with intellectual disabilities, and was rarely considered serious. Older people in dementia care were the highest risk group. In staff-to-resident abuse, staff were singled out as scapegoats. Organizational issues, rather than the details of abusive incidents, guided investigators’ judgments of seriousness. Tendencies to normalize violence and apply a narrow understanding of violence were found in the investigator’s judgments, particularly in resident-to-resident abuse. Applications Safeguarding adults from physical abuse in institutional settings is dependent on staff reporting and thorough investigations. This study shows that more training in assessing violence for social workers investigating reports is needed.

Cognitive impairment and exploitation: connecting fragments of a bigger picture through data.

Exploitation poses a significant public health concern. This paper highlights 'jigsaw pieces' of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation. We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and 'analysis of variance'. Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be 'slipping through the net'. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation. This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for 'at-risk' adults.

Assisted Decision Making in the Acute Hospital Setting – Staff Experiences of Working with Older Adults

Abstract Background The Assisted Decision Making (Capacity) Act 2015 was fully implemented in April 2023. This brought changes to how health and social care staff work with patients who may lack decision making capacity for certain decisions. The most significant group impacted by these changes in the acute hospital context is Older People with cognitive impairment. Staff working with these patients have been navigating the complex balance between embracing the guiding principles of the Act, testing the practical requirements of the Act on behalf of patients who require formal decision supports, all in the context of continued demand on unscheduled care. Methods The newly developed role of Principal Social Worker for Assisted Decision Making and Adult Safeguarding has enabled regular access to frontline staff working across 11 hospitals in a large hospital group. Both formal and informal feedback was gathered from a cross section of staff via focussed discussion at local implementation meetings and via individual qualitative interviews with key stakeholders from a broad range of professions. Results Staff were generally very positive about the introduction of the Act and its rights-based approach to providing health and social care. Themes which emerged from the interviews included the need for further education and training, continued forums for case discussion and review, clarity re roles and responsibilities and improved pathways for patients requiring support. Conclusion The enactment of the Assisted Decision-Making Act did not, as many feared, bring the healthcare system to a standstill. However, its impact on resources and time should not be underestimated. Increased investment in staffing, training and supports are needed to ensure continued integration of the Act in the acute hospital setting.

Adult Safeguarding Observed: How Social Workers Assess and Manage Risk and Uncertainty, Jeremy Dixon

Adult Safeguarding Observed: How Social Workers Assess and Manage Risk and Uncertainty, Jeremy Dixon

What progress has resulted since the Safeguarding Adults Review concerning the deaths of Joanna, Jon and Ben?

PurposeThe author, who is Chair of Norfolk’s Safeguarding Adults’ Board (SAB) reflects on the impact of a Safeguarding Adults Review (SAR) and the actions that resulted. The purpose of the paper is to provide an insight into a significant SAR and the resulting actions desinged to change practice.Design/methodology/approachThe actions illuminate the power of hospitals and politicians over people’s lives. It took the deaths of three young adults with learning disabilities, in a hospital, to move beyond the status quo and organise some very different service responses.Findings“Progress summits” have considered local and national actions. There have been important gains and setbacks, including the delayed reform of the Mental Health Act. Despite uncertainties, SAB can be detonators to listening and taking action.Originality/valueThis is a unique insight into the impact of a Safeguarding Adults Review and the actions that resulted from this.

Learning not blame: reflections on staying on the right side of the line for a Safeguarding Adults Review

PurposeThe author will describe the operational tasks of S.44’s statutory mandate: for example, commissioning the review; being responsive to the representatives of the relevant agencies concerned; securing pharmacological/medical advice; adding Ben’s death to the review; engaging with relatives; and ensuring that “lessons” were foregrounded. How the review was set up/recognising the standout features from the beginning/managing the situation when an agency is withholding information/“drip feeds” information into the review; navigating/steering the Safeguarding Adults Review (SAR) alongside other processes – police/inquest/Care Quality Commission.Design/methodology/approachThis practice paper describes the experiences of coordinating a complex SAR into the deaths of three adults at Cawston Park Hospital in Norfolk.FindingsThe system insights that SARs give us prompt exploration of how to inject this learning into current discourse on how we better protect the most vulnerable in our communities.Originality/valueThe purpose of this paper is to explore the process and requirements of conducting a complex SAR from the perspective of a safeguarding adults board manager. It will be of interest to anyone who is involved in SARs, in particular safeguarding adult board chairs, board managers, members of SABs and SAR authors as management of SAR is one of the three statutory duties of a SAB.

Adult Safeguarding Inequalities in Northern Ireland: An Exploratory Study

Abstract Whilst studies of child welfare inequalities have identified the impact of socio-economic deprivation on child protection rates, little is known about how this relates to intervention with adults who have care and support needs. This article examines the impact of area-level deprivation on adult safeguarding (AS) rates in Northern Ireland (NI). Routinely gathered statistics for community AS referrals (2015–2017) were linked to area-level deprivation across NI using service users’ postcode. The relationship between deprivation and the screening, investigation and safeguarding planning stages of intervention was examined. Our analysis identified a clear social gradient in relation to AS referrals; the higher the level of deprivation, the higher the rates of AS screening and protection plans. Findings for investigations showed more variability. Further research is needed to explore the factors associated with areas of high deprivation that shape AS social work responses. To our knowledge, this is the first time AS rates have been explored in relation to deprivation. The study findings, that structural factors play a significant role in AS interventions, will help to determine how and where social work interventions are best focused, helping to shape policy and AS theory.

Safeguarding adults within institutional settings: a narrative overview of the literature focused on the care of people with mental ill-health and learning difficulties

PurposeInstitutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.Design/methodology/approachA narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.FindingsA range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.Originality/valueThis paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

Learning to safeguard: exploring adult safeguarding officers' readiness for online learning and their perceptions of a blended learning safeguarding training programme

PurposeThis paper aims to present commentary on adult safeguarding designated officers’ (nominated senior staff members in the Health Service Executive and its funded services) in Ireland readiness for online learning and their perception of the blended approach used in their training and considers the implications of this for practice.Design/methodology/approachIn total, 233 designated officers were surveyed. A self-administered online survey comprising of two instruments was used. The questionnaire combines two previously validated tools measuring readiness for online learning and perceptions of blended learning. Minor modifications were made to account for local circumstance and language. Demographic questions relevant to the survey population were added. The response rate was 49%.FindingsDesignated officers regarded specified competencies for online learning as important to very important with highest importance placed in time management. Designated officers expressed they were confident to very confident in their ability to accomplish all competencies in online learning. The highest confidence was in the technical competencies. Designated officers are demonstrating high readiness for online learning. Designated officers reported positively on online contributions and on blended learning workload. The scores indicate positive perceptions of the blended learning experience. Responses to an open-ended question were largely positive with some suggestions for improvement made.Practical implicationsFindings have helped inform planning and development of the Health Service Executive’s adult safeguarding training for designated officers with changes made since this survey was undertaken.Originality/valueTo the best of the author’s knowledge, this is the first time a survey was undertaken of designated officers in Ireland with a view to improving safeguarding training. Recommendations for adaptions to the blended designated officer programme were proposed and subsequently accepted and implemented.

Restorative justice in safeguarding adults with hate crime and discriminatory abuse: exploring the evidence

PurposeThe purpose of this paper is to consider what safeguarding responses to discriminatory abuse and hate crime might learn from existing research on restorative justice and to drive practice development based on available evidence.Design/methodology/approachThis paper is based on a scoping review of literature using four academic databases and reference harvesting. This comprised a critical appraisal of 30 articles, which were thematically analysed to appreciate the benefits and challenges of restorative justice responses to hate crime and how this might inform safeguarding responses to discriminatory abuse and hate crime.FindingsThe analysis identifies four domains where learning can be drawn. These relate to theory on restorative justice; restorative justice practices; perspectives from lived experience of restorative justice and hate crime; and an appraisal of critiques about restorative justice.Originality/valueThis paper connects the emerging evidence on restorative criminal justice responses to hate crime to the “turn” towards strengths-based practices in adult safeguarding. Although this provides a fertile environment for embedding restorative practices, the authors argue certain precautions are required based on evidence from existing research on hate crime and restorative justice.

Safeguarding adults at risk of abuse.

Safeguarding adults at risk of abuse presents complex ethical challenges. By knowing what counts as adult abuse, recognising the signs of adult abuse and appropriately addressing suspected adult abuse, nurses contribute to protecting patients' safety, well-being, autonomy and dignity. This article discusses categories and indicators of adult abuse, relevant legislation and standards, the principles of adult safeguarding and the key elements of a nursing assessment of suspected adult abuse. The author highlights that nurses need to approach safeguarding concerns sensitively and strike a balance between acting to safeguard the person and preserving their right to autonomy. There is a need for ongoing education and training to enhance nurses' understanding of safeguarding practices, legislation, policies and standards.

A qualitative study of adult protection procedures: threshold screening of new referrals by designated adult safeguarding practitioners

Purpose This qualitative study set within Northern Ireland aims to explore professional perspectives on the application of evidence-informed practice to the adult safeguarding threshold screening process. Design/methodology/approach Data was gathered from seven social workers in one health and social care trust area, who perform the designated adult protection role, through individual semi-structured interviews in one region of Northern Ireland. The interview schedule comprised of a series of questions examining the role of the designated adult protection officer and included three vignettes (Appendix). A thematic analysis was undertaken using NVIVO software. Findings This paper reports main findings under the themes of: the role of the designated adult protection officer, threshold decision-making, evidence-informed practice and service improvement. One of the main findings was that professionals viewed the current process as too bureaucratic, and there was a desire to engage in more preventive safeguarding in collaboration with service users. There was a need to promote awareness of evidence-informed practice as it applies to the threshold screening process. Furthermore, the study raised the question of the need to consider the application of models or methods of assessment to the threshold screening process. Originality/value This in-depth exploration of the role of designated adult protection officers in Northern Ireland provides a valuable insight into the complexity involved in managing adult safeguarding referrals and investigations. This study adds to the existing knowledge base, identifies potential service improvements and highlights the gap in evidence-based practice as it applies to the threshold screening process. Threshold screening of adult safeguarding referrals remains a subjective process and is open to interpretation and differences in professional judgement. The study highlights the need to consider the application of quality improvement methodology to the threshold screening assessment and the need to promote the exchange of safeguarding knowledge.

Adult safeguarding in Australia after the Disability Royal Commission

The final report from the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability contains a number of important reform recommendations that, if implemented, will reshape Australia’s adult safeguarding environment. At the same time, these recommendations—which cover a variety of fields ranging from adult guardianship through to supported accommodation—are relatively modest; indeed, many of them have their origins in earlier systemic advocacy initiatives. Two central challenges confront their adoption: the fact that many of these recommendations are directed to the states and territories (not just the Commonwealth Government, which established the Royal Commission); and the lack of immediate apparent nexus between many of the proposed reforms and the harms suffered by people with disabilities that led to the Royal Commission’s work. Both of these challenges can be met, but this will take ongoing advocacy by people with disabilities and their supporters.

You do not suddenly become safe on your 18th birthday: managing safeguarding cases involving adult athletes in the United Kingdom

ABSTRACT Despite publicised cases of abuse impacting those above the age of 18, little research attention has been paid to the safeguarding of adults. The present study is informed by the recommendations of the Duty of Care in Sport Review, aiming to inform the development of a case data collection tool. Semi-structured online interviews were conducted with 11 key stakeholders. Inductive thematic analysis of the interview transcripts revealed several challenges to collecting adult safeguarding case data in sport which were categorised into three domains: conceptualising cases, managing cases, and recording cases. Developing an effective case management process for adults will require a broader, and shared, understanding of the conceptualisation of adult safeguarding cases, including that vulnerability is not solely determined by personal characteristics, but is affected by the behaviour of perpetrators and fluctuates as circumstances change. Top-down support is necessary to ensure greater consistency in the reporting of valuable adult case data. With clear expectations, regarding what an adult safeguarding case is, what data should be collected, how it should be collected and why, as well as adequate resources, sports of all levels will be in a better position to protect adults from abuse or harm. A clearer roadmap for the management of adult safeguarding concerns in sport is offered.

A97Applying the Mental Capacity Act through multi-disciplinary simulation - A successful pilot

An assessment of mental capacity involves determining if a person can make a decision, or whether this needs to be done in their best interests [1]. The Mental Capacity Act (MCA) 2005, provides a legal framework that protects people who might not be able to make decisions for themselves and guides professionals during their practice. Research has shown inconsistencies on how the Mental Capacity Act is applied in health and social care settings [2], therefore ensuring that professionals have are provided with the right support to confidently apply the act should be a priority. Simulation has been effectively used in healthcare education [3] and could also be implemented to support this area of practice. The Homerton Healthcare NHS Foundation Trust’s Simulation Team and Adult Safeguarding Team, jointly worked in developing a simulation-based session which focused on mental capacity assessments in different situations. The aim of these sessions was to increase participants’ confidence to assess mental capacity and to manage challenging conversations during assessment. Scenarios were designed for hospital and community settings, the topics covered included consent to treatment, self-discharge, compliance with treatment, substance misuse, mental health problems, dementia and learning disability. The target audience was senior healthcare professionals that are regularly involved in making decisions related to mental capacity. Scenarios were designed to be flexible and adaptable according to the attendants’ needs, for example the learning disability scenarios involved the use of easy read information that was specifically provided or created. Actors were used for the role of patients or relatives, and members of the adult safeguarding team were part of the faculty to support or lead the debrief process. Between January 2023 and February 2023, the faculty delivered 3 sessions, with a total of 20 participants from different professional groups including doctors, nurses and allied health professionals. Anonymous feedback was collected at the end of each session, with 84.62% ( Studies have shown that healthcare professionals’ confidence in applying the mental capacity act can vary [2]. Solely focusing on traditional forms of education might not be enough to prepare our workforce, in this case simulation-based training has provided a valuable tool to enhance participant’s abilities in relation to the mental capacity act and its application in healthcare practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Exploring the prevalence of loneliness and social isolation in an analysis of Safeguarding Adults Reviews in South Yorkshire

PurposeThis paper aims to explore the links between being lonely and isolated, and increased risks of abuse for adults with care and support needs.Design/methodology/approachThematic analysis was used to explore features of loneliness and social isolation present in South Yorkshire Safeguarding Adults Reviews (SARs) published since 2014.FindingsTen out of fifteen SARs indicated there had been issues of loneliness and/or social isolation for the person who was the subject of the SAR.Research limitations/implicationsThe limitations of this paper are that it only included SARs from the South Yorkshire area. Future research should explore national and international perspectives on these issues.Practical implicationsSafeguarding Boards should include actions to address loneliness and social isolation as part of prevention strategies and services to develop approaches that can minimise or prevent abuse before it occurs. Practitioners should routinely explore whether the people they work with feel lonely and/or isolated and support people to take appropriate action to mitigate these risks.Originality/valueThis paper uses the existing body of literature about loneliness and social isolation to explore the risks of abuse and neglect for adults with care and support needs.

260 Using participatory action research to examine attitudes and awareness of adult safeguarding practices in the acute hospital context

Abstract Background The investigation of, and interventions on, the alleged abuse of vulnerable adults has become an important feature of social work and other professional practices in Ireland. This implies important organisational challenges in ensuring that adult safeguarding responsibilities are delivered in ways that ensure positive outcomes for all stakeholders. Many factors can influence staff responses to concerns in acute care contexts. This can relate to awareness of the many forms of abuse and reporting obligations, attitudes to adult safeguarding and understanding the impact of abuse. Acute hospitals offer unique opportunities to intervene in abusive situations and to offer support to those at risk. This study set out to explore the awareness, understanding and attitudes towards safeguarding practices of staff in a large Dublin teaching hospital using a Participatory Action Research Approach (PAR). Methods A PAR methodology was utilised involving a social work academic and six members of the Medical Social Work team as co-researchers in the study design, data collection and data analysis. A quantitative, descriptive study design was adopted, which utilised a cross-sectional online survey of hospital staff which generated 100 responses from a variety of hospital staff including nurses, doctors and health and social care professionals. Results Findings indicate that acute care staff have varying levels of awareness of different categories of abuse. 59% of respondents reported being ‘somewhat confident’ in recognising and reporting suspected harm, neglect or abuse of a patient they were treating. 66% of respondents reported being aware of their mandated reporting requirements under the Criminal Justice (Withholding of Information on Offences against Children and Vulnerable Persons) Act 2012. Conclusion Many staff in acute care contexts lack confidence and knowledge in detecting and reporting the abuse of adults at risk, including their mandated reporting obligations with 90% of respondents stating that they need further training in this area.

Technology-Facilitated Domestic Abuse: An under-Recognised Safeguarding Issue?

Abstract Responding to domestic abuse is a key element of social work practice, in both child protection and adult safeguarding. This article sets out the ways in which rapid technological advances are being co-opted by perpetrators of domestic abuse to create new ways of exerting control. After starting with a brief reminder of recent UK legislative changes around domestic abuse, the article outlines the main ways in which technologies, including mobile phones and other Internet-enabled devices, are used by abusers for surveillance, monitoring, tracking and otherwise controlling all aspects of the lives of those they target. The article then moves on to consider how some groups may be at greater risk than others of technology-facilitated domestic abuse (TFDA), including women with insecure immigration status, women with learning disabilities and younger women and girls. Finally, the key social work tool for assessing risk in relation to domestic abuse is critiqued as lacking sufficient focus on TFDA. The article concludes by suggesting what individual social workers and local authorities need to do in order to better respond as TFDA continues to evolve.

Human stories about self-neglect: told, untold, untellable and unheard narratives in safeguarding adult reviews

PurposeThe purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. The initial data set was published in this journal in 2015 and has since been updated annually. The complete data set is available from the author. The second purpose is to reflect on the narratives about adult safeguarding and self-neglect by focusing on the stories that are told and untold in the reviews.Design/methodology/approachFurther published reviews are added to the core data set, drawn from the national SAR library and the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the domains used previously, direct work, the team around the person, organisational support and governance. SAR findings and recommendations are also critiqued using three further domains: knowledge production, explanation and aesthetics.FindingsFamiliar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. SAR findings emphasise the knowledge domain, namely, what is actually found, rather than the explanatory domain that seeks to answer the question “why?” Findings and recommendations appear to assume that learning can be implemented within the existing architecture of services rather than challenging taken-for-granted assumptions about the context within which adult safeguarding is situated.Research limitations/implicationsA national database of reviews completed by SABs has been established (www.nationalnetwork.org.uk), but this data set remains incomplete. Drawing together the findings from the reviews nonetheless reinforces what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, there is little analysis that seeks to explain rather than just report findings.Practical implicationsAnswering the question “why?” remains a significant challenge for SARs, where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. The challenge for SAR authors and for partners within SABs is to reflect on the stories that are told and those that remain untold or untellable. This is an exercise of power and of ethical and political decision-making.Originality/valueThe paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper analyses the degree to which SARs answer the question “why?” as opposed simply to answering the question “what?” It also explores the degree to which SARs appear to accept or challenge the context for adult safeguarding. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practice, and on the choices they make about the stories that are told.