Abuse Of Vulnerable Adults Research Articles

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.

Financial abuse of older people by third parties in banking institutions: a qualitative exploration

AbstractFinancial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.

20 FALLING THROUGH THE CRACKS: AN EXPLORATION OF SOCIAL WORKERS’ PERCEPTIONS OF THE NEED FOR ADULT SAFEGUARDING LEGISLATION

Abstract Background The investigation of, and interventions on, the alleged abuse of vulnerable adults, including older people,has become an important feature of social work.Policy and practice in adult safeguarding is characterised by competing debates about how regulators define core concepts and reporting systems. It has been argued that the introduction of specialist legislation could enhance responses to adult safeguarding (Montgomery et al.2016). This study sets out to shed light on how social work practitioners are navigating cases in the absence of primary legislation and to explore what benefits or challenges there might be should adult safeguarding legislation be fully enacted in the Irish context. Methods Focus Groups (N = 2) and face to face interviews (N = 14) were held with social work practitioners using a critical incident technique.An online survey questionnaire was also administered with N = 116 responses. Results Social workers reported that adults at risk were ‘falling through the cracks’ due to the absence of adult safeguarding legislation. In relation to older people, the issue of coercive control by another family member was repeatedly highlighted as a significant issue for which there was no legislative intervention available. Legislative powers such as a duty to cooperate, duty to share information and a duty to involve the adult at risk in the safeguarding process were deemed critically important but absent. In addition, social workers reported that the lack of access to support services for the adult at risk was significantly impacting on their ability to safeguard. Conclusion Whilst the current policy measures in place offer some protection, it is evident that social work practitioners believe that safeguarding procedures should be placed on a statutory basis to ensure the safeguarding process is applied in a consistent and effective way. Reference Montgomery, L., Anand, J., McKay, K., Taylor, B., Pearson, K. C., & Harper, C. M. (2016). Implications of divergences in Adult Protection legislation. Journal of Adult Protection, 18(3).

Adult Protective Services’ Intervention on Elder Abuse: Using Standardized Measures for Outcomes

Adult Protective Services (APS) investigates and substantiates vulnerable adult abuse, neglect, and exploitation (ANE) cases. The frontline social service agency also refers or provides needed services to ANE victims. Outcomes of APS has been scarce, with definitions of outcomes varying from study to study. Using a pretest-posttest design, we partnered with San Francisco and Napa APS to measure changes of ANE harm from case investigation (pretest) to case closure (posttest) using standardized measures called the Identification, Services, and Outcomes (ISO) Matrix. Forty-five APS supervisors and caseworkers used the ISO Matrix on 2,063 cases during the six-month pilot demonstration. Dr. Pi-Ju (Marian) Liu will examine findings on changes of ANE harm and APS services that effectively decreased ANE harm. Responding to 2020’s Annual Scientific Meeting theme “Turning 75: Why Age Matters”, ANE harm and APS services will be compared between younger APS clients age 18-64 and older ones above the age of 65. Dr. Zachary Hass will discuss allegation, abuse severity assessment, services provided, and outcomes across racial and language groups. Dr. Kendon Conrad will present reliability and validity of the ISO Matrix and a shorter version useful for APS practice. Ms Sara Stratton will review unusual cases with outlier ISO Matrix scores to inform researchers’ implementation and practitioners’ use of standardized measures. Dr. Kathleen Wilber, our discussant, will reflect on the use of standardized measures in APS and its impact on both practice and research based on the four presentations.

72 Adult Safeguarding, Abuse of Vulnerable Adults and Mandatory Reporting: A Rapid Realist Review of the Literature

Abstract Background The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies. Methods A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ‘what works, for whom and in what circumstances?’ [1] Results Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual. Conclusion Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection.

Mandatory Reporting of Domestic Violence: What Do Abuse Survivors Think and What Variables Influence Those Opinions?

For decades, states have passed legislation to mandate reporting of criminal conduct and the abuse of vulnerable persons. Four types of mandatory reporting laws have been enacted, including laws that require reports of injuries associated with crime or due to use of certain weapons, abuse of children, abuse of vulnerable adults, and reporting of domestic violence. While studies have been conducted to evaluate the effectiveness of mandatory reporting laws in domestic violence cases, methodological weaknesses in this body of literature make it difficult to make broad statements about whether mandatory reporting laws advance women's protection or actually place them at additional risk. This study's sample is based on 388 surveys administered in-person to women who had sought services from one of Kentucky's 15 regional domestic violence shelters. In addition to querying women regarding their own experience with mandatory reporting laws, the survey explored the factors that influenced women's views. The study advances research into women's decisions to access shelters, medical, or mental health services and how they are influenced by advance knowledge that their case would be reported if they disclosed abuse. A new and troubling finding was that almost two in five women reported they would have been less likely to contact a domestic violence shelter if they knew in advance that a mandatory report would be made. Future research on mandatory reporting is needed with an eye toward changing state policies and laws to ensure that women feel free to seek the type of assistance they need for themselves and their children.

Honour based abuse: the response by professionals to vulnerable adult investigations

PurposeThe purpose of this paper is to examine responses by police and Adult Social Care to honour based abuse (HBA) victims who have a diagnosed or perceived vulnerability, such as a physical disability or mental health issue. The aim is to improve professional practice in ensuring vulnerable victims are safeguarded.Design/methodology/approachFindings are drawn from 100 HBA investigations (2012-2014) derived from classified police electronic records and interviews with 15, predominantly specialist, public protection police officers in one UK force.FindingsHBA against vulnerable adults is an obscure crime area. In cases of diagnosed vulnerability (3 per cent), police officers wrongly attributed “freewill” and choice to vulnerable adults who legally lacked the capacity to consent to marriage. Conversely, in 9 per cent of cases where victims were depressed and/or self-harming, perpetrators exaggerated the poor mental health of victims in order to discredit them to law enforcement. Professionals illogically latched onto perpetrator explanations and in turn undermined and problematised the victims.Research limitations/implicationsThere is limited access to data on vulnerable adult abuse, making this an under researched area of crime.Practical implicationsFailing to undertake risk assessments, or record whether the victim is legally vulnerable should lead to a review of police practice. An evaluation of joint working arrangements is necessary concerning which agency (police or Adult Social Care) should take primacy.Social implicationsVulnerable adult victims were retained in risk predicaments alongside perpetrating family members.Originality/valuePolice officers suggesting vulnerable adults can “consent” to marriage is a new concept, along with issues of goal displacement which illustrates avoidance behaviours by professionals and under protection by the state.

Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force

Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force

The Advantages and Disadvantages of Different Models of Organising Adult Safeguarding

Professionals express divergent views about whether adults at risk are best served by safeguarding work being incorporated into social workers’ casework or being undertaken by specialist workers within local area or centralised teams. This paper draws on findings from the final two phases of a three-phase study which aimed to identify a typology of different models of organising adult safeguarding and compare the advantages and disadvantages of these. We used mixed-methods to investigate four different models of organising adult safeguarding which we termed: A) Dispersed-Generic, B) Dispersed-Specialist, C) Partly-Centralised-Specialist and D) Fully-Centralised-Specialist. In each model, we analysed staff interviews (n = 38), staff survey responses (n = 206), feedback interviews (with care home managers, solicitors and Independent Mental Capacity Advocates) (n = 28), Abuse of Vulnerable Adults (AVA) Returns, Adult Social Care User Survey Returns (ASCS) and service costs. This paper focuses on qualitative data from staff and feedback interviews and the staff survey. Our findings focus on safeguarding as a specialism, safeguarding practice (including multi-agency working, prioritisation, tensions, handover, staff confidence and deskilling) and managing safeguarding. Local authority (LA) participants described and commented on the advantages and disadvantages of their organisational model. Feedback interviews offered different perspectives on safeguarding services and implications of different models.

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.

Referrals to the police of vulnerable adult abuse

Purpose – The purpose of this paper is to examine the outcome of referrals made to one police force in England by three local authorities between March 2010 and April 2011, in order to identify and understand the barriers to prosecuting suspects of abuse or harm against vulnerable adults, and improve inter-agency co-operation. Design/methodology/approach – All referrals to this police force are given a crime number when they are recorded on the Criminal Justice System database together with a vulnerable adult flag and a status code which indicates the outcome following a police investigation. A search of the database using the vulnerable adult flag identifies the total number of referrals and outcomes for the selected period. This can then be imported into a Microsoft Excel spreadsheet to allow further analysis to take place. Findings – Over 87 per cent of all referrals of alleged abuse to vulnerable adults made to this police force did not establish that a crime had been committed. Of those that did only 1 per cent resulted in either a caution or court proceedings. Research limitations/implications – This is a small sample from one, predominantly rural, police force. Originality/value – The benefit of this research is that it contributes to a greater knowledge of the outcomes of adult safeguarding referrals made, primarily, by local authorities to the police and how police disclosures, on Disclosure and Barring Service checks, are being used as a means of providing employers of regulated activities with information on individuals who have been suspected of abusing vulnerable adults.

Collaborating across health and social care: joint funding an adult protection Coordinator post in Caerphilly, UK

Purpose – The purpose of the paper is to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients. Health and social care policy frameworks promote principles of service improvement and consistency, along with a focus on outcomes and resource effectiveness and interagency collaboration. The Protection of Vulnerable Adults (POVA) coordinator role carries the responsibility of coordinating a response to individual referrals of abuse and neglect as described as part of the Designated Lead Manager role in the Wales Interim POVA Policy and Procedures for the POVA from abuse (Wales Adult Protection Coordinators Group, 2013). Design/methodology/approach – This paper will explore the benefits realised through a registered nurse being seconded from the Aneurin Bevan University Health Board into a newly created joint adult protection Health Coordinator post within the Caerphilly County Borough Council social services department POVA team. Findings – This is the first example of such partnership working in adult protection in Wales and has provided a number of benefits in relation to: providing adult protection advice; coordinating the response to referrals of vulnerable adult abuse and neglect within health and social care settings; carrying out or buddying others to complete adult protection investigations; facilitating the two day non-criminal POVA investigation training course and, awareness raising within the local Health Board. The development of a student nurse placement in the social services POVA team cements the multiagency collaborative approach that this development sought to achieve. Originality/value – The need to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients.

Characteristics of Victims of Abuse and Abusers in Institutional Settings: a Systematic Review

Background and objectives Abuse of vulnerable adults in institutional settings has been reported from various countries; however, there has been no systematic description of the characteristics of the victims and their abusers. Our aim was to identify and synthesize the literature on victims and perpetrators of abuse in institutions in order to inform interventions to prevent such abuse. Methods Search of MEDLINE(OVID), CINHAL(EBSCO), EMBASE(OVID) and PsychINFO(OVID) databases identified 4279 references. After screening of titles and abstracts, 123 citations merited closer inspection. Applying inclusion and exclusion criteria, 22 articles were included in the review. Results The review suggested that the evidence available on risk factors is not extensive but some conclusions can be drawn. Patient, staff, institution and environment factors may play a role in increasing the risk of abuse. Cases of abuse may be often underreported. Conclusions Patients who are considered to be at higher risk need closer monitoring. Patients and staff may often lack the awareness and knowledge to identify and report abuse. Institutions should take proactive steps to monitor patients, train staff and devise systems that would be able to identify and report incidents of abuse and take steps to prevent such incidents from recurring. There should be well advertised policies for staff of all ranks to be aware of and report when they suspect or identify abuse. There is need for further research into the association between the individual factors and abuse. Such information may be useful in quantifying risk to individual patients and planning their care.

Legislative initiatives can speed PPPM innovation in medicine

Predictive, Preventive and Personalized Medicine (PPPM) not only offers reduced patient suffering, but also a reduction in the proportion of GNP needed for healthcare. Yet there is little public pressure for PPPM. Presses announcements continue to convince patients that the cures they have been promised are just around the corner, and the industry is happy to see things continue this way. Clearly, legislators need to take the lead if there is ever to be any serious exploration of PPPM in Medicine. For example, a decade ago, I and my colleagues developed a detailed understanding of how the Human Microbiome causes chronic disease, especially those diagnoses thought to be ‘autoimmune’. We also retargeted an approved, widely available pharmaceutical to prevent that autoimmune disease from getting worse, and in many case to actually reverse it. Our collaborating physicians have demonstrated success with hundreds of patients - yet some of them have been savagely attacked by their peers. For example, a complaint was laid with the College of Physicians and Surgeons of British Columbia against one of my Canadian colleagues, a coauthor of our peer-reviewed papers, alleging that he wasn’t adhering to “standard of care” during his successful science-based treatment of a patient with refractory, idiopathic, disease. In this case ‘the system’ worked, and his College determined that the physician had properly used a “rationale for the knowledge base and guidelines, accessible in peer-reviewed medical literature, including two papers, from the prestigious “Annals of the New York Academy of Sciences.” However, an essentially identical complaint was laid against a physician in Washington State, who was only able to retain her license by promising never to use this new science again, and to have her prescribing activities supervised by a Preceptor. Worse, in Arizona, a practitioner was arrested and charged with “Criminal Child and Vulnerable Adult Abuse.” She has lost her license, and is waiting to hear if she will go to jail. This on substantially the same accusation and evidentiary base as was dismissed in Canada. How are our Universities to focus on ingenious and imaginative scientific solutions when Police are tasked to enforce ‘the standard of care’? Legislators have a responsibility to determine public priorities, and make sure that Industry – all industries, even the Healthcare Industry – are attentive to them. In 2006, California passed simple (and successful) legislation to ensure that a physician or surgeon will not be subject to discipline for suggesting innovative therapies if he/she makes sure the patient is aware of ‘the standard of care’ and gives informed consent. The preamble notes that “it can take up to 17 years for a new best practice to reach the average physician and surgeon, it is prudent to give attention to new developments.” Europe is not immune from the pressures working against innovation, encouragement of pharmacists to second-guess the judgement of physicians has been particularly damaging to the adoption of new therapeutic modalities. Yet the California experience makes it clear that change in Medicine can be promoted with enlightened legislation. Changing the current healthcare focus to one of PPPM will require leadership, and the EU is in the box seat to provide that leadership.

The abuse of vulnerable adults at Winterbourne View Hospital: the lessons to be learned

PurposeThis article seeks to consider the lessons from one of the worst failures in adult protection in the UK in recent times: the abuse of a number of patients with learning disabilities or autism and challenging behaviour over a number of years at Winterbourne View private hospital in the outskirts of Bristol. The abuse persisted, irrespective of a number of attempts to alert a broad range of regulatory authorities and health professionals about the situation.Design/methodology/approachThe article provides a detailed analysis of the lessons for professionals responsible for adult protection by one of the journalists most responsible for exposing the abuse at Winterbourne View private hospital. Drawing on information the BBC uncovered during the making of its two films about the subject, the author shares details of relevance to professionals responsible for adult protection and considers the implications of the catastrophic failure to protect vulnerable people.FindingsThis article shows how the lessons from the abuse at Winterbourne View have permeated only to some areas and professionals, not necessarily to where those lessons are most needed. The author suggests that further efforts are required to prevent another, similar scandal happening elsewhere in the UK.Originality/valueThe paper is a unique piece, sharing experiences from a journalist involved with exposing a scandal directly with professionals responsible for adult protection.

Screening for Intimate Partner Violence and Abuse of Vulnerable Adults: U.S. Preventive Services Task Force Recommendation

Screening for Intimate Partner Violence and Abuse of Vulnerable Adults: U.S. Preventive Services Task Force Recommendation

The role of the general dental practitioner (GDP) in the management of abuse of vulnerable adults

Abuse of vulnerable adults is largely under reported. The most common forms of abuse amongst this group are neglect and financial abuse, although an individual may be at risk of any or all forms of abuse. Certain individuals are at an increased risk of abuse due to their domestic environment and any physical or mental disability they may have. Vulnerable adults constitute a significant proportion of the population. GDPs should be aware of the signs of abuse, to be able to identify those individuals at risk, and how and when to raise concerns of abuse to social services.

Adult Protection of People with Intellectual Disabilities: Incidence, Nature and Responses

Background There has been increasing recognition of the importance and extent of abuse of vulnerable adults, including people with intellectual disabilities, leading to the development of monitoring systems. This paper reports findings from one of the largest databases in the UK collected between 1998 and 2005.Method Analysis of the 1926 referrals relating to people with intellectual disabilities included description of the nature of abuse and the responses to the referrals, comparisons to those relating to other client groups and comparisons between those placed locally and those placed out‐of‐area.Results About one‐third of all adult protection referrals related to people with intellectual disability, remaining consistent over time. However, the number of referrals increased significantly. The majority of people lived in residential care or supported living and this was reflected in the nature of the referrals – people were more likely to have been abused in the care home and by staff or service users than those without an intellectual disability. The most common type of abuse was physical abuse. Sexual abuse was more prevalent in the intellectual disability sample than in other client groups. People with intellectual disability were more likely to have experienced follow‐up action, usually through more monitoring. There was a different pattern of abuse seen in those placed out‐of‐area.Conclusions The overall pattern of abuse is similar to that reported in earlier studies. There is some indication that residential situation and in particular being placed in a residential placement out‐of‐area, may be an important factor in predicting adult protection referrals.

Protecting vulnerable adults from abuse

Abuse of vulnerable adults is a growing yet under-reported problem. Episodes of abuse are often considered to be rare incidents of physical or sexual abuse that are widely reported in the media. However, the House of Commons Health Select Committee point out that the most common incidents of abuse relate to poor practice, neglect, and poor management. Although the great majority of abuse occurs in the person's own home, some 27% of abuse occurs in care homes and hospitals. In an attempt to prevent those who would abuse the vulnerable from entering the workforce, the Government is to introduce a revised Vetting and Barring Scheme for staff and volunteers under the Safeguarding Vulnerable Groups Act 2006, which will also apply to the NHS. This article discusses the extent and forms of abuse against the vulnerable, and the implications of the new Vetting and Barring Scheme for healthcare managers.

Safeguarding vulnerable adults

As the number of reports of abuse of vulnerable adults increases, healthcare trusts must ensure that strategies are in place to protect this patient population, as well as the staff who care for them. This article describes how a well-designed business case led to the creation of a clinical lead for vulnerable adults post at Musgrove Park Hospital, Taunton, Somerset, and explains how a new policy for safeguarding adults has been implemented throughout the hospital.