AYRSHIRE ADULT AYRSHIRE ADULT SUPPORT & SUPPORT & PROTECTION PROTECTION PROCEDURESPROCEDURES

North Ayrshire Council, East Ayrshire Council,

South Ayrshire Council, NHS Ayrshire & Arran

Strathclyde Police

ObjectivesObjectives

• To explore the support and protection of adults at risk.

• To clarify operational duties and processes.

• To identify best practice and areas of development.

• Introduce Interim pan-Ayrshire & Arran ASP Procedures.

• To consider the range of legal options.

• Familiarise staff with procedure to be followed when it is suspected that harm has occurred.

• Identify the roles and responsibilities of the agencies involved.

Learning Outcomes: Learning Outcomes: You Will Know ….You Will Know ….

• Harm happens.

• What it is, where it happens and how it happens.

• What to do and how to progress concerns.

• The systems in place.

• Health Board, Local Authority and Strathclyde Police responsibilities, duties and powers.

• The legislative basis; ‘the toolbox’

• Borders enquiry; learnings to apply here.

• Ms A; Justice Denied.

Introduction – historical contextIntroduction – historical context

• Growing public awareness of abuse/media coverage of incidents and public enquiries.

• Increasing older population of potential adults at risk.

• Procedures introduced from 2000, updated 2008.

• National policy; Law Commission 1997, Borders Inquiry, SG consultation 2005, ASP Bill.

• AWI & MHA left gaps re ‘vulnerable adult’ and ‘adult at risk’.

• Adult Support and Protection (Scotland) Act 2007

Introduction - purpose Introduction - purpose

• Prevention – always the first priority

• Procedures – the structure

• Action where harm has occurred

• Partnership across all sectors

• Abuse; an action

• Harm; the outcome

Abuse; group exercise

• Definitions; what is abuse

• Examples; from professional experience

• Signs; what to look for

• Who abuses; ??

• Context; where, when, how

Discuss in groups and feedback

What is Abuse?What is Abuse?

• An action.

• A violation of an individual’s human and civil rights by any other person.

• The wrongful application of power by someone in a dominant position.

• Includes aggressive, subtle and non-intentional acts, deficiency of care and treatment, exploitation, harm.

• Others …. ‘the martini approach’ ??

Abuse: examplesAbuse: examples

• Physical

• Emotional/Psychological

• Deprivation of ….

• Isolation

• Financial/Material

• Sexual

• Human Rights

• Institutional

• Malpractice

• Verbal

• Neglect

• Self Neglect

• Racial Abuse/Discrimination

• Random Violence

• Domestic Abuse

• Ageism

• Information Abuse

• Medication

Some SignsSome Signs

• Unusual or suspicious injuries.

• Unusual or unexplained behaviour.

• Allegations of abuse.

• Adult found alone in a situation of risk.

• Frequent/inappropriate contact with agencies.

• Interval between injury/illness and contact.

• Living with known perpetrator.

• Misuse of medication.

• Physical deterioration.

• Increases in confusion.

• Demonstration of fearof another person.

• Others.

Abuser?Abuser?

• ANYONE

• Staff member.

• Professional.

• Volunteer.

• Another person receiving the service.

• Spouse, relative, member of social network.

• Neighbour, member of public, stranger.

• A person who targets vulnerable people.

Abuse: ContextAbuse: Context

• Own home.

• A carer’s home.

• Residential/nursing care.

• Work setting.

• Educational setting.

• Hospital.

• Social situations/public place.

• Hostel/temporary accommodation.

• Accommodation with support.

Borders Report; factsBorders Report; facts

• A woman with learning disability taken to hospital with multiple injuries from physical assault and sexual assault. Police investigation revealed a catalogue of abuse and assaults over previous weeks and longer. Three men were convicted of the assaults in 2002.

• Over many years events and statements were taken by social work, health services and Police that raised serious concerns.

• Others were receiving care under the same circumstances, with varying degree of learning disability, physical disabilities and mental health needs, which were largely neglected.

• They were neglected, lived in unsuitable and unsanitary conditions and were financially and sexually exploited.

Borders Report; Some FindingsBorders Report; Some Findings

• Failure to investigate appropriately serious allegations of abuse.

• Acceptance of poor conditions in which the people lived.

• Lack of comprehensive needs assessments.

• Lack of risk assessments.

• Lack of information sharing and co-ordination.

• Disagreements between agencies at the front line.

• Un-sustained contact with the individuals concerned.

• Poor case recordings.

• Lack of care planning.

• Failure to consider statutory intervention.

• Lack of compliance with VA procedures.

• Poor supervision.

• Lack of senior management and leadership.

• Lack of clarity of role.

Borders Report; RecommendationsBorders Report; Recommendations

• Review all cases of adults with learning disability to assess level of risk and quality of service.

• Review of LD services.• Guidance of staff on complex cases.• Vulnerable adult procedures.• Comply with SSSC codes of practice.• Improve training for MHOs.• Acute discharge protocols.• Develop better risk assessment methods.• Improve case recording and review mechanisms.• Introduce random case monitoring processes.• Monitor the effectiveness of case transfer

arrangements.• Share information more effectively.

Borders; learningsBorders; learnings

• Is about people

• Key messages:

Attitudes (they live this way!)

Fragmentation of service response (who had the whole picture?)

Identifying risk at key times.

Communication and transfer of information.

Audit/recording/monitoring.

Resolving differing views (two tribes).

Poor consideration of statutory powers.

Borders Report; A Check ListBorders Report; A Check List

• Allocated worker with necessary skills and experience.

• All relevant information been gathered?

• Chronology of events and implications of these events understood?

• Comprehensive assessment, including risk?

• Care and protection plan?

• Statutory intervention considered?

• Individual seen on regular basis?

• Good communication and collaboration?

• Case been reviewed in accordance with procedure?

• Case been subject to oversight by line manager?

Underpinning Principles Underpinning Principles

• Every adult has a right to be protected from all forms of abuse, neglect and exploitation that result in harm

• The adult’s welfare takes primacy

• Self-determination

• If self-determination over-ridden, must be proportionate and be least disruptive response

ASP, AWI & MHA all take into account;

• Privacy, dignity, safety, choice, respect, empowerment, equal consideration, preferences, participation, benefit, minimum intervention

Adults Have RightsAdults Have Rights

• Adults have the right to make their own decisions in relation to their safety, security and behaviours:

• And can only be overturned by law

• Can the person understand the nature and consequences of the risks they may be subject to

• Can the person consent to any intervention that may be proposed

• Does the person have the capacity to make informed decisions to accept or refuse assistance

Consider….Consider….

• CONSENT

• CAPACITY

• RISK

• Consider; context, degree, frequency, outcome, effect

DilemmasDilemmas

• Intruding on someone’s liberty vs protecting this person.

• Acting vs not acting.

• Respecting the victim’s pride and fear of recrimination vs taking action.

• Dealing with tyranny vs respecting individual choice and control.

• Respecting vs intruding on confidentiality.

• Criminality vs confidentiality and fear

Ms A – Justice DeniedMs A – Justice Denied

• Mental Welfare Commission Report – April 2008

• 67 year old woman with a learning disability and in care of local authority since age 8

• Repeated sexual assaults by more than one man over a prolonged period of time

• The protective supports now in place amount to a severe restriction of liberty

Ms AMs A

• No prosecution

• People with a learning disability should have equal access to justice (UN Convention on Rights of People with a Disability)

• “... the responses of health, social care and criminal justice services combined to deny Ms A access to justice” (MWC report)

• Attitudes of professionals towards people with a learning disability affected their responses – different standards applied

Ms A - findingsMs A - findings

• Staff in agencies were confused about their professional responsibilities in reporting a crime

• Knowledge of relevant legislation and procedures lacking

• No consensus on whether Ms A had the capacity to consent to sexual activity

• Assessment of her competence as a witness did not include people who knew her well

• No consideration on support and means of preparing Ms A to act as witness

• PF left with little option than to abandon any action

Ms A; small group discussion Ms A; small group discussion

• Consider the facts and findings in the case of Ms A

• What changes would you bring into place

• What recommendations would you make

• Could this happen here

Ms A; selected recommendationsMs A; selected recommendations

• APC to coordinate multi-agency training on capacity and consent to sexual activity and vulnerable witnesses

• APC to ensure procedures include reference to vulnerable adult witness support

• APC to ensure procedures allow for appropriate sharing of information

• Clarify role of MHO in adult protection case conferences

Ms AMs A

AYRSHIRE ADULT AYRSHIRE ADULT SUPPORT & SUPPORT & PROTECTION PROTECTION PROCEDURESPROCEDURES

North Ayrshire Council, East Ayrshire Council,

South Ayrshire Council, NHS Ayrshire & Arran

Strathclyde Police

Inter-agency responsibilitiesInter-agency responsibilities

• Common responsibilities

• All staff must be capable of recognising and acting on concerns for the safety of adults (and children)

• Are familiar with the inter-agency procedures to support and protect adults at risk

• Can take immediate action in an emergency

• Cooperation across partner agencies

• Sharing of information for the purposes of inquiries and protection planning

• Be alert to child protection concerns where a child is present where an adult is at risk of harm

WhistleblowingWhistleblowing

• Guidelines, protection and reassurances to encourage disclosures of suspected or actual malpractice.

• Staff have the right to raise concerns and have them heard in an open and sensitive manner.

• Staff should be aware of procedures for whistleblowing, harassment policies, disciplinary procedures, complaints.

Framework for Assessment and Framework for Assessment and Intervention Intervention

• All partner agencies must ensure staff have an awareness of adult protection issues and a working knowledge of systems and practice

• Social work is lead agency

• Referrals require full referral information

• Principles applied

• Referral to police if it is believed a criminal offence may have been committed

• Refer to full procedures

Your Initial Practical ResponsibilitiesYour Initial Practical Responsibilities

• You witness, suspect or receive information about abuse:

Talk to victim seek consent to take action.

Where person does not give consent for action, discuss with line manager.

• Emergency - contact appropriate emergency service.

• Consult with line manager/supervisor (if unavailable an alternative manager):

To refer to local authority social work department.

To refer to police where indications of a criminal offence (referral discussion to decide on appropriate action if victim does not wish to make complaint).

Referral processReferral process

• Refer to the community care team for the area in which the adult lives

Enquiry and Information Team

Prestwick, Kyle St, Riverside/Holmston, Maybole

• Or, if known to a specialist team

Adult mental health, elderly mental health, learning disability, physical disability, sensory impairment

Young adults; disability, throughcare

• Initial inquiries; check with appropriate others, eg, NHS

• SSW/DepMan consider information and determine ASP or other action, eg, care management

Referral process – young adultsReferral process – young adults

• In addition to the referral routes listed previously, if a young adult of 16/17 is at risk of harm

Establish if an order under children’s legislation is in place

If so, refer to the relevant C&F team

If not or not known, refer to relevant community care team

• Initial inquiries; check with appropriate others, eg, NHS

• SSW/DepMan consider information and determine ASP or other action, eg, care management

Initial ActionsInitial Actions

• SSW/DepMan decide on level of investigation and plan

• Consider; consent, capacity, risk, services

• Safeguard the adult

• Professional judgement of recorded facts

• Context, degree, frequency, effect, outcomes

• Extent of harm, impact, a pattern, intent, legality, urgency

• Council Officer investigative role

• Investigation visit within 24 hours – council officer along with other appropriate person

• Case conference within 10 working days.

Case conferenceCase conference

• Purpose

– to make decisions about support and protection

• Multi-agency; shared responsibilities

• Convened by SSW/DepMan

• Considers;

– risk management and protection plan (JIT docs)

– Inclusion of the adult

– Legal options

Final pub quizFinal pub quiz

• Describe definitions;

– Of an adult at risk of harm

– The 3 point test

• Define the principles

• What do we mean by ‘consent’, ‘capacity’ and ‘risk’

• Answer the ‘martini’ question

• Describe some of the ways an adult might be harmed

• What protection orders are available

• What other laws are relevant

• Who are the partner agencies

• Who can carry out inquiries

Good practice in ASPGood practice in ASP

• Don’t promise to keep secrets.

• Don’t place yourself at risk

• Explain what you are going to do

• Protect people

• Accept responsibility

• Work in partnership

• Share and record information

• Be tenacious

AYRSHIRE ADULT AYRSHIRE ADULT SUPPORT & SUPPORT & PROTECTION PROTECTION PROCEDURESPROCEDURES

NHS Ayrshire & Arran

North Ayrshire Council, East Ayrshire Council,

South Ayrshire Council, Strathclyde Police