Adult Support and Protection Flashcards
who is an ‘adult at risk’
Adults at risk’ are adults (aged 16yrs or
over) who:
- are unable to safeguard their own wellbeing,
property, rights or other interests;
- are at risk of harm; and
- because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than `adults who are not so affected.
ALL 3 need to be met
what is meant by ‘risk of harm
adult at risk of harm if
- another person’s conduct is causing (or is
likely to cause) the adult to be harmed, or
- the adult is engaging (or is likely to engage)
in conduct which causes (or is likely to cause)
self-harm.`
inc neglect and other failures to act
who can cause harm?
anyone
where can harm happen
anywhere
health care setting, family home, own home, social club or activities
6 main types of harm
physical
psychological
financial
sexual
neglect
discriminatory
physical harm
This means hurting a person’s body or stopping a person moving about. Physical harm can be: - Hitting a person - Shaking a person - Locking a person up.
psychological harm
This means hurting someone mentally.
Psychological harm can be:
- Upsetting a person’s feelings
- Making a person feel scared
- Leaving a person alone for too long.
financial harm
This means stopping a person from having their
money or belongings.
Financial harm can be:
- Stealing money from a person
- Stopping someone using their own money
- Stopping someone using the things they own
sexual harm
This means getting a person to do sexual things
they don’t want to do or don’t understand.
Sexual harm can be:
- Making a person have sex
- Taking photos at private times
- Making a person look at sex DVDs or photos
- Getting a person to do sexual things for money or presents.
neglect
This means stopping a person getting the things
they need to be well.
Neglect can be:
- Stopping a person from seeing their doctor
- Stopping a person from getting their medicine
- Stopping a person from getting their food.
discriminatory harm
This means hurting someone by being hateful or bigoted towards them.
Discriminatory harm can
be:
- Harassment
- Mistreating or behaving differently towards
someone due to their gender, sexual orientation, race, disability, age, colour, language, religion or belief, and politics.
what should i o if i have concerns that a person is or may be an ‘adult at risk’?
You should do the following if you have concerns that a person is or may be
an ‘adult at risk’:
- Report this immediately to your line manager.
- Remember, harm can also happen within a
service setting and the source of harm can be a
colleague or a manager. - Regardless of this the
facts and circumstances must be reported to
Glasgow City HSCP.
what should i do if i witness, suspect or receive information about an adult at risk being subject to harm, mistreatment or neglect
If the person does not require immediate
medical attention speak to the person about your concerns.
What has happened,
has it happened before, who
was involved,
what the person thinks about the situation and what they want done about it.
Try to ascertain if there are any potential risks to other
adults and children.
You need to listen to what they have to say and obtain all the relevant information.
what is relevant information
Relevant details relating to the situation should include:
- Name, address, date of birth, ethnic origin, gender, religion, type of accommodation, family circumstances, support networks, physical health, any communication difficulties, mental health and any associated statutory orders, or whatever information is available.
- The staff member’s job title and the reason for
their involvement.
- The nature and the substance of the allegation or concern.
- Details of any care givers and/or significant others.
- Details of the alleged perpetrator, where appropriate, and his or her current whereabouts and likely movements over the next 24 hours, if known.
- Details of any specific incidents (for example dates, times, injuries, witnesses, evidence [such as bruising]).
- Background relating to any previous concerns.
- Any information given to the person, their expectations and wishes if known
checklist for reporting adult at risk
Record the date, time and where the harm is alleged to have taken place or where it was witnessed.
Record details of anyone else who was there.
Record what the adult at risk of harm says using the words of the person making the disclosure even if they seem rude or embarrassing.
Tell the adult at risk you need to speak to your
manager.
Try to separate the factual information from any opinions.
Date and sign your report.
Don’t forget your report may be required as part of any legal action or disciplinary
proceedings.
what do i do if the person needs immediate medical assistance
Contact emergency services on 999, if an adult at risk appears to be in immediate need of medical attention or if there is evidence of physical or sexual harm.
Uncertainty about consent and capacity should not
prevent the provision of urgent medical assistance.
- Inform the Police if a crime has or may have been committed.
- Staff must be aware of the need to preserve evidence.
- Staff should not put themselves at risk.
service providers will work to prevent/minimise the risk of harm occurring by
Following safe recruitment practices.
Having the correct staffing levels and staff that
have the right skills to meet the needs of the
service users.
Providing appropriate training including adult
protection training. Staff should be able to demonstrate an awareness of what is harm, that it can happen anywhere and can be caused by a range of people.
Ensuring that staff attend regular staff meetings and providing supervision, so staff can discuss and learn about care practices which could be harmful.
Ensuring staff are listened and responded to when staff, service users and carers raise concerns.
what is i suspect an offence has been committed and do i need the adults consent
An Adult’s consent should usually be sought
before the police are contacted, however this
is not always necessary.
Adults at risk of harm are individuals in their own
right and must be allowed to exercise their right to
choose the way they live their life, unless:
- The adult is at immediate risk of significant harm.
- The adult does not have capacity to understand
his/her choice or consequences.
- There is concern the person is being unduly
pressured to withhold their consent.
- The situation involves a service provider and other adults may also be at risk or harm.
- There is a public safety concern and it is in the
public interest to override consent because of the seriousness of the incident or allegation and/ or risk to other people.
- Any member of staff from any agency witnessed a crime being committed.
If in any doubt about contacting the police, discuss this with your line manager.
Contact Number 999 in an emergency.
- Request the assistance of the police and any other
emergency service that is required.
Police Scotland: 101
A referral must also be made to Glasgow City HSCP
- regardless of whether the police or any other
emergency services are contacted.
who would i report concern to within Glasgow City HSCP
either
- Social Care Direct on 0141 287 0555 - contact for all referrals.
- The Social Worker or Care Manager to which the person is already allocated or
- The Duty Social Worker.
- Out of hours - Glasgow and Partners Emergency Social Work Service (before 8.45am and after 4.45pm Monday to Thursday, before 8.45am and after 3.55pm on Fridays, and during weekends and public holidays).
0300 343 1505
what is i need advice about what to do
Social Care Direct can be contacted for advice at any time during working hours.
Social Care Direct: 0141 287 0555
Outwith office hours you can contact:
- Glasgow and Partners Emergency Services on
0300 343 1505
You can phone the Social Work duty team and ask to speak to a Duty Worker. - North East Area Team 0141 276 4710 - South Area Team 0141 276 5010 - West Area Team 0141 276 5252
who else should be contacted
Referrers from registered care providers should contact.
- Care Inspectorate: 0141 848 4230
- Glasgow City HSCP Commissioning Team via
Social Care Direct
Other contacts can include:
- The Mental Welfare Commission: 0131 313 8777
- Advocacy Services can also provide advice. Main contact for Advocacy Services is: Advocacy Project: 0141 420 0961
Adults support and protection context
Agencies should refer to their own policies and procedures
- overarching responsibility for Governance, Quality Assurance and Multiagency collaboration across the Partnership.
- vision statement- “By promoting health and well-being we aim to strengthen, safeguard and protect vulnerable people”.
Agencies are responsible for providing ASP training
Multi agency training provides an overview of the legislation and refers to the policies and procedures of the Local Authority.
Further information is available at - www.glasgowadultprotection.org.uk
key legislation used to support and protect adults
Adults With Incapacity (Scotland) Act 2000
- Allows intervention in an adult’s welfare and financial affairs where the adult lacks capacity.
Mental Health (Care and Treatment) (Scotland) Act 2003 - Enables medical professionals to detain and treat people on the grounds of mental disorder
Human Rights Act 1998
- The rights of individuals must be upheld at all times
All linked to the Human rights Act which ensures for example
- your right to have and express your own opinions
- your right to a private and family life
Adults With Incapacity (Scotland) Act 2000
Allows intervention in an adult’s welfare and financial affairs where the adult lacks capacity.
Mental Health (Care and Treatment) (Scotland) Act 2003
Enables medical professionals to detain and treat people on the grounds of mental disorder
Human Rights Act 1998
The rights of individuals must be upheld at all times
e. g.
- your right to have and express your own opinions
- your right to a private and family life
using the law to protect adults
The law overlaps - Triage of Legislation
- It will be for the social worker to determine while supporting the adult which area of legislation will be most appropriate.
- Sometimes it may be necessary to use more than one law
It can be difficult to find the best response
Consider alternatives to legislation
Adult protection situations are often complex and messy – the law will never be able to offer solutions for every situation
- Adult support and protection is a consenting piece of legislation
- much more powerful when the adult works with services to effect change in their own life and circumstances,
if they however have capacity and choose not to that is there right.
- ASP still allows us to gather the facts under the duty to inquire, investigation stage and hold a case conference if required,
- Continuing with ongoing inquires/ investigation will enable us to highlight the risks and concerns even when someone is not engaging and having these multi agency concerns documented.
Adult Support and Protection (Scotland) Act 2007
ASP Act was implemented in October 2008
- 12 years in practice to 2020
Introduced new measures to identify and protect “adults at risk of harm”
- New definitions and terminology
“Abuse” - replaced with “harm”
“Vulnerable adult” replaced with “adult at risk”
adult at risk 3 point test
Adults aged 16 and over who;
- are unable to safeguard their own well-being, property, rights or other interests; (and)
- are at risk of harm; and
- because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected
All 3 points above MUST be met, this is commonly referred to as the 3 POINT TEST
- adult needs help, support and protection as at risk of harm
‘unable’ definition
Oxford English Dictionary as ‘Lacking the skill, means or opportunity to do something’.
A clear distinction should be drawn between an Adult who lacks these skills and is unable to safeguard themselves or a person who is deemed to have the skill, means or opportunity to keep themselves safe, but chooses not to do so.
An inability to safeguard oneself is not the same as an adult not having capacity.
An adult may be considered unwilling rather than unable to safeguard themselves and so may not be considered an adult at risk.
For example, the issue of ongoing problematic use of drugs or alcohol may take place alongside (and on occasions contribute to) a physical or mental illness, mental disorder or a condition such as alcohol related brain damage.
- If this is the case an adult may be considered an “adult at risk”.
However, without any additional vulnerability, such as an illness or disability, adult protection intervention would not normally be appropriate.
- It is the co-existing illness, disability or frailty, which would trigger adult protection considerations, rather than the substance use itself.
adults deemed at risk of harm when
- Another person(s) conduct is causing (or is likely to cause) the adult to be harmed
- The adult is engaging (or is likely to engage) in conduct, which causes (or is likely to cause) self-harm
e. g.
- when someone takes money from an Adult or physically or verbally harming them, and that Adult cannot protect themselves.
- when an Adult engages in behaviour or conduct that is likely to cause them self-harm: for example hoarding behaviours, poor self-care or self-neglect.
principles of ASP (9)
Intervention must Benefit the Adult
Be the Least Restrictive Option
Have regard to the Adult’s ascertainable wishes
Take account of the views of the Adult’s nearest relative, primary carer, guardian or attorney
Take account of the views of any person who has in interest in the Adult’s well being or property
Encourage participation of the adult as fully as possible
Provision of information and support to enable the adult to participate
Ensure the Adult is not treated less favourably than any other adult in a comparable situation
Take account of the Adult’s abilities, background and characteristics
2 overarching principles of ASP
Intervention must Benefit the Adult
Be the Least Restrictive Option
principles of ASP use
guide on how we interpret legislation and how we engage and work with adults at risk of harm
Applying the principles when using the legislation enables practitioners to strike the balance between an Adults right to freedom of choice and the risk of harm to that individual. Any intervention must be reasonable and proportionate.
Any person making a decision under the Act must be able to demonstrate that the principles have been applied
council dutues/powers
The ASP act places a statutory duty on Councils/Local Authorities to:
- Make inquiries about an adults well-being, property or financial affairs, determine if the 3 Point Test is met and to determine if further action is required to stop or prevent harm from occurring
what is the responsibility of Social Work Scotland
to lead on the adult protection inquiry and or investigation.
Where inquiries have established that a formal ASP Investigation is required, this must be led by a Council Officer.
- QSW has been in practice for a year or more and worked with vulnerable adults, completed a 5 day
Council Officer training
Council Officer can interview the adult but must inform of the right not to answer questions
- Linked to principle of participation
Duty to consider importance of providing advocacy and other services
co-operation of which bodies is ASP (7)
Council
NHS
Police
Mental Welfare Commission
Care Inspectorate
Office Public Guardian
Health Improvement Scotland
multiagency staff responsibilities with each other
should be aware of how to initiate appropriate reporting if they have concerns about an Adult.
Equally, all staff should also be aware of their own organisations policies and procedures in regards to Adult protection
what do multiagency report to council
report the facts and circumstances to the Council when they believe an Adult is at Risk
3 multiagency jobs
These public bodies must report the facts and circumstances to the Council when they believe an Adult is at Risk
Public Bodies must Co-operate with the council to assist with their inquiries and
Share Information – e.g. agencies provide full co-operation and information across partner agencies, in regards to issues relating to confidentiality, adult protection, duty to inquire and protection planning, not undermine police if criminal activity indicated
The consent of the adult is not required
capacity
Adult can lack capacity and still be referred under ASP legislation
While capacity can be difficult to establish the Adult does not need to lack capacity in order to be considered as an Adult at risk.
consent
Adult does not need to consent to referral being made
- It would be good practice in the first instance to discuss the referral with the Adult.
Equally the adult does not need to consent to engage within the ASP process however this does not stop inquiries taking place
undue pressure
There are certain circumstances whereby action can be taken without the Adult’s consent when we are able to evidence Undue Pressure.
- Any person can inflict undue pressure, not just the person who is believed to be causing the harm.
- For the purposes of this Act, the adult cannot unduly pressure themselves (when there is no other person involved).
- Undue Pressure can be a threat from a person the adult already knows and may be afraid of.
E.g. Adult may have a relationship with the person causing them harm and they may be dependant for care from them.
This must be evidenced if taking action against the Adult’s wishes
10 examples of harm types
Sexual Harm Physical Harm Emotional/Psychological harm Self Harm Institutional Verbal Neglect and acts of omission Finance or material Discriminatory Multiple forms of harm
6 indicators for harm awareness
- physical harm
- psychological harm
- sexual harm
- neglect/acts of omission
- financial harm
- institutional harm
signs physical harm
Marks on the body, including:- ‘black eyes’, bruising, cuts, burns, finger marks, etc.
Dubious or inconsistent explanations of injuries or bruises
History of unexplained falls, injuries or fracture
Prolonged interval between illness/injury and presentation for medical care.
Adult experiences injuries coupled with chronic anxiety, distress or constantly fearful
Confusion, forgetfulness or drowsiness indicating possible illicit or unauthorised giving of pharmaceuticals by others (eg; drugs concealed in food or drink).
Excessive and/or inappropriate use of physical restraint and/or pharmaceutical restraint.
psychological harm signs
Agitated, fearful or paranoid behaviour around others.
Poor self-esteem and lacking in confidence.
Seeks isolation and is withdrawn.
Ambivalent about themselves and resigned to whatever happens to them.
Changes in behaviour that may influence personal hygiene or how they appear to others.
Extreme changes in appetite leading to weight loss or gain.
Has difficulty sleeping.
Can experience low mood and is easily distressed.
May show signs of obsessive behaviours.
sexual harm signs
Sexual activity with others when the adult has a mental disorder and does not have the capacity to consent to sexual activity.
Adult makes references to having a ‘boyfriend’ or ‘girlfriend’ but does not understand what that term means.
Physical trauma to the genitalia or rectum (signs of cuts, bruising, bleeding, etc)
Adult shows signs of pain, itching or discomfort around the genitalia, including:- marks on the inner thighs and difficult walking or sitting down.
Psychological trauma (mood instability, nightmares, anxiety, extreme changes in normal behaviour, appears withdrawn and low in mood).
Adult shows distress or agitation when there is personal contact.
Overt and inappropriate sexualised behaviour or language, that is a marked change from normal behaviour.
Challenging sexual behaviour directed at other vulnerable people.
Sexual images of the adult appearing on internet sites, other social media or distributed by e-messaging
The adult at risk lives with another member of the household who is known to the police, social work or health agencies as likely to present a sexual risk to the adult
Adult is victim of trafficking
neglect/acts of omission signs
The adult at risk found alone at home or in a care setting in a situation of serious but avoidable risk
Non-administration of medication or medication going missing
Sudden increases in confusion or drowsiness e.g. toxic confusion or over-sedation.
Unexplained physical deterioration in the adult e.g. loss of weight or dehydration
Demonstration of fear by the adult at risk to another person within home or if returning home.
Pressure injuries to the skin, such as ulcers or ‘bed’ sores.
Unkempt in appearance, poor personal hygiene and lack of dental care.
Poor environmental hygiene, including:- overpowering smell of urine and faeces
Lack of furniture and absence of utilities services (gas, electricity, etc)
Difficulty in interviewing the adult at risk of harm due to the insistence or presence of another
Hostile or rejecting behaviour by a carer towards the adult
Severing of contact with health and care services by others.
Difficulty of services in obtaining face-to-face contact with the adult.
Adult has no social contact with others
financial harm signs
Unexplained debts, reduction in assets or reports of money going missing.
Sudden change in ability to pay bills and lack of money.
Unexplained changes to way benefits are paid (changing bank accounts).
Unusual interest in adult’s finances by family members or attempts to obtain bank card and PIN number.
Family member or ‘friend’ claims to have financial power of attorney but is unable to evidence this.
Adult reporting regular loss of bank card and disclosure of PIN number to others.
Strangers appearing in adults home that adult appears uncomfortable with.
Family members or ‘friends’ using adults property without the adults approval or understanding.
institutional harm signs
Unusual number of staff complaints, disciplinary action or dismissals.
High numbers of disclosures of abuse but no further action taken.
Excessive levels of complaints from families.
Inappropriate intimacy between staff member and adult (also possible indicator of ‘grooming’).
Inappropriate or sexually challenging behaviour between adult service users is not perceived as harm, by staff.
Frequent and inappropriate use of physical and pharmaceutical restraint.
Use of forced incarceration in locked rooms.
Consistently poor standards of care.
Poor leadership, absent Managers and lack of control of staff group.
Poor morale amongst staff with high levels of stress and staff ‘burn-out’.
Stigmatisation and disregard of persons sense of identity and ‘self’, including
- lack of understanding of person’s condition; intolerance of person’s condition; lack of respect and dignity; mocking of residents/patients.
There is denial or lack of concern amongst staff, regarding the possibility of abuse occurring.
There is ambivalence at all levels of service when suspected or actual abuse is reported.
Medication concealed in food, without the adults knowledge, when the adult has the capacity to consent to treatment.
more unusual types of harm (9)
Forced Marriage Honour Based Violence Radicalisation Female Genital Mutilation Human Trafficking Fire Casualty Online Safety Modern Day Slavery Hate Crime
overall timescale for ASP inc case conference
total 20 days
timescales for ASP
Acknowledgement of referral within 1 working day
Duty to Inquire complete within 5 working days
- By social care worker within GCHSCP
Investigation complete within 20 working days
- Council Officer who is qualified social worker and has undertaken the full 5 days ASP training
Case Conference complete within 20 working days
- Council Officer who is qualified social worker and has undertaken the full 5 days ASP training
Protection Plan complete within 10 working days of case conference
3 monthly reviews if subject to ASP care management
ASP feedback
Acknowledgment of referral –Electronic from SCD
Outcome of ASP Inquiry- Letter from Social Work advising of outcome
No details of action taken will be noted on letter
Referrer encouraged to contact SWS if further information is needed.
- Feedback on referrals is always of concern to agencies and it is important to note that when a referral is received the worker will most often go to the person who made the referral for more detailed information
Carefirst will have detailed decision on ASP outcome
- team Leader responsible for recording their decision making in terms of ASP
first stage in ASP process
duty to inquire
when referral passed to area team
what is an inquiry
The initial inquiry is completed by Social Work Staff (does not need to be a qualified Social Worker)
Checking background information
- Records, Speaking to others involved e.g. professionals, GP, carers etc
- Establish accurate background information and determine risk
Speaking to the adult at risk of harm
- Determine their view of the situation and whether they agree with the concerns, also whether they are able to safeguard themselves
Establishing whether the 3 point test is met and a Risk Assessment is required.
An inquiry does not require the consent of the adult
investigation in ASP
completed when established the 3 point test met and adult continues to be at risk of harm
2 workers are required to complete an investigation. Lead worker must be a Council Officer
what is an investigation
Gathering information to inform a risk assessment which is completed by the Council Officer
Completion of a chronology of significant events relating to current concerns
Support to protect the adult from risk of harm – which is immediately available
Use of the legal framework in relation to the ASP Act.
- investigation will consider how the provisions contained within the legislation can be used
- consideration for the need to apply for a protection order
- use principles – key ones include benefit to the Adult and that any intervention is the least restrictive option to the Adult
Scenarios documents and AP1 - decide if you would make an ASP referral
investigation actions (4)
Visits
Private Interview
Medical Examinations
Examination of Records
Scenarios documents and AP1 - decide if you would make an ASP referral
protection order (4 types)
assessment order
removal order
banning order and temporary banning order
warrant for entry (s.37)
assessment order
allows the adult to be taken to a more suitable place for an interview or medical examination e.g. to carry out an interview or medical examination or assessment of wellbeing
can last for a period of 7 days
must apply via legal service
removal order
permits the adult to be moved to any place to protect them from harm e.g. removal to a care home
lasts up to 7 days
banning order and Temporary Banning Order
bans the subject of the order from a specified place-can have conditions and powers of arrest attached
6 months -can have Powers of Arrest attached.
who can apply for removal order and assessment order
Only LA can apply for Assessment and Removal order.
If LA applying for an order without the Adults consent then evidence of Undue Pressure must be clear
who can apply for banning order
Adult can apply for a Banning Order.
warrant for entry (s.37)
Granted by a Sheriff and expires after 72 hours-allows Council Officer access to the adult at risk
Once executed the warrant cannot be reused
who can apply for protection order if undue pressure of adult evidenced
A council officer can apply for a Protection Order if able to evidence Undue Pressure without the Adults consent.
ASP meetings 3 types
ASP case discussion
ASP initial case conference
ASP review case conference
ASP case discussion
process of formal discussion between inter agency professionals
- similar to initial referral discussion within Children and Families Procedures
chaired by Responsible TL
any time during ASP process
ASP initial case conference
20 days after initial referral
follows on from investigation and should be multi- agency.
- purpose of the conference is to invite those who are involved with the adult at risk of harm to contribute to formal discussions to decide on what further action is needed to reduce any further risk
Chaired by ASM
- independent and will look to hear from each participant to make an informed decision
- Decisions made at the case conference will be the chairs responsibility.
responsible for disseminating a 24 hour decision letter following the case conference outlining what actions have been agreed e.g. protection plan which each agency own responsibility to do
(e.g. council officers’ need to write up plan)
Adult should be encouraged attend, supports offered to enable them to
ASP review case conference
3 months after the initial case conference, then as required or within 3 months of each review
- review of the protection plan and decision making in relation to whether the Adult continues to require to be managed under ASP care management
Chaired by ASM
Adult should attend
attending case conference
Written reports should be given to the conference Chair before the conference starts.
- If you are invited to the case conference and you are unable to attend
Talk to the Adult at Risk about your views/concerns beforehand
- ensure that they are kept informed
- best practice
Be prepared to contribute your view of risk and protective measures
Be prepared to contribute to the development of a protection plan if needed
- aimed at how we can as agency’s work together to reduce risk.
Risk managements is everyone’s responsibility.
6 case conference outcomes
No further action required-Risk no longer evident
Refer for social work assessment
- this would be where there are unmet needs and the adult no longer meets the definition of the 3 point test
Refer to other agency
ASP Care management
Implement Protection Plan
Apply for a Protection Order
how to report concerns
3 Rs
the 3 Rs
Recognise – spot signs, do something
Record – listen carefully, believe and take short notes
Report – tell someone, complete AP1 and send to social care direct
if adult in immediate danger
call 999
Speak to line manager
Refer to agency Adult Protection procedures
Complete AP1 and send to Social Care Direct
