Any physical contact has the potential to be seen as a form of physical abuse. It can depend on the degree of force, or the nature of the contact, used and the intention behind the action.
Clear cases of abuse would be classed as common assault and subject to criminal prosecution. This could include hitting, slapping, kicking and pushing – the sort of actions involved in bullying. These may be carried out by care workers who lose their temper with a service user because they are being difficult or it may be in retaliation for being hit with a walking stick by a confused patient. A possible scenario could be:
George is angry at having to move to a care home when his wife is no longer able to look after him. He is becoming confused and shows his anger by lashing out with his stick at anyone who comes near. Anthea an agency worker has come in to cover for sickness and hasn’t been told about him. As she bends down to pick up something, he hits her across her back. He is surprisingly strong. Anthea instinctively lashes out in pain and hits him back.
Sexual abuse
Such abuse may range from inappropriate touching to rape. Staffs have a duty of care towards service users and it is inappropriate and against professional guidelines to engage in a sexual relationship with someone who is in their care. There have been prosecutions in recent times of staff who have taken advantage of patients who have been paralysed or sedated. Other staffs have had inappropriate relationships with service users in their care who have had learning disabilities. The individuals have not been able to give their full consent to such activities because of their limited understanding of the situation.
Psychological abuse
A service user who is being abused may also be threatened to keep quiet. They might be told that it is our little secret or that they will lose their accommodation if they tell anyone what has happened. Continuous put-downs and name calling in front of others humiliates people, causing them to lose self-respect and pride. This can lead to a self-fulfilling prophecy.
Just as bullying at school can lead to the bullied being driven to take extreme action the same can happen to vulnerable adults. This can especially be the case if they have difficulty in getting away from the bully.
Financial abuse
Financial abuse is probably the most common form of adult abuse, because it is so easy to take advantage of someone who has to rely on someone else to help them with their finances or because they don’t understand financial matters. Financial abuse is the mismanagement of money/assets.
Financial abuse includes theft and fraud, but in reality there are just so many different ways to financially abuse someone. Abusers can persuade a vulnerable adult to put bank or building society accounts into joint names or to obtain a cash or credit card and then use it themselves. People may obtain the right to access or manage a person’s money but again they keep money for themselves or mismanage it. So financial abuse can be:
- Taking/spending money without consent
- Taking pension/benefit
- Taking/selling possessions
- Theft
- Fraud
- Acting as appointee, attorney or receiver and then misusing money/assets
- Charging for services which should be inclusive in fees
- Adding points to one’s own reward card and not the service user’s when shopping
- Putting bank/building society accounts of money
- Obtaining a credit card in someone else’s name
- Using a cash card without consent
- Forcing changes to bank accounts and wills etc.
- Saying bill have been and they haven’t
- Saying shopping cost more than it did
- Denying access to money/assets
- Persuading someone to handover something which is valuable
Neglect
Neglect can be physical or emotional. Neglect can also be an act of emission – that is failing to do something not washing, dressing or toileting, failing to get medical attention and so on.
It can be difficult to prove neglect because it can be inflicted in very subtle ways for example, by consistently leaving a Zimmer frame out of reach. Rarely are people seen every moment of the day, so it might be difficult to pick up the fact that someone is not being stimulated. Every human being needs some form of social contact otherwise he or she will become isolated. If someone is not allowed out or is kept in a confined area it may feel like imprisonment. Other vulnerable adults can be abandoned when carers have had enough so they no longer visit them, or dump them in a casualty department.
Discriminatory abuse
Discriminatory abuse is a new category of abuse in that it became the sixth category of abuse. Many abuse policies had statements about principle underpinning adult protection work and this usually included something about equal opportunities and anti-discriminatory practice. Having discriminatory abuse as a category in its own right gives more recognition to the issue. However many policies are not detailed enough about this type of abuse. Many state the obvious that no person should be discriminated on the grounds of:
- Age
- Gender
- Sexuality
- Religion
- Culture
- Disability
- Race
Institutional abuse
People’s rights can be abused by the practices and procedures of the organisation that cares for them.
It was common practice in care homes and hospital wards to start waking service users from 5.30am onwards to enable the night staff to wash everyone and give them breakfast before the day staff came on duty. This was for the benefit of the organisation and not the service users.
Home-based service users who need help in going to bed and getting up in the morning may be put to bed at 8.00pm and have to wait until 8.00am before the carer returns. Their choice of bedtime is overruled by the needs of the organisation to get around a number of clients, using a limited number of staff.
Members of staff can be introduced to poor, and potentially abusive, care practices by staff telling them this is the way we do things here. This can include:
- Leaving toilet doors open so service users can be checked on
- Having some residents as their favourites and ignoring the quieter ones
- Making fun of people’s bodies when bathing them
- Spooning food into people’s mouths before they have finished their previous mouthful, to hurry them up.
Self-harm
Self-harm or self-abuse can take the form of self-inflicted wounds such as cuts to the arm and wrists, burns with lighters and cigarettes and the piercing of the skin with pins or sharp objects. These forms of abuse can be used to detract from, and replace, the psychological and emotional pain being felt by the individual. It can also be a reaction to feeling trapped in a situation from which there does not appear to be any escape.
Domestic violence/abuse
If there has been domestic violence within a partnership or family before an individual became a service user, it may continue even after the service user moves into supported accommodation or care home. Domestic violence covers physical, sexual and psychological abuse but other forms, such as financial abuse, may also exist.
Describe different indicators of abuse in vulnerable adults
P3
Describe the potential for abuse in health and social care contexts. Analyse the potential for abuse in four health and social care context.
P4 & M2
A Home that provides residential care for confused older people
Financial Abuse or Exploitation: stealing or taking money or property without permission, misrepresenting usage of funds, forgery, denying access to funds or property.
Caregiver Neglect: failure to provide appropriate and adequate care, such as proper nutrition, clothing, medication, not taking resident to the bathroom, not turning residents, not answering calls for help or providing other necessary assistance with daily living.
Physical Abuse: hitting, pushing, kicking, punching, slapping, pinching, rough handling, burning, biting, beating, hair-pulling, improper use of physical or chemical restraints and other physical aggressions.
Emotional Abuse: verbal harassment, insults, threats to physical being, threatening residents with discharge, threatening other forms of punishment, isolation, degradation, talking to residents like they are a child, using demeaning language, manipulation, ignoring residents and other transgressions against an individual’s mental health.
Sexual Abuse: inappropriate touching, forced sexual contact, unwanted sexualized behaviour, photographing individuals in suggestive positions, forced viewing of pornography and other non-consensual sexual activity.
Vulnerable adults, who do not wish to make a complaint, or be involved in an investigation of alleged abuse, have the right of refusal. Even in cases where the adult is not considered capable of giving their informed consent or agreement their advocate might feel it is not in their best interests to have the matter pursued.
Supported flats for people living in the community who have learning disabilities
People with learning disabilities may live in the community in supported houses that are not staffed at night. They can become prey to local teenagers and young adults who take advantage of their open, trusting nature and use their accommodation as a drop in and a place to have drinking parties, etc. The service user finds they are swept up in the activities and are unable to control the situation. Neighbours may act as informal carers and develop an abusive relationship because of the imbalance of power in the relationship.
People with learning difficulties tend to be over-complaint and to accept whatever happens to them. They have low expectations and low-self esteem. Their illness, condition or age tends to make them isolated and limit their social networks. As a result they become dependent on their abusers, or potential abusers, for help, services and social interaction. Being vulnerable increases the fear of retaliation from the abuser. Service users can blame themselves for their abuse and believe they have deserved it. The abuser can reinforce this.
A home care service that provides home support for physically disabled people living in their own homes.
Living alone, and depending on others, can be isolating for people who have limited social networks. They may find their main social contact is with their carers. Such isolation and dependency can increase the vulnerability of an individual who is confused, frail or has a learning disability.
Individuals with physical disabilities may be naive and have limited sexual knowledge, which leaves them more open to being taken advantage of. There is evidence that adults can be groomed in the same way as children.
Service users who have a previous history of being abused can come to see it as a continuance, even in different circumstances and settings, of the norm. They feel disempowerment and unable to resist.
The potential for abuse lies in the nature of the interaction and the powerlessness of the service users. The service user’s need for help with personal care increases the opportunity for abuse and can make it harder to be sure it has actually taken place. It is an intimate and personal relationship that takes place behind closed doors privately and therefore it is difficult to monitor.
A long stay hostel for homeless men
Physical Abuse: hitting, pushing, kicking, punching, slapping, pinching, rough handling, burning, biting, beating, hair-pulling, improper use of physical or chemical restraints and other physical aggressions.
Emotional Abuse: verbal harassment, insults, threats to physical being, threatening residents with discharge, threatening other forms of punishment, isolation, degradation, talking to residents like they are a child, using demeaning language, manipulation, ignoring residents and other transgressions against an individual’s mental health.
Sexual Abuse: inappropriate touching, forced sexual contact, unwanted sexualized behaviour, photographing individuals in suggestive positions, forced viewing of pornography and other non-consensual sexual activity.
Describe strategies and working practices used to minimise abuse
P5
Strategies
POVA (Protecting of Vulnerable Adults)
On 11th Dec 03, a consultation document was legislated through part VII of the Care Standards Act 2000. It outlined the practical guidance on protecting vulnerable adults. It will be a register of workers who have harmed or placed a vulnerable adult at risk whether or not in the course of their current employment. The POVA scheme will provide an effective, workable measure to safeguard vulnerable adults from people who are unsuitable to work with them.
Vulnerable adults will therefore receive a greater degree of protection from harm.
Phased implementation, starting with social care ensures that the most vulnerable are protected without delay. The carers and relatives of vulnerable adults as well as the general public will be assured that there is a system in place to safeguard some of the most vulnerable adults.
Harm as defined in section 121 of the Care Standards Act 2000 as, the ill treatment or the impairment of health an adult who is not mentally impaired the ill treatment or the impairment of health or development to an adult or a child, who is mentally impaired.
POVA will target workers in services that are provided predominantly for vulnerable adults. Workers in registered care homes with or without nursing on the premises and, domiciliary care agencies who provide personal care
Care Homes Regulation 2001
This set out the requirements that providers and managers of care homes must meet in order to be registered as fit or suitable for a job. It also sets out how care should be carried out within care homes. CRB checks are required for staff to assess their suitability to work with vulnerable adults. A fine would not normally preclude and individual from being employed but theft, or offences involving violence against a person, would be precluding them.
National Service Framework
As outlined in the NHS Wales White Paper "Quality Care and Clinical Excellence", National Service Frameworks provide a systematic approach on which to tackle the agenda of improving standards and quality across health care sectors. NSFs are implemented in partnership with social care and other organisations.
They:
- set national standards and define service models for a service or care group;
- put in place programmes to support implementation;
- Establish performance measures against which progress within agreed timescales would be measured.
Working Practice
Identify the legislation policies and procedures that protect adults receiving health and social care services. Explain how legislation, policies and procedures contribute to the protection of vulnerable adults.
P6 & M3
Legislation
The Disability Discrimination Act 1995
The Disability Discrimination Act (DDA) 1995 aims to end the discrimination that many disabled people face. This Act has been significantly extended, including by the Disability Discrimination Act 2005. It now gives disabled people rights in the areas of:
- employment
- education
- access to goods, facilities and services, including larger private clubs and land-based transport services
- buying or renting land or property, including making it easier for disabled people to rent property and for tenants to make disability-related adaptations
- functions of public bodies, for example issuing of licenses
The Act requires public bodies to promote equality of opportunity for disabled people. It also allows the government to set minimum standards so that disabled people can use public transport easily.
This can help disabled people because they can now work where they want and have access to locations like school and bars etc. With this policy disabled people can feel a bit safer knowing that there is a legislation that tends to their needs.
The Human Rights Act 1998
The Human Rights Act 1998 gives further legal effect in the UK to the fundamental rights and freedoms contained in the European Convention on Human Rights. These rights not only impact matters of life and death, they also affect the rights you have in your everyday life: what you can say and do your beliefs, your right to a fair trial and other similar basic entitlements.
Most rights have limits to ensure that they do not unfairly damage other people's rights. However, certain rights – such as the right not to be tortured – can never be limited by a court or anybody else.
You have the responsibility to respect other people's rights, and they must respect yours.
Your human rights are:
- freedom from torture and degrading treatment
- freedom from slavery and forced labour
- the right to liberty
- the right to a fair trial
- the right not to be punished for something that wasn't a crime when you did it
- the right to respect for private and family life
- freedom of thought, conscience and religion, and freedom to express your beliefs
- freedom of expression
- freedom of assembly and association
- the right to marry and to start a family
- the right not to be discriminated against in respect of these rights and freedoms
- the right to peaceful enjoyment of your property
- the right to an education
- the right to participate in free elections
- the right not to be subjected to the death penalty
If any of these rights and freedoms is breached, you have a right to an effective solution in law, even if the breach was by someone in authority, such as, for example, a police officer.
This act makes vulnerable adults feel like they have priority over their lives; it makes them feel like they’re the boss that they have to right to do whatever they wanted to do.
The Data Protection Act 1998
The purpose of the Act is to protect the rights of the individual about whom data is obtained, stored, processed or supplied rather than those of the people or organisations who control and use personal data. The Act applies to both computerised and paper records.
The Act requires that appropriate security measures will be taken against unauthorised access to, or alteration, disclosure or destruction of personal data and against accidental loss or destruction of personal data.
With this Act Vulnerable adults can feel assurance that their personal information is kept confidential. This way their personal information will not get in the wrong hands.
The Special Educational Needs Act 2001 and Disability Act 2001
The Special Educational Needs Act 2001strengthens the right of children with special educational needs to be educated in mainstream schools where parents want this and the interests of other children can be protected. It also requires schools to inform parents where they are making special educational provision for their child, and allow schools to request a statutory assessment of a pupil’s special educational needs.
The Disability Act 2001 states it is now unlawful for schools and Local Education Authorities to discriminate against disabled pupils, either current or future, for any reason related to their impairment. Parents who believe discrimination has taken place will be able to take action through the Special Educational Need and Disability Tribunal, or through admissions and exclusions appeals panels. Disabled children have the same rights of access to schools and their courses as any other children.
The Race Relation Act 2000
The Race Relations Act 1976 as amended by the gives public authorities a statutory general duty to promote race equality. The aim of the general duty is to make promoting race equality central to the way public authorities work; and this includes schools. The general duty says that the body must have 'due regard' to the need to:
- eliminate unlawful racial discrimination; and
- Promote equality of opportunity and good relations between people of different racial groups.
In addition the Act places specific duties on schools to help them meet the general duty. They are a means to an end; that is, they should result in and improve the educational experience for all children, in particular those belonging to minority ethnic groups. It should not become a bureaucratic exercise. These specific duties are:
- to prepare a written statement of the school's policy for promoting race equality, and to act upon it;
- to assess the impact of school policies on pupils, staff and parents of different racial groups, including, in particular, the impact of attainment levels of these pupils;
- to monitor the operation of all the school's policies, including, in particular their impact on the attainment levels of pupils from different racial groups; and
- To take reasonable steps to make available the results of it’s monitoring.
Policies and procedures
The role of the Criminal Records Bureau and enhanced disclosure
The Criminal Records Bureau (CRB), an Executive Agency of the Home Office, provides wider access to criminal record information through its . This service enables organisations in the public, private and voluntary sectors to make safer recruitment decisions by identifying candidates who may be unsuitable for certain work, especially that involve children or vulnerable adults. The CRB was established under Part V of the Police Act 1997 and was launched in March 2002.
Prior to 2002, access to police checks was mainly confined to organisations in the statutory sector for staff that had ‘substantial unsupervised accesses to children. There were many other organisations that could not access these checks and yet had staff with similar access to vulnerable groups. The CRB enables many more organisations to access these checks as part of good recruitment practice.
Working with Vulnerable adults
The guidance in No Secret identified the importance of having regional and local frameworks within which polices, strategies and procedures could be developed between agencies for the protection of vulnerable adults. These were along similar lines to those produced for child protection. It suggested a multi-agency management committee, which would oversee the development and implementation of such an approach, and set out procedures to be followed when investigating allegations of abuse. It also noted that abusers might be vulnerable adults who would need help, support and protection, in the form of an appropriate adult throughout such an investigation.
Analyse the role of multi-agency working in minimising the risk of abuse in health and social care context
D2
The role of multi-agency working
It has often proved difficult to establish the exact impact of multi-agency working, mainly because of the difficulty of isolating why and how a particular outcome has been achieved. This is changing as major programmes are evaluated.
Improving outcomes for children and families
School staff working with child and adolescent mental health services (CAMHS) identified that the joint work had led to an increase in children's happiness and well-being. They identified a measurable improvement in children's behaviour in two of the services reviewed, and better peer relationships were identified by workers. Although rarely measured, workers identified links to improved academic attainment, as children were able to learn and were developing learning skills.
In work with disabled children, families with key workers to coordinate services report improved quality of life, better relationships with services, better and quicker access to services and reduced levels of stress.
Even at a relatively early stage of development, the multi-agency On Track programme was identified as having a positive impact on children and families, with outcomes reported in the following areas:
- Improved behaviour
- Enhanced relationships with service providers, parents and other adults (such as police officers)
- Improved access to education
- Enhanced emotional and social well-being, especially relating to confidence and self-esteem
In healthcare, multi-agency working has been associated with better patient outcomes and lower levels of stress for staff.
Numerous projects report positive outcome measures which are specific to the type of teams and range of work studied:
- Innovative multi-agency projects targeting children's mental health showed a reduction in the proportion of those with clinically significant problems in many cases, as well as better engagement with school.
- One primary school with access to a behaviour and education support team (BEST) reports that its drastic reduction in exclusions and behaviour problems was due to the BEST. Their impact had been "tremendous - the best we've had. They've been superb in the support given to children, the family and the school. There has been a change in self-esteem, worth and children's expectations for the future".
- In its first two years of operation the Darnell and Tinsley On Track service reported a 50% reduction in levels of crime among 10-12-year-olds and a 50% reduction in the number of referrals to social services of children and young people aged 0 to 17, against a city-wide backdrop of just over 25%.
Extended schools offering a range of services have identified a positive impact on children's attainment, on their general well-being and on their overall life chances. Some of the key benefits are higher levels of achievement; increased motivation and self-esteem; more opportunity to participate in sports, arts and cultural activities; and specialist support to meet additional needs. Families report seeing improvements in their children's behaviour; being more involved in their children's learning and finding it easier to take up employment due to the provision of affordable childcare.
The multi-agency composition of BESTs was found to be advantageous in terms of working practices and ultimately the impacts achieved. Referral systems were said to be more streamlined, while schools, families and children benefited from more immediate access to support when required. The pool of skills within the team meant that BESTs could offer holistic support to those referred, and by addressing the health, domestic and social welfare concerns of children and families, steps were made towards improving attendance, behaviour and attainment.
BEST intervention was also seen to have impacted positively on parents in a number of ways. Most frequently mentioned was improved access to services being facilitated through contact with the BEST, both in terms of services within the BEST and through signposting on to other agencies. Also mentioned were: identification of adult's needs, access to grants or practical resources for families, and improved parent-child relationships through parenting skills and strategies acquired through BEST interventions.
Other commonly identified outcomes of multi-agency work are:
- Access to services not previously available, and a wider range of services
- Easier or quicker access to services or expertise
- Improved educational attainment and better engagement in education
- Early identification and intervention
- Better support for parents
- Children's needs addressed more appropriately
- Better quality services
- Reduced need for more specialist services
Benefits for staff and services
Practitioners with backgrounds in single, traditional agencies report high levels of satisfaction with multi-agency working. In particular, they feel liberated from the narrow bureaucratic and cultural constraints of their parent organisation. Where the initial bedding down phase is well-managed, they find the potential for cross-fertilisation between the different agencies stimulating; and many value the opportunity to take a more holistic approach to the needs of children.
Schools delivering extended services have identified opportunities for staff to work flexibly and for support staff to access more career development opportunities. Where there are swift referral systems to multi-agency support, extended schools have seen improvements in staff recruitment, retention and workload. They also provide opportunities for enhanced partnership working with the community and better school security.
Working within a BEST was described as having been a rewarding experience for the majority of the practitioners interviewed. Many of the positive impacts reflected those cited more generally as benefits of multi-agency working. Most commonly mentioned was professional development: opportunities to share expertise and learn from colleagues through discussion of casework and joint delivery of interventions.
The On Track evaluation identified positive impacts for staff. These were primarily associated with new ways of working within multi-agency teams, in particular:
- Less replication between different service providers
- Better links between service providers, including a greater understanding of their practices
- Professional development and career progression opportunities
- More involvement in community development
- Improved awareness of different services and changed public perceptions of service providers