Tools for Practitioners

This page contains a number of documents to support practitioners and their managers.

Multi Agency Risk Assessment Meeting Tool and Guidance

MARAM

This Guidance was initially issued following a number of serious incidents in Knowsley, which raised issues in relation to mental capacity, vulnerability and risk taking behaviour in respect of adults with care and support needs.
Specific issues in relation to the following areas were identified:
Fire Safety
Alcohol/drug dependence
Non compliant or challenging behaviour
Medical Intervention and Medication
Self neglect
Refusal of access to an adult with care and support needs.

In addition, although each situation demonstrated a commitment to multi-agency working, there were instances when efforts to support the adult at risk could have benefited from a clearer structure.
Accordingly, the Board decided that the recommendations from the Serious Incident Reviews would be implemented through a multi disciplinary review of current practice in assessing risk, co-ordinated by the Safeguarding Adults and Quality Assurance Unit. As part of the Merseyside shared learning the MSAB QA Sub Group used the original MARAM as the template to create a Merseyside Early Help Assessment.

This process mirrors the existing safeguarding process, which ensures that information on adults at risk is shared between agencies and enables the widest range of expertise and resources to come together to deal with instances of early help, abuse or neglect.

Complimenting the Assessment Tool is also a Distance Travelled Tool.
Please click on the link below for the full guidance and Tool, this also includes resources to support the meetings such as agendas and letter templates:

MARAM- Merseyside-Adult-Risk-Assessment-Model

Below is the assessment itself for ease of downloading.

Adult Early Help Assessment Tool

The Distance Travelled – Evidence tool will help you know when adults with care and support needs who you are supporting through the MARAM process are seeing improvements in their identified additional needs. It is aimed at ensuring that the right interventions are being provided and it will also allow you to demonstrate the impact on improving outcomes for those adults.

Please use this tool:
a) at the time of the MARAM assessment, to record the views of the adult, and
b) at subsequent review meetings to evidence the distance travelled.

Distance Travelled Score Card Making Safeguarding Personal 1

Alongside the ‘score card’ that the practitioner completes are a set of flashcards.  These are a useful guide for the adult to understand how to score themselves, there is also some tips in relation to supportive measures that can be taken.  At each meeting as support is in place the score reduces and the adult can see their own success.

Distance Travelled Flash Cards for Adults Feb 18

We Matter Too

The overall objective of the project was to develop the evidence base and shine a light on the needs of a group of young people less likely to be noticed, asked, heard or able to tell about abuse that goes on often behind closed doors. It aims to support practice development, inform service design and delivery at management levels and seek the development of policy and guidance at strategic levels. An additional outcome of the project was to develop and pilot training materials in order to directly improve understanding and practice responses by professionals.

Key findings

What disabled young people said they need: 

To be asked.  To be treated like they matter.  To have professionals who check if they have understood.  For professionals to understand that ‘asking for help is hard; it is scary’. 

For professionals to understand that it is difficult to make sense of what happens – we may not have understood that what we are witnessing and experiencing is abuse.  For professionals, and especially the police, to understand that we are scared.  To have people who try to understand our behaviour – we don’t always use words, we don’t always have the words.  To have help to understand healthy relationships and choices.

We-Matter-Too-Final-Report-9-Dec-2019

Merseyside exploitation and transition into adulthood.

Following the multi-agency webinar please find attached the full presentation given by Steve Baguley and Kay Wallace NWG CSE Response Unit.

Exploitation/Abuse

Exploitation affects young people and vulnerable adults;

Exploitation can affect any child or young person (male or female) under the age of 18 years;
Can affect any vulnerable adult over the age of 18 years;
Can still be exploitation even if the activity appears consensual;
Can involve force and/or enticement-based methods of compliance and is often accompanied by violence or threats of violence;
Can be perpetrated by individuals or groups, males or females, and young people or adults;
Is typified by some form of power imbalance in favour of those perpetrating the exploitation.
Examples of exploitation are; Sexual exploitation, Trafficking, forced labour, county Lines, criminal exploitation etc.

Please click on this link for the full presentation:

Merseyside Exploitation and Transition Presentation

 

Multiple Exclusion Homelessness A Safeguarding Toolkit for Practitioners

This is a prototype
This toolkit is currently a prototype for testing. Our intention is that practitioners use the document as an aid to fact finding and thinking where there are safeguarding concerns about any person experiencing homelessness.

Increasingly, new opportunities for interdisciplinary social care interventions are now being recognised through the research literature. This is of particular benefit to people experiencing multiple exclusion homelessness who may previously have been overlooked.
One example is that the legislation potentially places self-neglect under the Care Act. In the context of multiple exclusion homelessness, this emphasises the need for those involved in adult safeguarding to explore the complex interplay between needs, potential risks, and people’s ability to protect themselves.

Please click on this link: SafeguardingToolkitDRAFT-PDF

Self Neglect: Guidance for Practitioners

Liverpool John Moores University have developed guidance for practitioners who are supporting people who may be neglecting themselves. The guidance is based on the experience of practitioners from a wide range of related disciplines across Merseyside. The guidance is endorsed by the Merseyside Safeguarding Adults Board and is available here:

Self Neglect Guidance 2019

The 10 Point Dignity Challenge

Before the Dignity in Care campaign launched, numerous focus groups took place around the country to find out what Dignity in Care meant to people. The issues raised at these events resulted in the development of the 10 Point Dignity Challenge (now the 10 Dignity Do’s). The challenge describes values and actions that high quality services that respect people’s dignity should:

1. Have a zero tolerance of all forms of abuse
2. Support people with the same respect you would want for yourself or a member of your family
3. Treat each person as an individual by offering a personalised service
4. Enable people to maintain the maximum possible level of independence, choice and control
5. Listen and support people to express their needs and wants
6. Respect people’s right to privacy
7. Ensure people feel able to complain without fear of retribution
8. Engage with family members and carers as care partners
9. Assist people to maintain confidence and positive self-esteem
10. Act to alleviate people’s loneliness and isolation

10 Point Dignity Challenge

No More Suicide- Preventing suicide in Cheshire & Merseyside

Suicide is preventable yet in England 13 people kill themselves every day; one person every 90 minutes in the UK. The impact on family, friends, workplaces, schools and communities can be devastating; it carries a huge financial burden for the local economy and contributes to worsening inequalities. Friends and relatives of people who die by suicide have a 1 in 10 risk of making a suicide attempt after their loss 7 and they experience severe effects on their health, quality of life, ability to function well at work and in their personal lives.

Acting to eliminate preventable deaths is a public health concern. There is no single cause and no single solution to suicide, but a requirement for joint, collaborative effort utilising evidence-based interventions, intelligence and a drive to eradicate this preventable death.

This strategy is an all-age suicide prevention strategy, recognising that suicide and suicidal risk varies across the life course and that prevention and age-appropriate interventions are particularly important.

This 2017 update increases the focus on inequalities, men, children and young people, self-harm and safer care.  Please click on the link below:

No More- Zero Suicide Strategy

NHS Digital

Please find a link to the Safeguarding Adults Collection (SAC) ‘analytical hub’ which gives access to the publications and associated data tables for the SAC (as well as other adult social care publications).

The purpose of the safeguarding collection is to monitor safeguarding activity, with reference to the Care Act 2014, within Local Authorities in England.  The main output is an annual report which is deemed to be a national statistic.  It presents aggregated information about adults at risk for whom there were safeguarding concerns or enquiries which were opened and/or closed during the reporting period.  A safeguarding concern is where a council is notified about a risk of abuse, which instigates an investigation (enquiry) under the local safeguarding procedures.  Please click on the link below

Safeguarding Adults Collection

Home Office Seminar- Protecting Older People from the Effects of Crime

The Home Office Seminars on Protecting Older People from the Effects of Crime ran between December 2017 and February 2018. Feedback shows the seminars were a great success.

The Home Office would like to share a report of the seminars which highlights the results and key findings across England which you will find in the link above together with a Q&A document here.

Isolation and loneliness topped the national ‘big issues’ identified, with lack of service resource and support, and health concerns, following closely behind. Discussions regionally followed a similar trend, except in the Midlands where professionals assessed that isolation and loneliness were a symptom of wider issues (e.g. resources, community and abuse) rather than an issue in themselves.

Looking ahead, the report highlights the views and suggestions from frontline workers on how systems could be improved, and recommends action to be implemented.  The main gaps highlighted were Governance; of multi-agency work, training, funding and regulation, Information sharing, Campaigns and Community initiatives. I hope this provides you with an insight on the ‘big issues’ and action plans that you might like to consider.

Falls Risk Assessments

Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition.

Falls are a common, but often overlooked, cause of injury. Around 1 in 3 adults over 65 who live at home will have at least one fall a year, and about half of these will have more frequent falls.

Most falls do not result in serious injury. But there’s always a risk that a fall could lead to broken bones, and it can cause the person to lose confidence, become withdrawn, and feel as if they have lost their independence.

Liverpool Falls Tool

Financial Abuse and Scams

Guidance for councillors, directors, managers and social work practitioners

A mass marketing scam is a misleading or deceptive business practice where the person receives an unsolicited or uninvited contact (e.g. by letter, email, phone or advertisement) and false promises are made to con the victim out of money. A doorstep scam is whereby victims are cold called at their homes and persuaded to part with money as a result of rogue trading activity.

Top Tips- financial abuse and scams

Merseyside Safeguarding Adults Information Sharing Protocol

Information sharing is vital to safeguarding and promoting the welfare of *adults, and is an intrinsic part of any front line practitioner’s job when working with adults. The decision is how much information to share, with whom and when. Information sharing can have a profound impact on individuals’ lives.

* The adult experiencing, or at risk of abuse or neglect will hereafter be referred to as the adult throughout this document.

Fears about information sharing cannot be allowed to stand in the way of the need to safeguard and promote the welfare of adults. The aim of this section is to give all staff in every partner organisation under the Merseyside Safeguarding Adults Board umbrella, key points to keep in mind when making information sharing decisions. If you need more information when making your information sharing decision, you should read the rest of this document, speak with your manager and consult the Inter-Agency Safeguarding Adults Policy and Procedure. When making your information sharing decision, you should keep the following points in mind:

Seven golden rules for information-sharing

• Remember that the Data Protection Act (DPA) is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately
• Be open and honest with the person (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be, shared, and seek their agreement,
• unless it is unsafe or inappropriate to do so
• Seek advice if you are in any doubt, without disclosing the identity of the person where possible
• Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the public interest. You will need to base
• your judgement on the facts of the case
• Consider safety and wellbeing: base your information-sharing decisions on considerations of the safety and wellbeing of the person and others who may be affected by their actions
• Necessary, proportionate, relevant, accurate, timely and secure: ensure that information you share is necessary for the purpose for which you are sharing it, is shared only with those people who need to have it, is accurate and up to date, is shared in  timely fashion, and is shared securely
• Keep a record of your decision and the reasons for it – whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.

Please click on this link for the full document:

MSAB ISA March 2019

Safeguarding Adults:

The Role of Health Service Practitioners

Health services have a duty to safeguard all patients but provide additional measures for patients who are less able to protect themselves from harm or abuse.

‘Safeguarding adults’ covers a spectrum of activity from prevention through to multi agency responses where harm and abuse occurs. Multi agency procedures apply where there is concern of neglect, harm or abuse to a patient defined under No Secrets guidance as ‘vulnerable’.

Safeguarding adults is an integral part of patient care. Duties to safeguard patients are required by professional regulators, service regulators and supported in law.

The Role of Health Service Practitioners

ADASS: Making Safeguarding Personal

 Making Safeguarding Personal (MSP) is a sector led initiative which aims to develop an outcomes focus to safeguarding work, and a range of responses to support people to improve or resolve their circumstances. It is about engaging with people about the outcomes they want at the beginning and middle of working with them, and then ascertaining the extent to which those outcomes were realised at the end.

The work is supported by ADSS, the LGA and other national partners. The programme reports to the Towards Excellence in Adult Social Care Programme Board.

MSP seeks to achieve:

• • A personalised approach that enables safeguarding to be done with, not to, people
  • Practice that focuses on achieving meaningful improvement to people’s circumstances rather than just on ‘investigation’ and ‘conclusion’
  • An approach that utilises social work skills rather than just ‘putting people through a process’

• An approach that enables practitioners, families, teams and SABs to know what difference has been made

Please click on the link below:

Making-safeguarding-personal-publications

The NHS Pocket Guide contains 13 headings- please see below for a brief overview:

The link contains the full details:

NHS Adult Pocket Guide

Age UK have produced an evidence review and is part of a series produced by Age UK , in order to provide evidence to underpin decision-making for people involved in commissioning, service development, fundraising and influencing.  Please click on the link below.

Age UK: Evidence Review- Loneliness and Isolation

Community Action Group Agenda (FYI) Please click on the links below:

Community Action Group 15th March 18

Age UK Presentation

Merseyside SAB Presentation

Specials Presentation

The Red Heart Campaign Presentation

Community Care

The Community Care group is firmly placed at the heart of the social care sector, offering a range of products to help social workers and other professionals meet the demands of an ever-changing sector. These include a multi award-winning news website, as well as online learning tools, informative events and innovative recruitment solutions.Community Care Live London is our annual flagship event and is the UK’s largest free event for social workers. Due to an increase in demand in the North West, Community Care Live Manchester was launched in 2017 and continues the great work of London Live by providing a comprehensive, free-to-attend event for the region.

Whichever event you decide to attend, you can be sure that Community Care Live will provide you with essential learning and professional development through a mixture of training sessions, panel discussions, case studies and interactive learning, as well as an exhibition where you can meet and network with a range of local authorities, service providers, charities and universities from across the sector.  Please click on the link below to find out more:

Community Care Live

Community Care

The Care Act 2014

The Care Act 2014 sets out statutory responsibility for the integration of care and support between health and local authorities. NHS England and Clinical Commissioning Groups are working in partnership with local and neighbouring social care services. Local Authorities have statutory responsibility for safeguarding. In partnership with health they have a duty to promote wellbeing within local communities.

Your Responsibilities

All staff within health services have a responsibility for the safety and wellbeing of service users and colleagues.  Living a life that is free from harm and abuse is a fundamental human right and an essential requirement for health and well-being.  Safeguarding adults is about the safety and well-being of all people but providing additional measures for those least able to protect themselves from harm or abuse.  Safeguarding adults is a fundamental part of service user safety and wellbeing and the outcomes expected. Safeguarding adults is also integral to complying with legislation, regulations and delivering cost  effective care.   Definition of an adult at risk:

Aged 18 years or over;  Who may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.

Your Role as the Person Raising Concern

The person who raises a safeguarding concern within their own agency should follow their own policy and procedures

• This concern may result from something that you have seen, been told or heard

• Make a Safeguarding Adult referral where this is necessary.

Information Sharing

Where there are safeguarding concerns staff have a duty to share information. It is important to remember that in most serious case reviews, lack of information sharing can be a significant contributor when things go wrong.  Information should be shared with consent wherever possible.  A person’s right to confidentiality is not absolute and may be overridden where there is evidence that sharing information is necessary to support an investigation or where there is a risk to others e.g. in the interests of public safety, police investigation, implications for regulated service.

The Mental Capacity Act

In order to protect those who lack capacity and to enable them to take part, as much as possible in decisions that affect them, the following statutory principles apply:

• You must always assume a person has capacity unless it is proved otherwise
• You must take all practicable steps to enable people to make their own decisions
• You must not assume incapacity simply because someone makes an unwise decision
• Always act, or decide, for a person without capacity in their best interests
• Carefully consider actions to ensure the least restrictive option is taken

Deprivation of Liberty Safeguards

The Deprivation of Liberty Safeguards 2009 (DoLS) are an amendment to the Mental Capacity Act 2005. They provide a legal framework to protect those who lack the capacity to consent to the arrangements for their treatment or care, for example by reason of their Dementia, Learning disability or Brain Injury and where levels of restriction or restraint used in delivering that care for the purpose of protection from risk/harm are so extensive as to potentially be depriving the person of their liberty.  Deprivation of Liberty Safeguards goes beyond the actions permitted under section 5 of the Mental Capacity Act (MCA) 2005.

Learning Disabilities Mortality Review (LeDeR)

This is the third annual report of the English Learning Disabilities Mortality Review (LeDeR) programme. It presents information about the deaths of people with learning disabilities aged 4 years and over notified to the programme from 1st July 2016 – 31st December 2018. A particular focus is on deaths for which a review was completed during the last calendar year (1st January – 31st December 2018).

For ease of reading, data tables are not included here but are available from leder-team@bristol.ac.uk on request.

LeDeR-Annual-Report-Final-21-May-2019

Pressure Ulcer Staging

A pressure ulcer is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.  A number of contributing or confounding factors are also associated with pressure ulcers.

Prevent/Channel

The Government’s counter-terrorism strategy is known as CONTEST.  Prevent is part of the strategy and its aim is to stop people becoming terrorists or supporting terrorism.  The strategy promotes collaboration and co-operation among public service organisations. The Office for Security and Counter Terrorism in the Home Office is responsible for providing strategic direction and governance on CONTEST. You can read the CONTEST strategy in full at www.homeoffice.gov.uk.  CONTEST has four key principles:

Pursue: to stop terrorist attacks

Prevent: to stop people becoming terrorists or supporting terrorism

Protect: to strengthen our protection against a terrorist attack

Prepare: to mitigate the impact of a terrorist attack.

Domestic Violence and Abuse

One woman in three (and one man in five) in the UK will be a victim of domestic abuse during their lifetime, according to research estimates.  Two women a week are killed by a current or former male partner. Domestic abuse is officially classified as “any incident of threatening behaviors, violence or abuse between adults who are or have been in a relationship together, or between family members, regardless of gender or sexuality”.  We think of domestic abuse as hitting, slapping and beating, but it can also include emotional abuse as well as forced marriage and so-called “honour crimes”. It’s abuse if a partner, ex-partner or a family member:

• Threatens, frightens an individual
• Shoves or pushes an individual
• Makes an individual fear for their physical safety
• Puts an individual down or attempts to undermine their self-esteem
• Controls an individual, for example by stopping them seeing friends and family
• Is jealous and possessive, such as being suspicious of friendships and conversations

Female Genital Mutilation (FGM)

FGM comprises all procedures involving partial or total removal of the external female genital organs or any other injury to the female genital organs for nonmedical reasons. FGM is most often carried out on young girls aged between infancy and 15 years old.  It is often referred to as ‘cutting’, ‘female circumcision’, ‘initiation’, ‘Sunna‘ and ‘infibulation’.

Human Trafficking

Involves men, women and children being brought into a situation of exploitation through the use of violence, deception or coercion and forced to work against their will. People can be trafficked for many different forms of exploitation such as forced prostitution, forced labour, forced begging, and forced criminality, domestic servitude,  forced marriage, forced organ removal. When children are trafficked, no violence,  deception or coercion needs to be involved: simply bringing them into exploitative conditions constitutes trafficking.

Modern Slavery

Criminal Exploitation

Pick pocketing, shoplifting, drug trafficking. 16% financial fraud (benefits or loans)

Domestic Servitude

Forced to work in private houses with restricted freedoms, long hours, no pay. 24% are children

Forced labour

Long hours, no pay, poor conditions, verbal and physical threats, 36% of cases, 1/5 children, ¾ are male

Sexual Exploitation

Prostitution and child abuse, 42% of all trafficking, 20% of which are children

Other forms

Organ removal, forced begging, forced marriage and illegal adoption

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