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Self Neglect and Adult Safeguarding

News and presentations from today’s conference chaired by Suzy Braye, Professor of Social Work & Social Care at the University of Sussex and Editor of the European Journal of Social Work. 

Hoarding and safeguarding: Professional and practice issues
Megan Karnes
, Director, Hoarding UK

Pre-Event Abstract
Hoarding, Care Act & Safeguarding:  Here’s another fine mess
The presentation will provide an overview of hoarding, take a brief look at risk and then engage in a larger discussion about the Care Act, Safeguarding and Policy.

In 2014, as a result of the Care Act Code of Practice, Hoarding joined the list of risks/vulnerabilities about which safeguarding may provide protections and put a person on the pathway to appropriate support.  Unfortunately, local services-already struggling-are not able to provide the help needed.  The ping-pong process takes time and resources while not delivering outcomes for the person or the services around them.  What are our responsibilities?  
PowerPoint Presentation

In her presentation Megan described herself as an Activist. Megan looked to the group for words associated with Hoarders, compulsion, anxiety, coping, isolation, chaos. 

Megan stated: 

"A lot of work on Hoarding is done in the USA"

"People who have Hoarding behaviour will know there is an issue but not necessarily that their stuff is an issue"

"You have to deal with Hoarding holistically"

"I believe that the psychological aspect of this is the most important aspect"

"Our help to Declutter is seen as an attack"

"The Clutter Index Rating is an important document"

"Nobody has been evicted who has worked with Hoarding UK, I'm very proud of that"

"25% of people who died in fires were people living in a hoard"

Issues of Mental Capacity, Choice and Autonomy when responding to self neglect concerns and resistance to service engagement
Andy Butler,
Principal Social Worker (Adults), Surrey County Council

Andy comments "The reality is that working in this profession is challenging 
- as a Professional Social Worker you need to know what legal documents are available to you and how to use them
- we have to be good professional risk assessors to decide whether it's best to promote a person's interest or act in a person's 'best interest'
- Andy looked at the common quote from Lord Munby 'What good is it making someone safer if it merely makes them miserable'. But this is not the whole quote, it's just the end of long quote 100 years old
- we need to focus on what people want. We and the law are servants not masters
- for me 'Accommodation Moves' is the Big Issue
- liberty protection safeguards recommendations from the Law Commission: we can get on with these now, these are good practice. Don't have to wait for the law to change"

Pre-Event Abstract
Social Workers have an important role in responding to concerns about self neglect. They understand rights based, person centred approaches to supporting vulnerable adults in the community. Their core skills in assessment, a balanced approach to risk management and an applied knowledge of relevant legislation put them in a good place to assist other professionals to respond to concerns about self neglect in a less risk averse way than may otherwise be the case. Research indicates - frequently confirmed by professional experience and intuition - that resisting an initial default response to self neglect of 'intervention' in favour of 'good social work'; building relationship and taking a person centred approach; is often more effective and ultimately more professionally rewarding.

This does not mean that such assessments are easy, they often present with significant professional challenges that frequently require a balancing act between personal autonomy, positive risk taking and a general duty of care to protect people from avoidable harms. They also challenge both our professional and personal value base; 'would I feel so strongly about positive risk taking if it was my mother, father or child we were talking about?' They also take time - a commodity that is rarely in plentiful supply in local authority social work!

Assessing risk is inherently subjective and requires a high degree of professional skill and judgement, often in the light of inadequate or incomplete information. A professional approach to risk assessment cannot take away the need for people to make difficult decisions. Risk assessment models and strategies cannot prescribe what to decide but they can provide a framework and tools to assist in the decision-making process. Such an approach is important if the people we are assessing, their family and health and social care staff are to:

•    Make sound risk decisions 
•    Fully understand, and clearly explain why they have made, specific risk decisions 
•    Feel comfortable and confident about the decisions they have made 

The courts, primary legislation and statutory guidance all put great weight on supporting a person’s right to continue living in their own home for as long as is practicable - but where does the threshold lie? When do we intervene? Whose responsibility is it if things go wrong? Referencing a contemporary case example and recent research this presentation will explore some of the professional challenges, and some practical solutions in responding to concerns about people who 'self neglect'.
PowerPoint Presentation

Developing shared professional understandings of self-neglect and multi-agency interventions
Elaine Aspinwall-Roberts,
Senior Lecturer, Liverpool John Moores University, and Registered Social Worker

Elaine comments  "I'm really interested in Multi-Agency Working and improving outcomes for people who self Neglect

- self Neglect can be a very complex puzzle

- what encourages good multi-agency working with people who self Neglect and what may hinder?"

Pre-Event Abstract
The Care Act 2014 imposes a duty on local authorities to make statutory safeguarding enquiries where they have cause to suspect that an adult is self-neglecting.  The Act also imposes a new duty (S6) on local authorities and relevant partners such as health and housing, to work in partnership and ‘co-operate generally’.  However, safeguarding adults reviews and government ombudsman investigations have shown a consistent failure of agencies to work together on cases involving self-neglect, which are often highly complex and demanding for practitioners.  

Many different agencies may be involved in the life of a self-neglecting person, and it is essential that these agencies are able to work together, with shared aims, purpose and understanding. This session will explore the factors that may hinder effective multi-agency working in the area of self-neglect, and whether outcomes for people who self-neglect could be improved by addressing these.  Participants will have the opportunity to contribute ideas and to reflect on their own practice in working alongside other agencies.

Future events of interest:

Adult Safeguarding Summit 2017: Improving Adult Safeguarding Practice Decision Making, User Involvement & Outcomes
Monday 20 November 
De Vere West One Conference Centre, London

25 September 2017

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