Session Plan for Safeguarding Adults Self-Neglect Training Session
Session Plan for Safeguarding Adults Self-Neglect Training Session
“AM I YOUR JOB?”
Note: These notes are accompanied by a training video which is used as art of the session. The video breaks down into four scenes, all of which are under two minutes in playing time. The session length can be adjusted to the timings available to the trainer, but it is likely that a minimum of 50 minutes will be needed for showing the four scenes and allowing time for group discussion, then plenary to pull together the learning. To access the videos (the four videos each have a five second fade out and fade in between them to allow time to pause between scenes) use the link on the Gloucestershire Safeguarding Adults Board website:
http://www.gloucestershire.gov.uk/gsab/i-am-a-professional/learning-development-resources/
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:00:00 / Before Showing Video Scene One - Introduction
Introduce the session to the group – explain that we are looking at the topic of Self-neglect in Adults Safeguarding, and will be looking at a series of videos and discussing what we see, and what action we think should be taken. Mention the Care Act 2014 – self-neglect is a new category of abuse that was introduced.
Also introduced was the principle of Making Safeguarding Personal – creating a process around the needs of the person and what they say they want, rather than having the process first and making their situation ‘fit’.
Explain that we are getting a snapshot view into the life of Jim – an older person who has care and support needs. The view of the video you will see at first is from the perspective of his carer, who is going into Jim’s home to provide a short session of domiciliary home care – he does not have regular daily visits. / Self-neglect is a category of abuse for adults introduced under the Care Act 2014. It is increasingly being dealt with by many agencies involved in the care and support of adults at risk, and can include hoarding.
Self neglect can be a difficult area to deal with as a professional, because you can sometimes be dealing with an individual who has mental capacity and chooses to live like this (Principle 3 of the Mental Capacity Act – Unwise Decisions); also, very often the individual can choose to refuse to engage with services that are trying to put support in place (from all kinds of agencies) and so the situation can be complex.
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:
05:00 / Show video Scene One: (1 min 41 secs)
Break the delegates down into small discussion groups and ask them to discuss and make notes on the following questions:
Questions for the Group (5 minutes):
· What have you noticed? List all of the things that are already concerning you
· Can you think of partner agencies who you would like to ensure are involved with this person?
Feedback (3 minutes):
Ask group to give you examples on things they have noted from their discussion, and note them on a flipchart.
Explain that this is the initial view of Jim’s home that we are seeing, and that Scene 2 then provides us with some more information: / Depending on the background of delegates, some suggestions of things they may list as concerns from this initial scene could include:
· The state of Jim’s house
· His safety – lots of issues around the potential for falls due to all the tripping hazards, food left out, hygiene of kitchen, safety of things like knife in the toaster, clothes over the radiator (fire risks)
· Whether or not he is in rented accommodation and if the housing provider is doing their job to support him
· Whether Jim has a care plan that is current
· Does Jim have smoke alarms? (no he doesn’t)
· The standard of the provision of care from the care agency (how did the house get into this state in the first place?) – Glos Fire & Rescue Service advise that if someone is a hoarder, even if a home is tidies up, they can return a property to it’s unsafe state ina very short time; they also identify that calling the hoarded items ‘clutter’ or ‘rubbish’ is very unhelpful, as these are seen by the individual as important belongings that can’t be thrown away.
Partner agencies that can get identified at this point could include:
GP, District Nurse, Care provider, Social Worker, Church, Village Agents, Housing, Environmental Health, Voluntary & Community Sector (Age Concern, Meals on Wheels etc.) etc.
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:
15:00 / Show Video Scene Two: (1 min 10 secs)
Explain to the group that often, a picture of self-neglect can build up from lots of different bits of data that come to light. Ask the same small groups to go back to their initial concerns and now consider the following questions:
Questions for the Group (5 minutes) :
1. What else have you noticed now that concerns you?
2. What assumptions can you make about other agencies being involved with Jim?... How do you know this?
3. Is there any action that you think the care worker should be taking?
Discuss Answers again with groups (4 minutes) / New things that can be picked up as additional concerns:
Question 1:
· Jim’s inability to answer quite simple questions (some may view this as refusing to cooperate, but Scene 3 will show that the carers thinks that Jim is confused)
· Further evidence that he is self-neglecting – more hoarding, smoking where he is sitting, letter about a missed medical appointment, assorted medication boxes on the arm of the sofa, blankets on the sofa suggesting he may be sleeping there rather than going up to bed, loose bandage sticking out of his trouser leg (have the district nurses been able to get in to see him?), temperature in the house being dangerously low,
· Jim not wanting people to come into his home
Question 2:
We have to be careful about making any assumptions, because Jim may be refusing to engage, but from the evidence, we can pick up some information about agencies that should be involved with Jim e.g. GP (from letter), District Nurses (care agency worker asks him about having his dressings changed); others could include: Support Planner (if he has one), and also possibly a Social Worker, the Fire Service (because of Fire risks) Environmental Health (Health hazards due to lifestyle), Housing Authority (depending on whether he is a tenant or a homeowner), Village Agents (if he is living at home and social isolation is a problem that they have identified), members of his community (neighbours, church, social groups etc.), family?
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:
Video Scene Two (continued): / Question 3:
Suggestions of what the care worker could be doing re. initial actions to take:
· Contacting agency manager to report concerns
· Seeing whether she can get Jim’s consent to contact others e.g. to ring the GP surgery (details are on the missed appointment letter
25:00 / Show Video Scene Three: (1 min 30 secs)
Explain to the group that they now have three specific questions to consider:
1. Is this an issue that should be reported in to the Safeguarding Adults Team as a Safeguarding Concern? Give your reasons for your answer
2. What issues are there around Making Safeguarding Personal in this situation?
3. Which partner agencies could be supporting Jim? / Suggested answers:
1. Yes it should – Jim meets the thresholds for Safeguarding to take this concern up – he has care and support needs, he is at risk of harm/neglect, and he is unable to protect himself from the risk of harm or abuse.
2. Issues include: Jim’s capacity, which seems to be fluctuating – so ensuring that he is involved in the process and making as many decisions as he can for himself – also, whether Jim will engage with services; what a successful outcome will look like.
3. All of those we have already mentioned, sharing information to work together with Jim for a happy outcome
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:
35:00 / Show Video Scene Four: (1 min 10 secs)
Tell the group that Jim’s reply to the question, “What do you want?” is that he wants to feel safe, and he wants to stay in his own home.
Ask the group to answer the final set of questions (8 minutes);
1. What could be the barriers to achieving what Jim wants?
2. Are there any other partner agencies that you think should be involved having watched this last scene?
3. What might an ideal solution look like? / Suggested answers:
1. Lack of engagement with Jim – though there may be someone that he has a warm relationship with who can act as lead on this concern. Lack of communication between all of the agencies involved – self-neglect can be very complex and potentially need a lot of organisations to be speaking to one another. A lack of someone leading on getting this situation improved – issues arise where all agencies go in, ‘do their bit’ and then leave again without sharing concerns with one another.
2. Trading Standards – they deal with scamming and work closely with other public service partners if this is part of the problem.
3. Wait to see how creative your groups are!! An ideal solution will be decided by what Jim says and how he feels about intervention and support – sometimes, being safe is not the most important thing in a person’s life, so you can’t ever assume that your view of what ‘ideal’ looks like is the best one.
Timings (minutes): / Action: / Additional Notes for Trainer/Session Leader:
45:00 / Round up from the session: (5 minutes)
Key points – which can be pulled together by asking, “So what has come out of your discussion?”
· People’s lives are complex
· Many agencies can have their hand ‘on the baton’ when it comes to people such as Jim, who is not ‘out of the ordinary’ in terms of his life and circumstances
· We need to talk to one another – across agency boundaries
· We need to give ourselves permission to be the person who ‘takes the lead’, and gets people talking
· What a good outcome looks like should not be down to us – we should be looking for the outcome that the individual is happy with
· If someone won’t engage – don’t walk away – keep your hand on the baton (maintain contact with them). Try again, try lots of times – find out who the individual will engage with, and work through them. It’s not enough to say, “Well, I did my job”, or we end up with more Jims. / Sometimes, participants can want a nice neat ending, when there isn’t one at the end of Scene Four.
This is deliberate: cases such as Jim’s can be very complex and have a lot of agencies involved, and are consequently not easy to ‘sign off’ – they also don’t fi t to deadlines and timescales.
It is important to emphasise that they key to supporting Jim is to ensure that everyone involved is ‘Making Safeguarding Personal’ (the phrase from the Care Act 2014).
This means taking Jim’s views and wants into account from the outset, rather than doing things to him. The key question is; what does Jim want to happen?
After all, to quote Lord Justice Munby from a Court of Protection case,
“What good is it making someone safer if it merely makes them miserable?”
(http://www.bailii.org/ew/cases/EWHC/Fam/2007/2003.html)
Note: This resource has been made available thanks to the work of the Gloucestershire Safeguarding Adults Board. For any further information, please email:
May 2017