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This qualitative study set within Northern Ireland aims to explore professional perspectives on the application of evidence-informed practice to the adult safeguarding threshold screening process.

Data was gathered from seven social workers in one health and social care trust area, who perform the designated adult protection role, through individual semi-structured interviews in one region of Northern Ireland. The interview schedule comprised of a series of questions examining the role of the designated adult protection officer and included three vignettes (Appendix). A thematic analysis was undertaken using NVIVO software.

This paper reports main findings under the themes of: the role of the designated adult protection officer, threshold decision-making, evidence-informed practice and service improvement. One of the main findings was that professionals viewed the current process as too bureaucratic, and there was a desire to engage in more preventive safeguarding in collaboration with service users. There was a need to promote awareness of evidence-informed practice as it applies to the threshold screening process. Furthermore, the study raised the question of the need to consider the application of models or methods of assessment to the threshold screening process.

This in-depth exploration of the role of designated adult protection officers in Northern Ireland provides a valuable insight into the complexity involved in managing adult safeguarding referrals and investigations. This study adds to the existing knowledge base, identifies potential service improvements and highlights the gap in evidence-based practice as it applies to the threshold screening process. Threshold screening of adult safeguarding referrals remains a subjective process and is open to interpretation and differences in professional judgement. The study highlights the need to consider the application of quality improvement methodology to the threshold screening assessment and the need to promote the exchange of safeguarding knowledge.

This paper aims to present commentary on adult safeguarding designated officers’ (nominated senior staff members in the Health Service Executive and its funded services) in Ireland readiness for online learning and their perception of the blended approach used in their training and considers the implications of this for practice.

In total, 233 designated officers were surveyed. A self-administered online survey comprising of two instruments was used. The questionnaire combines two previously validated tools measuring readiness for online learning and perceptions of blended learning. Minor modifications were made to account for local circumstance and language. Demographic questions relevant to the survey population were added. The response rate was 49%.

Designated officers regarded specified competencies for online learning as important to very important with highest importance placed in time management. Designated officers expressed they were confident to very confident in their ability to accomplish all competencies in online learning. The highest confidence was in the technical competencies. Designated officers are demonstrating high readiness for online learning. Designated officers reported positively on online contributions and on blended learning workload. The scores indicate positive perceptions of the blended learning experience. Responses to an open-ended question were largely positive with some suggestions for improvement made.

Findings have helped inform planning and development of the Health Service Executive’s adult safeguarding training for designated officers with changes made since this survey was undertaken.

To the best of the author’s knowledge, this is the first time a survey was undertaken of designated officers in Ireland with a view to improving safeguarding training. Recommendations for adaptions to the blended designated officer programme were proposed and subsequently accepted and implemented.

Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.

A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.

A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.

This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

The purpose of this paper is to consider what safeguarding responses to discriminatory abuse and hate crime might learn from existing research on restorative justice and to drive practice development based on available evidence.

This paper is based on a scoping review of literature using four academic databases and reference harvesting. This comprised a critical appraisal of 30 articles, which were thematically analysed to appreciate the benefits and challenges of restorative justice responses to hate crime and how this might inform safeguarding responses to discriminatory abuse and hate crime.

The analysis identifies four domains where learning can be drawn. These relate to theory on restorative justice; restorative justice practices; perspectives from lived experience of restorative justice and hate crime; and an appraisal of critiques about restorative justice.

This paper connects the emerging evidence on restorative criminal justice responses to hate crime to the “turn” towards strengths-based practices in adult safeguarding. Although this provides a fertile environment for embedding restorative practices, the authors argue certain precautions are required based on evidence from existing research on hate crime and restorative justice.

This research was conducted as part of a PhD study. The purpose of this paper is to explore the factors taken into consideration when multi-agency practitioners were considering financial harm in the context of adult protection and how this influenced their decision-making processes.

An adapted q sort methodology initially established the areas of financial harm considered to have additional factors, which led to complexity in adult protection decision making. These factors were further explored in individual interviews or focus groups.

The data identified that the decision-making process varied between thorough analysis, rationality and heuristics with evidence of cue recognition, factor weighting and causal thinking. This highlighted the relevance of Kahneman’s (2011) dual processing model in social work practice. Errors that occurred through an over reliance on System 1 thinking can be identified and rectified through the use of System 2 thinking and strengthen social work decision-making.

This paper considers the practice of multi-agency adult protection work in relation to financial harm and identifies the influences on decisions.

In 2014, the Health Service Executive (HSE) in Ireland published its Safeguarding National Policy and Procedures (HSE, 2014). Under this policy, all agencies providing services through the social care directorate must ensure a robust culture of safeguarding is in place. Concurrent to this has been a move in social policy, practice and research to include the voice of the service user, both in terms of planning and reviewing services. (e.g. HIQA, 2012; Flanagan, 2020) This article examines whether service users with intellectual disabilities want to be involved in safeguarding plans and, if so, how that can be supported. Using focus groups service users demonstrated their knowledge of safeguarding as a concept, how they felt about the issues raised, and, crucially what they felt they would like to see happen next in addressing a safeguarding incident or concern. The focus groups took place in a large organisation providing residential services, day services, independent living supports and clinical supports. Engaging service users in planning and responding to safeguarding concerns is a fundamental principle of human rights legislation, both nationally and internationally. This study aims to highlight that it is both possible and desirable to engage fully with service users using a range of simple communication tools. For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time, human resources and will need champions to get on board with the necessary culture shift.

Qualitative research examined peoples’ “lived experiences” and knowledge of safeguarding. Focus groups were used with thematic analysis highlighting common themes throughout, as guided by Braun and Clarke (2006). There were two objectives: Objective 1: measuring participant’s understanding of the safeguarding process. Objective 2: compare the potential differences between safeguarding plans devised by the participants in the focus groups, versus plans devised by trained designated officers responsible for safeguarding within the service.

Four principal themes emerged – 1. participants understanding of safeguarding; 2. restorative justice; 3. consent; and 4. high levels of emotional intelligence and compassion. Participants demonstrated that they could and did want to be involved in safeguarding planning and showed little variation in the plans compared to those completed by trained staff.

The study was completed with a small sample size in a single service in one area. It may not represent the lived experiences and knowledge of safeguarding in other services and indeed other countries. The video may have led to some priming; for instance, the Gardai in the footage being called may have resulted in the participants stating that contacting Gardai should be part of the plan. After the video was shown, there was a heightened awareness of safeguarding. This may indicate that participants are aware of safeguarding but unsure of the terminology or how to discuss it out of context.

For this to be implemented as routine practice in services providing support for people with intellectual disabilities, authentic leadership is required. Services will need to devote time and human resources and will need champions in the safeguarding arena to get on board with the shift in culture required.

While there did not appear to be many barriers to listening to participants, to progress this as a standard practice a very real shift in culture will be needed. It is important for practitioners to ask: Is the vulnerable person aware that this concern has been raised? What is known of the vulnerable person’s wishes in relation to the concern? To truly engage with service users in safeguarding plans these questions need to be more than a “tick box” exercise. This process needs to be fully embedded into a culture that promotes a person-centred, rights-based, inclusive approach as a standard rather than a one-off project. Some structural changes will be needed regarding the time given to designated officers, and what resources they can access (such as speech and language therapy). However, the real difference will be made by services operating authentic leadership that champions engagement on this scale, to fully answer the question posed by the researchers at the beginning of this report, “Whose safeguarding is it anyway?”

There appears to be little evidence of service user engagement in terms of planning and processing safeguarding responses, either in research or anecdotally.

Engaging with heritage to support mental health and wellbeing has become a focus of research and policy, more recently moving towards social prescription of heritage interventions. While there are benefits to active participation, there are potential risks to those taking part and to the non-renewable historic remains and landscape that form the core of these projects. The purpose of the current research paper was to develop best practice guidelines for organisations offering heritage projects as interventions for people who live with mental health issues to protect both participants and heritage.

There were two research phases; a Sandpit with World Café discussions to produce a set of research priorities, and a Delphi Consultation, using three questionnaires distributed over six months, to develop best practice guidelines. The panel in both phases comprised experts through lived experience, policy, practice and research.

The Authentic and Meaningful Participation in Heritage or Related Activities (AMPHORA) guidelines cover three stages: project development, project delivery and project follow-up, with a set of action points for each stage. Of particular importance was authentic participation and expertise to ensure appropriate management of heritage/ historic environment assets and support for participants.

The AMPHORA guidelines can assist all organisations in the delivery of safe projects that support the mental health of those involved, as well as enhancing and protecting the historic environment.

To the best of the authors’ knowledge, these are the first research-led guidelines that help heritage organisations support those living with mental health issues.

This systematic review paper aims to investigate seasonal ambient change’s impact on the incidence of falls among older adults.

The population, exposure, outcome (PEO) structured framework was used to frame the research question prior to using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Three databases were searched, and a total of 12 studies were found for inclusion, and quality appraisal was carried out. Data extraction was performed, and narrative analysis was carried out.

Of the 12 studies, 2 found no link between seasonality and fall incidence. One study found fall rates increased during warmer months, and 9 of the 12 studies found that winter months and their associated seasonal changes led to an increase in the incidence in falls. The overall result was that cooler temperatures typically seen during winter months carried an increased risk of falling for older adults.

Additional research is needed, most likely examining the climate one lives in. However, the findings are relevant and can be used to inform health-care providers and older adults of the increased risk of falling during the winter.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

Gender identity assessments (GIAs) have been criticized by practitioners and trans and gender non-conforming (TGNC) individuals alike. With the practice of exploring individuals’ gender identity for treatment pathway purposes being potentially invasive and inappropriate, the current study aims to explore explicit standards.

The current study used the Delphi methodology to survey practitioners familiar with GIA. Over three rounds, 14 international participants rated their agreement about six areas relating to the assessment: purpose; content; approach; forensic application; psychometric instruments; and wider issues. Statements that reached an 80% cut-off among participants were viewed as a sufficient level of agreement, while the remaining items were fed back for repeated ratings. Furthermore, participants had the opportunity to suggest additional items that the group could rate.

Overall, a consensus across 23 items was achieved. The findings indicate a practice emphasizing collaboration between clinician and client to facilitate an informed decision. Furthermore, participants advocated for a non-pathologizing version of the GIA. This is a departure from diagnoses like gender dysphoria toward an approach which encapsulates also positive aspects of the trans experience, for example, resilience and future plans.

Limitations include sampling biases due to participants’ high specialization and challenges in recruiting TGNC individuals. Furthermore, findings appear restricted to adult services.

To the best of the author’s knowledge, this pilot is a first step to making current practice transparent and comparable, with the hopes to improve trans care. Furthermore, it is contextualized with the previously suggested application of the power threat meaning framework to GIA.