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This short paper outlines the work of the advisory group established by the Welsh Assembly Government to monitor implementation progress and identify possible weakness in the adult protection guidance In Safe Hands.

In the wake of publication of guidance by the National Assembly for Wales, a monitoring tool was developed for use in adult protection investigations. This paper explains how the monitoring tool, to be used by all Welsh local authorities, will work.

In adult protection many of the concerns that are highlighted about possible abuse relate to non‐criminal situations in which neglect may have occured. Designated lead managers, often social services team managers, act as gatekeepers. In conjunction with police, health and inspectorate colleagues they have to determine if allegations and referrals should be dealt with either as possible abuse or as poor practice, triggering different mechanisms. A tool has been developed in Wales to promote and support consistency in decision‐making in ‘grey areas’. Also, the Welsh Assembly Government(2009) has published helpful guidance on the management of escalating concerns in care homes, which helpfully informs arrangements for adult protection and provider performance to be managed in tandem.

Adult protection is about prevention and, failing that, investigation and aftercare. This article describes innovative work in Powys, mid Wales, where trainers are working with vulnerable adults to help them to reduce the risk that they will be abused, or if the worst happens, where to turn for help. College staff have developed a course that runs on one afternoon a week for the academic year for people with learning disabilities. For people with mental health problems the approach had been workshop based, with a programme of six or eight workshops run by skilled trainers. For older people a third approach has been developed because there are so many older people who need to hear about Keeping Safe. After piloting one‐off workshops and presentations, the trainer has worked with staff and volunteers from a variety of agencies who already work with older people to train them as trainers working in pairs. Those who have received the training will be delivering sessions in luncheon clubs, day services, care homes etc.

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.

One of the challenging facets of mental health care can be that of trying to deal with a patient's level of insight. Problems that seem apparent to assessing practitioners are sometimes not regarded in the same way by the patient. Measuring a concept like insight is not easy. The Behavioural Status Index (BSI) breaks insight into components and measurable criteria. Such a measurement instrument provides opportunities for detailed analysis of function, opportunity for very specific interventions, further detailed assessment and measurement of progress. This paper begins with a theoretical introduction to the concept of insight and a description of the BSI. Data analysis then follows for the BSI insight subscale. Data were collected, using a repeated measures method from a sample of 503 individual patients in two high‐security mental health hospitals. Results are reported for the central tendency and spread of items; the differences between the Mental Health Act 1983 classifications of mental illness, psychopathic disorder and learning disabilities, patient‐ward dependency level and gender; and the relationship between items, within the subscale. The relationship between items suggests two distinct groupings of acceptive (the ability to recognise and differentiate inner feelings of tension or anger) and cognitional (conscious awareness of inner states) behaviours.

The protection of vulnerable adults from abuse is paramount for those working in adult protection. However, staff supporting vulnerable adults who are alleged to have abused them can feel very vulnerable and their needs must also be taken into account. The purpose of this paper is to consider the impact of adult protection investigations from the experiences of people who have been identified as alleged perpetrators in adult protection cases in order to identify improvements in practice.

This limited study used qualitative semi-structured interviews to collect data that reflected views of the issues and experiences of participants.

This study shows that expectations set out in the Wales Interim Policy and Procedures document under “support for alleged perpetrators” do not match with the experience of those who took part in this study. The experience of some alleged perpetrators is that the investigation process can be protracted, they may be left isolated with little or no information and feel very vulnerable.

A limitation of this study was the small number of participants who were interviewed and the selection and bias. Participation was on a voluntary basis and the participants were self-selecting. The participants were all paid staff. Vulnerable adults who had been identified as alleged abusers were excluded from the study on the premise that their experiences were likely to be quite different.

It is vital that alleged perpetrators are not themselves abused by the process. The findings from this study should be used to develop recommendations to improve practice.

The effects on staff who have been investigated as alleged abusers under adult protection policy and procedures has been under-researched. This study will make a contribution to addressing this.