Search results

Local Safeguarding Adults Board (SAB) policies, procedures, guidance and related documents on self-neglect were gathered and analysed, to map what approaches are being taken across England. This paper aims to identify areas of divergence to highlight innovations or challenges faced by SABs.

Self-neglect documents were identified by searching SAB websites. Data were extracted into a framework enabling synthesis and comparison between documents.

This paper reports on how English SAB documentation defines self-neglect, treats executive capacity, lays out pathways for self-neglect cases, advises on refusal of service input and multi-agency coordination and draws on theories or tools. Greater coherence in understanding self-neglect has developed since it was brought within safeguarding in 2014; however, variation remains regarding scope, referral pathways and threshold criteria.

This review was limited to published SAB documentation at one point in time and could not consider either the wider context of safeguarding guidance and training or implementation in practice.

This review provides an overview of how SABs are interpreting national guidance and guiding practitioners. The trends and areas of uncertainty identified offer a resource for informed research and policy-making.

To the best of the author’s knowledge, this is the first systematic survey of SAB self-neglect policies, procedures and guidance since self-neglect was included under safeguarding.

The purpose of this paper is to report the findings from research into 40 serious case reviews (SCRs) involving adults who self-neglect.

The study comprised analysis of 40 SCRs where self-neglect featured. The reviews were found through detailed searching of Local Safeguarding Adult Board (LSAB) web sites and through contacts with Board managers and independent chairs. A four layer analysis is presented of the characteristics of each case and SCR, of the recommendations and of the emerging themes. Learning for service improvement is presented thematically, focusing on the adult and their immediate context, the team around the adult, the organisations around the team and the Local Safeguarding Board around the organisations.

There is no one typical presentation of self-neglect; cases vary in terms of age, household composition, lack of self-care, lack of care of one's environment and/or refusal to engage. Recommendations foreground LSABs, adult social care and unspecified agencies, and focus on staff support, procedures and the components of best practice and effective SCRs. Reports emphasise the importance of a person-centred approach, within the context of ongoing assessment of mental capacity and risk, with agencies sharing information and working closely together, supported by management and supervision, and practising within detailed procedural guidance.

There is no national database of SCRs commissioned by LSABs and currently there is no requirement to publish the outcomes of such inquiries. It may be that there are further SCRs, or other forms of inquiry, that have been commissioned by Boards but not publicised. This limits the learning that has been available for service improvement.

The paper identifies practice, management and organisational issues that should be considered when working with adults who self-neglect. These cases are often complex and stressful for those involved. The thematic analysis adds to the evidence-base of how best to approach engagement with adults who self-neglect and to engage the multi-agency network in assessing and managing risk and mental capacity.

The paper offers the first formal evaluation of SCRs that focus on adults who self-neglect. The analysis of the findings and the recommendations from the investigations into the 40 cases adds to the evidence-base for effective practice with adults who self-neglect.

Self-neglect is a public health concern that can manifest as failure to provide oneself adequate food, water, clothing, shelter, personal hygiene, medication or safety precautions. This paper sought to inform federal policy and research priorities regarding effective strategies to detect, prevent and address self-neglect. This study aims to inform federal policy and research priorities regarding effective strategies to detect, prevent, and address self-neglect.

The authors conducted a rapid review of self-neglect literature and interviews with five national subject matter experts to inform federal policy and research priorities.

This study identified gaps in the literature and several approaches and numerous challenges to preventing, identifying and addressing self-neglect. The lack of a nationally accepted definition of self-neglect, a dearth of longitudinal studies which has limited research on self-neglect etiology and trends, and limited development and validation of screening tools, are among the challenges.

Findings indicate that comparisons of self-neglect definitions, and longitudinal studies of self-neglect by subpopulations, are needed areas of future research. Issues for policy consideration include national self-neglect data collection and reporting requirements.

This study synthesizes recent literature on self-neglect, highlights gaps in the literature on self-neglect and points toward federal policy priorities for advancing effective strategies to detect, prevent and address self-neglect.

The purpose of this paper is to draw on systemic and psychodynamic theories to subject published serious case reviews (SCRs) involving self-neglect to a deeper level of scrutiny, in order to understand how complex contexts impact on self-neglect work. It also updates the dataset of self-neglect SCRs and accompanying thematic analysis.

Psychodynamic and systemic ideas are applied to the content of published SCRs in order to understand how different contexts – societal, legal, organisational, professional and personal – impact on and are influenced by work with adults who self-neglect. Further published reviews are added to the core dataset, with thematic analysis updated using four domains.

Thematic analysis within and recommendations from SCRs have focused on the micro context, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis also commonly extends to how organisations have worked together and how Local Safeguarding Adults Board (LSABs) have supported and scrutinised their collaboration. This level of analysis enables an understanding of local geography. However, there are wider systems that impact on and influence this work, especially law and the societal context. If review findings and recommendations are to fully answer the question why, systemic analysis should be extended to appreciate the influence of national geography.

There is still no national database of reviews commissioned by LSABs so the dataset reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in LSAB annual reports. This makes learning for service improvement challenging.

Answering the question why is a significant challenge for safeguarding adults reviews (SARs). Different approaches have been recommended, some rooted in systems theory. The theoretical formulations here extend the lens of systemic analysis on the different contexts that influence how practitioners work with adults who self-neglect and simultaneously are shaped by that work. This adds to the practice, management and organisational evidence base for working with adults who self-neglect but also shines the analytic lens on legal and policy mandates.

The paper extends the use of systemic theory for understanding and learning from practice with adults who self-neglect and additionally offers psychodynamic formulations to appreciate what happens within and between practitioners and their organisations. The paper therefore contributes new perspectives to the methodology for conducting SARs. It also extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice.

The research reported here aims to scope the concept of self‐neglect as it is explored in the literature and interpreted in practice by professionals involved in adult safeguarding.

The approach taken included a systematic search and thematic analysis of English‐language literature on self‐neglect, workshops with UK‐based adult safeguarding leads and practitioners from social services, police and health services, and scrutiny of Safeguarding Adults Boards' documentation.

The concept of self‐neglect is complex with contrasting definitions and aetiology, accompanied by debates on the principles that guide intervention. Decision‐making capacity is a key pivot upon which professional responses to self‐neglect turn. Intervention in self‐neglect requires careful exploration in the context of principles of personalisation, choice, control, and empowerment that underpin policy in adult social care and safeguarding.

As a conceptual scoping review, this study seeks to establish broad themes of use to practitioners working with self‐neglect. It thus does not carry out a full quality review of the literature identified and discussed, but serves as a base for this to be done in future.

Assessment in self‐neglect should consider the influence of a number of possible causative factors, and intervention must balance respect for autonomy on the one hand and a perceived duty to preserve health and wellbeing on the other.

This article summarises and critically analyses the emerging key features of evidence‐informed practice in the challenging field of self‐neglect.

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. The initial data set was published in this journal in 2015 and has since been updated annually. The complete data set is available from the author. The second purpose is to reflect on the narratives about adult safeguarding and self-neglect by focusing on the stories that are told and untold in the reviews.

Further published reviews are added to the core data set, drawn from the national SAR library and the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the domains used previously, direct work, the team around the person, organisational support and governance. SAR findings and recommendations are also critiqued using three further domains: knowledge production, explanation and aesthetics.

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. SAR findings emphasise the knowledge domain, namely, what is actually found, rather than the explanatory domain that seeks to answer the question “why?” Findings and recommendations appear to assume that learning can be implemented within the existing architecture of services rather than challenging taken-for-granted assumptions about the context within which adult safeguarding is situated.

A national database of reviews completed by SABs has been established (www.nationalnetwork.org.uk), but this data set remains incomplete. Drawing together the findings from the reviews nonetheless reinforces what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, there is little analysis that seeks to explain rather than just report findings.

Answering the question “why?” remains a significant challenge for SARs, where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. The challenge for SAR authors and for partners within SABs is to reflect on the stories that are told and those that remain untold or untellable. This is an exercise of power and of ethical and political decision-making.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper analyses the degree to which SARs answer the question “why?” as opposed simply to answering the question “what?” It also explores the degree to which SARs appear to accept or challenge the context for adult safeguarding. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practice, and on the choices they make about the stories that are told.

The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England.

In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper.

In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined.

By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect.

The first purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SAR) and accompanying thematic analysis. A second purpose is to rebalance the narrative about adult safeguarding and self-neglect by highlighting two case studies where the practice was informed by SAR and the evidence-base of best practice.

Further published reviews are added to the core data set, drawn from the websites of Safeguarding Adults Boards (SAB). Thematic analysis is updated using the four domains used previously. Two case studies are presented, using the four domains of direct practice, team around the person, organisational support and governance, to demonstrate that positive outcomes can be achieved when practice and support for practitioners align with the evidence-base.

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. The case studies are illustrative examples of what can be achieved and signpost SABs and SAR authors to question what enables and what obstructs best practice.

A national database of reviews completed by SABs has been established (https://nationalnetwork.org.uk) with the expectation that, in time, this will become a comprehensive resource. It is possible, however, that this data set is incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, no published SARs have been found that were commissioned specifically to learn lessons from what had worked out well. More emphasis could be given to what might be learned from such cases.

Answering the question “why” remains a significant challenge for SAR not only where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of case studies with positive outcomes might enable learning about what enables positive system change.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper presents two case studies where practice and the context within which practitioners were working closely aligned to the evidence-base for best practice. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practices.

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases.

Further published reviews are added to the core data set, mainly drawn from the websites of safeguarding adults boards (SABs). Thematic analysis is updated using the domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously.

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations.

The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice.

Answering the question “why” remains a significant challenge for SARs. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the “why” question. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated.

The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review.

The purpose of this paper is twofold: first, to update the core data set of self-neglect serious case reviews (SCRs) and safeguarding adult reviews (SARs), and accompanying thematic analysis; second, to respond to the critique in the Wood Report of SCRs commissioned by Local Safeguarding Children Boards (LSCBs) by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice.

Further published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs) and from contacts with SAB independent chairs and business managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of SCRs commissioned by LSCBs, with implications discussed for Safeguarding Adult Boards.

Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely, that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned.

There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of SCRs enables conclusions to be reached about their potential to transform adult safeguarding policy and practice.

Answering the question “why” is a significant challenge for SARs. Different approaches have been recommended, some rooted in systems theory. The critique of SCRs challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting SARs by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned.