UKATA Safeguarding Best Practice Guidelines – Adults

As therapists working with children and young people and adults, there are times when we are informed of, become aware of, or suspect that our client, or someone they tell us about, is at risk of harm, so what do we do next? At the present time there is no law in the UK that requires the reporting of suspected abuse. There is in Northern Ireland.

UKATA is committed to safeguarding all our clients, and members have a legal duty to act prudently and this means that they must take all reasonable steps within their power to ensure that the people they work with, or gain knowledge of are safeguarded from harm.

As an organisation, we believe that we have a responsibility to protect and safeguard those clients who may be at risk of harm. “Safeguarding is everybody’s responsibility and includes measures to prevent or minimise the potential for abuse occurring.” (Quality Assessment Framework April 2009)

It is particularly important where UKATA clients are children or young people, or ‘at risk’ (formerly ‘vulnerable’) adults. * this term will be explained later in this document.

We recognise that maintaining confidentiality is important for our clients, and that this can cause conflict when considering reporting suspected abuse of at risk adults. However information-sharing is key, in line with ‘No Secrets’ the Department of Health guidance (last updated January 2015) which sets out a code of practice for the protection of vulnerable adults.

Purpose of Guidelines

• To set out the approach of UKATA in relation to safeguarding at risk adults that their members work with or gain knowledge of.

• To provide UKATA members with guidance on procedures they should adopt in the event that they suspect an at risk adult may be experiencing harm, be at risk of harm or be harming a child or at risk adult

• ‘With adults at risk one of the strongest messages in relation to safeguarding adults is that safeguarding must be built on empowerment, on listening very carefully to the voices of individuals who are at risk, and those who have been harmed. Without empowerment, without peoples voices, safeguarding does not work’ (Safeguarding Adults Report on the Consultation on the review of No Secrets 2009)

These guidelines apply to all members of UKATA.

Introduction

UKATA operates on the basis of the fundamental ethical principles of Transactional Analysis:

• Path of least Harm

• Open communication

• Contractual method

The guidelines take into account UKATA’s Code of Ethics and recognises, with regard to ethical issues, “that there may be competing obligation or principles.” The guidelines have endorsed the above principles in relation to this.

Definitions of Safeguarding:

Quality Assessment Framework Communities and Local Government (April 2009) ‘There is a difference between safeguarding vulnerable adults/children and adult/child protection. Safeguarding is everybody’s responsibility, and includes measures to prevent or minimise the potential for abuse occurring. Protection is a statutory responsibility in response to individual cases where risk of harm has been identified.’

Who is an ‘Adult at Risk’?

The term ‘adult at risk’ replaces the term ‘vulnerable adult’ within national Safeguarding Adult Partnership Multi-agency procedures, which form the basis for these guidelines, as it is thought to be more respectful to those whom it refers. An adult at risk is described as an individual aged 18 years or over.

“Adult at Risk” is a term used to describe:

• who is or may be in need of community care services by reason of mental or other disability, age or illness; and

• who is or may be unable to take care of him or herself, or unable to protect him or herself against… harm or exploitation (No Secrets, 2000)

‘No Secrets’ subsequently defines ‘community care services’ as including ‘all care services provided in any setting or context’. Such a definition includes adults with physical, sensory and mental impairments and learning disabilities, howsoever those impairments have arisen e.g. whether present from birth or due to advancing age, chronic illness or injury.

Also included are people with a mental illness, dementia or other memory impairments and people who misuse substances or alcohol.

The definition also includes carers (family and friends who provide personal assistance and care to adults on an unpaid basis).

An adult at risk may therefore be a person who:

• Is frail due to age, ill health, physical disability or cognitive impairment.

• Has a learning disability.

• Has a physical disability and/ or a sensory impairment.

• Has mental health needs including dementia or a personality disorder.

• Has a long-term illness/ condition.

• Misuses substances or alcohol.

• Is a victim of domestic violence or abuse

• Is a carer such as a paid or unpaid family member/ friend who provides personal assistance and care to adults and is subject to harm

• Is unable to demonstrate the capacity to make a decision and is in need of care and support.

• Is aged 18+ and is continuing within the Special Education system.

(This list is not exhaustive)

If you are in any doubt as to an adult’s ‘at risk’ status, refer to a member of the UKATA Safeguarding committee, a line manager if you work within an organisation, or seek advice from your local Adult safeguarding Team, in accordance with these procedures.

Local advice line numbers can be found online. This can be done without disclosing the name of the service user.

Relevant procedures

These guidelines must be read in conjunction with local Council Safeguarding Board at risk adult’s procedures.

UKATA Safeguarding Committee Responsibilities

• All appropriate staff will have received safeguarding training on safeguarding At Risk Adults at a level commensurate with their organisational responsibilities. This training will be updated at the recommended intervals

• To ensure that all aspects of these guidelines are kept up to date in line with current legislation;

• Failure to immediately report any disclosures or suspicions of abuse may result in disciplinary action and/or legal liability;

• Safeguarding is a priority and must be discussed regularly throughout UKATA at all levels, from committee to Board meetings, to the website, newsletter etc;

• Making safeguarding and promoting the welfare of children and at risk adults an integral feature in UKATA guidelines

• Follow the reporting process for any contractual or governance framework requirements (e.g. Care Quality Commission).

• To ensure that all members’ DBS check show that they are safe to work with children, young people and adults at risk.

UKATA members’ responsibility in all cases

• No member is to investigate any allegation, disclosure or incident;

• If an at risk adult is in imminent danger to life or limb members are to take immediate action by calling 999 in order to safeguard

• If the situation is not an emergency, members will work to these guidelines and make an advice call to the UKATA safeguarding team.

• if you are working with Children, Young People or designated 'at risk' adults, you may be required to hold a DBS check certificate. For further information, please visit UK Government Guidelines https://www.gov.uk/government/publications/dbs-guidance-leaflets/working-with-children-in-the-charity-sector-and-overseas-aid-organisations

Legal / Regulatory / Guidance background Reference Sources:

• Quality Assessment Framework (C1.3 Safeguarding and Protection from Abuse) Communities and Local Government (April 2009)

• Care Quality Commission Essential Standards of Quality and Safety (Outcome 7 Safeguarding People who use services from abuse) (March 2010)

• No Secrets . Department of Health. (First published March 2000. Last updated January 2015)

• The Human Rights Act (1998)

• Vetting and Barring Scheme (2009)

• Mental Health Act (2007)

• Safeguarding Vulnerable Groups Act (2006)

• Protection of Freedoms Act (2012)

• Domestic Violence Crime and Victims Act (2004)

• Sexual Offences Act (2003)

• Equalities Act (2010)

• Public Interest Disclosure Act (‘Whistleblowing Act’) (1998)

• Mental Capacity Act (2005)

• Mental Health Act (2007)

• Safe from Harm: A Code of practice for safeguarding the Welfare of Children in Voluntary Organisations in England and Wales (Home Office 1993)

Forms of Abuse

UKATA recognises that an abusive relationship often includes the misuse of power by one person over another and is most likely to take place in situations where one person has power over another. For example where one person is dependent on another for their physical care or due to power relationships in society e.g. between a professional worker and a service user, a man and a woman and a person belonging to the prevailing race / culture and a person belonging to an ethnic minority.

UKATA recognises that there are different forms and indicators of abuse. Not all indicators associated with these particular categories have to be present for abuse to be confirmed. Many situations involve combinations of different abuse.

Definitions

These definitions have been taken from The Department of health policy document ’No Secrets – Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (2009) Abuse is a violation of an individual’s human and civil rights by any other person or persons. Bev Gibbons & Deborah Wortman UKATA Safeguarding January 2016 5 In giving substance to that statement, however, consideration needs to be given to a number of factors.

• Abuse may consist of a single act or repeated acts.

• It may be physical, verbal or psychological

• It may be an act of neglect or an omission to act,

• It may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent.

Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it.

A consensus has emerged identifying the following main different forms of abuse:

• Physical abuse, including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions;

• Sexual abuse, including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting;

• Psychological abuse, including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks;

• Financial or material abuse, including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits;

• Neglect and acts of omission, including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating;

• Discriminatory abuse, including racist, sexist, that based on a person’s disability, and other forms of harassment, slurs or similar treatment

Any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance.

Incidents of abuse may be multiple, either to one person in a continuing relationship or service context, or to more than one person at a time. This makes it important to look beyond the single incident or breach in standards to underlying dynamics and patterns of harm.

Some instances of abuse will constitute a criminal offence. In this respect vulnerable adults are entitled to the protection of the law in the same way as any other member of the public. In addition, statutory offences have been created which specifically protect those who may be incapacitated in various ways.

Examples of actions which may constitute criminal offences are assault, whether physical or psychological, sexual assault and rape, theft, fraud or other forms of financial exploitation, and certain forms of discrimination, whether on racial or gender grounds. Alleged criminal offences differ from all other non-criminal forms of abuse in that the responsibility for initiating action invariably rests with the state in the form of the police and the Crown Prosecution Service (private prosecutions are theoretically possible but wholly exceptional in practice).

Accordingly, when complaints about alleged abuse suggest that a criminal offence may have been committed it is imperative that reference should be made to the police as a matter of urgency. Criminal investigation by the police takes priority over all other lines of enquiry.

Contract between Therapists and Clients

All practitioners should ensure that their communication is open and clear in all their professional contact with clients.

The contractual method requires all contracts at the start of the therapy to be clear and explicit. Therapists should include in their contracts:

• Information regarding protection from harm and prevention of abuse

• Their obligations and responsibility in respect of safeguarding – i.e. limits of confidentiality.

• Clear information about how they will deal with a safeguarding issue.

Supporting our clients to recognise abuse and prevent harm:

We will seek to safeguard adults at risk by:

• Valuing them, listening to and respecting them

• Ensuring all members undertake the DBS process

• Sharing information about adult protection and good practice

• Sharing information about concerns with agencies who need to know, and involving the relevant individuals appropriately

• Providing effective support to members through the UKATA Safeguarding Best Practice Guidelines and the UKATA Safeguarding committee

Ensuring concerns or allegations of abuse are always taken seriously the wishes and choices of at risk adults should be encouraged and supported in order that they take control of making their own decisions. During this process, information should be offered by the UKATA member to the person in question about the options available to them in dealing with the abuse.

Identifying and Responding to Safeguarding Concerns

If a UKATA member suspects that an at risk adult is suffering, or at risk of suffering significant harm, deliberate and repeated self-harm and / or at high risk or very high risk of harm to others, then they should follow the internal procedures relating to safeguarding alerts of the organisation if they are employed or volunteering, or of their professional bodies if they work solely in private practice.

For adult services, concerns, disclosures or allegations may come from an adult about a child known to them. This may be in relation to their own child or other children. In this instance the following guidelines still apply, however any information to aid referral must be gathered from the adult reporting the concern, rather than directly from the child. The source of this information must be made clear in any discussions with safeguarding leads and in any referrals that follow.

There are three possible outcomes following a consultation with a safeguarding officer.

1. Do Nothing –

• The therapist does not have enough evidence or information on which to proceed with a concern or disclosure process.

• There is no risk to any other young person or adult, as the perpetrator is dead, no longer in a position of trust. The client wishes to take responsibility and will inform the necessary agencies. This is contracted for and followed up with the client. Other agencies are involved and are aware of the information and are able to safeguard the client.

2. Initiate Concern Process –

The client has given some information, that would indicate there may be risks, but it is not immediate and it requires more information gathering and support for the client.

This may an ongoing process with advice and guidance in which advice and guidance is sought on a regular basis with the safeguarding officer.

Consideration of the following elements can help in decision-making where there are concerns but no actual disclosure:

• Identifying whether the abuse is historic or current.

• The client decides that the abuse should not be reported.

• The abuse is not judged by the counsellor/s and supervisor to be immediately life threatening based on information from the client

• Other potentially vulnerable children/young people/adults are not to be judged to be at risk from the same abuser

• Reporting the abuse either with or without the clients’ consent would seriously jeopardise the counselling relationship which may be a crucial support to the client.

• Other professional workers such as teachers, support workers and /or social workers are currently monitoring the client and/or their family

• The client is aware of other potential sources of help such as GP, helplines, or NSPCC.

Concern Process

• Initially talk to the client about what you are observing. It is okay to ask questions, for example: “I’ve noticed that you don’t appear yourself today, is everything okay? Never use leading questions; • Ensure medical attention is sought if required;

• Listen carefully to what the young person has to say and take it seriously;

• Never investigate or take sole responsibility for a situation where a client talks about matters that may be indicative of abuse;

• Always explain to clients that any information they have given will have to be shared with others, if this indicates they and/or other children are at risk of harm;

• Register a concern with the employing/hosting organisation’s or UKATA’s Safeguarding Lead/team or other appropriate staff member and clinical supervisor.

• The interests of the client to be given priority and their wishes given utmost respect until definite decisions are made regarding disclosure.

• Members will take any child protection issues and /or decisions made and action to supervision to be examined and explored.

• Where a decision cannot be agreed then the UKATA safeguarding committee can provide support and guidance to practitioners

• UKATA members will agree and implement appropriate ways of supporting the at risk adult during the process of decision making about disclosures of information relating to safeguarding and protection.

• UKATA Safeguarding committee members can support UKATA members making contact with officers at Adult Social Services on behalf of an at risk adult, without disclosing any clients’ details, to ask for advice and guidance on the options available to the client, for them to consider.

• In instances where you believe the at risk adult is at immediate risk of harm contact the police;

• Record what was said as soon as possible after any disclosure.

• Respect confidentiality and file documents securely.

3 Initiate Referral to Social Care Process

The following guidelines are provided to guide and support decision-making to report a safeguarding issue:

• When an adult client discloses current and ongoing abuse.

• Historical abuse and the alleged perpetrator is still in contact with the children, young adults or adults at risk.

• The client is concerned about the behaviour of another adult and the appropriateness of their behaviour towards young people.

• The client is identified as a direct risk to children or young people the client encloses that they have harmed or abused a child.

UKATA members, with the support of a safeguarding lead either from their organisation or from UKATA, will take immediate action if there is a clear disclosure of abuse or a strong suspicion that a child or at risk adult has been abused or likely to be abused:

• If there is a risk to life and limb the police must be contacted immediately and the client kept safe until they can get to a place of safety.

• In all other cases local Adult Social Care must be contacted within 48 hours – many areas have an initial response team.

• Their procedures must then be followed and must be followed up in writing within 48hrs.

Information to collect

In any case where an allegation is made (by a child or adult) or where a UKATA member has substantial concerns a record should be made.

Details must include, as far as practical:

• Name, full address and telephone number of the person

• Age and date of birth

• Address and contact numbers for chosen emergency/support contact

• Date and time of alleged incident(s)

• Where appropriate, current location of person in question and if known, current location of alleged abuser

• Nature of injury or behaviour

• If the person arrived with an injury

• Person’s explanation of what happened in their own words

• Any other persons’ explanation of what happened, if appropriate

• Date and time of the record

• Any questions that were asked

• Name and signature of the person recording the incident

• Person’s first language

• Partner/carer’s first language, if known

• Action taken and people contacted since concern arose, including any information given to or received by the partner/carer

• Any immediate or impending danger to the person

• Any specialist needs of the person and/or the partner or carer e.g. interpreter or signer

NB. Information should be based on facts. It should not include assumptions and may be required by a Social Worker, The Police or the Courts at some time in the future.

Case Management

• Therapists are encouraged to discuss safeguarding issues initially with their supervisor as soon as possible if an immediate disclosure is made or within two working days. However experience tells us that not all supervisors have the appropriate knowledge and experience in relation to safeguarding.

• UKATA has a team of dedicated safeguarding officers who have the knowledge and experience of working in the area of Safeguarding, who will be to offer advice, guidance and support as to how to manage sensitive information.

Dealing with a Disclosure

In terms of a culture which encourages disclosure, this can occur when someone notices the signs and impact of abuse and asks about it.

Record any disclosure information factually and as soon as possible as this may be required by the police if there is an investigation

• All records, information and confidential notes should be kept securely. Paper records should be stored in separate files in a locked drawer or filing cabinet; electronic records should be stored on secure systems and be password protected in accordance with Data Protection principles and organisational policies.

• Only the designated persons will have access to these files.

• Never guarantee absolute confidentiality, as Child Protection/protection of at risk adults will always have precedence over any other issues.

• Advise that you will offer support, but that you must pass the information on.

• Explain what you have to do and whom you have to tell.

• Use the client’s words or explanations – do not translate into your own words, in case you have misconstrued what the client wanted to say.

• Respect confidentiality and file documents securely

• UKATA Safeguarding committee members can support UKATA members who need to make or have made a disclosure.

• Seek guidance and support from clinical supervisor

• Record any discussions or actions within 24 hours

• Any child protection decisions made and actions will be taken to supervision to be discussed and explored.

• UKATA members will agree and implement appropriate ways of supporting the young person during the process of disclosures of information relating to child protection.

Duty of care to the client

Account should be taken of both the protection of the client and respect for the client’s stated choice. Again our ethical principles, as well as legal requirements provide a framework for our decision-making, as set out above.

Therapists need to be mindful that there may be occasions when they will have to make a safeguarding decision without consent of the client. If a client decides that she/he does not want to report the abuse then the UKATA member will follow the appropriate policies and procedures in making a decision about what action to take. This decision should be made following discussion with the client and explanation of why it is necessary to report.

These occasions will primarily be where a young person or adult is at ongoing risk and where the abuse is happening at the present time or the alleged perpetrator continues to be in a position of trust and has direct contact with the young person or adult, or with other young people or at risk adults.

UKATA’s Safeguarding guidelines endorse the practitioner’s professional judgement and their fiduciary duty of trust to their clients.

Our duty of care still remains with the client, following a referral. The advice is that the consent of the disclosure should not be discussed, if an investigation is pending as this may contaminate any evidence. Supporting and guiding the client through the process is important in maintaining the relationship and confidence of the client.

Duty of care to the therapist

As therapists we may not always appreciate the impact client information has on us. Safeguarding and Protection work can sometimes leave us feeling deeply impacted and so it is important that we debrief with a colleague or personal therapist and with clinical supervisor.

What happens after a referral to Social Care or the police has been made?

Depending on the level of risk the house/family will be visited by the police or a social worker the same day or in a timeframe of no more than 48 hours. The client and their family will then be given the support/interventions they need from statutory services in order to be safe from harm. This may differ slightly form area to area, and this information can be obtained from the local duty team.

If a case goes to court the therapist may be called upon to provide a report or to give evidence. All records that are made in relation to a safeguarding case should be retained.

Very often therapists fear that if they report safeguarding concerns their relationship with their client will be irreparably damaged, leaving the client more vulnerable. This is not supported by research evidence, which shows that most clients’ want to continue the therapeutic relationship, and indeed have a greater need of it and the holding and support it can give them. However the preservation of the relationship may, at times, need to be balanced against our duty of care in relation to safeguarding, and preservation of life and limb.

N.B. Individual members are independent practitioners, and will ultimately be held responsible for their own actions.