Here are some definitions and other information you will need to know for effective safeguarding.
What is a Vulnerable Adult?
A Vulnerable Adult, as described in “No Secrets , (DH 2000)” is any adult who may be eligible for community care services and who are unable to protect themselves from significant harm. This could be due to physical, mental or sensory impairment and learning disabilities, howsoever those impairments have arisen (i.e. present at birth or developed later on). The residents at 18 Hope Street all fall into this group.
What is abuse?
“No Secrets, (DH 2000)” defines abuse as a violation of an individual’s human and civil rights by any other person or persons. It is a single act or a series of repeated acts that results in significant harm and or the exploitation of the person involved. It can also be due to the failure to act on the part of a person caring for the victim. Abuse can take a number of different forms from punching, kicking and verbal bullying, to encouraging them to take part in activities against their will, some are subtle and some are more obvious. Most acts of abuse can be placed into one of the following categories:-
- Physical – Hitting, hair pulling, biting, kicking etc. Using restraints in an inappropriate way or in inappropriate situations. Force feeding and forced or improper administration of medication. Withdrawal or inappropriate use of mobility aids and adaptations including hoists, wheelchairs, hearing aids and spectacles. Being forced to situations with other service users who are aggressive or violent towards them. Physical intimidation and threats.
- Emotional/Psychological – Name-calling, belittling and humiliation. Ignoring requests, preferences and choices. Excluding someone from conversations or activities. Denying contact with friends or family members.
- Sexual – Any sexual activities or relationships that the person has not consented to, they do not understand or is with a member of staff, family member or another who is in a position of power over the individual. These include intercourse, penetration, kissing, masturbation, touching, watching pornography, indecent exposure, harassment and teasing.
- Financial/Material – Exploiting or manipulating someone for money or property. Staff, volunteers or students borrowing money from service users. Spending a service users’ money without their informed consent. Stealing money or property. A care giver buying or selling property to a vulnerable adult. Coercing a vulnerable adult into paying for services they do not need/want without their informed consent.
- Neglect/Acts of Omission – Behaviour on the part of staff, volunteers or students at 18 Hope Street that results in the service users failing to receive the appropriate care either deliberately or by accident. Ignoring medical advice or failing to administer medication correctly. Failure to produce a risk assessment and allowing the service user to come harm in a way that could have been avoided. Ignoring personal care and toileting needs. Under or over feeding or ignoring dietary requirements. Failing to provide access to regular medical check-ups such as dentist and opticians.
- Discriminatory – Harassment or slurs based on a person’s ethnicity, gender, sexuality, age, disability etc. Denying opportunities for religious worship. Not providing appropriate clothes, food, toiletries for a person’s cultural needs. Withholding care or denying access to activities based on ethnicity, gender, sexuality, age, disability etc.
- Institutional – Routines in place that deny service users’ rights. Inadequate staffing levels. Poor management. Staff lacking appropriate or sufficient training. Low morale amongst the staff due to working conditions. Policies and procedures in place to suit staff rather than services users. Policies and procedures not kept up to date to reflect national standards. Lack of awareness about “whistle-blowing” and reporting abuse.
How do I spot abuse?
The first step in safeguarding vulnerable adults is to be able to recognise abuse when it occurs, which means being familiar with the “Signs and Symptoms of Abuse”. This term, “Signs and Symptoms of Abuse” is one that is used frequently when talking about safeguarding and abuse in general. It simply means the sort of indicators you might notice if someone is the victim of abuse, changes to their behaviour or appearance, difference in mood or attitude to certain people etc. This is by no means a complete list of possible signs and symptoms, nor is the presence of one (or more) signs or symptoms a guarantee that abuse has taken place. These are just examples of the sorts of things to look out for that MAY indicate abuse is taking place.
- General (these could apply to any category of abuse) – Allegations of mistreatment. Unexplained changes in appearance, behaviour, mood or routine. Refusal to discuss injuries, loss of money or property. Low self-esteem. High levels of stress. Marked change in relationships. Refusing medical treatment. Avoiding certain people or insisting on being with certain people.
- Physical – Bruises, cuts, burns, grazes or other injuries, especially if they cannot be explained. Reluctance or refusal to accept personal care or medical treatment. Changes in personality for example becoming more compliant, withdrawn or aggressive. Covering up, wearing long sleeves or sunglasses.
- Emotional/Psychological – Becoming withdrawn or depressed. Deliberate self-harm. Changes in sleeping or eating patterns. Relationships becoming strained. Sudden increase or decrease in weight. Increased aggression or other challenging behaviour.
- Sexual – Bruising or pain around the genital area. Unexpected pregnancy or sexual infection. Torn or blood stained clothes. Behaviour or language becoming more sexual. Reluctance to be with certain people. Fear around bathing or having staff help them with personal care.
- Financial/Material – Large or frequent cash withdrawals with no specific reason. Reluctance to pay for food, clothes or essential bills. The person has been encouraged to buy gifts for others (staff, family members, friends etc). Disparities between assets and living conditions. Recent changes in control of or access to their money. An appointee using a person’s money for their own personal gain. Inability or reluctance to budget that is out of character.
- Neglect/Acts of Omission – Inappropriately craving attention. Stealing or scavenging food, clothes or other items. Poor physical state including excessively over or under weight. Physical needs not met, equipment or aids not being used correctly or not all. Withholding of medication, clothing or heating. Living environment poorly maintained. Unwashed or poor appearance.
- Discriminatory – Denial of cultural or religious needs and/or practices. Use of discriminatory language by care givers. Loss of interest in activities and socialising. Refusing meals or specific activities on certain dates.
- Institutional – Threats or denial of food/services/processions in response to challenging behaviour. Denial of access to money or medical treatment. Insisting services users are bathed together to save time for the staff. Lack of choice in meals and other aspects of life in the home.
It is important to remember that these are just indicators and no concrete evidence that abuse has taken place. Anybody who has worked at 18 Hope Street from some time, or indeed any setting with vulnerable adults, will be able to identify service users who present with one or more of the above indicators even though no abuse has take place. Have you ever met a service user who uses discriminatory language, or one who is reluctant to be supported to tidy their room for reasons other than abuse? The answer is probably yes.
The times that these indicators should raise alarm bells are when they are out of character for the service user, when they represent a change from the norm. For this reason it is vitally important as support workers that you get to know the service users, interact with them, develop a therapeutic rapport with them. Knowing the service users personality and creating an environment in which they feel safe and supported is by far the best way of identifying abuse as soon as possible.