There is growing evidence that adults who are vulnerable face an increasing risk of abuse when compared to the less vulnerable in society. Those most affected are older people, people with mental conditions and those with learning disabilities (Northway and Jenkins, 2017, p.6). While there is no formal definition of a vulnerable person, the UK Department of Health defines a vulnerable person under the “No Secrets” policy as someone who is in need of community care services because they suffer from a mental illness or disability and are unable to take care of and protect themselves from harm, exploitation and abuse (2017, p. 27). The concept of safeguarding refers to protecting the right to life of a person, free from abuse, harm and neglect. Individuals are also supported so that they have control and make choices for themselves (NHS England, 2017). This assignment will analyze three scenarios while referring to the theory of safeguarding by looking at the main issues in the scenario, indicators that cause concern, the capacity of the individuals in the study to make personal choices.
The complexity theory is a model that is used by social workers in safeguarding adults and children by providing an approach to understanding and evaluating outcomes. By using complexity, social workers are able to develop their knowledge and skills to better understand the client’s environment and its interconnectedness (Wolf-Branigin, 2013, p.142). This theory looks at individuals as constitutive components of the various systems that they live or work in and that the individual’s behavior has an impact on the whole system (Pycroft and Bartollas, 2014, p. 15). The complexity theory has concepts that are used to understand complex adaptive systems which are characterized as being determined by order or chaos. These complex systems lack equilibriums making them prone to abrupt changes (Stevens, 2008). Small changes in the system might lead to large-scale changes that are unpredictable or no changes at all. People in need of special care are exist within a complex system and caring for them leads to further complexities (Stevens, 2008)
In the first scenario, Leo is a 42-year-old man with Down syndrome who has made friends with a group of men from the local pub. The men are using him to deliver their packages and he thinks the contents are washing machine parts. It can be assumed that these men are using Leo to deliver drugs or illegal products. His support workers are concerned and they have told him to stop his interaction with these men but he has refused. The men are most likely taking advantage of Leo’s intellectual deficits by using him to deliver their packages.
In the second case, Mrs. B is 85 years old and has been admitted to hospital following a fall. She lives on her own but she receives help from her neighbors and her daughter who lives 50 miles away. The fall has created mobility issues and has affected her ability to take care of her personal care needs independently. There is a suggestion to move her to a nursing home but Mrs. B is against this idea and her daughter has stated she will not be able to support her if she lives at home. There is a chance she can stay at home with assistance but she has not been assessed by a social worker.
The third scenario deals with Susi, a 45-year-old female who has a moderate learning disability but is highly independent. She was sexually abused as a child by older males in her family which made her accept violence and unwanted sexual relationships as something normal. She disclosed to her social worker that she was sending pictures of herself online to strangers. Her family is dysfunctional and they are unable to provide protective care for her.
The indicators that cause concern in Leo’s case are that he is being used to deliver suspicious packages by men he met at a pub. In the complexity theory, a concept known as self-organization states that an individual’s behavior is a product of their interactions with other people and their environment. It is during interactions that self-organization occurs within the person’s environment, making it easy for them to be harmed by their complex environment or relationships (Stevens, 2008). Leo’s social workers are concerned that his complex relationship with the men might cause harm him at some point.
In Mrs. B’s case, the fall has affected her independence and she can no longer take care of herself, therefore requiring full support. Jin (2018), notes that falls are the main cause of injuries in people who are 65 years and older. The risk of falls in this age group is high because of balance issues, fragility and weakness, poor vision, and cognitive problems (Jin, 2018). Mrs. B’s situation falls under self-organization concept in the complexity theory because her behavior will affect whether she will receive assistance with her care in a nursing home or she will place a significant burden on her daughter (Stevens, 2008).
Indicators of concern for Susi are that she engages in unwanted sexual relationships, sends pictures of herself to strangers online and she has a tolerance for violence. Her moderate learning capability has made it hard for her to differentiate between a normal and violent relationship. According to the Social Care Institute for Excellence (2018), people with special care needs are more likely to be abused because they are an easy target, are not aware they are being abused and are less likely to report abusive situations. In the complexity theory, her abuse is seen as an occurrence of events that will occur with certainty because of her complex environment/dysfunctional family (Stevens, 2008).
The Mental Capacity Act of 2005 states that, anyone 16 years and above with mental impairments can make informed decisions on their own as long as they have all the relevant information to make a decision (Brown, Barber and Martin, 2015). This information should be easy to understand and can be in the form of diagrams, symbols, videos or a verbal conversation (Down’s Syndrome Association, 2018). Under the Act, Leo has the capacity to make decisions for himself because he receives support decision making from his social workers.
In the scenario, Mrs. B gets confused at times which might affect her cognitive functions and ability to make sound decisions. According to Mitoku and Shimanouchi (2014), older people want to make decisions on their own despite the fact they need assistance with care. They need support in decision making but when their cognitive functions are impaired, it becomes difficult for them to do it on their own. Mrs. B does not have severe cognitive impairment so she can still make decisions for herself but her daughter might be required to speak for her especially when she becomes confused.
People with moderate learning disabilities have a degree of independence and might require support in some areas to achieve this independence. They can make decisions on their own as long as they have enough time to consider all aspects that are needed in reaching a decision. In England, there are policies that support people with learning disabilities by making provisions for their rights, independence and capacity to choose. These policies give guidance to the patient and the practitioner when it comes to decision making (Atherton and Crickmore, 2011, p.77). Susi can make decisions on her own based on the Mental Health Act of 2005 because she is a highly independent person.
In Leo’s situation, he does not receive support from social services during the evenings and night. This has created an avenue for him to engage with the men at the bar because there is no one to monitor his activities during this time. To mitigate this problem, two support workers should be hired for the evening and night shift to monitor him and report concerning activities to the team manager. For Mrs. B, her daughter lives 50 miles away, making it difficult to take care of her mother on a frequent basis. It can be assumed the daughter has caregiver stress because of the burden of taking care of her elderly mother (Del-Pino-Casado et al. 2018). To address this concern, an aide can be hired part-time to take care of Mrs. B so that her daughter can have some time to rest.
In Susi’s case, she has no contact with her child who has been placed in permanent care. According to the attachment theory, parents or caregivers need to be present and accessible for the children to form a bond with them (Howard et al. 2011). A child assesses attachment as having a mother or father who is physically accessible to the child. If the parent is not available, there is a disruption to the family unit and the child might experience emotional distress, instability and a lower cognitive functioning. This is a cause of concern in Susi’s case because her child might be negatively affected by this mother-child separation (Howard et al., 2011). Steps can be taken by social support for her to visit the child as long as it’s deemed suitable for both her and the child.
In their study, Graham et al. (2016) developed three models which can be used to address safeguarding concerns. The first model known as the dispersed-generic-model involves social workers who perform investigations, senior social workers who conduct complex investigations and provide supervision, team managers who coordinate and chair meetings (Graham et al., 2016, p.10). In the dispersed-specialist model, social workers specialized in safeguarding coordinate high risk investigations while local social workers perform the low-risk investigations (2016, p.11). The centralized operational model involves specialist teams that investigate and coordinate high risk investigations (Graham et al., 2011, p.14).
If a concern is deemed to be low-risk, senior social workers within the local teams coordinate the investigations while the high-risk investigations are done by the specialist teams (2011, p.14). In Leo’s case, it can be considered high-risk because of the interactions he has with the men from the pub. Therefore, the people involved will be centralized specialist social workers in the local team to coordinate and conduct investigations. The local police will also be involved to investigate the men.
In Mrs. B’s case, the people involved will fall under the dispersed-generic model where a social worker within the local team will address safeguarding concerns especially related to home care (Graham et al., 2011, p. 10). Her daughter should also be involved especially in the assessment so that she can be involved in decision making. Susi’s situation is high-risk because of her tolerance to violence, unwanted relationships and past sexual abuse. The people concerned with her case will be specialist social workers who can coordinate and investigate safeguarding concerns under the dispersed specialist model (2011, p.14).
What to do and Why (Safeguarding Plan)
A safeguarding plan is a set of actions that have been agreed on to manage ongoing cases of negligence or abuse involving special care adults (Gloucestershire.gov, 2018). The tables below represent the safeguarding plans for Leo, Mrs. B and Susi. There is a comprehensive safeguarding plan in the appendix.
Leo’s Safeguarding Plan (Western Care, 2016)
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What are you trying to do? Determine what kind of business Leo has with the men at the pub, if it is legal or illegal, if they are taking advantage of his intellectual disability. |
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What safeguarding actions will be done: Carry out an investigation of Leo’s activities and involve the local police to investigate the men’s business activities |
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People responsible: Specialized social worker, local police, team manager/coordinator |
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Completion date: The investigation will be done in three months to effectively monitor Leo and the men |
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Review date: In four months’ time |
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Status/update (initial review should be within six months): Green RAG: Red- unable to complete action/significant delay, Amber-difficulty achieving, Green- Action complete or will be complete within timescale |
Name of Safeguarding Co-ordinator: Date of Initial Safeguarding Plan: Date of Review of Safeguarding plan:
Mrs. B’s Safeguarding Plan (Western Care, 2016)
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What are you trying to do? Perform a home care assessment to determine if Mrs. B should live at home with assistance or be moved to a nursing home |
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What safeguarding actions will be done: Observe how she performs her activities of daily living (independently, with minimal, moderate or full support) |
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People responsible: Social worker within the local team |
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Completion date: One month |
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Review date: Eight weeks |
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Status/update (initial review should be within six months): Green RAG: Red- unable to complete action/significant delay, Amber-difficulty achieving, Green- Action complete or will be complete within timescale |
Name of Safeguarding Co-ordinator: Date of Initial Safeguarding Plan: Date of Review of Safeguarding plan:
Susi’s Safeguarding Plan (Western Care, 2016)
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What are you trying to do? Find out if she is in a relationship that is coerced or violent |
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What safeguarding actions will be done: Provide support and engagement in activities to increase her self-esteem, seek counselling services and encourage her to attend a survivors group for abused women. |
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People responsible: Specialist social workers |
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Completion date: Two months |
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Review date: Three months |
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Status/update (initial review should be within six months): Green RAG: Red- unable to complete action/significant delay, Amber-difficulty achieving, Green- Action complete or will be complete within timescale |
Name of Safeguarding Co-ordinator: Date of Initial Safeguarding Plan: Date of Review of Safeguarding plan:
References
Atherton, H.L. and Crickmore, D.J. (2011). Learning disabilities: toward inclusion. Churchill Livingstone Elsevier, [online], available: https://books.google.co.ke/books?id=T5PzwMYPkbYC&pg=PA87&dq=can+people+with+moderate+learning+disabilities+make+decisions&hl=en&sa=X&ved=0ahUKEwi9n4Dm1vbeAhUkzoUKHf93BiQQ6AEIRzAF#v=onepage&q=can%20people%20with%20moderate%20learning%20disabilities%20make%20decisions&f=false[accessed 28 November 2018]
Brown, R.A., Barber, P. and Martin, D. (2015). The Mental Capacity Act 2005: a guide for practice. Sage, [online], available: https://books.google.co.ke/books?id=bRJiCgAAQBAJ&printsec=frontcover&dq=mental+capacity+act+2005&hl=en&sa=X&ved=0ahUKEwiDvfXSq_neAhXNVhUIHe5TDwsQ6AEINDAC#v=onepage&q=mental%20capacity%20act%202005&f=false [accessed 28 November 2018]
Del-Pino-Casado, R., Frias-Osuna, A., Palomino-Moral, P.A., Ruzafa-Martinez, M. and Ramos-Morcillo, A.J. (2018). Social support and subjective burden in caregivers of adults and older adults: a meta-analysis. Plos One, [online], available: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189874
Down’s Syndrome Association. (2018). For families and carers: making everyday decisions post 16, available: https://www.downs-syndrome.org.uk/for-families-and-carers/making-everyday-decisions-post-16/ [accessed 28 November 2018]
Gloucestershire.gov. (2018). Adult safeguarding plans, available: https://www.gloucestershire.gov.uk/media/11315/adult_safeguarding_procedures_-_section_11_safeguarding_plansc41e.pdf [accessed 28 November 2018)
Graham, K., Stevens, M., Norrie, C., Manthorpe, J., Moriarty, J. and Hussein, S. (2016). Models of safeguarding in England; identifying important models and variables influencing the operation of adult safeguarding. Journal of Social Work, [online], pp. 1-32, available: https://eprints.whiterose.ac.uk/101627/1/MOS_first_phase_findings_PURE.pdf [accessed 28 November 2018]
Howard, K., Martin, A., Berlin, L.J. and Brooks-Gunn, J. (2011). Early mother-child separation, parenting, and child well-being in early head start families. Attachment and Human Development, [online], 13(1), pp. 5-26, available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115616/ [accessed 28 November 2018]
Jin, J. (2018). Prevention of falls in older adults. JAMA, [online], 319(16), available: https://jamanetwork.com/journals/jama/fullarticle/2679279 [accessed 24 November, 2018].
Mitoku, K. and Shimanouchi, S. (2014). The decision-making and communication capabilities of older adults with dementia: a population-based study, Open Nursing Journal, [online], 8, pp. 17-24, available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083186/ [accessed 28 November 2018]
NHS England. (2017). Safeguarding adults, available: https://www.england.nhs.uk/wp-content/uploads/2017/02/adult-pocket-guide.pdf [accessed 24 November, 2018].
Northway, R. and Jenkins, R (2017). Safeguarding adults in nursing practice. Sage [online], available: https://books.google.co.ke/books?id=ofWQDQAAQBAJ&printsec=frontcover&dq=safeguarding+theories+for+the+vulnerable&hl=en&sa=X&ved=0ahUKEwjHh4ydmO3eAhUBYxoKHT7JDAIQ6AEITzAH#v=onepage&q=safeguarding%20theories%20for%20the%20vulnerable&f=false [accessed 21 November, 2018].
Pycroft, A. and Bartollas, C. (2014). Applying complexity theory: whole systems approaches to criminal justice and social work. Policy Press [online], available: https://books.google.co.ke/books?id=9VqkAwAAQBAJ&printsec=frontcover&dq=complexity+theory+of+safegurding&hl=en&sa=X&ved=0ahUKEwjw1rTOq-3eAhUJzhoKHS5yCyoQ6AEITTAG#v=onepage&q=complexity%20theory%20of%20safeguarding&f=false [accessed 24 November, 2018]
Social Care Institute for Excellence. (2018). Safeguarding adults: types and indicators of abuse, available: https://www.scie.org.uk/safeguarding/adults/introduction/types-and-indicators-of-abuse [accessed 28 November 2018]
Stevens, I. (2008). Complexity theory: developing new understandings of child protection in field settings and in residential care, available: https://webcache.googleusercontent.com/search?q=cache:q3xKRxr6Ez8J:https://strathprints.strath.ac.uk/4923/2/Stevens_and_Cox_complexity_paper_revised5.doc+&cd=2&hl=en&ct=clnk&gl=ke [accessed 28 November 2018]
Western Care. (2016). Safeguarding plan, available: https://www.westerncare.com/uploads/Co-ord/Website%20external/SafeguardingPlan_FSP1_%20implementNov2105ReviewMay2016.docx [accessed 28 November 2018]
Wolf-Branigin, M. (2013). Using complexity theory for research and program evaluation, Oxford University Press [online], available: https://books.google.co.ke/books?id=uZCCtIih7OIC&pg=PA146&dq=complexity+theory+of+safeguarding&hl=en&sa=X&ved=0ahUKEwjw1rTOq-3eAhUJzhoKHS5yCyoQ6AEIOjAD#v=onepage&q=complexity%20theory%20of%20safeguarding&f=false [accessed 24 November, 2018].
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