Adult Safeguarding

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Safeguarding adults at risk of harm or in need of protection

Most adults in Northern Ireland live independent, comfortable and secure lives free from exploitation and neglect. However, there are some adults who, because of their situation or circumstances, may have been harmed or may be at risk of harm. Health and Social Care (HSC) agencies play a lead role in preventing, detecting and providing protection to adults at risk of harm.

Adult safeguarding is the term used for activities which prevent harm from taking place, and which protects adults at risk (where harm has occurred or is likely to occur without intervention)

In 2010 the Northern Ireland Adult Safeguarding Partnership (NIASP) and the Local Adult safeguarding Partnership (LASP) were established in each Trust area. They provide strategic leadership and direction to organisations involved in the spectrum of safeguarding activities. NIASP is made up of representatives from the main statutory, voluntary and community organisations involved in adult safeguarding work across the region.

CLICK HERE FOR LASP MEMBERSHIP DETAILS

Click here for the Southern LASP Leaflet on Adult Safeguarding

Adult safeguarding in the Southern Trust

Health and social care services provided by the Southern Trust play a lead role in preventing, detecting and providing protection to adults at risk of harm and in need of protection. With the support and assistance of other statutory agencies, independent and voluntary organisations they aim to ensure adults receive the necessary protection, support, and equitable access to the criminal justice system.

The overall aim of adult safeguarding is to prevent the abuse of adults whose exposure to harm may be increased by their personal characteristics and/or life circumstances. An empowering, consent driven, rights based, interagency approach to adult safeguarding is promoted.

Adult Safeguarding- Older people's feedback

Action on Elder Abuse- My promise

Are you concerned about someone?

If someone tells you they have been hurt or are afraid, you should listen and respond sensitively. Do what you can to make them feel safe.

If you are concerned that you or someone you know has been harmed, exploited or neglected, it is very important to tell someone.

Click here for the ‘See something, say something’ leaflet

You can either visit your nearest social service office or contact the Southern Trust adult protection gateway service or alternatively your local PSNI.

If you feel in immediate danger or think that someone else may be in immediate danger, Dial 999.

How do I access the service?

If your concern relates to an adult over 18 years and resident in the Southern Trust area or has been in the Southern Trust area when the abuse, neglect or exploitation occurred you can access the service either by

Contacting the adult’s social worker, nurse or other professional from the Southern Trust directly. Click here for contact details.
If you are unsure if the adult has a Trust contact person please contact the Adult Protection Gateway team below

During office hours 9-5pm Monday – Friday.

Adult Protection Gateway Service 02837564423

Out of hours (5pm-9am, weekends and bank holidays)

Regional Emergency Social Work service – 02895049999

Useful links

NIASP website link: www.hscboard.hscni.net/niasp/
What happens when you report concerns?

What happens after you contact?
Would you like to tell us your story?
What do we mean by abuse?
Signs and Indicators of Adult Abuse
Physical Abuse
Psychological Abuse
Domestic Violence and Abuse
Financial Abuse
Neglect / Acts of Omission
Discriminatory Abuse
Institutional Abuse
Human Trafficking/Modern Slavery
Who is an adult at risk of harm?
Who is an adult in need of protection?
Where can abuse occur?
Responding to Initial Disclosures of Adult Abuse

What happens when you report concerns?

Every concern will be taken seriously.

Your concern will be listened to and someone will ask some questions to make sure they understand your worries. This is important as the person taking your call needs to be able to understand the seriousness of the concern you are describing, and if there are any immediate actions required to keep someone safe.

Any information you give will be treated in strictest confidence. You will be asked for your name and address, as there may be a need to get in touch with you at a later date to clarify what you have reported. However, if you choose not to share your name and address, your call will still be taken and acted upon.

What happens after you contact?

Your concerns will be dealt with by either a member of staff from the local core service teams or someone from the Adult Protection Gateway team.

It is important that all safeguarding concerns are responded to in a balanced, proportionate way and with the consent of the person you are worried about. There may be some circumstances where the adult may be unable to consent or where consent may not be required because the professionals involved believe actions are necessary to safeguard others.

Some concerns will be more appropriately responded to through professional assessment and support. However there may be some concerns where serious harm as occurred that requires further investigation by Southern Trust and / or PSNI. This will be explained to you if this is the case.

If you have a complaint about how your concern has been responded to, please refer to the Southern Trust complaint procedure

Would you like to tell us your story?
If you would like to share your experience of adult safeguarding with us, you can complete the 10,000 voice survey (http://10000voices.info). Responses are anonymous and confidential.

What do we mean by abuse?

“Abuse is a violation of an individual’s human and civil rights by any other person or persons.” (No Secrets DH 2000)

Abuse is ‘a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to another individual or violates their human or civil rights’. (Action on Elder Abuse 1993)

There are many kinds of abuse some of which include:

Physical Abuse

Physical abuse is the use of physical force or mistreatment of one person by another which may or may not result in actual physical injury. This may include hitting, pushing, rough handling, exposure to heat or cold, force feeding, improper administration of medication, denial of treatment, misuse or illegal use of restraint and deprivation of liberty. Female genital mutilation (FGM) is considered a form of physical AND sexual abuse.

Sexual violence and abuse

Sexual abuse is ‘any behaviour (physical, psychological, verbal, virtual/online) perceived to be of a sexual nature which is controlling, coercive, exploitative, harmful, or unwanted that is inflicted on anyone (irrespective of age, ethnicity, religion, gender, gender identity, sexual orientation or any form of disability). 2 Sexual violence and abuse can take many forms and may include non-contact sexual activities, such as indecent exposure, stalking, grooming, being made to look at or be involved in the production of sexually abusive material, or being made to watch sexual activities. It may involve physical contact, including but not limited to non-consensual penetrative sexual activities or non-penetrative sexual activities, such as intentional touching (known as groping). Sexual violence can be found across all sections of society, irrelevant of gender, age, ability, religion, race, ethnicity, personal circumstances, financial background or sexual orientation.

Psychological / Emotional Abuse

Psychological / emotional abuse is behaviour that is psychologically harmful or inflicts mental distress by threat, humiliation or other verbal/non-verbal conduct. This may include threats, humiliation or ridicule, provoking fear of violence, shouting, yelling and swearing, blaming, controlling, intimidation and coercion.

Financial Abuse

Financial abuse is actual or attempted theft, fraud or burglary. It is the misappropriation or misuse of money, property, benefits, material goods or other asset transactions which the person did not or could not consent to, or which were invalidated by intimidation, coercion or deception. This may include exploitation, embezzlement, withholding pension or benefits or pressure exerted around wills, property or inheritance.

Institutional Abuse

Institutional abuse is the mistreatment or neglect of an adult by a regime or individuals in settings which adults who may be at risk reside in or use. This can occur in any organisation, within and outside Health and Social Care (HSC) provision. Institutional abuse may occur when the routines, systems and regimes result in poor standards of care, poor practice and behaviours, inflexible regimes and rigid routines which violate the dignity and human rights of the adults and place them at risk of harm. Institutional abuse may occur within a culture that denies, restricts or curtails privacy, dignity, choice and independence. It involves the collective failure of a service provider or an organisation to provide safe and appropriate services, and includes a failure to ensure that the necessary preventative and/or protective measures are in place.

Neglect

Neglect occurs when a person deliberately withholds, or fails to provide, appropriate and adequate care and support which is required by another adult. It may be through a lack of knowledge or awareness, or through a failure to take reasonable action given the information and facts available to them at the time. It may include physical neglect to the extent that health or well-being is impaired, administering too much or too little medication, failure to provide access to appropriate health or social care, withholding the necessities of life, such as adequate nutrition, heating or clothing, or failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the capacity to assess risk

Exploitation

Exploitation is the deliberate maltreatment, manipulation or abuse of power and control over another person; to take advantage of another person or situation usually, but not always, for personal gain from using them as a commodity. It may manifest itself in many forms including slavery, servitude, forced or compulsory labour, domestic violence and abuse, sexual violence and abuse, or human trafficking.

This list of types of harmful conduct is neither exhaustive, nor listed here in any order of priority. There are other indicators which should not be ignored. It is also possible that if a person is being harmed in one way, he/she may very well be experiencing harm in other ways.

2.2 Related Definitions There are related definitions which interface with Adult Safeguarding, each of which have their own associated adult protection processes in place.

Domestic violence and abuse

Domestic violence or abuse is ‘threatening, controlling, coercive behaviour, violence or abuse (psychological, virtual, physical, verbal, sexual, financial or emotional) inflicted on anyone (irrespective of age, ethnicity, religion, gender, gender identity, sexual orientation or any form of disability) by a current or former intimate partner or family member’. Domestic violence and abuse is essentially a pattern of behaviour which is characterised by the exercise of control and the misuse of power by one person over another. It is usually frequent and persistent. It can include violence by a son, daughter, mother, father, husband, wife, life partner or any other person who has a close relationship with the victim. It occurs right across society, regardless of age, gender, race, ethnic or religious group, sexual orientation, wealth, disability or geography.

The response to any adult facing this situation will usually require a referral to specialist services such as Women’s Aid or the Men’s Advisory Project. In high risk cases a referral will also be made to the Multi- Agency Risk Assessment (MARAC) process. Specialist services will then decide if the case needs to be referred to a

HSC Trust for action under the safeguarding procedures. If in doubt, anyone with a concern can ring the Domestic and Sexual Violence helpline (0808 802 1414) to receive advice and guidance about how best to proceed.

Human Trafficking/Modern Slavery

Human trafficking/modern slavery involves the acquisition and movement of people by improper means, such as force, threat or deception, for the purposes of exploiting them. It can take many forms, such as domestic servitude, forced criminality, forced labour, sexual exploitation and organ harvesting. Victims of human trafficking/ modern slavery can come from all walks of life; they can be male or female, children or adults, and they may come from migrant or indigenous communities.

The response to adults at risk experiencing human trafficking/modern slavery will always be to report the incident to the Police Service.

Hate Crime

Hate crime is any incident which constitutes a criminal offence perceived by the victim or any other person as being motivated by prejudice, discrimination or hate towards a person’s actual or perceived race, religious belief, sexual orientation, disability, political opinion or gender identity.

The response to adults at risk experiencing hate crime will usually be to report the incident to the Police Service.

Signs and Indicators of Adult Abuse

Indicators are the main signs and symptoms, which suggest that some form of abuse may have occurred, but caution is suggested against establishing adult abuse merely due to the presence of one or more of these indicators without further detailed assessment/investigation. Typically an abusive situation will involve indicators from a number of groups in combination.

Physical Abuse

Physical injuries which have no satisfactory explanation or where there is a definite knowledge, or a reasonable suspicion that the injury was inflicted with intent, or through lack of care, by the person having custody, charge or care of that person, including hitting, slapping, pushing, misuse of or lack of medication, restraint, or inappropriate sanctions.

Possible Indicators of physical abuse

History of unexplained falls or minor injuries especially at different stages of healing
Unexplained bruising – in well protected areas, on the soft parts of the body or clustered as from repeated striking
Unexplained burns in unusual location or of an unusual type e.g. burns caused by cigarettes and rope burns etc.
Unexplained fractures to any part of the body that may be at various stages in the healing process
Unexplained lacerations or abrasions
Slap, kick, pinch or finger marks
Injuries/bruises found at different stages of healing or such that it is difficult to suggest an accidental cause
Injury shape similar to an object
Untreated medical problems
History of frequent changing of General Practitioners or reluctance against General Practitioner consultation or visit
Weight loss – due to malnutrition or dehydration; complaints of hunger
Appearing to be over medicated
Accumulation of medicine which has been prescribed for the client but not administered
ulcers, bed sores and being left in wet clothing.

Psychological Abuse

Psychological, or emotional abuse, includes the use of threats, fears or bribes to negate a vulnerable adult’s choices, independent wishes and self-esteem; Cause isolation or over-dependence (as might be signalled by impairment of development or performance) or prevent a vulnerable adult from using services, which would provide help.

Possible Indicators of psychological abuse
Ambivalence about carer
Fearfulness expressed in the eyes; avoids looking at the carer, flinching on approach
Deference
Overtly affectionate behaviour to alleged perpetrator
Inability to sleep or tendency to spend long periods in bed
Change in appetite - Loss of appetite or overeating at inappropriate times
Unusual weight gain/loss
Tearfulness
Unexplained paranoia
Low self-esteem
Excessive fears
Anxiety, confusion or general resignation
Agitation
Sexual Abuse
Sexual acts which might be abusive include non-contact abuse such as looking, pornographic photography, indecent exposure, harassment, unwanted teasing or innuendo, or contact such as touching or penetration.

Possible Indicators of sexual abuse

A change in usual behaviour for no apparent or obvious reason
Sudden onset of confusion, wetting or soiling
Withdrawal, choosing to spend the majority of time alone
Overt sexual behaviour/language by the vulnerable person which is out of character
Self-inflicted injury
Irregular and disturbed sleep pattern and poor concentration
Difficulty in walking or sitting
Torn, stained, bloody underclothes
Love bites
Pain or itching, bruising or bleeding in the rectal or genital area
Sexually transmitted urinary tract/vaginal infections
Bruising to the thighs and upper arms
Frequent infections
Severe upset or agitation when being bathed/dressed/undressed/medically examined
Pregnancy in a person not able to consent

Domestic Violence and Abuse

As well as physical violence, examples of domestic abuse can involve: undermining an individual’s self-confidence; threats to others including children; controlling behaviour such as isolation from friends and family; restricting access to money, personal items, food, telephone etc.; and stalking.

Possible Indicators of Domestic Violence and abuse

Destructive criticism and verbal abuse: shouting/mocking/accusing/name calling/verbally threatening
Pressure tactics: sulking, threatening to withhold money, disconnect the telephone, commit suicide, take the children away, report you to welfare agencies, lying to your friends and family about you, telling you that you have no choice in any decisions
Disrespect: persistently putting you down in front of other people, not listening or responding when you talk, refusing to help with childcare or housework
Breaking trust: lying to you, withholding information from you, being jealous, having other relationships
Isolation: monitoring or blocking your telephone calls, telling you where you can and cannot go, preventing you from seeing friends and relatives
Harassment: following you, checking up on you, opening your mail, repeatedly checking to see who has telephoned you
Threats: making angry gestures, using physical size to intimidate, shouting you down, destroying your possessions, breaking things, punching walls, wielding a knife or a gun, threatening to kill or harm you and the children
Sexual violence: using force, threats or intimidation to make you perform sexual acts, having sex with you when you don't want to have sex
Physical violence: punching, slapping, hitting, biting, pinching, kicking, pulling hair out, pushing, shoving, burning, strangling
Denial: saying the abuse doesn't happen, saying you caused the abusive behaviour, being publicly gentle and patient, crying and begging for forgiveness, saying it will never happen again.

Financial Abuse

Usually involves an individual’s funds or resources being inappropriately used by a third person. It includes the withholding of money or the inappropriate or unsanctioned use of a person’s money or property or the entry of the vulnerable adult into financial contracts or transactions that they do not understand, to their disadvantage.

Possible Indicators of financial abuse

Unexplained or sudden inability to pay household shopping or bills etc
Unexplained or sudden withdrawal of money from accounts
Person lacks belongings or services or Living conditions are substandard and unsatisfactory in contrast to adult's apparent financial position
Lack of receptiveness to any necessary assistance requiring expenditure, when finances are not a problem – although the natural thriftiness of some people should be borne in mind
Unusual and extraordinary interest and involvement by the family, carer, friend, stranger or door to door salesperson in vulnerable adult's assets
Power of Attorney obtained when the vulnerable adults is not able to understand the purpose of the document they are signing
Recent change of deeds or title of property
Carer only asks questions of the worker about the user’s financial affairs and does not appear to be concerned about the physical or emotional care of the person
The person who manages the financial affairs is evasive or uncooperative
A reluctance or refusal to take up care assessed as being needed
A high level of expenditure without evidence of the person benefiting
The purchase of items which the person does not require or use
Personal items going missing from the home Unreasonable and /or inappropriate gifts

Neglect / Acts of Omission

Neglect can be both physical and emotional it is about the failure to keep a vulnerable adult clean, warm and promote optimum health, or to provide adequate nutrition, medication, being prevented from making choices

Neglect of a duty of care or the breakdown of a care package may also give rise to safeguarding issues i.e. where a carer refuses access or if a care provider is unable, unwilling or neglects to meet assessed needs. If the circumstances mean that the vulnerable adult is at risk of significant harm then Safeguarding Adults procedures should be invoked.

Possible Indicators of neglect

Poor condition of accommodation
Inadequate heating and/or lighting
Physical condition of person poor, e.g. ulcers, pressure sores etc
Person’s clothing in poor condition, e.g. unclean, wet, etc. Clothing may be inappropriate or inadequate, or the person may be kept in night clothes during the day
Sensory deprivation, not allowed to have access to glasses, hearing aids etc
Vulnerable adult has no method of calling for assistance
Apparently unexplained weight loss. Malnutrition – inadequate food or fluids
Failure to give prescribed medication or obtain appropriate medical care
Failure to ensure appropriate privacy and dignity
Carers inconsistent or reluctant to accept contact from health or social care professionals
Refusal of access to callers/visitors
A person with capacity may choose to self-neglect, and whilst it may be a symptom of a form of abuse it is not abuse in itself within the definition of these procedures.

Discriminatory Abuse

Is abuse targeted at a perceived vulnerability or on the basis of prejudice including racism or sexism, or based on a person's disability. It can take any of the other forms of abuse, harassment, slurs or similar treatment.

Discriminatory abuse may be used to describe serious, repeated or pervasive discrimination, which leads to significant harm or exclusion from mainstream opportunities, provision of poor standards of health care, and/or which represents a failure to protect or provide redress through the criminal or civil justice system.

Possible Indicators of discriminatory abuse

hate mail
verbal or physical abuse in public places or residential settings
criminal damage to property
target of distraction burglary, bogus officials or unrequested building/household services
Tendency to withdrawal and isolation
Fearfulness and anxiety
Being refused access to services or being excluded inappropriately
Loss of self esteem
Resistance or refusal to access services that are required to meet need
Expressions of anger and frustration

Institutional Abuse

Institutional abuse happens when the rituals and routines in use, force residents or service users to sacrifice their own needs, wishes or preferred lifestyle to the needs of the institution or service provider. Abuse may be perpetrated by an individual or by a group of staff embroiled in the accepted custom, subculture and practice of the institution or service.

Possible indicators of institutional abuse

May be reflected in an enforced schedule of activities, the limiting of personal freedom, the control of personal finances, a lack of adequate clothing, poor personal hygiene, a lack of stimulating activities or a low quality diet – in fact, anything which treats service users as not being entitled to a “normal” life

Institutions may include residential and nursing homes, hospitals, day centres sheltered housing schemes, group or supported housing projects. It should be noted that all organisations and services, whatever their setting, can have institutional practices which can cause harm to vulnerable adults.

The distinction between abuse in institutions that results from poor standards of care, lack of knowledge, understanding and training and specific allegations of abuse of one or more named service users by the service or by staff within a service requires careful consideration. Depending upon the allegation and nature of the abuse, different interventions and action will be necessary by one or more agencies such as Joint Protocol investigations, care management, regulatory authorities (RQIA), contract departments etc.

Human Trafficking/Modern Slavery

The response to adults at risk experiencing human trafficking/modern slavery will always be to report the incident to the Police Service.

Hate Crime

The response to adults at risk experiencing hate crime will usually be to report the incident to the Police Service.

Who is an adult at risk of harm?

An ‘adult at risk of harm’ is a person aged 18 or over, whose exposure to harm through abuse, exploitation or neglect may be increased by their personal characteristics and/or life circumstances.

Personal characteristics may include, but are not limited to, age, disability, special educational needs, illness, mental or physical frailty or impairment of, or disturbance in, the functioning of the mind or brain. Life circumstances may include, but are not limited to, isolation, socio-economic factors and environmental living conditions.

Who is an adult in need of protection?

An ‘adult in need of protection’ is a person aged 18 or over, whose exposure to harm through abuse, exploitation or neglect may be increased by their: A. personal characteristics and/or B. life circumstances AND C) who is unable to protect their own well-being, property, assets, rights or other interests; AND D) where the action or inaction of another person or persons is causing, or is likely to cause, him/her to be harmed.

In order to meet the definition of an ‘adult in need of protection’ either (A) or (B) must be present, in addition to both elements (C), and (D).

In most situations HSC Trusts will make decisions regarding the degree of risk and level of harm an adult may be facing and decide on the most appropriate action to take. If there is a clear and immediate risk of harm, or a crime is alleged or suspected, the matter should be referred directly to the PSNI or HSC Trust Adult Protection Gateway Service.

If you think a crime has occurred where medical or forensic evidence might still be present consider the need for an urgent referral to the police service and be cautious not to touch or disturb possible evidential material

Where can abuse occur?

Abuse can occur anywhere including in your own home, in residential or nursing care facilities, day care facilities or in hospital.

Who might be the abuser?

•a member of the family, a friend or neighbour

•a paid or volunteer care worker

•a professional worker

•someone else who is receiving care

•someone you don’t know.

Predisposing Factors

Abuse can happen in a range of settings, in a variety of relationships and can take a number of forms. There are a number of indicators, which could, in some circumstances, in combination with other possibly unknown factors suggest the possibility of abuse. Abuse may be more likely to happen in the following situations:

Environmental Problems – overcrowding/poor housing conditions/lack of facilities
Financial Problems – low income, a dependent vulnerable adult may add to financial difficulties, unable to work due to caring role, debt arrears, full benefits not claimed
Psychological and Emotional Problems – family relationships over the years have been poor and there is a history of abuse in the family or where family violence is the norm
Communication Problems – the vulnerable person or their carer has difficulty communicating due to sensory impairments, loss or difficulty with speech and understanding, poor memory or other conditions resulting in diminished mental capacity; this also includes people for whom English is a second language
Dependency Problems – Increased dependency of the person, major changes in personality and behaviour, carers are not receiving practical and/or emotional support
Organisational culture – services which are inward looking, where there is little staff training/knowledge of best practice and where contact with external professionals is resisted increase the vulnerability of service users. High staff turnover or shortages may also increase the risk of abuse.

Responding to Initial Disclosures of Adult Abuse

If someone tells you about abuse, your role is to respond sensitively and pass the information on to social services or the PSNI. Disclosure may take place many years after a traumatic event or when someone has left a setting in which they were afraid. This delay should not, in itself, cast doubt on its truthfulness.

If someone discloses abuse to you:

Stay calm and try not to show shock or disbelief
Listen carefully to what they are saying
Be sympathetic ('I am sorry that this has happened to you')
Be aware of the possibility that medical evidence might be needed.

Tell the person that:

They did the right thing to tell you
You are treating the information seriously
It was not their fault
You are going to inform the appropriate person
Report to social services or the police
Write down what was said by the person disclosing as soon as possible

And Do Not

Press the person for more details. This will be done at a later date
Stop someone who is freely recalling significant events; (e.g. don't say 'Hold on we'll come back to that later,') as they may not tell you again
Ask leading questions that could be interpreted as putting words or suggestions to vulnerable adult or any vulnerable witnesses
Promise to keep secrets. You cannot keep this kind of information confidential
Make promises you cannot keep (such as, 'This will never happen to you again')
Contact the alleged abuser
Be judgmental (for example 'Why didn't you run away?')
Pass on the information to anyone other than those with a legitimate 'need to know.'
At the first opportunity make a note of the disclosure and date and sign your record.
You should aim to
Note what was said, using the exact words and phrases spoken, wherever possible
Describe the circumstances in which the disclosure came about
Note the setting and anyone else who was there at the time
Separate out factual information from your own opinion
Use a pen or biro with black ink, so that the report can be photocopied
Be aware that your report may be required later as part of a legal action or disciplinary