Making Safeguarding Personal Outcomes Framework

The Association of Directors of Adult Social Services and the Local Government Association asked the Institute of Public Care (IPC) at Oxford Brookes University and Research in Practice for Adults (RiPfA) to develop a national MSP outcomes framework. The purpose of the framework is to provide a means of promoting and measuring practice that supports an outcomes focus and person led approach to safeguarding. IPC and RiPfA worked with the sector in early 2018 to develop this outcomes framework. More detail about the activities undertaken and the councils involved in the development of the framework can be found in the accompanying report.

The framework consists of seven questions in total. The questions are detailed below. Questions 4, 5, 6 and 7 are about the individual’s – or their representative’s - experience of the safeguarding activity. Different versions of questions 4 to 7 are given below depending on whether the adult at risk or their representative (whether a friend, carer, family member or an Independent Mental Capacity Advocate) is being asked. These questions can be asked using an interview method by an independent person (i.e. not the person leading the enquiry) after the case was closed, but within eight weeks of the case closing. Alternatively the person leading the information gathering or enquiry can ask the questions at case closure. There are pros and cons of either method.

More detail about the rationale of the questions can be found in the accompanying report along with guidance on the gathering of qualitative data through audit-style questions for Safeguarding Adults Board partners.

Outcomes focus questions

1. Was the individual or individual's representative asked what their desired outcomes were?

Answer options

• Yes they were asked and outcomes were expressed
• Yes they were asked but no outcomes were expressed
• No
• Don't know
• Not recorded

Further information

This question is adapted from the voluntary data on MSP which is collected as part of NHS Digital’s annual Safeguarding Adults Collection (SAC). The SAC guidance is clear that desired outcomes are the wishes of the adult at risk or their representative which have been expressed at some point during the information gathering or enquiry phases. Further guidance is available from NHS Digital: Guidance for Completing the Safeguarding Adults Collection.

Domain

Outcomes - involvement

2. Did the person or their representative feel that the desired outcomes were achieved?

Answer options

• Fully achieved
• Partially achieved
• Not achieved

Further information

This question is adapted from the voluntary data on MSP which is collected as part of NHS Digital’s annual Safeguarding Adults Collection (SAC). The SAC guidance states that the process for deciding whether an outcome has been achieved will be different for different local authorities. Ideally the adult at risk or their representative should identify whether their outcomes have been met, but sometimes it is the safeguarding team that would make this decision. Further guidance is available from NHS Digital: Guidance for Completing the Safeguarding Adults Collection (2018: page 27)

Domain

Outcomes - involvement

Questions about risk

3. To what extent was the individual or individual’s representative involved in understanding and responding to acceptable levels of risk?

Answer options

• Fully involved
• Partially involved
• Not involved

Further information

This question was developed for the framework to measure the level of involvement of the person in understanding and responding to risk. It can be answered by the individual, their representative or a member of the safeguarding team. At the core of practice in safeguarding adults is a tension between two important principles: duty of care and individual autonomy (the right to take risks). A specific question about risk was developed to reflect the fact that reducing risk may not be the sole aim of the safeguarding activity.

Domain

Risk/involvement

Questions about the experience of the safeguarding enquiry

4a. Requires response from the adult (question 4a) or their representative (question 4b) Did you understand why people did what they did to try to keep you safe?

Answer options

• Fully understood
• Partially understood
• Did not understand

Further information

This question was developed for the framework to check whether people understood why the action taken was taken. This version is intended for the individual.

Domain

Understanding

4b. Did you understand why people did what they did to try to keep [INSERT NAME OF ADULT AT RISK] safe?

Answer options

• Fully understood
• Partially understood
• Did not understand

Further information

This question was developed for the framework to check whether people understood why the action taken was taken. This version is intended for the individual’s representative.

Domain

Understanding

5a. Requires response from the adult (question 5a) or their representative (question 5b) Did you feel listened to during conversations and meetings with people about helping you feel safe?

Answer options

• I was always listened to
• I was listened to quite a bit
• I was not listened to very much
• I was not listened to at all
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study.

This version is intended for the individual. It aims to capture if the participant felt they were involved in the safeguarding enquiry as much as they wanted to be and whether they thought their view was heard and taken into consideration.

The question has been subject to cognitive testing, a process that aimed to make sure that respondents understood the questions in the way that they were meant to be understood and they were willing and able to answer them. “The question worked well in cognitive testing and people thought the term ‘listened to’ meant the process of others listening to what they had to say and taking it on board. For those that struggled to fully comprehend what was meant reference to the social worker by name and descriptions of the meetings that took place helped elicit a response.” (HSCIC, 2014: page 23).

Domain

Listened to

5b. Did you feel listened to during conversations and meetings with people about helping [INSERT NAME OF ADULT AT RISK] feel safe?

Answer options

• I was always listened to
• I was not listened to very much
• I was not listened to at all
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study.This version is intended for the individual’s representative. It aims to capture if they felt they were involved in the safeguarding enquiry as much as they wanted to be and whether they thought their view was heard and taken into consideration. 

Domain

Listened to

6a. Requires response from the adult (question 6a) or their representative (question 6b) How happy are you with the end result of what people did to try and keep you safe?

Answer options

• I am very happy with the end result
• I am quite happy with the end result
• I am not very happy with the end result
• I am not at all happy with the end result
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study. This version is intended for the individual. It aims to capture how satisfied people were with the outcome of the safeguarding enquiry. The question has been subject to cognitive testing, a process that aimed to make sure that respondents understood the questions in the way that they were meant to be understood and they were willing and able to answer them. The HSCIC pilot study authors substituted the word ‘satisfied’ for ‘happy’ in the cognitive testing stage because not all participants understood the meaning of the word satisfied. Cognitive testing showed some adults at risk were able to understand the question and focussed on what had been done and what had been discussed at the end of the enquiry. Some people needed help focussing on what to think about, and support workers aided the adult at risk by mentioning specific meetings or asking respondents to think about the meeting where we discussed e.g. what happened when X was arrested for stealing your money. “The word ‘outcome’ proved problematic, not everyone understood what it meant and it does not exist in British Sign Language, therefore it has be substituted with ‘end result’.” (HSCIC, 2014: page 24) .

Domain

End result – overall (not just whether outcome met or not)

6b. How happy are you with the end result of what people did to try and keep [INSERT NAME OF ADULT AT RISK] safe?

Answer options

• I am very happy with the end result
• I am quite happy with the end result
• I am not very happy with the end result
• I am not at all happy with the end result
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study. This version is intended for the individual’s representative. It aims to capture how satisfied people were with
the outcome of the safeguarding enquiry. 

Domain

End result – overall (not just whether outcome met or not)

7a. Requires response from the adult (question 7a) or their representative (question 7b or 7c depending on whether the person is alive or has died) Do you feel that you are safer now because of the help from people dealing with your concern?

Answer options

• I feel that I am a lot safer now
• I feel that I am quite a bit safer now
• I feel that I am not much safer now
• I feel that I am not at all safer now
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study. This version is intended for the individual. This question aims to understand if what the local authority did, or any actions taken, helped the adult at risk to feel safer. The question has been subject to cognitive testing, a process that aimed to make sure that respondents understood the questions in the way that they were meant to be understood and they were willing and able to answer them. “Questions about safety need to be clear that they’re asking about feeling safer as a result of the safeguarding activity, not about safety in general. In cognitive testing one of the answer choices was ‘I feel completely safe now or I feel that the person in this case is completely safe now’, however feedback was that you can never be completely safe and so this was changed to ‘I feel I am a lot safer now or I feel that the person in this case is a lot safer now’.” (HSCIC, 2014: page 25)

Domain

Feeling safer

7b. Do you feel that [INSERT NAME OF ADULT AT RISK] is safer now because of the help from people dealing with the concern?

Answer options

• I feel that [the person in this case] is a lot safer now
• I feel that [the person in this case] is quite a bit safer now
• I feel that [the person in this case] is not much safer now
• I feel that [the person in this case] is not at all safer now
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study. For representatives, two versions of question 7 have been developed, one which is present tense and to be used when the adult at risk is alive and one which is past tense for where the adult at risk has since died. This version is intended for the individual’s representative if the person is alive. This question aims to understand if what the local authority did, or any actions taken, helped the adult at risk’s representative feel that the adult at risk was made safer.

Domain

Feeling safer

7c. Do you feel that [INSERT NAME OF ADULT AT RISK] was made safer because of the help from people dealing with the concern?

Answer options

• I feel that [the person in this case] was a lot safer
• I feel that [the person in this case] was quite a bit safer
• I feel that [the person in this case] was not much safer
• I feel that [the person in this case] was not at all safer
• Not answered

Further information

This question is taken from the HSCIC Safeguarding Outcomes Measure Pilot Study. For representatives, two versions of question 7 have been developed, one which is present tense and to be used when the adult at risk is alive and one which is past tense for where the adult at risk has since died. This version is intended for the individual’s representative if the person has died. This question aims to understand if what the local authority did, or any actions taken, helped the adult at risk’s representative feel that the adult at risk was made safer.

Domain

Feeling safer