Making safeguarding personal videos

Hello, my name is Kate Ogilvie and in this session, we're going to go back to basics and look at what making safeguarding personal is all about.

I'd like to start by taking you back in time to the beginning of the new century back to March of 2000.

When the Department of Health and Social care published this document No Secrets: guidance on protecting vulnerable adults in care.

Now it might be quite relevant appropriate to note here that we don't use a term vulnerable adults today.

It's not the adult who's vulnerable.

It's the situation or the circumstance that they find themselves in which might make them more vulnerable or subceptible to harm to exploitation to neglect or to abuse.

However, this was the terminology that was used at the time more acceptably today you would refer to adults at risk of abuse or neglect sometimes shortened to adults at risk.

So the No Secrets guidance set out how Commissioners and providers A care service should protect vulnerable adults in the guidance.

We saw encouragement for statutory agencies to work together in Partnership to ensure that appropriate policies and procedures and practices were in place and implemented locally to create a framework for Action to protect vulnerable adults from abuse.

Unfortunately, despite these good intentions this all became very process driven and more worryingly.

Perhaps the individuals who were the the subject of the investigations had very little involvement or say in what was happening.

In fact for many they were completely oblivious some unaware that they were even involved in a safeguarding concern.

So in 2008/9 there was a public consultation on No Secrets which highlighted the issues and the shortfalls of the systems that had been established.

The making safeguarding personal program which was developed collaboratively with the Local Government Association the association of directors of adult social services in England and social care institute for excellence for research and practice and the Department of Health.

All of them came together and sought to address the concerns raised within that consultation process.

And making safeguarding personal has been running now since 2010 and from its Inception is always emphasized that safeguarding adults should be person-centered and outcome focused advocating and move away from that process that really characterized practice under No Secrets to being centered on conversations with the people concerned about what they thought needed to happen.

Now remember this was before the Care Act of 2014.

So it represented quite a shift in Social Work practice for safeguarding.

Because within the principles of making safeguarding personal person-centred safeguarding was and remains paramount.

So focusing on the empowerment and the well-being of the person and ensuring that any approach taken was rights-based listening to the person and asking their views and seeking their consent while ensuring that they understood as well as the benefits also the potential risks of the were in particular situations making sure that their wishes were at the heart of all decisions and their strengths were identified through having those genuine conversations.

Also respecting the rights of people with capacity to make unwise choices with a course those, you know, the obvious caveats of being alert to people being subjected to coercion or to any undue influence.

What we're trying to ensure was that people could make informed Decisions by providing information and advice in accessible formats keeping people well informed in a way that they could understand.

If needed also offering advocacy and support to enable people to have more choice and control.

Now these were the aims and the objectives of making safeguarding personal having they may seem very familiar to you.

As this is now very much the approach that's outlined within the Care Act 2014 for everyone requiring care and support.

In May 2014 when the character was implemented it set out a clear legal framework for how local Authority should protect adults at risk of abuse or neglect.

and place new safeguarding duties on local authorities, which were to lead a multi-agency local adult safeguarding system that sought to prevent abuse and neglect and stop it quickly when it happened.

Making queries or request others to make them when they think that an adult with care and support needs may be at risk of abuse or neglect.

Establishing safeguarding adults board now prior to the Care Act the were some safguarding adults board.

However, there was no statutory requirement for this to be some so this included the requirement for the to be boards that had local Authority NHS police and all other relevant partner agencies involved to develop and share and Implement a joint safeguarding strategy.

Also carry out safeguarding adults reviews so sadly when someone with care and support need dies or experiences extremely neglect and abuse, and there's a concern that the local Authority or its Partners could have done more to protect them than there needs to be a safeguarding adults review.

And also to arrange an independent Advocate to represent and support a person who is the subject of a safeguarding inquiry or of a safeguarding adults review if that's required and we'll consider that a little more in the in a minute.

So here we see section 42 of the Care Act which relates directly to professionals responding proactively to risk of abuse and neglect by making inquiries.

Where the local Authority has got a reasonable cause to suspect that an adult in its area even if they don't usually live there.

Then they if they have need for care and support whether or not the authorities Meeting those needs and they're experiencing or at risk of abuse on neglect.

And as a result of the needs that they have they're unable to protect themselves against that abuse or neglect or the risk of it.

Then the local authority must make or cause to be made whatever inquiry it thinks necessary to enable it to decide whether any action should be taken and if so, what action should be taken and who that should be should be taken by.

It's important to note that safeguarding Duty Supply regardless of whether that person's care and support needs are being met either by the local Authority or anyone else and it also applies to people who pay for their own care and support services.

There is a useful publication on the local government association website and is called making decisions on the duty to carry out safeguarding adults inquiries suggestive framework to support practice reporting and recording which is the title suggests offers support in making decisions about whether or not a reported safeguarding adult concern requires an inquiry under section. Now when these inquiries are made the adult at risk of harm may need support to understand what's happening to be able to express their needs and their wishes and also to to secure their own rights.

So that's why the care and supports statutory guidance underlines and I quote the value of advocacy support in sensitive safeguarding situations, which are often daunting and present difficult decisions where people are often demoralized fearful or embarrassed and that's why in accordance with their safeguarding duties in the Care Act each local Authority must arrange where appropriate for an independent Advocate to represent and support an adult who is the subject of a safeguard inquiry or a safeguarding adults review.

You find out because you set out in section 67 and an advocate to support people who got care and support needs and not related necessarily and not necessary not related to safeguarding adults while 68 refers to the involvement of an advocate to specifically support a safeguarding process.

Now the Department of Health and Social care statutory guidance.

We sits alongside the Care Act.

Endorses making second impersonal as the recommended approach to safeguarding encouraging all partner agencies to take a broad Community approach to establishing safeguarding arrangements and it Advocates the use for all sectors of the six core principles of safeguarding, which we can see here.

So first of all empowerment supporting and encouraging people to make their own decisions and provide informed consent asking them.

What is that they want as outcomes from the safeguarding process and using these to inform what happens.

Prevention is always better to take action before harm occurs.

They're for ensuring people have clear and simple information about what abuse is how they can recognize the signs and what they can do to seek help.

Proportionality making sure the least intrusive response is taken which is appropriate to the risk that that is presented.

Now this provides confidence that the professional professionals involved will work in the interests of the adult at risk, and they'll only get in as involved as they need to.

Protection being mindful of the support and representation required for those in greatest need the individual is given the help and the support to report abuse and neglect.

They receive the help they need and they're assisted to participate in the safeguarding process to the extent they wish to do so and if required they may need the assistance of an advocate.

Partnership: Here we see in the encouragement of local Solutions through Services working with their own communities.

This recognizes that communities have a part to play in preventing detecting and Reporting neglect and abuse.

It also includes assurance that the individual can be confident that any personal and sensitive information can be is treated with due respect and it will only be shared on a need to know basis when this is helpful and necessary.

The person at the center of the inquiry should always feel confident.

The professionals will work together with them to get the best results be mindful of their views and wishes and beliefs and desires and relating to their well-being.

Accountability as with anything associated with care and support there should be accountability and transparency in delivering safeguarding.

That there's ownership of the concern that people are passing the buck that everybody understands and knows their roles and responsibility and there are clear multi-agency guidelines and protocols.

The adult at the center of the inquiry understands the role of everybody who's involved and in turn they understand the individual their life and their situation and the circumstances that they find themselves in Now the reason I've taken you back to the beginning of making safeguarding personal is firstly to set it in context and also to show you how it began in response to a system which was driven by process.

No Secrets are good intentions, but turned into a set of rigidly applied rules, which ultimately didn't work.

It would be a great shame.

If the intent of making safeguarding personal just became another rigid process rather than the vehicle to empower and enhance people's lives.

Remember, it should be person-led and outcome focused engaging and evolving the person at every stage ensuring they've got choice and control over what happens and as a result this will improve the quality of their life their well-being and most importantly their safety.

I'm going to draw to close with some reflective questions for you to consider.

So why is it I I noted the fact that some people didn't even know that they were in a safeguarding situation.

Why is it important for those experiencing or at risk of abuse or neglect to be aware that they are involved in a safeguarding inquiry?

How do you ensure that the six core principles of safeguarding are reflected in the work in safeguarding adults?

And the Department of Health and Social care guidance acknowledges that there are many forms of abuse and neglect and it lists 10 types.

What are they?

However with that in mind why should practitioners be mindful of not being overly constrained by these categories of abuse.

What do you think that might be?

During a safeguarding process what support might an advocate provide for the adult at risk?

Hello, my name's Kate Ogilvie.

And in this session, we're going to consider some of the tools and the resources available to you when you're making safeguarding personal.

So safeguarding adults means protecting a person's right to live in safety free from abuse neglect violence and exploitation.

It's about promoting individuals well-being and preventing both the risk of and the experience of abuse and neglect.

The making safeguarding personal program recognized that adults who've experienced abuse and neglect may need support to build up their resilience and to develop coping mechanisms and strategies.

Therefore encouraging people to use their own strengths and abilities to overcome what had happened learn from the experience and develop an awareness that may prevent a recurrence or at least enable people to recognize the signs and the risks of abuse and neglect and to know who to contact for help if needed.

We know from the early work with making safeguarding personal, but when we ask people who had experienced abuse or neglect what they wanted they told us that what they wanted was for the abuse to stop that.

They didn't want it to happen again, and they didn't want it to happen to other people.

They're for building on these strengths to help develop resilience is a positive approach.

This might be from drawing on strengths that they have within themselves or it could be tapping into other assets available to them from within their immediate and network of friends and family or from their wider community.

As practitioners when you're working in this strength-based approach you need to begin by first and foremost having a conversation the starting point listening exploring with the person their own feelings thoughts aspirations and intentions recognizing the expertise that they themselves bring.

What is it that has led them to this point in time and the situation that they find themselves in.

Start building a relationship with the person to help understand them in a holistic way find out what they would like to achieve in their lives Support them to recognize the resources that they have at their disposal which they may be able to use to counteract the problems that they’re experiencing.

Find out about the people the associations and the groups that they have contacts with and connections with who may have something to offer them which might be useful in building on their strengths.

Also try to increase and encourage hopefulness.

For them to be able to see beyond the present and their current situation to how things might be.

And recognize that people are the experts in their own lives after all they've managed until this point.

How have they done that?

They must have some strengths to be able to have done that.

Make sure you clearly explain their choices and encourage people to make their own decisions, which are informed as a result of understanding their situation and what is available to them.

Resilience is supported by recovery actions which include adults identifying actions that they would like to see to prevent the abusive situations from recurring.

Now a resource that you might find helpful in assisting people to think and act in a more resilient way.

It's the making safeguarding personal toolkit, which provides a range of helpful tools and practice based case examples.

Now this toolkit is available on the local government association website where you can easily access the information and download various tools and resources that it holds.

This is a screenshot of the web page.

And if you click on any one of these 26 headings, you'll see that they have a drop down function which takes you to the relevant information advice tools or whatever.

It is.

It's hidden behind the the particular headings that are here.

So for example if we click on number six.

When you can't make your own decisions, this takes you to a document produced by the office of the public Guardian with information about lasting power of attorney.

Try another one.

Where you find the practice tool for a solution focused communication?

Within these sections, it's not just not just kind of documents have been written or or tools.

You'll also find sections where you'll find links to podcasts and video clips as well.

So there's a lot of information here plenty of resources there to help you with the information and support that you require a vice-related to upholding the rights of people involved in safeguarding as well as tools for resolution and Recovery as we've just been discussing, but what about you?

What is it that you need?

Is something which might help you personally?

Professional curiosity is a concept which has been recognized as important in safeguarding children for many years.

More recently we've seen safeguarding adults reviews highlighting a similar need for professional curiosity in safeguarding adults.

So curiosity is required to support practitioners to question and challenge the information.

They receive identify the concerns and to make importantly make the connections that might be to enable a greater understanding of that person's situation.

Now this strategic briefing draws from research and safeguarding adults reviews to examine the nature of professional curiosity as well as some of the barriers that inhibit professional curious practice.

Also, the enablers that strategic leaders could put in place to help create the conditions for a culture of curiosity within their organizations.

Now once you've used the toolkit and become more curious in your practice, you might find them making sake calling personal outcomes framework a useful tool to help you see the difference all of this is making It was developed to provide a means of promoting and measuring practice that supports an outcome focus and personal-led approach to safeguarding adults it aims to help councils and safeguarding adults boards to identify how practice is impacting on outcomes and indicates areas where there could be some improvements made.

It could also be useful for a benchmarking as well to share best practice and learning amongst different agencies different organizations and across safeguarding adult boards.

In addition, it also provides examples of case file audit tools and guidance and methodologies.

So that could be really useful too all of this can actually help you and your organization to understand the difference that safeguarding support makes for people the people who are at risk of harm or abuse.

I want to finish this section by drawing your attention to this publication myths and realities about making safeguarding personal from a practice perspective.

There can be misunderstandings and this briefing author by Dr. Adi Cooper helps to identify and address these potential misunderstandings.

While reminding us that making safeguarding personal is not just about safeguarding practice, but it's also about prevention strategic and operational safeguarding as well.

So the the briefing itself reminds us that making safeguarding personal doesn't mean walking away.

It's about safeguarding practice and cultural change.

It stops abuse and neglect.

It's time effective.

It's for everyone including people who lack mental capacity or refuse support.

Everybody's business and responsibility.

It's about prevention and early intervention and perhaps most importantly making safeguarding personal.

keeps people safe Now some reflective questions Do you feel well equipped to know where and how to find the information that you need to understand that implement the aims of making safeguarding personal?

Are you confident that the safeguarding training provided by your organization is comprehensive and of good quality And can those experience abuse and or neglect easily find and access appropriate information and advice.

And do you think your organizations approach to adult safeguarding supports people to achieve resolution and Recovery.

What do you think of the enablers or potentially the barriers to this?

Hello, my name's Kate Ogilvie.

And in this session, we're going to consider some learning and key messages from cases and research related to safeguarding adults.

Now the making safeguarding personal program has been in place since 2010 and then in 2014.

We saw the implementation of the Care Act which brought with it a clear legal framework for how local authorities and their Partners should protect adults at risk of abuse or neglect.

So surely by now, we've totally got this sorted and everything is running smoothly.

Therefore can we safely assume that safeguarding is being person-led and outcome focused that it engages as in an involves the person who's at the centre of the inquiry ensuring that they've got choice and control over what happens and as a result the quality of their life is improved along with their well-being and most importantly their safety.

Can we assume that?

Now SCIE, the Social Care Institute for Excellence, recently questioned if we'd learned lessons from the murder of Stephen Hoskins.

Now Stephen was a man of 39 who had learning difficulties.

He wanted to have friends.

Although this enthusiasm he had for this meant that he was targeted by those who sought to take advantage of him.

He was sadly exploited and he was coerced and ultimately he was tortured and this resulted in his murder on the sixth of July 2006.

Now two people were charged with his murder and another with manslaughter.

However, the serious case review that was undertaken by Margaret Flynn highlighted considerable disconnects both between and within the responsible agencies there had in fact been a lot of information available prior to Steven's death.

However, a bit like a jigsaw puzzle the pieces needed to be put together in order to see the full picture and the extent of the abuse that was taking place.

Now I said this tragic event happened in 2006.

Therefore that was before making safeguarding personal and the Care Act of 2014 which brought a statutory requirement for there to be safeguarding adult boards for the Section 42 inquiries and for the duty to cooperate so surely things are much better now.

Unfortunately, the findings from the SCIE report indicate that the lessons have not been learned and therefore they've suggested some key messages for practice at both the case level as well as the Frontline operational and strategic levels.

So let's have a look at what these were the case level they say that we should be ensuring a caseworker and lead officer are always appointed and that both a plan and a contingency are agreed.

And most importantly from making safeguarding personal perspective.

The person involved is right at the centre of everything that you do.

At the front line level there needs to be a real awareness about safeguarding among the stuff who are working at that front line and also the people who've got care and support needs.

And their carers and the general public that way you can encourage vigilance and ensure that everybody knows how to spot abuse and neglect.

Should it occur this includes publicizing the contact details and the ways of reporting concerns.

And at the operational level there needs to be an open culture which promotes positive working relationships and Joint working across the key sectors the organizations need to ensure that managers understand things like information sharing law to enable them to share information in the right way with the right people at the right time and this follows on at strategic level with local joint working strategies developed to enable effective information sharing and coordinated responses.

Strategically there needs to be clear accountability and the named lead officer appointed in each key organization.

And the lead officers need to support the safeguarding adults boards to ensure compliance with partnership duties across the sectors.

Now these findings from SCIE are backed up by various work by Professor Michael Preston-Shoot and professor Suzy Braye showing this still a need for improvements in communication better legal literacy and a cultural shift by all agencies involved.

This is one of these reports commissioned by the sector-led care and health Improvement program co-produced and delivered by the Local gGovernment Association and the Association of Directors of Adult Social Services in England.

It's the most in-depth quantitative analysis of safeguarding adults reviews today.

Authored by Professor Michael Preston-Shoot and by Professor Suzy Braye along with others and with the oversight of Dr.

Adi Cooper.

The research was conducted within the two-year period from April 2017 to March of adults reviews within the data set.

As I'm sure you can imagine there's a huge amount of information in this report, which will hopefully be used to make the improvements which are needed.

Just to pull out a few of the themes and the recommendations there were suggestions for safeguarding adults boards to better understand their role and their mandate the most prevalent theme for direct practice was for more attention to and better understanding of mental capacity and the quality and effectiveness of procedures and record sharing with particularly poor themes in relation to interagency working.

While at the organizational level the most prevalent theme was organizational training that related to poor practice.

So staff workloads the sharing of the learning from safeguarding elements reviews quality insurance improvements and better policies and procedures related to self neglect also came out strongly as recommendations for improvements.

Now while it's always important to take learning from things when they go wrong, I'm a firm advocate of learning from good practice.

So appreciating the things that are working well and building on these as I believe.

This is a much more strength based approach.

So this document provides just that examples of cases which illustrate outcome Focus practice and safeguarding adults in line with the making safeguarding personal approach.

They're from 18 different council areas and encompasses a range of examples all of which demonstrate the effect of using outcome Focus practice and the benefits for those receiving safeguarding support.

Do please seek out some good examples and compare them to your own practice?

I mentioned a few moments ago that legal literacy is an area for improvement.

And that's because research have researchers have concluded that legal literacy is necessary for practitioners to make important connections between legal rules and their professional practice.

Practitioners will be able to practice more effectively if they have the confidence to use a full range of legal options available being able to collate analyse and present the evidence and the reasoning that underpin their decision-making process.

Professor Suzy Braye and Professor Michael Preston-Shoot tell us that this requires the ability to identify how real world circumstances fit with the grounds within the grounds of legal intervention while also ensuring that human rights principles are maintained and weighing the balance between different possible courses of actions.

Deciding to evoke the law frequently requires the use of discretion in complex situations where the right decision might not be immediately apparent and this can be particularly pertinent in adult safeguarding situations.

So Suzy and Michael suggest that legal literacy has got three key components.

Sound technical knowledge of the legal rules and understanding of their relevancy practice and this they say enables people to do things right. And then the strong engagement with professional ethics which enables people to do right things.

And then respecting the principles of human rights equality and social justice, which enables people to bring a rights-based thinking to their decision making so do things right because you understand those legal rules do write things because of the ethical value base that you come from and then you engage that rights-based thinking because you're respecting principles of human rights and equality.

And now for some reflective questions just to finish off.

I'd like you please in thinking about your own organization to decide how and where do you think frontline workers people with care and support needs carers and the general public are about safeguarding adults.

Do you think they're aware?

Are you partner agencies easy to engage when there are safeguarding inquiries?

And what would you do if they weren't?

How confident do you feel in your own knowledge of legal rules?

Do you consider yourself to be legally literate?

And do you feel able to discuss the implications of Human Rights mental capacity equalities legislation in relation to your practice and safeguarding adults.

Hello everyone.

My name is Katy Shorten and I work for Research in Practice.

I'm really pleased to be introducing some new resources to support learning from making safeguarding personal.

In this video, we'll be focusing on self-neglect.

The videos can be used on your own for self-directed learning or with a colleague or in a group for peer learning.

And there is a workbook that will be alongside this video to support reflection and discussion.

I'm delighted to introduce Professor Susie Bray and Professor Michael Preston.

Shoot who will now take you through the content of this video.

Hello everyone and welcome to this video recording on making safeguarding personal when working with people who self neglect.

My name is Michael Preston shoot and I'm going to start this video.

By describing to you what we believe to be the challenges that you will be facing when working with people who self neglect.

We know that self neglect currently constitutes around 8% of all safeguarding inquiries under section 42 of the Care Act.

A percentage that has more than doubled since reporting first became a mandatory requirement for self neglect in the financial year.

2017-2018.

And if that is one indicator of the challenge of working with people who self neglect.

a more striking indicator still is that we know from the first national analysis of safeguarding adult reviews.

Completed in 2020 and published on the local government association website.

We know from that National analysis that between 2017 and 2019 featured self neglect.

It was the most commonly reviewed form of abuse and neglect covered by safeguarding adult reviews.

And we know from the most recent survey of safeguarding adult board chairs.

Covering the the period since 2019 that that percentage 45% Remains the current position in relation to safeguarding adult reviews.

So this tells us something about the challenge of working with self neglect the challenge for practitioners and operational managers and the challenge for multi-agency Partnerships.

We also know that the pandemic has been a major challenge for practitioners and services right across the board of adult safeguarding.

But particularly in relation to self neglect with people becoming increasingly isolated and practitioners finding it increasingly difficult to undertake home visits in order to gain a true appreciation of the particular risks and the particular needs that individuals will be experiencing.

So we know that self neglect is a major challenge.

But we also know that there is good news and sitting next to me is Suzy Braye and Suzy.

I think you're going to talk to us about the good news within this introductory picture.

Thank you, Michael.

And and hello, everybody.

There is indeed some good news.

So if we're asking ourselves the question what works in self neglect, how can we achieve positive outcomes in this very challenging territory of practice we can refer to an emerging evidence base.

Now the evidence-based consists of of information from a variety of sources it consists of learning from safeguarding adults reviews which show us what goes wrong and it consists of learning from research from practitioners.

And from people with lived experience of self neglect which show us what can go right Now that evidence basis is is constructed across five domains really it focuses on the five domains of understanding self-neglect and of effective interventions in self-neglect.

The first domain is the work that we do face-to-face with the individual whether that's on the doorstep whether it's at the end of the hospital bed are our attempts to engage and to build rapport and to build relationship and indeed to to create interventions that are going to alleviate risk and improve well-being.

The second domain is the domain of the interagency network that are engaged in assessment at intervention.

We could call this the team around the adult the third domain is consists of the agencies in which those professionals are located and we could call that domain the organizations around the team.

The fourth domain then is the interagency governance role that the safeguarding adults board exercises with its safeguarding policies procedures specific self neglect guidance multi agency risk management guidance and indeed the constant oversight that it is able to exercise on interagency working in all forms of abuse and neglect.

So including self neglect And then finally, of course all the work that we do takes place within a social policy and economic context in which in which our work takes place and that indeed itself exercises and influence on what can happen face-to-face with the individual.

So this particular talk is focusing solely on the first of those domains.

We're looking at making safeguarding personal in self neglect direct practice with the individual.

What we do know from research from safeguarding adult reviews from talking with practitioners and managers.

Is that making safeguarding personal is quite commonly misunderstood.

However, we do have a statutory definition of making safeguarding personal and you can find it in the statutory guidance that accompanies the Care Act particularly in a paragraph that definition says that making safeguarding personal means that work should be person-centered person-led outcome focused.

So making safeguarding personal is an approach which engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement choice and control as well as improving quality of life well-being and safety.

So as you're listening to this recording here and indeed elsewhere, you might want to undertake a temperature check or an appreciative inquiry of both your own practice and the practice of your colleagues within your own service and indeed the practice of practitioners and managers in other services with with which you work in in order to see how close you get to the statutory definition of making safeguarding personal.

And we know that that's important because there are some common myths about making safeguarding personal.

And there are some toolkits and some Publications on the local government association website.

Which indicate what some of the myths about making safeguarding personal are?

For example, there is a myth that if someone says they don't want anything to happen, then you can close the case and walk away.

It's all about talking to people to find out what they want and then doing just that.

A second myth is that doing making safeguarding personal takes far too much time the staff because of their workloads and increasing demands just don't have time to explain what safeguarding is.

They don't have time to talk to people about their lives and everything that is happening to them and all of the available options.

It's just not realistic you might think And a third of the many myths that surround making safeguarding personal is that you can't do it when a person refuses help and there is no obvious way in.

However, once again, we know that there is good news derived from research reviews and practitioner and service user accounts of of best practice and Suzy is going to take us through what we know about best making safeguarding personal practice in relation to self neglect.

Thank you Michael.

So for the next few minutes, I'm going to run through some of the the key headlines really of the findings from research that relates specifically to the the making safeguarding personal in that engagement in direct work with the individual.

So first of all, we have a lot of evidence from the stories of people with lived experience of self neglect who participated in our research and when when they will have been asked to tell their stories and to identify what has helped them.

They've emphasized the importance of four key elements of the approach that practitioners have used first of all engagement and Rapport building.

This is about taking time about showing respectful curiosity sometimes about offering practical help that can be accepted even when offers of other kinds of support won't be accepted and attempts really and time to understand their own perspective.

The second key element that they mentioned was the importance of working at the person's Pace.

Sometimes that's just about keeping the person company talking about something that you can find in common to talk about being alongside them.

But all the time being honest about your your role and function and about the concerns that you might have.

The third element that they mentioned was the importance of building a relationship of trust.

They described an emotional connection that that can be formed that can enable the person to find a different way of being or even to see themselves differently.

So that relationship becomes both the the Avenue through which you can take a an intervention related to the self neglect.

But it also sometimes becomes the intervention in itself in that the development of that emotional connection and Trust can help the person to see themselves differently and to make more self-careful decisions.

And then finally they talked about the the careful use of language.

Hoarded possessions for example are not rubbish as certainly a number of people with direct experience of self-neglect have described it being being the term being used to them in discussions with professionals.

The these possessions are often objects of immense emotional significance.

They sometimes serve a key function in the person's life.

They're perhaps a response to trauma a way of staying safe a way of hiding a way of not being seen or sometimes a way of avoiding waste.

So it's really important and they indicated to us that it was really important that we choose our language very very carefully and indeed respectfully of those possible meanings behind the the Hoarding in that case.

So that's the first direct element of evidence about direct practice NSP and direct practice in self neglect.

The second kind of cluster of indicators comes from safeguarding adults reviews and indeed from research evidence because both of those sources tell us about the importance of avoiding assumptions that self neglect is a lifestyle choice.

What we sometimes experience as unwillingness when we're standing on the doorstep or indeed trying to communicate through the letterbox or receiving a in a sense of reluctance to engage that can often arise more from an inability to self-care rather than from an unwillingness and the inability may result from an unacknowledged care and support need it could result from a health need or from a life experience or from loss and bereavement or from adverse childhood experiences or indeed from the influence of a of a third party.

We need to find the meaning of the mess.

The third key source of learning really is that it's vital while taking time to build relationship and to understand the person's own perspective to keep a professional focus on two key questions.

The first of those is the question of mental capacity does the person have capacity to make decisions about self-care?

Have they made specific choices to live in the way that we see them living?

Do they have capacity to make decisions about the care of their domestic environment?

Do they have to capacity to make decisions about accepting Healthcare or accepting care or support?

We need to test capacity very carefully particularly in high risk situations where persistent pattern of unwise decisions does require capacity to be quite explicitly considered and that consideration of capacity also needs to include consideration of whether they may have an impairment of executive brain function which may cause problems for them in using or weighing relevant information in the moment that a decision needs to be made.

So alongside capacity assessments undertaken in interview where we are essentially talking about the decision.

We also need to witness the person walking through the decision.

We need sometimes to use real-world observation of decision-making and what are sometimes called articulate and demonstrate models of assessment to to gain a true and more holistic picture of their their capacity in relation to self-care decisions.

And the second key element to keep on our on our shoulders as a as a kind of question to be answered over the development of our interaction with the individual is whether the risks from the self neglect either to the person or to other people are they such that we need to be Hands-On in relation to risk management.

Now, it may take time to build a true risk picture and it's sometimes only through interagency working that we're able to build a true risk picture and to determine which of the potential harms that are evident are most likely to happen and how serious the outcome would be if they did but that consideration of risk is in sense a key partner alongside the relationship building and the raport building.

We do need to be fulfilling our professional function of identifying risk and working out how proportionately we can work to reduce risks to in a sense buy more time to develop relationship that can enable the person to make decisions about their living so I'll now hand back to Michael to summarize some of the key messages from the evidence base.

So in summary, we have four key messages.

And once again, I would we would encourage you to take a temperature check or to conduct an appreciative inquiry in relation to your own practice the practice of your colleagues in the service that employs you and indeed the practice across the multi agency partnership because working with self neglect has to be everybody's business.

This is not just a responsibility of one particular service.

So what are the four key messages that we would wish to leave you with?

The first is that making safeguarding personal in the context of self neglect and indeed more generally requires us to try to find the person.

This means showing professional curiosity.

It means asking what one former service user described to me as carefrontational questions.

questions for exploration That he could appreciate.

We're asking him to address.

issues challenges in his life But which he knew the practitioner was asking from a position of care and carefulness.

Finding the person means Suzy has already said searching for the meaning of the mess.

It's only through finding the meaning of the mess.

The reason for hoarding.

The reason for the way the person is living it is only through finding the meaning of the mess that we can help the person to find a viable Way Forward.

So it's about finding the person.

And if you have had experience of cases where there have been deep cleaning and decluttering only for the situation to return to what it was several months later.

You will know that simply addressing a symptom is less effective than spending time to find the person and the reason for how they come to be the person that you know them to be today.

The second key message is to prioritize relationship building.

Relationship is often the key to being able to make a difference.

And whether that intervention is negotiated or imposed it's the relationship of trust that influences how the individual experiences that intervention and to Suzy has already said it may be that for a while as you are building up a relationship of trust a companionship of being with the person.

That you will spend less time talking about self-neglect as you see it manifesting in a situation and more time getting to know the person so prioritizing relationship building is part and parcel of finding the person.

The third key message is to identify the risks again involving the person to develop their understanding.

It is about sharing your perceptions your hypotheses your understandings alongside seeking to enable the individual to share with you their understanding of the journey that they have been through that results in them being the person that they are that you see today.

And finally the fourth key message, is that through relationship We are working towards what we would call positive autonomy.

Respect for autonomy, as a core professional value doesn't simply mean abandoning people when they say they don't want any help.

It does not mean closing the case and walking away.

It means resilience.

courage to return persistence a careful attempt to build up a relationship of trust with the individual we need to carefully balance respect for autonomy in other words with the duty of care.

We need to balance exploring the person's own perceptions of needs and risks.

With sharing our perceptions of needs and risks and working with them to expand their options.

Supporting them to find more self-careful ways of living.

So those are the four key messages that we would leave you with in the hope that making safeguarding personal.

in cases of self neglect Is something that you feel?

Even more able to do than you might have felt before you began listening to this video presentation.

We'd like to conclude this presentation by inviting you to view a short video.

This was produced by Lambeth safeguarding adult Sport and it draws explicitly on our Research into self neglect and indeed includes some quotes from some of the people that we spoke to it summarizes very powerfully.

I think the key messages.

First how important it is to understand the person and to place them at the heart of your intervention and second the value of working closely with others in a shared approach.

As such it provides an excellent summary of what making safeguarding personal means when working with people who soft neglect.

We all need help sometimes.

It sounds simple, but it's often hard to admit.

Safeguarding adults reviews in London show that one of the leading causes of death is self neglect.

Professionals on the front line we help people every day, but when people self neglect they often refuse our help.

When they do it's easy to think it's their lifestyle choice.

You might feel stuck.

frustrated and unsure what else you can do?

You're not alone.

People are complicated and so is self neglect.

People may give up on their personal hygiene or avoid vital Health Care.

They might neglect their surroundings or compulsively hoard problems can be deep rooted and concealed.

And often times the result of bereavement or trauma.

when asked people who self neglect say things like I got it into my head that I'm not important.

I'm not worth it.

I've always neglected my own feelings.

The distress of not collecting things is more than the distress of doing it.

Next time you're faced with the case like this where you believe they've got mental capacity and there's nothing you can do.

always bear in mind their vital interests Is their life at risk if we do nothing?

If a person isn't ready willing or able to make their own decisions to protect their well-being.

It's up to you.

To find better ways to help them working alone doesn't work.

For change to happen service users and practitioners agree that forming a supportive network of professionals friends neighbors and family works.

It builds trust and connection and it reduces feelings of Shame.

So step by step one agreement at a time.

The person can receive the Practical medical and emotional support they need imagine your next call and out to be a friend.

He'd want them taken care of.

Let's work collaboratively to find creative ways to help those who self neglect.

That show them we're not giving up on them.

Safeguarding adults at risk.

It's what we do that counts.

For more information visit www.lambethsab.org.uk/ we thank you for the work that you are all doing and wish you well in your endeavors and thank you for listening.

Thank you from us both.