Title: UK Study of Abuse and Neglect of Older People: Qualitative Findings (2007)
Authors: Alice Mowlam, Rosalind Tennant, Josie Dixon and Claudine McCreadie
Affiliations: King’s College, University of London, and National Centre for Social Research
Title: Partnership and Regulation in Adult Protection: the effectiveness of multi-agency working and the regulatory framework in adult protection (2007)
Authors: Bridget Penhale, Neil Perkins, Lisa Pinkney, David Reid, Shereen Hussein and Jill Manthorpe
Affiliations: University of Sheffield and Social Care Workforce Research Unit, King’s College, University of London
The first piece of research is the third of a four-stage qualitative study on abuse of older people. This part involved nearly 40 interviews with older people who had been abused and identified through a national survey. As part of a wider programme of research the study was intended to generate insight into experiences from the perspective of older people themselves.
Second is a study of multi-agency working and the regulatory framework in adult protection. Partnership working arrangements in England and Wales were examined by a postal survey of social services departments, followed by focus groups and interviews with key staff, and further groups and interviews with service users and their carers. The study was undertaken as part of the Department of Health policy initiative on Modernisation of Adult Social Care (MASC), and was the only one of the 11 studies to focus on adult protection.
Adult protection issues are not focused solely on older people. However, the findings on elder mistreatment are relevant to any wider consideration of adult abuse and vulnerability. The need for a national prevalence survey of elder abuse has been identified repeatedly in order to move knowledge beyond that obtained from literature reviews and case studies. The prevalence survey was the second stage of the programme (involving more than 2,000 people aged 66 and older throughout the UK). The in-depth interviews of the third stage followed up people who had experienced or encountered mistreatment “in order to explore issues around impact, resilience and coping mechanisms and barriers to reporting”.
The definition of abuse or mistreatment is controversial. Mowlam and colleagues followed international conventions and consensus in the definition they adopted in the national survey and defined abuse in wide-ranging terms of five categories: neglect physical abuse psychological abuse financial abuse and sexual harassment/abuse. However, the qualitative follow-up interviews indicated “that older people may have a different understanding from researchers or policymakers”.
The older people interviewed were “purposively sampled”. This means that the sample was structured to reflect a full range of respondent characteristics. The authors describe this approach as capturing “the full range and diversity of respondents’ experiences, attitudes and perceptions”.
The study found that the definition of five categories of mistreatment might be seen as a way of classifying the behaviour characteristics of perpetrators, rather than people’s experiences of mistreatment. People may encounter more than one of these behaviours as part of the same overall experience. This is an important finding: for example, focusing on different types of abusive behaviour “may obscure helpful insights that an understanding of the experience as a coherent and singular experience of spousal abuse would provide”. Accordingly, the study identified several broad categories of experience which often involved multiple forms of abuse:
● Spousal mistreatment, abuse and conflict.
● Family mistreatment, abuse and conflict (other than spousal).
● Abuse experienced in the course of caring for the perpetrator.
● Theft, financial exploitation and financial disputes.
● Institutional neglect and service failure.
● Sexual harassment and abuse.
This classification is also in line with the approach of much policy and practice in adult protection which focuses on harm and risk regardless of the nature of the relationship with the perpetrator.
The qualitative study found a broad diversity of cases represented in terms of the nature, severity and duration of abuse. These included a range of experiences, including those “in the context of caring for the perpetrator, legal disputes and general family conflict that would not, for a range of reasons, be considered by many people to be abusive”. It was also found that age was sometimes a factor, and other times it did not appear to be. For example, it could be relevant where there were age-related health problems or if a person were targeted because of their age (and assumed vulnerability), but in others cases (such as long-standing family conflict) age did not seem to influence the incidence of abuse.
The diversity of abusive situations uncovered by the study suggests that there is “no such thing as a typical case”. Each situation is mediated by various complex factors which reflect the different capacities and resources of the people involved as much as differences in context.
The study on multi-agency working in adult protection found that a “partnership approach” to adult protection was seen as the best framework to protect vulnerable people. The benefits of partnership working identified by respondents included:
● Information sharing.
● Sharing of skills, knowledge and expertise.
● Shared decision-making, shared ownership and responsibility in drawing up joint procedures and strategies.
● Co-ordination of responses and incorporation of different agency perspectives.
Despite positive views on multi-agency working and partnership approaches to adult protection, it was also clear that this was by no means straightforward, and not even one in 10 respondents reported that there were no barriers to multi-agency working. The most frequently identified barrier was a perceived lack of commitment to partnership working by some agencies – identified by more than half the respondents. Other barriers included:
● Variation in priority agencies gave to adult protection (affecting shared ownership and responsibility).
● Lack of clarity and conflict over respective roles and responsibilities.
In common with research on partnership working in other policy areas, this study identified the “costs” associated with multi-agency endeavour. In particular, “multi-agency working was viewed as time-consuming, hard to co-ordinate and, with multiple agencies involved, a difficult means by which to reach consensus decisions”.
The study also identified the effects of the regulatory and legislative framework on adult protection development. No Secrets/In Safe Hands guidance was identified as the most significant, with 80% of respondents believing it had a strong or very strong impact. Despite this, the documents were also identified as being difficult to implement, which Penhale and colleagues observe “may be due to the permissive nature of these documents as guidance rather than absolute requirements for all agencies to follow”.
These two studies, although undertaken separately, can be considered together. They shed light on two sides of a coin: the incidence and experience of abuse and mistreatment, and the response of statutory services.
In addition to understanding people’s experiences of abuse, the qualitative study of older people was concerned to explore the barriers which exist to older people identifying abuse (or mistreatment) and taking action. This is of particular relevance to the focus of the study on adult protection. The authors remark: “It is clear that agencies can play an important role in the action taken by older people against mistreatment. However, this appears to be limited by the respondents’ understanding of them and their willingness to involve them.” The likelihood of people taking action was influenced by fear for their personal safety on the one hand, and the encouragement and support given by others on the other. The implications for making it easy for people to access help or report concerns are apparent. At the same time, the authors identify the importance of agencies most likely to have contact with older adults – notably GPs, community nurses and other health care staff – to be aware of the existence of abuse, and to understand the remit and responsibilities of adult protection officers.
Building on the findings from all phases of the study on multi-agency working and adult protection, recommendations were made on three areas:
● Improving practice in adult protection (particularly through multi-agency training).
● Developing more effective services (and exploring the development of specialist adult protection teams, as well as the development of specific legislation in adult protection).
● Improving public awareness and raising the profile of adult protection.
The policy area of adult protection is one which is continuing to evolve. In particular, the development of the vetting and barring scheme in implementing the Safeguarding Vulnerable Groups Act 2006 could have a major impact. However, the study highlights the continuing difficulties caused by “the apparent looseness and permissiveness” of guidance which fails to drive progress equally in all areas. The arguments for further and specific legislation concerning adult protection reflect the study’s findings about the lack of priority that some agencies give to this area of work in the absence of statutory requirements.
It is illuminating to consider these two substantial studies alongside each other. The qualitative study of elder abuse provides invaluable insight into some of the realities and complexities which are entailed in situations where people may need protection. The study of how multi-agency and partnership working in adult protection operates underlines the operational and practical challenges of making systems work. What unites both of these studies is their emphasis that abuse and protection issues must attract greater recognition, public awareness and priority if the next stage of development is to see the standardisation of good practice everywhere.
Melanie Henwood is an independent health and social care consultant
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