Safeguarding co-ordinators in East Sussex interview victims of abuse to inform adult care practice, writes Natalie Valios
When a safeguarding investigation is closed in East Sussex, the matter doesn’t end there. To ensure these investigations are working for vulnerable adults, the council’s four safeguarding co-ordinators start interviewing abuse victims about their experience of the process.
The initiative, which started last year, came after the council was assessed as only adequate for safeguarding in a July 2008 inspection. The Care Quality Commission found that the quality of case work was variable and there were weaknesses in how management oversaw it.
The selection process for prospective interviewees is challenging, says safeguarding co-ordinator Carol Redford. It starts with the co-ordinators looking through case file audits of investigations.
“It’s a delicate balance because we want authentic feedback but don’t want to risk destabilising family dynamics or cause people increased or renewed distress,” Redford says. “That investment of time is key. The interviews themselves are usually at least an hour, sometimes several hours. It’s important that these are face-to-face and, where possible, one-to-one.”
The interviews demand a great deal of sensitivity, some even more so than others. “For someone with learning disabilities, for example, there will be staged contact to build a rapport,” says Redford. “On the first visit the co-ordinator will be introduced, they’ll go back another time for a cup of tea, and build up to the interview.
“With an adult with mental health problems we have to make a judgement about how an interview could affect them. We shouldn’t enter their life when it’s not the right moment for them.”
Of 26 interviews conducted from February to December 2009, four have been with a carer or relative when it has not been possible to talk to the service user. Several themes have emerged, says Angie Turner, the council’s head of safeguarding vulnerable adults: “We discovered variation in feeding back the outcomes of investigations to people. Some service users didn’t know the case was closed. We might tick our boxes, have our case conference and close the case, but how is that fed back? They don’t feel involved in the process.”
Learning is shared with practitioners and senior managers. There are bi-monthly feedback meetings and, from these, action plans are updated and reflective practice workshops are held.
“Whatever has been fed back to us, if it hasn’t worked for the user we have done something about it and worked with frontline staff to change their practice,” says Turner.
“Our staff are getting much better at involving people in safeguarding investigations and more users agree. This is the most significant change.”
Marian Trendell, head of social care and safeguarding adults lead at Sussex Partnership NHS Foundation Trust, says: “We’ve learned from the interviews that, when you have a vulnerable adult who hasn’t felt able to attend a case conference, it’s not sufficient to say ‘this is what’s happened in the case conference and here are the notes from it’. Instead, the care co-ordinator will go to their home to tell them about actions arising from the case conference, or that the case has been closed. This is probably our greatest piece of learning.”
The council has reached the same conclusion about case conferences and changed its practice accordingly. It has just produced its first quarterly report on service user feedback and is sharing its work with the south eastern region of the Association of Directors of Adult Social Services, as well as other interested local authorities.
The council’s rating for “maintaining personal dignity and respect”, which covers safeguarding, was “performing well” in the 2009 annual performance assessment, up from “adequate” in 2008. It suggests the work is making a difference.
➔ For more information, telephone East Sussex’s safeguarding team on 01273 336820
Reassurance after son’s attack on mother, 85
Mrs R, 85, has some short-term memory loss. Her brother phoned the police to say she had been physically assaulted by her son. The adult social care team investigation substantiated the allegation. But Mrs R told the police she didn’t want any further action.
Carol Redford conducted the subsequent interview.
“She said she hadn’t been informed that a safeguarding investigation was being held,” Redford says. “She had been interviewed by police and social services but hadn’t been invited to any meetings or offered the support of an advocate.
“She was unable to remember what and when she was told of the outcome or that she was happy with it.
“She still seemed troubled by the assault. Although she had forgiven her son and she doubted that he would abuse her again, she said her trust was broken. But she said she now feels safe and was reassured by the intervention of adult social care.
“She may have felt even more reassured if there had been a follow-up visit following the closure of this investigation. No such visit or closure letter is recorded on the case file. She appeared unaware of contact details for adult social care for future reference and again I could not find a record of this information being given to her. Mrs R relies on written communication and lists to assist her due to memory problems and something in writing may have been helpful.”
● Invest time in finding suitable service users to ensure authentic feedback without causing distress.
● Don’t discount adults with learning disabilities, mental health problems or dementia; with sensitivity they can give powerful interviews. If this is not possible, talk to their carers or relatives instead.
● Analysing service user feedback at a strategic level, which captures information on quality and outcomes rather than amounts of activity, is essential to improving safeguarding practice.
This article is published in the 11 February 2010 edition of Community Care under the headline “Victims lend their insight”