Managing risk at Christmas

As the festive season approaches, Vern Pitt looks at some of the unexpected difficulties for which social workers must be prepared.

Risk management doesn’t go away, even at Christmas. While some incidents might leave you with a black mark on your professional record, others will leave you with a red face. “I remember Santa’s suit being left hanging up in the sleeping-in room a couple of weeks after Christmas,” recalls Fiona*, a former manager of a supported housing facility for severely autistic adults. “A 28-year-old resident who still believed in Santa had only gone in for his medication,” she says. “It shattered his illusion.”

The distress caused by the death of Santa might be minor but there are far bigger emotional risks this time of year.

For children in care, Christmas can be tough, says Action for Children safeguarding officer Cathy Henchion. “There is a considerable emotional risk to children from being separated from their family.” Children often have particular dates that are important to them and Christmas is one of these.

Depressive and anxious behaviour can increase and even lead to self-harming. Henchion is clear there are positive steps to be taken to mitigate the risks. “It can be things like ensuring that they had some contact with their family or that a particular member of staff is working with that child over that period,” she says. “It might be some additional activities to distract them and give them a positive experience.”

Unwelcome guests

It’s not just in the young that loneliness can cause  risk. Older people living in their own homes can find themselves isolated at a time when others have family and friends around them. As well as the usual effects of depression this can leave people vulnerable.

“I have seen cases where old men have gone down the pub and they are befriended by people who take advantage of them,” says Action on Elder abuse chief executive Gary FitzGerald. “They have gone back to the older man’s place and used it for a number of days as a place to party and then left him with the mess.”

Older people subject to financial abuse will often be targeted at Christmas, which is often the only time of year some families visit, with the intention of taking money. FitzGerald feels domiciliary care workers are most likely to spot this vulnerability because of the greater time they spend with the person. He advocates regular contact by phone or in person over the holiday period to ensure people’s safety.

Parties are also likely to be an area of concern for those working with young adults in either a residential or community setting, but for different reasons. Christmas parties can provide an opportunity for young people to bend the rules on drink and drugs. But the way to handle it is upfront, says John Brownlow, director of the NSPCC and Children England’s Safe Network.

“It’s good to get them involved in the ground rules with drinking, drugs and behaviour,” he says. “If the young people know their rules beforehand it can make it easier to deal with any potential problems.” Then, if a problem does occur, an “authoritative and calm approach” can solve it.

Balancing act

In all care services Christmas can be a difficult balancing act for managers who will need to ensure that there are enough staff to meet risks. Andrew Cozens, the Improvement and Development Agency’s strategic adviser for children’s and adults services, is upbeat about the task. “Regulated services have to maintain the same level of staff regardless of the time of year,” he says.

But rewarding staff is a good way to keep them motivated and ensure there are staff willing to work over Christmas. “It’s a good opportunity to promote positive stories about social care [in the local press],” Cozens adds. “It’s an extra bonus for staff if they feel their work has been noticed.”

However, even if staffing is adequate there can be a few surprises. When he managed a domiciliary care service, FitzGerald had to check on an older client at Christmas, accompanied by a student nurse. “We went into this three-storey property and it was pitch black, quiet and very cold,” he recalls. “We were going up the stairs calling and knocking to see if there was any answer. Then we reached the top of the stairs and from there we can see the bedroom and this old woman lying in the bed.

“I’m thinking, ‘Oh dear, something has happened.’ I went across and the student nurse stayed by the stairs. As I got to the bed I gently felt to see whether she was cold and this old woman shot up in bed loudly shouted, ‘Who the hell is there?’. I turned around and there was no student nurse. We didn’t see her for a week.”

*Not her real name

➔ Have your Christmas celebrations for clients gone wrong because of inadequate risk assessments? Join the discussion at www.communitycare.co.uk/xmas-disasters

Top tips for managing risk

● Listen to colleagues who may be better placed to spot the signs of seasonal stress and depression.

● Be aware of families visiting patterns. Christmas can serve as a cover for family members to exploit people.

● Try to include family or organise alternative activities to make the season enjoyable.

● Include service users in seasonal planning to avoid future disputes.

● Reward staff for their work to ensure people come forward to work next year and keep them motivated.

‘Tree was stripped, a kid hung over the stairwell’: Mavis*, social worker and former children’s home assistant

“While I was doing my social work training I was also working as a care worker at a children’s home where the kids were a rowdy lot.

“It was the day before Christmas Eve and I was on shift. I’d got this lovely big Christmas tree and gone to Woolworths to get decorations. I’d made all this effort. I tried to get the kids involved but they weren’t interested. So I put it up and felt happy with myself. Then I went to make a cup of tea and to do some maths homework with one of the kids.

“I came back and the rest had bullied this one younger kid. They had stripped the Christmas tree of its lights and used them to tie this one kid to the top of the banisters. He was just hanging there over the stairwell.

“I had to spend the next half hour unwinding this child. He was mortified that he had been tied up and, once he was released, I asked him if he wanted to redecorate the tree; funnily enough, he wasn’t really interested.

“The next day they trashed it again and that was pretty much the end of the Christmas tree having decorations on it.”

*Not her real name

This article is published in the 10 December issue of Community Care magazine under the heading Have yourself a risk-free Christmas