Helping social workers resolve intractable adult safeguarding cases

One council has adapted family group conferencing to an adult protection context to help social workers deliver good outcomes in cases where individuals choose to remain in harmful situations - and save money in the process.

One of the most challenging situations in adult safeguarding practice is where an individual chooses to remain in a harmful situation. This can lead to cases having to be closed if it is deemed nothing further can be done.

“This is particularly the case where you have the cared-for person and the carer living together,” says Emily White, safeguarding vulnerable adults manager at Central Bedfordshire council. “It can lead to high stress situations with either the carer at tipping point or the cared-for person is exercising power and control over the carer. But if the two people don’t want to separate it leaves social workers feeling quite stumped because they can’t see a way forward.”

However, Central Bedfordshire has achieved better outcomes from these cases by modifying an approach traditionally associated with children’s services – the family group conference, in which families hold meetings with professionals to develop child protection plans.

 Emily White

White says she wanted to apply family group conferencing to adults’ services when she took up the role in 2010, but knew it had to be adapted. “As adults may have lost contact with their family and are more likely to have other people who are important to them, such as friends and neighbours, we thought the name family group conferencing could be misleading.”

White came up with the concept of ‘network meetings’, which could include people close to the person but outside the family. An opportunity to apply the approach came with the Social Care Institute for Excellence’s social work practice pioneer pilots, announced in 2011 to test innovative forms of practice. Central Bedfordshire successfully bid to become a pilot, which ran from January 2012 to January 2013.

Referrals came from the safeguarding team and were passed to social worker Lynda Fuller, who was appointed network meeting co-ordinator – a role funded by Scie.

“I visited the individual to explain what a network meeting was and if they wanted to go ahead I talked to them about the problem from their perspective and the outcomes they wanted to achieve,” says Fuller, now a senior practitioner in the safeguarding team. “They decided who they wanted involved in the meeting and I met everyone individually.”

Fuller then drew up an agenda for the meeting with the key points that needed to be ironed out. Participants at the meeting included Fuller, the case social worker, the individual and their network.

 Linda Fuller

“My role was to ensure we went through the agenda. The social worker’s role was to provide information on any services or support that might be available. Once this was discussed, the social worker and I left the room so that the individual and their network could discuss how the problems could be rectified and come up with an action plan. That’s the main beauty of a network meeting in terms of the empowerment it gives the individual and the fact they are not ‘being done to’.”

The professionals were called back into the room once an action plan had been formed to discuss how it would work in practice. The social worker continued to be involved in the case until it felt safe to close it. Fuller reviewed each case after four to six weeks.

A couple of challenges in using network meetings emerged during the year, primarily to do with time. Fuller’s initial visits to individuals and their network could last one-and-a-half hours each, and network meetings lasted up to two-and-a-half hours. “But if you invest that time at the start, you gain it back by resolving the situation because the case isn’t re-referred to the social worker,” says White.

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‘Intractable problems’

Another challenge – which can happen in any safeguarding case – is that a network meeting may not resolve anything. “Some cases have intractable problems that won’t be resolved in a couple of hours. The challenge is to try to get an outcome even if it doesn’t seem significant, even if it is just that the individual feels empowered to speak out and as a result feels better about their situation,” says White.

Central Bedfordshire’s pilot has also been part of the Local Government Association’s and Association of Directors of Adult Social Services’ Making Safeguarding Personal project to develop and review the impact of an outcomes-based response in adult safeguarding.

Cathie Williams, LGA’s adult safeguarding lead, says: “After a safeguarding referral what tends to happen is that people end up with additional monitoring or services, as opposed to their circumstances being resolved. We wanted to find local authorities that were keen to find alternative ways of resolving what can be quite difficult circumstances. It was a small sample [in Central Bedfordshire] and it is too soon to say, yes, this definitely works everywhere but we want to look at network meetings as part of a range of responses to try to make safeguarding responses personal.”

There were 11 network meetings during the pilot. “The numbers are small,” says White, “but there was a positive outcome in every case. It didn’t always remove the safeguarding issue but it meant they could say how they felt about it and something changed.”

Benefits for social workers ‘far outweigh challenges’

White and Fuller agree that the benefits to social workers of using network meetings far outweigh the challenges. “Social workers struggle with withdrawing from situations where an individual is saying ‘this is just how it is and I’m not going to change my life’ because the safeguarding situation is still there,” says White.

“Giving the individual the power to direct the way forward gives social workers an evidence base for managing the situation. It means the social worker can see how the individual plans to manage that risk so they are more comfortable closing the case. Plus, individuals often say they feel dragged through a safeguarding process. This method shows social workers that safeguarding situations can still be handled in a person-centred way. And there are good outcomes, which gives social workers personal satisfaction.”

Now the pilot has ended – with no funding to continue the co-ordinator’s role – neither wants the work to be lost.

“We are trying to keep the momentum by promoting it as one way that social workers might respond to safeguarding situations,” says White. “In an ideal world it would be lovely to have a co-ordinator but that means we need funding. It may be possible to join up with the children’s family group conferencing team, promoting it as an approach rather than a dedicated resource.”

CASE STUDY: ‘The social worker was at a loss as to what to do’

The first case referred to Fuller as a possible candidate for a network meeting involved a man with multiple sclerosis being cared for by his wife. The alert to the safeguarding team came from the care provider, which was concerned that the wife was verbally abusing and bullying her husband.

“I contacted the social worker and she was at a loss as to what to do because the man felt that his only option was to go into residential care because it was so unbearable at home,” says Fuller. “As part of the safeguarding response he had already gone into respite care.”

“I went to see him in the care home and the outcomes he wanted from the network meeting were: peace and harmony at home; his wife to understand his condition and the limitations it placed on him; and access to his bank accounts because his wife did internet banking, he wasn’t computer literate so he had no idea about their finances. That was a curveball because in itself that could be a safeguarding issue.

“His wife agreed to see me and she was very frustrated in her caring role. She confided that she couldn’t show her husband the bank accounts because she was supplementing her unhappiness with an out-of-control online shopping habit. But she did realise that the way she was speaking to him was wrong.”

Neither wanted anyone else involved in the meeting, so it was just the couple, Fuller and their social worker. “It was a breath of fresh air when they finished. They had addressed all the issues and said they would respect each other. They wanted an MS nurse to support them; a carer’s assessment for her; a personal budget so that he could go out during the day; she made a pact to curb her online spending and they were going to sit down together and look at the bank statements.

“He said he couldn’t remember the last time they had had such a good conversation.”

A few days later the husband returned home. “The social worker said if we hadn’t had the network meeting she would have had to make the case for permanent residential care to resolve the problem. So not only has the solution saved the local authority over £17,000 a year, but ultimately for me it’s about supporting them to remain together.”

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