Health and Social Care - Suspecting Abuse in Vulnerable Adults

What should care workers do if they suspect abuse?
Most people working in health and social care settings are familiar with the terms ‘abuse’ and ‘vulnerable adult’, but what should a care worker do if they suspect a vulnerable adult is being abused?

Who are vulnerable adults?
A vulnerable adult is a person aged 18 or over who is:

• In need of community care services by reason of their age, or their mental or other disability
• Unable to take care of him or herself
• And is unable to protect him or herself against significant harm or exploitation

This definition includes older people, adults of working age who may have a learning disability, mental health issues or any other condition which makes them temporarily or permanently vulnerable.  It is the inability to protect themselves from significant harm or exploitation that makes individuals vulnerable to abuse.

Abuse is the intentional harm done to another person through mistreatment or ill-treatment, or failing to act to prevent harm.  It affects all groups, all social classes, both genders; all ages; all abilities, all cultures and ethnic groups.  

How might a care worker spot abuse?
It is not easy to identify abuse; being one reason it is so prevalent.  However, there are actions care workers can take to minimise or preclude abuse being inflicted on individuals in their care.

1. Be aware of the potential for abuse.  Is the individual living in an environment where there has been, or is, domestic violence, drug or alcohol misuse, or financial strains?
   
   
2. Share any concerns they might have that an individual is being abused.  Things to look out for include:
   - Physical abuse: burn or scald marks, bruising or unexplained bone fractures and other injuries
   - Psychological and emotional abuse: poor or a loss of confidence, or appearing frightened or worried.
   - Material and financial abuse: possessions going missing or being ‘borrowed’, not having any money or another person having access to their bank account
   - Neglect or omission: is the individual clean and dressed appropriately for their age, gender or the weather? Are they hungry or showing signs of dehydration or malnutrition?
   - Sexual: are they in pain sitting or walking with a strange gait?
   - Discriminatory: are they being treated with the same consideration as other people of a different ethnic or cultural background, or because of their sexuality?
   - Institutional: do any of the above occur in a hospital, care home or other institution where they are living or being treated?
   
   
3. If a care worker suspects abuse they should record their suspicions and tell someone – usually their line manager
   
   
4. Make sure that any reporting is followed up.  Ask if it was investigated
   
   
5. Most importantly, do something – don’t just do nothing if you suspect abuse 

John Rowe works for the Open University and has a wealth of practice experience in health and social care settings.

Further Education and Adult Learning - Children and Young People's Workforce: Fun with puppets in the EYFS

The final report on the review of the Early Years Foundation Stage (EYFS) is due to be published in April this year. One of the key proposals involves a change from the current 6 areas of learning to 7 areas, split into 2 groups: “prime” and “specific”.

The 3 PRIME areas of learning would be:
• Personal, Social and Emotional Development (PSED)
• Communication and Language (CL)
• Physical Development (PD)

The 4 SPECIFIC areas of learning would be:
• Literacy (L)
• Mathematics (M)
• Understanding of the World (UW)
• Expressive Arts and Design (EAD)

Highlighting Communication and Language as a prime area, distinct and separate from Literacy, represents a significant change and emphasises the importance of effective communication with children. This is a very important component of both the Level 2 Certificate and Level 3 Diploma for the Children and Young People’s Workforce.

Particularly:
Level 2
Unit TDA 2.7 Maintain and Support Relationships with Children and Young People
Unit SHC 21 Introduction to Communication in Health, Social Care or Children’s and Young People’s Settings

Level 3
Unit CYP 3.5 Develop Positive Relationships with Children, Young People and Others Involved in their Care
Unit SHC 31 Promote Communication in Health, Social Care or Children’s and Young People’s Settings

Young students can often struggle with the concept of appropriate communication with children, for a variety of reasons, including:

• they often feel self-conscious or silly when communicating with young children, particularly babies
• they may have different experiences of communication with significant adults in their own lives 
• their lives can be dominated by electronic communication and social networking, often to the detriment of real, face-to-face communication

The attached sheet (Communicating with Children - download this here) can be a useful starting point for your students to reflect on their practice in placement and share examples with each other. Communication techniques can be further explored by using practical diversions like puppets.

I have recently been involved in teaching a group of single, teenage mums with their babies. We have been focusing on developing strong attachment relationships, the importance of playful communication and parent/child interaction, (giggling, tickling games, blowing ‘raspberries’ etc.). The young mums were all extremely self-conscious and very resistant and the session seemed doomed to failure. As a last resort, I decided to help them make simple puppets, which they could then use to communicate and interact with their babies. This made a world of difference and by the end of the session, the young mums were playing and laughing with themselves as well as with their babies.

Your students can easily make simple puppets in the classroom, using socks, gloves/mittens, cardboard or paper plates and craft sticks. Some examples can be found at:
http://www.teacherhelp.org/puppets.htm
http://montessoribyhand.blogspot.com/2008/02/puppets-on-stick.html
http://www.eduplace.com/hac/pdf/puppet.pdf

Your students could then use their puppets to communicate playfully with each other and think about how they might use puppets to communicate with children in their placement or work setting, for example:

• to communicate with a baby
• to encourage a shy child
• to comfort a child who is upset
• to use at story time with a group of children

Students could use this experience both to help them generate evidence and prepare for practical assessment in the real work environment at different levels, for example:
L2: Unit SCH 21 (AC 2.2 and 3.2); Unit TDA 2.7 (AC 1.1 and 1.2)
L3: Unit SHC 31 (AC 2.3 and 3.3); Unit CYP 3.5 (AC 1.2 and 1.3)

Janet Stearns
Lecturer in Early Childhood Studies, former Lead Examiner for CACHE

Health and Social Care - What care workers can do when consent is witheld

Why is consent sometimes withheld, and what can care workers do to establish consent?

This blog expands on issues around consent that candidates studying Levels 2 and 3 of the Health and Social Care Diploma, BTEC Health and Social Care, Dementia Care units and other courses relevant to the field of health and social care will encounter.

What is consent?
Consent is giving permission to do something. In health and social care settings it usually means that the individual gives consent to take part in an activity or to accept some kind of care or treatment.

It is important to remember that:

• It is a legal requirement that consent is established before any intervention or care-giving activity takes place
• Establishing consent is one way care workers can demonstrate they respect the individual and the individual’s personal dignity
• The process of establishing consent is instrumental to developing trust between care worker and the individual 
• The individual is more likely to want to take part in an activity they have given permission for

Consent can be given in a number of ways: verbally, in writing or through actions.  The individual might also allow another person to do something with or to them, perhaps by raising an arm to be supported when dressing, and thereby imply consent.  Informed consent is given when the individual understands what they are consenting to.

However, it is not always possible to readily establish informed consent, and in some circumstances, consent might be withheld.  

Why would consent be withheld?
Individuals might withhold their permission for an action to be performed because care workers:

• Do not understand the individual’s needs, condition or capacity to make decisions 
• Do not have the relevant information or be able to impart information in a form that is understandable to the individual
• Do not themselves understand available options, and potential or actual risks to the individual

What can care workers do to establish consent when it is withheld? 

1. Ensure they understand and act on understanding of the health status or condition of the individual
2. Ensure they understand the individual’s needs and preferences
3. Ensure they understand the individual’s ability to make decisions
4. Ensure they have available the relevant information in a form that the individual can understand
5. Ensure they themselves understand the information and options open to the individual
6. Listen to the individual and observe for other responses 

Conclusion
Consent is giving permission for something.  Sometimes permission is withheld but there are actions that care workers can take to establish consent where it is withheld.  These actions are in keeping with an approach to care that respects the individual, improves care and sits securely within the legal framework for practice.

John Rowe works for the Open University and has a wealth of practice experience in health and social care settings.

Health and Social Care - Benefits of Active Participation

This blog is for candidates studying Levels 2 and 3 of the Health and Social Care Diploma, BTEC Health and Social Care, Dementia Care units and other courses relevant to the field of health and social care

What is active participation?

Active participation is defined by Edexcel (2010), the body that sets the specifications for the Levels 2 and 3 Health and Social Care Diplomas, as recognising an individual’s right to participate in the activities and relationships of everyday life as independently as possible; the individual is an active partner in their own care or support rather than a passive recipient.  This definition accentuates two key principles underpinning care: the rights of the individual and the independence or autonomy of the individual.

Many people who experience health and social care, especially individuals with significant needs, are marginalised, excluded and disenfranchised.  They are not given the same opportunity to have a say in how they live their lives as most other people in the general community; their choices in what they do are severely limited.

What are the benefits of active participation for the individual?

Active participation is an approach that enables individuals to be included in their care and have a greater say in how they live their life in ways that matter to them.

The benefits of active participation can be divided into primary benefits and secondary benefits.

Primary benefits include:

1. Physical benefits including greater activity levels.
2. Increased independence and autonomy in what people do.
3. An opportunity for individuals in health and social care settings to have a say in matters of direct concern to their lives.
4. Increased opportunities for social contact and interpersonal relationships.
5. Encouraging involvement and self-awareness.  Individuals become more involved in the community and more aware of opportunities and what they can hope for themselves. 
6. Increased opportunities for learning and development of important skills, knowledge, education and employment.
7. Enhanced well-being, with increases in self-confidence, self-esteem and self-belief.

The benefits of active participation include the above primary benefits where the individual gains from its application in the real world of health and social care practice, but there are also some secondary benefits.

The secondary benefits can be described as benefits that occur as a result of active participation, but are not a direct aim of active participation.  These include:

1. Decreasing the likelihood of abuse. As the individual engages positively by actively participating is area of their life, such as in personal care, the scope for abuse by others is reduced.  
2. Decreasing vulnerability. As individuals gain in their self-confidence and self-esteem they are less prone to exploitation and harm from others

Conclusion
Active participation is an approach that empowers individuals in the activities and relationships of everyday life leading to them living as independently as possible. The importance to the individual as an active partner in their own care or support is that it brings physical, psychological, relational and over all wellbeing benefits.

John Rowe works for the Open University and has a wealth of practice experience in health and social care settings.