Report 41: Prevention in adult safeguarding
Training and education
'These approaches are effective in enabling people to learn new skills and gain confidence, but it is hard to demonstrate that the skills gained will generalise to real-life situations.'
Some of the most common prevention interventions discussed in the literature are training and education, for both adult at risk and staff within services.
Small group training approaches can raise awareness of abuse in adults at risk and enable them to build skills to protect themselves from abuse. Approaches may need to be different with different groups.
Training of adults at risk needs to be backed up by training and education of staff to ensure a receptive environment to the newly skilled adult. It should include awareness raising about abuse and safeguarding adults policies and procedures as well as communication skills in order to promote prevention.
Training for adults with learning disabilitiesOpen
There are several examples in the literature of work with people with learning disabilities to enable them to recognise abuse and develop the skills to protect themselves.(38, 39, 40, 41) Most report the evaluation of some kind of 'keeping safe' training approach with small groups, often using role play or other interactive methods. The training programmes very in length and different techniques are used to assess their effectiveness. Broadly, the authors suggest that these approaches are effective in enabling people to learn new skills and gain confidence, but it is hard to demonstrate that the skills gained will generalise to real-life situations.
Bruder and Kroese reviewed nine papers (including those listed above) which considered interventions aiming to teach new skills to children and adults with learning disabilities. They conclude that people with learning disabilities can acquire skills to help protect themselves from abuse, but that these do not necessarily generalise to a real situation (or at least, cannot easily be proved to do so). They identified three elements for successful training programmes of this kind:
- information giving and instructions
- modelling and rehearsing in role play
- testing and rehearsing in 'in situ' assessments.
They also recommend complementary staff training to run alongside it and identify the need for improved evaluation tools.(15)
Another key issue identified by Bruder and Kroese is the importance of the home/living environment supporting people's change in behaviours in order to ensure their new skills are maintained. If people return to an institutional regime, they are unlikely to retain the assertiveness or decision-making skills learnt in a training context. Singer proposed that training individuals to protect themselves from sexual abuse is more likely to succeed if staff have also been trained to understand and accept clients' rights and needs.(38)
Training with other groupsOpen
Collins and Walford report on work in Powys where the local Adult Protection Committee developed 'Keeping safe' training with three different groups of adult at risk. First they worked with people with learning disabilities, then with people with mental health problems and then with older adults. They found a different approach was needed with each group, but that all required careful planning, appropriate support available during the training and the use of experienced, flexible trainers.(42) The need for support for participants is also highlighted in the case studies collected for this resource; participants may feel encouraged to report current or past abuse during such training workshops so staff need to prepare for this eventuality.
One of the observations made by Collins and Walford was the acute sense of powerlessness and fear of retribution expressed by people with mental health problems when talking about feeling unsafe on inpatient wards. This led the staff to set up a series of half-day workshops to develop people's confidence and assertiveness skills. Once again, the long-term effectiveness and transferability of this is unclear, although anecdotally they reported improved confidence among participants.(42)
Ansello and O'Neill suggest that adults (and children) with lifelong disabilities should be provided with education and training to build resilience, which includes sex education, self-protection and self-defence skills, and a greater awareness of community resources.(32)
There are a few examples in the literature where small group work has been used with people who have experienced abuse, in order to build their skills to prevent abuse in the future. Singer worked with a group of adults with learning disabilities who had experienced abuse at the hands of previous staff.(38) Hester and Westmarland report similar work with women who had previously experienced domestic abuse.(4)
Staff training and educationOpen
Research and policy guidance recommends mandatory training for registered care home owners and managers in respect of their safeguarding responsibilities. No secrets recommended that all agencies should provide training for staff and volunteers at all levels within their organisation, in accordance with their responsibilities in the adult protection process.(1) Kalaga and Kingston (7) refer to the recommendations of the Joint investigation into the provision of services for people with learning disabilities at Cornwall Partnership NHS Trust which stated that the Trust should:
… as a priority, develop a programme of training, supervision and support for all staff which helps them deliver care in accordance with the principles of the Valuing People strategy.(43)
CSCI further stated that care providers need to:
… ensure staff are trained on how to safeguard people and that this is reinforced through team meetings and supervision.(6)
CSCI also found a correlation between staff training on safeguarding and the quality rating of the service, with only 40 per cent of the lowest-rated services indicating that all staff had received training. In addition, they found that access to good quality training and the reinforcement of that training in day-to-day practice is the 'area that needs most improvement in regulated services'.(6)
Parry reminds us that Supporting People requires all frontline staff to have training on adult protection.(44)
The importance of training and education of staff within residential settings is highlighted by all of the authors writing about institutional abuse. Staff education regarding residents' rights, care, safety, advocacy and abuse was noted by Payne and Fletcher following a survey in the US of 76 nursing home administrators/managers.(45) Kalaga and Kingston report the education of staff as a significant factor in preventing abuse and neglect in long-term care settings.(7) Marsland et al highlight the importance of staff development, training and supervision within the context of a positive values base.(29)
Training in communicationOpen
There is substantial support for the importance of including communication skills in training for staff to prevent abuse. DeHart et al interviewed nursing home staff, policy makers and related professionals to identify the training needs for preventing mistreatment of older adults. They came up with four categories of staff competencies required to prevent abuse:
- definitions and policies
- risks for mistreatment
- communication and respect
- development of a cooperative working environment.
Each of these areas is broken down into individual competencies. Communication and respect, for example, includes ten competencies including:
- identify verbal and non-verbal communication strategies to build rapport
- differentiate appropriate and inappropriate responses to resident behaviours perceived as problematic
- the importance of knowing the resident as a person and individualising care.(25)
Ansello and O'Neill also propose that staff need training in communication skills in addition to the detection of abuse and neglect.(25) Angus and Brailsford have produced a practice and assessment guide which outlines the skills needed by care workers to safeguard vulnerable older people in their care. The areas covered are: the legal framework for adult protection; definitions of harm, abuse and vulnerability; and using communication skills to prevent abuse.(46)
Case study: Bradford DCMOpen
The Bradford Dementia Group at the University of Bradford has developed an observational tool for developing person-centred dementia care practice, known as Dementia Care Mapping (DCM). DCM measures quality of life from the perspective of the person with dementia and is nationally and internationally recognised for its role in improving the quality of person-centred care for people with dementia. The tool also promotes preventative safeguarding practice by greatly improving interactions between care staff and people who use services and reducing negative interactions. This benefits everyone – well-being increases among people who use services and job satisfaction for staff increases too.
For more information on the links between DCM and prevention in safeguarding, follow the link to a power point presentation on this topic, shared at a conference in Kent in March 2010.
Contact Jo Crossland, email: J.Crossland1@Bradford.ac.uk