Safeguarding is Everyone's Business - Isle of Man Safeguarding Forum

1. Safeguarding is Everyone’s Business ISLE OF MAN SAFEGUARDING FORUM Thursday 21st September 2017 Sefton Hotel, Douglas

2. WELCOME

3. PROGRAMME FOR THE DAY • Welcome • Opening remarks: Minister for Home Affairs, Mr Malarkey MHK • SCB/SAP Update/Safeguarding Bill: Paul Burnett, Independent Chair • Self-Neglect: Cath Erine • Neglect: Professor Professor Antonia Bifulco • Open Forum • Workshop Sessions • Evaluation and Feedback

4. Minister for Home Affairs Mr Malarkey

5. Paul Burnett Independent Chair Safeguarding Children Board (SCB) and Safeguarding Adults Partnership (SAP)

6. Presentation outline • Annual Report 2016/17 • Safeguarding Bill • Jersey Inquiry and Social Affairs Policy and Review Committee Inquiry

7. Safeguarding Board Effectiveness SCB AND SAP ANNUAL REPORT 2016/17

8. SCB/SAP KEY STRATEGIC PRIORITIES • Safeguarding is Everyone’s Business • Children, Young People and Adults are safe through effective policies, procedures and practice • Areas of safeguarding risk are addressed • The workforce is ‘fit for purpose’ • The voice of service users is heard and acted on

9. SAFEGUARDING BILL

10. Safeguarding Bill Context • Programme for Government 2016-2021: aim for a society that is both inclusive and caring. • Under theme ‘Healthy and Safe Island’ a key outcome is to have improved the quality of life for children, young people and families at risk. • COMIN agreed one key action to support these intentions was to place the SCB and SAP on a statutory footing through the introduction of a Safeguarding Act

11. Process • Internal consultation: June/July • Public consultation: 22 August – 3 October 2017 • First reading: October 2017 • Second Reading, Clauses Stage, Third Reading and Legislative Council • Submission for Royal Assent It is anticipated that implementation would take place between April and July 2018.

12. 3 Key Headlines Creation of: • A single statutory Safeguarding Board broadly covering the current work of SCB and SAP • Statutory Duty for those working with children and vulnerable adults to ‘consciously consider the need to safeguard children and vulnerable adults’ when carrying out their work • A duty for partners to co-operate with each other when carrying out safeguarding functions

13. Relevant Safeguarding Bodies • Department of Education and Children • Department of Health and Social Care • Department of Home Affairs • Department of Infrastructure • Isle of Man Constabulary • Other persons providing services to children or vulnerable adults • Such other persons as may be prescribed

14. Definitions • Child – any person under the age of 18 • Vulnerable Adult • Has attained the age of 18 • Is in need of care and protection; and • Satisfies a number of conditions in subsection 2 of the Bill

15. The Board • Statutory Body • Independent Chair appointed by Chief Secretary • Member of the Board • CEOs for DEC, DHSC, DHA • Director of Public Health • Chief Constable • 2 independent members

16. Board Objectives • To co-ordinate the work done by relevant bodies for the purpose of safeguarding and promoting the welfare of children and safeguarding and protecting vulnerable adults; and • To ensure the effectiveness of work done by each of those authorities for those purposes

17. Board Functions • Safeguarding policies and procedures • Promoting safeguarding awareness • Reviewing effectiveness relevant bodies safeguarding arrangements • Identifying lessons learned from SCRs/SARs and other case reviews and action to be taken as a result • Promoting communication – including information sharing and data protection – and consultation

18. Committees and Sub-Committees • Child Death Overview Panel • Case Management Review Panel • Safeguarding Panel • Any other committees it deems to be required

19. Other matters • Board must present an Annual Report at the end of each financial year and lay before Tynwald • Requests for information by the Board related to their business must be complied with • Duty to co-operate – both between the Board and relevant bodies and vice versa • Duty to safeguard • Regulations to be issued in support of the Act

20. QUESTIONS

21. :Launch of the Isle of Man Self Neglect Policy and Procedures Keynote Speaker: Cath Erine

22. Self Neglect – Isle of Man adopts its multi agency policy Cath Erine

23. Take a bow! • The Isle of Man has developed a multi agency policy and supported this with multi agency training, despite having no legal requirement to do so • A number of multi agency events have been held over the last 15 months to engage all partners in the development of the policy • Training was provided earlier this year to “test drive the policy and organisational commitment to its implementation. • The conference today is the formal launch of the policy. • Why is it important?

24. Why is it important? Impact of workers Impact on Adults Feeling judged Loss of family, friends, home, status Embarrassment Worthlessness Sense of failure Helplessness Negative impact on physical and/or mental health “In control” but with negative costs Financial costs Anger Isolation Denial Denial Guilt Helplessness Self doubt StressAnger IllnessIsolation Distress Fear Shock Loss of Self esteem Leaving the profession or team Feeling special, the “one”

25. Key messages from the research completed by Sussex university for SCIE and the DoH • Understanding the causation? Links with

26. Understanding the lived experience of self neglect I got it into my head that I’m unimportant, so it doesn’t matter what I look or smell like I’m drinking, but not washing or eating. I’m not losing the will to live – that’s too strong but I just don’t care what people think It makes me tired, daily routines are exhausting even doing the simple things like getting washed or finding clean clothes I wouldn’t say I let my standards slip – I didn’t have any. Never had I’ve always neglected my own feelings, I didn’t address them. I thought that “my feelings don’t come into it”

27. The lived experience of self neglect – on the adult’s home environment The only way I kept toys after xmas was by hiding them I want things that belonged to people so that they have a connection to me The distress of not collecting is much greater than the distress of doing it! When I was a little boy, the war had just started, everything had a value to me – it still has value or potential use now I don’t have time to make a note of everything in the paper I’m interested in so I’m very fearful of throwing anything away in case I lose something important

28. Organisational context • Eligibility Criteria • Care Management models • Discharged – non engagement • Performance management • Thresholds that limit or prevent preventative work • Time limited interventions • Charging policies • Increased demand and limited resources

29. Self neglect – the challenges “The combination of people who are terrified of losing their independence or of state intervention; combined with a state process that is desperate to apply eligibility criteria and find reasons NOT to support people, is just lethal. “Oh – you’re saying it is all fine – thank goodness, we can go away and respect your views” ADULT’S RELUCTANCE TO ENGAGE ORGANISATIONAL PRESSURES

30. Robust interagency working Interagency policy and governance Forum for shared risk management Referral pathways Commissioning Time and space for relationship based work Case coordination and leadership Training, supervision and support

31. What does the Isle of Man policy say…. • Is based on the six core principles of the Care Act and the Mental Capacity Act and applies to adults aged 18 plus who have mental capacity to make the decisions causing the concern • Single agency interventions have failed to reduce the risks to the adult • The risk(s) to the adult are likely to result in serious harm or risk to the life of the adult • Must make active attempts to engage the adult to identify measures that will reduce the risk, this may mean discussing with the adult the involvement of an advocate and/or family/friends • Choosing the “best person” to have the initial conversation with the adult, who has maintained a trust based relationship with the adult

32. What does a trusting relationship look like? • Interventions delivered as part of an emotional connection/trust – an ability to challenge the adults without judgement working with them at their own pace (on issues they view as “important” to them – which may not be the priority of the workers/organisations” “He has been human, that the only word I can use – human and on my level” • Support that fits with the individual’s own perception of need with practical interventions when necessary “When X came along they were hands on – we’ve got to do this…..shall we start cleaning up now” “She got it into my head that I am important that I am on the earth for a reason” • Respectful and honest engagement “ He’s down to earth, he doesn’t beat around the bush. If there’s something wrong he will tell you. If something needs sorting he will tell you and support you to do it” “Care-frontational” challenges – not discounting unrealistic options but working with any options that are likely to been acceptable to the adult that are have a high chance of success

33. Mapping the risks • Putting the adult central to the assessment and if agreed involving family/friends – even if professionals believe that they may be “part of the problem” • Once the risks are identified and some agreement reached about their priority, the adult should be asked to explore the impacts (Current and possible if nothing changes), what are the impact of the adult and workers/agencies not taking opportunities to take risks/make changes? • The adult should be supported to say if they are “Keen to try this”, “may be willing to do this” or “ not willing to do this” • From the keen to and may be willing to try agree the roles and timescales of all involved in managing the risks • This mapping needs to be revisited on a regular basis to evidence change and empower the adult to take additional actions.

34. “Betty” – Former teacher, no family. In social housing refusing to allow people into the house so utilities cut off. Lots of books/newspapers. Fire risk to neighbours. Eating poorly due to lack of cooker, only shops once a week buying close to end date food. Landlord considering eviction Mobile library highlight of her week, the only person she has meaningful conversation with Self Neglect risk assessment completed – mobile librarian supported to discuss concerns with Betty who agreed she would like to be able to “stretch her brain”. As a result she joined a local book group after being supported to buy some new clothes (second hand shop). The new network boosted her self worth and led to engaging with housing - utilities restored after safety checks completed. Finding the Key…. • Case example

35. Jack – 47, evicted from temporary accommodation for fighting with another resident, 7 months ago and is now living rough. Jack has a history of alcohol misuse, which commenced after breakup of his marriage – 10 years ago. Jack is a qualified joiner and had his own business, which collapsed 7 years ago. He has two children, but they refuse to see him due to his alcohol misuse. Jack has diabetes , which is poorly managed. He had a stroke affecting his right side – weakness which leaves him vulnerable on the street. He has been admitted to hospital several times in recent weeks with significant injuries. Jack has refused to name the perpetrators. The admissions to A&E have been linked to complications of his diabetes. There are concerns he may lose limbs if he fails to manage his diabetes more effectively. Key intervention – Offer from son to re-engage with his dad and to support contact with grandchild if he addressed his alcohol issues. Jack was detoxed and has remained largely sober and lives in a supported tenancy and is looking to volunteer with ex-offenders developing practical skills Case example – finding the key (what is causing the self neglect?)

36. Scoring the risks • Does NOT replace professional opinions but support evaluation of the impact of the work completed with the adult/multi agency response • Two elements – Risk to the adult ( 1, 2 or 3) multiplied by Likelihood of the risk (3, 4 or 5). All cases that score 10 or over should be managed within the self neglect policy and commitment given by all agencies to deliver the agreed action plan • If the score is less than 10 BUT we need a multi agency response the policy should be used • ALL cases will be coordinated by the Safeguarding Adults office • The risk management plan and impact should be evaluated regularly at meetings or virtual meetings • The adult must be encouraged to engage with the process

37. Exiting the self neglect journey • The risks are reduced to a level that all parties feel are acceptable • All interventions have been attempted, by a range of workers/agencies and non professionals and no agreement has been reached with the adult to accept any of the interventions (this decision must be taken in a multi agency forum and documented in detail). The adult must be told how they can make contact, should they choose to • The adult dies or is detained under the Mental Health Act Or criminal justice processes.

38. Any questions? Thanks for your attention

39. Launch of the Neglect Pathway Keynote Speaker: Professor Antonia Bifulco

40. Understanding childhood neglect for social care services Antonia Bifulco Professor of Lifespan Psychology & Social Science Centre for abuse and trauma studies Middlesex University, London a.bifulco@mdx.ac.uk Isle of Man Safeguarding Forum September 2017

41. Centre for Abuse and Trauma Studies (CATS)www.cats-rp.org.uk • An interdisciplinary research centre, spanning Psychology and Criminology. • Focus on both academic and applied research. • Investigation of abuse and trauma from family, victim and perpetrator perspectives. • Working with psychological, social care and forensic services. • Run assessment trainings for child protection, adoption and residential care.

42. Aim of session • What constitutes neglect • Short and long term impacts of neglect • Practice implications - multiagency working; early help; resilience • Models to aid practice; what works • Key messages

43. IoM Neglect pathway – issues to be addressed(Policy document Oct 2017) • How can the prevalence of neglect be established and tracked to demonstrate the impact of support and intervention? • Ensure Neglect training is linked to competency framework, identified, commissioned and delivered to target professional audiences – awareness, signs, symptoms • Ensure specific neglect assessment and intervention tool are available and staff trained in them.

44. Neglect…. and more • Daniel Pelka was a four-year boy from the West Midlands who died in March 2012 from an acute head injury. For at least six months before his death, Daniel suffered from starvation, neglect and physical abuse. A sibling felt compelled to hide food for him while he was being starved by his parents. • Daniel was denied food, force-fed salt, held under the water in a bath until unconscious and regularly beaten. He was also imprisoned in a box-room and died alone in the dark from a head injury. • The mother and stepfather had a long-standing history of domestic violence and substance misuse. • In August 2013, Daniel’s mother and stepfather were convicted of murder and sentenced to 30 years in prison.

45. Service failure… • Police were called to 26 separate incidents at the family home many involving domestic violence and alcohol abuse. • Excuses made by Daniel's "controlling" mother were accepted by agencies. Professionals needed to "think the unthinkable" and act upon what they saw, rather than accept "parental versions" • Daniel's "voice was not heard" because English was not his first language and he lacked confidence. No record of "any conversation" held with Daniel about his home life, his experiences outside school, or of his relationships with his siblings, mother and her partners • There were "committed attempts" by his school and health workers to address his "health and behavioural issues" in the months before his death. But "too many opportunities were missed for more urgent and purposeful interventions" • Two of those chances were when Daniel was taken to an accident and emergency department with injuries • None of the agencies involved could have predicted Daniel's death.

46. What constitutes neglect • Prevalence • Definitions • Severity

47. Neglect • A persistent failure to meet a child’s basic physical and/or developmental needs. • Includes failing to provide for a child’s health, education, emotional development, nutrition, clothing, shelter, safety and safe living conditions, and includes exclusion of the child from the home and abandonment. Differentiated from poverty. • Neglect is defined developmentally, so indicators can change by age. For unborn child neglect may occur during pregnancy as a result of maternal substance abuse. • Development means physical, intellectual, emotional, social or behavioural development DCSF, 2010, p.38

48. Definition cont.. Neglect includes: • a parent’s or guardian’s failure to provide adequate food, clothing and shelter, • failure to protect a child from physical or emotional harm, or danger • failure to ensure that the child has adequate supervision • failure to ensure the child has access to appropriate medical care and treatment • unresponsiveness to a child’s basic emotional needs

49. Prevalence Registrations to child protection registers England 2015-16 Neglect most prevalent maltreatment Department for Education (2015) Characteristics of children in need in England, 2014-15. London: Department for Education (DfE).

50. Registrations – comparison previous years Neglect increasing somewhat, whilst Other maltreatment declining DfES 2006, 2015