Professor Marian Brandon Dr Penny Sorensen Sue Bailey Professor Sara Connolly Dr Ann Anka

1. Self-neglect An intervention study Professor Marian BrandonDr Penny SorensenSue BaileyProfessor Sara Connolly Dr Ann Anka

2. Structure of the presentation • Background to the research • Methodology • Findings (self-neglect)

3. Research Questions • What is the experience of the clients where this preventative approach has been tried? • Are there any practical or emotional barriers for adults to overcome in order to participate and engage in their community? • Do clients feel that they are more able to support their needs using community resources than before they had the service? • What are the perceived benefits to individuals? • How does involvement with the community social work service impact on the quality of life of its users? • What are the perceptions of other agencies about this preventative work and how it meets their own agency priorities? • What are the outline costs of this way of working? • How have team members approached this preventative work with clients? • What do they do? • How do they practice? • How has this preventative approach to the work had an impact on social workers’ shared working with other agencies?

4. Methodology • Mixed methods consisting of: • Interviews with: • service users (n=13); • social workers (n=3) • managers (n=2); • stakeholders from external services and agencies (n= 6) and • costing analysis • Analysis of goals and ‘satisfaction with life’ questionnaires with service users • Today’s focus – Interviews with social workers and managers only • Telephone interviews with social workers (n=3) and managers (n=2) • All interviews were transcribed and analysed using thematic analysis.

5. What does the literature tells us? • Ayers et al. (2014) • Braye, et al. (2011), SCIE. • Braye, et al. (2015), • British Psychological Society (2015). • Day et al. (2012).

6. Model of practice: Structure

7. What do they do? How do they practice? The model comprises engagement with service users The model is based on developing relationship and building trust over time, building on the client’s strengths and resilience. Social workers worked with service users and helped them to identify and set specific goals which were aimed at addressing their needs, concerns and outcomes that the service user wishes to achieve. The social workers met the majority of service users at own homes, sometimes outside in the service users’ front gardens or in public premises such as cafes. A few of their meetings took place at the social work office premises.

8. How does it work? -Timescale of intervention

9. How does it work: Social work task …what is particularly distinctive is that we work with people more intensely, we are able to build relationships with people, which helps with supporting them to change We help people not to lose their tenancies, there is quite a lot of joint work being done with our Housing colleagues, more around tenancy sustainment … we prevent them becoming homeless, we support them to come into the Housing Department, we will support with letters I mean one gentleman I am working with at the moment, he is a very high-risk hoarding person at the very high clutter rating... I have had to work in partnership with the London Fire Brigade to try and minimise the risk to him and the other tenants that live above him

11. ”…it is good that we are supported to be able to work with someone for that long because it is impossible, this is someone who has been hoarding for 30 years, you can’t create change in two months or three months.” ”…one lady in particular when her mental health destabilised, after discussion, I sort of started to see her more regularly until she was stabilised again because she had made fantastic progress initially, that was somebody that self-neglected and hoarded.”

12. Evaluation – How did social workers assess the impact of involvement? ‘Okay, let’s look back over your photos and see where you were when we first met’ …there is nothing more powerful than seeing the actual image of what your home used to look like and then what it looks like maybe, you know, several months down the line. People lose sight.

13. Challenges ”…they wanted to refer a lady who lacked capacity and had dementia into our team because she hoarded and I am like no, no! If people don’t have capacity that is a different, you know, you are into best interests and all sorts of realms. The people that hoard in our team, even though they are quite severe, they are deemed to have capacity and we can work with them so it is trying to get the message over internally as to actually what we do and what we don’t do and I think sometimes that gets blurred.”

14. In what way has the Care Act 2014 changed practice? I think the Care Act has made us more… safer because it talks about prevention… local authorities have to look at prevention and the eligibility …it’s broadened out the eligibility, so whereby before, the people we were working with may not have been eligible under the previous Community Care Act, now especially with the people that are self-neglecting and hoarding, they would most likely meet that threshold We have got a strong grip of the pathway for people who have eligible needs, but we need to think a little bit more around what goes into that prevention and wellbeing in our level of service

15. Reference https://www.uea.ac.uk/centre-research-child-family/social-work-practice/making-decisions-about-children/disabled-and-older-people/current-projects/a-follow-up-review-of-community-social-work-in-a-london-borough Allen, K. & Glasby, J. (2013). The ‘billion dollar question’: embedding prevention in older people’s services – ten ‘high-impact’ changes, British Journal of Social Work, 43, pp.904-924. Allen, K. & Miller, R. (2012) Prevention services, social care and older people: much discussed but little researched? National Institute for Health Research, School for Social Care Research http://www.sscr.nihr.ac.uk/PDF/Findings_17_prevention-initiatives_web.pdf Ayers, C., R., Iqbal, Y. & Strickland, K. (2014). Medical conditions in geriatric hoarding disorder patients Aging & Mental Health, 18, (2), pp. 148–151. Braye, S., Orr, D. & Preston-Shoot, M. (2011), Self-Neglect and Adult Safeguarding: Findings from Research, Social Care Institute for Excellence, London. British Psychological Society (2015). A Psychological Perspective on Hoarding DCP Good Practice Guidelines. London: The British Psychological Society Day, M., R., McCarthy, G., & Leahy-Warren, P. (2012). Professional Social Workers’ Views on Self-Neglect: An Exploratory Study, British Journal of Social Work 42, pp. 725–743 Mariam, L., M., McClure, R., Robinson, J., B., & Yang, J., A. (2015). Eliciting Change in At-Risk Elders (ECARE): Evaluation of an Elder Abuse Intervention Program, Journal of Elder Abuse & Neglect, 27 (1), pp. 19-33 Miller, R. (2014). Is integration or fragmentation the starting point to improve prevention? HSMC - Policy Paper 17, Birmingham: Health Services Management Centre, University of Birmingham Sutcliffe, K., Rees, R., Dickson, K., Hargreaves, K., Schucan-Bird, K., Kwan, I., Kavanagh, J., Woodman, J. & Gibson, K. (2012). The adult social care outcomes framework: A systematic review of systematic reviews to support its use and development. London: EPPI-Centre Taylor, A. (2015). New act, new opportunity for integration in Scotland, Journal of Integrated Care, 23 (1), pp. 3 - 9