Risk and participation in adult support and protection

1. Risk and participation in adult support and protection IRISS SEMINAR

2. Two projects overlapping themes • Risk is about “the possibility of positive beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale” (Alberg 1996:9) • Participation is about the how of practitioners’ work with people: • to fully hear their views • to gain a shared understanding • to ensure that people are involved as fully as possible in any decision-making.

3. Nature of today • Interactive! • Hope to hear your voices as much as ours • Co- researchers will move around tables to join in discussion rather than lead them • Photo exercise • Select a photo from those on the table that best speaks to you about trust

4. A Joint Research Project into Supporting and Protecting Adults Presenter on behalf of research team : Kathryn Mackay

5. A joint research project • East Dunbartonshire Council: Claire McLaughlan, Sylvia Rossi • Falkirk Council: Justin McNicholl • Perth and Kinross Council: Diane Fraser, Mary Notman • Stirling University: Kathryn Mackay

6. Research outline Aim: To explore the assessment, decision making and intervention from the perspective of the practitioner and the person Method: Semi-structured qualitative interviews -October 2010 and May 2011 Sample: 29 practitioners , 6 adults defined as at risk of harm (adults AROH) and 1 proxy/relative Ethical approval: University and agencies

7. Key findings around participation Many excellent examples of working with risk alongside the person, however key messages for today are : • Being subject to ASP intervention is scary • Building and maintaining relationships are essential AND take time • Working with uncertainty requires confidence and support • Use of words still the chief communication approach • Case conferences: a low point in participation.

8. It’s scary • First contact Well, in a way it was good. Although I was scared…… I was hoping they could help me. It was what I wanted, somebody to help me. But it was fear…. Person 1 • Professional power One of the big things for (person) was they thought that we had the power to (put them in care) and that was always a fear ..So we continually reassured (the person) that we would set up supports in the community. Practitioner 10

9. Building relationships 1 He did have his ups and downs and his place did deteriorate again……….….He is quite an able person as well, and it’s looking at that and saying, well he’s lived like that and he’s managed to stay out of the criminal justice system and manage his own mental health at times…. and not to actually storm in and take that all away from him. Practitioner 15

10. Building relationships 2 • Why should a person have confidence in you or your advice? • This takes time: more of a process not an event or outcome • Practitioners talked of: • having something to practical offer to demonstrate usefulness • ‘chipping away’, going the person’s pace • being given more time, like being a social worker than care manager • Having ‘frank conversations’

11. Working with uncertainty 1 We would never be able to stop that, she would choose when not to and when to drink and that’s what she did. But I mean her quality of life improved as well because things like getting things done in the house like she had her living room decorated, new carpet that sort of thing. If we hadn’t been involved she would have had none of that Practitioner 1

12. Working with uncertainty 2 • Some risks will never go away • Practitioners need support too> • To be confident with and within uncertain situations • Being realistic about what change might be possible • Responsibility ( limits to it) has to openly shared with person, management etc.

13. Recognising loss as well as gains • Whilst feeling safer there was often a sense of loss about changed relationship where harmer was a relative. I think that’s the time …he put his hand up, but it wasn’t a bad, you know what I mean. But it’s the thought; aye, your boy doing that to you, he couldn’t have done anything worse… and I miss him terrible. Person 5 • Importance of acknowledging • Consideration of how addressed

14. Participation and Communication • Practitioners referred on to experts • learning disability nurses, psychologists • When there were questions • Of capacity • Or challenges in communication e.g. autism- how people interpreted the world and relationships • One example of talking mats but again an ‘expert’ undertook work • Practitioners therefore relied on the spoken word a lot of the time

15. Case conferences: meaningful participation? …cos I’ve never been in before so it was really, really bad. But (name of practitioner), she was marvellous….And I wasn’t really picking up everything. But…like (name of practitioner) would explain anything I wanted. I didnae know anybody so…I’d say who was that…and she would tell me who it was. My daughter went with me for support. Person1

16. Some of the report’s recommendations Working with the adult at risk of harm: • Continued support for relationship- based work • Recognise losses as well as gains for the person • Promote choice and self-determination as the adult grows in confidence and skills • Consideration of different forms of case conferences • Exploration of alternative methods of communication to help people to verbalise their thoughts and feelings.

17. Round table discussion • To what extent do the research findings match your experience? • What are the challenges / reasons behind people not fully participating? • What might be some of the solutions?