Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice
| Pages | 219-234 |
| DOI | https://doi.org/10.1108/JAP-02-2019-0008 |
| Published date | 01 August 2019 |
| Date | 01 August 2019 |
| Author | Michael Preston-Shoot |
| Subject Matter | Health & social care,Vulnerable groups,Adult protection,Safeguarding,Sociology,Sociology of the family,Abuse |
Self-neglect and safeguarding adult
reviews: towards a model of
understanding facilitators and barriers
to best practice
Michael Preston-Shoot
Abstract
Purpose –The purpose of this paper is twofold: first, to update the core data set of self-neglect safeguarding
adult reviews (SARs) and accompanying thematic analysis; second, to draw together the learning available
from this data set of reviews to propose a model of good practice that can be used as the basis for
subsequent SARs.
Design/methodology/approach –Further published reviews are added to the core data set from the
websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains
employed previously. A sufficient number of reviews have been performed from which to construct an
evidence-based model of good practice. A framework is presented with the proposition that this can be used
as a proportional methodology for further SARs where self-neglect is in focus.
Findings –Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time
and across reviews, enables a framework to be developed that pulls together the findings into a model of
good practice with individuals who self-neglect and for policies and procedures with which to support those
practitioners involved in such cases. This framework can then be used as an evidence-based model with
which to review new cases where SARs are commissioned.
Research limitations/implications –The national database of reviews commissioned by SABs is
incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014
does not require publication of reports but only a summary of findings and recommendations in SAB annual
reports. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the
reviews nonetheless enables conclusions to be proposed about the components of effective practice, and
effective policy and organisational arrangements for practice. Future reviews can then explore what enables
such effective to be achieved and what barriers obstruct the realisation of effective practice.
Practical implications –Answering the question “why”is a significant challenge for SARs. A framework is
presented here, drawn from research on SARs featuring self-neglect, that enables those involved in reviews
to explore the enablers and barriers with respect to an evidence-based model of effective practice. The
framework introduces explicitly research and review evidence into the review process.
Originality/value –The paper extends the thematic analysis of available reviews that focus on work with
adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new
approach to SARs by using the findings and recommendations systematically within a framework designed
to answer “why”questions –what promotes and what obstructs effective practice.
Keywords Reviews, Safeguarding, Self-neglect, Hoarding, Proportionality, Evidence base
Paper type Research paper
Introduction
This paper has two purposes. The first is to update the database of safeguarding adult reviews
(SARs) featuring self-neglect, reported annually since 2015 (Braye et al., 2015a; Preston-Shoot,
2016, 2017a, 2018). This expanding database reflects a trend in England of increasing numbers
of reviews (NHS Digital, 2016, 2017) and significant growth in reported cases of self-neglect
Received 19 February 2019
Revised 6 April 2019
10 May 2019
Accepted 20 May 2019
Michael Preston-Shoot is
based at the Faculty of Health &
Social Sciences, University of
Bedfordshire, Luton, UK.
DOI 10.1108/JAP-02-2019-0008 VOL. 21 NO. 4 2019, pp. 219-234, © Emerald Publishing Limited, ISSN 1466-8203
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THE JOURNAL OF ADULT PROTECTION
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PAG E 21 9
(Barnsley Safeguarding Adults Board, 2018). Section 44 (Care Act 2014), in providing the
mandate for Safeguarding Adults Boards (SABs) to review cases, specifies the criteria that, when
met, require SARs to be commissioned. However, SABs may additionally commission cases
when these criteria are not met but when useful learning for multi-agency policy and practice may
be captured (Department of Health and Social Care, 2018). Increasing numbers of SARs
raise policy and financial questions as to the value they add and the impact they are having on
adult safeguarding.
The second purpose, therefore, is to draw on lessons learned from SARs featuring self-neglect to
propose an approach that foregrounds this evidence to answer the “why?”question: what
facilitated and what disrupted best practice? Alternatively expressed, repetitive findings and
recommendations from SARs involving self-neglect enable a model of good practice to be
constructed against which policy and practice in specific cases can be compared. For SABs
seeking a proportional approach to self-neglect reviews, this model uses the existing evidence
base to ask questions of those involved about local and national policy and practice.
Methodology
As previously, the research sought to answer four main research questions:
RQ1. What is the nature of the self-neglect cases being reviewed?
RQ2. What types of recommendations are being made?
RQ3. What themes emerge as findings from reviewed cases?
RQ4. What are their implications for policy and practice?
The main source for locating reviews was through searching SAB websites for published SARs.
This approach has been used by other researchers, for example Manthorpe and Martineau
(2015). Once again, websites varied in accessibility and quality. SAB annual reports for 2017/
2018 were also read where available since they are supposed to provide terms of reference and
summary findings for commissioned reviews, including those unpublished (Department of Health
and Social Care, 2018). Once again, however, not all SABs are complying with this statutory
guidance requirement and not all annual reports had been published by December 2018.
Finally, personal contacts enabled retrieval of several unpublished reviews for analysis.
The England repository for SARs, available through the Social Care Institute for Excellence website,
was accessed. It remains incomplete; not all the SARs referenced in this database are available
through the repository. It was also impossible to navigate its contents by type of abuse/neglect.
Although the legislative context differs, included in this database once again are reviews
commissioned by the Jersey SAB, Adult Protection Committees in Scotland and SABs in Wales.
In Wales, these are located on the National Safeguarding Board Wales website.
The same analytic approach is used here as previously (Braye et al., 2015a, b), adapted from studies
of Serious Case reviews (SCRs) in children’s services (Brandon et al.,2011).First,thekey
characteristics of each case and each review are recorded, followed by the frequency and content
recommendations. Second, themes are extracted from a cross-case analysis, organised around four
domains. This approach is similar to scoping studies that review and present findings from diverse
sources of evidence, what may be termed descriptive research (Manthorpe et al.,2015).Itisfrom
these four domains of analysis –direct practice with the individual, the professional team around the
adult, the organisations around the professional team and SAB governance –that the evidence-based
model has been constructed as a proposed set of practice standards and a foundation for
future reviews.
Case numbering continues the database sequence (Preston-Shoot, 2018). One challenge when
constructing any database is to define inclusion criteria. Some reviews themselves (143, 168)
comment on the challenges surrounding definition of self-neglect, especially in cases involving
neglect, for example by family members or care providers (144, 174, 194). Not all reviews
explicitly reference self-neglect or, indeed, name the type of abuse/neglect that prompted the
original referral. However, cases that contained reference to one or more of the constituent
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