Models of adult safeguarding: what works best?

How is adult safeguarding best organised to get good outcomes for people? Eagle eyed elves may have noticed that this study elaborates on a previous elf post, which summarised a paper outlining the literature on models of adult safeguarding. Here, we preview and summarise a forthcoming paper from Stevens et al, outlining the next phase of the work, describing safeguarding models based on managers’ accounts.

The authors explain that while the Care Act makes adult safeguarding statutory, it still allows local authorities to decide for themselves how to organise their services. This work aims to compare the advantages and disadvantages of different ways of organising safeguarding work.

Methods

A literature review was undertaken which identified a number of themes that differentiated models of practice. The team then undertook 23 interviews with managers from a purposive sample of local authorities who described adult safeguarding policies, practices and development in their area.

All managers worked in authorities that had a strategic safeguarding role and a Safeguarding Adults Board, which were both requirements under No Secrets, the policy guidance applicable at the time of the research. Nine of the 23 local authorities included had recently re-structured safeguarding activity, or were planning to.

Should safeguarding specialists be dispersed in teams or centralised?

Findings

The literature review identified the following themes relating to the organisation of adult safeguarding (further information at my blog here)

Decision making – how and where are decisions made about whether safeguarding should be triggered?
Thresholds – How are ‘risk’ and ‘vulnerability’ defined?
Multi-agency working – how is safeguarding organised over different agencies (e.g. in Multi Agency Safeguarding Hubs)?
Outcomes – What factors influence outcomes – for example, the role of a safeguarding coordinator. How are outcomes measured?
Survivor experience – how much and kind of work is done with the person after the abuse?

During the interviews with staff from the 23 local authorities, three types of organisation were identified. This highlight two major considerations – whether referrals were conducted by specialists or generic social workers, and whether those staff were centralised or dispersed.

The categories identified were generic, dispersed specialist, and centralised specialist. The authors note that these factors work on a continuum, and elaborate further on how the types of organisation can be differentiated – this is summarised below.

Local authorities

If you are reading from a local authority – which model do you operate at the moment? What are the advantages and disadvantages? And how does this work in the context of Making Safeguarding Personal?

A pure generic model (identified in five sites) meant that there was limited or no involvement of specialists in safeguarding concerns. Safeguarding is seen as a core aspect of social work and all allocated or duty social workers are trained to undertake investigations. Often the strategic safeguarding team are involved in investigations relating to numerous concerns within one setting.

Dispersed specialist models (identified in four sites) are where specialist safeguarding workers are based in operational teams. Two types of these were identified:

Dispersed specialists who coordinate high risk referrals only
Dispersed specialists who coordinate all referrals.

Which model do you prefer?

Specialist teams

Centralised specialist teams (identified in 14 sites) are where a team of specialists take varying roles in coordinating and investigating safeguarding concerns. Three types of this model were identified:

Semi-centralised (five sites), where specialists coordinate ‘high risk’ referrals and ‘low risk’ referrals are passed to senior practitioners or team managers to coordinate. Social workers generally act as investigators.
Semi-centralised (six sites), where specialists coordinate and investigate ‘high risk’ referrals. For lower risk referrals, team managers coordinate and social workers investigate.
Centralised operational specialist safeguarding team (three sites) , where all referrals are coordinated and investigated by a team of specialists – either solely social workers or a multi-agency team.

Determining risk and organising safeguarding

So how is risk determined? The interviews uncovered a number of factors that influence perceptions of risk. These included:

Location –did the abuse occur in the community, or is it provider-related?
Whether a multi-agency response is required
Whether there are concerns about institutional abuse

A number of other factors were also identified that affected how safeguarding is organised:

Where it is situated in the organisation – e.g. in commissioning, or in care management/assessment.
Where decisions about whether a safeguarding response is needed take place.
The degree of multi-agency working – centralisation seems to be associated with having a MASH (Multi-Agency Safeguarding Hub), although MASHs weren’t always arranged in the same way.
How case conferences were chaired – e.g. using an independent chair or not.

There’s more than one way to skin a cat (or organise safeguarding) – but some ways might work better than others.

Conclusions

This is a useful description of the types of models of safeguarding that exist in practice. The authors note that the research was carried out before the Care Act came into being, which may further impact on the organisation of safeguarding.

The conceptualisation of risk and allocation of cases on the basis of perceived risk may be interesting to explore further, as it can be difficult to ascertain level of risk of harm to the person from an initial referral. How do practitioners manage where cases that appeared ‘low’ risk to begin with become more complex over time? This distinction may become muddied with Making Safeguarding Personal, which may result in people being asked about the outcomes they’d like to achieve from the process, and even for their consent for safeguarding to progress.

Each model undoubtedly has its advantages and disadvantages. Generic responsibility for safeguarding maintains it as everyone’s business, ensuring social workers retain skills in this area of practice, and potentially keeping the person at risk in contact with someone they know. However specialist teams can bring greater focus, consistency and experience to safeguarding issues, and centralised multi-agency teams are perceived to lead to better multi-agency working.

While this research does not explicitly set out to determine which model works best, it does highlight advantages and disadvantages of different models. It remains to be seen whether implementing the new Care Act guidance impact will lead to a further shift in how safeguarding is organised.

Link

Graham, K., Stevens, M., Norrie, C., Manthorpe, J., Moriarty, J. and Hussein, S. (Submitted) Models of Safeguarding: identifying important models and variables influencing the operation of adult safeguarding, Journal of Social Work.