Early Indicators of Concern in Care Services

a) Services for People with Learning Disabilities

For information purposes the original project objectives are listed in full in the box below:

People with learning disabilities - staffed services

With regard to people with learning disabilities (adults) the objectives are to validate the original Abuse in Care research findings in the context of Dundee and to construct a process or guidance tool that is appropriate to the needs of local health and social care practitioners. An additional objective will be to begin to analyse and evaluate the implementation of the newly adapted process in the local context.

i) The project group will undertake 2/3 focus groups with local health and social care practitioners to compare local observations in respect of "early indicators" of abuse with the original data collected in England. Similarities and local differences will be noted and assimilated into the overall data set where appropriate.

ii) The project group will work with local health and social practitioners to produce a process or tool(s) that will complement existing service monitoring and safeguarding systems.

iii) The project group will design and deliver appropriate training to the relevant health and social care practitioners, including providers of services.

iv) The project group will begin to monitor the application of the newly constructed and implemented Abuse in Care process in Dundee. In essence, this stage is about finding out how staff are beginning to use the process that has been developed.

Research Undertaken - Focus Groups

• The project group undertook 2 focus groups with local health and social care practitioners to compare local observations in respect of "early indicators" of abuse with the original data collected in England.

These focus groups were attended by a variety of health and social care professionals including care managers and various allied health therapists. The two focus groups were conducted using the same basic method. Participants were asked to reflect on a service that they were involved with where they know that harm or abuse was proven to have occurred. Participants were then asked to reflect on the points of concern or 'things that they noticed' about such services before the actual abusive (or criminal) acts were discovered. Responses were noted and recorded.

Secondly, in the last quarter of the focus group, participants were presented with the findings from the original research, in the form of the six groupings given above. They were asked to comment on whether or not these groupings represented a 'good fit' with their experiences and / or whether or not there were important areas omitted. Participants were finally asked to rank the six groupings in terms of the perceived significance. In other words, participants were asked to consider and identify the relative importance of the original indicator groups, in light of their own experience and the discussion which had taken place in the focus group.

Research Findings

• The examples provided by participants, in both focus groups, were consistent with the original research in England. Although one or two groups were represented more heavily than others e.g. indicators related to the actions or inactions of managers, the participants identified examples corresponding to each of the original groupings.
• The participants did not identify examples which could not be appropriately included within one of the original groupings. In other words, though the discussion was extensive and the level of knowledge and experience was great, the participants did not identify 'new' groups of indicators.
• Participants agreed that the original six headings did reflect the content of the focus group discussions in Dundee and their observations of underlying (or pre-existing) concerns. There were some helpful comments concerning the wording of these headings and people did request some clarification, but overall the groupings were recognised and welcomed.

Ranking of Significance

• Participants provided a great variety of perspectives in respect of the ranking of the groupings or headings. No single indicator was identified as being more important than the others. In fact, participants responded to the task by pointing out (without prompting) that they found it difficult to separate the six indicators or groupings and felt they were often inextricably related. This suggests that the indicators (and in effect the types of observable problem) are not occurring in isolation, but represent a more fluid combination of several indicators. This, in turn, suggests that professionals can become aware of (and can therefore seek to explore) patterns of problems developing in particular services. This finding is of particular significance in respect of the potential application of the evidence gathered.

Applying the Research Findings - Developing a Process or Tool Based on the Early Indicators

The project team, including both health and social care practitioners from Dundee, examined different approaches to the presentation of the research findings (for both older people and people with learning disabilities).

It was agreed firstly, that it would be beneficial to shift the focus of the terminology slightly from Abuse in Care? (as a title) to Early Indicators of Concern. Such a change, it was agreed, would reflect the fact that any evidence or observations gathered by the tool or process does not prove the existence of abuse or neglect but does suggest that there are evident concerns that need to be addressed. It was therefore envisaged that the term Early Indicators of Concern would prove less controversial and perhaps more accurate.

Secondly, it was agreed that the process or tool should be based on a framework constructed using the six areas or dimensions of concern. The tool that evolved was made up of two parts. One part was a portable memory aid or set of examples that practitioners could use for reference when considering services they were visiting (Fig.1). The second part was a blank recording form for the practitioner to write down, in their own words, what it was they had seen or noticed that had given them cause for concern (Fig. 2).

Fig 1. Early Indicators of Concern - Services for People with a Learning Disability

Fig 2. Early Indicators of Concern - Services for People with a Learning Disability

An information and training session was developed by the project group and delivered to a multi-disciplinary team of practitioners from the relevant health and social care agencies.