A Project To Support More Effective Involvement Of Service Users in Adult Support and Protection Activity
We also drew upon wider research to consider whether themes coming out of the Scottish research reflected or contradicted the more general comments made within the literature on adult safeguarding and service user involvement.
2.2 In summing up what work has been done it is important to remember that service users contributed to the development of the ASP. Their views were listened to and helped shape how the law was worded (Mackay et al 2011, Scottish Government 2008). For example
The term 'vulnerable adults' was replaced by 'adults at risk of harm'. Age and receipt of community care services were deleted as criteria. The term 'abuse' and allied specific criteria was replaced to that of being 'at risk of harm' which has a more open ended meaning. Listening to Those Who Have Been There
Service User Views
2.3 A small survey carried out by East and Midlothian Adult Protection Committee's APC (2010) found that some services users spoke highly of ASP, but others had mixed feelings. SCLD has carried out an evaluation for East Dunbartonshire, interviewing 8 service users with learning disabilities (Miller 2012). It found that most communication was verbal with only one respondent reporting they were given anything in writing. Respondents were unfamiliar with terminology of proceedings and were unsure what the process was, or, if an investigation had been carried out. Of the five respondents who said they had attended a case conference, three said they were given help to prepare for the meeting and four said they had had support in the meeting. However, many of their comments reflect the unease that they felt at the meetings:
"You walk in 'blind'"
"You walk in a stranger. They all know each other and you're the odd man out"
"They all had crib sheets in front of them"
"I didn't know my role"
"I was like a fish out of water"
"They had all attended these meetings a hundred times" (Miller 2012)
2.4 Those who had help preparing for the meeting reported the most positive experience of the meeting itself (Miller 2012). It is interesting to note that one respondent highlights their lack of a 'crib sheet' in contrast to everyone else around the table. This prompts the question: if they had accessible 'crib sheets' that they were able to bring to the table, would this have put them on a more equal footing with more confidence to participate?
2.5 This help beforehand can be done in a number of ways. For example in Dumfries and Galloway the chairperson of the case conference meets the person beforehand. Many people use an independent advocacy worker to speak for them or to help them speak for themselves. The papers a person brings to the table so that they have a 'crib sheet', to use the words of the person in the East Dunbartonshire evaluation, could be a list of things they want to say and questions they have. There are other ways in which a person can be helped to have their say. This was then shared with other workers and the family. Talking Mats is a way of exploring and recording issues through the use of pictures.
2.6 Six service users and one relative were interviewed in the Mackay et al (2011) study. Most of those interviewed found that the process of investigation was stressful. There was anxiety about what social work might do, having to answer personal questions and attending case conferences. Some service users experienced losses as well as gains around changes in relationships. Though they have become safer, such losses needed to be acknowledged and where possible ameliorated.
2.7 The Altrum Risk Research Project (2011) consulted with 42 service users with a range of service needs about ASP work. Many of those consulted had experienced harm in the past, but only a few had worked with social workers about issues of harm since the ASPA has been implemented. Service users did express concerns about what the ASP process might be like. Their experience suggested any inquiry process can affect a person's sense of self. They raised concerns that risk assessment forms, capacity assessments and case conference reports may act to further damage a person's sense of self. They wanted attention to be given to the person's own sense of what they can do to recover and gain resilience.2.8 East Dunbartonshire Adult Protection Committee also conducted an evaluation of carers' views through a local carers' group. Carers highlighted that whilst the 4-chlorodehydromethyltestosterone outcomes were generally positive, there was criticism about the process. They felt ill informed, found case conferences too nerve wracking to be able to say what they wanted to say and generally felt they were not always listened to. They raised concerns that language was intimidating and showed a lack of sympathy for the stress carers were under. Of the four carers contributing to the survey two felt that "more information should have been provided and help should have been offered earlier" (East Dunbartonshire Council 2012). Some of the key challenges were around balancing the individuals' rights with practitioners' legal duties and developing better inter agency working. These same issues are evident in the wider literature (Calder 2010, Hogg et al 2009, Mackay 2008 and 2O11, Patrick and Smith 2009 and Stewart 2012).
Half of the social workers interviewed felt that the ASPA had enabled them to take more time and therefore make sensitive efforts to gather and weigh up information, enabling them to build relationships with those at risk of harm more so than within their main role (Mackay et al 2012). Social workers reported that service users engaged with ASP investigations in a range of ways from welcoming openness Buy Cheap Jintropin Online to cautious acceptance to occasional rejection of contact, which was respected in some cases depending on the situation and the presence or absence of undue pressure. Social workers and those helped agreed that the adults at risk were safer and had a better quality of life as a result of the plans put in place through adult support and protection work. Positive outcomes included
being safer feeling happier being able to make decisions staying at home having debts cleared being more socially active. 2.10 Social workers also recognised the process could be stressful and Buy Anadrol With Credit Card involve losses for the person as well as gains. This led to them making a number of recommendations about how to help the person participate more meaningfully in the future, which included developing alternative forms of capturing the person's story and looking at different types of case conferences. For this reason it is important that social workers consider using forms "Anaboliset Aineet" of communication beyond standard interviewing.
2.11 Members of the Altrum Risk Research Team and Kathryn Mackay carried out two workshops to discuss findings with social workers and other professionals who do ASP work. Those who came to the workshops discussed the findings, and the issues and challenges they were facing in their own contexts. In addition Anavar Cycle Length to these two workshops, the Altrum Risk Research Team ran a number of interactive workshops on increasing service user participation. These dissemination events provided a further mechanism for taking the pulse of adult support and protection implementation.
2.12 Some of the common themes practitioners raised across the above work were:
Balancing respect of fully informed choices with a duty of care Being aware of and responding to the needs of adults, who for the most part cope on their own in the community, in ways that build on their strengths in addressing harm Working through issues around intimacy and relationships Balancing protection from harm with promotion of healthy risk taking as integral to a good quality of life Addressing tensions between giving the service user time to have their say and the procedural demands of agency decision making: report writing, case conferences etc. The majority of committees 4-chlorodehydromethyltestosterone now have some form of service user and carer involvement. Some sit on the main committee and have support to do this. Other committees have set up a sub committee where larger groups buy cheap jintropin online of service users and carers can get together in a less formal setting to share views that are then forwarded to the main committee (Scottish Government 2011, Ekosgen 2013). There is a concern that unless the main committee is accountable to this sub committee it becomes a talking shop (Social Care Institute for Excellence 2011). This accountability can take the form of the committee members meeting with the sub committee and sharing their paperwork, decisions and explaining why they may not have accepted recommendations made by the sub committee. In some cases volunteer groups and forums for older people, people with mental health issues, and disabled people choose their own committee members to represent them. However, the perceived meaningfulness from the view point of service users and carers has yet to be evaluated.
2.15 Reference groups are like forums that are set up to advise services. These can be at a local and national level. The Scottish Consortium for Learning Disability (SCLD) has led the way in developing a co production approach. For example they established a reference group of people with learning disabilities to help them with their work with local area coordinators who are responsible for supporting and promoting independence of people with learning Bio Primo Methenolone Enanthate disabilities. They have also developed resources to encourage co production and hosted events that introduce co production to more services and organisations.