Engaging the adult at risk in planning

Any care and support protection plan that impacts on the well-being of the adult must be constructed with the active participation of the adult at risk, their advocate or representative. They are best placed to make choices about their circumstances and possible risk-taking.

When developing the plan consideration should be given to:

• the adult at risk ’s personal outcomes;
• the impact of the plan on their lifestyle and independence;
• how will we know if the outcome has been achieved?

It is vital that the adult at risk be in control of decisions about how risks are managed, and “what matters” conversations take place. Practitioners must assume that the adult at risk has the capacity, unless there is reason to suspect they cannot make specific decisions at that particular time.

Where a person has been formally assessed as lacking the mental capacity to make decisions about their own safety, decisions about protective arrangements must be made in their best interests considering their wishes, feelings, beliefs and values and in accordance with the provisions of the Mental Capacity Act 2005 and related Code of Practice.

It is essential that practitioners engage with an adult appropriately, taking into account their mental capacity and any particular communication needs. It is important to establish whether the plan is improving the quality of their lives and protecting them from abuse or neglect.

Effective engagement is much more than the adult at risk attending an adult protection conference or ‘seeing’ practitioners during routine checks within the home. It means understanding their daily lived experience, their wishes, and feelings and desired outcomes and ways in which the plan is keeping them safe and meeting their desired outcomes.

The lead practitioner is expected to ‘see’ the adult within 5 working days of the strategy meeting and subsequently on a regular basis, at a minimum every 4 weeks. Moreover, the adult should be offered to be seen alone during all or part of visits.

Securing engagement

Effective engagement means:

• providing the adult with information in a manner that enables them to understand practitioner concerns and why they are involved in their lives;
• giving them time and opportunities, recognising their communication needs, to express their wishes, feelings and opinions as to the impact of the plan on their daily lives;
• checking out that these opinions etc. have been clearly understood by the practitioner;
• taking the adult at risk’s opinions seriously and ensuring their opinions are considered by the strategy meeting and at reviews;
• consideration of mental capacity and balance the duty of care to safeguard the adult at risk against their right to self-determination.

It is important that the adult at risk is provided with opportunities to meet with the lead co-ordinator or delegate. This ensures that their particular needs, views and opinions are considered without being influenced by others.

An adult at risk who does not agree to the plan: harm reduction

The adult is best placed to make decisions about their well-being which may involve taking certain risks. If the adult has the mental capacity to make decisions in this area of their life and declines assistance, this can limit the intervention that organisations can make. The focus should therefore be on harm reduction. It should not however limit the action that may be required to protect others who are at risk of harm.

An adult at risk may not agree to the care and support protection plan. If the adult:

• has the mental capacity to make informed decisions about their own safety;

and

• there is no public interest or vital interest considerations. (Throughout any response it is necessary to consider the safety and well-being of others; this may be those people living in the same family home, those in the same care environment or members of the wider public)

and

• they choose to live in a situation in which there is potential risk or have refused a care and support plan.

The enquiry findings should be clearly recorded on the individual’s case record and include the protection arrangements offered and the work undertaken to understand the reasons for not accepting support.

N.B. It is crucial, where the adult at risk does not consent to the plan, that the strategy group explore all possible ways in which to actively engage the adult at risk and the plan is implemented as far as possible with the adult’s consent.

Pointers for Practice: Promoting Participation Amongst Adults at Risk with and Without Mental capacity

Lack of engagement by the carers or family members with the plan

Family members and/or carers included in the care and support protection plan who are identified as contributing to the overall plan, need to understand and recognise the importance of their contribution and encouraged to actively participate, where appropriate.

It is important that practitioners recognise and assess whether carers have the capacity to engage meaningfully with the plan.

Some carers may lack the ability and/or motivation to actively engage; this lack of engagement can lead to:

• carers/families engaging with practitioners in a tokenistic manner and completing tasks that do not necessarily lead to agreed outcomes;

For example, they collect medications from the pharmacy appropriately as agreed in the plan but continue to administer the medication in an ad hoc way.

• assuring practitioners, they intend to complete tasks but never quite getting around to them;

For example, the carer/family member always appears to have crises or excuses for failing to bring the adult at risk to hospital appointments etc.

• avoiding practitioner contact;

For example, always being out when the practitioner visits the home

• being physically or verbally aggressive and defiant.

For example, threatening practitioners, not letting them into the house

Whilst in some cases, lack of engagement demonstrates a failure to commit to the plan and outcomes it is not necessarily always the case. Therefore, the strategy group should be specific about the behaviours that demonstrate a lack of engagement and assess what these behaviours are demonstrating.

For exampIe: the carer afraid to say they cannot cope in their caring role?

Are family members verbally aggressive because they are afraid of having their relative removed?

If, after assessing the lack of engagement, the strategy meeting is unable to implement the plan agreed, for whatever reason, consideration needs to be given to seeking legal advice and agreeing an alternative care and support protection plan .

Denied access to the adult

If the lead practitioner or other practitioners implementing the plan are obstructed or denied access at any time to an adult at risk, the relevant safeguarding manager in social services should be informed as well as other strategy group members. Discussion should take place to agree who is best placed to attempt to carry out face-to-face contact. The lead co-ordinator , in consultation with safeguarding managers and legal advisors, should consider whether any form of legal action, is required to ensure the adult is protected and safe. Any necessary protective action to secure the safety and well-being of any adult at risk must not be delayed.

Consideration of an Adult Protection Support Order may be required (see section 3 APSO).