What works well?
- Good communication between agencies - opinions are valid - being able to discuss with partners what can be offered, and how to respond - what to say and what not to say
- Information sharing, informed case handover, shared experiences
- Collaboration/shared working and responsibility - all working to the same level of intervention/agreed action plans
- Concern identified and being addressed
- Support workers in Social Work - more time/capacity to work with people - flexible
- RSL - continued housing support once issue identified
- Therapeutic relationships are really critical
- Involvement and inclusion
Self-neglect is a real challenge in times of shrinking resources and ever-growing demands and most agencies cannot go it alone. What is required is a joint approach with both statutory and voluntary organisations working together to find solutions. Partnership working also supports evidence-based practice which is important within the complexities of self-neglect.
A co-ordinated approach by a range of organisations are likely to be more effective than a single agency response, and a co-ordinated action have led to improved outcomes for individuals. The message is that there does not need to be an adult support and protection investigation for different groups to work together. Self-neglect concerns are everyone’s responsibility and if self-neglect is significant and ongoing risks remain, it will be necessary to convene a multi-agency meeting. (List of partners / roles at Appendix 5)
Multi-agency meetings are often the best way to ensure effective information and communication, and a shared responsibility for assessing risks and agreeing an action plan.
Principles of a multi-agency meeting:
- A lead agency will need to be identified [if not considered under ASP, in which case a Council Officer will take the lead];
- The lead agency is responsible for convening the meeting and minute taking;
- Involve the adult as early in the process and if the adult does not wish to or is unable to attend, the lead agency will agree how information will be fed back to them;
- Advocacy support should be offered if required;
- The meeting will be formally chaired, and responsibilities recorded on a shared action plan; and
- Participants come prepared with required information and ensure any actions have been carried out.
When convening a multi-agency meeting, the practitioner must check with the Scottish Fire and Rescue Service whether the case is known, and a relevant member of that team should be invited to attend the meeting.
The adult at risk should be informed by the worker that a meeting will take place and why. An advocate should be offered if this is identified or if this is the wish of the individual. An appropriate ‘lead professional’ should be agreed at a multi agency meeting. This professional will coordinate the support around the individual, and chair multi agency meetings. The agenda (Appendix 6) and aide memoire (Appendix 7) templates can be used.
- Identify who will be responsible for coordinating actions.
- Determine when a further meeting will be required.
It is important that the meeting is accurately recorded, and action points are clearly identified. Timescales for achieving actions should be set at the meeting and will be specified within the shared action plan but remember that each adult’s situation is unique. A date will also need to be set for a review meeting and any revised actions agreed.
The multi-agency meeting should agree the risk management support plan using the template provided in Appendix 4. [NB Where an individual is being supported and protected under ASP, relevant ASP documentation would be used.] The multi-agency meeting should identify the level of risk by using the risk matrix and completing the risk matrix outcome, determining the current risk factors and completing the risk management plan. Members of the core group should be clearly identified in the plan along with the lead co-ordinator. This could be a social worker or other relevant professional.
Having established a risk management support plan, the adult’s resistance and willingness to be supported should be tested through the implementation of the risk management support plan. The implementation of the plan should be coordinated by the person or agency most likely to succeed in further engagement with the adult to attempt to achieve the outcomes.
How a case is monitored should be agreed with the lead professional identified at a multi agency meeting, and any subsequent review meetings to monitor the situation or concerns should be scheduled. (Appendix 8). The level of risk should be reviewed at subsequent review meetings, if necessary. Where a key person is identified to take the lead in engaging with an adult who is self-neglecting, it is important that appropriate support is provided from relevant professionals when needed and the ability to reflect upon the case is managed through appropriate supervision, guidance and specialist self-neglect training where this is relevant to their role.