Safeguarding is there to protect everyone’s ‘right to live in safety, free from abuse or neglect’ [1]. Local authorities have lawful duties to safeguard people who may be experiencing or at risk of abuse or neglect [1]. 

At present, there is a public health crisis surrounding domestic abuse and violence with the Office of National Statistics reporting, pre lockdown, that 1/3 women will experience domestic abuse in their life [2]. It is difficult to measure the increase of abuse, but we do know that there has been an increase in: self-reporting honour-based abuse at antenatal appointments​, MARAC referrals​, reports and referrals to support helplines​, and reports of adolescent to parent violence [3].  

Kenny Gibson​, National Head of Safeguarding for NHS England & NHS Improvement​, spoke at our Adult Safeguarding Conference in September about how we should be tackling this problem. He focused on 4 areas that he believes are key to providing effective safeguarding services. 

  1. Aim to be Trauma-Informed 

Kenny says that to inform the way we help victims and survivors we must be ‘trauma-informed’. To help practitioners, researchers, and trauma survivors understand the concept of trauma, the Substance Abuse and Mental Health Services Administration (SAMHSA) has collaborated with experts to define a universal concept of trauma: 
  
‘Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being’ [4]. 

Kenny agrees, stating that the individual is a “person with problems, not a patient with an illness so we should ask ‘what’s happened to you?’ not ‘what’s wrong with you?’”.  

The keywords in SAMHSA’s definition are The Three E’s of Trauma:  

  • Event(s) 
  • Experience 
  • Effect [4]  

Intrusive memories, insomnia, and self-destructive behaviours are all examples of the effects of trauma. If we understand trauma then we can understand the individual’s behaviours and well-being, taking a trauma-informed approach to treatment.  

  1. Contextual Safeguarding  

‘Contextual safeguarding’ is an approach to safeguarding. This approach considers and responds to external factors that could lead to experiences of harm, exploitation or abuse. It requires the NHS and local authorities to assess “spaces and places” and collaborate to support, or where necessary, intervene.  

Kenny uses the below diagram to help show the opportunities for exploitation or abuse that could be identified [3]. He gives us the example of fast-food outlets or stairwells that often attract anti-social behaviour and asks how we could respond to these risks.   

3. A Strengths-Based Approach  

Through understanding the personal context and trauma of individuals we can work with social services to take a strength-based approach. Steve Morgan, a practice development consultant, explains:  

“Strengths-based assessment – helps to build a unique and full picture of a person, identifying what they had achieved and enjoyed previously (what has worked in the past); what qualities and resources they have in place (what is working for them now); and what their priorities are (what they want in the future).” [6] 

A strength-based approach considers the individuals’ whole circumstances and should be a collaborative practice between the person being supported and those supporting them. It is important to recognise the individual’s own capabilities and encourage them to improve their skills and ask for support from friends and family. This approach promotes self-confidence, reduces isolation and enables the individual to create positive life practices to move forward with.   

4. Data sharing  

All commissioned care organisations have a duty, if not a contractual obligation, to share aggregated population data. The care worker must seek informed consent to share their concerns. However, if a client declines the practitioner can still use clinical prerogative and choose to share for reasons of public safety and the client’s health. They must then record their decision to do so in the patient’s record [3]. The UK Government has produced a list ‘myth-busting worries and concerns about sharing data [7]. 

NHS Safeguarding has moved to work collaboratively with local safeguarding partnerships, integrated care systems, and across populations. Kenny feels very strongly about the importance of data sharing, telling us that every death and safeguarding review he has seen has recommended data sharing as a response. To ensure this collaborative approach is successful, he argues that aggregated data should be shared: 

“Only when we begin to look at data from each of our organisations, aggregated data, we can begin looking at risk factors, extra familiar factors and protective factors. Then under our joint strategic need’s assessment, we can begin to reduce vulnerability and put early interventions into space and place” [3]. 

Key Takeaways: 

  • ‘The Three E’s of Trauma’ can aid a trauma informed practice 
  • Contextual safeguarding requires a localised understanding of places and spaces 
  • A strength-based approach considers the individuals’ context and experiences of trauma. Utilising a collaborative practice between the person being supported and those supporting them 
  • It is becoming increasingly evident that data sharing Is key to safeguarding. 

Sources:

[1] Mind.org. Health and social care rights. [Accessed 27 January 2021] 

[2] ons.gov.uk. 2019. Domestic abuse in England and Wales overview: November 2019. [Accessed 27 January 2021] 

[3] Kenny Gibson​. 2020. Adult Safeguarding Conference 2020. 

[4] Crisis Prevention Institute. What’s Your Concept of Trauma? [Accessed 27 January 2021] 

[5] Contextual Safeguarding Network. 2017. Contextual Safeguarding. [Accessed 27 January 2021] 

[6] London Borough of Islington. Strengths-Based Practice and Safeguarding. [Accessed 27 January 2021] 

[7] Gov.uk. 2018. Information sharing: Advice for practitioners providing safeguarding services to children, young people, parents and carers. 

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We heard from Kenny Gibson​, National Head of Safeguarding for NHS England & NHS Improvement​ on 4 approaches to improve safeguarding outcomes.

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