Self-neglect An intervention study Professor Marian Brandon Dr
Self-neglect An intervention study Professor Marian Brandon Dr Penny Sorensen Sue Bailey Professor Sara Connolly Dr Ann Anka Structure of the presentation Background to the research Methodology Findings (self-neglect) Research Questions What is the experience of the clients where this preventative approach has been tried?
Are there any practical or emotional barriers for adults to overcome in order to participate and engage in their community? Do clients feel that they are more able to support their needs using community resources than before they had the service? What are the perceived benefits to individuals? How does involvement with the community social work service impact on the quality of life of its users? How have team members approached this preventative work with clients? What do they do? How do they practice? How has this preventative approach to the work had an impact on social
What are the perceptions other agencies aboutother this workers sharedofworking with preventative work and how it meets their own agency priorities? agencies? What are the outline costs of this way of working? Methodology Mixed methods consisting of: Interviews with: service users (n=13);
Todays focus Interviews with social workers and managers only social workers (n=3) Telephone interviews with social workers (n=3) and managers (n=2) managers (n=2); All interviews were and analysed using thematic stakeholders fromtranscribed external services and agencies (n= 6)
analysis. and costing analysis Analysis of goals and satisfaction with life questionnaires with service users What does the literature tells us? Ayers et al. (2014) Braye, et al. (2011), SCIE. Braye, et al. (2015), British Psychological Society (2015). Day et al. (2012). Model of practice: Structure What do they do? How do they practice? The model comprises engagement with service users
The model is based on developing relationship and building trust over time, building on the clients strengths and resilience. Social workers worked with service users and helped them to identify and set specific goals which were aimed at addressing their needs, concerns and outcomes that the service user wishes to achieve. The social workers met the majority of service users at own homes, sometimes outside in the service users front gardens or in public premises such as cafes. A few of their meetings took place at the social work office premises. How does it work? -Timescale of intervention Tier 1 Tier 2
Tier 3 12 weekly sessions 20 contact sessions Interventions that last over 16 weeks (70% over 24 weeks (20% more than 24 weeks of clients) of clients) (10% of clients) How does it work: Social work task what is particularly distinctive is that we work with people more intensely, we are able to build relationships with people, which helps with supporting them to change I mean one gentleman I am working with at the moment, he is a very high-risk hoarding person at the very high clutter
rating... I have had to work in partnership with the London Fire Brigade to try and minimise the risk to him and the other tenants that live above him We help people not to lose their tenancies, there is quite a lot of joint work being done with our Housing colleagues, more around tenancy sustainment we prevent them becoming homeless, we support them to come into the Housing Department, we will support with letters
Case 1 Reason for referral Mr Z lives on his own He was referred for support with decluttering his property. He has been hoarding for many years There were things both inside and outside of the property which placed him and his neighbours at risk Mr Z does not feel comfortable to invite anyone, including the social worker, into his property Intervention The social worker has worked with this client over a long period and carried this case over from the previous model the community care case management system Weekly sessions, meeting client under the Community Social Work model framework mainly by focusing on building a relationship and gaining Mr Zs trust Outcome The social worker has still not been able to enter Mr Zs property Ongoing work with Mr Z mainly focusing on monitoring his progress and building trust and maintaining a good working professional relationship Although the social work team are working under a new framework (the twelve weekly intensive sessions with clients), supporting people with hoarding difficulties may require more time to effect change.
one lady in particular when her mental health destabilised, after discussion, I sort of started to see her more regularly until she was stabilised again because she had made fantastic progress initially, that was somebody that selfneglected and hoarded. it is good that we are supported to be able to work with someone for that long because it is impossible, this is someone who has been hoarding for 30 years, you cant create change in two months or three months.
Evaluation How did social workers assess the impact of involvement? Okay, lets look back over your photos and see where you were when we first met there is nothing more powerful than seeing the actual image of what your home used to look like and then what it looks like maybe, you know, several months down the line. People lose sight. Challenges they wanted to refer a lady who lacked capacity and had dementia into our team because she hoarded and I am like no, no! If people dont have capacity that is a different, you know, you are into best interests and all sorts of realms. The people that hoard in our team, even though they are quite severe, they are deemed
to have capacity and we can work with them so it is trying to get the message over internally as to actually what we do and what we dont do and I think sometimes that gets blurred. In what way has the Care Act 2014 changed practice? I think the Care Act has made us more safer because it talks about prevention local authorities have to look at prevention and the eligibility its broadened out the eligibility, so whereby before, the people we were working with may not have been eligible under the previous Community Care Act, now especially with the people that are self-neglecting and hoarding, they would most likely meet that threshold We have got a strong grip of
the pathway for people who have eligible needs, but we need to think a little bit more around what goes into that prevention and wellbeing in our level of service Reference https://www.uea.ac.uk/centre-research-child-family/social-work-practice/making-decisionsabout-children/disabled-and-older-people/current-projects/a-follow-up-review-of-communitysocial-work-in-a-london-borough Allen, K. & Glasby, J. (2013). The billion dollar question: embedding prevention in older peoples services ten high-impact changes, British Journal of Social Work, 43, pp.904-924. Allen, K. & Miller, R. (2012) Prevention services, social care and older people: much discussed but little researched? National Institute for Health Research, School for Social Care Research http://www.sscr.nihr.ac.uk/PDF/Findings_17_prevention-initiatives_web.pdf
Ayers, C., R., Iqbal, Y. & Strickland, K. (2014). Medical conditions in geriatric hoarding disorder patients Aging & Mental Health, 18, (2), pp. 148151. Braye, S., Orr, D. & Preston-Shoot, M. (2011), Self-Neglect and Adult Safeguarding: Findings from Research, Social Care Institute for Excellence, London. British Psychological Society (2015). A Psychological Perspective on Hoarding DCP Good Practice Guidelines. London: The British Psychological Society Day, M., R., McCarthy, G., & Leahy-Warren, P. (2012). Professional Social Workers Views on Self-Neglect: An Exploratory Study, British Journal of Social Work 42, pp. 725743 Mariam, L., M., McClure, R., Robinson, J., B., & Yang, J., A. (2015). Eliciting Change in At-Risk Elders (ECARE): Evaluation of an Elder Abuse Intervention Program, Journal of Elder Abuse & Neglect, 27 (1), pp. 19-33 Miller, R. (2014). Is integration or fragmentation the starting point to improve prevention? HSMC - Policy Paper 17, Birmingham: Health Services Management Centre, University of Birmingham Sutcliffe, K., Rees, R., Dickson, K., Hargreaves, K., Schucan-Bird, K., Kwan, I., Kavanagh, J., Woodman, J. & Gibson, K. (2012). The adult social care outcomes framework: A systematic review of systematic reviews to support its use and development. London: EPPI-Centre Taylor, A. (2015). New act, new opportunity for integration in Scotland, Journal of Integrated Care, 23 (1), pp. 3-9
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