Thematic review: Working with multiple disadvantage and trauma
Background
We encourage all staff and managers to discuss and share the briefing. This helps embed the learning to improve our best practice and develop where needed.
The East Sussex Safeguarding Adults Board commissioned this review to understand the circumstances of the deaths of four women.
They were aged between 19 and 51 years and all died between May and November 2020 from suicide or from causes linked to drug overdoses.
All four women had contact with a number of the same health and social care services.
Several parallel themes were identified including:
- Childhood trauma
- Poor mental health
- Domestic abuse
- Substance misuse
- Homelessness
- Difficulty engaging with individuals who are hard to reach
- The impact of Covid-19 on service delivery and the impact on people’s mental health and wellbeing.
Key findings
- Suicide prediction and prevention requires consideration of multiple factors including background, events, and stressors.
- Organisational policies and practices will need to change to support hard to engage people who have traumatic life histories.
- Think Family approaches may be useful to support engagement and harm prevention.
Key learning
We encourage managers to explore the learning points in team meetings and supervision.
Don't rely solely on what a person says
Adverse experiences, trauma and prolonged substance misuse use can result in frontal lobe brain damage, which can affect behaviour and decision making. Undertaking a mental capacity assessment to assess their ability to put a decision into effect (executive functioning) is therefore essential.
Working relationships
It is important to consider who may be best to work creatively and proactively with a person who does not wish to engage. For example, they may have already established a positive working relationship with another professional. This might be a worker from a voluntary agency, care agency or health service.
The review identified the following themes for learning.
Suicide prevention
- Do you complete safety plans with individuals at risk of suicide?
Safety Planning | Every Life Matters - Have you read Health Education England's Self-harm and suicide prevention framework to help identify and work with adults who are at risk?
Self-harm and suicide prevention frameworks | NHS England
Trauma-informed
- Do you and your agency take a trauma-informed approach which recognises and responds to the impact of adverse childhood experiences in adulthood?
- Do you ask individuals about their childhood experiences?
Multiple disadvantage
- Are you confident in when and how to refer individuals with Multiple disadvantages to the Multi-agency risk management (MARM) forum to manage their risks?
Multi-agency risk management (MARM) - Have you considered the effects of substance dependency on mental capacity?
- Do you offer different approaches to engage with people, such as face to face, text, phone, and virtual communication?
- Does your agency ensure cases remain open when an individual is not engaging?
- Does the person have a lead practitioner to maintain contact, provide assertive outreach and initial support from other agencies?
Further reading and resources
- Sussex safeguarding adults policy and procedures
- Safeguarding and multiple compound needs | Sussex Safeguarding Adults Policy and Procedures
- Sussex Safeguarding Adults Review Protocol
- Sussex Information sharing guide and protocol
Training
A range of multi-agency safeguarding courses are available. These include domestic violence and abuse, and coercion and control. Find the training on the Learning Portal.
East Sussex Learning Portal (ESLP) | East Sussex County Council
