Title: Improving collaborative inter-agency systems and practice in self-neglect: identifying barriers and co-producing solutions
Funder: Department of Health and Social Care

Abstract: Self-neglect covers a range of behaviours and situations where not caring for one’s health, safety or surroundings puts the self at risk. The person experiencing self-neglect may reject or be ambivalent about service input, yet practitioners have a duty to consider risk. Many practitioners, from Adult Social Care, Health, Fire & Rescue, Environmental Protection and other organisations, must often collaborate – with each other and with the person experiencing self-neglect – to respond to the person’s needs and wishes. Yet practice reviews highlight repeated failings in this regard, leading to disjointed assessments, inconsistent communications, incohesive planning, and concerns being missed. At best this results in negative experiences of safeguarding processes; at worst in serious harm or death. _x000D_ Joint working in self-neglect under current policies is under-researched; what there is has focused exclusively on social worker perspectives. This study aims to identify why common problems arise in interagency and interprofessional practice with self-neglect, what systems, knowledge and practices professionals and people experiencing self-neglect have found helpful in avoiding them, and what recommendations and resources can improve practice. _x000D_ A comprehensive review of all Safeguarding Adults Boards’ (SAB) multi-agency procedures, Safeguarding Adults Reviews and the research literature will map models used and evidence on factors influencing collaborative working. In each of 5 SAB areas, interviews with 15-20 practitioners and managers across the range of agencies working with self-neglect will explore experiences of collaborative working. Practitioners will identify 15-20 people who have received input from multiple agencies for self-neglect – who can share their experiences in interviews. An economic assessment, based on interview and service data, will estimate service costs of multi-agency self-neglect working through case studies reflecting diverse manifestations of self-neglect. _x000D_ Four focus groups will then be held with up to 12 practitioners to assess the findings and to co-design service solutions and resources, with people using services scrutinising and feeding into the co-design process throughout. The uptake, acceptability, utility and impact on practice of the group’s outputs will be evaluated within participating SABs using an online survey and follow-up interviews with 15 practitioners. _x000D_ A PPI panel will be recruited from service user groups linked to participating SABs, who will bring local knowledge and experiences giving insight into self-neglect. To address the diversity of self-neglect, the panel will include older adults, people who hoard, people with mental health difficulties and clients of substance use services, and consider diversity of gender and ethnicity. The panel will have a key role in advising on each stage of the study._x000D_ Key beneficiaries are SABs, practitioners, and people in self-neglect. Outputs will be tailored to each stakeholder: findings report for SABs; guidance and learning tools tailored to each of Housing, Community Nursing, etc; online training resources; professional journal articles. The researchers have strong links among SABs and safeguarding networks, and will work with them on how to apply the research findings in local policies and guidance. The desired impact is improvement to the cohesion of assessment and intervention, leading to more seamless support and reduced service gaps.

Lay abstract: Research Question_x000D_ What can be learned from experiences of self-neglect practice about what facilitates or inhibits collaborative working between services, and how can this inform more coordinated, person-centred and effective input?_x000D_ Background_x000D_ Safeguarding Adults Reviews, research and practice experience attest to continuing challenges in collaborative working in self-neglect. Contributing factors include: lack of a shared understanding of self-neglect, roles and responsibilities; uncertainty over referral and information sharing protocols; low safeguarding literacy; and organisational pressures and barriers. Yet the evidence-base is partial and offers few solutions. _x000D_ Aims and Objectives_x000D_ The study aims to_x000D_ -identify what common problems arise in interagency and interprofessional practice with self-neglect, for whom, and in what circumstances, and to develop mid-range theory exploring how these can be avoided or mitigated;_x000D_ -improve collaborative assessment and care for self-neglect by developing tailored strategies, models and resources to assist LSABs and practitioners to reduce silo working, enhance the person-centredness of their work and support collaborative, strengths-based multi-agency working with self-neglect._x000D_ Methods_x000D_ This study consists of five WPs, informed at all stages by PPI input:_x000D_ 1. A realist synthesis will develop initial theory of the relationship between context, mechanisms and outcomes in collaborative working in self-neglect, using relevant international research, Safeguarding Adults Reviews and LSAB policies. _x000D_ 2. Semi-structured interviews will be used to develop this theory further. Working with 5 Safeguarding Adults Boards, 15-20 practitioners/managers from across the organisations working with self-neglect will be interviewed in each area, to gather a systemic overview of collaboration from the perspectives of different professionals and agencies. 15-20 further interviews will take place with people who have experienced multi-agency intervention for self-neglect. _x000D_ 3. An exploratory health economics assessment will be undertaken of the costs of self-neglect and their distribution among agencies for interviewees experiencing self-neglect, to inform understanding of resource use underpinning agency collaboration. _x000D_ 4. Three focus groups will be held with managers/practitioners to co-design indicators, resources, guidance and recommendations, responding to the theory of collaborative working already developed. _x000D_ 5. An online survey and 15 follow-up practitioner interviews will be used to evaluate uptake and value of implemented indicators, resources and guidance. _x000D_ Timelines for Delivery_x000D_ The study will run from 1st March 2022 to 30th June 2024. _x000D_ Impact and Dissemination _x000D_ Tailored outputs will be produced for the key project beneficiaries to improve training, practice and policy planning. The project will generate a clear understanding of the nature of current challenges to collaborative working in self-neglect, a framework for addressing them, and indicators for success, for use by LSABs to inform their work. For practitioners this should mean increased confidence, clarity of roles, and smoother integration of practice; at a service level this should mean increased efficiency of multi-agency working. Ultimately, the impact for people in self-neglect should be experience of more cohesive approaches to assessment and intervention, and more seamless support, with reduction in service gaps.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE