Types of abuse and seriousness Levels of harm and related indicators/examples Level Lower Level Harm May not meet the threshold for Section 42 enquiry. Outcomes may include advice, information, signposting to other agency, assessment of need, care management/care coordination, risk management, staff training, disciplinary or complaints procedures. Significant Very significant Harm Likely to meet threshold for Section 42 enquiry Critical Serious criminal matter – Immediate discussion with police required. Likely to result in urgent request for s.42 enquiry Physical Error causing no/little harm, e.g. skin friction mark due to ill-fitting hoist sling Minor events that still meet criteria for ‘incident reporting’ Isolated incident not involving a staff member Inexplicable very light marking found on one occasion Inexplicable marking or lesions, cuts or grip on a number of occasions Inappropriate restraint Withholding of food, drinks or aids to independence Inexplicable fractures/injuries Assault Grievous bodily harm/assault with weapon leading to irreversible damage or death Sexual Isolated incident of teasing or unwanted attention, either verbal or touching (but excluding genitalia) which has NOT been committed by a person in a position of trust, where this is not of a serious nature and the effect on the vulnerable adult is low. Verbal sexualised teasing or harassment Isolated incident of teasing or low-level unwanted sexualised attention (verbal or by gestures) directed at one adult by another whether or not capacity exists - no harm or distress caused Sexualised touch or masturbation without valid consent Being subject to indecent exposure Contact or sexualised behaviour which causes distress to the person at risk Attempted penetration by any means (whether or not it occurs within a relationship) without valid consent Being made to look at pornographic material against will/where valid consent cannot be given Sex in a relationship characterised by authority, inequality or exploitation, e.g. staff and service user Sex without consent (rape) Voyeurism
Psychological Isolated incident where adult is spoken to in a rude or inappropriate way – respect is undermined but no or little distress caused Occasional taunts or verbal outbursts which cause distress The withholding of information to Treatment that undermines dignity and damages esteem Denying or failing to recognise an adult’s choice or opinion Frequent verbal outbursts Humiliation Emotional blackmail e.g. threats of abandonment/ harm Frequent and frightening verbal outbursts Denial of human rights/civil liberties, over-riding advance directive, forced marriage Prolonged intimidation Vicious/personalised verbal attacks Domestic Violence (Where there are children in the household or present this must be referred to the children's MASH) One off incident with no injury or harm experienced Occasional taunts or verbal outbursts Victim has no current Adequate protective factors Children in household or present-refer to Children’s Services Inexplicable marking or lesions or grip marks on a number of occasions Subject to controlling behaviour Frequent verbal/physical outbursts Children in household or present - refer to Children’s Services Assault causing serious harm Subject to stalking/harassment Serious sexual assault or humiliation Experiences constant fear Subject to severe controlling behaviour e.g. finances/medical treatment Children in household or present-refer to Children’s Services Subject to regular violent behaviour Threats to kill/choke /suffocate etc In constant fear of being harmed Sex without valid consent (rape) Honour based violence &/or forced marriage Children in household or present - refer to Children’s Services Neglect & acts of omission Isolated missed home care visit - no harm occurs is not assisted with a meal/drink on one occasion and no harm occurs Inadequacies in care provision leading to discomfort - no significant harm e.g. occasionally left wet. No access to aids for independence Recurrent missed home care visits where risk of harm escalates, or one miss where harm occurs Hospital discharge, no adequate planning and harm occurs Ongoing lack of care to extent that health and well-being deteriorate significantly e.g. pressure wounds, dehydration, malnutrition, loss of independence/ confidence Failure to arrange access to life saving services or medical care Failure to intervene in dangerous situations where the adult lacks the capacity to assess risk
Self-neglect Self-care causing some concern - no signs of harm or distress Property neglected but all main services work Some evidence of hoarding - no major impact on health/safety First signs of failing to engage with professionals Property neglected Evidence of hoarding Lack of essential amenities No access to support Refusing medical treatment High level of clutter /hoarding Insanitary conditions in property Won’t engage with professionals Problematic substance misuse Potential fire risk/gas leaks Multiple reports from others Self-neglect is life threatening Lack of self-care results in significant deterioration in health/wellbeing Chaotic substance misuse Environment injurious to health Potential fire risk or gas Others affected by self-neglect Multiple reports from other agencies Behaviour poses risk to self/others Failure to arrange access to lifesaving services or medical care Life in danger without intervention Chaotic substance misuse Environment injurious to health* Imminent fire risk/gas leaks Access obstructed within property Multiple reports from other agencies Behaviour poses risk to self/others Only exceptional cases of self-neglect will trigger adult safeguarding. All standard interventions must be used first to manage risk e.g. Care Management/Care Plan Approach/Multi-Disciplinary Team Appropriate services must be notified there is a risk to others e.g. fire, environmental health