Towards explanations for the findings of serious case reviews: understanding what happens in self-neglect work

Abstract

Purpose – The purpose of this paper is to draw on systemic and psychodynamic theories to subject published serious case reviews (SCRs) involving self-neglect to a deeper level of scrutiny, in order to understand how complex contexts impact on self-neglect work. It also updates the dataset of self-neglect SCRs and accompanying thematic analysis. Design/methodology/approach – Psychodynamic and systemic ideas are applied to the content of published SCRs in order to understand how different contexts – societal, legal, organisational, professional and personal – impact on and are influenced by work with adults who self-neglect. Further published reviews are added to the core dataset, with thematic analysis updated using four domains. Findings – Thematic analysis within and recommendations from SCRs have focused on the micro context, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis also commonly extends to how organisations have worked together and how Local Safeguarding Adults Board (LSABs) have supported and scrutinised their collaboration. This level of analysis enables an understanding of local geography. However, there are wider systems that impact on and influence this work, especially law and the societal context. If review findings and recommendations are to fully answer the question why, systemic analysis should be extended to appreciate the influence of national geography. Research limitations/implications – There is still no national database of reviews commissioned by LSABs so the dataset reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in LSAB annual reports. This makes learning for service improvement challenging. Practical implications – Answering the question why is a significant challenge for safeguarding adults reviews (SARs). Different approaches have been recommended, some rooted in systems theory. The theoretical formulations here extend the lens of systemic analysis on the different contexts that influence how practitioners work with adults who self-neglect and simultaneously are shaped by that work. This adds to the practice, management and organisational evidence base for working with adults who self-neglect but also shines the analytic lens on legal and policy mandates. Originality/value – The paper extends the use of systemic theory for understanding and learning from practice with adults who self-neglect and additionally offers psychodynamic formulations to appreciate what happens within and between practitioners and their organisations. The paper therefore contributes new perspectives to the methodology for conducting SARs. It also extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice.

Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

“…As evidenced previously (Preston-Shoot, 2016;2017b), the importance of considering and responding to repeating patterns is highlighted (106,111,127). Two cases (120, 121) observe that (101,105,106,111,112,121).…”

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

“…We draw first on previous research (Braye et al 2015;Preston-Shoot, 2016) into reviews of individual cases (previously known as serious case reviews (SCRs) and now renamed safeguarding adult reviews (SARs) since implementation of the Care Act 2014. A systematic search of all Safeguarding Adult Boards (SAB) websites in England was undertaken.…”

What is Really Wrong with Serious Case Reviews?

“…It is of course possible that national Serious Case Inquiries that Wood () envisages could in future highlight, for example, the advisability of legislative reform or amendment of central government guidance. However, hitherto, insufficient attention has been given to the political, legal and social context (Preston‐Shoot, ), even when permitted by statutory guidance for SCRs (Brandon et al, ). Put another way, systemic review methodologies may themselves be insufficiently systemic.…”

“…Alternatively expressed, policy implementation and SCR‐informed practice will be influenced by local management agendas, professional and organisational cultures, relationships within and between agencies, and the interpretation and experience of national policy, including the legal rules (Preston‐Shoot, ). One means of capturing such interaction and impact is to draw on the systemic coordinated management of meaning (Preston‐Shoot, ). This offers a framework for exploring how practitioners and managers are affected by the many contexts in which they work, contexts which interact with each other and which influence how cases are perceived.…”

“…The challenge facing commissioners and reviewers, however, includes not just representing practitioners' and managers' perspectives but recognising that this picture is mediated by the lenses of those same commissioners and reviewers. Their contextual framework, their patterns of thinking also shape the outcome of the review (Preston‐Shoot, ) so they too must bring a reflective approach to the process, moving between different perspectives and co‐creating learning.…”