Safeguarding Guide for Occupational Healthcare Workers

What risk factors make someone more likely to experience abuse?

Abuse and neglect can occur anywhere to anyone; however, there are risk factors that can make a person more vulnerable to abuse.

An adult at risk of abuse may:

• Have an illness affecting their mental or physical health
• Be physically dependent on others
• Have a sensory impairment
• Have a learning disability
• Suffer from drug or alcohol problems
• Have low self-esteem
• Be unable to make their own decisions
• Have a previous history of abuse
• Have negative experiences of disclosing abuse
• Be of increasing age
• Be frail
• Have experienced a lack of access to health and social services or high-quality information
• Financial hardship, tenancy/home security risk
• History of chaotic lifestyle

There is no way to know which children are most vulnerable to abuse, but there are some factors for abuse and neglect risk to be aware of including, but not limited to:

• Very young children
• Children with disabilities and health problems
• Children who have already been, or are currently being, abused and/or neglected
• Parents who are young when their child is born
• Parents who are poorly informed about parenting
• Parents with mental health issues, especially untreated issues, for example depression, antisocial personality disorder, substance abuse and related disorders
• Single parent households
• Intimate-partner violence
• Parents experiencing emotional and/or financial stress
• Poverty, poor housing and deprivation
• Social isolation
• Violence in the community

These lists are not exhaustive, and other adults and children might also be considered to be at risk.

The types of abuse adults can encounter

There are ten types of abuse listed in the Care Act (2014).

These are:

• Physical abuse – this may involve physical violence, misuse of medication, inappropriate restraint or sanctions.
• Sexual abuse – this can include verbal sexual abuse, non-consensual touching, fondling, physical restraint, cornering, tickling, kissing, excessive cleaning of genitals, enemas, intercourse, sodomy, oral sex, invasion of privacy and stalking.
• Psychological abuse – this includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, harassment and verbal abuse.
• Financial or material abuse – including theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, and misuse or misappropriation of property, possessions or benefits.
• Neglect and acts of omission – including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, or withholding medication, adequate nutrition and heating.
• Discriminatory abuse – including racist, sexist or abuse based on a person’s disability.
• Domestic abuse – including psychological, physical, sexual, financial and emotional abuse, and so-called honour-based violence.
• Modern slavery – includes slavery, human trafficking, forced labour and domestic servitude.
• Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home.
• Self-neglect – includes a wide range of behaviour neglecting to care for personal hygiene, health or surroundings and includes behaviour such as hoarding.

The types of abuse children can encounter

Statutory guidance across the four countries of the UK describes four main categories of child abuse, and these definitions will normally be reflected in local organisations’ policies and procedures.

The four categories are:

• Physical harm/abuse – this may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child/young person. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child/young person. Harm can also occur due to practices linked to faith and culture, for example, Female Genital Mutilation (FGM).
• Emotional harm/abuse – this is the persistent emotional maltreatment of a child/young person such as to cause severe and persistent adverse effects on the child/young person’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child the opportunities to express their views, deliberately silencing them or “making fun” of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child’s developmental capacity, as well as overprotection and limitation of exploration and learning, or preventing the child from participating in normal social interaction. It may involve seeing or hearing the ill treatment of another. It may involve serious bullying, including cyberbullying, causing children/young people frequently to feel frightened or in danger, or the exploitation or corruption of children/young people. Some level of emotional abuse is involved in all types of maltreatment of a child/young person, though it may occur alone.
• Sexual abuse – this involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetrative acts, for example rape or oral sex, or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may include non-contact activities, such as involving children in looking at, or in the production of, pornographic sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse, including via the internet. Sexual abuse is not solely perpetrated by adult males; women can also commit acts of sexual abuse, as can other children.
• Neglect – this is the persistent failure to meet a child/young person’s basic physical and/or psychological needs, likely to result in the serious impairment of the child/young person’s development. Neglect may occur during pregnancy, for example as a result of maternal substance abuse, maternal mental ill health or learning difficulties or a cluster of such issues. Where there is domestic abuse and violence towards a carer, the needs of the child may be neglected.
  Once a child is born, neglect may involve a parent or carer failing to:
  – Provide adequate food, clothing and shelter, including exclusion from home or abandonment
  – Protect a child/young person from physical and emotional harm or danger
  – Ensure adequate supervision, including the use of inadequate caregivers
  – Ensure access to appropriate medical care including dental care or treatment and also including the neglect of, or unresponsiveness to, a child/young person’s basic emotional needs

The safeguarding issues occupational healthcare workers may come across

Understanding what abuse and neglect might look like and how to recognise warning signs is an important aspect of safeguarding. Some examples occupational healthcare workers might encounter may include, but are not limited to:

Self-neglect – this can be a complex and challenging issue for occupational healthcare workers to address, because of the need to find the right balance between respecting a person’s autonomy and fulfilling their duty to protect the adult’s health and wellbeing. It is important to recognise that self-neglect may present itself in many ways and it is unlikely to have a “typical” case.

Indicators associated with self-neglect include, but are not limited to:

• Poor diet and nutrition
• Poor personal hygiene, poor healing of medical conditions or injuries

Organisational abuse – this can be the mistreatment of people brought about by poor or inadequate welfare or support in the workplace, or systematic poor policies and practices that affect the whole workplace.

Bullying or harassment – this can be defined as deliberately hurtful or discriminatory behaviour. It is usually repeated over a period of time, and occurs when it is difficult for those bullied to defend themselves. It can take many forms, but the three main types are physical, verbal and emotional. The damage inflicted by bullying can often be underestimated. Bullying can cause significant distress to the individual so much so it affects their health and work.

Domestic violence and abuse – this is any type of controlling, bullying, threatening or violent behaviour between people in a personal or family relationship. Domestic abuse may be disclosed or exposed through occupational health assessments.

A series of complaints or comments from a client about staff workplace behaviours or attitudes.

Danger or risk to health and safety, such as where health and safety rules or guidelines have been broken.

Issues to do with the workplace in general, such as concerns over resources, products, people, staffing or the organisation as a whole, which impact negatively upon the health and wellbeing of employees.