In this article
Specialist drug recovery workers work with individuals affected by substance misuse. The role involves working with and supporting individuals and groups, who by the very nature of their substance misuse may be vulnerable to abuse and neglect. It is the responsibility of each recovery worker to recognise the signs of potential abuse and to take action if they suspect that someone is being abused.
What is safeguarding?
Safeguarding adults and children is an integral part of a recovery worker’s role. As a recovery worker, you will usually find yourself visiting service users, whether that is in their own homes or in hospitals, courts, or police stations, and you may meet all members of the family, adults and children. Safeguarding means protecting people from harm including physical, emotional, sexual and financial harm and neglect. Anyone who misuses substances can be considered to be in vulnerable circumstances, as too can the family of a substance misuser, particularly any children. Those who are in or seeking treatment for substance misuse may also have particular vulnerabilities that are related to their stage in recovery.
Safeguarding means protecting people from harm including physical, emotional, sexual and financial harm and neglect. Recovery workers have a duty to recognise the signs and symptoms of abuse and to act on any concerns. Duties to safeguard are required by professional regulators and service regulators and are supported by law.
Safeguarding adults at risk means protecting their right to live in safety and free from abuse and neglect.
Adults at risk means anyone aged 18 or over who:
- Has needs for care and support.
- Is experiencing, or is at risk of, abuse or neglect.
- As a result of those care and support needs, is unable to protect themselves from either the risk of or the experience of abuse or neglect.
Children means anyone aged under 18 years, or under 25 years if they have special educational needs or disability (SEND).
Safeguarding children and young people’s welfare is defined in ‘Working Together to Safeguard Children’ as:
- Protecting children from maltreatment.
- Preventing impairment of children’s health or development.
- Ensuring that children grow up in circumstances consistent with the provision of safe and effective care.
- Taking action to enable all children to have the best outcomes.
Safeguarding also means that individuals are adequately supported to access care and support where this is needed, so that they are able to stay well and maintain a high quality of life. This is achieved by different organisations working effectively together to prevent and stop both the risks and experience of abuse or neglect. Safeguarding aims to balance the right to be safe with the right of the individual to make informed choices and to have their wellbeing promoted at all times.
The Care Act 2014 lists six key principles of safeguarding. These are intended to form a core set of standards for anyone who has a responsibility for safeguarding. Although these principles have been designed with a focus on vulnerable adults, they should be applied to any type of vulnerable individual, children included.
The principles are as follows:
- Accountability – in the event of a disclosure, if an adult or young person entrusts you with information that you know could be indicative of abuse, you must be clear with the individual that you need to report what you have heard.
- Empowerment – it’s important for any person who has been a victim of abuse to feel that they have control over their situation. Support and encouragement are key to effective working with a victim of abuse or neglect.
- Partnership – it is important to work in partnership with your local authority and all services or organisations in your community that might be able to assist in detecting and reporting abuse.
- Prevention – it is sometimes possible to take action before harm has come to an individual. If you know the signs and indicators of abuse, you will understand when something is not quite right and will be better placed to report any concerns for an individual’s wellbeing.
- Proportionality – when a safeguarding incident occurs, you should report your concerns in a manner that is appropriate for the risk presented. For example, if you suspect that a child is in immediate danger, dialling 999 is the recommended response.
- Protection – it is crucial to be an ally for individuals who have experienced or who are at risk of abuse. Supporting and representing these individuals in the appropriate manner can help to protect them from further harm.
What risk factors make someone more likely to experience abuse?
Abuse and neglect can occur anywhere to anyone; however, there are risk factors, particularly in drug abuse, 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 frail
- Have experienced a lack of access to health and social services or high-quality information
Any child can be at risk of abuse; however, there are a number of factors that can increase a child’s vulnerability to abuse and neglect including, but not limited to:
- Socioeconomic factors such as poverty, poor housing, homelessness and deprivation.
- Child factors, for example disabled children are more vulnerable to abuse or neglect.
- Family factors such as parental/carer substance misuse problems, parental/carer mental health problems and domestic abuse. These factors may be compounded if the parent/carer lacks support from family or friends and experiences social isolation.
- The parent or carer does not engage with services.
- There have been one or more previous episodes of child abuse or neglect.
- The parent or carer has a mental health or substance misuse problem which has a significant impact on the tasks of parenting.
- There is chronic parental stress.
- The parent or carer experienced abuse or neglect as a child.
- A family history of maltreatment.
- Being in care, a looked-after child.
- A history of offending, either parent or child.
These lists are not exhaustive, and other people might also be considered to be adults or children at risk.
The types of abuse adults can encounter
There are ten types of abuse listed in the Care Act (2014).
- 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 or treatment, also including neglect of, or unresponsiveness to, a child/young person’s basic emotional needs.
What safeguarding issues do recovery workers need to be aware of?
Abuse and neglect can take many forms, ranging from exploitation and disrespectful treatment to physical harm. It can be at a low level, and take place over a long time, or it can take place over a short time and be more extreme. It is all abuse.
Organisations and individuals should not be constrained in their view of what constitutes abuse, neglect or harm and should always consider the circumstances on a person-centred basis. Safeguarding concerns vary according to the nature of harm, the circumstances it arose in and the people concerned.
Substance abuse and recovery can lead to issues which are safeguarding matters such as, but not limited to:
- Basic needs not being met such as shelter, food, warmth and clothing.
- Social isolation.
- Impact of stress within a household including emotional abuse, domestic abuse or neglect.
- Deliberate self-harm including attempts of suicide and/or drugs and alcohol misuse.
- Odd, anti-social or embarrassing behaviour.
- Barriers preventing people from getting help or staying in treatment.
- Effects of long-term substance misuse including relapse.
- Risk of being homeless which may exacerbate physical and/or mental ill health and impact negatively upon individuals’ ability to care for and protect themselves.
- Individuals may be temporarily unable to make decisions because of their misuse of substances.
- Women with childcare responsibilities.
The roles and responsibilities of a recovery worker in regard to safeguarding
Safeguarding is a huge part of the recovery workers’ role, because they are working with some of the most vulnerable people in the country. They balance support and protection/safeguarding roles carefully and in keeping with the specific needs and circumstances of the person or family.
Safeguarding adults and children covers a spectrum of activity from prevention through to multi-agency responses where harm and abuse occurs. Multi-agency procedures apply where there is concern of neglect, harm or abuse to a person defined under the Care Act (2014) guidance as vulnerable.
A recovery worker’s role in safeguarding is to:
- Recognise – you should have a clear understanding of what the different signs and symptoms of potential abuse, harm and neglect can be. Robust safeguarding training can help you to spot these signs and symptoms.
- Respond – it is essential that you respond appropriately and do not ignore the situation.
- Report – concerns need to be reported without delay. Confidentiality is important, so only share information with those who are a part of the safeguarding process.
- Record – you should make precise, comprehensive notes that detail everything about your safeguarding concern.
- Refer – if the safeguarding risk is urgent and you suspect somebody is under immediate or severe threat, you should contact the relevant local authority or police services.
Recovery workers have a duty to make sure that:
- Safeguarding concerns are dealt with promptly, appropriately and reported in a secure and responsible way to all relevant agencies.
- Steps are taken to escalate or alert those able to protect adults and/or children at risk from harm and minimise the risk of abuse.
- Appropriate and proportionate measures are in place to protect from harm all those who work for them, or with them, or come into contact with them.
The safeguarding issues a recovery worker 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 recovery workers might encounter may include, but are not limited to:
- Children and young people’s drug treatment data shows that they experience high levels of self-harm, domestic violence and sexual exploitation.
- Ex-prisoners with a history of opiate misuse are at high risk of accidental overdose when released; if they have not taken opioids in prison, they will have no tolerance.
- Clients having treatment for substance misuse aged over 60 may need safeguarding support for issues related to ageing.
- Substance misuse may contribute to domestic abuse, and relationship breakdown can also contribute to homelessness and housing problems.
- Pregnant women may have increased health and safeguarding concerns for both mother and baby if the mother misuses drugs, or during detoxification.
- Sex workers and people involved in prostitution can struggle to break free whilst in recovery as the selling and buying of sex and drugs are often intertwined and mutually reinforcing.
- Different mental health symptoms may emerge in some individuals as recovery treatment progresses.
- Children affected by parental substance misuse and during the stages of recovery may engage in role reversal, for example protecting others, acting as a mediator and/or confidant, and taking on an adult role above their own mental and physical development capacity.
- Many women may find it difficult to stop misusing substances, especially with the additional stress if pregnant and/or in poor socioeconomic circumstances.
- Parents and carers who misuse substances may turn to crime to fund their dependency. This may mean exposing their children to unsafe adults or involving them in criminal activity.
Where should a recovery worker go with a safeguarding concern?
Every organisation working with people who are in recovery should have a local Safeguarding policy so that teams know how to respond to concerns about abuse. If you encounter a safeguarding incident at any point, whether that is while providing support or when interacting with a vulnerable individual, you will need to take responsibility for the situation and provide immediate action to ensure the person in question is properly protected.
Some concerns may be minor in nature but provide an opportunity for early intervention, for example advice to prevent a problem from escalating. Other safeguarding concerns may be more serious and need a response through multi-agency procedures and possible statutory intervention through regulators, the criminal justice system or civil courts.
Immediate concerns about abuse or neglect should be dealt with under local safeguarding procedures first. The person who raises a safeguarding concern within their own organisation should follow their organisation’s policy and procedures. This concern may result from something that you have seen, been told or heard.
If you witness or suspect that there is a risk of immediate harm to an adult or child, you must act straight away to protect their safety. You should report your concerns to the appropriate person, usually the designated safeguarding lead or authority, immediately; this may be the police in some situations. Involvement of the police is indicated in incidents of suspected theft and common assault, including sexual assault, and assault causing actual bodily harm. However, the police may also be involved in other safety incidents such as wilful neglect of a child.
You should also keep an accurate record of your concerns and action that you have taken, and you should always inform the designated safeguarding lead of your actions.
In following local procedures for reporting incidents/risks you may be required to report the concern to the Safeguarding Adults or Children Boards. These are multi-agency partnerships comprising statutory, independent and charitable organisations. The board’s objective is to protect and promote individual human rights and independence and improve wellbeing, so that adults and children at risk stay safe and are protected at all times from abuse, neglect, discrimination or poor treatment.
What legislation do recovery workers have to follow in regard to safeguarding?
There are various legal powers and duties across the health, housing and social care sectors that may be relevant in specific cases. These include:
The Human Rights Act 1998 applies to anyone whose care or treatment is funded or provided by a public body. Section 6 requires all public authorities to act in ways that are compatible with human rights when making decisions.
The Care Act 2014 sets out statutory responsibility for the integration of care and support between health and local authorities. NHS England and Clinical Commissioning Groups are working in partnership with local and neighbouring social care services. Local Authorities have statutory responsibility for safeguarding. In partnership with health they have a duty to promote wellbeing within local communities.
Safeguarding Vulnerable Groups Act 2006 and the Protection of Freedoms Bill – this Act was passed to help avoid harm, or risk of harm, by preventing people who are deemed unsuitable to work with children and vulnerable adults from gaining access to them through their work. Organisations with responsibility for providing services or personnel to vulnerable groups have a legal obligation to refer relevant information to the Disclosure and Barring Service (DBS).
Working Together to Safeguard Children 2010 – the way that agencies and organisations should work together to carry out their duties and responsibilities under the 1989 Children Act and other legislation is set out in a document called ‘Working Together to Safeguard Children’.
It sets out the responsibilities of all agencies in the protection of children, and is aimed at staff in organisations that are responsible for commissioning or providing services to:
- Children, young people and adults who are parents/carers.
- Organisations that have a particular responsibility for safeguarding and promoting the welfare of children and young people.
The Mental Capacity Act 2005 – in order to protect those who lack capacity and to enable them to take part as much as possible in decisions that affect them, the following statutory principles apply:
- You must always assume a person has capacity unless it is proved otherwise.
- You must take all practicable steps to enable people to make their own decisions.
- You must not assume incapacity simply because someone makes an unwise decision.
- Always act, or decide, for a person without capacity in their best interests.
- Carefully consider actions to ensure the least restrictive option is taken.
The Deprivation of Liberty Safeguards 2009 (DoLS), an amendment to the Mental Capacity Act 2005, provide a legal framework to protect those who lack the capacity to consent to the arrangements for their treatment or care, for example by reason of their dementia, learning disability or brain injury, and where levels of restriction or restraint used in delivering that care for the purpose of protection from risk/harm are so extensive as to potentially be depriving the person of their liberty.
The General Data Protection Regulations (GDPR) and the Data Protection Act 2018 introduced new elements to the data protection regime, superseding the Data Protection Act 1998. Practitioners must have due regard to the relevant data protection principles which allow them to share personal information. However, the GDPR and Data Protection Act 2018 do not prevent, or limit, the sharing of information for the purposes of keeping vulnerable adults safe.
The Equality Act 2010 lists nine protected characteristics, and health and social care providers come under the Act as employers and service providers, so they must not discriminate on the grounds of these characteristics.
The Public Interest Disclosure Act 1998 – this Act, often referred to as the Whistleblowers Act, encourages staff to report suspected wrongdoing and protects those that do against being dismissed or suffering a detriment by their employers. It also gives protection to employees against suffering a detriment or retaliation from another employee for reporting suspected wrongdoing.
Why is safeguarding training important?
It is important that we all understand safeguarding, and know what to do should safeguarding concerns arise.
Safeguarding induction and training is essential for all recovery workers appropriate to their role, including:
- Information on types of harm, abuse and neglect.
- How to spot abuse.
- How to respond to concerns.
- Who to report concerns to.
Training should be directly applicable to the responsibilities and daily practices of the person being trained, and to the care and support needs of the individuals that they are working with. An example of appropriate safeguarding training includes Safeguarding Vulnerable Adults (SOVA) Level 2, designed for people who are working with vulnerable adults and teaches the skills needed to safeguard people who are at higher risk of abuse. Safeguarding Vulnerable Adults (SOVA) Level 3 is designed for people who are wanting more in-depth knowledge into safeguarding vulnerable adults.
Safeguarding Children Level 2 is designed for people who are working with children and teaches the skills needed to safeguard children who are at higher risk of abuse and is recommended for recovery workers who have regular contact with families and children as part of their role.
Other training that is recommended for recovery workers to provide the skills and knowledge for effective safeguarding include, but are not limited to:
- Domestic Violence Awareness
- Substance Misuse Awareness
- Modern Slavery Awareness
- Adolescent Mental Health Awareness
- Mental Health Awareness
- Self-Harming Awareness
- Suicide Awareness
- Mental Capacity Act
Managers should evaluate changes in understanding and confidence of recovery workers before and after training, assessing this:
- Immediately after the training.
- In regular long-term evaluations, for example as part of supervision sessions.
- Annually, for example as part of the performance management/appraisal process.
Managers should provide feedback through supervision and appraisals, acknowledging how the recovery workers have learned from their experience of identifying, reporting and managing safeguarding concerns.
How often should recovery workers renew their safeguarding training?
Managers should assess recovery workers’ safeguarding knowledge annually, and run refresher training if needed. To help recovery workers increase their confidence in managing safeguarding concerns, they should at a minimum refresh their safeguarding training at least every 2 years and participate in continuing professional development (CPD).