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settings because there is the opportunity to keep the harm hidden; thepresence of others can lead to intervention and sanctions.• Shared living situation: this situation can provide a major risk toindividuals because of the increased opportunities for contact. The riskof harm may be increased from staff and other service users in sharedsettings.• Where a carer experiences mental illness or misuses alcohol there maybe an increased risk of harm to a dependent adult.• Where the carer is heavily dependent on the individual there may be anincreased risk of harm.• Behaviour that challenges others: the individual who displayschallenging behaviour, particularly someone with a learning disabilityand/or communication difficulties, may be at increased risk of harm tothemselves and to others.It is important to be aware that harm can take place with or without anyof these factors being in place.1.4 Signs of harmAbrasions: particularly suspicious are tears to the skin on parts of the bodyother than the arms and legs. May indicate physical harm or neglect.Bruises: the pattern of the bruise can indicate the cause e.g. finger pattern orfist mark may be retained. “Tramline bruising”; parallel bruises indicative ofinjury from a stick. Non-accidental injury bruising is more common on face,neck, stomach, chest and buttocks.Fractures: these may result from falls therefore it is important to check recordsfor relevant details. Fractures of head, spine or trunk are more likely to be theresult of physical harm than fractures to limbs.Pressure sores: these may be an indicator of neglect, especially if the soreshave not been brought to the attention of medical staff.Malnutrition: there are a variety of factors that can lead to malnutrition: failureto respect cultural food preferences leading to food refusal; the effect ofmedication on appetite suppression; poor oral hygiene leading to eatingdifficulties; insufficient care staff to assist individuals with eating difficulties.Malnutrition may be an indicator of neglect.Dehydration: may be a consequence of lack of staff support to maintain fluidintake; failure to provide liquids or to recognise the consequences ofinadequate intake. Dehydration may be an indicator of neglect.Misadministration of medication: incorrect administration of medication or overmedication to control the individual may indicate neglect or physical harm.Burns: research suggests that burns in older people may be an indicator ofneglect or physical harm. Burns may also result from self-neglect.14
Hygiene: poor hygiene indicated by rashes or sores, dirty/smelly clothes,squalid living environment, out of date food. Some individuals may elect to livethis way therefore there is a need to take account of the individual’s past lifeand habits. May be an indicator of neglect or self-neglect.Sexual Harm: evidence of sexually transmitted diseases, especially when theindividual lacks capacity, is an indicator of sexual harm. Bruising of the palatemay indicate forced fellatio: bleeding or bruising to the genital or anal area;difficulty sitting or walking are all indicators of forced sexual activity. Inaddition, withdrawal, fear, depression, anger, insomnia, increased interest insexual matters, or increased sexual or aggressive behaviours may bedisplayed.This is not an exhaustive list of indicators.Remember the presence of an indicator alone, does not confirm that harm hasoccurred.15
Page 1 and 2: Fife Multi-AgencyAdult Protection G
Page 3 and 4: ContentsPageIntroduction 7Governanc
Page 5: Appendices 45Appendix 1Appendix 2Ap
Page 8 and 9: Governance roles and responsibiliti
Page 11 and 12: 1 Adult Protection: Definitions1.1
Page 13: Suggested definition of emotional o
Page 18 and 19: the circumstances, the line manager
Page 20 and 21: eported via your agency’s interna
Page 22 and 23: There is a possibility that a worke
Page 24 and 25: 3.9 Harm by organised networks and/
Page 26 and 27: If the adult has no open referral t
Page 28 and 29: 4.3 Actions resulting from an IRDFo
Page 30 and 31: nurse, or midwife) and may be requi
Page 33 and 34: 5 Adult Protection Case Conferences
Page 35 and 36: It is important to record whether t
Page 37 and 38: 6 Adult Protection Orders6.1 Protec
Page 39 and 40: • An assessment order is required
Page 41: A banning order can last for any pe
Page 44 and 45: 7.3 Adult protection recording incl
Page 46 and 47: November 2011Appendix 1bFlow Diagra
Page 48 and 49: DETAILS OF NEAREST RELATIVE (if kno
Page 50 and 51: BRIEF DETAILS OF CIRCUMSTANCES:Plea
Page 53 and 54: Appendix 4Social Work (Assessment a
Page 55: Appendix 5 Post Screening ResponseD
Page 59 and 60: Appendix 7ADULT PROTECTION CASE CON
Page 61: ADULT PROTECTION PLANAction Person/
Page 64 and 65:
To produce reports as requested by
Page 66 and 67:
Appendix 9Dilemmas in adult support
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or mental health; and the impairmen
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10.14 Child Concern Formhttp://www.
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TermDefinitionAppropriate Adult Sch
Page 74 and 75:
TermInter-agency ReferralDiscussion
Page 76 and 77:
TermSWIFTSWISSTeam ManagerUndue Pre
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www.fifedirect.org.uk/adultprotecti
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