76 Practice Guidance – Protocol for Working with Adults at Risk who do not wish to engage with services and are or may become at serious risk of harm. This guidance is to provide managers and professionals working with adults who have mental capacity and refuse to engage with services but are/or may become at serious risk of harm, with a framework within which to manage their concerns. Managing the balance between protecting adults at serious risk against their rights to choose and control is a serious challenge to managers and professionals. This guidance aims to support good practice in this area. In the majority of circumstances case management, review and risk assessment procedures will provide the most appropriate route to engage with adults at risk. Where this is not the case the multi-agency decision process outlined below should be followed. Where an adult is at risk of harm from another person, or service, the safeguarding adult procedures must be used. This protocol applies to all adults in need of community care services regardless of financial status i.e. those who self-fund or receive financial support from another organisation. Community Care Services should be interpreted in the wider context for the purposes of this protocol and includes local health services. Healthcare professionals should consider if an adult requires community services and make a referral if necessary. Key Practice Principle When an adult at risk with capacity (including the ability carry out the necessary tasks, i.e. executive functioning not compromised) might be at serious risk of harm, but declines suggested care and support, good practice means considering the following: Rights: Adults have the right to make choices about their care and support needs and take risks, subject to the degree of impact those risks may have on other adults and children. Duty of Care: risk assessment and management are essential to establishing the likelihood and impact of risks which may be so serious that agencies need to take action to protect adults. A duty of care applies in common law in relation to all services. Councils, health bodies, private care providers and individual care staff owe a duty of care to adults to whom they provide services. Information: should be provided in a form that the adult can understand. Equality: services and support should be provided with dignity and respect and not discriminate because of disability, age, gender, sexual orientation, race, religion, belief, or lifestyle. Work to engage: always try to work with the adult, highlighting triggers that may increase dependency or harm and actions that could minimise or eliminate risks. Adopt a Trauma Informed approach (see page 47) Multi-agency Risk Management Meeting (MARM): the importance of holding a MARM meeting cannot be overstated to involve all relevant agencies to share information, planning proactive contact with the adult and monitoring on going risks. It is imperative that the adult is involved in the MARM, either by attending all or part of the meeting or having their views represented. Open Door: adults at risk should always be given contact details of various agencies to request support when they think it’s needed. Appendix 7- Practice Guidance – Protocol for working with adults at risk who do not wish to engage with services
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