Most social workers in adult social care work in services that primarily focus on the immediate presenting issues faced by clients and their accompanying care and support needs, rather than in services that are specifically organised around supporting people who have experienced trauma. However, many people who are affected by trauma seek support from social care services, whether or not the service considers itself to work with survivors.

For example, issues such as substance use, mental health problems, homelessness, self-harm, being in a domestically abusive relationship or being in the criminal justice system are often symptomatic of past trauma. And there is evidence that people who are in contact with mental health services are more likely than others to have experienced traumatic events (Sweeney et al, 2018).

This is why it’s important to recognise trauma and to understand how it can influence an individual’s way of relating to their situation and how their “behaviour” is often about keeping themselves safe, because that is how they’ve coped in the past.

Talking about trauma

Despite clear evidence linking psychological distress to experiences of trauma, survivors often report that they are rarely asked about traumatic experiences (Read et al, 2007).

When asked, practitioners say that they are afraid of asking about traumatic experiences for two main reasons: that they are paying attention to the person’s immediate needs, or that they are concerned that asking about the person’s experiences might cause them distress.

These are understandable concerns, and it can be difficult to get the balance right. Not asking about traumatic events can give a message that the worker isn’t interested, or that it is too shameful to talk about, but asking in an insensitive way or at the wrong time can cause distress.

Asking about traumatic events: practice tips

• Consider the purpose of asking about the person’s experiences of trauma:
  Is it relevant to your work with them? How long are you expecting to work with each other? How will it help you to meet their needs if you know about their experiences? Does it feel ethical and safe to ask this question at this time?
• Don’t ask during a crisis:
  During a moment of heightened distress is not a sensible time to ask questions which encourage the person to revisit past traumatic events.
• Offer a brief normalising statement before asking:
  The purpose of this is to “warm up” the person to the idea that you are going to ask about some difficult experiences, rather than it coming out of the blue. The statement should include a recognition that they do not need to answer. For example, you could say: “I’m going to ask you about some experiences which you may have had during your life. The reason for this is that it can sometimes help us to understand difficulties later on. It’s ok if you don’t want to answer these questions at this time.”
• If a person makes a disclosure of abuse:
  If a person gives information about an identifiable person who has harmed them, then most agencies will require you to pass this information on to the relevant safeguarding authorities.

It is good practice to remind people about the limits of confidentiality as soon as possible in the conversation, so that they can make informed choices about how much to say to you. It can also be sensible to ask whether the person has ever spoken about it before, and what happened as a result.

If someone makes a disclosure, validate it and reassure them that it’s good that they have spoken about it. Also check out their current situation – are they safe and free from abuse now? If appropriate, it can be a good idea to ask the person what sense they have made of their experiences and how they think they relate to their current situation.

It’s important to focus on what they would like to happen next and what sources of support they can draw on. If possible, offer a follow-up contact, such as an appointment or a phone call with you at an agreed time, to reassure them that you aren’t rejecting them.

Throughout the conversation, be aware of your non-verbal communication – regulate yourself by breathing steadily, keep your speech slow and measured, and try to remain calm and still. The person speaking will be very tuned-in to your responses, and may be expecting to see non-verbal signs that you feel uncomfortable or that you will reject them.

References

Read J, Hammersley P and Rudegeair T (2007)
‘Why, when and how to ask about childhood abuse’
Advances in Psychiatric Treatment, Volume 13, Issue 2, p101-10

Sweeney A, Filson B, Kennedy A, Collinson L and Gillard, S (2018)
‘A paradigm shift: relationships in trauma-informed mental health services‘
BJPsych Advances, Volume 24, Issue 5, p319-33

If you have a Community Care Inform Adults licence, log in to access the full guide and read more on the different types of trauma and how the Power Threat Meaning Framework encourages practitioners to shift their thinking from “What’s wrong with you?” to “What’s happened to you?”

What is reflection?

There are many definitions of reflection, but essentially it is about thinking things through carefully, considering things from different perspectives and possibly restructuring the way that we see things.

In many ways, it is about the way we think. Reflection also helps us to learn from experiences. When the learning from reflection is put into practice, this becomes reflective action/reflective practice.

Why is reflection so important for students?

It is generally agreed that reflective practice is important in social work. However, it is worth asking a student why they think there is an emphasis on critical reflection. When we understand why we need to do something, it generally motivates us to develop our skills in that area.

Reflection is vitally important for social work in general, but it is perhaps even more important for students, because it is so closely linked to the process of learning. A deeper approach to learning involves critically reflecting on new ideas and linking them with existing knowledge.

Taking a reflective approach means the learner will understand the knowledge they acquire and apply their learning to new situations. Deep learning assists with problem solving and making wider connections, resulting in a new and different understanding.

Sometimes students are not always aware of the importance of reflection and see it as simply something that is required as part of their portfolio evidence.

Supporting students to recognise the vital importance of reflective practice and asking them to read around the subject will be important if they lack commitment.

Reflective questioning

It can be very tempting for practice educators to ask information-based questions in supervision to find out what is happening for the people who are receiving support and to ensure the student is meeting agency requirements. They may also be tempted into providing solutions, advice and guidance to students.

This often cuts across students developing as truly reflective practitioners. Learning is much more likely to occur where a practice educator asks reflective questions to assist the student to consider the situation and find their own solutions. This also role models good practice in social work.

People sometimes look to practitioners to provide the solution, which can lead to them developing ‘learned helplessness’. Social workers who are able to use their skills to support people to develop their own ‘solutions’ are generally better, more effective practitioners.

McClure (2002) suggested that reflective practice is about a process of dynamic questioning and developed a range of “reflective questions” that can be used to assist in reflective practice – either in writing or in reflective discussions. The following questions are adapted from those suggested by McClure for use in supervision with a student:

• Tell me about what you did…
• What were you aiming for when you did that?
• What exactly did you do?
• Why did you choose that particular action?
• What theories/models/research informed your actions?
• What were you trying to achieve?
• What did you do next?
• What were the reasons for doing that?
• How successful was it?
• How do you know? What criteria are you using to judge success?
• What alternatives did you have?
• Could you have dealt with the situation any better?
• How would you do it differently next time?
• How do you feel about the whole experience?
• How did the person/carer/other worker feel about it?
• How do you know they felt like that?
• What sense can you make of this considering your past experiences/what we have discussed/your university studies (and so on)?
• Has this changed the way in which you will do things in the future? How?

Skilled, dynamic reflective questioning very often leads to more questions rather than ‘answers’. This can be very challenging for students who feel a pressure to ‘know’ something.

I find it useful to explain that even after over 30 years in social work I don’t know things. Sharing this with students can be helpful because the creation of uncertainty through reflective questioning and reflective practice more generally may create a crisis of confidence.

A willingness to live with uncertainty is important to social workers. In his report into the death of Victoria Climbié, Lord Laming introduced the phrase “respectful uncertainty” to describe the attitude social workers need to maintain in their work (Lord Laming, 2003).

References

Lord Laming (2003)
The Victoria Climbié Inquiry
Command Paper 5730

McClure, P (2002)
Reflection in Practice: Making Practice Based Learning Work
University of Ulster

If you have a Community Care Inform Adults licence, log in to access the full guide. You can access more supervision guidance on the practice education knowledge and practice hub.

The number of people with dementia from black, Asian and minority ethnic backgrounds in the UK is growing rapidly. According to the All-Party Parliamentary Group on Dementia (2013), there were 25,000 people from black, Asian and minority ethnic groups with dementia in England and Wales. This number is expected to double to 50,000 by 2026 and rise to over 172,000 by 2051.

Contributing factors include the ageing of those who migrated to the UK in the decades immediately after the second world war; increasing awareness and willingness to seek diagnosis; and the possible higher risk of developing dementia due to higher levels of cardiovascular disease and diabetes in certain black, Asian and minority ethnic groups (Alzheimer’s Research UK, 2019).

In 2024, the Office of Health Economics published an evidence review of inequalities in dementia, finding high quality evidence that people from black, Asian and minority ethnic groups living with dementia are less likely to have access to timely diagnosis, present later for assessment, have a lower diagnosis rate and are less likely to access support services than the white British population (Hodgson et al, 2024).

The full Community Care Inform Adults guide promotes a person-centred approach to supporting individuals, while encouraging practitioners to work in a culturally competent way, and presents the following tips for practice.

Practice tips

• Treat everyone as an individual by applying a person-centred approach to supporting people with dementia and their families.
• Understand different socio-economic barriers that individuals may face when accessing care.
• Work in a culturally competent way – be open and respectful.
• Know your local area and who should be accessing your service – record self-ascribed ethnicity.
• Make links with local community groups in order to promote dementia awareness, develop partnership working and learn about how they view dementia as a condition.
• If services are refused, do not assume ‘they look after their own’. Explore whether the services are meeting cultural needs adequately – maybe an aspect of the provision can be changed or adapted?
• Include cultural issues within assessments.
• Take account of practical needs, including meals, personal care preferences and religious and end-of-life practices.
• Recognise faith communities as a vital part of the wider support network.
• Promote effective communication – access interpreters where needed.
• Use translated written materials, but with caution.
• Provide services in different languages.
• Ensure culturally appropriate resources are available and used, for example, during reminiscence groups.
• Pay attention to how support for carers is marketed to ensure people who may not relate to the term “carer” can access them.

References

All-Party Parliamentary Group on Dementia (2013)
Dementia does not discriminate: the experiences of black, Asian and minority ethnic communities

Alzheimer’s Research UK (2019)
Reducing your risk of dementia

Hodgson, S; Hayes, H; Cubi-Molla, P and Garau, M (2024)
Evidence Review in England, Wales, and Northern Ireland. Inequalities in Dementia: Unveiling the Evidence and Forging a Path Towards Greater Understanding
Office of Health Economics

If you have a Community Care Inform Adults licence, log in to access the full guide. The guide forms part of Inform Adults’ dementia knowledge and practice hub.

Attending a court of law can cause significant anxiety for social care practitioners. Being able to understand what is expected and prepare effectively is often key to managing anxiety and building confidence.

The following is a practical preparation checklist that sets out some of the things it are beneficial to do in the run-up to the hearing to help you get ready for the experience.

• Find out the date of the hearing as early as possible.
  This means you will know how much time you have to prepare and can do this in a planned way.

• For a face-to-face hearing, find out the time of the hearing and the time that you need to arrive.
  You can decide the best way of getting to and from the court in a timely way. Think about parking availability, commuting times and any planned travel disruptions.

• For a remote hearing, find out what the method of joining will be (telephone or video) and if the equipment you have is suitable. Make sure you have a way to charge your device on the day and that you will have good access to the internet. Also, plan where you will join the hearing – make sure your chosen location is private and available on the day.
  You can then make sure you have the right equipment and it is working.

• Find out at what point in the hearing you are likely to be called.
  Knowing this will alleviate anxiety and manage expectations on the day.

• Make sure you know the name of the barrister (counsel) who will be representing your organisation in court. Ask your legal representative who is likely to be in court.
  This will help you understand what will happen on the day and who will be present.

• Talk to your line manager about any additional support you need from them on the day.
  If the experience is likely to be particularly challenging, it may be possible for your line manager to accompany you to court for moral and emotional support.

• Review your written evidence; set aside some time in your diary and liaise with your line manager about other workload as required.
  The better you know your own evidence the more confident you will be on the day, the easier you will find being questioned and the less likely you will be to provide a conflicting oral account of your written testimony.

• Find out from your legal representative the kind of questions that will be asked.
  This will enable you to practise your responses and build your confidence.

• Role play different scenarios during supervision.
  This enables you to test out different possible scenarios in a safe environment.

• Meet your legal representative to explore:
  – If your evidence conflicts with that of others submitted.
  – Any gaps in your own evidence.
  – Any key areas of dispute.
  – Any elements of your practice that could be questioned.
  This will enable you to anticipate where you may be cross-examined, so that you can prepare potential responses and reduce the risk of being caught off guard in court.

• Ask your legal representative who will be cross-examining you.
  Specifically, establish whether P (the person at the heart of the case) or a family member intends to question you. This can be particularly challenging as they may pose different questions to that of a barrister, and may also become angry or upset themselves. If this is likely, discuss with your legal representative how best to respond to such questions and emotions.

• Reflect on your own practice in supervision or in your own time.
  This will help you consider if there is anything you would have done differently on reflection. You will need to be honest if questioned about this.

• Talk through any anxieties or concerns as soon as possible and as regularly as required.
  This will help you to keep your anxiety in check and prevent any undue stress from building up.

If you have a Community Care Inform Adults licence, log in to access the full guide. The guide forms part of Inform Adults’ knowledge and practice hub on court skills.

Section 76 of the Serious Crime Act 2015 created the offence of controlling or coercive behaviour in an intimate or family relationship. If found guilty, a perpetrator faces a maximum sentence of five years in prison, a fine, or both. The Domestic Abuse Act 2021 extends the offence of coercive and controlling behaviour, no longer making it a requirement for abusers and victims to either still be in a relationship or to still live together when it occurs.

Coercive and controlling behaviours are a form of gender-based violence used by perpetrators to limit another person’s freedom by making them subordinate via the use of humiliation and threats. They do not relate to a single incident but rather a purposeful pattern of behaviours carried out over a period of time, in order to exert power and control.

People experiencing coercive control often struggle to come forward to seek support, but there are ways that social workers can assist if they spot the signs of coercive control:

• Speak to the victim alone – where possible, try and speak to them away from their partner. This may not be as simple as being in a different room in a house, but rather being in a different building. Victims are often justifiably reluctant to speak about what is happening in their relationships, and will be particularly unlikely to do so if their partner is with them or in close proximity.

• Ask questions but allow people to make their own decisions – if you suspect that someone is being controlled, speak to them (if it is safe to do so) about what they are experiencing and what they would like to happen. There are many services that can support people who are experiencing domestic abuse, including specific services for women, those in LGBTQ relationships, those from black and minority ethnic communities and men.

• Listen, and refer to appropriate services – in many cases this will include domestic abuse services, but be aware that some people may not want this. The fear of speaking about the abuse to an organisation may be too much for some people, who may worry that their partner will find out, they will lose their children/housing/finances etc, or may believe that the relationship will get better without intervention. Listening to the individual’s concerns and worries and acting accordingly will result in a better outcome for them than acting without their consent. Remember, perpetrators may tell their partners that social workers will come and remove their children if they do not ‘do as they are told’, which will make many reluctant to speak out.

• Reporting to the police – again, listen to the individual about their wishes. If someone does wish to report to the police, they will be taking risks and will need to be supported through this process. Social workers should ensure that if anyone wishes to report abuse they have appropriate support in place – whether that is emotional support, practical advice and/or help with sourcing alternative housing. Also, social workers should ensure that they understand coercive and controlling behaviour and know about the statutory guidance framework in relation to the offence and the evidence needed to build a case. Being equipped and able to explain this to victims will help them make an informed decision about whether they want to proceed down this route.

• Support after reporting – be aware that if someone does report to the police or other services, the abuse will not necessarily cease. Research suggests that stalking and harassment continue after a relationship has ended, and the effects of this can be equally as devastating as abuse perpetrated within the relationship. Evidence suggests that victims are also most at risk of homicide when first leaving an abusive relationship, or shortly after. If someone has ties to their partner, for example, children, they can also be used as a tool of control by the perpetrator. Ensure that victims are supported after reporting, if this is what they decide to do.

• Financial support – many people may not have access to their own income if they decide to leave a relationship. The prospect of having to access a refuge or becoming homeless may discourage them from leaving. Ensure that housing options are discussed with the victim so that they are provided with advice on how to secure appropriate housing if they decide to leave the relationship. In addition, ensure that they are aware of any benefits they are entitled to claim.

If you have a Community Care Inform Adults licence, log in to access the full guide. The guide forms part of Inform Adults’ knowledge and practice hub on domestic abuse.

A scam is a fraud. It’s an attempt to steal money or goods, usually through a scheme or ploy, and can involve intimidating and threatening behaviour.

There are a variety of different scams, ranging from the romance scam, to the pension scam, to the clairvoyant scam. Then there is the lottery scam and the doorstep scam. The list continues to grow.

In October 2023, National Trading Standards published research revealing that 73% of UK adults – or 40 million people – had been targeted by scams, with 35% (19 million) losing money as a result. But, it said, fewer than a third of victims (32%) report the crime to the authorities.

Scammers often target older and socially isolated people, who are made to feel unsafe and afraid.

The care and support statutory guidance to the Care Act 2014 is explicit in stating that scams targeting adults at risk are a form of financial abuse – which is where professionals come in.

Best practice tips

The goal of intervention should be to develop a protection plan and manage risks. Here are some key points to remember:

• Consider scams and mass marketing fraud as a form of financial abuse under the Care Act 2014 or Social Services and Well-being (Wales) Act 2014. If the client has care and support needs and is unable to protect themselves from the scam because of those needs, then the local authority is under a duty to make safeguarding enquiries. This provides an excellent forum to start protection planning.
• Work in a multi-agency manner. Safeguarding enquiries should involve safeguarding board partners such as the police, trading standards, third sector advocates and care providers. The statutory guidance to the Care Act says local authorities should always report cases of scams to trading standards and the police. A safeguarding planning meeting or case conference provides a useful arena for positive information sharing and protection planning.
• Act quickly. Scammers and fraudsters will often intensify the frequency and level of their fraud when they hear about professional involvement. Recognise that scammers will either find out about your involvement or sense that things have changed in terms of their access to the victim or the victim’s willingness to co-operate.
• Where you have proper reason to do so, consider the client’s mental capacity in relation to relevant decisions to do with the scam, including around accepting help. Ensure you provide all practicable support to the person to enable them to make decisions before concluding that they cannot. If a capacity assessment is required, then ensure that you have sufficient knowledge of the client’s background (in relation to how they have historically managed their finances) in order to help form a baseline against which to assess how they are managing now.
• Scams are crimes (normally falling under the Fraud Act 2006) and should be reported to trading standards, which may carry out a criminal investigation.
• Risk assess and protection plan: ensure that a comprehensive risk assessment is done, ideally one that involves the client and their wishes and outcomes. The resulting actions form the protection plan, which should be multi-agency in nature.
• Work in a manner that upholds the principle of making safeguarding personal (as explained in the Care Act statutory guidance). Communicate with the client and involve them in safeguarding, risk assessments and meetings.
• Keep checking on their desired outcomes as these may change as the safeguarding process moves forward. Remember the concept of slow burn social work as you will often be undoing years of relationship building between the scammer and the client. This will not happen overnight. Your relationship with the client will likely be the most important tool that you bring to the safeguarding plan.

The importance of multi-agency working

Dealing with complex fraud is not easy and is often protracted and complicated.

It is important that working to protect people from scams is not kept within trading standards and social work.

Consider all professionals who go across the threshold when engaging with clients, including police officers, such as those from local neighbourhood teams) domiciliary care workers, pendant alarm response officers, financial assessment officers, housing repair staff, third sector workers, tenancy officers and those working for meals on wheels type services.

All can be the eyes and ears for safeguarding and trading standards intervention to begin.

If you have a Community Care Inform Adults licence, log in to access the full guide. There, you can read more on the risk factors that make someone more likely to fall victim to scams as well as on the impact on people’s health, wellbeing and quality of life.

When practitioners are working with adults going through challenging times, they should be especially aware of signs that may indicate self-harm, thoughts of self-harm or a deterioration in a person’s mental state.

Factors that increase vulnerability to self-harm

In particular, they should be alert to factors that can increase someone’s vulnerability, for example, mental health needs or demographic factors such as poverty or homelessness.

All social workers, not just those working in mental health services, should be aware that rates of self-harm are higher in marginalised groups, for example, ethnic minorities, sexual minorities, asylum seekers, people in the criminal justice system and those who have lost loved ones through suicide.

People sometimes harm themselves when they are under stress for a variety of reasons. These include domestic abuse, financial abuse or other forms of exploitation, financial difficulty/poverty, separation and loss.

If you discover that someone has started to self-harm, it could indicate that something in their life is upsetting them and they might benefit from having some support.

If self-harm is suspected or needs to be considered as a possibility, you should be prepared to explore this in social work visits, assessment or interventions.

Practice tips

• Try to be calm and reassuring. When asking questions, try to do this as sensitively as possible.
• Say clearly that you are asking questions to help and that the person is not in trouble. Tell them that you can provide or arrange for support. If possible, ask whether they have been supported by mental health services before and try to obtain their consent to share information with other mental health professionals.
• As part of an assessment, you should make sure you are clear about what support or involvement, if any, the person has had from other services in the past, either in relation to their mental health generally or self-harm in particular. This information might be included in the referral to your team, it might already be available in records held by your organisation or you may need to make contact with other organisations to find it out.
• When people have moved from another area or have been transferred from children’s services to adults’ services, contacting their GP is a good way to find out what care, support or treatment they have had in the past, as well as asking the person themselves during the assessment.
• Always treat the person with respect and dignity and try to give them as much control over what happens next as you can.
• Check if they are willing to share anything with you which they think may have contributed to them hurting themselves. This might relate to recent stressors such as difficulties at home, having had an argument with someone or losing a job, or it might relate to their psychological state such as feeling low in mood.
• In some cases, it may be necessary to sensitively unpick whether the harm relates to self-harm or has been caused by another person. Inevitably, this requires careful handling. To have this kind of conversation, the person must feel comfortable speaking to you and, where possible, they should be given the option to have someone they know and trust present to support them if this would help.
• It can be hard for people to tell someone that they have harmed themselves. Feelings of shame and the fear of rejection can be factors. Acknowledge how difficult it might have been for them to share this information with you.
• Remain calm and non-judgmental, be prepared to listen and give them time to talk. If someone has harmed themselves, there will be a reason for this, but they might not understand why they have done it. It is important to try and work collaboratively with them and for them to feel in control of what happens next.
• People do not always recognise that the behaviour and actions of others are abusive. Sometimes the harm you are investigating will have been directly caused by others, but sometimes others’ abusive behaviour will have precipitated self-harm. Where you suspect abuse in either form, you will need to probe the person’s use of language, for example, when they say someone has “borrowed” money from them, do they really mean that they have stolen it, or when they say that somebody “pushed” them, do they mean that they struck out?

Practitioners should remember that people who self-harm do not always do so as a result of mental illness; levels of risk can also be affected by social isolation and adverse life events.

Psychosocial stressors can have a significant impact in terms of self-harm, sometimes involving people who are already regularly involved with adult social care. It is worth taking the time to ask questions and act on any answers that suggest someone is at risk of self-harm.

If you have a Community Care Inform Adults licence, log in to access the full guide and read more detailed information on the signs that social workers should look out for and what to do if self-harm is confirmed.

Useful resources on self-harm

• Samaritans, freephone 116 123
• Mind’s self-harm webpage provides information about helplines and other sources of support
• Young people’s suicide prevention charity Papyrus
• Training and support organisation Self Injury Support.
• Online support forum run by the National Self Harm Network.

We understand that the issues set out above will apply to some practitioners, so please consider making use of any of the resources listed above that you feel would be helpful to you.

Over the last decade, national carer organisations have increasingly recognised the particular nature of caring for someone as they approach the end of life, and some specific support has been created, for example, the End of Life Carers Project run by Carers Network.

This has encouraged local carer organisations to recognise carers of those approaching the end of life as being in need of specifically developed, targeted services.

Many of the challenges faced by carers are the same whatever the stage of an illness or disability, but at end of life their urgency and significance are magnified.

Communicating with carers as needs increase

Carers’ needs can change as the cared-for person’s condition progresses, and practitioners should encourage open discussion between all involved. Sometimes the needs of carers conflict with the needs of the person nearing the end of life, so practitioners will require skills in facilitating difficult conversations.

End-of-life carers may want information about their loved one’s prognosis and symptoms, and what to expect as death approaches.

Equally, they may find the only way to cope is to ignore the inevitable. This can be difficult if they are required to have discussions about advance care planning, such as resuscitation, artificial feeding or active treatment coming to an end.

This is especially pertinent if the person they care for lacks capacity to make relevant decisions for themselves or the carer has lasting power of attorney for health and welfare.

The person nearing end of life may want help to organise their will, plan their funeral or discuss arrangements for dependent children.

Again, this can work well if the carer is in the same place emotionally, but it can be painful for both if they are not. If the cared-for person and carer are parents, and the carer wants to make forward plans or prepare the children, it can be very difficult to talk to their children about what is happening if this goes against the other parent’s wishes.

Practitioners will have to think how best to communicate with the carer about matters such as options for a preferred place of care and of death. Should it be at home, in a hospice or in hospital? What are the practicalities in each case? These are not always easy questions to ask or answer.

Tips for communicating with carers as the person nears end of life

• Enable a conversation about end-of-life concerns, both between yourself and the carer, and between the carer and their loved one. Practitioners may worry about offending or upsetting the carer (or the cared-for person), but the worst thing is to say nothing.
• A good place to start can be to ask more general questions about difficult conversations. For example: “In your family, how do people begin difficult conversations?”; “In your household, if someone wants to talk about a sensitive subject who is usually the person to initiate that?”
• We have come across many families/couples who want to talk about difficult or painful matters but wait for a time when it will feel easier. In our experience, the time for it to feel easier never comes. Practitioners should gently probe the possibilities here, perhaps suggesting that planning for dying can be done in the same way as we plan for other unwanted events, like an accident or a burglary. We make an insurance plan and then put it on the shelf to be brought out as and when.
• You may encourage carers to reflect on the personal cost of ignoring the inevitable. You can ask: “If you didn’t have to worry about upsetting them, is there anything you would like to talk about with them?” And if they tell you, you can answer: “What do you think would happen if you were unable to have that conversation with them?”
• The only exception to the rule of persevering with discussions along these lines is if there are reasons to suspect that the carer is abusing the dying person, in which case local authority safeguarding procedures should be followed.

Professionals need skills in initiating and engaging in conversations that are often avoided because they are so difficult. By modelling these conversations, we can encourage individuals and communities to be less frightened of death and more ready to become involved in end-of-life care.

Useful resources to share with carers in end-of-life situations

• Hospice UK’s information and support resources and advice from its Dying Matters campaign.
• Carers UK’s helpline, 0808 808 7777, which is available, Monday to Friday, 9am-6pm.
• Healthtalk.org’s section on caring for someone with a terminal illness.

The guide also covers applying the law on assessment, support planning and review to support carers at this difficult time. Inform Adults subscribers can access the full guide here.

What to read next

• Tips for keeping assessment processes strengths-focused
• How to communicate with people who are deafblind
• Tips for coping with difficult conversations

There are a number of different groups who fall under the title of Gypsies and Travellers, including:

• Roma, Romany Gypsies, Irish Travellers, Scottish Gypsies and Travellers (who are all recognised as ethnic minority groups and therefore protected against race discrimination under the Equality Act 2010);
• Welsh Gypsies and Travellers;
• New Travellers;
• Bargees and other liveaboard boaters;
• Travelling Showmen.

While members of each specific community may share some common experiences, every person is individual. There can be no replacement for listening to each individual and/or family about their own values and experiences.

Overcoming fear from families about social workers

Social services are rarely seen by Gypsy and Traveller parents as a resource for support. As a way of dealing with social services intervention, families may feel that the best thing to do is to pull away. This can then be interpreted by social workers as them being evasive and unwilling to co-operate.

This means that it may be necessary to spend extra time building up trust with Gypsy and Traveller families. You may find it helpful to encourage them to appoint an independent advocate, perhaps from a Gypsy or Traveller organisation, or a family friend whom the person you are working with trusts. This will make it clear that you understand the vulnerable position they are in and are willing to find ways to support them.

Practice tips

• Learn more about Gypsy and Traveller culture
  When working with Gypsy and Traveller families, take the time to learn the facts about their cultures, values and traditions from unbiased and fair sources. Media depictions are often negative and unrepresentative, so ask the family you are working with or a Gypsy and Traveller organisation to help you learn more. By showing willingness to proactively engage with Gypsy and Traveller cultures, you will improve your communication with families and also learn how you can provide the appropriate forms of support.

• Ensure you communicate in the best way for the family
  Only 56.8% of Gypsies and Travellers who responded to the 2021 Census reported having any formal qualifications. This may mean that literacy could be an issue for some parents you support and that information in written form may be difficult to understand.
  While it might be standard practice for you to deliver information in written form, it is important that this is backed up with a verbal explanation and an opportunity to ask questions.
  Difficulties around literacy may be embarrassing for some parents, who may already feel their capabilities are being called into question by the fact they are going through the child protection process. So, instead of asking, “Can you read?”, you could say, “Would you like some help reading this?”

• Make efforts to engage in cross-boundary collaborations
  As nomadism is an important part of Gypsy and Traveller cultures, it is likely that some families that you are working with will want to travel. This is something you should discuss at an early stage and when planning support. Travelling has an important economic and social function for many families. Some will have patterns of nomadism and will have a good idea of where they will be travelling to and when. If this is the case, it is important to make contact with social workers in that area and agree a collaborative approach to supporting the family. If this is not the case, open communication and agreement with the family may be necessary.

• Challenge discrimination against Gypsies and Travellers at every opportunity
  Prejudice and discrimination against Gypsies and Travellers is common and can often go unchallenged, even in professional contexts.
  Romany Gypsies, Irish Travellers and Scottish Gypsies and Travellers are defined as ethnic groups and protected from discrimination under the Equality Act 2010. So, not only do professionals have a moral imperative, but they also have a legal one not to discriminate against them. Also, under the public sector equality duty (section 149 of the Equality Act), councils must have due regard to the need to eliminate unlawful discrimination in the exercise of their functions. As a result of fear of discrimination or bias, some Gypsies and Travellers may, for example, feel more comfortable choosing their own psychologist for psychological assessments and opt for a lawyer who is not local during court proceedings, and they should be encouraged to do this.

A history of suspicion and mistrust has often marked the relationship between Gypsy and Traveller families and social workers. The only way this can be overcome in practice is by building trusting relationships between the two.

This cannot be achieved overnight, but it is essential that Gypsy and Traveller families and children feel that their culture and ways of life are approached in a positive way by social workers.

Subscribers can access the full guide on Inform Adults and Inform Children.

Assistive technology can potentially support people with dementia in a range of ways, including to facilitate participation in daily living activities, maintain skills, sustain relationships, enable positive risk taking, and hold on to a sense of personhood, self-esteem, confidence and wellbeing.

However, if assistive technology is used in a prescriptive or restrictive way, it may undermine people’s independence and autonomy, as well as waste resources (Woolham et al, 2021). For this reason, thoughtful, person-centred and strengths-based planning around assistive technology is essential.

What is assistive technology?

Alzheimer’s Society defines assistive technology as “devices or systems that help maintain or improve a person’s ability to do things in everyday life” and says that these can “assist with a range of difficulties, including problems with memory and mobility”.

Assistive technology may include:

• Relatively simple ‘low tech’ standalone devices, such as a calendar clock, adapted cutlery, ‘easy-reachers’ or a pressure activated plug, such as Magiplug.
• More complex electronic assistive technology (EAT), such as electronic medication dispensers, memo minders or falls sensors.
• Digital technology, such as smartphones and tablets, Satnav and AI assistant systems like Amazon Alexa. People are increasingly making use of these to organise their lives, find information, access leisure activities and even manage aspects of their home environment such as lighting, heating and security.
• Telecare, which is not any one device, but rather a whole system of care delivered remotely by a 24-hour service centre. It includes remote sensing devices that monitor events, such as falls, temperature, gas being left on and bed occupancy, and communication devices, including a central intercom and one or more community alarms, usually worn as a pendant or wristband, often alongside pull cord alarms in the property.
• Telehealth/telemedicine, in which health monitoring, support and management for particular, usually long-term conditions, such as heart problems or COPD, are delivered remotely within a package of care.

Benefits for people with dementia

There are many ways assistive technology may be of benefit for people with dementia and related memory problems, such as mild cognitive impairment. These include:

1. Supporting cognition within activities of daily living by facilitating the person’s memory, orientation and other cognitive abilities to enable them to carry out daily living tasks that are becoming harder to manage.
2. Facilitating meaningful occupation and participation in everyday life, including leisure activities and maintaining valued roles within society and family, for example, through contact with carers, friends, family, and groups in the community, for example.
3. Supporting the person to maintain their personhood, self-esteem, confidence and wellbeing.
4. Supporting empowering and reassuring caregivers and enabling families and friends to maintain meaningful relationships with the person. This could include promoting better understanding of dementia and how to communicate with the person.
5. Enabling positive risk taking so that activities can be maintained safely, meaningfully and manageably, widening choices in relation to support and care.

Practice tips

As a practitioner, you can enable the people you support to have a positive experience with assistive technology by keeping in mind the following tips:

• Assistive technology is not a quick fix. It is only as good as the package of care, support and treatment that goes with it.
• When technology is used, it should be to enable the person and to promote mobility, participation, inclusion, meaningful activity and positive risk taking.
• Person- and relationship-centred assessment is key. Use professional reasoning, reflective and reflexive practice and critical thinking in your assessment process.
• Always consider ethical and legislative context and guidance.
• Always consider human solutions and the role/needs of the person and their carers.
• Ensure that the way technology is being used does not disable the person further.
• Don’t overwhelm people with technology or changes. Instead go at their pace and, when possible, build on what they already know and do.

References

Woolham J, Steils N, Fisk, M, Porteus, J and Forsyth, K (2021)
‘Outcomes for older telecare recipients: The importance of assessments’
Journal of Social Work, Volume 21, Issue 2, pp162-87

If you have a Community Care Inform Adults licence, log in to access the full guide. You can also find more guidance on the dementia knowledge and practice hub.