The purpose of this policy is to protect clients including vulnerable adults and children & young people who receive ECPT services. Our overarching philosophy is that we expect every practitioner (qualified and trainees in practice) to have professional supervision and the appropriate qualifications. Moreover, all practicing practitioners will be expected to provide evidence of insurance, enhanced DBS check and membership of a professional body.
All practitioners who work from ECPT will have had the appropriate training background and qualifications to be competent in the services that they are offering. This is regularly monitored and reviewed by ECPT in terms of overseeing their CPD and training programmes and advanced specialisms. Membership of a professional body such as UKCP, UKATA, BACP with adherence to their stipulations is a requirement for CPD.
A placement trainee will have discussions with their placement provider regularly on the importance of swift action in case of concerns over potential safeguarding issues within their clinical placements and become familiar with policies and procedures in place. Trainees on placement within ECPT under the Valued Minds service will fall under the S2BH policies and procedures.
ECPT has an open culture where people feel able, positively supported, and encouraged to raise their concerns, even when they relate to the practice of their colleagues. Any such concern would be referred to and addressed by the Ethics Committee.
Appropriate ECPT safeguarding lead
ECPT will provide a safeguarding Lead who is a highly qualified clinician with experience to provide safeguarding support.
Name: Michelle Shanley Clinical Director S2BH
Available to contact Monday, Tuesday, Wednesday and Thursday, between 9am and 5pm
Phone number/email: 07534285519 firstname.lastname@example.org
Should the safeguarding lead not be available, the admin office will signpost an alternative contact and confidentiality must be adhered to.
NSPCC Helpline 0808 800 5000
Hull City Council Safeguarding – Early Help and Safeguarding Hub (EHASH)
01482 448879 (normal office hours)
01482 300304 (emergency out of normal office hours)
Multi Agency Safeguarding Hub (MASH)
You can find more information on safeguarding by visiting the Hull City Council Safeguarding website (Adults and Children) at www.hullcc.gov.uk
Safeguarding – Children & Young People
This safeguarding policy is informed by legislation, policy and guidance that seeks to protect children and young people in England. A summary of the key legislation and guidance is available from: nspcc.org.uk/childprotection
The purpose of this policy is to protect children and young people and outlines the overarching principles that guide our approach to child protection.
We believe that:
* children and young people should never experience abuse of any kind.
* we have a responsibility to promote the welfare of all children and young people to keep them safe and to practise in a way that protects them.
We recognise that:
* the welfare of the child is paramount.
* all children, regardless of age, disability, gender reassignment, race, religion or belief, sex, or sexual orientation, have a right to equal protection from all types of harm or abuse.
* some children are additionally vulnerable because of the impact of previous experiences, their level of dependency, communication needs or other issues.
* working in partnership with children, young people, their parents, carers and other agencies is essential in promoting young people’s welfare.
We will seek to keep children and young people safe by:
* valuing, listening and respecting them
* developing child protection and safeguarding policies to reflect best practice.
* using our safeguarding procedures to share concerns/relevant information with agencies who need to know. Involving children and young people, parents and carers, appropriately
* recruiting staff and volunteers safely, ensuring all necessary checks are made.
* support, training and quality assurance measures.
* implementing a code of conduct for staff, trainees and therapists.
* using our procedures to manage any allegations against staff, therapists and trainees appropriately.
* ensuring that we provide a safe physical environment for our children, young people, staff, therapists and trainees, by applying health and safety measures in accordance with the law and regulatory guidance.
* recording and storing information professionally and securely in line with current legislation.
DEALING WITH DISCLOSURES OF CHILD ABUSE AND RISK
In the course of counselling and psychotherapy at ECPT clients may disclose child abuse:
- They experienced in the past;
- Historical abuse they are aware of;
- Current and immediate risk of abuse to children.
ECPT is not a statutory agency and does not have a role in administering Child Protection legislation. However, the service is committed to ensuring good practice and safety in Child Protection policy and reporting guidelines.
Under s.47 of the Children Act 1989, the local authority has a statutory duty to investigate situations where a child under 18 is suffering, or is likely to suffer ‘significant harm’, whether physical or psychological in nature. There is no general legal duty on citizens (or on counsellors as such) to report suspected child abuse. The nature of counselling and psychotherapy requires trust and confidentiality. In most cases best practice requires the practitioner to seek to empower the client in addressing the situation. Where a disclosure by practitioner is required it is important to seek the consent for any disclosure of personally sensitive information.
If there is a risk of harm to children the client must be given adequate information and time to make a considered decision.
Procedure for dealing with allegations of child abuse and risk:
- Report the incident to your primary supervisor and discuss in relation to professional codes of ethics and advice about clinical strategies. Discuss the circumstances and options for dealing with the incident, referring to the Counselling/Psychotherapy agreement. If a supervision session is some time away you may need to place an urgent phone call to your supervisor.
- You may need to consult the insurance legal helpline and obtain legal advice about the best course of action;
- You may wish to consult Hull City Council Safeguarding. They offer help to all professionals to think through and discuss issues that relate to safeguarding children with a view to whether a referral should be made.
In cases where you need to report child abuse you can contact:
- Hull Safeguarding Early Help and Safeguarding Hub (EHASH) on
- 01482 448879 during normal office hours
- Emergency Duty Team on 01482 300 304 out of normal office hours
- NSPCC has a recognised statutory role and legal authority in this field. NSPCC Child Protection Helpline (24 hours): Tel: 0808 800 5000.
In emergencies you can contact:
- The police on 999
- Hull Safeguarding Emergency Duty Team on 01482 300 304 out of normal office hours
The therapists procedures outlines what therapists need to do in a range of situations in order to best protect the client within the therapeutic setting.
As with all these procedures, the first step at a general level is Supervision.
Supervision’s major focus is to help the placement therapist to provide their best services for the client. It is in supervision that the placement therapist brings their anxieties, worries and concerns to the supervisor.
As well as the above, the placement therapist will endeavor through supervision to develop their skills in the area of therapy and therapeutic discourse. This will include learnings in how to work with clients, techniques and treatment planning towards resolution.
If the client discloses that they are being abused, harming themselves or have been abused in the past:
* The first port of call is to gently enquire and check out what you have heard to make sure you are understanding correctly – this is not interrogation – though you have to be specific to make sure of the facts this needs to be done in a relational manner.
* Remember that the information you will be hearing in this context will be very difficult for them to talk about and it will have taken a lot of courage for them to disclose at this level, so it is imperative that you treat the person in an empathic manner with a great sense of integrity, authenticity and respect.
* It is imperative that you do not lead the client to the conclusion that they were being, or were, abused. For example, do not put thoughts into the client’s head.
* If there is a risk to the person, or you are not sure if there is a risk to the person, it is imperative you speak to your personal supervisor as soon as possible to discuss the situation fully. (In specific situations you may decide to contact the safeguarding lead at ECPT) – certainly this needs to be recorded in your own notes.
* If there is a risk you may need to disclose – dependent on level of risk, ie if you think they are of harm to themselves or other people, you will need to disclose this immediately. If there is no immediate risk, then discuss it at your next scheduled personal supervision.
* In your personal notes, vis a vis your client, this must be recorded as said above, even if you choose not to take this to your supervisor. However, it is highly recommended that you do take all considerations to your supervisor.
* All actions that you have taken have to be noted in your client records and you need to tell your supervisor of these actions, with dates and times against each of the actions.
If the client discloses they are abusing:
* Check out gently what you have heard to make sure you have understood them correctly and remind them of the contracting about confidentiality and its limits.
* Try to get them to take the appropriate action, for example with your support contacting the police.
* You will need to disclose the information that is being given to you and you must make this clear to your client.
* If the risk is significant and imminent you will need to disclose it straightaway to the ECPT safeguarding lead and/or social services or the police.
* Offer to continue to support the client through the ongoing therapy if appropriate and safe to do so.
* If you no longer feel safe to work with the client seek advice from the ECPT safeguarding lead and your supervisor.
* Make sure that you made notes of all your appropriate actions and discussions with your client, supervisor and safeguarding lead.
If the client discloses that a third party is abusing:
* First of all check out gently what you have heard to make sure you have understood correctly.
* Try to get them to take appropriate action.
* Whether or not they are prepared to take appropriate action speak to your supervisor and the safeguarding lead at ECPT as soon as possible.
* In your client notes you need to record all discussions with the client, supervisor and the safeguarding lead.
Suicide and self harm framework
This document has been informed by the BACP Information Sheet P7 Working With Suicidal Clients, and the Suicide Risk Document produced by Newcastle, North Tyneside and Northumberland NHS as well as the information produced by Beacon Counselling.
When working with Placement clients who present with a wide variety of issues, such as depression, anxiety, stress, repression of feelings, hopelessness, and a feeling of helplessness in the world and indeed in their levels of functioning, you may well find as the therapeutic sessions evolve that sitting underneath these presenting issues the placement client may report feelings/thoughts of suicide/suicidal idealisation.
This is when clients may have fantasies, dreams or even imaginations of the ideas of what it’s like to take their own life and indeed may have whole thought processes on how their suicide may impact other people around them.
More often than not when people report suicidal ideation it does not mean that they are then going to go and take their life. However, their reporting of this to yourself is important and must be taken extremely seriously by yourself. This is where supervision is imperative.
The Threshold Model
The threshold model shows how different types of risk and protective factors interact to produce a threshold for suicidal behaviour for the individual. The different types of factors are:
- Long term predisposing risk factors that can be present at birth or soon after birth – these identify people who are in risk groups.
Genetic or Biological Influences:
(a) Family history of suicide or attempted suicide
(b) Family history of depression
(c) Family history of alcohol or other substance misuse
- Personality Traits
Rigid thinking characterized by patterns of thought that are difficult to change.
Black and white thinking or “all or nothing” thinking.
Excessive perfectionism, where high standards are causing distress to the person or others.
Hopelessness with bleak and pessimistic views of the future
Impulsivity, tending to do things on the spur of the moment
Low self-esteem with feelings of worthlessness
- Short Term Risk Factors
(a) Divorced, separated of widowed
(b) Being older and/or retired
(c) Having few social supports
(d) Being unemployed
The three psychiatric disorders most strongly correlated with suicide are:
* Substance misuse (including alcohol)
4. Precipitating Factors
These are events that may tip the balance when a person is at risk. They include:
* High stress/life crises
* Imprisonment or threat of imprisonment
* Recent job loss
* Recent house move
* Recent loss or separation
* Unwanted pregnancy
* Interpersonal problems
Depression is the most common of mental illnesses. People may often report low mood and lack of energy as criteria for depression.
Depression comes in many forms. Often it is defined as “anger turned inwardness”, repression of feelings, an incapacitation or/and a general sense of worthlessness and lack of purpose.
In a continuum of health you may get mild depression where a person may report the above and will be able to move from this state with relative ease.
If a person reports “at the other end of the health continuum” which we might call “high intensity” depression the person will report “stuck” or “fixed” in that particular state and an inability to move from one ego state to another.
What follows is a check list of the most common symptoms of depression. If at least three-five of the symptoms below have been present for at least 2 weeks the person is likely to be suffering from clinical depression (high intensity).
- Depressed mood
- Loss of interest and enjoyment
- Increased fatigue or loss of energy
- Appetite or weight disturbances
- Disturbed sleep
- Ideas of self-harm or suicide
- Reduced concentration and attention
- Problems with sleep or indeed incapacitation
- Reduced self-esteem and self confidence
- Lack of pro-activity
- Lack of purpose or structure in life
Process of Assessment (taken from Suicide Risk Document- Northumberland NHS)
Key stages in applying the threshold model to suicide risk and assessment are:
- To establish a working relationship with the placement client. This means developing rapport and a trusting relationship with your client. This working relationship will provide a container and a secure safe space for the placement client to feel more able to disclose important information with regards to what they are presenting. The use of empathy, active listening, and genuineness is imperative in this, not only throughout therapy but also particularly important at this first stage of meeting.
- Phenomenological Inquiry about the person’s presenting issues and narrative is vitally important within the therapeutic sessions. You will also need to be aware of inquiring about their current mental health, physical health and any substance problems.
- When listening to their historical and presenting issues you will also be able to assess their previous methods of coping with similar problems within what we call in Transactional Analysis their “Script”.
- It is imperative to seek information on their support system which would include availability and help provided by families and friends, for example do they live by themselves, with other people, within the family or do they in fact access any other type of service help.
- Ask about current circumstances, life events and worries. Through this inquiry you will be able to assess any precipitating factors which/could be triggering any suicidal thoughts, feelings or indeed potential actions.
- Finally, through the above you will have been throughout assessing the potential existence and specificity for any plans for suicide, including any nearby dates that have special significance for the person. Investigating the availability of means to commit suicide is crucial at this stage. This information will help to assess any suicidal intent.
- After evaluating the placement client’s narrative and information that you will have gleaned throughout the stages above, will help you to judge how close the person is to his or her threshold for suicidal behaviour. This then is your assessment of risk.
- Having stated the above stages of risk assessment, it is important that you have this framework and information with regards to working in the area of mental health. Please note that the initial assessor will also have done their own risk assessment and will have made clinical judgements in terms of the clients that they will be referring to you in terms of the placement.
Managing Suicide Risk
Managing suicide risk in many ways comes with the territory of risk assessment and management techniques will differ depending on the assessed level of risk. For example, if your risk assessment is low then the management techniques will differ from working with a high assessment risk.
Low Risk to High Risk (in Ascendency with 1 being Low risk and 8 being High risk):
1. If a risk is low, maintain usual contact/sessional arrangements.
2. A therapeutic approach is useful in promoting contact and encouraging the client to take a shared responsibility for their future care and safety. (The FRAMES approach to brief therapy is summarized below).
3. If you are concerned or anxious talk to your colleagues at the placement service and/or contact your Placement Supervisor (do not wait necessarily for your next booked supervision session).
4. Use the person’s existing support system by encouraging them to engage with their contact/friends/family.
5. As said earlier, if you believe the risk is more urgent contact your Placement Supervisor and also talking with your colleagues may well be useful at this junction.
6. If they are the high end of suicide risk contact your Supervisor immediately to work out an action plan with regards to future sessions.
7. The same as above – immediate contact with your Supervisor and immediate plans may need to be implemented, such as an urgent mental health assessment or even a 999 call.
8. Please note with regards to point (7) and (8) you will need to notify the Safeguarding Lead at ECPT.
(a) Always be aware of suicide risk.
(b) It is vital to keep good and accurate records.
(c) Use the FRAMES approach as a therapeutic style to promote contact and change.
Feedback to the client
Responsibility for change lies with the client
Advice to change
Menu of strategies for bringing about change
Empathy as a therapeutic style
Self-efficacy or optimism
This mnemonic is a useful technique for memory recall and may be useful if this context.
At ECPT, all placement clients who are referred to placement therapists through the Valued Minds Service will have undertaken a “risk assessment” and will come under the Space2BHeard policies and procedures. If at the assessment the assessor thinks that there is a high risk in the area of suicide, these high risk clients will not be passed to the placement therapists. However, that does not mean that the clients’ feelings of suicide or suicidal idealization may not be triggered during the placement.
information around safeguarding can be found in the UKCP Safeguarding
Guidelines at the end of this document or on the UKATA Website.
These guidelines sit alongside the UKCP Safeguarding Protocol and The UKCP code of ethics. They are to help you to manage your practice in relation to safeguarding and adhere to the standards set out by any organisation that you are working for. These guidelines are designed to inform and enable adherence to standards of good practice within a sound ethical framework.
It is important that you keep up to date with the statutory regulations pertaining to safeguarding in your part of the UK as there are different interpretations and processes across the individual home nations.
Safeguarding practices and procedures are drawn up within a legal framework. Local Authorities have clearly laid out responsibility for making provision for these to be carried out. This includes the provision of a designated safeguarding lead professional who is available to support with enquiries or reported cases of disclosure, or where there is reasonable cause to suspect significant harm. This is available to the general public and to all professionals including those working in private practice or working alone. (Email your Local Authority for specific information on Safeguarding.)
Clinical supervision is an ongoing requirement of psychotherapeutic practice and provides a space where safeguarding issues can be discussed. Those working in private practice or alone should consider any additional support or sources of information which they might need to have in place.
However, even where procedure is clearly defined and psychotherapeutic support is in place, the therapist may at times meet dilemmas within the interface of safeguarding and psychotherapeutic practice that will require careful judgment and consideration.
The following guidelines consider key points in relation to the interface between the requirements of safeguarding procedure and the role of the therapist. To this end the seven principles of ethical practice (avoiding harm, benevolence, candour, competence, honesty, human rights and social justice and personal accountability) help you to frame your responses to the Five Steps approach set out in these safeguarding guidelines.
It is recognised that each case will be unique, and the process of learning will be continuous.
Step one: be aware
- Abuse may be physical, psychological, sexual, financial, material, discriminatory, or involve neglect.
- If working directly with a child or vulnerable adult you may hear or see signs that reasonably indicate preliminary evidence that they or another person have suffered, is suffering, or is likely to suffer actual abuse.
- You may hear or see signs that reasonably indicate preliminary evidence that the client has inflicted, is inflicting, or is likely to inflict actual abuse on a child or vulnerable adult. Note that this is possible whether your client is an adult or a child.
- You may also become aware of possible abuse via other means, for example in an enquiry email from a potential client.
- You have a responsibility to protect children, vulnerable adults, your client and yourself.
But also consider:
- proportionality and be measured: what is the weight of the evidence pertaining to the signs? In the case of an adult client reporting historical abuse where there is no evidence or indication of present abuse, good practice would be that they should be facilitated to consider whether to report the matter or not rather than you making the decision to report.
- that there could also be circumstances when an adult client may disclose information about a present-day relationship that you may consider includes harmful or abusive elements. Remember adults with capacity can makes choices; sometimes choices that you may consider harmful. Questions you could consider asking in this situation are: How harmful? Is it significant harm? What might be the reasons a client would not want to report? What might happen if you were to report and the client then denies it? As a therapist you may consider that there is a rationale not to report when the abusive behaviour is not significant but to work with the client so that they are no longer in a harmful relationship.
- that an adult’s description of childhood events could be considered abusive in the current legislative context but would not have been at the time when the client was a child.
- that therapy can evoke a changing and complex kaleidoscope of ‘memories’, feelings and perceptions which are multi layered. Experiences described may be actual, perceived, phantasy or an exploration, a wondering or a ‘What if?’. Be aware that accounts offered by clients will need to be assessed against this landscape.
- the effect of allegations on all involved (not just on the client).
- your responsibility compared to that of others.
- the implications where alleged abuse involves a professional.
Step two: immediate response
During a therapy session you may become aware that a client is sharing or giving an indication of, a possible/probable safeguarding situation that meets the threshold of significant harm.
This is defined as ‘the threshold that justifies compulsory intervention in family life in the best interests of the child. This covers physical, sexual and emotional abuse and neglect.’ (The Children’s Act 1989)
Your response may be:
- to listen and be empathic when a client is telling you something serious. If it proceeds to be a full or clear allegation clarifying questions should not be asked.
- to show empathy without collusion and listen actively to what is being said without asking leading questions.
- where partial or unclear comments are made, to seek to clarify, but be aware that the client may be indicating that they are not ready to share more detail at this stage of the therapeutic work and should not be pressured to do so. By clarifying you may contribute to a need to take action after the session. Any response should be in the considered best interest of the child, adolescent or adult at risk.
- to show an expression of concern: reassure but do not promise inappropriate confidentiality.
- good practice is to make clear in an initial contract that where their safety or the safety of others is a concern, the therapist may need to talk with relevant people in order to ensure their safety. You may want to remind a client of this agreement.
- to make the client aware of any statutory responsibilities that would be invoked by specific disclosures.
- to provide support for the client to report (or similar).
(The categories were also enshrined in the Children’s Act 2002 enacted 2005 and the inter-agency guidance Working Together to Safeguard Children 2015)
There are helpful definitions of abuse relating to children and adults to be found in Appendix 2 of the NHS Safeguarding Policy (June 2015).
In the case of adults, the threshold of significant harm has been replaced by the phase ‘adult at risk’ from: self-neglect, modern slavery, domestic abuse and exploitation (Adult and Care Act 2014).
Step three: think!
- If working in an organisation such as the NHS, a school, college or university or within an organisation in the private or voluntary sector, you have a responsibility to formally inform and consult the designated safeguarding person in that setting at the earliest opportunity.
- If in private practice, unless you are certain that no action needs to be taken, it is good practice to consult your supervisor to discuss your concerns.
- By giving yourself time to discuss in supervision, you can separate yourself from the emotion of the moment so that you can see things clearly, which allows for consideration of the many things that may need to be taken into account.
- If your assessment of risk suggests that you need to take urgent action and you are not able to contact your supervisor in time, you could call the local authority designated safeguarding lead professional or local authority duty care officer who will have experience of dealing with many cases and ask for advice on the case. Note that once the name of the client is given, the person you have contacted would be required to take the case forward. In extreme circumstances where you perceive that someone is in imminent danger and that you are legally obligated to act, you would need to call the police.
- It is useful to have a pre-planned arrangement as to whom to call if your supervisor is unavailable.
- In ALL cases full notes should be taken of your decision, actions and reasons for them.
Step four: act
Following the above steps your actions may be:
- in the first instance, to make a formal report to the designated safeguarding lead in your setting
- to make a formal report of the case to an employer/other service
- to discuss further with your client
- to formally contact children’s or adult services
- to formally contact the police
- to do nothing – (the rationale for your decision should be recorded and where appropriate agreed with your supervisor)
- should you continue to have a well-reasoned concern which has not been taken up by the setting in which you are working, you should take the responsibility for reporting your concern to the relevant authority.
But also consider:
- how to respect the confidentiality of clients and treat information that does not need to be disclosed about them as confidential
- how you ensure that clients are informed about how and why information about them is collected, stored and shared with others in relation to matters of safeguarding
- how and when you inform clients that a disclosure could trigger further action by a relevant body that there would be the possibility of heightened risk to them by continuing to make such a disclosure.
- Share confidential information without consent if it is required by law, or directed by the court, or if the benefit to the child or adult that will arise from sharing that information outweigh both the public and the individual’s interest in keeping the information confidential.
- Weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between yourself and your client, whether a child or an adult, from releasing the information.
- Discuss the case with the local authority safeguarding team if you are uncertain that the child or adult is at risk. They are the body that takes responsibility (ultimately passed to the courts) for any further action. In the first instance you may want to withhold personal details of the person at risk. In sharing concerns about neglect and abuse you are not making the final decisional how best to protect the individual.
Step five: Reflect
You may wish to review how you have dealt with a disclosure and the impact that it had on you as a practitioner by:
- use of supervision
- reviewing your recording process
- reviewing your own support strategies and processes
- noting your learning from the case.
Further information can be found on the following websites;
- NSPCC www.nspcc.org.uk/preventing-abuse/safeguarding provides guidance and legislation information for England, Northern Ireland, Scotland and Wales
- Children’s Acts and all relevant legislation at www.legislation.gov.uk
- Government publications on safeguarding can be found at gov.uk/publications
- Your local authority will have a .gov.uk website address, for example: www.devon.gov.uk.