Page 21 - Adult C Overview Report - FINAL

This document was classified as: OFFICIAL

misuse services nor domestic abuse services had any contact with the GP.

7.42. It would appear therefore that domestic abuse, alcohol dependence and chronic health

problems were all being managed in parallel lines rather than in a coordinated manner with
each cognisant of the others plans. Adult 1 told the author that it was very difficult for Adult C
to keep appointments as they were constant with some on the same day as others. Adult 1
indicated that she would sometimes come out of an appointment and go straight to get a
drink. There were some positive elements of trying to have an improved approach e.g. when
the alcohol worker arranged a joint appointment at a convenient venue for Adult C. This type
of approach was not sustained and was not used as a model moving forward.

7.43. Adult C did show some insight into the reasons why she did not engage well during a

conversation with substance misuse services. It was apparent that many of the services that
Adult C needed, had criteria that she was required to meet. The real barriers to her
engagement and improving outcomes may well have been the service requirements were not
ones that someone with the complex needs of Adult C could easily achieve. The coercion,
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control and power imbalance of domestic abuse alongside her having little agency and
control of her situation due to alcohol dependency required a more assertive outreach
approach to support Adult C to engage and address these issues.

7.44. Improvements made to MARAC locally, may well offer a more effective route for multi-
agency working for those who are victims of domestic abuse.

7.45. Whilst there were safeguarding referrals made and these were responded to, Adult C refused
intervention or sporadic engagement led to delays with needs assessments. Latterly, the
safeguarding referral was not progressed as there was a need to assess Adult C directly; she

died before this could happen.

7.46. Adults who have care and support needs, who are alcohol dependent and victims of domestic
abuse, can come under the care required under the Care Act Section 42 under several
categories of abuse. Whilst issues addressed earlier in this report provide an explanation as to
why Adult C did not engage with Adult Social Care, a TATI approach would have led to a
better understanding of the needs that she had leading Adult Social Care to see a role for
them in a wider safeguarding response much earlier. These issues were also picked up in the
SAR Alcohol Change UK Report referenced previously.

7.47. The new TATI process has now been introduced. At the time of writing this report, the first
two meetings have shown to be positive. This model has been developed locally and provides

20 In social science, agency is defined as the capacity of individuals to act independently and to make their own free choices. Those not able
to exercise agency due to other influences struggle to bring their influence to bear on what they can control.

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