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thematic approach was used in this synthesis.
Findings
The main findings of the synthesis showed three broad themes affecting
decision making with adults with disabilities.
1. Practitioner factors e.g., knowledge, experience.
This was the most prominent theme found in the studies which included social
work, nursing, police, allied health professionals and care staff perspectives.
The findings showed the variations between practitioners in the ways that they
have constructed adult safeguarding issues and how this is linked to each
practitioner's understanding of the nature of what adult safeguarding is, what
the procedures are, how they approach it, and ultimately how they apply
thresholds for intervention.
2. Case Factors e.g., type of abuse, environment.
Characteristics in relation to vulnerability of the service users, including issues
of capacity, were highlighted in many of the studies. Characteristics of the
perpetrator were also referred to by participants in the studies. What could be
described as different rules for different perpetrators was particularly
concerning as it suggests that different thresholds are being applied
depending on who the alleged perpetrator is with a de-emphasising on abuse
perpetrated by institutions. The exclusion of service users in the adult
safeguarding process was raised on multiple occasions and serves to remind
of the gap in the research of the views of the adults directly affected.
3. Organisational Factors e.g., caseloads, resources.
Professionals working in adult safeguarding often do that work in a multidisciplinary
setting. While there is a presumption that practitioners follow
policy guidance it cannot be assumed that all professionals from various
professional backgrounds do so in a consistent way. The impact of different
approaches by organisations or managers has an effect on multi-disciplinary
working and management of risk. The application of policy into practice in
short is problematic for front-line practitioners. The issue of caseload
pressures and resources was a recurrent theme. The positive impact of
legislation in other jurisdictions in terms of how organisationally adult
safeguarding operates was an encouraging finding.
Conclusions
The systematic review concludes that decision-making is influenced by many
factors which are intrinsically linked to the decision-making process.
Practitioner factors cannot be divorced from the organisational context in
which practice is conducted. Case factors, with particular focus on disability,