Profile of repeat victimisation within multi-agency referrals

To help reduce victimisation, safeguarding practices in England and Wales are becoming more multi-agency, with Multi-Agency Safeguarding Hubs (MASH) being a contemporary example of such an approach. MASH aims to reduce victimisation by identifying and managing vulnerability at the earliest opportunity. This is achieved through the co-location of safeguarding agencies, joint decision making and the co-ordination of interventions. Previous research has indicated that the demand placed upon MASH often outweighs available resources, questioning the extent to which MASH effectively safeguards vulnerable people at the earliest opportunity. Whilst existing literature has focused upon the characteristics of MASH referrals, alongside referral processes, rates of repeat referrals have been overlooked. This paper aims to bridge this gap by exploring the number of repeat referrals made over a two-month period to a MASH location in the north-west of England (n ¼ 2,134). By investigating repeat referrals, reasons why some individuals are susceptible to being victimised on multiple occasions are identified. The paper concludes that whilst MASH has taken a step towards identifying and managing victimisation, practices and processes need to be reviewed if MASH is to proactively prevent repeat victimisation

Investigating the Characteristics of Vulnerable Referrals Made to a Multi-Agency Safeguarding Hub

Multi-Agency Safeguarding Hubs (MASHs) have been a feature of safeguarding processes since 2010, aiming to increase information sharing, joint decision-making, and co-ordinated interventions between safeguarding agencies. However, understanding the mechanisms underpinning MASH, and who they protect, is limited. This article attempts to bridge this gap in knowledge by quantitatively examining referrals made to one MASH location in the North of England between 1 October 2013 and 30 November 2014 (n=51,264). The findings outline general features of a MASH framework while demonstrating that demand placed upon MASH is influenced by a range of static and dynamic risk factors, including gender, age, and ethnicity. The study highlights the complex nature of referrals made to MASH and suggests that while MASH has taken a step towards a multi-agency approach to safeguarding, questions regarding MASHs ability to effectively safeguard vulnerable individuals at the earliest opportunity remain

Development and application of 'systems thinking' principles for quality improvement

Introduction: ‘Systems thinking’ is often recommended in healthcare to support quality and safety activities but a shared understanding of this concept and purposeful guidance on its application are limited. Healthcare systems have been described as complex where human adaptation to localised circumstances is often necessary to achieve success. Principles for managing and improving system safety developed by the European Organisation for the Safety of Air Navigation (EUROCONTROL; a European intergovernmental air navigation organisation) incorporate a ‘Safety-II systems approach’ to promote understanding of how safety may be achieved in complex work systems. We aimed to adapt and contextualise the core principles of this systems approach and demonstrate the application in a healthcare setting. Methods: The original EUROCONTROL principles were adapted using consensus-building methods with front-line staff and national safety leaders. Results: Six interrelated principles for healthcare were agreed. The foundation concept acknowledges that ‘most healthcare problems and solutions belong to the system’. Principle 1 outlines the need to seek multiple perspectives to understand system safety. Principle 2 prompts us to consider the influence of prevailing work conditions—demand, capacity, resources and constraints. Principle 3 stresses the importance of analysing interactions and work flow within the system. Principle 4 encourages us to attempt to understand why professional decisions made sense at the time and principle 5 prompts us to explore everyday work including the adjustments made to achieve success in changing system conditions. A case study is used to demonstrate the application in an analysis of a system and in the subsequent improvement intervention design. Conclusions: Application of the adapted principles underpins, and is characteristic of, a holistic systems approach and may aid care team and organisational system understanding and improvement

Developing new portals to safety for domestic abuse survivors in the context of the pandemic

Abstract: This study examined the emergence and implementation of community touchpoints established in the UK during the COVID‐19 pandemic for victims/survivors of domestic abuse (DA). Community touchpoints are designated places, both online and in accessible settings such as pharmacies and banks, where victims/survivors can seek confidential advice and be directed to expert DA services. The research adopted a case study approach and explored a range of perspectives through expert interviews, document analysis, consultation with survivors and stakeholders and a survey of DA co‐ordinators. Four national community touchpoint schemes were identified and, of these, three were implemented rapidly and were available in 2020–2021 when the UK experienced lockdowns. Partnerships between Government/voluntary organisations and commercial businesses‐assisted design and implementation. Some stakeholders considered that the schemes lacked responsivity to the local context and noted challenges in providing a confidential service in rural areas. Whilst pharmacies, banks and online spaces were identified as non‐stigmatised and trusted places to seek advice, community touchpoints were judged less accessible for some groups including those experiencing digital poverty and victims whose movements were heavily scrutinised. Most of the touchpoint schemes targeted adults only. There were also concerns about whether frontline staff in commercial businesses received sufficient training. Whilst robust evidence of outcomes was limited, there were indications that the schemes had achieved good reach with some early evidence of take‐up. Testimonials indicated that victims/survivors were using the touchpoints in flexible ways which met their needs. Moreover, the wide reach and visibility of these initiatives delivered in non‐stigmatised settings may have served to raise public awareness of DA, reducing the silence that has traditionally surrounded it. Further research into the use and impact of these initiatives is required and there may be future potential to extend community touchpoints to include children and young people experiencing DA

Standardising multi-agency safeguarding hubs (MASH): Building a framework to effectively identify and manage risk

MASH has been a feature of safeguarding practices in England and Wales since 2011, bringing safeguarding agencies together to effectively share information and prevent organizational silos. Core agencies include the police, social care, and health, with key features of co-location, joint decision-making and co-ordination. A standardised definition for MASH implementation does not exist, and this lack of a clear definition has meant various structures have emerged, impacting on safeguarding practices. This policy brief draws on workshops with a range of safeguarding practitioners between May and July 2022, about the challenges of collaborative working practices and how MASH can become more standardised. Whilst national standardisation is required, there needs to be flexibility when implementing guidelines, so that practices and processes reflect regional needs and resources

Standardising multi-agency safeguarding hubs (MASH): Building a framework to effectively identify and manage risk

MASH has been a feature of safeguarding practices in England and Wales since 2011, bringing safeguarding agencies together to effectively share information and prevent organizational silos. Core agencies include the police, social care, and health, with key features of co-location, joint decision-making and co-ordination. A standardised definition for MASH implementation does not exist, and this lack of a clear definition has meant various structures have emerged, impacting on safeguarding practices. This policy brief draws on workshops with a range of safeguarding practitioners between May and July 2022, about the challenges of collaborative working practices and how MASH can become more standardised. Whilst national standardisation is required, there needs to be flexibility when implementing guidelines, so that practices and processes reflect regional needs and resources

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Debate: Achieving public value in adult multi-agency safeguarding processes

Debate piece exploring the role of public value in adult multi-agency safeguarding settings