Helping people make an informed choice in relation to disclosure of non-recent abuse

Please describe a relationship, service intervention, program implementation, policy, or other that you initiated or know about that would be considered trauma-informed:

In line with the Social Care Act our Trust shifted in the safeguarding advice that was being given to clinicians around our response to non-recent disclosures of abuse. The new advice led to a much more proactive safeguarding response to disclosures than had previously been the case and was largely driven by public protection reasons. This meant that information which would previously have been considered ‘confidential’ was now needing to be shared with our Safeguarding Lead and at times with the Police and Social Care. This was a shift for clinicians and service users alike and there were examples of people making disclosures without a full understanding and awareness of this change. This had a negative impact on those service users who wanted to disclose for therapeutic reasons but who did not want information sharing with other services, in some cases this led to traumatisation resulting from a lack of control over what was shared and how. It also led to ruptures in therapeutic relationships, and clinician’s reported dissatisfaction with the change in safeguarding advice.

We wanted to improve people’s ability to give informed consent before disclosing non-recent abuse, increasing people’s control over what information was shared, whilst at the same time not inadvertently placing barriers in the way of disclosure. To this end, we devised a leaflet that outlined this change in advice. The leaflet was devised by the Clinical Psychology department following meetings with our safeguarding lead, the Police, and discussions with service users affected by the above changes. These groups also gave feedback on the leaflet.

The leaflet aimed to communicate:

1) advice about what happens when information is shared with other agencies and what support is available were someone wishing to do this,

2) emphasise our commitment and desire to support the person irrespective of what information they choose to share, and validating possible reasons behind people not wanting information shared,

3) emphasising our duties in relation to safeguarding and the reasons as to why we sometimes need to share information even if the person with whom we are working does not want this to occur,

4) encouraging people to discuss with their worker if this is an issue for them, so that possible ways of working with this can be found (e.g., either by working on the fears someone has around ramifications of disclosure or accepting there may be limits in what identifying information the person is prepared to give at any point in time).

This leaflet is freely available on our website and is left in prominent places in waiting areas. Some services are considering sending this leaflet out prior to initial assessment. The leaflet forms part of the Derbyshire Safeguarding Strategy for non-recent abuse and I believe is being considered for use by other agencies.  

  

What was the outcome?  

Whilst it has not been formally evaluated, clinicians are reporting an increased ability to have conversations with people around this (and have been able to use the leaflet to support these conversations). Anecdotally there appears to have been some reduction in people making disclosures of non-recent abuse without having full informed consent around the limits of confidentiality (i.e., possible reduction in retraumatisation through disempowerment). There are instances of conversations that have taken place where the person has been able to say that the leaflet relates to them and they have been able to find a way to work on past abuse by limiting the information they provide, in a way that still adheres to our safeguarding policy. For some individuals once this therapeutic work has been done, they have felt more empowered to choose to share information with other agencies.

People who had previously been negatively affected by the change in safeguarding advice, reported they would have benefited in hindsight from the availability of this leaflet.  

 

What supported the positive outcome? (Systemic supports? Organizational supports? Interpersonal supports?):

Liaison with other agencies/professionals. Expert by experience advice.

 

In what way has your example changed you, your practice, or your goals:

Prompting shared conversations/decision making with people with whom I am working around any dilemmas around disclosures.

 

Tell us more about what motivated you to bring this example to discuss:

Example of importance of empowering people to have full informed consent around information they share.

 

Whose needs are met in the example that you outline:

Clinicians

Service users

 

Was there any one person or factor that was central to the success of your example and why:

Leaflet required multiple revisions and incorporation of feedback from various interested parties, needed some determination to see this through and ability to synthesis different priorities/messages.

 

What can you or others do to spread this good practice to colleagues and services:

Share with others.