Constructing “harm” and “ASP” in practice

At a policy level, I have argued, the problem of “harm” to “adults at risk” has been constructed in particular, contingent ways. So too has the type of response we call “adult support and protection”. Some sociology that aligns with this view seems to emphasise the ways that these kinds of constructions constrain the ways we think and act. That is, we have fashioned certain concepts at a professional, political and/or societal level, and now they are the lenses through which we view the world.

Social construction isn’t just about constraints on our thinking, however – just as policy isn’t simply “imposed” onto practice. I would argue instead that quite an active type of construction is inevitably going on at a practice level too. Certainly, professionals are taught that they must spot when “harm” to an “adult at risk” is indicated, and they must activate ASP procedures when they consider that it is. But a number of pieces of research have begun to suggest that the process of determining what comes to count as “harm” and/or as “ASP” is more complicated than this. Most of this research does not come from Scotland. Even less comes from the post-ASPSA Scottish context. A fair bit comes from England, for instance, where they talk about “safeguarding” and “abuse” and sometimes about “vulnerable adults” (17,18,19). I think that the really important messages from these types of findings are transferable across policy and legislative contexts, though, and I’ll come back to explain why at a later point.

Some of the research on which I based my PhD was conducted in Scotland immediately prior to the implementation of the ASPSA. This work produced some findings that conflicted with a policy assumption at that time: namely, that “adult protection” is something that happens when “abuse” to a “vulnerable adult” is suspected or established. In contrast with this assumption, the concept of “abuse” did not seem to be particularly helpful to practitioners in our research, when deciding what was to count as an “adult protection” issue. Sometimes they thought of something as “abuse” but they didn’t think an “adult protection” response was appropriate. Sometimes they thought an “adult protection” response was appropriate to circumstances they didn’t think of as “abuse”. You can read more about this here or here.

In two later papers, I tried to show that this wasn’t just because “abuse” is a tricky concept to define, although it undoubtedly is. And it wasn’t just because practitioners did not know or understand the definitions they were supposed to be working to. This means that re-wording the definitions and training people more thoroughly in them, as happened when the ASPSA was implemented, was not necessarily the “answer” to this “problem”. Rather, I suggested that deciding  to go down a particular route called “adult protection” or “ASP” was never just an issue of identifying a discrete phenomenon, whatever you called it and however you defined it. It was an issue of making judgements about what would happen, if a set of circumstances was defined in a certain way. These judgements might be more or less explicitly negotiated, and they might be more or less consciously strategic. Overall, however, they were arguably better thought of as setting out to achieve something (i.e. a particular response or outcome), rather than just to describe something (i.e. “abuse” or “harm”).

Take the patterns I identified, in those concerns that were channelled into ASP processes as opposed to those that weren’t. In particular, it was very common for concerns about paid carers’ practice to make their way into ASP processes: a single incident of concern was usually enough to make this happen. Meanwhile, there was much more variability in the ways concerns about family carers were dealt with, and it was much more common for concerns to build up over months or years before ASP processes began to be considered. Concerns understood to stem from institutions and their workings were treated differently again. These types of concerns included familiar issues of neglect in residential settings, but also a range of other things that could concern some service users as much as, or more than this: for instance, monitoring that was experienced as excessive and intrusive; disrespectful and/or dismissive professional attitudes; under-resourced services that let people down. Issues across this whole range of institutionally-perpetrated concerns were less likely to be understood to “count” as ASP than concerns perpetrated by individuals. You can read more about this here or here.

I would suggest that these patterns become more comprehensible, once we understand that practitioners were channelling things down an ASP route with a view to what this might achieve, rather than with a view to abstract definitions of “abuse” alone. So, they knew that ASP processes had a great deal of leverage, should the concern be a paid carer’s callous or neglectful behaviour. On the other hand, they knew that many other types of concerns would not be influenced by invoking ASP. For instance, it could be argued that some adults in the sample had suffered or were placed at risk because of the under-resourcing of social work departments, or because of the discharge policy of the NHS. On paper, these types of concern might equally meet the definition of “abuse” or “harm”. But they were screened out of ASP procedures because practitioners knew what such procedures could or couldn’t do.

The particularly variable responses to concerns about family carers was interesting in this respect, because it seemed to be linked in turn to a varied range of ideas about what ASP is and/or what it can do. Some practitioners seemed to think that ASP involved a less consensual, more coercive form of practice. They tended to argue that concerns arising in families might more sensitively be addressed in other types of way. Other practitioners felt able to reconcile ASP practice with flexible and collaborative ways of working. They seemed more able to conceptualise something both as a “family” or “relationship” issue and as an ASP concern. You can read more about this here or here. Why practitioners had such different views about what ASP involves is a subject for more research. However, it might be linked in part to different approaches and processes in different local authority areas, some of which were more flexible and less bureaucratised than others (19).

It could (and undoubtedly has at times) been argued that all these types of consideration should be immaterial, in deciding what is to count as ASP. According to this argument, either something meets the definition of “harm”/”abuse” or it does not. Whether it does so should be the one deciding factor. This flies in the face of the way that many theorists would argue that the social world works, however. Human beings just aren’t like that: they categorise the world in order to influence it, not only in order to describe it. Phenomena like “abuse” or “harm” are continually constructed and re-constructed in these micro-processes (12). Nor is there a bottom-line “truth” to guide practitioners, about the “actual” boundaries of abuse or harm, according to the sociology I have drawn upon before. Studies of social policy and administration over many years and in many types of field have also indicated that practitioners actively interpret policy. In a sense they have to, at the very least when they’re dealing in human lives and human meanings: no top-down prescription will ever capture all the nuances, and all the answers to all the uncertainty that people like social workers have to work through on the ground (20,21). This has been argued and evidenced a number of times in the more developed field of child protection (22,23).

This leaves us with the question of how best to support ASP work in ways that follow the grain of real social processes, and the real ways that policies are translated into practice, rather than trying to work against them, or at least not to an unrealistic degree.