Lesson 3 - Safeguarding, Domestic Abuse and Escalation
1. Introduction
Safeguarding is everyone’s responsibility. Case workers often develop trusting relationships with patients and families and may therefore be among the first people to notice that someone is being harmed, neglected, controlled or placed at risk.
Safeguarding concerns are not always disclosed directly. A patient may become unusually anxious when a partner enters the room, a child may describe frightening events at home without calling them abuse, or an adult may repeatedly miss appointments because somebody controls their telephone, money or movements. Concerns may also emerge gradually through a pattern of apparently minor observations.
The role of the case worker is not to investigate or decide whether abuse has occurred. The role is to recognise possible concerns, listen carefully, respond safely, record information accurately and escalate promptly through the correct safeguarding pathway.
This lesson examines safeguarding children and adults, with particular attention to domestic abuse. It explains how to respond to disclosures, how confidentiality applies, when consent may not be required and how to escalate concerns according to urgency.
This lesson should be read alongside the organisation’s current safeguarding policies, local safeguarding partnership procedures and emergency escalation arrangements.
2. Learning Outcomes
By the end of this lesson, learners should be able to:
Explain what safeguarding means in relation to children, young people and adults.
Recognise common indicators of abuse, neglect, exploitation and domestic abuse.
Respond appropriately when a patient or family member discloses abuse.
Distinguish between immediate danger, an urgent safeguarding concern and a concern requiring routine escalation.
Record and share safeguarding information accurately, proportionately and safely.
Escalate concerns to the appropriate senior clinician, safeguarding lead, local authority or emergency service.
3. The Lecture
What Is Safeguarding?
Safeguarding means protecting a person’s right to live safely and free from abuse, neglect and exploitation. It includes identifying risks, preventing harm where possible and taking appropriate action when harm may already be occurring.
Safeguarding is broader than responding to confirmed abuse. It includes situations in which:
Abuse is suspected but has not been proven.
A person is being neglected by somebody else.
A person may be unable to care for themselves safely.
A child is being affected by risks within the family home.
An adult is being controlled, exploited or intimidated.
A person is being targeted online.
A patient’s behaviour may place a child or vulnerable adult at risk.
A professional or service may be behaving in an unsafe or abusive way.
Safeguarding work requires professional curiosity. This means noticing inconsistencies, considering what may be happening behind the information presented and respectfully seeking clarification. It does not mean treating every patient or family with suspicion.
Safeguarding Children
A child is anyone who has not yet reached their eighteenth birthday. Safeguarding and promoting the welfare of children includes protecting children from maltreatment, preventing impairment of their physical or mental health or development, ensuring that they receive safe and effective care, and taking action to help them achieve the best possible outcomes.
The main categories of child abuse are:
Physical abuse.
Emotional abuse.
Sexual abuse.
Neglect.
Children may also experience exploitation, domestic abuse, online abuse, criminal exploitation, sexual exploitation, trafficking, forced marriage, so-called “honour”-based abuse, female genital mutilation or harm associated with radicalisation.
A child does not need to make a direct allegation before a concern can be escalated. A combination of behavioural changes, unexplained injuries, family circumstances and professional observations may be sufficient to create a reasonable safeguarding concern.
Safeguarding Adults
Adult safeguarding duties generally apply when an adult:
Has needs for care and support, whether or not those needs are currently being met.
Is experiencing, or is at risk of, abuse or neglect.
Is unable to protect themselves from that abuse or neglect because of their care and support needs.
Care and support needs may arise from mental illness, learning disability, physical disability, cognitive impairment, frailty, illness or other circumstances affecting the person’s ability to protect themselves.
Not every adult who experiences abuse will meet the legal criteria for a statutory adult safeguarding enquiry. However, this does not mean that concerns should be ignored. The person may still need support from domestic abuse services, the police, healthcare services, housing services or another agency.
Forms of adult abuse include:
Physical abuse.
Sexual abuse.
Psychological or emotional abuse.
Domestic abuse.
Financial or material abuse.
Neglect and acts of omission.
Organisational abuse.
Discriminatory abuse.
Modern slavery.
Self-neglect.
Adults should usually be involved in decisions about their safety. Their wishes, autonomy and desired outcomes should be respected wherever possible. However, action may still be required without consent when there is an immediate danger, a serious risk to others, concern about a child, possible coercion, impaired decision-making capacity or another overriding public-interest justification.
Abuse Does Not Always Look Obvious
Safeguarding concerns often present indirectly. Possible indicators include:
Injuries that are unexplained or inconsistent with the explanation provided.
Frequent injuries or repeated attendance for medical treatment.
Sudden changes in mood, behaviour, sleep, attendance or functioning.
Fearfulness, hypervigilance or becoming unusually withdrawn.
A person appearing frightened of a partner, relative or carer.
A companion refusing to allow the patient to speak privately.
A partner answering every question or controlling access to appointments.
Poor hygiene, hunger, inappropriate clothing or untreated health problems.
A child taking on excessive caring responsibilities.
Repeated loss of money or unexplained financial difficulties.
A person being denied access to medication, mobility aids, communication devices or healthcare.
Sexualised behaviour or knowledge that is not developmentally expected.
Running away, going missing or unexplained gifts and money.
Significant deterioration without an adequate explanation.
A person describing abuse and then quickly withdrawing their account when another person is present.
These signs are not proof of abuse. There may be other explanations. They should nevertheless prompt careful enquiry, accurate documentation and discussion with an appropriate senior professional.
Understanding Domestic Abuse
Domestic abuse is not limited to physical violence. It can involve a single incident or a pattern of behaviour between people aged 16 or over who are personally connected.
It may include:
Physical or sexual abuse.
Violent or threatening behaviour.
Controlling or coercive behaviour.
Psychological or emotional abuse.
Economic abuse.
People may be personally connected because they are or have been partners, spouses, civil partners, relatives, parents of the same child or connected through another qualifying family relationship.
Domestic abuse can occur in any community and can affect people of any sex, gender identity, sexual orientation, ethnicity, religion, age, social background or profession. Men can be victims, women can be perpetrators, and abuse can occur within same-sex relationships. However, patterns of serious and repeated domestic abuse are not evenly distributed, and responses should remain sensitive to the person’s individual circumstances.
Coercive and Controlling Behaviour
Coercive control is a pattern of behaviour used to dominate another person and reduce their independence. It may be subtle when individual incidents are considered separately.
Examples include:
Isolating someone from friends, relatives or professionals.
Monitoring calls, messages, social media or location.
Controlling clothing, food, sleep, medication or access to healthcare.
Preventing someone from working, studying or leaving the home.
Dictating where the person can go and who they may see.
Repeated humiliation, criticism or degradation.
Threatening suicide, harm, exposure or loss of the children.
Using immigration status, disability, religion or sexuality to control the person.
Destroying property or harming pets.
Making the person account for every action or purchase.
Using children to monitor, manipulate or intimidate the other parent.
Controlling access to money, benefits, bank accounts or essential items.
A patient may minimise these behaviours because they have become normalised. They may say, “They are just protective,” “I am bad with money,” or “It is easier if they make the decisions.” The practitioner should consider the overall pattern and its effect on the person’s freedom, safety and wellbeing.
Economic Abuse
Economic abuse involves behaviour that has a substantial adverse effect on a person’s ability to obtain, use or maintain money, property, goods or services.
Examples include:
Taking wages or benefits.
Preventing access to bank accounts.
Taking out credit in the person’s name.
Deliberately creating debts.
Preventing the person from working.
Withholding money for food, transport or medication.
Controlling all household spending.
Damaging possessions needed for employment or independence.
Economic abuse can continue after a relationship has ended and may prevent someone from leaving safely.
Children and Domestic Abuse
Children can be victims of domestic abuse in their own right when they see, hear or experience its effects and are related to either the victim or the perpetrator.
A child does not need to witness a physical assault directly to be harmed. They may:
Hear shouting, threats or violence from another room.
See injuries or damaged property afterwards.
Intervene in an incident.
Try to protect a parent or sibling.
Be used to pass messages, monitor a parent or enforce contact.
Experience disrupted sleep, school attendance or routines.
Live in fear of the next incident.
Develop anxiety, low mood, aggression, withdrawal or trauma symptoms.
Feel responsible for keeping family members safe.
Domestic abuse involving a household with children should therefore prompt consideration of the safety and welfare of every child in that household.
Why People May Not Disclose Domestic Abuse
A person may remain silent, minimise the abuse or return to an abusive relationship for many reasons. These may include:
Fear of retaliation.
Concern that the abuse will become more serious.
Financial dependence.
Lack of safe housing.
Emotional attachment to the abusive person.
Concern about the children.
Fear that children will be removed.
Shame, guilt or self-blame.
Threats involving immigration status.
Disability or dependence on the abusive person for care.
Previous negative experiences with services.
Social, religious or family pressure.
Monitoring of communications.
Belief that nobody will believe them.
Fear of being “outed” or discriminated against.
Hope that the relationship will improve.
Leaving can be a particularly dangerous time. Practitioners should not simply tell a person to leave or confront the alleged perpetrator. Safety planning and specialist advice may be required.
Asking About Domestic Abuse Safely
Questions about domestic abuse should, wherever possible, be asked when the person is alone. Do not ask about abuse in front of a partner, family member or anyone who may be involved in controlling them.
In remote appointments, confirm whether the person can speak freely. Consider whether somebody may be in the room, listening outside the door or monitoring the device.
Helpful opening questions include:
“Do you feel safe at home?”
“Is anyone hurting, frightening or controlling you?”
“Does anyone stop you from seeing people, attending appointments or managing your own money?”
“Has anybody threatened you or made you feel afraid?”
“Sometimes people experience controlling or abusive behaviour in relationships. Has anything like that happened to you?”
“Are you able to speak freely at the moment?”
Ask calmly and without judgement. Avoid interrogating the person or demanding unnecessary detail. If privacy cannot be established, consider arranging a safer opportunity to speak rather than asking questions that could increase the danger.
Responding to a Disclosure
A disclosure should be met with calm, respectful listening. The person may have taken a significant risk by speaking.
A helpful response includes:
Listening without expressing shock or disbelief.
Thanking the person for telling you.
Acknowledging that the behaviour is not their fault.
Taking the concern seriously.
Checking immediate safety.
Explaining what will happen next.
Avoiding promises that cannot be kept.
Seeking senior safeguarding advice promptly.
Useful phrases include:
“Thank you for telling me.”
“I am sorry that this has happened to you.”
“You are not responsible for another person choosing to behave abusively.”
“I need to ask a few questions to understand whether you or anyone else is in immediate danger.”
“I cannot promise to keep this completely confidential, because I may need to share information to help keep you or somebody else safe. I will explain what I am doing wherever it is safe to do so.”
Avoid saying:
“Why didn’t you leave?”
“Why did you let this happen?”
“Are you sure?”
“I won’t tell anyone.”
“You need to go home and confront them.”
“If it was serious, you would have reported it before.”
Responding to a Child’s Disclosure
When a child discloses abuse:
Stay calm and listen.
Allow the child to use their own words.
Take what they say seriously.
Reassure them that telling you was the right thing to do.
Explain that the information must be shared with people who can help.
Ask only enough questions to clarify immediate safety and what action is required.
Record the child’s words as accurately as possible.
Escalate without delay.
Do not:
Promise secrecy.
Ask leading questions.
Conduct a detailed investigation.
Ask the child to repeat the account to multiple people unnecessarily.
Confront the alleged perpetrator.
Contact parents or carers before seeking safeguarding advice if doing so could place the child at greater risk.
Delay escalation while attempting to obtain proof.
Open prompts such as “Tell me what happened” or “What happened next?” are preferable to questions that suggest an answer.
Immediate Safety Assessment
After a disclosure, establish whether anyone is in immediate danger.
Relevant questions may include:
Is the alleged perpetrator present or expected soon?
Has anybody been injured?
Are emergency medical services required?
Have weapons been used or threatened?
Has there been strangulation or suffocation?
Has the violence recently increased?
Have threats to kill been made?
Is the person being prevented from leaving?
Are children present?
Is the person safe to end the call?
Is it safe to send a text, email or voicemail?
Does the alleged perpetrator have access to the person’s telephone or online accounts?
Is there somewhere safe the person can go?
Strangulation, threats to kill, weapon use, escalating violence, stalking, separation and severe coercive control are particularly concerning indicators. The case worker should not attempt to manage these risks independently.
Levels of Escalation
Immediate danger
If someone is in immediate danger, a serious assault is occurring, urgent medical attention is required or a serious crime may be in progress, contact 999.
If the appointment is remote, obtain the person’s current location if it is safe and possible to do so. Remain connected when appropriate while another team member contacts emergency services. Follow organisational procedures and seek immediate senior support.
Do not rely solely on sending an email or leaving a message for a safeguarding lead when there is an immediate threat to life or safety.
Urgent safeguarding concern
A concern may be urgent even when no assault is taking place at that exact moment. Examples include:
A child reporting recent abuse.
A person facing a credible threat of serious harm.
An alleged perpetrator expected to return shortly.
Escalating violence or stalking.
A dependent adult being left without essential care.
A person being denied essential medication.
Concern that a child or adult may be taken away or become uncontactable.
A high-risk domestic abuse disclosure.
Concern involving sexual abuse or exploitation.
The case worker should contact the senior clinician or safeguarding lead immediately and follow the relevant referral pathway. Depending on the situation, this may involve children’s social care, adult social care, the police, healthcare services or a specialist domestic abuse service.
Concern without immediate danger
Concerns that do not appear immediately dangerous must still be acted upon. Discuss them with the senior clinician or safeguarding lead as soon as possible and within the timescale set by organisational policy.
A lack of immediate danger is not the same as an absence of risk. Patterns of neglect, coercion or emotional abuse may cause serious cumulative harm.
The Case Worker’s Role in Escalation
The case worker’s responsibility is to recognise, record, report and escalate. It is not to determine whether abuse is proven.
A practical approach is:
Recognise the concern.
Respond calmly and check immediate safety.
Record the relevant facts.
Report the concern promptly.
Refer through the appropriate pathway when instructed or authorised to do so.
Confirm that the concern has been received.
Continue to escalate if the response does not adequately address the risk.
Telling a colleague is not always the end of the case worker’s responsibility. The practitioner should make sure the concern reaches somebody with the authority and competence to act. If the usual safeguarding contact is unavailable and the situation cannot safely wait, use the next level of escalation described in organisational policy.
Consent, Confidentiality and Information Sharing
Confidentiality is important, but it is not absolute. Relevant information may need to be shared to protect a child or an adult from serious harm.
Where possible, explain:
What information you propose to share.
Who it will be shared with.
Why sharing is necessary.
What may happen next.
For adults, consent should normally be sought when it is safe and appropriate. However, information may sometimes need to be shared without consent. Examples include:
Immediate or serious risk to the person.
Risk to a child.
Risk of serious harm to another person.
Concern that the person is being coerced or controlled.
Concern that the person lacks capacity to make the relevant decision.
A serious crime.
Risk to other vulnerable people.
A legal duty or other overriding public-interest justification.
A refusal of consent should not automatically end the safeguarding response. It should prompt discussion with the safeguarding lead about the risks, the person’s capacity, the impact on others and the lawful basis for any proposed information sharing.
Share only information that is relevant and proportionate. Record what was shared, with whom, why it was shared and whether consent was obtained. If a decision is made not to share information, document the reasons.
If uncertain, seek advice. Uncertainty should not be used as a reason to do nothing.
Mental Capacity and Coercion
An adult should not be assumed to lack capacity simply because they make a decision that professionals consider unwise. Capacity is decision-specific and time-specific.
At the same time, apparent agreement may not represent a freely made decision. Domestic abuse, threats, dependency and coercive control can significantly affect a person’s ability to express their genuine wishes.
Case workers should escalate concerns when:
The person appears unable to understand relevant information.
They cannot retain or weigh the information needed to decide.
They cannot communicate a decision.
Their stated wishes appear to be controlled by fear or threats.
Another person repeatedly prevents private conversation.
There is doubt about whether consent is voluntary.
Formal capacity assessments and complex decisions should be undertaken by an appropriately trained professional.
Recording Safeguarding Concerns
A safeguarding record should be factual, clear, timely and sufficiently detailed to support further action.
Record:
The date, time and type of contact.
Who was present.
Whether the person was seen or spoken to alone.
The concern and how it arose.
The person’s own words, particularly for important disclosures.
Relevant observations, including injuries or behaviour.
Questions asked and responses given.
Immediate safety considerations.
Details of any children or other people who may be at risk.
Advice sought and from whom.
Decisions made and the reasons for them.
Information shared, with whom and why.
Whether consent was sought or obtained.
Referrals or emergency action taken.
Any agreed follow-up.
Distinguish clearly between:
What the person said.
What another person said.
What you directly observed.
Your professional concern or interpretation.
For example, write, “She said, ‘He pushed me against the wall last night,’” rather than, “She was definitely assaulted.” Write, “A bruise approximately 3 cm in diameter was visible on her left forearm,” rather than, “She had clearly been grabbed.”
Do not use judgemental language, speculate about motives or include unnecessary personal information.
Safe Communication and Digital Risks
Domestic abuse may involve monitoring of telephones, email accounts, online records, location services or browsing history.
Before sending information, consider:
Is this telephone number safe?
Is it safe to leave a voicemail?
Can text messages be read by another person?
Is the email account private?
Could an appointment reminder reveal that the person has sought help?
Has the person identified a safe method or time for contact?
Could shared access to patient portals expose sensitive information?
Do not place a person at greater risk by sending domestic abuse resources or detailed safeguarding information without checking whether the communication method is safe.
Working With Alleged Perpetrators
A mental health difficulty does not excuse abusive behaviour. Abuse should not automatically be attributed to stress, alcohol, neurodevelopmental differences, trauma or mental illness.
If a patient describes perpetrating abuse:
Take the disclosure seriously.
Assess immediate risk to the victim, children and others.
Do not collude with minimisation or victim-blaming.
Do not conduct informal couples work where coercive control is suspected.
Escalate to a senior clinician or safeguarding lead.
Consider whether information must be shared to protect others.
Follow organisational and local multi-agency procedures.
Maintain professional boundaries.
Do not confront an alleged perpetrator about another person’s confidential disclosure unless this has been specifically planned with the safeguarding team and can be done safely.
Professional Disagreement and Escalation
Safeguarding decisions are not always straightforward. Professionals may disagree about the level of risk or the action required.
If you believe that a concern has not been taken seriously:
Explain your concern clearly.
State the specific risk and the evidence supporting it.
Ask what action will be taken and within what timescale.
Escalate to the safeguarding lead or another senior professional.
Follow the local professional challenge or escalation procedure.
Record the disagreement and the action taken.
Professional hierarchy should never prevent a practitioner from raising a genuine concern. Respectful challenge is part of safe practice.
Concerns About a Colleague or Organisation
Safeguarding concerns may involve a colleague, contractor, volunteer or another professional.
Examples include:
Harmful or abusive behaviour towards a patient.
Sexualised comments or boundary violations.
Inappropriate private contact.
Rough handling or punitive care.
Financial exploitation.
Deliberate neglect.
Falsification or concealment of records.
Retaliation against somebody who has raised a concern.
Do not investigate the matter yourself or alert the person who is the subject of the allegation without senior advice. Preserve relevant evidence and report the concern immediately through the organisation’s safeguarding and whistleblowing procedures.
Where an allegation concerns a person working with children, specific local authority designated officer procedures may apply.
Safeguarding and Therapeutic Relationships
Patients may worry that raising a safeguarding concern will damage trust. In practice, trust is more likely to be preserved when practitioners are honest about their responsibilities.
Explain confidentiality and its limits early in the relationship. Avoid presenting information sharing as a punishment. The purpose is to protect people and obtain appropriate support.
Where safe, continue to involve the patient in decisions. Tell them what has been shared and what is likely to happen next. A safeguarding referral should not mean that the person loses all choice or control.
4. Clinical Perspective
Clinical Pearls
A disclosure is not required before you can raise a safeguarding concern. Patterns, observations and contextual information may be enough to justify escalation.
Do not confuse a calm presentation with low risk. People experiencing long-term abuse may describe serious events in a flat, detached or matter-of-fact way.
A person withdrawing a disclosure does not prove that the original account was false. Fear, pressure or concern about the consequences may have influenced the withdrawal.
Always consider who else may be at risk. A disclosure by an adult may reveal risks to children, older relatives, disabled family members or future partners.
In domestic abuse cases, the period around separation may be particularly dangerous. Do not assume that leaving immediately is always the safest action.
Practical Tips
At the beginning of remote contacts, confirm the patient’s location and whether they can speak privately when this is clinically appropriate.
Use plain, direct questions. Vague questions such as “Is everything okay at home?” can be easy to dismiss. Asking whether anyone is frightening, hurting or controlling the person is often clearer.
If a patient seems unable to speak freely, do not force a disclosure. Try to create a safe opportunity for private communication and seek senior advice.
Write the record as soon as possible. Exact words and important details can be lost quickly.
Know how to contact the organisation’s safeguarding lead, local children’s social care, adult safeguarding service and emergency services before a concern arises.
Common Pitfalls
One common mistake is waiting for certainty. Safeguarding referrals communicate concerns so that the appropriate agency can assess them. The referrer is not expected to prove abuse.
Another is promising complete confidentiality. This can damage trust if information later has to be shared.
A further pitfall is asking too many questions. Detailed questioning may distress the person, contaminate evidence or make them repeat their experience unnecessarily.
Do not assume that another professional will make the referral unless this has been explicitly agreed. Confirm who is taking responsibility and by when.
Do not send sensitive information through a potentially monitored telephone or email account without considering safety.
Do not minimise domestic abuse because there has been no physical violence. Coercive control, threats, stalking and economic abuse can produce severe and lasting harm.
Advice for Newly Qualified Practitioners
You are not expected to manage safeguarding concerns alone. Escalating promptly is a sign of safe practice, not professional inadequacy.
When seeking advice, be ready to explain:
Who you are concerned about.
What happened or what was disclosed.
What you directly observed.
Who may currently be at risk.
Whether children are involved.
Whether the alleged perpetrator is present.
Whether there is immediate danger.
What action has already been taken.
Whether the person knows that the concern is being escalated.
If you remain concerned after receiving advice, say so clearly and continue through the escalation pathway.
Situations Requiring Immediate Senior Escalation
Seek immediate senior advice when:
A child discloses abuse or neglect.
There is suspected sexual abuse or exploitation.
Domestic abuse involves children.
There are threats to kill, strangulation, stalking, weapon use or escalating violence.
A patient fears returning home.
An adult may lack capacity to make a relevant safety decision.
Coercion may be affecting consent.
The alleged perpetrator has access to vulnerable people.
There is disagreement about whether information should be shared.
A colleague or professional is implicated.
You are uncertain whether emergency services are required.
A referral has been declined but significant concerns remain.
If there is immediate danger, contact 999 first and notify the senior clinician without delaying emergency action.
5. Summary
Safeguarding involves protecting children and adults from abuse, neglect and exploitation. Case workers may identify concerns through direct disclosures, observations, changes in behaviour or patterns that develop over time.
Domestic abuse includes physical and sexual abuse, threats, controlling or coercive behaviour, emotional abuse and economic abuse. Children who see, hear or experience the effects of domestic abuse are victims in their own right.
The case worker’s role is to recognise concerns, respond calmly, assess immediate safety, record information accurately and escalate promptly. The case worker should not conduct an investigation, promise secrecy or confront an alleged perpetrator.
Confidentiality is important but does not prevent proportionate information sharing when this is necessary to protect a child or prevent serious harm. Adults should be involved in decisions wherever possible, but consent is not always required before safeguarding information is shared.
The central practical principle is:
Recognise → Respond → Record → Report → Refer → Review
When uncertain, seek safeguarding advice. When immediate danger is present, contact 999.
6. Further Reading
Department for Education: Working Together to Safeguard Children 2026
Department for Education: Information Sharing to Safeguard Children and Young People
Department of Health and Social Care: Care and Support Statutory Guidance
Practitioners should also read the organisation’s safeguarding children policy, safeguarding adults policy, domestic abuse procedure, information-sharing policy and local multi-agency referral guidance.
7. Knowledge Check
Question 1
A 14-year-old tells a case worker, “My stepfather hit me last night, but you must promise not to tell anybody.” What is the most appropriate response?
A. Promise confidentiality so that the child continues talking.
B. Explain that the information must be shared with people who can help keep them safe.
C. Telephone the stepfather to ask for his account.
D. Wait to see whether the child mentions it again.
Correct answer: B
Explanation:
A is incorrect because the practitioner cannot promise secrecy when a child may be at risk of harm.
B is correct because the child should be listened to, taken seriously and given an honest explanation that relevant information must be shared to support their safety.
C is incorrect because contacting the alleged perpetrator could increase the risk to the child and interfere with safeguarding enquiries.
D is incorrect because a direct disclosure of physical abuse requires prompt escalation. The practitioner should not wait for a second disclosure.
Question 2
Which example most clearly describes coercive control?
A. A couple disagreeing once about how to spend their holiday money.
B. A partner repeatedly monitoring messages, controlling money and preventing contact with friends.
C. A patient asking their spouse to remind them to take medication.
D. Two adults choosing to use a joint bank account.
Correct answer: B
Explanation:
A is incorrect because ordinary disagreement, without fear, domination or a pattern of control, is not necessarily abuse.
B is correct because repeated monitoring, financial control and isolation form a pattern that restricts the person’s independence.
C is incorrect because agreed support with medication is not inherently controlling. The important issues are consent, freedom and the wider pattern of behaviour.
D is incorrect because a jointly agreed financial arrangement is not abuse. It becomes concerning when one person uses money to dominate, deprive or trap the other.
Question 3
During a video appointment, a patient repeatedly looks towards the door and gives only yes-or-no answers. Their partner can be heard nearby. What should the case worker do?
A. Ask directly about domestic abuse while the partner can hear.
B. Assume the patient does not want to engage and end the appointment.
C. Consider whether the patient can speak safely and arrange a private method of contact if possible.
D. Send domestic abuse information immediately to the shared email address.
Correct answer: C
Explanation:
A is incorrect because asking directly while a potentially abusive partner is listening could increase the patient’s risk.
B is incorrect because the behaviour may indicate fear, monitoring or lack of privacy rather than unwillingness to engage.
C is correct because the practitioner should consider privacy and try to create a safer opportunity for communication.
D is incorrect because a shared or monitored email account may expose the disclosure or the patient’s attempt to seek help.
Question 4
An adult with full decision-making capacity discloses domestic abuse but does not want a referral. There are no children and no identified risk to anyone else. What is the best initial approach?
A. Automatically contact the police against the adult’s wishes.
B. Respectfully explore the risks, offer support and seek senior safeguarding advice.
C. Tell the adult there is nothing the service can do.
D. Contact the alleged perpetrator to negotiate an agreement.
Correct answer: B
Explanation:
A is incorrect because adults with capacity should generally be involved in decisions, and disclosure does not automatically require police contact against their wishes. Exceptions may apply when there is an immediate or serious risk, a serious crime, risk to others or another lawful justification.
B is correct because the practitioner should assess safety, explain options, offer support and discuss the situation with the appropriate senior professional.
C is incorrect because support, safety planning, specialist services and safeguarding advice may still be available even if the adult does not currently want a formal referral.
D is incorrect because confronting or negotiating with the alleged perpetrator may increase risk and is outside the case worker’s role.
Question 5
Which is the best example of an objective safeguarding record?
A. “The patient’s husband is clearly violent and dangerous.”
B. “The patient looked like a typical abuse victim.”
C. “The patient said, ‘He pushed me against the wall last night.’ A bruise was visible on her left forearm.”
D. “The relationship is toxic and she should leave immediately.”
Correct answer: C
Explanation:
A is incorrect because it presents an unverified conclusion as fact.
B is incorrect because it is vague, stereotyped and judgemental.
C is correct because it distinguishes the patient’s own words from the practitioner’s direct observation.
D is incorrect because “toxic” is imprecise and the statement imposes advice without recording the relevant evidence or considering safe planning.
Question 6
A child lives in a home where they regularly hear one parent threaten and assault the other. The child has not been physically assaulted. Which statement is correct?
A. There is no safeguarding concern because the child was not directly hit.
B. The child may be a victim of domestic abuse in their own right.
C. The situation concerns only the adults.
D. Action is required only if the child’s school attendance falls.
Correct answer: B
Explanation:
A is incorrect because children can be seriously harmed by seeing, hearing or experiencing the effects of domestic abuse.
B is correct because legislation recognises children as victims in their own right when they see, hear or experience the effects of domestic abuse and are related to the victim or perpetrator.
C is incorrect because domestic abuse within a household can have significant consequences for a child’s safety, emotional wellbeing and development.
D is incorrect because safeguarding action does not depend on measurable deterioration in school attendance.
Question 7
A patient says that their partner strangled them yesterday and has threatened to kill them if they leave. What is the most appropriate response?
A. Arrange a routine review in four weeks.
B. Advise the patient to confront the partner.
C. Treat the disclosure as a potentially high-risk situation and seek immediate safety and safeguarding action.
D. Wait until there is visible evidence of injury.
Correct answer: C
Explanation:
A is incorrect because strangulation and threats to kill are serious indicators requiring urgent action.
B is incorrect because confrontation could place the patient at greater risk.
C is correct because immediate safety should be assessed and urgent senior, police, medical or safeguarding action considered according to the circumstances.
D is incorrect because strangulation may cause serious injury without obvious external marks. A lack of visible injury does not make the concern less serious.
Question 8
A case worker reports a child safeguarding concern to a colleague, who says, “It is probably nothing.” The case worker remains seriously concerned. What should they do?
A. Accept the colleague’s opinion because the concern has been reported.
B. Investigate the family independently.
C. Escalate the concern through the safeguarding or professional challenge procedure.
D. Remove the concern from the clinical record.
Correct answer: C
Explanation:
A is incorrect because the practitioner retains a responsibility to escalate if they believe a significant risk has not been addressed.
B is incorrect because the case worker should not conduct an independent child protection investigation.
C is correct because respectful professional challenge and further escalation are necessary when safeguarding concerns remain unresolved.
D is incorrect because the concern and the actions taken must be documented accurately.
Question 9
Which statement about sharing safeguarding information is most accurate?
A. Information can never be shared without consent.
B. All information in the clinical record should be shared whenever a concern arises.
C. Relevant and proportionate information may be shared without consent when necessary to protect a child or prevent serious harm.
D. Confidentiality no longer applies once the word “safeguarding” is used.
Correct answer: C
Explanation:
A is incorrect because confidentiality is not absolute. There are circumstances in which information can and should be shared without consent.
B is incorrect because information sharing should be necessary, relevant and proportionate. Entire records should not routinely be disclosed.
C is correct because protecting a child or preventing serious harm may justify information sharing without consent. The rationale should be recorded.
D is incorrect because confidentiality continues to matter. Safeguarding does not permit unrestricted or unnecessary disclosure.
Question 10
Which statement best describes the case worker’s responsibility when abuse is suspected?
A. The case worker must prove that abuse has occurred before making a referral.
B. The case worker should recognise, respond, record, report and escalate the concern.
C. The case worker should question every possible witness before speaking to a senior clinician.
D. The case worker should decide whether the alleged perpetrator is guilty.
Correct answer: B
Explanation:
A is incorrect because practitioners do not need proof before raising a safeguarding concern. Waiting for certainty may leave somebody at risk.
B is correct because the case worker’s role is to identify possible harm, respond safely, document the relevant facts and ensure that the concern reaches the appropriate professional or agency.
C is incorrect because interviewing witnesses would amount to an investigation and may compromise subsequent safeguarding or police enquiries.
D is incorrect because determining guilt is not the case worker’s role. Safeguarding focuses on identifying risk and protecting those who may be harmed.
