Talofa and welcome to the final topic in this module! Here, we’ll explore what vulnerability means for the people you support. We’ll look at the different factors that can contribute to a person’s vulnerability and discuss how you can respond if you think tāngata or their whānau may be in a vulnerable situation and at risk of abuse or neglect.
Trigger Warning
In this topic we will be discussing abuse and neglect. Please note that this content may be distressing for some people.
What is Vulnerability?
Vulnerability is defined as "the quality or state of being exposed to the possibility of being harmed, either physically or emotionally" (Oxford Dictionary). People who rely on health and wellbeing services often depend on others for support, which can put them in a more vulnerable position. This dependence may make them more susceptible to abuse or neglect.
As a support worker, understanding vulnerability is key to providing effective, compassionate care. This awareness not only helps you build trust with tāngata and their whānau but also enables you to recognise the signs that may indicate they are at risk of abuse or neglect. By identifying these signs early, you can take appropriate action to protect their well-being and safety.
Types of Vulnerability and Contributing Factors
Vulnerability can take different forms, each shaped by a range of factors that can increase the risk of abuse or neglect for tāngata and their whānau.
Click on the expand button to explore the types of vulnerabilities and the factors that contribute to them.
- Physical vulnerability refers to an increased risk of injury or harm due to a person’s reliance on physical support for daily activities.
- This reliance may stem from chronic health conditions (e.g., diabetes, liver disease), mobility issues, sensory impairments, difficulties with coordination or balance, reduced physical strength, physical isolation, or age-related changes.
- When individuals depend on others for physical support, they may be at a greater risk of abuse or neglect, especially if they seek help from untrustworthy individuals who could exploit their situation.
- Emotional vulnerability occurs when individuals experience feelings of loneliness, powerlessness, or isolation, often due to relying on others for care or support, which can create power imbalances.
- This type of vulnerability can be caused by factors such as stress, anxiety, depression, mood disorders, past trauma, emotional distress, low self-esteem, or a lack of close relationships. These factors can affect an individual's emotional resilience.
- Emotionally vulnerable people may form unhealthy or inappropriate relationships, putting them at risk of emotional abuse. In such cases, an abuser might exploit their power or control to manipulate the vulnerable individual, creating an emotionally dependent and potentially harmful relationship.
- Cognitive vulnerability refers to difficulties with thinking, memory, or decision-making that can affect a person’s ability to perform everyday tasks, manage stress, or make informed decisions.
- This type of vulnerability can result from a variety of factors, such as intellectual disabilities, mental health conditions, sleep deprivation, addiction, age-related cognitive decline (e.g., dementia), substance use, developmental stages, or neurodivergence.
- Individuals with cognitive vulnerabilities are often at a higher risk of harm or abuse because they may struggle to identify dangerous situations or may not be able to defend themselves effectively. Their increased dependence on others for support also makes them more susceptible to exploitation, neglect, or abuse by those in positions of power or trust.
- Social vulnerability refers to an individual’s increased exposure to harm due to factors like social isolation, limited support networks, or experiences of discrimination.
- This vulnerability can stem from having few social connections, exclusion from community resources, or facing prejudice based on age, gender, ethnicity, or physical or mental health conditions.
- Individuals who are socially vulnerable may have fewer people to advocate for their well-being, making it harder for them to access help. Their isolation also makes them more susceptible to exploitation, neglect, or abuse, as they have fewer opportunities to seek assistance or escape harmful situations.
Cultural vulnerability arises when individuals face disadvantages or barriers due to differences in language, cultural practices, or beliefs that affect their ability to engage with services and support systems.
This type of vulnerability can be caused by a lack of cultural competence among healthcare or service providers. Other contributing factors may include difficulties understanding and accessing health information, either written or spoken, and cultural beliefs that discourage seeking help, especially for physical or mental health concerns.
These barriers can lead to individuals not receiving adequate care or support, which may result in misunderstandings, discrimination, or neglect. People facing cultural vulnerability are at a higher risk of being harmed or exploited due to insensitivity or biases from those around them, potentially affecting their health outcomes or wellbeing.
- Economic vulnerability occurs when individuals or families face financial instability that limits their ability to access necessary services and resources for daily living.
- This vulnerability can stem from low income, unemployment, increased living costs, or reduced work hours. It may also involve a lack of control over personal finances or a dependency on financial support from others. Factors contributing to economic vulnerability include difficulty paying for essential needs such as healthcare, treatments, food, and housing.
- Economic vulnerability increases the risk of poverty, restricts opportunities for personal and family wellbeing, and can make people more reliant on external support systems. It can lead to stress, reduce access to necessary healthcare
- Environmental vulnerability is the increased risk of harm due to poor living conditions or surroundings that negatively affect one's health and safety.
- Factors contributing to environmental vulnerability include unsafe or substandard housing, homelessness, exposure to pollution or environmental hazards, living in high-crime areas, and natural disasters. Other factors include living in remote areas with limited access to healthcare, support services, or emergency facilities.
- This type of vulnerability can worsen existing health problems, increase exposure to danger or exploitation, and reduce access to vital resources. Unsafe or unstable living conditions can also heighten the risk of neglect and abuse due to a lack of protective social and healthcare structures.
- Age vulnerability refers to the increased risk of harm or neglect that can occur at different stages of life due to age-related factors. Vulnerability can look different at different ages:
- Infants and children are vulnerable due to their dependence on adults for basic needs like safety and emotional support, putting them at risk of neglect or abuse if not adequately cared for.
- Adolescents face risks related to peer pressure, identity formation, and exposure to harmful behaviours like bullying or substance abuse.
- Adults may experience vulnerability due to life stressors such as financial instability or health challenges, which can lead to exploitation or mental strain.
- Older adults are at greater risk of neglect or exploitation due to age-related physical and cognitive decline, particularly when reliant on caregivers.
Reflection
As a support worker, you need to be able to identify the signs that a client or their whānau may be in a vulnerable situation.
What do you think are the signs and symptoms that could indicate tāngata and their whānau are in a situation of vulnerability. Consider the following and create your own list:
- Physical appearance
- Environment
- Communication
- Behaviour
Now that you've had time to think about the signs and symptoms, click on the expand button to check out our list. You might find some new insights to help expand your own ideas and strengthen your understanding.
- Physical Signs of Neglect: Unkempt appearance, poor hygiene, malnourishment, or untreated medical issues could indicate that an individual is not receiving adequate care.
- Bruises or Injuries: Unexplained injuries, particularly in places difficult to injure accidentally, may be signs of abuse.
- Deterioration in Health: Sudden weight loss, visible fatigue, or other signs of declining health could suggest a person is not receiving proper care or support.
- Unsafe Living Conditions: Unsanitary or hazardous living environments, such as cluttered or unclean spaces, could indicate neglect.
- Lack of Basic Resources: Insufficient food, heating, or medical supplies in the home might be signs that the individual or whānau is struggling financially or unable to access necessary services.
- Isolation: Lack of social connections or limited family support can also be an environmental factor that contributes to a person's vulnerability.
- Reluctance to Speak Freely: If a person seems hesitant, guarded, or avoids certain topics when speaking, they may be in a vulnerable situation or fear repercussions.
- Inconsistent or Confusing Statements: Individuals in a state of vulnerability may have trouble communicating clearly about their situation or contradict themselves when sharing details.
- Fearfulness or Anxiety: Nervousness, distress, or fear when talking about their home life or caregivers could suggest a situation of abuse or neglect.
- Withdrawal or Isolation: Individuals who become increasingly withdrawn from social activities or avoid interactions with others may be experiencing vulnerability.
- Aggression or Anger: Outbursts of anger or irritability, especially when directed at seemingly minor issues, could be a response to underlying stress or maltreatment.
- Sudden Changes in Mood: Unexplained shifts in mood, such as becoming more anxious, depressed, or fearful, might indicate emotional or psychological vulnerability.
Supporting Vulnerable Tāngata and Whānau
As a support worker, your role extends beyond recognising vulnerability. It’s about taking proactive and compassionate steps to ensure that tāngata and their whānau are protected, empowered, and given the support they need. Here are some ways you can assist those in vulnerable situations:
- Create a safe environment, foster trust and open communication so that tāngata feel safe sharing their experiences and concerns.
- Offer a listening ear and validate their feelings, helping them process any emotional distress they may be facing.
- Ensure privacy and confidentiality are maintained at all times to provide a secure environment where they can freely express their needs.
- Stand up for tāngata and their whānau by ensuring their rights are upheld, especially in cases where they may be facing discrimination, exclusion, or unfair treatment.
- Follow all relevant legal and ethical guidelines to ensure the safety and dignity of the individuals you support. For example, the Health and Disability Commissioner (Code of Health and Disability Service Consumers’ Rights), Privacy Act 2020, organisational codes of conduct and practice guidelines
- Provide practical assistance, such as helping them access healthcare, facilitating communication with other services, or connecting them with cultural or community groups that align with their identity and values.
- Respect and incorporate their cultural values, beliefs, and practices in the care provided.
- Provide clear and accessible information about their rights, services available, and potential risks, ensuring that they have the knowledge to make informed decisions.
- Encourage and support them in making their own choices, even in difficult situations.
- Assist them in accessing services and resources, such as financial aid, housing, or medical care, that will help improve their living conditions and quality of life.
- Be vigilant and aware of any signs or symptoms of abuse, neglect, or heightened vulnerability. Early identification can help prevent situations from escalating.
Support workers often work in environments where clients and their whānau are especially vulnerable. These settings include homes, healthcare facilities, community centres, or care institutions, where individuals may face emotional, physical, or social challenges. In these environments, maintaining professional boundaries is crucial to ensure that compassionate care does not blur the lines between personal and professional roles.
Professional boundaries refer to the clear limits that define appropriate interactions between support workers and clients, ensuring respect, safety, and an ethical relationship. When boundaries are maintained your actions remain focused on the well-being of the person. These boundaries protect both the support worker and the client from potential exploitation, misunderstandings, harm or abuse. By setting and maintaining these boundaries, you contribute to creating a safe and supportive environment for vulnerable individuals.
Relationship Boundaries
Relationship boundaries refer to the limits placed on emotional and personal interactions with tāngata and their whānau
Maintaining these boundaries means:
- Respecting personal space: Ensure physical and emotional space is maintained so that clients feel safe and comfortable. Avoid behaviours that could be perceived as overly personal or intrusive.
- Avoiding personal relationships: It is important to keep the professional relationship separate from personal connections. This means refraining from developing friendships or engaging in social interactions outside the professional environment.
- Managing emotional involvement: While compassion is a key part of the support worker role, it's important not to become emotionally over-invested in the client's personal issues. This helps prevent situations where the worker might be swayed by personal feelings rather than professional judgement.
Before starting care, it is recommended to:
- Talk with the person and their family to decide the best way to care for them.
- Agree on appropriate areas of the body to touch or support. (e.g., under the arms, upper back, calves vs. lower back, upper legs, etc.)
- Set boundaries to ensure touch is helpful and supportive, avoiding confusion, unwelcome gestures or crossing cultural boundaries
- Ask how people like to be addressed, avoid nicknames and endearing terms such as dear or love, as they are unprofessional and cross boundaries
Read
- Read helpful advice for support workers on maintaining professional boundaries when working in vulnerable settings.
- Read the Nursing Council of New Zealand’s guidelines on professional boundaries. This interactive flip book has a lot of valuable information about maintaining boundaries in professional relationships that are directly relevant to your role as a support worker
As we’ve seen, individuals in vulnerable situations face a higher risk of abuse and neglect. In the next section, we will explore this subject further to deepen your understanding and awareness.
Being in a vulnerable situation can increase the risk of both abuse and neglect. Understanding what these terms mean, the forms they can take, and how to respond if you have knowledge of, or suspicions about, abuse or neglect are all essential knowledge for support workers. Let’s define some terms:
- Abuse: Abuse refers to any action that intentionally harms or injures another person. It can be physical, emotional, financial, or sexual and often involves a misuse of power or control over someone in a vulnerable position.
- Neglect: Neglect occurs when a person responsible for providing care fails to meet the basic needs of an individual, whether intentionally or unintentionally. This can include failure to provide food, shelter, medical care, or attention necessary for the person's well-being.
Forms of Abuse and Neglect
Abuse and neglect can take many forms, each with distinct impacts on the wellbeing of tāngata and their whānau.
Click on the expand button to see an explanation of forms of abuse and neglect. This section also provides examples and the impacts of each type.
Physical abuse involves inflicting physical pain or injury on another person.
Examples: Hitting, slapping, pushing, burning, or using physical restraints.
Impact: Can lead to bruises, fractures, chronic pain, or even death.
Emotional abuse includes behaviours that harm an individual’s emotional well-being or sense of self-worth.
Examples: Verbal assaults, threats, humiliation, intimidation, or isolation.
Impact: Can result in depression, anxiety, low self-esteem, and long-term psychological trauma.
Sexual abuse involves any non-consensual sexual contact or behaviour.
Examples: Rape, molestation, inappropriate touching, or forcing someone to watch or engage in sexual acts.
Impact: Can cause physical injuries, sexually transmitted infections, and severe psychological effects.
Financial abuse is the illegal or improper use of someone’s money, property, or assets.
Examples: Theft, fraud, exploitation, or manipulating someone to change their will.
Impact: Can lead to financial ruin, loss of assets, and increased dependence on others.
Neglect is a form of abuse. It can be intentional or unintentional. It may be caused by others or by the individual themselves (self-neglect)
Intentional neglect
Intentional neglect by others occurs when a caregiver deliberately and knowingly fails to provide necessary care and support to an individual, resulting in harm or distress.
Intentional Self-neglect happens when an individual consciously chooses not to take care of their own basic needs, such as personal hygiene, health care, or safety, resulting in harm or distress.
Unintentional neglect
Unintentional neglect by others happens when a caregiver fails to provide necessary care and support due to a lack of knowledge, resources, or ability. It is not deliberate but still results in harm or distress.
Unintentional Self-neglect occurs when an individual is unable to take care of their own basic needs due to factors such as cognitive impairment, physical disability, or lack of awareness or knowledge leading to harm or distress.
Neglect by others
Examples: Not providing adequate food, shelter, hygiene cares, medical care, or social support.
Impact: malnutrition, untreated health conditions, and severe emotional distress
Self-neglect
Examples: Not maintaining personal hygiene, refusing or failing to seek medical treatment when needed, not following prescribed medicine and treatment plans, behaviours that create health and safety hazards
Impact: Health issues, such as infections, injuries, and exacerbation of chronic conditions, social isolation, increased risk or worsening of mental health problems, increased risk of accidents and environmental hazards in the living space
Who May Cause Harm Through Abuse or Neglect
Abuse and neglect can be caused by anyone in a position of power or trust, including:
- Family Members: Relatives or spouse who may be caregivers or have control over the individual's health and wellbeing.
- Caregivers: Professional or informal caregivers who are responsible for providing daily care and support.
- Healthcare Providers: Medical staff or support workers who may misuse their authority or fail to provide adequate care.
- Peers: Other individuals within care environments, such as fellow residents in a group home or clients in a support group.
- Strangers: Individuals who take advantage of vulnerable people in various settings.
In some situations it may be the individual themselves who causes harm through self-neglect or self-abuse. They may intentionally or unintentionally fail to meet their own needs or engage in harmful and risky behaviours. Self-harm and self-abuse can result from underlying mental health issues, emotional distress, or substance use.
Responding
If you suspect abuse or neglect, or if a client reports it, it is essential to respond promptly and appropriately. The following is an 8 step guideline of how to respond:
- Reassure and Validate: Confirm the person’s concerns are valid and taken seriously. Reassure them that you are there to support them and emphasise that the abuse is not their fault. Do your best to ensure the immediate safety of the person if necessary.
- Actively Listen: If a person hints at or reports abuse, listen attentively without showing your own emotions or judgments, such as alarm or disgust.
- Empower: Help the service user understand their rights and options. Acknowledge their disclosure and let the person know you take their disclosure seriously and appreciate their courage in speaking up.
- Keep it confidential: Respect the person’s privacy and confidentiality as much as possible but inform them that you are required to report the abuse to ensure their safety.
- Report: Notify a trusted authority such as your supervisor of your suspicions or follow organisational/workplace protocols for reporting abuse
- Provide support resources: Offer information and access to support services
- Document: Record the facts accurately and report it according to your organisation’s protocols.
- Provide follow-up support: Ensure ongoing support and follow-up. Remember, it is not your role to:
- Investigate the suspected abuse.
- Question the person about their abuse.
- Make judgments about the abuse, potential abuser, or the abused.
End of Topic and End of Module
Kei runga noa atu—outstanding work! Not only have you completed this topic on vulnerability, but you have also finished your online learning for our first module. In this module, you have covered the following topics:
- Te Tiriti o Waitangi and Māori Health
- Development of Healthcare in Aotearoa New Zealand
- Health Models and Approaches
- Introduction to the Support Worker’s Role
- Understanding Vulnerability
We hope you have enjoyed your haerenga ako -learning journey so far. You’ve made excellent progress and should feel proud of your efforts.
Up next is our module on Communication and Cultural Identity. We’re excited to continue this journey with you.
Keep up the great work!
