Paul Cambridge

Reconstructing the Sexuality of Men with Learning Disabilities: Empirical evidence and theoretical interpretations of need

Research and practice in sexuality and learning disability has directly and indirectly highlighted the pathological sexual behaviour of men with learning disabilities, particularly their abuse and exploitation of women with learning disabilities, and relatively high HIV risk sexual behaviour with men without learning disabilities. It is consequently argued that there has been a relative neglect of their wider sexuality and sexual needs. This paper reconstructs this wider agenda, drawing on empirical evidence and theoretical interpretations of need from research and sex education in support of the observations made. In identifying a range of key issues for sexuality work with men with learning disabilities and arguing that they require greater recognition and attention, the paper also provides directional pointers for informing such work and for responding more widely.

How far to gay? The politics of HIV in learning disability

This paper examines work in sexual health and HIV prevention in services for people with learning disabilities from a political stance associated with the rehomosexualisation of AIDS in Britain. Arguments are made for the re-homosexualisation of AIDS in services for people with learning disabilities, based on evidence of where HIV risk lies in relation to men with learning disabilities who have sex with men. This provides an opportunity to critically review approaches and responses to HIV risk assessment and risk management in services for people with learning disabilities, with reference to the assumptions which underpin practice and issues of sexual identity. The case is made for a more radical sexual politics in learning disability to help combat HIV and to provide more realistic approaches to service commissioning and safer sex education. Pointers for service development and key areas where the re-homosexualisation of AIDS can inform practice and resource development are also provided.

Using individualised communication for interviewing people with intellectual disability: a case study of user-centred research

The importance of participative research methodologies is now widely acknowledged. A case study using individualised communication for interviewing people with intellectual disability in outcome and quality of life research is reported. The methodology and processes employed are described and lessons for the wider application of the model identified. In collaboration with Somerset Total Communication and local speech and language therapists, researchers from the Tizard Centre developed a flexible communication strategy for involving service users, drawing on core, local and individual vocabularies and using signs, graphic symbols and photographs to supplement spoken English. Individualised communication was used both to ascertain informed consent to participation in the research and to conduct the user interview. The initiative was part of a wider study looking at the outcomes and costs of community care 12 years on from de-institutionalisation. The approach was found to facilitate user participation compared with previous follow-ups, with wider lessons evident for user involvement.

The First Hit: A case study of the physical abuse of people with learning disabilities and challenging behaviours in a residential service

This paper describes the circumstances surrounding the physical abuse of persons with learning disabilities and challenging behaviours in a residential service and the general findings of a related inquiry. Evidence is interpreted in relation to wider policy and practice intelligence on the abuse of people with learning disabilities, with lessons for the recognition, reporting and management of abuse identified. The discussion is designed to help those charged with responsibility for the support and protection of people with learning disabilities understand the complex circumstances and conditions which may be associated with an abusive service culture, with the culture of abuse itself examined at four levels. Suggestions for reviewing the development and implementation of adult protection policies and procedures are offered, along with priorities for action and implementation for purchasers and providers.

Adult Protection Incidence of Referrals, Nature and Risk Factors in Two English Local Authorities

• Summary: This study focused on the incidence of adult protection referrals, the people involved as victims, perpetrators and referrers and the type of abuse in two local authorities in the south-east of England. • Findings: The number of referrals increased over time; those for older people stabilized but those for younger adults were still rising. There was a clear association between location or setting, perpetrator and type of abuse. A referral about someone living in a care home was more likely to identify abuse by multiple staff and institutional abuse or neglect, especially if the individual was an older person with mental health problems. People with learning disabilities were more likely to experience sexual abuse, mainly from other service users or members of their family. Those living in a private home with others, primarily relatives, tended to be at risk of financial, physical or psychological abuse. Older people living alone were particularly vulnerable to financial abuse by family members or, less frequently, home care workers. • Applications : This study suggests that well-developed adult protection procedures identify many more cases than previously estimated. Further research is needed to explain the low level of referrals from mental health services and variation between territories.

Care in the Community: Five Years On

How well does community care work for people with learning disabilities? Do people enjoy a good quality of life? Are they able to gain access to the services they need and are their preferences taken into account? How is community care coordinated at the area level and in relation to individual users? And what are the costs? These are among the questions addressed in this book. The authors conducted research which examined the lives of more than 200 people with learning disabilities who had left long-stay residence in hospital five years earlier. They were being supported in the community by local and health authorities, voluntary and private agencies and – in a few cases – by families and informal carers. Twelve areas of the country were covered by the study. Although there were significant improvements in quality of life between leaving hospital and after five years in the community, most of the changes had occurred in the first year after the move. People expressed greater satisfaction with their lives in the community, enjoyed wider social networks and were offered more choice. Not everyone was better off and no one had found employment. Some service gaps and inadequacies were clearly evident. Community care was more expansive than hospital. Care in the Community: Five Years On describes these changes and their relevance for people with learning disabilities and their carers. It sets out the implications for local and health authorities, for central government and for others with a role to play in the support of people in community care. This is the third book in a series examining aspects of care in the community for former long-term hospital residents, following on from Care in the Community: The First Steps (1988) by Judy Renshaw et al. and Care in the Community: Challenge and Demonstration (1992) by Martin Knapp et al, both pub by Ashgate. Link to Ashgate Publishing

Good enough decision-making? Improving decision-making in adult protection

This paper examines decision‐making in adult protection based on arrangements operating in a local authority social services department and discussion generated in a specialist training intervention. The paper seeks to identify ways in which approaches to decision‐making can be made both more effective and more user centred. The need for good information for efficient and effective decision‐making is highlighted, along with the need for user involvement for the production of positive and valued outcomes. The paper looks at how user centred arrangements can be put into practice and discusses the potential for advocacy, outlining possible approaches for adult protection casework. With local authority social services departments struggling to implement No Secrets (2000), with adult protection a key social care competence and with the implementation of PCP and similar approaches a priority (Valuing People, 2001), it is important to improve decision‐making in adult protection in ways that are not only time and resource efficient, but place service users and their advocates at the centre of related processes.

Community support teams for people with learning disabilities and challenging behaviours: results of a national survey

A survey was undertaken of community support teams for people with learning disabilities and challenging behaviour in England and Wales. It is estimated that such teams currently employ over 450 staff, have running costs in excess of 10 million per annum and serve over 2000 people with learning disabilities and challenging behaviour. With regard to service aims, the majority of teams emphasise pro-active work and provide: technical support to carers and support staff; a service primarily to adults; a service to those with the most severe challenging behaviour. With regard to organisational context, structures and procedures, the majority of teams are: funded, managed and staffed by NHS Trusts; expressed a general behavioural orientation; reported allocating the largest proportion of their time to working with direct care staff. With regard to impact, teams reported that they served the majority of their clients with some degree of success. More detailed analysis, however, suggested that the majority of ca...

Adult protection: The processes and outcomes of adult protection referrals in two English local authorities

• Summary: This article examines the processes and outcomes of adult protection referrals in two local authorities in England using adult protection monitoring data collected between 1998 and 2005, identifying learning for the use and development of adult protection monitoring. • Findings: Associations were found between aspects of process and outcome in adult protection case management; police and regulatory agency involvement increased over time, over four-fifths of referrals resulted in investigations which were associated with higher levels of inter-agency involvement, abuse was confirmed for over two-fifths of referrals, there was significant territorial variation across a range of process and outcome measures and specialist adult protection coordinators were associated with higher levels of monitoring and post-abuse work. The study concluded that more work is needed to improve and standardize adult protection monitoring data if it is to more effectively inform case management and inter-authority comparisons. • Applications: The evidence from the study suggests that adult protection monitoring data can be used to help review and organize adult protection work at agency, team and case levels and is consequently of potential value to team managers, social workers and specialist co-ordinators working in adult protection.

Good friends are hard to find? The social networks of people with mental illness 12 years after deinstitutionalisation

Background While community care is now well established in England, the development and maintenance of social networks of people with long-term mental illness remains a major challenge to services. Aims To investigate the size of the social networks of people with long-term mental illness and the types of social support they receive in relation to their age and accommodation. Sample Thirty-nine men and 46 women (mean age: 61 years; range: 38–88). Forty nine (60%) were 65 years or under and 32 (40%) were over 65. Methods Participants were interviewed using the Social Network Guide. Comparisons were made using generalised linear modelling. Results Social networks (median 19; range 2–85) were generally larger than those reported in previous studies. Older residents (over 65 years) had closer ties than younger residents. Congregate types of community settings were relatively devoid of social supports. Conclusion Appropriate activities and social contexts are still needed to facilitate the social networks of people with mental illness, in particular, for those aged under 65 years.