Adult protection

1
Adult protection people with intellectual
disabilities Exploring their multiple
vulnerabilities

• Improving the quality of life for people with
  learning disabilities Research into practice
• James Hogg, University of Dundee

2
A day in the life of.

• (Friday May 7 2004) yielded many examples to
  support this statement
• Scotsman, p.1 Rumsfeld under fire over new
  torture images
• Scotsman p.1 Council rocked by fresh claims of
  abuse (report by Social Work Services
  Inspectorate and the Mental Welfare Commission on
  victimization and abuse of people with learning
  disabilities in Scottish Borders Region)
• Guardian, p.7 Pastor faces jail for sex assaults
  Former church head preyed on vulnerable female
  worshippers
• Scotsman p.8 Two sentenced to total of nine
  years detention after racist attack
• Guardian, p.11 Sex offender banned from contact
  with children
• Guardian, p.14 Nigerian Muslims bury 600 after
  Christian slaughter
• Scotsman, p.17 UN a factor in trafficking of
  women, Kosovo report says (enforced prostitution
  of over 2000 women)
• Guardian p.17 Village council approved rapes
  (in Pakistan landlord permitted to rape the
  sister and sister-in-law of a man accused of an
  illicit relationship with his daughter)

3
..and another day.

• Joanne Nelson
• Marion Edgington
• Anthony Sawoniuk
• Leah Mates
• Joe Chillemi
• Guardian 8 November 2005

4
The concept of the vulnerable adult

• Scottish Law Commission (1997)
• Wide definition
• capable of being wounded, liable to injury or
  hurt to feelings open to successful attack
  capable of being persuaded or tempted"
• Narrow definition
• an adult (aged 16 or over) who is unable to
  safeguard his or her personal welfare, property,
  or financial affairs, and is in need of care and
  attention arising out of age or infirmity, or
  suffering from illness or mental disorder, or
  substantially handicapped by any disability.

5
The concept of the vulnerable adult

• The concept of vulnerable adult should be applied
  to a person who
• is, or may be, in need of community care
  services by reason of mental or other disability,
  age or illness, and who is or may be unable to
  protect him or herself against significant harm
  or exploitation.
• Department of Health (2000) No Secrets The
  protection of vulnerable adults. London
  Department of Health.

6
The concept of the vulnerable adult

• accommodation, and nursing or personal care,
  are provided in a care service personal care is
  provided in their own home under arrangements
  made by a domiciliary care agency or prescribed
  services are provided by an NHS Board, or an
  independent hospital, independent clinic or an
  independent medical agency, or National Health
  service body that is registered under the Care
  Commission.
• Scottish Executive (2004)

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What constitutes abuse?

• Victimising and abusive behaviour includes
• physical abuse
• sexual abuse
• emotional abuse
• financial abuse
• neglect
• of an individual who has not given, or is
  incapable of giving, informed consent to the
  transaction.

8
A model of abuse

• Characteristics of the individual
• Characteristics of the potential or actual
  perpetrator
• The relationship between the victim and
  perpetrator
• Environmental factors
• Nettlebeck, T., Wilson, C., Poter, R. Perry,
  C. (2000) The influence of interpersonal
  competence on personal vulnerability of persons
  with mental retardation. Journal of Interpersonal
  Violence, 15, 46-62.

9
A general definition

• Thus, a vulnerable adult is an individual 16
  years of age or over who is, due to personal
  characteristics, vulnerable to a potential
  perpetrator of abuse, and is in such a
  relationship with that person and in such a
  setting, that the probability of physical,
  sexual, emotional and/or financial abuse and
  neglect is significantly increased.

10
A model of abuse Direct effects of disability

• Characteristics of the individual
• incapacity to avoid or escape from the situation
• inappropriate decision making regarding what is
  appropriate or acceptable
• Attractive victim
• victim precipitation
• gullibility? credulity?

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A model of abuse Socially mediated effects of
disability

• Characteristics of the person who may be abused
  
• failure to teach the person behaviour that will
  decrease victimization
• may have been taught to be passive and
  compliant rather than assertive
• may be sexually uneducated instead of being
  knowledgeable about sexuality and sexual
  behaviour
• more subtle distortion of an individuals
  psychosexual development

12
An ecological model of abuseThe perpetrator

• Two types
• Predatory
• Corrupt
• Gender
• Psychological dimensions
• Retributive
• Abuse reactive

13
A model of abuse The relationship between the
victim and perpetrator

• Power imbalance
• Coercion
• Dependency

14
A model of abuse Environmental factors

• Nature of care activities
• Closed environment opportunity
• Service sub-culture
• Absence of procedures to preclude and respond to
  abuse
• Inadequate screening of staff

15
What proportion of people with intellectual
disabilities have been abused?

• there is a consensus that adequate research to
  specify precisely what this difference is lacking
• definition of the problems in defining abuse,
  and in collecting the relevant data, lead to
  widely differing figures in different studies
• same conclusion applicable to elderly people and
  those with mental health problems

16
Who are the abusers?

• Family member
• Paid staff
• Other people with intellectual disabilities
• Other people known to the abused individual
• Other people not known to the abused individual

17
What are the consequences of abuse for
perpetrators?

• 18 of 26 cases referred to police
• 4 staff members were arrested and interviewed.
  None were prosecuted
• family members, 3 were interviewed but not
  proceeded against
• 2 members of the public were arrested but not
  proceeded against
• 1 because the victim would not pursue the
  allegation and one because lack of consent could
  not be demonstrated
• 3 cases of service users being perpetrators the
  police were not involved
• there were no court cases as a result of this
  process with the most typical decision being to
  monitor the situation
• Joyce, T.A. (2003) An audit of investigations
  into allegations of abuse involving adults with
  intellectual disability. Journal of Intellectual
  Disability Research, 47, 606-616.

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What are the consequences of abuse for the abused?

• bruising, cuts, broken bones, burns, head injury,
  dehydration and malnutrition
• sleeping difficulties, stomach problems,
  breathing problems or confusion
• anxiety, depression and peri-menstrual symptoms
  in women
• mental health and behavioural consequences

19
Scottish Executive Response to Adult Protection

• Pre-legislative consultation process
• New duties powers conferred on public
  authorities
• Establishment of Multi-agency Adult Protection
  Committees to manage adult protection policies,
  systems and procedures at local level
• The List people unsuitable to work with
  vulnerable adults

20
The Scottish Child Protection Review Aims

• Explored the effectiveness of the Scottish child
  protection framework with respect to
• Describing practice with respect to child
  protection
• Evaluating of the quality of child protection
  practice
• Daniel, B. (2003) The Scottish Child Protection
  Review Development of a methodology for a
  national multidisciplinary audit of child
  protection Practice. Qualitative Social Work, 2,
  435-456.

21
The Scottish Child Protection Review Methods

• Case study methodology
• Case file scrutiny
• Interviews with relevant personnel
• Agency evaluation
• Overall evaluation

22
The Scottish Child Protection Review Outcome

• Successful outcome of this study provides a
  procedurally firm and valid base on which to
  develop a parallel methodology to investigate
  adult protection procedures in Scotland.

23
Scottish Adult Protection Study Aims 1

• Investigate practice with respect to the
  protection of adults subject to victimization and
  abuse in the light of inter-agency procedures and
  through the development of an agreed protocol
  that reflects best practice
• infer from this investigation the quality of
  practice as it impacts on individual adults
  physical and mental health and general well-being

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Scottish Adult Protection Study Aims 2

• To determine for a limited number of cases the
  ecological context of the victimization and abuse
  in the light of recent models of victimisation
  and abuse discussed earlier
• To provide a baseline, and pilot a methodology,
  to monitor impact of Scottish Executive
  legislation

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Scottish Adult Protection Study Scope

• Adults
• With intellectual disabilities
• Elderly people
• With mental health difficulties

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Scottish Adult Protection Study Respondents

• At least the following involved
• Social work
• Nursing
• Medical (GP, specialist)
• Police
• Voluntary organisation

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Age Concern Scotland (2004) Interagency
Procedures for the Protection of Vulnerable
Adults. Edinburgh Age Concern Scotland.

• This document has been selected to guide the
  research because it
• is research-based
• has been developed through an interagency,
  practitioners working group
• took account of failures in practice
• took account of existing and future possible
  legislation and agency responsibilities

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Neglect as abuse Avoidable deaths

• Under-diagnosis and delayed or absent treatment
  of medical conditions leading to avoidable
  deathsJanicki et al 2002 Mencap 2004 Treat me
  right!
• High prevalence of external causes of death among
  people with intellectual disabilities Strauss et
  al 1998
• Inadequate screening programmes Cancer Davies
  Duff 2001 helicobacter pyloriWallace et al
  2002

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Positive negative abuse

• Systemic issues for intra- and interagency
  working
• Care staff in social and health settings need to
  be made more aware of risks, responses to signs
  and symptoms and monitoring of special incidents
• Enhanced awareness of spectrum of positive and
  negative abuse among people with intellectual
  disabilities