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Case notes

Practitioners:   Jane Munton-Davies, social worker, and John Goosey, social work team manager. 

Field: Learning difficulties. 

Location: Staffordshire. 

Client: Robert Cresswell is in his early 30s and has mild to moderate learning difficulties. He lives at home with his mother and two of his three brothers. His two sisters no longer live at home. His father takes no part in the family. 

Case history: An educational welfare officer who works with Robert's youngest brother because of his non-attendance at school, referred Robert to social services. The EWO was concerned that when he visited the family home that Robert, who has verbal communication difficulties, had seemingly no services or support. Munton-Davies took the case and carried out an assessment of Robert's needs, although enduring some hostility from the family. Although Robert had attended a special school, there had been no contact with social services since he left over 15 years ago. 

Dilemma: Police investigated the allegations made by Robert but could find no evidence that he had been physically abused by his brother or other family members. They continued to deny that any assaults had taken place. 

Risk factor: Although lacking evidence, there was a strong suspicion that if Robert returned home he would be at risk of physical abuse. 

Outcome: Robert remains at the care home, is settled and happy, and continues to choose to have no contact with his family.

If a procedure languishes on an office shelf unread it is failing. The challenge for any procedure is to be well-thumbed. However, to be so, staff need to feel confident that they can follow it, particularly if it is taking them through aspects of work they haven't previously faced.
Adult protection is a new departure for many and given its unfocused legal base it can be a difficult and disarming process. Having the confidence to follow a new procedure through provided the background in the case of Robert Cresswell, who has learning difficulties and whose case was taken up by social worker, Jane Munton-Davies.

The family, who had a history of conflict with authority, proved hostile. "They weren't terribly happy. There was suspicion as to why we were there: why do an assessment of his needs now?" says Munton-Davies.

There appeared to be little happening in Robert's life: "It seemed that all he did was watch TV or go shopping with mum. We linked Robert up with a local day service. We set it up slowly: one day a week initially and then increased it gradually to three days a week," she adds.

Robert was happy; he enjoyed the activities and started going to college. However, during a six-monthly review, Robert alleged that one of his brothers had hurt him. He showed some scratches around his neck. Robert was accommodated while the allegations were investigated, but returned home about five days later as police were unable to uncover any evidence.

"Although Robert said he was happy to return home, there was an element of dissatisfaction among some workers that no action was taken," says team manager, John Goosey. Munton-Davies adds: "Mum had been saying that because of his learning difficulties Robert didn't know what he was saying and that we shouldn't listen to him."

"It's fair to say that at that time we lacked confidence in using vulnerable adults procedures. For us, adult protection was new; we were still finding our feet," says Goosey.

"Although the government guidance No Secrets sets out a framework for multi-agency working, the process of case conferences and how you arrive at decisions are not clearly laid out," adds Clive Cartman-Frost, adult protection co-ordinator.

Things settled down only for Robert to make another allegation. "Again he said his brother had assaulted him (and his mother) but this time Robert was adamant that he wasn't going home from day services and that he didn't want the family to know where he was or have contact with him," says Munton-Davies, who admits this time they were better prepared.

"We had more professionals involved early on this time: advocates, psychologist and speech and language therapist. We were prepared for the issue of Robert's capacity to consent which we knew would come up. We looked at how the Mental Health Act could help to prevent Robert going home," she says.

To prevent contamination of evidence and possible intimidation, it was decided to prevent all family contact. "By the time of the second case conference we were more confident of the procedure. As chairperson, I discussed with Clive Cartman-Frost the legal framework which then helped identify the strategy we then took," says Goosey.

The family remained hostile: "They said, 'We've been through this before. This is appalling. You shouldn't believe what he says.' But there was no proof that it hadn't happened, there was just no evidence that it did," says Munton-Davies.

However, once again police could not find evidence and took no further action. "As the direction was no longer linked to a criminal investigation, the focus shifted," explains Goosey. "What did Robert now want? Did he want to go back home? Did he want contact with the family? And he made a very clear choice to stay where he was."

Says Cartman-Frost: "It was important that despite the collapse of the police investigation we didn't lose sight of the adult protection issues; which I think in the past would have happened to some extent. We relied on police and if that fell through we just felt there was nothing else we could do." Goosey agrees: "This case proved how successful we can be given the confidence and the experience."

Robert remains in the home and has refused all contact with his family. He is on an independent living skills programme with a view to reviewing his placement options.

Arguments for risk

• With Robert's capacity to consent confirmed it is right that social services listen to what he wants to happen. He is very clear that not only does he not want to return home neither does he want any contact with his family. This is a powerful statement.
• Robert has grown in confidence - he has support networks at the day services, and through advocacy services and speech therapy he is beginning to articulate what he wants rather than what everyone thinks is best for him.
• With his new life experiences he finally had something to compare living at home with: he knew what life was like away from his family. There is a choice and he has made it.
• Although police did not pursue any action, this in itself is not unusual. Despite the arrival of special measures to assist people with learning difficulties to obtain justice, police and the Crown Prosecution Service still waver over taking many cases on.

Arguments against risk

• Robert has spent his whole life with his family. There had been no complaints or allegations in the 15 years since Robert left his special needs school. All families have their ups and downs - and to have managed for all that time without recourse to social services should at least be acknowledged.
• His entire social network has been removed and he has been placed a long way from home. With some additional monitoring Robert could have returned to his family and the lifestyle he knows well.
• Both allegations were thoroughly investigated by police who did not pursue the cases because of a lack of evidence that any abuse took place. What does the social services department know that the police do not?
• Robert has said that he doesn't want any contact with his family. The family only have social services' word that this is the case.

Independent comment

A person with a learning difficulty being listened to? And being supported to do what they want even though others don't think that it's right? This makes such a refreshing change from the daily stories of heavy-handed intervention or complete lack of action we hear on our helpline, writes Kathryn Stone.

After the first incident Robert said that he was happy to return home. After the second he wants out. Many people who are subject to domestic violence, for example, go back before they finally decide to leave permanently. People with learning difficulties have the right to make such choices too; no matter how uncomfortable it might be for professionals on the sidelines.

Fortunately Jane Munton-Davies and John Goosey have pitched their support at the right level. Robert feels that when he does make choices they will help him to make informed choices and also be there to help him make different ones.

The case also shows the value of an adult protection co-ordinator. Clive Cartman-Frost provided guidance to the team through what can be an incredibly stressful time for all concerned.

At Voice UK we also occasionally hear from carers and parents who feel their relatives have been turned against them by social workers hell-bent on "valuing people", which, in their eyes, seems to mean that living at home with family is bad, and living anywhere else is good. It seems that in this case Robert really has been valued as a person in his own right.

Kathryn Stone is director of learning difficulties charity Voice UK.