Archive

Case Study
The name of the service user has been changed

SITUATION: Janice Walsh is a 27-year-old woman with moderate learning difficulties, who lived independently and attended a day service, which was training her towards employment. Through this she gained a part-time job in a bakery. However, soon after she started work Janice alleged that she had been sexually assaulted by a care worker at the day service, but nobody believed her - partly because the worker was so popular. She left the day service. Over time more allegations surfaced about this worker who was ultimately sacked with

charges brought against him, but none of these cases made it to court.

PROBLEM: Scared and upset after her attack (and because nobody initially believed her) Janice became too anxious to live alone and moved back in with her parents and quit her job. She couldn't go out and all she could think about was the abuse. She started eating too much, would not get out of bed or wash herself or her hair. The parents begged for help but nothing constructive happened. Then, following the charges made against the worker, a care manager came to re-assess her needs. Janice's parents believed that therapy would be the best way forward, and although the worker agreed, she felt this would be too costly. Janice could have therapy only if the parents paid for it or at least contributed. They did not have any money but said they would be willing to sell some jewellery and other items to raise the cash.

Practice Panel - Bath and North East Somerset (Banes) - learning difficulties services

Helen Thompson - social worker, Bridges Community learning difficulties team (CLDT) ; Mike MacCallam - joint commissioning manager, Banes learning dificulties service ; Kirsten Ashman - social worker, Bridges CLDT ; Andrew Luff - clinical lead nurse, CLDT, Banes PCT ; Dawn Gillard - social worker, Bridges CLDT

Panel responses

Helen Thompson

Janice was assaulted in an environment where she should have been protected and it is wrong that her family have had to beg for help and consider selling their belongings.

The approach that needs to be taken should be centred upon rebuilding relationships and empowering Janice and her family. It is important to let the family know that there is a formal complaints procedure and they should be encouraged to voice their feelings about their experiences. Janice may want to join a self-advocacy group or to work with an independent advocate to help her rediscover the confidence to tell people how she feels or what she wants. It is essential to try to rebuild Janice's self-esteem and this could begin with listening to her.

In Bath and North East Somerset, the community learning difficulties team is an integrated and multi-disciplinary service and as such we would be able to refer Janice to psychologists or other team members. This would be of no cost to Janice or her family. We can only assume that Janice's care manager was misinformed, as nobody should have to pay for therapy in this situation and by suggesting that Janice should pay is almost implying that it is in some way her responsibility. Effectively, those working with Janice in the past have been guilty of practising in an oppressive way and compounding the abuse.

If Janice would like to work with a therapeutic approach we would ensure that this happened. There seem to be many issues needing to be addressed in future work with her including the losses she has faced - both contact with friends and her social network, the loss of her job and issues of trust. Janice may also wish to explore these issues in group-work situations. She may also like to consider input from Victim Support.

If Janice agrees to re-establish relationships with the CLDT a community care assessment would enable Janice and her family to discuss her eating, mobility, finances and personal care needs. Janice should have the opportunity to regain power and control in her life and needs to be central to decision-making and able to direct the services she wishes to receive -direct payments or individualised budgets could be used to facilitate this.

Mike MacCallam

The incidence of sexual abuse of people with learning difficulties has been claimed to be as much as four times higher than that of the general population, with an estimated 1,400 cases reported each year. And yet, in one study less than 1 per cent of cases resulted in a conviction. 

The reasons why people with learning difficulties are more vulnerable to sexual abuse include a lack of power within relationships, dependency on others for personal care, a lack of capacity to consent to sexual relations, fear of recrimination or not being believed and not knowing who to complain to. Victims are most often abused by people they know who are in positions of trust or authority.

Learning difficulties services have often created ideal opportunities for abusers - people who have little power or influence in other walks of life have found it easy to exert these within care services, with an often passive client group who have not known how to stand up for themselves.

It can be argued that the biggest change in practice that we should all strive to achieve is that of a change in culture. Ultimately, incidents of sexual abuse may only decrease when people with learning difficulties are recognised as individuals to be supported as equal citizens, and who gain that support from people who feel privileged to be able to provide it, rather than it be offered as something that people should be grateful to receive, and something that can be exploited.

Future services depend on developing a different practitioner: one who is comfortable with handing over control and the power within relationships to the person with learning difficulties. This should be addressed by learning difficulty partnership boards working with managers of services.

With the advent of direct payments and individualised budgets it is envisaged that people will have more choice and control over how they live their lives. Local commissioners need to ensure that their policies and procedures to support these initiatives safeguard the welfare of the individuals concerned. In addition, partnership boards can promote the existence of organisations such as Voice UK, Respond and the Ann Craft Trust. These can offer confidential advice and support to people with learning difficulties who have been sexually abused, and can be easily contacted.

User view

The care worker who Janice accused of abusing her should have had a Criminal Records Bureau check to see if he had abused before. This is especially important because he was working with people with learning difficulties who can be more vulnerable than other client groups, writes Daniel Hardy.

Janice was right to be angry because nobody would listen to her, just because the care worker was so popular. She should have been listened to and an investigation into her allegations should have occurred.

Nobody believed Janice and she received little help and became depressed, started eating too much, and got sick and felt vulnerable. She didn't even want to go out on her own because she was thinking about the abuse.

Going back to her parents' place did not help Janice with her confidence; but it was the only thing she believed would make her feel safer.

The manager of the day centre helped Janice too late; she didn't take any time to talk to her about the allegations and only re-assessed her needs after the charges against the worker had surfaced.

The day service manager should have taken into account that Janice's parents did not have enough money to pay for therapy. The manager didn't really care about what their employee had done to Janice or the state he had left her in. It isn't right that Janice's parents have to pay for the therapy.

It may be a good idea for Janice to join an advocacy group or talk to people who have been in the same situation as her.

Janice's parents begged for help, but as they didn't get any from the day centre, they should have gone straight to the police and made a formal complaint. Even though charges were brought against the care worker, the cases did not get to court.

The police may have believed that those involved were unreliable witnesses, but they were not: they still knew what had happened to them and they should have been allowed special measures that are available for vulnerable people. For example, if they needed help to communicate they should be given the chance to have an intermediary: an independent communication expert, such as a speech and language therapist, who can help a witness with communication difficulties understand the questions they are asked and then communicate their responses.

Daniel Hardy is equal access to justice project worker at Voice UK, a national charity working with people with learning difficulties who have been abused or the victims of crime, www.voiceuk.org.uk