In the shadow of abuse

    Practice Panel: Learning difficulties team, Bath
    and North East Somerset

    CASE STUDY

    The names of the service user  and her family have been
    changed


    SITUATION: Michelle Adams is 27 years old
    and has learning difficulties. She is strapped into an electric
    wheelchair (once released her arms flail uncontrollably) but can
    use her fingers to move the chair. She has speech but it can be
    very difficult to understand. She lives with her parents who devote
    most of their private time to the church. Michelle’s mother, in
    particular, feels that Michelle was a punishment from God in
    response to which she is dedicating her life to the church to seek
    forgiveness. 
    PROBLEM: Michelle has become involved with an
    advocate based at a day service she has attended for the past year.
    She has also joined a self-advocacy group. She has started to learn
    about independence and choice. While discussing sex and sexuality,
    Michelle became upset. Pictures demonstrating sexual acts caused
    her to be very aggressive, particularly one depicting oral sex.
    Working with Michelle sensitively, an advocate, the day service
    manager and member of the self-advocacy group concluded that
    Michelle was disclosing that she had been sexually assaulted by a
    senior member of her parents’ church. The parents were shocked that
    Michelle had been attending sex and sexuality “classes” and were
    outraged at the unsubstantiated allegations about a respected and
    much loved man whom they counted as a dear friend, and who had died
    the year before and could not defend his name. The parents now
    refuse to let Michelle attend the day service.

    Panel Responses
    Hannah Fordham
    Although Michelle does not appear to be in immediate
    danger of abuse we need to ensure that the vulnerable adult
    protocol was followed. Further investigation is likely to be needed
    and may involve the police and other agencies. The disclosure may
    have implications for other church members.

    Social services has a duty of care for Michelle and can assess her
    needs. A planning meeting would be useful in which Michelle’s
    wishes and feelings need to be central and a person-centred
    approach could be taken. This will establish if Michelle would like
    to return to the day services, pursue alternative accommodation and
    question how she wants to spend her time.

    As the White Paper Valuing People highlights, people with learning
    difficulties have the right to fulfilling and varied lives within
    the community. Any involvement with Michelle would also need to
    take account of her individual communication needs. Michelle
    appears to have developed a good working relationship with her
    advocate and this should continue. Advocacy enables people to put
    forward their views and play an active part in planning their
    future services.

    Michelle could receive a variety of support including psychology,
    psychiatry, support groups or victim support in connection with the
    abuse. Consideration should also be given to the impact that
    Michelle’s mother’s views of disability are having on Michelle. We
    would take particular care to avoid a stigmatising approach to this
    situation. Michelle’s family would be offered carer’s assessments.
    It is essential that we re-establish contact and trust with
    Michelle’s family and direct them to carer organisations for
    support. They may find the ending of day care provision and their
    increased caring responsibilities difficult to manage.

    The reaction of Michelle’s family indicates that lessons can be
    learned to ensure that greater sensitivity is taken at the day
    service. While confidentiality needs to be respected, day care
    services could be more open with family and carers by sharing
    activity programmes and seeking feedback. Finally, staff at the day
    services should be aware of the impact of using material showing
    sexual acts and need to consider how information used might be
    acted upon.

    Sheena Jones
    From a community learning difficulties team
    perspective, the physical and psychological health, safety and
    general well-being of Michelle is of paramount importance.

    The first necessary step must be to initiate a vulnerable adults
    meeting because of the nature of the disclosure made by Michelle.
    Any contact before this happens may lead to contamination of
    evidence in what might result in legal proceedings. In informing
    Michelle’s parents of her disclosure the day centre staff have
    probably acted incorrectly and not in accordance with a vulnerable
    adult policy and guidelines. It is also questionable whether the
    centre was following any sexual health guidelines when introducing
    pictures of oral sex into a group which is described as a
    self-advocacy group.

    It is vital that Michelle has the best opportunity to communicate
    her thoughts and feelings, and an independent advocate along with
    communication support and advice is crucial. This may involve a
    speech and language therapist from a community learning
    difficulties team who would be able to offer assessment and ongoing
    support.

    At a suitable time there may be involvement from other team members
    (psychologist, psychiatrist, occupational therapist,
    physiotherapist or social worker) to offer Michelle support for her
    physical, psychological and social needs. This support would need
    to be dovetailed into any vulnerable adult and legal
    proceedings.

    Any team input would need to be co-ordinated and approached with
    great sensitivity. It will be essential to maintain contact with
    all those involved in Michelle’s support and, if appropriate, to
    work with Michelle’s parents to try and build confidence and
    communication. It might also be appropriate to involve outside
    agencies specialising in working with people with learning
    difficulties who have been abused, such as Respond
    (www.respond.org.uk) or Voice UK (www.voiceuk.org.uk).

    In the long term it might be a good idea to offer Michelle and her
    parents family therapy to help them address emotional conflicts.
    Issues that need to be raised at managerial level include the
    implementation of the local vulnerable adults policy, and
    guidelines for work around sexual health.

    User View
    This must be very difficult for Michelle. We think
    that Michelle’s parents were wrong to stop her attending the day
    service. Michelle is 27 years old and is not a child anymore and
    has the right to attend the services that she wants to, write Keith
    Taylor and Colin Waters.

    Michelle’s parents are denying her access to information and
    options to help her make choices about her life by withdrawing her
    from the day care service. Michelle has a right to know about sex
    and sexuality issues and Michelle also has the right to attend the
    self-advocacy group if that is her wish. 

    Michelle must have felt comfortable and safe at the day service to
    be able to tell people about what happened to her. It must also
    have been frightening for Michelle to go through what she has been
    through, not least because she is “strapped” into her chair and has
    difficulty with her speech and didn’t have anyone to tell.

    It must be really hard for Michelle because her parents are almost
    telling her that she is wrong about what happened. This must be
    causing problems for Michelle and her relationship with her
    parents.

    She must be feeling extremely upset that her parents do not want to
    know about what happened or, worse, don’t believe her. And now that
    she has been taken out of the day service she might feel that she
    has nobody to talk to about it.  

    We think Michelle needs somebody else to talk to about what
    happened so that she can discuss how she feels. Michelle is a
    vulnerable person and her parents cannot ignore this and should
    involve the police and social services. She needs a lot of support
    to help her through this issue. 

    We would also like to know if the day care service has contacted
    anybody else other than Michelle’s parents about what happened to
    their daughter? Just because the person who is alleged to have
    abused her is dead does not mean that the incident did not
    happen. 

    Another question that we would ask is that if this happened to
    Michelle, has it happened to anyone else? If it has also happened
    at the church and by a “respected” church member, the church has a
    duty to investigate how the abuse of Michelle was allowed to
    happen. If they do not do this they are saying that it is ok for
    other people to abuse people with learning difficulties. 

    Keith Taylor and Colin Waters are members of Milton Keynes
    People First, a self-advocacy group for people with learning
    difficulties

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