Not Such an 'Ordinary' Relationship: the role of women support staff in relation to men with learning disabilities who have difficult sexual behaviour

This paper brings together some preliminary data on the management of men with learning disabilities who have unacceptable/abusive sexual behaviour patterns with a small pilot study which specifically explores the roles of women support workers in relation to difficult sexual behaviour. A specific focus on the behaviour of men with learning disabilities is justified because of consistent evidence that it is men, rather than women, service users who challenge services in this way. The studies explore with staff the boundaries of what is considered acceptable sexual behaviour and how breaches of these are responded to within services. One issue which we have chosen to highlight is the frequent exposure of women staff to the men's sexual behaviour, sometimes precipitated by the unusual relationship that exists between the two parties, and exacerbated by the lack of clear management guidance within the gendered hierarchies found in service agencies.     

The Ethics of Research With Men who Have Learning Disabilities and Abusive Sexual Behaviour: a minefield in a vacuum

In the wake of the recent awareness of the sexual abuse of people with learning disabilities is the recognition that a small number of men with learning disabilities are themselves sexually abusing. The need to understand the men's behaviour and provide effective responses is pressing yet the search for an ethical course of enquiry appears illusory. The two conflicting dilemmas which make this task so difficult are whether the men's learning disabilities preclude their giving informed consent to the research process, and/or whether men who are sexually abusing have lost some rights to exclude themselves from research which is intended to prevent further abuse. This paper explores in depth these dilemmas and describes the authors' attempts to resolve them as they attempted to devise a protocol for consent to involvement in a qualitative study of men with learning disabilities who sexually abuse. Issues raised in this particular context have relevance to many other issues in learning disability services where robust ethical debate is needed, but often glossed over.     

Sexual coercion in gay male and lesbian relationships: Predictors and implications for support services

Numerous studies have documented the prevalence of forced sex in heterosexual couples. Positive effects of this research include increases in awareness about the problem among helping professionals and the public, as well as increases in support services and prevention programs. However, no research has been done on sexual coercion in gay male and lesbian relationships, and few support services exist. Therefore, this study is an investigation of the prevalence and correlates of coercive sex in gay male and lesbian relationships. Participants were 36 women and 34 men who were in gay or lesbian relationships. The results indicated that 12% of the gay men and 31% of the lesbians reported being victims of forced sex by their current or most recent partners. The higher reporting rate among women may be due to greater awareness of issues pertaining to sexual abuse, and greater likelihood of identifying various forms of coercion as force. For men, being a victim of forced sex was generally associated with being a victim of other forms of violence. For both sexes, victims of forced sex believed that it would be relatively difficult to get counseling. Implications for support services are discussed.     

The impact of child, family, and child protective services factors on reports of child sexual abuse recurrence

This study identified selected child factors (e.g., age, gender, race/ethnicity, disabilities, prior victimization, and relationship to perpetrator of abuse), family risk factors (e.g., substance abuse, domestic violence, inadequate housing, and financial problems), and services provided by child protective services that likely increased reports of child sexual abuse recurrence by type of reporter. Survival analysis was conducted using the National Child Abuse and Neglect Data System data set of 2002-2004. Child disability, being a prior victim, having a perpetrator as a caregiver, family financial problems, and receiving family supportive services increased the likelihood for reports of child sexual abuse by mandated reporters. Being Hispanic, having a disability, having a perpetrator as a caregiver, financial problems, and receiving family preservation services statistically decreased the likelihood for reports of child sexual abuse recurrence.     

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.     

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.     

No safety net for disabled children in residential institutions in Ireland

The voices of adults and children with disabilities who have experienced violence and abuse are slowly beginning to surface in the public domain. Segregated residential institutions run by religious congregations appear to be dangerous places for children with disabilities and perceived differences – according to the former residents, speaking and communicating to us today as adults in Ireland. A statutory Commission to Inquire into Child Abuse in Ireland attracted important numbers of former residents – witnesses – who recounted appalling experiences of violence as children. The UN Convention on the Rights of Persons with Disabilities contains articles concerning the prevention of cruelty, sexual assault, violence and acts of humiliation that may be useful for countries like Ireland which have been unable to ratify the Convention. The protection of children with disabilities requires legal reform in Ireland, statutory licensing, monitoring and inspection of the segregated centres where children with disabilities are living.     

Childhood sexual abuse, teenage pregnancy, and partnering with adult men: exploring the relationship

Although the mechanism by which early victimization, specifically sexual abuse, increases the risk of adolescent pregnancy is unclear, a relationship between previous victimization and adolescent pregnancy has been demonstrated. While partnering with an older man may initially offer the means necessary to escape a neglectful or violent family of origin, this protection be accompanied by an imbalance of power and control. Both adolescent mothers partnered with adult men and adolescent mothers partnered with male peers reported sexual abuse perpetrated by family members, family friends, strangers, and peers. Policies developed to protect young people from victimization, including mandatory reporting and statutory rape laws, should be evaluated for their consistent application to all children, regardless of age, race, gender, or pregnancy status.     

Recognizing Abuse and Neglect in People with Severe Cognitive and/or Communication Impairments

ABSTRACT

It is widely acknowledged that physical abuse of persons with severe developmental disabilities is prevalent, usually perpetrated by a residential care provider and is rarely reported. However, no solid research on the topic has been reported. This article notes the lack of information about protective services directed to the developmentally disabled population and lack of coordination between agencies serving people with developmental disabilities and those providing protective services. The signs and symptoms of abuse in the developmentally disabled population, the alternative communication strategies required when interviewing, and the special skills needed for case assessment are presented. The author ends with a series of federal, state, and community level policy recommendations.     

Discrepancies in Reporting of Physical and Sexual Abuse Among Homeless Young Adults

This study investigated risk factors for discrepant reporting of physical and sexual abuse among 172 homeless young adults. Discrepant reporting includes situations in which a respondent denies experiencing abuse in general but reports being a victim of specific forms of maltreatment. The results revealed that discrepant reporting rates tended to be highest for minor physical assault and for noncontact sexual abuse. Multivariate results revealed that demographic characteristics were important correlates of both discrepant physical and sexual abuse reporters. Family background characteristics also played a role in discrepant reporting for physical abuse. Overall, some young people with abuse histories are not adequately labeling their maltreatment experiences and, as a result, may not be receiving the necessary treatment.     

Potential for the Abuse of Medication for the Elderly in Residential and Nursing Homes in the UK

ABSTRACT

Abuse of the medication prescribed to the elderly living in long-stay care homes may be perpetrated by a minority of unscrupulous doctors, pharmacists, or home staff caring for the residents. Disorganised practices and homes, poor communications, and sloppy professional practices may create opportunities for over-dosing, errors, fraud, or theft. This article describes the circumstances leading to the potential abuse of elderly residents' medication, and the measures that may be taken to avoid or minimise such abuse from occurring.     

Child Sexual Abuse and Adult Religious Life: Challenges of Theory and Method

The religious consequences of child sexual abuse in adulthood remain relatively unexamined in the research literature, especially where abusers are not clergy. Some studies suggest child sexual abuse survivors may rely on religion as a source of support, though the majority document a decrease in religiosity. Given the propensity for psychological challenges among adult survivors with diminished spiritual coping, we are calling for increased research attention to religion in the context of child sexual abuse. The objectives of this article were to review the literature on intersections between child sexual abuse (perpetrated by nonclergy) and religiosity in adults and set forth relevant research approaches for future investigation. Findings revealed a comprehensive, multidisciplinary, and theoretically informed approach to research may be needed.     

Independent Living: gender, violence and the threat of violence

In what ways is independent living for young adults with disabilities compromised by violence and its threat? A qualitative study of 42 young adults with severe physical disabilities explored their perceptions and concerns about independent living, access to services and the meeting of needs. Young women especially experienced difficulties about leaving home, because of their own and their parents' fears about vulnerability; some who did leave home experienced highly restricted social lives because of anxiety about neighbourhood violence. Few had established partnerships, but violence and sexual abuse from partners emerged as an issue for which there is little policy. Control and abuse within caring relationships are serious issues for those who need personal care. Violence and lack of protection may undermine independent living, especially for women.     

Self Psychology and Male Child Sexual Abuse: Healing Relational Betrayal

The prevalence of male child sexual abuse (MCSA) is higher than initially thought with up to 26 % of men in community samples reporting sexual abuse in childhood, and up to 36 % of men in clinical samples reporting childhood sexual abuse. Disclosure of MCSA is complex because of men’s difficulties in viewing themselves as victims, especially of sexual violence. This difficulty is exacerbated by societal attitudes that sexual abuse rarely occurs with boys, and is further complicated with the taboo of victimization by same sex perpetrators. Too often, the response to disclosure is disbelief and minimization. For these reasons disclosure is often delayed or withheld thus prolonging the abuse. The negative effects of child sexual abuse are well documented and far reaching with depression, anxiety, post-traumatic stress disorder, addictions, sexual dysfunction and impaired interpersonal relations as common presenting issues in therapy. Treatment is indicated for significant numbers of male survivors. This paper identifies aspects of interpersonal relational difficulties commonly experienced by male sexual abuse survivors, and describes self psychology as guiding a clinical approach to address these interpersonal difficulties. The application of self psychology with male sexual abuse survivors is traced and discussed through the use of a clinical case study with Adam.     

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.     

Cocaine Abusing Women Who Report Sexual Abuse: Implications for Treatment

ABSTRACT

Four hundred seventy-three substance-abusing women were assessed for histories of sexual abuse. The results of bivariate analysis indicated that Sexual Abuse Survivors (SAS) had higher levels of depression, anxiety, and psychological distress. A greater number of SAS reported histories of emotional and physical abuse. They also had greater severity on ASI scales of alcohol, drug, medical, and family/social difficulty. Logistic regression analysis indicated that women who were survivors of sexual abuse were more likely to have histories of emotional and physical abuse, higher levels of addiction severity, and more family members who used drugs. Implications for research and treatment are discussed.     

Adolescents with learning disabilities who show sexually inappropriate or abusive behaviours: development of a research study

This paper sets out some key issues regarding sexual abuse perpetrated by adolescents with a learning disability. The limited evidence currently available is largely anecdotal or from small‐scale/case studies, but emphasizes that much behaviour of this kind never comes to the attention of either statutory social services or the criminal justice system. It is argued here that statutory services should be involved in such cases in order both to protect potential victims and to improve the ongoing life chances of alleged perpetrators. Speci?cally, it is posited that only by naming this problem can professionals hope to make effective interventions. The various organizational structures and systems adopted by four social services departments are outlined and their possible impacts on case outcomes are discussed. Little empirical research has so far been undertaken in this highly sensitive area, but an initiative from The Ann Craft Trust (formerly NAPSAC) aims to provide new evidence to help shape future best practice in this ?eld. Copyright © 2003 John Wiley & Sons, Ltd.     

Asking the Question: Childhood Sexual Abuse in Adults with Mental Illness

Enquiry about childhood sexual abuse (CSA) is not routine practice for mental health practitioners undertaking client assessment. This study audited 100 patient charts to determine rates of enquiry and response by mental practitioners around CSA. Fifty-seven mental health staff also completed a subsequent questionnaire exploring factors that influence practice in regard to sexual abuse. Staff lacked confidence in how to ask and effectively respond to sexual abuse disclosure. Mandatory training focusing on trauma informed care could improve staff confidence and capacity to identify and effectively address not only sexual abuse, but childhood trauma and abuse more generally.     

Understanding the social exclusion and stalled welfare of citizens with learning disabilities

Despite the UK’s recent history of promoting the social inclusion and equality of men and women with learning disabilities they remain a significantly disadvantaged group. Compared with their non‐disabled peers they are more likely to be unemployed, less likely to own their own homes and are at a significantly greater risk of physical and mental ill health. The first part of this paper discusses the welfare rights of citizens with learning disabilities in terms of New Labour’s welfare to work policies. The second part discusses the UK’s mixed welfare economy and its impact upon services for men and women with learning disabilities. The paper concludes by considering whether the social inclusion of men and women with learning disabilities can be promoted solely through policies that emphasise inclusion through work and the personalisation of welfare services.