The State of Care Management in Learning Disability and Mental Health Services 12 Years into Community Care

This paper reports on the organization of care management froma longitudinal study of community care for people resettledfrom long-stay learning disability and psychiatric hospitals.The findings from a 12-year follow-up of care management arrangementsin 12 learning disability and eight mental health study siteservices are described. The diversity of care management arrangementsfound at earlier points in the evaluation remained evident.Also, many of the former ‘care in the community’service users were excluded from mainstream care managementarrangements in their localities. The difficulty of developingperson-centred arrangements in learning disability and the lackof integration of the Care Programme Approach and care managementwere evident. The findings and observations are placed in thewider policy and practice context, with suggestions for takingcare management forward nationally and locally.     

The Tension between Mainstream Competence and Specialization in Adult Protection: An Evaluation of the Role of the Adult Protection Co-ordinator

With the implementation of No Secrets (Department of Health, 2000),the question of how far to specialize in adult protection hasbeen raised for social services departments. Related issuesinclude the extent of specialization within the vulnerable adultclient groups as well as between adult protection specialistsand other workers. This paper draws on an evaluation of therole of the adult protection co-ordinator across two local authoritysocial services departments (the case study) who share adultprotection policies, protocols and procedures but where thespecialist role has only partially been implemented and hasevolved in different ways. It identifies a number of criticalconsiderations for the local implementation of national policy,including the particular model for adult protection specialization,working relationships with district management and care management,decision making and accountability, adult protection case managementand the development of mainstream competence in adult protection.     

The Management and Practice of Joint Adult Protection Investigations between Health and Social Services: Issues Arising from a Training Intervention

The implementation of government policy for the protection of vulnerable adults [Department of Health (2000 Department of Health. 2000. No Secrets: Guidance on Developing and Implementing Multi‐agency Policies and Procedures to Protect Vulnerable Adults from Abuse, London: HMSO.  [Google Scholar]) No Secrets] has set expectations for the development of multi‐agency policies and procedures in adult protection in England. Multi‐agency working in adult protection mainly concerns complex cases involving more than one service user or where a number of managers or practitioners are involved. However, these also tend to be the most serious abuse cases where the necessity for effective inter‐agency co‐ordination collaboration between social services authorities (local authorities) and health trusts (NHS) is most acute, especially with the development of partnership working such as in learning disability [Department of Health (2001 Department of Health. 2001. Valuing People: A New Strategy for Learning Disability for the 21st Century, London: Department of Health.  [Google Scholar]) Valuing People]. Moreover, effective collaboration with the police in the conduct of adult protection casework and process is required for cases where criminal offences may have been committed. These demands put high expectations on the professionals involved. Based on a series of joint training interventions between social services and health personnel in Kent, this paper identifies key issues for the effective performance of joint adult protection investigations and maps both the challenges and management and practice competencies required. Potential solutions to the complexities of managing multi‐agency investigations in adult protection were identified with potential relevance to improving adult protection case management and co‐ordination more widely.     

Social work education in the West Indies

Social Work Education has been offered in the West Indies at a professional certificate level since 1961. Programmes exist within multi-disciplinary Departments of academic institutions in six countries. Given limited staff resources, they benefit from the availability of instruction in related subject areas but lack the autonomy to create fully integrated social work curricula. Graduates are prepared to function in a post-colonial (post slavery) West Indian society characterized by increasingly democratized patterns of social organization and indicators of modernization but with a serious catalogue of contextual, structural and human behavioural problems which impact the economic social and cultural lifestyles of the people. While there have been some positive developments, the major constraining factors for regional social work education are: limited resources which deny programme autonomy, limit staffing and subject offerings; an unsatisfactory dependence on metropolitan social work education models; and an insufficient sensitivity to the challenge to produce indigenous theory and culturally appropriate practice models. Challenges to be addressed are the need for authentic West Indian (Caribbean) social work models, the strengthening of field practice experience for students, more preparation for advocacy and policy development roles and the extension of professional education at the undergraduate level through the distance education mode, and at the post graduate level.     

Good enough decision‐making? Improving decision‐making in adult protection

This paper examines decision‐making in adult protection based on arrangements operating in a local authority social services department and discussion generated in a specialist training intervention. The paper seeks to identify ways in which approaches to decision‐making can be made both more effective and more user centred. The need for good information for efficient and effective decision‐making is highlighted, along with the need for user involvement for the production of positive and valued outcomes. The paper looks at how user centred arrangements can be put into practice and discusses the potential for advocacy, outlining possible approaches for adult protection casework. With local authority social services departments struggling to implement No Secrets (2000), with adult protection a key social care competence and with the implementation of PCP and similar approaches a priority (Valuing People, 2001), it is important to improve decision‐making in adult protection in ways that are not only time and resource efficient, but place service users and their advocates at the centre of related processes.     

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.     

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.     

温情派的居家情趣

剑桥公寓的设计经典而永恒,充满旧世界的浪漫迷人,以及美式的温馨舒适。独一无二的设计模糊了年代的界限,让家从本质上成为一个隽永的概念。     

The characteristics and management of elder abuse: evidence and lessons from a UK case study

Despite older people representing a significant majority of victims of abuse in the UK and Europe, evidence about its characteristics and management is limited. This article reports on an analysis of adult protection referrals for older people over an eight year period in two English local authorities. It extends understanding of the characteristics of elder abuse and identifies lessons for its effective management. Findings suggest that older people are at particular risk of multiple and physical abuse. Those living alone are especially vulnerable to financial abuse and those living in a care home to multiple abuse. The most common sites of abuse were the person's own home or a care home. Just two fifths of abuse referrals were confirmed, with the vast majority involving multi-agency consultation and most resulting in ongoing monitoring. Findings also suggest that risk is a product of the intersection of dependency and setting and that information about user and carer need—especially the nature of disability—could enhance the quality of adult protection data and safeguarding responses. The study underscores the need for adult protection legislation and of committing professional resources to the prevention, identification, assessment and management of elder abuse across Europe.     

The Quality of Life of People 12 Years after Resettlement from Long Stay Hospitals: users' views on their living environment, daily activities and future aspirations

We report service users' views on three important domains of their quality of life in the community 12 years after resettlement for long-stay hospitals. These concerned their living environments, daily activities and future aspirations. We asked a series of open questions as part of a structured interview with service users with learning disabilities (n = 196) and mental health problems (n = 102). The study is the longest reported follow-up of deinstitutionalisation in the UK and one of the longest anywhere in the world. The most frequently self-reported positive aspects of users' quality of life were the living environment, the social milieu and independence. The most frequently mentioned problems occurred within the social milieu and included bullying, the social regime, the physical aspects of the accommodation, and the personal feelings of loneliness and boredom. The most preferred activities were outings, education and work, relaxation and leisure. The most disliked activities were household chores and having nothing to do. About half those interviewed did not or could not answer a question about their future; those who did mentioned a wish for greater independence, more outings and personal and sexual relationships. We remark on some implications for services and for staff training.