Strategies for coping with abuse maintained participant's engagement in local communities. Sexuality was often problematized by others despite being generally accepted by participants. Coming out was a continual process of decision-making to facilitate safety and acceptance. To feel fully supported, participants desired holistic service provision sensitive to their sexuality and intellectual disability needs. Clinical and research implications are suggested.

Objectives This paper sought to conduct a meta‐analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. Design Systematic review and meta‐analysis. Methods PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre–post/post‐follow‐up effect sizes (ESs) were extracted and synthesized in a random‐effects meta‐analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between‐group ES from trials of CAT. Results Twenty‐five studies providing pre–post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre–post improvements in global functioning (ES = 0.86; 95% CI 0.71–1.01, N = 628), moderate‐to‐large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51–0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80–1.29, N = 586). All these effects were maintained or improved upon at follow‐up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small–moderate, significant post‐treatment benefits compared to comparators in nine clinical trials (ES = 0.36–0.53; N = 352). The average dropout rate for CAT was 16% (range 0–33%). Conclusions Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base. Practitioner points Large pre–post reductions in global functioning and depression outcomes and moderate–large reductions in interpersonal problems are evident after CAT. The effects of CAT appear durable, and interpersonal functioning significantly improves over follow‐up time. CAT produces small–moderate benefits compared to trial comparators. CAT appears to be an engaging psychotherapy that maintains patients in treatment.

Accessible summary  Our health service ran a group to support people to stand up for their human rights.  People with learning disabilities have their own stories to tell about human rights.  Group members created a character called FREDA (fairness, respect, equality, dignity, autonomy) to understand how human rights laws affect their lives.  The group did not follow its original plan. The group shared their own knowledge and experiences with each other. Acting on what people in the group wanted was most important. Written by Tina O’Connor1 SummaryService user inclusion is a key component of a human rights‐based approach to healthcare and models of inclusion are developing rapidly. This article describes work with a group of NHS service users, designed to increase their knowledge of human rights, as part of a broader set of initiatives focussing on changing organisational culture. During a mutual learning journey, ‘co‐production’ emerged as a preferred model for promoting service user’s understandings of human rights. ‘Co‐production’, or sharing service design and delivery more equally with service users, led to outcomes that were initially inconceivable. During the group, co‐production appeared to be a vehicle for resolving dilemmas about services ‘empowering’ service users. This article considers how, when service user involvement and a HRBA are combined, a move away from tokenism towards collaboration, empowerment and redistribution of power is possible.

Purpose -People with learning disabilities are vulnerable to human rights violations, creating a need for human rights education for both services users and support staff. This research paper aims to examine factors contributing to effective human rights training for staff. It seeks to investigate human rights awareness training (HRAT) within an NHS setting and its effect on human rights knowledge and attitudes towards human rights.Design/methodology/approach -A total of 23 support staff were given HRAT, completing a ''human rights based approach knowledge quiz'' and an ''attitudes to human rights questionnaire'' before and after training.Findings -The results indicated that HRAT had a significant effect on human rights knowledge scores; however, training had no significant effect on attitudes towards human rights and no significant relationship between staff attitude and human rights knowledge was found. Research limitations/implications-Future training would benefit from a greater focus on psychological theories of attitudes and behaviour in the planning, execution and evaluation of the training. This may help to facilitate development of positive attitudes towards human rights. A validation of the measure of attitudinal change is needed. Training models with a greater emphasis on staff's emotional responses, defences and the impact of organisational culture may allow a deeper understanding of the complexities of delivering effective human rights training.Originality/value -This research paper highlights the need for human rights training; one that encompasses attitudinal change as well as basic education. Without effective training to secure staff engagement in organisational change, human rights legislation is unlikely to create meaningful change in the lives of people with learning disabilities.