A Learning-Disabled Woman who had been Raped: A Multi-Agency Approach

Abstract

was raised by the vertical position of the stent in the initial abdominal X-ray. After insertion, duodenal stents assume the C-shape of the duodenum. A vertical position might simply indicate straightening of the stent 3 . However, it could also represent migration or perforation; indeed, straightening-out might well be a risk factor for perforation.In a patient with malignant duodenal obstruction, the expected survival is only a few months 4 . Therefore the aim of stenting is to provide good palliation with avoidance of surgery. In this short period the risk of stent occlusion is negligible, but the risk of duodenal perforation needs to be borne in mind. People with learning disabilities are vulnerable to sexual exploitation and abuse 1 . Moreover, when incidents occur, the victims are sometimes perceived to make poor witnesses and the cases do not come to court 2 . Support and care may demand a multi-agency approach 3,4 , as illustrated by the following case. REFERENCES CASE HISTORYA woman with severe learning disabilities, from an ethnic minority group, was referred to her local community team for people with learning disabilities (CTLD) for speci®c nursing support around a termination of pregnancy. A disclosure of sexual abuse to her community keyworker also resulted in the involvement of social services, the police, primary care services and specialist health services for people with learning disabilities. In spoken and sign language (Makaton) she consistently identi®ed the alleged perpetrator and communicated her distress. Findings on examination were consistent with a pregnancy of 6 weeks gestation.Since the allegation involved a family member, social services offered the client the option of moving into a woman's refuge for people with learning disabilities. She accepted despite loss of daily contact with her daughter, who could not be accommodated. This decision provoked hostility from her extended family toward any professional. The CTLD allocated an experienced community nurse to support the client and liaise with other agencies, and a dedicated adult protection worker took the lead in coordinating and chairing multi-agency meetings between health services, social services and the police. A social services care manager was appointed to oversee the client's community care plan, which involved her safe house, day care, transport, funding issues and access to her daughter. Termination of pregnancyThe client consistently indicated through Makaton signing and her limited verbal skills that she did not want the pregnancy to continue to term. She referred to the pregnancy as a`bad baby', and reinforced this by signing bad', saying she wanted it`taken away'. Concerns that she was being pressured into accepting a termination of pregnancy generated extra vigilance to ensure that she understood the consequences and was determined on this course of action. She constantly reaf®rmed her choice. The process was initially explained by her community nurse and she then had a routine pretermination counselling session w...

Parents with learning disabilities: a study of gender and cultural perspectives in East London

“…The rate of termination (18%) amongst the English women reflected the underlying rate for England and Wales (Raleigh 1998) and compared to 6% amongst the Bangladeshi women. One was the direct result of a sexual assault (O'Hara & Martin 2001) and the other involved a severely learning disabled woman who had been taken back to Bangladesh where she was married and became pregnant. However, data collection showed that terminations, though known to practitioners, were rarely documented in clinical notes and that specialist emotional support was not offered.…”

Sexual health for people with intellectual disability

“…Still less cases of serious sexual abuse or assault are actually dealt with by the courts. 6,7 However, a person with limited communication skills can be assisted by the use of dolls, drawings or models. As with abuse in children, this needs to be performed by a person with appropriate skills and training to avoid leading questions.…”

“…3 If appropriate methods are used, even a person with severe disability may be able to report abuse and make decisions about how to proceed. 7 The best protection has been shown to be sexual abuse knowledge 5 so there is a very real place for education programmes to reduce the risk of sexual abuse.…”

“…In particular, the lack of power many people with disabilities experience in their relationships generally may make it difficult to be sure whether consent is truly given. 7 As a parallel, it may be useful to consider the issues that need to be considered when assessing a person's capacity to make other complex decisions, such as consenting to medical treatment. In a medical situation, a person needs to be able to:…”

Understanding the Sexuality of Persons With Intellectual Disability in Residential Facilities: Perceptions of Service Providers and People With Disabilities

“…Furthermore, people with disabilities are more vulnerable to sexual assault than the general public. Reasons for vulnerability also include poor understanding of the nature of the disability and the limitations presented by it, difficulty negotiating equality in relationships and difficulty reporting abuse (O'Hara & Martin, 2001;Valenti-Hein, 2000). Also, persons with the disability may themselves not feel that they have a right to make their own decisions about sex because of their upbringing, or they may be manipulated into an abusive relationship by means of rewards or flattery (Polusny & Follette, 1995).…”