Authors/Year Participants Sampling Strategy Design Assessment Findings/Factors identified Methodological Strengths Methodological Limitations Factors Allington, 1992 N=107 Staff working in residential and day facilities for AWLD. Returns from postal survey. Questionnaire assessments. Questions provided in appendices. 14% of staff reported not knowing what to do in a sexual abuse situation. One third of staff would like teaching on sexual abuse. Large sample. No questionnaire validity or reliability information provided. Sample represented one third of questionnaires sent. Bowman, Scotti and Morris, 2010 N= 124 Direct care staff or supervisors from day centres or residential group home settings for AWLD. Participants were recruited through attendance in voluntary sexual awareness training. Pre and post training questionnaire assessments. Participants completed a variety of demographic information questions, the Sexual Abuse Attitudes and Knowledge Questionnaire (SAAKQ) and the Global Perceptions Scale (GPS). Post training: Staff showed significant increase in sexual abuse awareness however, scores remained low. Staff rated themselves as only having an ‘average amount of knowledge’ of sexual abuse in AWLD. There was no significant change post training with regards to staff attitudes about AWLD as measured by the GPS. Large sample. Participants were mainly young females and therefore not representative of population most likely to abuse. Study did not report GPS pre or post test scores; it is therefore difficult to make assumptions about staff general attitudes towards AWLD. Study experienced participant drop out before post workshop measures could be completed. Brown, Hunt and Stein, 1994 N=94 Staff from health service districts working across a number of settings including domiciliary and residential services for AWLD. Participants attended a group providing an introduction to a Sexual Abuse Project. Questionnaire assessments. Questionnaire information not included. Some questions are provided throughout the course of the article. 70% of could remember almost nothing of their employee’s sexuality guidelines. Staff respondents identified irregular or temporary staff as more likely to abuse AWLD. Administering the questionnaire in the context of the group increased the likelihood of returns. Data were gathered from a range of employees. Large sample. Staff may have felt uncomfortable giving honest responses and real life case examples in front of colleagues. This may have increased concerns around confidentiality. No data is provided as to the overall response rate. Administering questionnaire in the context of a special interest group could have resulted in selection bias.
Crossmaker, 1991 - - Discussion/Commentary - Staff may rationalise boundaries between care giving and sexual abuse. A staff view of residents as objects, dehumanises and increases victimisation. references the works of others to support ideas. Does not describe method. Hames, 1996 N=105 working across 3 LD day centre sites. Opportunity sample of staff who attended sexual abuse training. Staff completed a questionnaire pre and post. The questionnaire measured staff attitudes to sexual abuse and the vulnerability of AWLD. Staff showed a lack of realistic understanding of the vulnerabilities and potential risks of sexual abuse in AWLD before training particularly in relation to risk posed by known individuals. Training failed to increase perceived risk posed by known individuals. Questionnaires surveyed a range of direct care professionals. Opportunity sample may not be representative of all staff. Social pressure of completing questionnaire as part of training and group may have impacted on results. The proportion of staff who attended the training and the response rate for completing the questionnaire is not included. No information provided on the authors, design, validity or reliability of the questionnaire used. Not all participants completed the questionnaire before and after training. A description of the management and analysis of subject attrition is not provided. Jenkins, Davies and Northway, 2008 N=70 LD direct care staff Participants that had an interest in the protection of AWLD from different of abuse were invited to participate in the study. A stratified sampling technique was used. Focus groups on staff attitudes towards practice issues. Thematic analysis of transcripts was undertaken. Staff expressed ambivalence and uncertainty as to best course of action and use of procedures in abuse situation The thresholds at which people decide to take action to abuse varies between staff. Stratified sampling technique. Transcript coding was reviewed by research team to ensure coding consistency. Selection bias, all participants had expressed interest in the prevention of of AWLD. The paper does not discuss response rates.
McCarthy and Thompson, 1996 - - Discussion/Commentary - Sexual abuse training for staff is short and there is little follow up. - Paper is based on ideas developed through experience working in the area of sexuality and sexual abuse of AW LD settings. No evidence. Mainly focuses on sexual abuse. Owen, Griffiths, Feldman, and Richards, 2000 N=32 14 members of and 18 consumers from community residential services for AWLD. Voluntary participation Questionnaire assessment likert scale format. Questionnaire was developed with participant population through thematic analysis of semi structured interviews. Questionnaire assessed consumers and staff judgements of appropriateness of social behaviours towards him/herself by different individuals. Staff considered face-to-face hugging acceptable when there had been a long association with the consumer. Half of the staff interviewed did not mind being patted on the leg by a consumer. Provides details of questionnaire development and content. Participants were representative of both genders of staff. Participants had been interviewed previously for the development of the questionnaire potentially leading to demand characteristics. Does not clearly describe sampling strategy and participant recruitment. Thompson, Clare and Brown, 1997 N=5 Female support workers working with men with LD. Unspecified Pilot study using structured interviews to look at boundaries between male client and female staff member. Unspecified Staff appraise appropriateness of forms of touching including kissing, holding hands, hugging and sitting on laps by making a judgement about which men are potentially sexual. - Female sample not representative. Does not include sampling strategy. Does not include interview questions, reliability or validity formation.
Sampling Strategy Design Findings/Factors identified Strengths Methodological Limitations Setting 1991 - - - Institutions impinge on people’s privacy and dignity which may contribute to the occurrence of sexual abuse. Paper references the works of others to support ideas. Does not describe method. Davies and 2008 N=70 LD direct care Participants that had an interest in the protection of AWLD from different types of abuse were invited to participate in the study. A stratified sampling technique was used. groups on staff attitudes towards practice issues. analysis of was Attitudes towards abuse can go unchallenged when organisations become isolated. Stratified sampling technique. Transcripts coding was reviewed by research team to ensure coding consistency. Selection bias, all participants had expressed interest in the prevention of abuse of AWLD. The paper does not discuss response rates. and 1996 - - - The bigger the service the more chance of an abuser working there. Large dehumanising settings provide the space for abuse dynamics to flourish. - Paper is based on ideas developed through experience working in the area of sexuality and sexual abuse of people in LD settings. No evidence. Mainly focuses on client-to-client sexual abuse. and 1997 N=5 Female support workers working with men with LD. Unspecified Pilot study using structured interviews to look at boundaries between male client and female staff member. Sexual abuse training is viewed as a special interest area. . - Female not representative of those who abuse. Does not include sampling strategy. More women went of sexual abuse training than men Brown way,
really, I don’t think I’ve ever really talked about it’. The discussion of boundaries for a number of participants appeared genuinely thought provoking. Claire said that the interview ‘made me think, made me think of some que-, you know, for myself’ and Anna said ‘I shall be thinking about this all day today now (laughs) It’s got me actually. Yeah when, it’s not when you start thinking about it you know’. This could potentially give further weight to the notion that this is not a subject area regularly discussed and reflected upon by staff. However, participants appeared to be genuinely interested in the subject. For some, the benefits of talking about boundaries were connected with the protective and restorative nature of supervision. This was seen as a space to bring complex clients and ethical dilemmas and that supervisory discussions were helpful in the management of boundaries. For example Sarah said ‘I think we’re, we’re very fortunate, I think we get, we get opportunities, you know we get opportunities to meet clinically, at least once a week and talk through people, and to raise, issues that, you know, we’ve also got, we’ve got an ethics committee, so if there are issues that we’re concerned about we can take that to ethics and talk about’. The importance of supervision was also identified in Mary’s account, when reflecting on how she managed multiple roles she said ‘I mean, we have good support from above…I know that if I’m struggling I can just pick up the phone and say, ‘Oh god, I’m really struggling’. I think that makes a lot of difference’. Claire additionally discussed the value of peer supervision and reflected that in pressurised
participants’ accounts that assume this agreement given the extensive literature on the ‘acquiescence bias’ (Sigelman, Budd, Spanhel & Schoenrock, 1981a, 1981b) and ‘handicapped smile’ (Sinason, 1992), which suggests that staff tend to assume the person with a learning disability is enjoying or agreeing to certain interactions when this may not be the case (Hollins & Sinason, 2000). In other cases, instead of focusing on boundaries in their client relationships participants often spoke about ‘good care’ and likened this to interactions with family and friends. These ideas are in line with the concept of ‘Intelligent Kindness’ (Ballat and Campling, 2011). Campling suggests that the word kindness has historical roots in the word ‘cynd’, which means family or kin. Kindness therefore implies ‘the recognition of being of the same nature as others, being of a kind, in kinship’ (Campling, 2015, p. 3). ‘Intelligent Kindness’ relates to the care of those with a physical illness however, its ideas could be applied to the care of people with learning disabilities. ‘Intelligent Kindness’ proposes that kindness lies at the centre of effective front line healthcare and that staff are motivated to treat others as members of the family, creating a virtuous cycle which supports a better therapeutic alliance, better outcomes and a subsequent reduction in staff anxiety and increase in satisfaction (Ballat and Campling, 2011). Whilst the suggestion that nurses treating patients as family member in many ways may sound idyllic, it is important to note that this raises issues for client care. Given the differences in family values and relationships, it
References Allington, C.L.J. (1992). Sexual abuse within services for people with learning disabilities. Staffs’ perception, understandings of, and contact with the problem of sexual abuse. Mental Handicap, 20, Ballatt, J., & Campling, P. (2011). Building the case for kindness. In Intelligent Kindness: Reforming the Culture of Healthcare. Royal College of Psychiatrists, 33-47. Bandura A. (1999). Moral disengagement in the perpetration of inhumanities. Personality and Social Psychology Review, 3, Banning, M. (2005). Approaches to teaching: current opinions and related research. Education Today, 25(7), 502-508. J., Mansell, J., Cambridge, P., Milne, A., & Whelton, B. (2010). Adult protection of people with intellectual disabilities: incidence, nature and responses. Journal of Applied Research in Intellectual Disabilities, 23(6), 573-584. Bowler, M., & Nash, P. (2014). Professional boundaries in learning disability care. Nursing Times, 110, 12-15. Bromley J., & Emerson E. (1995). Beliefs and emotional reactions of care staff working with people with challenging behaviour. Journal of Intellectual Disability Research, 39, 341–352. Brown, H., Hunt, N., & Stein, J. (1994). ‘Alarming but very necessary’: working with staff groups around the sexual abuse of adults with
60-69 years 70-79 years What is your ethnicity? White: British White: Irish White: Gypsy or Irish Traveller White: Other White: Please Describe …………………………………………………. Mixed: White and Black Caribbean White and Black African Mixed: White and Asian Other Mixed: Please Describe …………………………………………………... Asian: Indian Asian: Pakistani Asian: Bangladeshi Asian: Chinese Asian: Other: Please Describe ………………………………………….…. Black: African Black: Caribbean Black: Other: Please Describe ……………………………………………… Arab Other: Please Describe ……………………………………………… How many years have you been working as a registered nurse? Up to 5 years 5-10 10-15 years 15-20 years 20-25 years More than 25 years What was the title of the nursing qualification you completed? How long have you worked in services for adults with learning disabilities? What kind of services for adults with learning disabilities have you worked in? Community Services Forensic Services