Intimate and personal care is a major area of support and provision for people with intellectual disability (ID), particularly those with profound and multiple ID. However, its management and practice has largely been neglected outside the use of individual guidelines and same-gender intimate care policies, with little research evidence or theoretical literature to inform the planning, conduct and organization of associated care tasks. The present paper reports on the methodology and findings of an exploratory study designed to map the key management and practice issues, and suggest ways forward for the providers of services for people with ID in relation to the quality and outcomes of intimate and personal care.
The task of assessing people with profound intellectual disabilities and multiple impairments can be a daunting one, for experienced and newly qualified clinicians and practitioners alike. Difficulties with definitions in the context of challenging, excluding service delivery models can sometimes lead to incoherent and inconsistent approaches. The author examines a number of issues, including the paucity of adequately sensitive, standardized assessment tools, the importance of collaborative working, and the acknowledgment that services can be ill‐equipped to face the challenges presented by people with such complex and chronic support needs. The role of an overly generic service philosophy in potentially limiting the work of clinicians is noted, and the author notes that evaluating development is a crucial factor in any overall assessment. The author concludes with a number of recommendations for developing good practice in this crucial area of the support process, including: agree on terminology and inclusion criteria; take a transdisciplinary approach; use a developmental model; consider the impact of neurological conditions; select measures and informants carefully; and consider the assessment as an intervention.
Masturbation is frequently referenced as a key issue for supporting the sexuality of people with learning disabilities, yet the subject has received little attention in the professional and academic literature. This article provides an overview of masturbation in relation to service responses and user support in sexuality work in learning disability more widely, drawing in evidence and experience from sex education, clinical work and staff training. Issues such as gender, sexuality, culture and consent are addressed and some of the commonly held myths and assumptions about sexuality and masturbation are challenged. The discussion and related suggestions are designed to be of value to service managers and practitioners, particularly those involved in sexuality work and one-to-one support.
An established individual planning service was evaluated using a service-user-centred approach, which looked at the extent to which people are involved in the process and their understanding of its nature and function. Responses recorded during interviews with service users, their keyworkers and some family members are complemented with data collected from participant observation of individual planning meetings. The findings suggest that the majority of service users able to speak for themselves who were interviewed have a good understanding of the planning process and find it a positive experience; this is supported by participant observation data. Those speaking on behalf of people unable to speak for themselves are unclear as to how much understanding the group has of the process. Observation data suggest that people needing others to speak on their behalf are excluded from discussion during meetings more often than they are included. Recommendations are made for developing the service and providing additional support for keyworkers, building upon the considerable progress made during the service's inception.
This paper identifies considerations for managing the risks of abuse during intimate and personal care for people with learning disabilities and complex needs. Drawing on insights gleaned from research involving interviews with staff, policies and procedures in specialist day and residential services, and the development of a staff training resource, the paper identifies a framework for adult protection practice in this critical area of support.
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