Detection and prevention of abuse of adults with intellectual and other developmental disabilities in care services: A systematic review

Abstract

Background: The abuse of adults with intellectual and developmental disabilities in care services seems to be relatively common, although there are anecdotal suggestions that abuse may be predictable and preventable.Method: Evidence related to how abuse is detected and prevented within services was reviewed. Database and ancestry searches were conducted, and the methodological quality of studies assessed using the mixed methods appraisal tool.Results: A total of 48 articles were reviewed. The characteristics of victims, perpetrators and organisations were summarised. Several recommendations for how abuse can be detected and prevented were made, including better staff training, supervision and monitoring of services. The quality of studies limits the reliability and validity of research findings. Conclusion:Risk and protective factors related to the abuse of adults with intellectual and other developmental disabilities remain largely consistent. Further research is required to support the implementation of recommendations aimed to detect and prevent abuse.

A picture is worth a thousand words: A proposal to incorporate video into the evaluation of adults with intellectual or developmental disability living outside the home

“…This would be a convenient, easy way for a direct care worker to learn about the adult with whom they are working. Furthermore, visual aids, particularly narrative-based ones, have been shown to facilitate development of empathy and a positive attitude toward others ( 28 , 30 ), which are protective factors against neglect and abuse ( 13 , 19 , 22 ). Knowledge of an individual's functional capacity and enjoyed activities may allow a direct care provider to provide activities that promote overall mental and physical health.…”

“…These individuals are at increased risk for premature morbidity or mortality associated with preventable illness or deterioration (3)(4)(5)(6)(7)(8)(9)(10)(11) and have a 20year decrease in life expectancy (12). Adults with IDD are also at risk for neglect and mistreatment, a finding documented across multiple countries and in a variety of care settings (13)(14)(15)(16); key contributing factors have been identified (13,(17)(18)(19)(20)(21). Thus, adults with IDD represent a large and vulnerable population that experiences disparities in health and overall well-being.…”

“…Stakeholders in the system including service users and their families, care workers and case workers, face significant challenges in safeguarding the well-being of adults with IDD. Protective factors include positive attitudes of the staff toward the residents, value congruence and the perception of a relationship [reviewed in Collins and Murphy, 2021] ( 13 , 19 , 22 ). Conversely, a perception of ‘otherness', ‘resistance' or an attitude of ‘staff-centeredness' were associated with worse care performance ( 18 ).…”

“…Health care disparities, neglect and mistreatment are facilitated by inconsistent record-keeping and ineffective oversight secondary to a systemic lack of resources, variability in management, and frequent turnover of care workers and of case workers ( 13 , 17 , 31 ). Proposed interventions to improve oversight include the use of constant video surveillance, which has limitations in difficulty of implementation, privacy considerations and service user wishes ( 32 ).…”

Exploring the knowledge base of trauma and trauma informed care of staff working in community residential accommodation for adults with an intellectual disability

“…While there is generally a more heightened risk to abuse for adults with an intellectual disability the Division of Clinical Psychology (DCP, 2017) reports that they are more likely to have experiences of multiple placements, sudden changes to their living arrangements, be excluded at times of bereavement, have bullying experiences and lose the right to parent or have relationships. In their systematic review of abuse for adults with an intellectual disability in care settings Colins and Murphy (2021) describe individual, perpetrator and organisational risk factors for abuse of adults with an intellectual disability, noting risks due to severity of intellectual disability, being known to services over time, challenging behaviours and involvement with behaviour management services. A recent scoping review by McNally et al (2021) highlighted growing evidence for the NICE (2018) recommended interventions but challenges remain for the formal recognition and assessment of trauma for adults with an intellectual disability.…”