Cognitive impairment and exploitation: connecting fragments of a bigger picture through data.

BACKGROUND: Exploitation poses a significant public health concern. This paper highlights 'jigsaw pieces' of statistical evidence, indicating cognitive impairment as a pre- or co-existing factor in exploitation. METHODS: We reviewed English Safeguarding Adults Collection (SAC) data and Safeguarding Adults Reviews (SARs) from 2017 to 22. Data relevant to exploitation and cognitive impairment were analysed using summary statistics and 'analysis of variance'. RESULTS: Despite estimates suggesting cognitive impairments may be prevalent among people experiencing exploitation in England, national datasets miss opportunities to illuminate this issue. Although SAC data include statistics on support needs and various forms of abuse and exploitation, they lack intersectional data. Significant regional variations in recorded safeguarding investigations and potential conflation between abuse and exploitation also suggest data inconsistencies. Increased safeguarding investigations for people who were not previously in contact with services indicate that adults may be 'slipping through the net'. SARs, although representing serious cases, provide stronger evidence linking cognitive impairment with risks of exploitation. CONCLUSIONS: This study identifies opportunities to collect detailed information on cognitive impairment and exploitation. The extremely limited quantitative evidence-base could be enhanced using existing data channels to build a more robust picture, as well as improve prevention, identification and response efforts for 'at-risk' adults.

Risk of forced marriage amongst people with learning disabilities in the UK: Perspectives of South Asian carers.

BACKGROUND: People with intellectual disabilities are at increased risk of forced marriage compared to those without intellectual disabilities. In the UK, this risk is particularly, though not exclusively, associated with South Asian communities and is linked to the desire to secure long-term care. METHOD: Focus groups and semi-structured interviews were undertaken with South Asian parents and family carers (n = 22) of adults with intellectual disability and the resultant data thematically analysed. RESULTS: Although securing care for their intellectually disabled relative was identified as a key motivator for forced marriage, other important themes also emerged. These included cultural and religious beliefs about disability and marriage, and limited understanding of relevant laws. Factors militating against forced marriage were also identified, including fears of abuse and neglect. CONCLUSIONS: Implications for the provision of services and the need for improved access to information on forced marriage of people with intellectual disabilities are highlighted.

Staff understandings of abuse and poor practice in residential settings for adults with intellectual disabilities.

BACKGROUND: A common factor in the abuse of people with intellectual disabilities in residential settings has been the failure of care staff and frontline managers to recognise poor practice at an early stage and prevent its development into a culture of abuse. In this context, staff understandings of abuse and poor practice in residential services for people with intellectual disabilities were explored. METHOD: Semi-structured interviews (n = 56) were undertaken with care staff and frontline managers working across England. Interviews included the use of vignettes, based on real-life experiences of people with intellectual disabilities, to prompt discussion. RESULTS: Staff struggled to define either "abuse" or "poor practice", focussing more on individual acts or omissions than on institutional practices. When faced with vignettes, staff demonstrated a lack of agreement regarding what constitutes either abuse or poor practice. CONCLUSIONS: The implications for practice in residential care settings and for safeguarding training are discussed.

Cognitive Impairment as A Vulnerability for Exploitation: A Scoping Review.

Exploitation is a form of abuse that occurs when one person unfairly manipulates another for profit or personal gain. Various individual and social characteristics have the potential to increase an individual's risk of being exploited. Cognitive impairment is one potential vulnerability factor that has received minimal research attention. This scoping review aimed to investigate cognitive impairment as a factor that may increase an individual's vulnerability to exploitation. Study inclusion criteria were: (a) empirical studies; (b) studies presenting extractable data related to cognitive impairment and exploitation; (c) studies exploring cognitive impairment as a vulnerability factor for exploitation; (d) studies published after 1998; and (e) studies available in English. A six-step search strategy was employed: (a) electronic searches of bibliographic databases; (b) screening reference lists of included studies; (c) forward citation tracking in Google Scholar; (d) expert recommendations; (e) website searches of relevant Non-Governmental Organizations (NGOs); and (f) a call for evidence. Twenty studies met the inclusion criteria. Three types of exploitation were reported: sexual (n = 10), financial (n = 8), and criminal (n = 2). Intellectual disability (n = 8) and mental health (n = 8) were the most frequently described forms of cognitive impairment. The results indicate that cognitive impairment is a factor that increases vulnerability to exploitation. However, the limited number and disparate nature of the studies means that it is impossible to disentangle all the complexities in the relationship between cognitive impairment and exploitation. Further research is needed to understand if cognitive impairment increases vulnerability to all types of exploitation or if it results in varying levels of susceptibility to different types of exploitation.

Acquired Brain Injury, Social Work and the Challenges of Personalisation.

Increasing numbers of adults in the UK are living with acquired brain injury (ABI), with those affected requiring immediate medical care and longer-term rehabilitative and social care. Despite their social needs, limited attention has been paid to people with ABI within the social work literature and their needs are also often overlooked in policy and guidance. As a means of highlighting the challenge that ABI presents to statutory social work, this paper will start by outlining the common characteristics of ABI and consider the (limited) relevant policy guidance. The particular difficulties of reconciling the needs of people with ABI with the prevailing orthodoxies of personalisation will then be explored, with a particular focus on the mismatch between systems which rest on presumptions autonomy and the circumstances of individuals with ABI-typified by executive dysfunction and lack of insight into their own condition. Composite case studies, drawn from the first author's experiences as a case manager for individuals with ABI, will be used to illustrate the arguments being made. The paper will conclude by considering the knowledge and skills which social workers need in order to better support people with ABI.