A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with a reduced ability to cope independently (impaired social functioning); and a condition which started before adulthood, with a lasting effect on development (Scottish Executive, 2010).
People with learning disabilities comprise of a highly vulnerable section of the society, who have limited access to health care facilities / services offered to them. They are often faced with obstacles and challenges while copying with grave situations such as loss and bereavement of loved ones, personal illness, death etc (Elliott, 1995). This in turn tends to aggravate their situation and increase their dependence on the society - which includes their friends, family and loved ones as well as the community in general. They are known to have been ignored persistently in terms of providing services in the need of personal illness, death, and other challenging life situations, thus increasing their vulnerability all the more.
Risk & vulnerability:
People with learning disabilities are one of the most vulnerable groups in the society (Department of Health 2001). People with learning disabilities has probably one of the worst histories is neglect and ill treatment in any group of society. Among the most vulnerable members of society they can't speak up for themselves. Concepts of risk assessment and management in psychiatry increasingly reflect public and professional anxieties that people with a mental disorder may harm others (Simon Halstead (997).
At risk are the men's victims whose suffering was often exacerbated by service providers' failure to protect them. For example, if consequences are limited when a man with learning disabilities abuses another person with learning disabilities, the victim may be left with the idea that such behaviour is normal and acceptable, and that services will provide little protection and that their complaints will not be heard. It may also increase their vulnerability to further abuse because abuse can become normalised (McCarthy and Thompson, 1996).
The oxford dictionary define noun 'risk' as meaning a hazard, a dangerous, exposure to mischance or peril, as verb it also similar which means ''hazard, to danger, to expose to the chance of injury or loss''(P. Parsloe, 2005). Risk is closely linked to dangerousness, resulting in harm which seems to be agreed means harm to self or others and extend of harm which constitutes a risk in various situations especially adult with learning disabilities.
'If you don't know for sure what will happen, but you know the odd that is risk and if you don't know the odd that is uncertainty' (Knight, 1921).
From this definition of risk concentrate upon the probabilistic components in knowledge, and is agnostic as to whether this involves probabilities of good of bad outcomes. Royal Society(1983), risk assessment which saw as the probability that a particular adverse event occurs and social services has been concerned predominate with risk assessment to prevent harm.
They may also suffer further if they have to deal with seeing their perpetrator on a regular basis, and may be subject to further assaults in retaliation of their initial complaint. It has been noted above how services frequently respond inadequately to the abuse of people with learning disabilities by men with learning disabilities: only rarely will the police be involved
and most victims will have no option but to continue to see their attacker on a daily basis (Thompson, 1997). In addition to the risks to existing victims, poor responses may result in increasing numbers of people being abused.
Definiation of 'vulanarable adult' in section 80(6) care standard act 2000 states that-
(a) ''an adult to whom accomodation and nursing or personal care are provided in care hom'' (b) ''in adult to whom personal care is provided in their own home under arrangements mad by a domiliciary care agency''.(Ian. Peate&D.Fearns-2006)
Adult with learnign disabilities, and thos peopl who have a lescapcity like who have mental illness, old and frail,need protection from potentially abusive sitaution over which they might have little control (Department of Health,2000). Learning Disability Adolescents obviously do not always act in ways that serve their own best interests, even as defined by them. Sometimes their perception of their own risks, even of survival to adulthood, is larger than the reality; in other cases, they underestimate the risks of particular actions or behaviours. It is possible, indeed likely, that some adolescents engage in risky behaviours because of a perception of invulnerability-the current conventional wisdom of adults' views of adolescent behaviour. Others, however, take risks because they feel vulnerable to a point approaching hopelessness (Fischhoff et al., 2000). In either case, these perceptions can prompt adults to make poor decisions that can put them at risk and leave them vulnerable to physical or psychological harm that may have a negative impact on their long-term health and viability.
Risk Assessment Decision Making Process/ Practice Tools:
Every day a lot of risk situation changes rapidly and what applied yesterday but may not today. Those service users who are identified as "at risk" would be provided highly effective instruction to reduce their risk in the identified area (e.g., language, reading, numeracy/ math, behaviour). Service users whose response to instruction moved them out of risk status would receive no further supplemental intervention. Service users whose response to well-documented, effective, and well-implemented instruction was low or who remained at risk would be considered for placement in special education. Thus, potentially, many Users could benefit from this type of an identification procedure. (S.Vaughn and Lynn S. Fuchs, 2003). For minimize risk and make it useful and meaningful, may risk situations need to be reassessed regularly perhaps daily basis according service users daily need. People with learning disabilities are subject to risk all time due to their vulnerability they sometimes abused by those who have control over them or by those who realize that they are vulnerable because of their disabilities they often find it very much more difficult to assess risk the way most of us do. While most of carer don don't asses risk very efficiently they generally make some attempt to do so. It's not easy at all to do risk assessment as it is a complex task and most of the time carer or support worker they do adequately but not very thoroughly. Adult with learning disabilities they always find this difficult and also fail to recognize any risk at all as they can't explain due to lack of communication. In spite of some difficulties, there is an increasing awareness that people with learning disabilities can make choices, moreover they want to do so. However it's often fail to consider is that, the amount of risk that these choices carry and most of us have grown up accustomed to risk-taking. Life is full risks we all take risk all the time and the more familiar they are the less we tend to recognize the real level of risk involved.(Refe.........). Many problems about assessing risk that different services user may perceive the different risk. What is acceptable to one person may not be acceptable to another. Main objective of the risk assessment when it's possible may sometimes affect decision making in number of different ways.
Its true many people with learning disabilities who are always facing risk in their everyday life. Significantly about choice decision sometimes it's difficult for adult as well carer to make right choice how could be at risk. The difficulty for people with learning disabilities is that carers often do feel often they are expected to make these choices for them. The law of negligence can appear to inhibit decision making 'personal freedom and choice sit uncomfortably next to the concepts of duty of care and professional liability (Ref..........).' people with learning disabilities may not have done perhaps carers need to be encourage to help their service users how to make choices with and appreciation of the risk involved. This is more challenging task than just encouraging choice alone it seems that not only should people with learning be allowed to make choices and take risk 'they should actively be encourage to do.'
Multidisciplinary Risk Assessment:
The problem with the right to make choices is that it assumes that adult with learning disabilities are able to make choice about risk in the same way every one does(Refe....). we have to acknowledge that adult with learning disabilities do have real difficulties with many cognitive takes. Most we have problems in assessing risk effectively because of the complexity of doing so it is likely that people with learning disabilities will find the particular difficult. The assessment of ability to consent and the ability to make real choice, especially in relation to understanding the likely consequences of the choices or decision made. It could be helpful when any risk assessment pan to do like-
If carer want to take any decision about the adult person, Is person are aware that about their decision at all? Are they communicating their choice decision making?
Giving people with learning disabilities more choice especially about taking risk, it's mean that carer have to be alert to the extent to which the service users are able realistically to assess the level of risks involved(Ref.............). In order to decide when risk is acceptable, they need to consider a large number of pieces of information which is decision making become difficult for carer/support worker.
Many adult with learning disabled the most successful way to avoid and minimize risk to avoid further problem is by effective management. When the person concerned may have been living in a setting where the opportunities for such behaviour have been very limited or absent, carers and professionals are sometimes tempted to assume that because the recent past has been incident-free the problem has disappeared.
Never take someone with a learning disability swimming without first reviewing their risk assessment plan. A risk assessment is in place to address issues of importance such as dangers, hazards, and known triggers and how best to avoid them. Make sure you are familiar with the particular risks that you could face with the person in your care and that you have put measures in place to reduce, or eliminate, them.
Assessment is a complex and time consuming task and it is a continuous process. Assessment of risk for adult with learning disabilities which should be evolutionary in nature constantly informed and shaped by changes of circumstances upon service users needs (M.Brown, 2003). The practice of risk assessment and management is the process of data collection, recording, interpretation, communication and implementation of risk reduction plan (Maden, 1996). For the risk of learning disability, clinical model of risk assessment have become the norm. There are two kinds of risk that are relevant to work people with learning disabilities, risk of unnecessary exposure to undesirable events or experience, and risk of negative consequences when possible benefits and desirable experiences are perused (Paul William, 2006). Above this it is clear that a strategy of prevention should implement, and management is required so that risk and benefit are balanced.
In social care and health care there are broadly two main context of risk which are not provided and everyday risk in their life. people with learning disability to have a history of formally documented offence.
People with learning disabilities are beginning to reclaim the lives they lost in the institutions, having choices, jobs, sex lives and even becoming parents - unthinkable until even quite recently. Slowly, perhaps far too slowly, the rest of the community is beginning to realize that the majority of people with learning disabilities are not so different from everyone else, and need the same things in their lives that all of us do: work, leisure, partners, and a sense of being part of a social group. They want to feel useful and valued, as we all do.
Life is full of risks. We all take risks all the time, and the more familiar they are the less we tend to recognize the real level of risk involved. We actually take the greatest risk in our lives every time that we step into a car, but few of us really consider that risk seriously. This is the other side of the coin; we are inclined to believe that 'it won't happen to me', even when the objective statistics suggest otherwise.
The difficulty that now exists for people with learning disabilities, especially those with greater handicaps, and those who care for and support them, is that the law specifies that many such people are vulnerable, and not able to make this choice for themselves. They are considered to be unable to assess the risks involved and thus make an independent choice. The onus of assessing risk and making the decision therefore often rests with carers. Because it is such a difficult decision to make for someone else, carers often take the simple way out, and avoid letting situations arise where learning-disabled people in their care have the opportunity to develop sexual relationships: if a person cannot make an 'informed choice'
then perhaps it is easier not to offer them that choice. This is the current dilemma for those who work in community care situations. The issue of sexual relationships is perhaps the most difficult and complex, but this problem of balancing risk and choice is a constant one for carers and professionals, in relation to many aspects of everyday life. In the background is the ogre of the law (and/or local management), ready to jump on the unwary, should they get it wrong. No wonder, perhaps that many are cautious about enabling such choices to be made.
Social services departments have seen a rise in the numbers of vulnerable adults referred to them because they are at risk of physical and sexual abuse, as well as financial fraud, a study has found.
The survey of directors of adult services suggests the fallout from the death of Baby Peter has influenced social workers' attitudes to vulnerable adults - with more older people or those with a learning disability deemed to be at risk of abuse being referred for assessment.
Speaking ahead of the national children and adults conference that opens today in Harrogate, the Local Government Association (LGA) warned that adults' services were coming under increasing strain and called for reform of the way adult social services are funded to meet the explosion in demand and escalating costs.
"In others - for example, in the increase in the number of adult safeguarding referrals - it might be that the higher profile of risk and vulnerability has led to a greater vigilance by our care staff and by members of the public alike."