Adults with learning disabilities who are vulnerable need support to ensure that they are not denied the right or opportunity to make their own decision and give their own consent (Peate & Fearns, 2006). According to Hayes, (1993) states that, adults with learning disabilities who may have had no choice but to accept the labels dingbat or airhead to cover the confusion, memory lapses, misread or misunderstood directions, or the dozens of other mean tricks that adult has played on through the years.
People who have much less the ability and capacity to understand new or complex information, either less able learn new skills also has a little ability to dealing independently like-the ability to social work weakness and the requirement that of the beginning before the age of puberty have a lasting effect on development (Scottish Executive,2010).
Adults with learning disabilities comprise of a highly vulnerable part of the society, who have limited access to health care facilities /services offered to them. According to Kerr et al., (1996a) he states that, learning disabilities suffer form a similar range of morbidity as the general population, but some conditions are seen with greater frequency within certain syndrome. They are often faced with obstacles and challenges while coping with grave situations such as loss and bereavement of loved ones, personal illness, death etc (Elliott, 1995).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 (Elliott, 1995).
Vulnerability & Risk:
A vulnerable adult is a person who is eighteen years of age or older who is, or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or protect him or herself against significant harm or exploitation.
-No Secrets March 2000, p 45.
Every human being becomes vulnerable during their lifetime for many of reasons they all respond differently to events that happen to them because of who they are and the lack of support that they have around them (Jacki, 2001). The term vulnerable adult(s) is now use more widely in the social care field than it ever was, but it may be open to interpretation and being vulnerable means different things to different people (Jacki,2001).
People with learning disabilities are one of the most vulnerable groups in the society (Department of Health 2001). Learning disabilities may be more at risk not only because their own difficulties in understanding or communication but also because of the way they receive services and the fact that they may be actively targeted or taken advantages (Jean and Anthea, 1997). The broad definition of vulnerable adults is a person:
who is or may be in need of community care services by reason of mental or disability, age or illness; and who is or may be unable to take care of themselves, or unable to protect him against significant harm, risk or exploitation (DOH 2000, s.2.3).
Among the most vulnerable members of society they cant speak up for themselves. For example, if consequences are limited when an adult with learning disabilities abuses another person, 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 and more likely to be the victim of abuse physically (McCarthy and Thompson, 1996).
The Oxford Dictionary define 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( 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 dont know for sure what will happen, but you know the odds thats risk, and if you dont even know the odds, thats uncertainty (Knight, 1921, p.25). Royal Society (1983) states that, risk assessment which axiom 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. In addition to the risks to existing victims, poor responses may result in increasing numbers of people being abused.
Definition of vulnerable adult in section 80(6) Care Standard Act 2000 states that-
(a) an adult to whom nursing and accommodation or personal care are provided in care whom (b) in adult to whom personal care is provided in their under arrangements made by a domiciliary care agency own home (Peate & Fearns, 2006). Adults with learning disabilities, and those people who have a less capacity like who have mental illness, old and frail, need protection from over which they might have little control (Department of Health, 2000). Learning disability Adolescents obliviously it is not always acted in ways that serve their own best interests, even as defined by them (Fischhoff et al., 2000). 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 since adults abuse and risk has gain higher profile. According to Kemshall and Pritchard (2001) states that, there has been much debate about a welfare model or a criminal justice model should be adopted. After the recent death Steven Hoskin 22 years young man who has been dead by numbers people. Adults vulnerable protection systems are likely to come under close scrutiny (Jacki, 2001).
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 and viability.
Learning Disabilities:
The concept of learning disability Brumback (2004), people who have, speech, reading and associated communication skills needed for social interaction also who have sensory handicaps such as blindness or deafness and generalized mental retardation. According to Robert (2009) Learning disability is a neurodevelopment disorder affecting a specific cognitive skill that occurs in the presence of intact skills in most others realms and specific impairments are presumed to be due to dysfunction of the brain and to have been present since birth. And learning disability substantially limits functioning in one or more aspect of persons life (Mapou, 2004).
According to Mencap (2010) reports that, in the UK there are 1.5 million people with a learning disability. Most are treated as different and dont have the same control over their own lives as the rest of our society. Over the past century and a half there have been huge changes in the in the labelling of those people presently categorize as having learning disabilities. In social policy terms, they have been variously labelled as vagabonds, idiots, mentally handicapped, learning disabled, and people with learning difficulties among others names (Gordon,2005).
Above the definition indicates that, Learning Disabilities is th terminology used to label people that function at an intellectual level that is significantly lower than the average people in society (David and Hinor,2003). Different periods in history have meant different things, depending on the social and economic circumstances of the time, and of course on how long people with learning disabilities lived (Brian, 2006).
Risk Assessment Decision Making Process / Practice Tools:
Increasingly responding to the risks of others, preventing risks to vulnerable adults or running risks to themselves is all in days work for the busy practitioners and manager in the field of social care (Brearley, 1982). 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) (Brown, 2003). David Carson (1988b) points to about risk Risks should be taken to achieve specific goals in the light of possible harms occurring and Taking risks involves deciding that the potential benefits of a proposed act out weight the potential drawback (p.248).
Hence risk always should be taking whether or not to act to achieve beneficial results in an awareness of potential harm. To 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 social carer and services do (Vaughn and Fuchs, 2003).
While most of carer don dont asses risk very efficiently they generally make some attempt to do so. Its 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 (Carol, 2002). In spite of some difficulties, there is an increasing awareness that people with learning disabilities can make choices, moreover they want to do so. Nevertheless its often failed to consider is that, the amount of risk that these choices carry and most of us have grown up accustomed to risk-taking. 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 its possible may sometimes affect decision making in number of different ways (Heilbrun, K.et.al (1999). It is true many adults with learning disabilities who have always facing risk in their everyday life. Significantly about choice decision sometimes its 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 (Fuchs, 2003). People with learning disabilities may not have done perhaps carers need to be encouraged 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 (Kemshall & Pritchard, 1996).
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There are a range of sources where information can be gained for a through risk assessment which include the prospective resident, their relatives or practitioners involve with the person and any written reports; which may be historic or recent (Alaszewski and Manthorpe, 2002). 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 (Heilbrun, K.et.al.1999). It acknowledge that adult with learning disabilities do have real difficulties with many cognitive takes. Most 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. An endeavour to make balance the protection of vulnerable adults, as standard in the No Secrets guidance ( DoH, 2000) where different policies that encourage and aid to take more control to service users in their lives which also including to take opportunities and manage risks. In 2007, Department of Health established risk assessment and management regulation and various assessment tools for help practitioners and professional to work predominately in the field of social care. According to Jones, 1998 states that, 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.
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