News – Nursing Times – Resource on domestic abuse for people with learning disabilities released

A unique and carefully designed information card is helping people with learning disabilities who might be experiencing domestic violence and abuse. This initiative won the Learning Disabilities Nursing category in the 2020 Nursing Times Awards

Abstract

This article outlines the development of an easy-to-read, wallet-sized resource produced in collaboration with people with learning disabilities and professionals who work with them. It is now being used widely across Nottinghamshire by healthcare, social services and the police, and an electronic version has been made available nationally.

Citation: Atkinson S (2021) A resource on domestic abuse for people with learning disabilities. Nursing Times [online]; 117: 11, 43-44.

Author: Sarah Atkinson is primary care liaison nurse (learning disabilities), Nottinghamshire Healthcare NHS Foundation Trust.

Introduction

Over the last 24 years working as a learning disability nurse, I have seen an increase in cases of domestic violence and abuse in this vulnerable group. In my current role, I needed an easy-to-read, small, wallet-sized domestic abuse information card – like those widely available for men, women and members of the LGBTQ+ community – that are produced in many different languages. An extensive search uncovered lots of useful resources, but nothing discreet, that can be easily hidden from perpetrators. This article outlines how a wallet-sized information card was produced for people with learning disabilities and how it is being used now.

Meeting a need

While supporting a woman with a learning disability to access primary and secondary care services, I learned that she was in a well-established abusive relationship. This was noted clearly in her medical records but, to my surprise, was never raised at any of her appointments. A brutal assault by her partner led to a hospital admission, and even that did not generate any discussions, advice or support. She reported that she had been handed the generic domestic abuse information cards in the past by health professionals and the police; however, being unable to read very well, they were useless to her and she dismissed them.

Having found there was no suitable resource available, I decided to create one. The key aim of the project was to afford people with learning disabilities the same access to information about domestic violence and abuse as the rest of the population by creating a dedicated resource that used simple words and symbols. My goal was for this to be shared with health and social care services, the police, domestic abuse support agencies, and anyone who may have contact with people with a learning disability who they suspect, or know, are experiencing or witnessing domestic violence and abuse.

Developing the resource

With support and encouragement from the domestic violence and abuse subgroup at Nottinghamshire Healthcare NHS Foundation Trust, I developed a project plan. The aims were to:

  • Increase awareness of domestic abuse with people with a learning disability;
  • Increase awareness of domestic abuse with all services who support people with a learning disability;
  • Increase learning disability awareness in domestic abuse services;
  • Help professionals recognise, discuss and report domestic violence and abuse in this vulnerable group;
  • Prevent people with learning disabilities dying as a result of domestic violence and abuse.

Careful consideration was given to the design of the card. It was essential for the resource to be gender neutral. Specialist advice was sought from the speech and language team, which helped to create bespoke symbols and offer guidance to ensure the colour and font met accessible information standards. Several prototypes were produced before agreeing the final design, based on the feedback received from people with a learning disability.

The resource is the size of a credit card, with a discreet black cover that folds out to provide the information. We chose to include national, rather than local, agency phone numbers to allow the resource to be used widely by those in need, and included information on assisted technology.

Collaboration with people with a learning disability was vital to this project. The Speak Out group at the local day centre for people with learning disabilities, along with other groups and individuals, provided invaluable feedback. They helped to choose the symbols and words used and were instrumental in helping me to get this resource right. It was a personal and emotional journey for some who had lost a close friend to domestic violence.

In developing the final product, I used the skills and knowledge of services and professionals working with people who experience domestic violence and abuse. The trust’s communication team helped with formatting the design, and the finance department helped me to navigate the funding and printing process.

“This project demonstrates the passion, dogged determination and motivation [that] epitomises good learning disability nurses” (Judges’ feedback)

Outcomes

While there is no way of formally auditing the success of the card, the demand for it as well as informal feedback has shown that this was an unmet need. Those who are making use of it say it is a valued and useful resource.

The following feedback from a community learning disability nurse sums up many of the messages I have received about the resource:

I find the domestic violence and abuse card invaluable and I have used it several times with my service users. I had a lady recently on my caseload, who was struggling to recognise the abusive behaviour of her partner and disengaged from discussing it. She was very interested when I produced the card and approached the discussion in a more generalised manner [and] it then resulted in her opening up to me to describe her own experiences of what had happened with her partner. She was happy to keep a copy in her purse and also requested a further copy to enable her to share it with her friends to help them to seek help if necessary.

Initial funding for printing came from the safeguarding team and the initial 2,000 cards were all snapped up on launch day by the various agencies who attended. More were printed and sent out to specialist learning disability services locally, and all those who requested it.

After the launch, I was approached by Nottinghamshire Police to ask if I could produce a similar document to the card to be included in their new domestic violence investigative guide. This is now carried by all officers in the force to help improve communication when attending domestic abuse incidents.

Subsequently, NHS Nottingham and Nottinghamshire Clinical Commissioning Group agreed to fund a high-quality print of 10,000 cards and have committed to this being available in every GP surgery across the city of Nottingham and Nottinghamshire. The resource was shared across social media platforms, generating a huge response from people across the country. I have shared an electronic version of the resource with those who have requested it.

Although my target audience was people with learning disabilities, I am aware the resource has been used successfully with people for whom English is not their first language, people with dementia, and also with children.

The future

I have since taken up a secondment with the safeguarding team as their first learning disabilities lead to build on this work. While it is gaining wider recognition, my ultimate goal is for the resource to be adopted nationally by the large domestic violence and abuse organisations, so that it is available for everyone who needs it.

In the future, I would like to share more widely some of the positive stories (of which there are many) from my personal experience; these illustrate how it has helped service users to disclose abuse, and how their lives have been changed in a positive way by getting help and support.

Conclusion

This simple idea has the potential to transform people’s life for the better by enabling them to get help and support. My proudest point was handing a copy of the card to the woman who inspired the work and watch her pop it into the back of her phone case.

Feedback from professionals who have used the cards, including nurses, GPs and the police, shows that there was a real need for this resource for people with learning disabilities and that it has paved the way for more conversations. We must do everything we can to help identify survivors of domestic violence and abuse before they become victims.

Key points

  • Everyone deserves the same quality of response when domestic abuse is identified
  • Health professionals may often be reluctant to have conversations about domestic abuse when it is suspected
  • A wallet-sized information card specifically designed for people with learning disabilities has helped raise awareness