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The British Journal of Developmental Disabilities Vol. 44, Part 2, JULY 1998, No. 87, 134-135 BOOK REVIEWS THERE ARE NO EASY ANSWERS James Churchill, Hilary Brown, Ann Craft & Christiana Horrocks, C. (Eds.) Chesterfield: Association for Residential Care
This text deals with the specific subject area of the provision of continuing care and treatment to adults with learning disabilities who sexually abuse others. On the basis that little has been specifically written about this crucial aspect of the emerging field of sexual abuse and learning disability, the book must be seen as an important ground breaker. Furthermore, while the subject area of the book is narrow, it should not be marginalised. Just as the scale of sexual abuse of children only began to emerge in the 1980s, we are only now beginning to acknowledge the fact that people who have learning disabilities are also subject to such abuse and we do not accurately know the scale of the abuse. As a footnote in the book points out, research suggests that around 40% of reported sexual abuse of adults with learning disabilities was perpetrated by other service users. As we now know the far reaching negative consequences of sexual abuse, the subject may be narrow but is not trivial. The book builds upon a previous publication by the same authors It Could Never Happen Here (1993) which dealt with prevention and treatment of sexual abuse of people with learning disabilities in residential settings and set out a policy and procedural framework in which to apportion responsibility. It is these themes that are expanded to good effect in the current book. Drawing from the expertise of practitioners and academics across a range of disciplines, the authors are quick to point out that the book is not intended as an academic text. Rather, it attempts to focus upon practical options for the range of professionals whose job it is to commission, contract, provide and manage services for people with learning disabilities. It does this very successfully, given that the territory being explored has suffered from lack of clarity and lack of inter-disciplinary collaboration to date. The book is set out according to its intention as a practitioner's guide. Each of the chapters is exhaustively broken down into clearly defined sub-headings for ease of access. While the book is an easily readable entity, the reviewer tested the viability of a random selection of these sub-headings in advance of reading the whole book, and found that, for the most part, they could stand alone as points of reference. The text makes good use of tables and bullet points to clarify key issues and it is generally well substantiated by research. At certain points it makes good use of brief case studies to underpin issues of practice, which is helpful in pursuit of the notion of a practitioner's guide. The content spans a wide range, exploring related literature to define the problem in terms of the predominance of male perpetrators, the scope of actions that can be helpfully construed as abusive, the range of learning disabilities experienced by abusers, the extent of abuse, the motivation for sexual abuse and other subjects. Lessons to be learned from recent enquiries are explored, the function of policies and guide-lines is examined, initial responses to abuse, such as when to call in the police are discussed, and assessment is looked at in detail. Treatment issues including consent to treatment, compulsion under law and various treatment options are explored. The final chapter on managing the service on a day to day basis could stand alone as a guidance manual for service providers. There are also four appendices, two of which outline specialist aspects of assessment, testing and treatment programmes including sex education, social skills training, operant treatment and medication. These are only brief outlines, enough to explain the basic principles of practice rather than guide-lines for practitioners themselves. The last two appendices give key principles in service standards, a bibliography and a list of useful addresses. The reviewer's only criticism of a readable and practical book is that, in keeping with most texts, in every reference to the law, it fails to acknowledge the very different legal position of Scotland and Northern Ireland, assuming that the UK all falls under the law for England and Wales. In some instances the treatment of the law does lack fine detail, but it serves well as a comprehensive, broad overview. The law does have an appropriately high profile in the book and is discussed in particular clarity, useful to practitioners who do not live north of Berwick or west of Stranraer. Michael Lowit
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