Community based services for children and adults with

learning disabilities

Trauma what it means

for people and how we are
working to support people
Dr Noelle Blackman
&
Dr Paul Cundy

Respond Community Based

Services
Psychotherapy for children and adults with
learning disabilities
Helpline 0808 800 0700
Assessments
Independent Sexual Violence Advisors
Circles of Support and Accountability
Family advocacy and support
Training/consultancy/clinical supervision
Policy and campaigns work

Referral Criteria
People with Learning Disabilities who have
experienced abuse or trauma (includes
bereavement)
Perpetrators of Abuse & Sexually Harmful
Behaviours
Most referrals made by professionals
Funded by Health or Social services
Some self-referrals or from family
Some free or subsidised places

Trauma Assessment for former

patients of Winterbourne View
Context

The Improving Lives Team had a conversation with

Respond about the possibility of conducting trauma
assessments for ex-patients of Winterbourne View

NHS England and DH agreed to fund the

assessments

This does NOT include funding for provision of

therapeutic interventions for people suffering from
trauma.

Trauma and PWLD

People with Learning disabilities more likely to
experience traumatic life events.
Educational, social and intellectual
disadvantage are predictive of development of
Post Traumatic Stress Disorder following
exposure to trauma.
People with Learning Disabilities at increased
risk of developing Post Traumatic Stress
Disorder following trauma.

Experience of Trauma in People

with Learning Disabilities
Post Traumatic Stress Disorder symptoms
include:
Avoidance
Re-living
Hyperarousal
These may be expressed differently.
There may also be reductions in daily living
skills and behavioural reactions.

Assessment of trauma (1)

Until recently there have been no psychometric
measures for using with People with Learning
Disabilities. Use of existing or adapted measures has
been problematic.
LANTS (Lancaster and Northgate Trauma Scales) selfreport and informant measure of effects of stressful,
traumatic life events in People with Learning Disabilities.
IES-IDs (Impact of Events Scale Intellectual
Disabilities) Measure of PTSD symptomatology in
response to a specific traumatic event that meets
diagnostic criterion A.

Assessment of trauma (2)

High prevalence of co-morbid depression and/or anxiety in
people with Post Traumatic Stress Disorder.
Depression and anxiety measures for People with Learning
Disabilities:
Glasgow Depression Scale & Carer Supplement.
Glasgow Anxiety Scale form

Assessment of trauma (3)

Assessment must also consider the most appropriate
type of therapeutic intervention for each individual.
NICE guidelines for treatment of PTSD in general
population recommend either:
TF-CBT
EMDR
But no guideline for People with Learning Disabilities,
and minimal evidence for these treatments with People
with Learning Disabilities.

Therapeutic Intervention (1)

NICE guidelines caution that it may initially be very
difficult and overwhelming to disclose details of the
traumatic events.
The guidelines also state that trauma-focused
psychological treatment should only be delivered when
the patient considers it safe to proceed.
In these cases they recommend establishing a trusting
therapeutic relationship and emotional stabilisation
before addressing the traumatic event(s).

Therapeutic Intervention (2)

Psychodynamic Psychotherapy is a relational
approach. Since the abuse at Winterbourne
View involved breaking trust between patients
and carers this approach may be particularly
suitable.
Psychodynamic Psychotherapy can be effective
when treating PTSD in People with Learning
Disabilities. There is also evidence that this
approach can be useful in the general
population.

Assessment report (1)

Summary of traumatic experience(s).
Description of how PTSD symptoms are expressed
in the patient (since manifestation may vary from
general population, and from person to person).
Description of how the patient interprets their
distressing experience(s) as this can also vary in
PWLD.
Description of any risk(s) to patient and others, and
consideration of how this can be managed.

Assessment report (2)

Recommendations for therapeutic
intervention, including the strengths
and weaknesses of each type of
treatment approach for that patient.

Relational therapy in your

area
How would people with learning
disabilities in your area access
suitable psychotherapy or
counselling?

24-32 Stephenson Way

London
NW1 2HD
020 7383 0700
@respond.org.uk

www.respond.org.uk