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People with an intellectual disability are much more likely to be sexually violated and the violation is less likely to be reported. Despite this being high-lighted at least 3 decades ago and improvements in both safeguarding and national reporting processes, under-reporting remains a problem. This paper explored under-reporting alongside prevention possibilities using safeguarding alerts raised in a Community Learning Disability Team within a UK NHS trust.

Using a combination of authentic but anonymised case vignettes and descriptive data drawn from the safeguarding team, under-reporting was examined through the lens of an ecological model. Safeguarding alerts raised in a particular year were compared with the number expected if all (estimated) cases of abuse were disclosed and reported.

Only 4.4 per cent of expected abuse cases were reported to the team, which is lower than the reporting level the authors had expected from the literature. There is evidence in the literature of the under-reporting of sexual assault for all kinds of people. Arguably, the implications of under-reporting for PwID are even more traumatic.

Constraints included the lack of standardisation in data collection within the statutory services that report to the Birmingham Safeguarding Adults Board. One key recommendation is that the national provider of data for the NHS in the UK requires more complex and standardised audit information that would allow each local authority to benchmark their practice against a higher protection standard. Another recommendation is that compliance to quality standards sits within a comprehensive strategy.

This paper explored the extent to which the previously documented under-reporting concern remains an issue. Certainly eye-balling safeguarding compliance data in the NHS organisation we worked in led us to a concern that reporting might be even lower than implied in the literature. This together with a renewed spot-light on sexual violence (e.g, NHS England, 2018) led us to decide that it was timely to re-examine the problem.

Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD.

Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA).

The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual.

A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice.

This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD.

The findings indicate that a group intervention is both feasible for and acceptable to adults with ID.

To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.