Mandatory Procedures

8.1 Managerial Responsibilities

8.1.1    Managers must ensure that their staff understand and respect that all service users have, to a greater or lesser extent, needs in relation to personal relationships and sexual expression.

8.1.2    Managers must ensure that staff fully understand this policy and the need for a consistent and coherent approach to relationships and sexual expression across the organisation, irrespective of the personal feelings and beliefs of individual staff members.
 
8.1.3    All staff will have their own experiences, feelings and beliefs. Managers need to be alert to situations where the personal beliefs or experiences of staff impact on their ability to fully implement this policy, and ensure they are appropriately supported.

8.1.4    Managers must ensure that staff are aware of the Multi agency safeguard policy and procedures | Safeguarding Adults in Gloucestershire  and are clear in their duty to report any suspicions of abuse of a service user by a staff, other service users, relatives, friends and members of the public.

8.1.5    Each Gloucestershire County Council Learning Disability day centre will have access to a ‘Relationship Champion’ who will have received the appropriate level of training and are competent and confident in their role. Staff can also seek advice from the Champions or from the Community Learning Disability Teams (CLDT).

8.1.6    Managers must offer support and planning time to staff who are supporting the delivery of information and/or training to service users. This may include checking the plan and materials to be used.

8.1.7    Managers have a professional responsibility to keep their knowledge and skills up to date. If they have any doubts about their own competence in this area, they must consult with one of the ‘Relationship Champions’.

8.2    Staff Training

8.2.1    The employing organisation will ensure that appropriate training programmes are available to staff to enable them to explore their own attitudes/values and acquire the necessary knowledge and skills. Each employing organisation will decide to what extent such training is mandatory.

8.2.2    However, any staff giving advice on sexuality, intimate personal relationships and/ or related health issues will have to have attended the basic intimate personal relationships training course.

8.2.3    Relationship Champions have a responsibility to share what they have learned in their intimate and personal relationship training courses with other staff.

8.2.4    A County Relationships and Sexuality Strategy Group (CRSSG) will be formed to advise upon and share best practice, new developments, information and resources. (Appendix 1).
 
8.3    The Role of a Relationship Champion

8.3.1    There will be a core team of fully trained members of staff who will be ‘Relationship Champions’. They will cover all the localities and will respond to demand for support and advice as needed.

8.3.2    Relationship Champions will attend the full training course on personal relationships and sexuality for adults with a learning disability provided by the approved GCC training provider (currently the Interact Service, part of Guidepost Trust). The Relationship Champions will ensure that they keep their knowledge current and attend any subsequent training courses to maintain an informed and competent level of expertise.

8.3.3    The Relationship Champions will provide advice and information to other members of staff and service users on matters relating to relationships and sexuality.

8.3.4    The Champions will oversee appropriate group training on this topic in day centres and lead on one to one sessions with services users, as part of an agreed individualised care plan/sexual education and relationships programme.

8.3.5    The Relationship Champions will be available to talk to service users in all GCC day centres and localities. Wherever possible, service users will be given the option to talk to a Champion of the same sex or to a Champion they know/don’t know, if this is what they want.

8.3.6    Parent carers may contact the Relationship Champions to discuss matters relating to information and education on relationships and sexuality received by their son/daughter and to discuss any concerns or related matters.

8.3.7    Where the Relationship Champions are unable to resolve a particular issue, the matter will be taken to the Countywide Relationships and Sexuality Strategy Group for guidance and advice.

8.4    Confidentiality & Privacy

8.4.1    As in other aspects of their lives, service users are entitled to confidentiality. Personal information should not be shared without their consent, unless there are issues of personal safety. In that case, they must always be told that confidentiality cannot be maintained.

8.4.2    Everyone has the right to be private and safe. Safe privacy enables an individual to express themselves sexually, for example, within a consenting sexual relationship or in masturbation. Difficulties can arise when people lack access to privacy and can experience frustration in their lack of opportunity to express their sexual feelings and can lead to them expressing themselves inappropriately, and illegally, in the company of others and /or in public places.

8.4.3    Personal and sexual relationships, and individual expressions of sexuality, require access to private space, which must be offered and respected. In residential establishments, public and private areas should be clearly identified.

8.4.4    Day centres are, by definition, public places and services users need to be aware that they must not engage in inappropriate sexual activity whilst attending day centres or in other public places. Staff will need to help individuals to understand what sort of behaviour is acceptable and what is unacceptable in public places. People with learning disabilities are sometimes limited in their opportunities to develop personal relationships. Their work placement/day centre might represent the only environment for the fulfilment of this human need. Staff should be sensitive to this and work towards supporting relationships within the boundaries and expectations of the given context.

8.4.5    Residential establishments and the Gloucestershire Adult Placement Scheme (Shared Lives) need to be particularly aware of the rights and need for service users to have privacy.

8.4.6    If an individual is showing a need for, or asking for privacy in order to engage in sexual activity alone, or if two consenting individuals are showing their need for, or asking for privacy to engage in sexual activity together, then workers have a responsibility to respond to this and try to ensure that the individual’s/ couple’s needs are met. This may need a multidisciplinary approach involving an advocate.

8.5    Education & Information

8.5.1    Service users need information and support to understand their bodies, their sexuality and the nature of relationships. Such information needs to be appropriate for their age and ability and may need to take into account the service user’s religion or belief system. Staff may need to build on understanding developed at school and within families. Staff may also need to address needs arising from sexual and relationship dysfunction.

8.5.2    Needs relating to a service users’ intimate relationships and sexual behaviour should be an integral component of any assessment.

8.5.3    Individual assessments should be scrutinised to identify the need for individual or group intervention. When the need for group intervention is identified, staff leading such sex and relationship programmes must be appropriately trained and supported. Line managers must be kept fully informed.
 
8.5.4    Service users known to be sexually active or planning to be sexually active must be given access to information and services relating to contraception, emergency contraception, sexually transmitted infections and other aspects of sexual health. Staff must keep themselves informed about relevant local services, and, if necessary, enable those services to better meet the needs of people with learning disabilities.

8.5.5    Any information or training given should be adapted to the individual’s level of ability, moving at their pace and in a language or other communicative medium (e.g. signs, pictures) that they are able to understand.

8.5.6    All service users attending GCC day centres will receive basic information and training on appropriate touching and on keeping safe. This may be done within a mixed group, in groups of all women or all men, or on an individual basis depending on the ability and wishes of the individual.

8.5.7    Parent carers will be informed that all service users attending GCC day centres will receive some level of training, appropriate to the individual, in having safe and healthy relationships. See Appendix 2 for the sort of things that may be included in this training.

8.5.8    Service users who have the capacity to decide whether they want to attend more detailed training on sexuality and relationships with the GCC contracted provider or, if appropriate, with the CLDT, will also decide whether they want to inform their parents and carers about their choice to attend this training.

8.5.9    Central to any training and information given to service users will be the emphasis on enabling the individual to exercise choice and control, to stay safe and healthy and to build a wide range of social and personal relationships, encouraging integration and interaction with their community.

8.5.10    All training on sexual matters, relationships and staying safe must be appropriate for the age and ability of the service user.

8.5.11    People with a learning disability may have difficulty in retaining information over a long period of time. Refresher courses in having safe and healthy relationships should be offered on an annual basis to all services users who have attended the full training course. Accessible information should also be available to service users at all times, eg dvd, leaflets.

8.6    Pregnancy & Parenthood

8.6.1    Staff must be aware of the legal and medical implications of an unplanned pregnancy and be prepared to access advice promptly to ensure that the service user can make an informed decision between continuing, or terminating the pregnancy.
 
8.6.2    Where the decision is to continue the pregnancy, the mother (and, where possible, the father) must be enabled to consider the various options and assisted to decide whether to bring the child up themselves or seek fostering or adoption.

8.6.3    Where there are serious and well-founded concerns as to their ability to care for a child, colleagues in the Children and Young Persons Directorate (CYPD) must be consulted.

8.6.4    Ongoing advice and support should be given to parents who are learning disabled to enable them to keep and raise their children accordingly. Ideally this should be carried out in partnership with workers in the Children and Young Peoples Directorate.

Valuing People Now :

(‘Overall policy objective: people with learning disabilities have the choice to have relationships, become parents and continue to be parents, and are supported to do so.’)

8.6.5    If a woman who lacks the capacity to give consent to sexual activity becomes pregnant a criminal offence will have taken place and must be investigated. Multi agency safeguard policy and procedures | Safeguarding Adults in Gloucestershire   must be followed and the police must be informed in such circumstances.

8.7    Sterilisation or termination of pregnancy

Where a person lacks the capacity to give consent to sterilisation or to the termination of a pregnancy, case law directs that the matter should be referred to the Court of Protection by the medical practitioner proposing to carry out the operation. Other than the Court of Protection, no-one may sign a consent form on behalf of a woman for a termination or any other operation.

8.8    Sexual Health and Screening

8.8.1    All adults with a learning disability should be offered a Health Action Plan (HAP). Day centres, GPs and the CLDT can help services users to fill in a questionnaire and to make an appointment to have a health check. (For more information on Health Action Plans, click on the link http://www.partnershiptrust.org.uk/content/services/services_healthfacilitation.ht ml )

8.8.2    All adults with a learning disability are entitled to annual health checks. This is where GPs should ask questions about an individual’s health, including sexual activity and (along with the use of other indicators) be able to be determine the need to give more information about contraception, smears tests, breast screening, testicular checks and screening for sexually transmitted infections. Staff completing annual reviews should ask if the service user has a HAP.
 
8.8.3    Staff should encourage service users they know to be sexually active to go for regular screening and checks either with their GP, Family Planning Clinic or Genitourinary Medicine Clinics (GUM). GUM clinics are protected by law with an extra level of confidentiality, so they can’t pass on any information about patients or what infections they have without their consent, even to the patients GP. Everyone is entitled to free, confidential contraceptive advice and condoms are usually freely available from these clinics.

8.9    Enabling

Direct interventions which, under some circumstances, could involve the use of sexual aids or direct physical touch. Such interventions must be agreed in advance by the CLDT or multi-disciplinary team, whose responsibility it is to ensure all other options have been explored. The decision must be properly recorded and monitored.

8.10    Sexually Explicit Material

8.10.1    Other than for training purposes, staff must not bring sexually explicit material into the work setting or seek to influence service users to obtain it. On those occasions where it is deemed appropriate for staff to assist in accessing such material for service users’ personal use, this must be agreed in advance by the CLDT or by a multi-disciplinary team and the decision recorded and monitored.

8.10.2    An individual person may purchase legally available sexually explicit material if he or she wishes and is able to use it in a socially responsible manner. Although they should not be made to feel guilty about using such material, staff should inform them that other people may find it offensive and embarrassing.

8.10.3    Staff have no right to destroy a person’s property just because they do not agree with it.

8.10.4    Where service users are known to be accessing material that involves illegal sexual activity (e.g. paedophilia, bestiality or sexual violence) this must be reported to the line manager and Relationship Champion, who will advise the worker on informing the police. The police must be informed if any sexual material involving children is found. Where there are also concerns that the service user poses a potential threat to others or is being unduly influenced by others, Multi agency safeguard policy and procedures | Safeguarding Adults in Gloucestershire or MARMAP procedures will be invoked.

8.11    Professional Behaviour

8.11.1    Some aspects of personal care (especially those involving undressing) can involve intimate touch and can have sexual connotations. Staff must behave in a sensitive and respectful way when undertaking such personal care. C&ACD staff are referred to the policy on Intimate-Personal-Care-and-Clinical-Tasks-Policy.pdf

8.11.2    Staff should be alert to colleagues who fail to respect service users’ privacy, gossip, tease, flirt or are inappropriately intimate (verbally or physically). Any such concerns must be discussed with their line manager or appropriate senior manager. Staff wanting to raise areas of concern observed while visiting contracted providers should refer to the Inter agency Protocol for Raising Concerns policy.

8.11.3    Relationships between service users and staff need to be established and maintained within clear boundaries. If clear boundaries around touch, for example, hugging, holding hands, delivering intimate personal care are not understood and implemented, then people with a learning disability may receive varied and confusing messages. Staff in CACD should refer to the Relationships between staff and the people they support | Gloucestershire County Council   policy.

8.11.4    It is a disciplinary offence for any staff member to have any type of sexual relationship with a service user regardless of their level of understanding or ability, or whether they welcome a sexual
relationship or not. It is essential that staff work to agreed standards of care and support and recognise the power imbalance that exists in staff and service user relationships. Any sexual touch or expression between staff and service user is inappropriate and may constitute breaking the law.