Case Study

Improving the services we provide to people with learning disabilities was a key focus of our work this year. NHS funding allowed us to explore the issues surrounding sexual violence among people with learning disabilities and how we could improve both our service delivery and communications.

Key objectives:
 Encourage people with learning disabilities to access the services of St Mary’s SARC
 Explore how new technology could improve the way we communicate with people with learning disabilities
 Improve confidence through training of our staff and other professionals who work with people with learning disabilities.

As a result of our research we decided to incorporate augmented reality into our information leaflets. This allows short films, triggered by text in newly created booklets, to be easily accessed on smart phones. In addition, booklets are used to record all information discussed and act as a record of their visit to SARC. The use of augmented reality has been welcomed by both clients with learning disabilities but also general users who have welcomed the visual and interactive use of technology to help explain and record their visit to SARC.

An audit conducted by a medical student for St Mary’s SARC revealed that a number of people who used the service had a learning difficulty. Following this study we decided to find out more, both from our staff and from clients about their experience of the service and how we could improve.

We embarked on a piece of work with the help of local support organisations and, following a series of workshops and face-to-face research, we were able to identify the barriers people with learning disabilities faced both in disclosing sexual abuse and assault as well as understanding their views on how they were treated by health professionals and how we could best address these concerns.

One of the key issues raised was the desire to have professionals speak clearly and directly to the person not their carer and have literature that used short, simple language. We also discovered that staff lacked confidence in speaking to people with learning disabilities. As a result we undertook a review of all of our communications including website and information material to see what we might be able to do better.

As a result of this review and discussion, we decided that bringing short text to life via short films would help improve our communications. Having seen augmented reality in action, we felt this would be a good way of combining traditional text with new innovations.

It was important to the team to ensure that people with learning disabilities were included in our discussions about how to improve our communications. We worked with Manchester People First, an organisation that supports people with learning disabilities of all ages and also Pure Innovation, an organisation that supports people with learning disabilities into work. We wanted their clients to share their views and experience, tell us what communications they felt worked for them and provide input to the shape and content of our new website and other promotional materials.

A series of face to face meetings and workshops took place and a toolkit of questions were developed, shared and answered by people with disabilities and their carers. Meetings to discuss design and content of new literature all took place and we also produced a training film which included people with learning disabilities who explained the challenges they faced and how they wanted health professionals to treat them.

Throughout the planning and research process a clear message that people with learning disabilities wanted short, concise, direct information was evident. They did not want lots of long words or complicated sentences and preferred visual images. We asked those participating how they felt about the use of films as well as simple language and images and also carefully analysed who would access the films i.e. the number of people with learning disabilities using smart phones. Many young people said they felt films would be a good way to communicate and were happy using their smart phones. Those less familiar with smart phones were older but said they would have help through carers or support workers to access the films.
Research was also undertaken with St Mary’s doctors and crisis workers to determine how they would use augmented reality. Many staff and other health professionals welcomed the use of this technology to help show clearly what happened in a forensic medical examination and explain some of the complex medical discussions such as when to take HIV PEP in these films and using the booklet as way to record all discussions as well as giving people the opportunity to access films at home.

Understanding the evaluation of this project requires also understanding how we work with our clients. Often clients will arrive with the police having reported rape or sexual assault immediately. However, it is also possible to attend the service without making a report to the police. Often people are in a state of high anxiety and trauma when they arrive, so it is important for crisis workers and doctors to take the time to explain what the service is and what is happening very clearly, so as to reduce stress and ensure clients understand what is happening and why. This is particularly important for people with learning disabilities. We launched the new booklets at our Annual Conference and involved people with learning disabilities in the presentations about how these were developed. Professionals from a range of organisations from health, police, social care and voluntary sector gave positive feedback and sought information on how to develop similar products in their areas.

The new booklets, have provided crisis workers with a simple but effective tool to help with their communications. People with learning disabilities have expressed their gratitude that the films used are easy to access and understand. They have commented to staff that they were apprehensive about attending SARC and in particular, what the forensic examination entailed, but the ease to access, short films helped with that explanation. Staff also said it was a useful tool in reinforcing medical information that could easily be picked up following a visit to SARC.

Since the pilot, the two core leaflets have been adapted to include Augmented Reality in the general leaflet aimed at promoting our services. This includes a key piece about the forensic examination which causes anxiety among many professionals and clients. Health professionals who work with those who have experienced child sexual exploitation have also said they find the leaflets an excellent way of engaging with young people. Following a forensic examination, all clients are re-contacted after three working days to check how they are doing and during this time our clients were asked about the leaflets and whether they found them useful. Feedback received has been universally positive.

In March 2018, it will have been a year since we used augmented reality in our leaflets. We are looking to explore ways to carry this work forward into other printed materials aimed at specific audiences which will hopefully encourage more people to report rape and get the support they need. Key to the project is that we communicate more effectively with people with learning disabilities and ensure they have a better understanding of our services and we improve the way in which we work with people with learning disabilities.

We have shared this work and the augmented reality input in a variety of ways. Within the Foundation Trust we have attended the Quality Forum and provided live demonstrations. The leaflets have been presented at the Annual General Meeting as well as national training courses delivered by SARC on how to work with people with learning disabilities. This has included the SARC Best Practice Day, Sexual Offences Masterclass, Annual Conference and Forensic Medical Examinations in Sexual Assault courses. We have also shared the information through social media using Twitter and Facebook.

Other departments in the Foundation Trust have expressed a keen interest, including Safeguarding and Midwifery and Genetics colleagues. We have also shared the booklets and contents with a range of local community groups and also other health professionals who work with people who have been raped or sexually assaulted. A key audience has been young people at risk of CSE who are difficult to engage with but who find quick access to the films describing SARC services valuable.

The interesting element of this project has been combining the traditional (and much sought after) method of providing detailed information through printed materials with new and innovative technology. We know that smart phones are used by a wide range of people with a wide range of abilities and recognising this reliance on technology and using it to improve our communications with people with learning disabilities has been rewarding for the whole team.

1. Involve and speak to your target audience. Understand their challenges and barriers to accessing your service.
2. Assess technologies available to them and you before you make a decision on the best way forward.
3. New technologies may be expensive either through start up or sustainability – test, test, test!
4. Future proofing is difficult with new technology, so we made sure the films we produced were used in a wide range of platforms from social media to the