By Linda Jepkoech Kimaru ,Cheng Cheng Hu, Sudha Nagalingam, Priscilla Magrath, Elizabeth Connick, Kacey Ernst, and John Ehir

Adherence to antiretroviral therapy (ART) is crucial for achieving and maintaining viral suppression in people living with HIV (PLWH). While individual factors affecting HIV viral suppression have been extensively studied, there is less attention on community-level factors, specifically perceived neighborhood disorder. This study aims to assess the relationship between perceived neighborhood disorder and achieving virologic suppression among people living with HIV. One hundred and eighty-eight PLWH 18 years of age and older from two HIV clinics completed a cross-sectional study. We assessed perceptions of neighborhood disorder, ART self-efficacy, social support, alcohol and drug use, depression, HIV stigma, provider-patient relationship, demographics, and length at the zip code. HIV viral loads were obtained from the clinical record. The analysis involved the use of Fisher’s Exact test, Spearman’s Rank test, Wilcoxon rank sum test, and Firth logistic regression. All analyses were conducted using STATA 17. Most participants were male (79%), white (62%), and identified as non-Hispanic (66%). Individuals with no perceived neighborhood disorder had median scores of 10 for integration and perseverance in ART self-efficacy. Those with high perceived disorder displayed decreased scores of 8.4 and 8.3 for integration and perseverance respectively. Both integration and perseverance showed statistically significant negative correlations with perceived neighborhood disorder, (Spearman’s rho -0.2966; p<0.000 and -0.2387; p = 0.0010 respectively). Individuals with virologic suppression (n = 167) reported significantly lower perceived neighborhood disorder scores (median = 0.9 [IQR: 0.2–2.0]) compared to those without virologic suppression (n = 10, median = 3.2 [IQR: 2.4–4], p = 0.0012). The study highlights a notable correlation between perceived neighborhood disorder, ART adherence self-efficacy, and virologic suppression. This indicates that improving HIV treatment outcomes needs to extend beyond individual-level factors and include strategies to address neighborhood-level conditions. Public health policies and programs should consider the broader social and environmental contexts in which people living with HIV reside.

PLOS Glob Public Health, 2024, 13p.

By CSE Aware

  The United Nations and other experts have highlighted that women with learning disabilities (LDs) are at higher risk of experiencing gender-based violence (GBV) because of the lifelong isolation, dependency and oppression they often they experience. These inequalities also put them at risk of commercial sexual exploitation (CSE). Despite global recognition of these impacts, in Scotland to date there is very limited evidence and information on how commercial sexual exploitation affects women with learning disabilities. In the recent report Unequal, Unheard, Unjust: But not Hidden Anymore,the Scottish Commission forPeoplewithLearningDisabilities (SCLD) highlighted SEason of the types of GBV women with learning disabilities experienced. What’s more, this groundbreaking report specifically recommended that the Scottish Government “commission national research examining the commercial sexual exploitation of women with learning disabilities in Scotland,” noting the lack of documented information. While some information does exist about learning disabled women’s experiences of selling or exchanging sex, it is mostly anecdotal and has not been documented nor analysed to truly understand the effects on this population and the effectiveness of, andgaps in, service responses.The present report was born from therecognition that there is a significant knowledge gap on the issue of CSE and its intersection with this particularly vulnerable group of women. Whilst the present report is not the much needed full-scale research which SCLD and ourselves are calling for (see recommendations), it does provide initial findings and recommendations from the exploratory researchweconductedoverthecourseofthreemonths. The Aims Of This research were to: Collect and document evidence of learningisabledwomen’sexperiencesof sellingorexchangingsex. Understandthedynamicsofwomen’s involvement and their specific needs. Explore service responses and challenges and opportunities when addressing women's experiences and needs. Produce Initial Recommendations thattheScottishGovernment and organisations canuseas abasis to design service and policy responses that meet theneeds women with LDs impacted byCSE.

Glasgow: CSE, 3035. 32p.

By Anne Summers, Thomas Shortridge, Kristen Sobeck

Whichever way you look at it, many women are paying a huge economic price in addition to the physical, emotional and psychological damage done to them by domestic violence. It is no accident that employment and education – the pathway to better employment – are targeted by perpetrators as a prime means of depleting or even destroying women’s ability to be financially self-sufficient.

The data used in this report enables the authors, for the first time, to quantify the economic impact of domestic violence on Australian women. The report sets out in detail how large numbers of women have not attained a degree, have left the labour force, have reduced their working hours, or have taken time off work– all because of domestic violence.

The authors identify changes that need to be made across the following areas: paid domestic violence leave policie tthe operation of paid domestic violence leave multiple avenues of support are needed support to (re-)enter employment the Leaving Violence Program.

Sydney: University of Technology Sydney 2025. 52p.

By Dean J. Connolly, Santino Coduri-Fulford c, Katherine Macdonald , Gail GilchristLuke Muschialli

Sexualised drug use (SDU) is a highly prevalent phenomenon of increasing public health significance in communities of men who have sex with men (MSM). This prospectively registered PRISMA-ScR-adherent systematic scoping review examines the current state of knowledge surrounding violence amongst MSM in the context of SDU. A broad search was conducted across four databases, with no restrictions. Studies citing or cited by all database-identified records retained for full-text review were retrieved and screened. Three journals were hand searched across the past five years, and three searches were conducted on Google Scholar. In addition, 13 key opinion leaders were contacted via email to request any additional published or unpublished data. The twentyeight studies included in the final synthesis reported mostly qualitative data from geographically diverse nonrepresentative samples, predominantly relating to sexual violence with other typologies seldom investigated or reported. Although quantitative data were limited, sexual violence appeared common in this context and was directly associated with impaired mental health and suicidality. Some participants reported first- or second-hand accounts of non-consensual administration of incapacitating doses of GHB/GBL to men who were subsequently raped. This was frequently perpetrated by men whose age, status, or financial privilege afforded them power over their victims. While reports from some participants suggested context-specific blurring of the lines of consent, a few quotes demonstrated a dearth of knowledge surrounding the centrality of consent in lawful sex. Given the historical denigration of MSM, any efforts to further investigate or address this issue must be community-led.

International Journal of Drug Policy

Volume 136, February 2025, 104706

By Ingrid Diane Johnson

Purpose: How victims of violence against women (VAW) label their experiences and selves can be important for help-seeking, but descriptive research on the prevalence of experience- and self-labels among VAW victims is limited. This study sought to fll some of the gaps in this quantitative literature using new measurement tools. Method: The current study used quantitative survey data from a weighted sample of 1694 community-based women in Alaska who had experienced VAW (determined using behaviorally specific items) to measure the prevalence of a variety of labels these victims could apply to their experiences and selves. Results Generally, victims of specific forms of violence had minimal agreement on the terms they used to label their experiences. The most commonly endorsed label was 28.5% of those who had experienced alcohol or drug involved sexual assault applying the label rape to their experiences. Across all victims, the most commonly endorsed self-label was survivor, with one-quarter to one-third endorsing this label, depending on the subsample. Roughly one-tenth used the self-label victim across all subsamples. Conclusion: VAW service providers should consider labels used to promote services and how to increase awareness about which behaviors constitute VAW; policymakers should improve the accessibility of healthcare so that labeling oneself or one’s experiences in a certain way is not a prerequisite of help-seeking; and researchers should continue exploring how to measure experience- and self-labels with minimal priming of participants and greater specificity to the actual experiences with violence.

Journal of Family Violence (2024) 39:421–433

By Matthew Logan and Susan McNeeley

Studies explicitly examining the antecedents of prison victimization are rare relative to other institutional outcomes (e.g., misconduct) and are virtually nonexistent for incarcerated military veterans. In the current study, we employed Firth regression models to predict victimization among a subsample of military veterans housed by the Minnesota Department of Corrections (MnDOC) using a target congruence approach. Inconsistent with prior theory and research, we observed no differences among veterans on the basis of race and physical or mental health disorders. We did, however, observe a relationship between an individual’s risk of recidivism as measured by the MnSTARR 2.0 and victimization whereby higher scores corresponded with greater odds of victimization. Implications for theory and correctional policy are discussed and directions for future are given.

St. Paul: Minnesota Department of Corrections, 2023. 25p.

By Joshua Long and Susan McNeeley

It is a commonly held belief that people convicted of sex crimes against children are at an increased risk for being targeted for violence in correctional facilities due to their low status in the prison hierarchy, but most of these assumptions are based on anecdotal evidence or extreme cases. The current study is the first quantitative assessment of victimization risk for incarcerated people convicted of sex crimes that separates cases according to the age of the sex crime victim (children 0-12 years old, young teenagers 13-15 years old, teenagers 16-17 years, and adults 18 years old and over). Data were obtained from the administrative records of 1,487 incarcerated men convicted of sex crimes and held in Minnesota state prisons. Cox regression models and negative binomial models found that people convicted of sex crimes against adults were the most likely to suffer prison victimization out of the four groups, contrary to the assumption of incarcerated people committing violence to avenge child sex offense victims. However, only the difference between those with adult victims and those with young teenage victims was statistically significant after controlling for other predictors of prison victimization. Possible explanations and pathways for future research are discussed.

St. Paul: Minnesota Department of Corrections, 2024. 27p.

By Shelby Hickman, Charlotte Lopez-Jauffret, Stephanie Fahy, Vanessa Masick

Abt Global (Abt) conducted a study for the Bureau of Justice Statistics (BJS) to identify and recommend methods for estimating the prevalence of human trafficking in the United States (U.S.). This study supports BJS’s mission to collect, analyze, publish, and disseminate information on crime, criminal offenders, victims of crime, and the operation of justice. As part of the study, Abt completed an environmental scan and held an Advisory Panel Meeting on Human Trafficking Estimation with BJS in February 2024 that included experts invited to serve on the Advisory Panel. The environmental scan yielded 24 research articles that provided or discussed prevalence of any form of human trafficking spanning geographies inside and outside of the U.S. Between 2017 and 2023, seven articles included random sampling to estimate trafficking prevalence, five used link tracking, three used convenience sampling, four used capture-recapture/multiple systems estimation, and four used respondent-driven sampling. A summary of each sampling method is included in the findings for the environmental scan in Volume I, including strengths and limitations for each type of method. Additionally, key recommendations (balancing precision and generalizability, aligning methods to data sources available, and aligning methods to the characteristics of the population of interest) are included from the environmental scan together with considerations for how BJS can develop a methodology that can produce an unbiased prevalence estimate of human trafficking in the U.S. The Advisory Panel Meeting on Human Trafficking Estimation occurred on February 28, 2024, and included subject matter experts, BJS and National Institute of Justice representatives, and Abt Global study team members. The meeting resulted in key decision points for estimating human trafficking victimization in the country, including considerations around trafficking type, geography, methodology, and data access and quality. Possible priority areas for trafficking type and trafficking subpopulations are presented in the meeting summary included in this report. Findings from the environmental scan and the expert panel meeting were used to develop three recommendations for a pilot study to test the feasibility of estimating the prevalence of human trafficking in the U.S. Capture-recapture is the preferred method since it has the strongest capability for estimating the prevalence of hidden populations, including human trafficking. Vincent link-trace sampling is the second recommendation, followed by random sampling. This report is arranged in three volumes: 1) Findings from the Environmental Scan; 2) BJS Advisory Panel Meeting on Human Trafficking Estimation Meeting Summary; and 3) Recommendations for a National Estimate Pilot Study.

Rockville, MD: Abt Global, 2025. 66p

By Susie Hulley and Tara Young

OWHRs were introduced under the Police, Crime, Sentencing and Courts Act 2022 to address concerns that existing statutory homicide reviews were not formally capturing information about the ‘growing proportion’ of homicides involving offensive weapons. Like other homicide reviews, the purpose of OWHRs is to help national and local agencies understand the causes of serious violence, to better prevent homicides involving offensive weapons and ‘save lives’.

Authors Dr Susie Hulley and Dr Tara Young examine the potential benefits and risks of OWHRs, particularly in regards to young adult safety. Young adults (18- to 25-year-olds) were identified as overlooked by existing homicide reviews, and as such were considered a priority for OWHRs. 

They identify the potential benefits as:

• Serving a symbolic function to victims’ families and the wider community of the Government’s commitment to taking offensive weapon-related homicides seriously.

• Providing a victim’s family and friends with additional information about a homicide.

• Offering valuable local and national data about offensive weapon homicides involving young adults that is not currently available.

• Having the potential to help local and national agencies develop policies and practices to address weapon-related homicide among young adults.

However, there are also some potential risks:

• OWHRs may not be effective, as evidence suggests that existing homicide reviews have not reduced homicide rates.

• Local and national agencies may not engage with or act on the findings from OWHRs, particularly given the lack of a statutory duty.

• 'Hindsight bias’ may be applied by OWHR panels.

• 'Selection bias'  may generate misinformation about offensive weapon homicides and potentially reinforce existing racialised stereotypes. 

While the report does urge the government to instead consider well-evidenced interventions, it also provides five recommendations that could mitigate some of the risks, if OWHRs are to be rolled out.

London: Centre for Crime and Justice Studies, 2025. 27p.   

By Nicola Helps, Charlotte Bell, Chloe Schulze, Rodney Vlais, et al.

While men’s behaviour change programs (MBCPs) were never meant to be a panacea for domestic, family and sexual violence, their role and effectiveness in addressing domestic, family and sexual violence is often questioned.

This evidence brief provides a summary of the literature on MBCPs, focusing primarily on their role in addressing domestic, family and sexual violence in Australia. It synthesises what is known about MBCPs based on available peer-reviewed and grey literature and practice-based evidence.

A shared understanding of the role and capability of MBCPs is critical for their impact. Expecting significant, transformational change from a single intervention is unrealistic. There is now a growing appreciation and understanding that MBCPs are one piece of the puzzle in a wider system of accountability for people who use violence. Yet the potential outcomes from such collaborative practice are often limited or undermined by how MBCPs have been implemented, or by inadequacies in the broader systemic infrastructure upon which the intended behavioural change relies.

Key findings

• MBCPs are conceptualised as one piece of the puzzle however are yet to be operationalised as part of a fully integrated system.

• MBCPs need to be better funded to provide tailored, holistic and timely services that can support meaningful behaviour change.

• MBCPs need to be embedded collaboratively within the broader domestic, family and sexual violence ecosystem so they can work together with other services towards improved outcomes for victims and survivors including children, as well as improved outcomes for meaningful behaviour change, accountability, increased visibility and risk management.

• MBCPs are only one piece of the response to domestic, family and sexual violence.

Alexandria, NSW: Australia’s National Research Organisation for Women’s Safety Limited (ANROWS), , 2025. 35p.

By Isabella Voce and Anthony Morgan

This study presents the results from a survey of 14,994 Australian adult computer users conducted in June 2021.

Nearly five percent of all respondents had ever experienced ransomware victimisation, while two percent of respondents had experienced ransomware in the last 12 months.

Small to medium enterprise (SME) owners were twice as likely as other respondents to have been the victim of ransomware attacks in the past year and were more likely to have paid the ransom. The prevalence of ransomware victimisation varied according to the industry in which respondents were currently employed.

Most ransomware victims did not pay the ransom. The advice given to ransomware victims was identified as the most common reason for a respondent’s decision about whether or not to pay the ransom, particularly in the case of SME owne

Statistical Bulletin no. 35. 

Canberra: Australian Institute of Criminology  2021. 17p

By Dan Whitten, Eleanor Neyroud & Peter Neyroud 

Research question - 

Sexual Risk Orders (SRO) have been advocated as a means to prevent Violence Against Women and Girls (VAWG). This is despite significant detriment to the fundamental rights of the legally innocent and a lack of empirical assessment that can speak to preventative efficacy. This study asks; do SROs serve to prevent sexual-harm?

Data - 

The Police National Computer (PNC) was used to identify two samples of SRO subjects. Legal Services’ data from the Metropolitan Police Service (MPS) was used to construct a counterfactual group, for whom SRO was considered but not obtained. PNC was used to identify arrests as a proxy for offending and a harm index applied.

Methods - 

Before-after and between-group comparisons are used, along with an interrupted-time-series analysis, to assess the relationship between SRO and sexual-harm prevention. Rank-ordering of harm caused by alleged sexual-offenders in London enables an estimate of how precisely SROs are used against the highest-harm offenders.

Findings - 

SROs are associated with a significant 84.5% reduction in sexual-harm. This increases to a 93.1% reduction in the case of high-harm offenders, controlling for time incarcerated. Despite this, SROs are rarely used and are not systematically targeted against the most harmful offenders.

Conclusions - 

Within the limitations of the methodology we conclude that the evidence supports SRO use as a primary tactic to counter VAWG. Preventative impact may be maximised by increasing use, actively targeting SROs at the highest-harm offenders and considering use at an earlier stage of a subjects sexual-offending. A randomised trial is the next logical step to augment causal inference.

Camb J Evid Based Polic 9, 1 (2025, 19 p.

By Patrick Lussier and Evan McCuish

Objectives

There is empirical evidence that sexual recidivism rates have been dropping for several decades, but it remains unclear whether this drop is an artifact of changing research methodologies over the years. The current study, therefore, examines whether the sexual recidivism drop is robust while accounting for various methodological factors.

Method

The study is based on a systematic review and a quantitative meta-analysis of 468 empirical studies published between 1940 and 2019 that reported sexual recidivism rates. A total of 626 estimations (n = 388,994) of sexual recidivism were retrieved for the study period and of those, 238 were independent observations (n = 196,651). A series of sensitivity analyses were conducted using a meta-regression approach.

Results

A series of meta-regression analyses show that, even after accounting for various methodological factors (e.g., study settings, follow-up length, recidivism criteria), there has been a sexual recidivism rate drop of about 45–60% since the 1970s.

Conclusions

The study findings confirm the presence of a sexual recidivism drop while recognizing that sexual recidivism rates are sensitive to methodological details.

Journal of Criminal Justice

Volume 92, May–June 2024, 102188, p. 16

By Kaitlyn Rines

This report summarizes law enforcement reports of sexual assault offenses for the State of Ohio during the years 2016-2023. We also summarize characteristics of crime incidents, victims and suspects. We provide sexual assault rates throughout this report, and it is important to understand how we calculated them and what they mean. First, we calculate offense totals by counting the number of sexual assault victimizations documented within each law enforcement incident report. Sexual assault victim totals do not necessarily represent unique victims. For example, law enforcement could report that a suspect sexually assaulted an individual more than once during a single incident. Further, a suspect could assault the same individual during a different incident. Therefore, it is almost certain that the sexual assault offense total is larger than the number of individuals who were victims of sexual assaults. Next, we calculate the rate of sexual assault by dividing the sexual assault total by the population total and then multiplying the resulting number (the quotient) by 100,000. This yields a sexual assault crime rate per 100,000 persons. We provide Ohio’s overall sexual assault crime rates over time, and we also compare rates of sexual assault for Ohio’s standard demographic groups (e.g., age, sex, race). Rates can vary significantly depending on how many victimizations a group experienced as well as the size of one group versus another. For example, the sexual assault crime rate is much higher for female Ohioans than males, largely because the number of female sexual assaults is much larger than male. Further, most sexual assault victims are White females because most of Ohio is White. However, Black females have the highest victimization rate because their sexual assault total is large while their overall population size is small.

Columbus:; Ohio Department of Public Safety, Office of Criminal Justice Services. 2024. 62p.

By United Nations Office on Drugs and Crime, UN Women

In this publication, the term “femicide” is used to refer to all types of gender-related killings of women and girls as described in the “Statistical framework for measuring the gender-related killing of women and girls (also referred to as “femicide/feminicide”)”.

Globally, approximately 51,100 women and girls were killed by their intimate partners or other family members during 2023. Higher than the 2022 estimate of 48,800 victims, this change is not indicative of an actual increase as it is largely due to differences in data availability at the country level. The 2023 figure means that 60 per cent of the almost 85,000 women and girls killed intentionally during the year were murdered by their intimate partners or other family members. In other words, an average of 140 women and girls worldwide lost their lives every day at the hands of their partner or a close relative...

P.18 When considering possible risk factors, it should be noted that fewer victims (11 per cent) and perpetrators (20 per cent) of femicides are under the influence of alcohol than in the case of male homicides (25 and 30 per cent respectively). Some studies point to the drug intoxication of victims as a homicidal risk factor,13 but in the case of femicides in France, this does not seem to be the case, with 3 per cent of victims and 5 per cent of perpetrators of femicide being under the influence of drugs at the time of the crime.

Vienna: UNODC, 2024. 36p.

By Wim Bernasco*, Marre Lammers, Barbara Menting, Stijn Ruiter

The interpretation of research findings based on self-reported delinquency requires knowledge of how response rates depend on the attributes of potential respondents, including their prior offending. The purpose of the present study was to quantify the extent to which, in a sample of offenders, the two main determinants of non-response – non-contact and refusal – depend on prior offending frequency. We used binomial and multinomial regression models to assess whether frequent offenders are more difficult to contact and less willing to participate in online surveys. These hypotheses are tested on a sample of offenders who were invited by regular mail to participate in the Online Activity Space Inventory Survey (OASIS), an online survey on mobility and safety. Controlling for gender and age as potential confounders, our findings do not confirm that frequent offenders are less likely to be successfully contacted, but they do confirm that, if contacted, they are less likely to participate. Response rates in offender-based research are selective and thus potentially biased towards infrequent offenders. They generally favour conservative estimates and conclusions, implying that any associations found between crime and its predictors are likely stronger in reality.

European Journal of Criminology, Volume 19, Issue 6, November 2022, Pages 1403-1420

By Barbara Menting, Marre Lammers, Stijn Ruiter*, Wim Bernasco

Crime pattern theory predicts that offenders commit offences in their activity spaces. We also propose that they most likely offend in the more frequently visited parts. Previous studies used offenders' residential areas or other activity space proxy measures but lacked data on other routinely visited places (e.g., work, school, and leisure activities). A major contribution of this study is the use of an online survey in which 78 offenders reported on their own activity spaces and committed offences (n = 140). Results show that offending is much more likely in offenders' activity spaces than elsewhere, and effects increase with visiting frequency. Although residential area is a good predictor, offenders' more extensive self-reported activity spaces predict much better where they commit offences.

The British Journal of Criminology, Volume 60, Issue 2, March 2020, Pages 303–322,

Edited by Teela Sanders Jane Scoular · Barbara G. Brents Susie Balderston · Gillian Abel

This open access book draws on an international research project, using extensive and multiple methods to explore unwanted sexual contact and violence in sex work populations. A project delivered by a large team of sex workers, peer researchers, and academics, and with practitioner input over a four-year period, the central question they explore is: how do social, legal, and judicial contexts shape the safety and well-being of people engaging in sex work? The book compares survey and interview data conducted in 2023 across four different legal environments: legalisation (Nevada, USA), criminalisation (Northern Ireland), decriminalisation (New Zealand) and partial criminalisation (UK). It explores how the interaction between legal consciousness (how people in sex work interpret law, consent, their rights, and how or whether to report), legal norms (legal theory, case rulings, legal codes) and legal practices (what police, lawyers, and judges actually do) affects unwanted contact against sex workers. This book advances understanding of the various layers regulating sexual autonomy for marginalised peoples — the specific factors that impact the negotiation, experiences, and disposition of crimes of sexual violence in different socio-legal contexts.

Cham: Springer Nature, 2025. 283p.

By Aisha Abubakar, Rowland Seymour, Alison Gardner, Nicola Wright, Rachel Fyson, Imogen Lambert, and Rachael Clawsona

People with an illness, disability or other health conditions are more likely to experience various forms of exploitation in comparison to other groups, particularly if their health condition necessitates assistance with daily functioning such as personal care, financial management, or socialising. For the purpose of this study, we consider a wide range of cognitive impairments and differences that affect processing, understanding, and memory, and therefore may cause additional challenges in everyday life. People with ‘hidden’ disabilities such as mental health conditions, cognitive decline, intellectual disabilities, autism, and ADHD are more vulnerable to exploitation than people with other types of disability. For example, they may be vulnerable due to trauma from adverse experiences leading to dissociation, or addiction means they can be exploited to fulfil their needs. They may struggle to recognise when they are being exploited and may be unable to effectively communicate or report abuse. Adults with cognitive impairment living alone may be vulnerable, while those having difficulty understanding financial matters may be more vulnerable to financial exploitation. The aforementioned factors not only increase vulnerability to exploitation but also amplify the severity of harm when exploitation occurs, making the relationship between cognitive impairment and exploitation a complex and multidimensional phenomenon. Hence, implementing strategies that pay attention to these factors is imperative in preventing exploitation and mitigating the severity of harm. Yet, there is a lack of public and official statistics to quantify the intersections between exploitation and disability/cognitive impairment to inform appropriate strategies for mitigation. Adults with cognitive impairments may be classed as a vulnerable group of individuals at increased risk of being exploited because of their reduced capacity to identify and report abuse or exploitation. Hence the prevalence of exploitation in this population is

not well understood, it is thought to be under-reported due to the challenges faced by these individuals in communicating their experiences . Section 42 (S42) of the Care Act 2014 requires local authorities in England to conduct investigations when they have reasonable grounds to suspect that an adult with care and support needs is experiencing, or is at risk of experiencing, abuse, neglect, or exploitation. Social workers, health professionals, the police, and other relevant stakeholders are all involved in S42 investigations, with the aim of ensuring the safety and well-being of adults with care and support needs, as well as preventing and responding to incidences of maltreatment. Hence, these enquiries are intended to garner information about the adult and their circumstances, assess the risks to their safety, and determine the best way to protect them. Estimates from the Crime Survey for England and Wales (CSEW) show that between 2014 and 2020, people with cognitive impairment aged between 16 and 59 were more likely to be victims of different forms of domestic abuse and sexual assaults than people with other forms of impairment, particularly women. However, it is not possible to extrapolate what incidents reported by individuals with lived experience constitute exploitation in the CSEW. Hence this paper is an exploratory study aimed at quantitatively understanding the intersections between cognitive impairment and exploitation. Given that there is currently very little intersecting data, quantitative statements about how people with cognitive impairment are at risk of, or are being exploited, need to be extrapolated. To extrapolate the relationship between cognitive impairment and exploitation, this

study provides a descriptive account of disability prevalence, exploitation prevalence and S42 enquiries in English LAs using data from the Family Resources Survey (FRS), the National Referral Mechanism (NRM), and the Safeguarding Adults Collection (SAC), with the aim of addressing the following important questions: • Are there trends in disability prevalence and exploitation by types of impairment, and if so, what types of cognitive impairment and exploitation are more prominent? • Are there trends in S42 enquiries, and if so, what are they? • What proportion of S42 enquiries involved people with cognitive impairment? • How frequently did exploitation appear as a factor of S42 enquiries? The remainder of the paper is structured as follows. Section 2 explains what data is currently available to quantify the relationship between cognitive impairment and exploitation. The results and discussion in Section 3 then provides a contextual and descriptive account of the prevalence of disability and exploitation in England, including findings from the analysis of S42 enquiries. The final section offers concluding remarks, limitations, and emerging recommendations.

Working Paper 2023 50p.

By Alison Gardner, Aisha Abubakar, Imogen Lambert, David Charnock, Rachael Clawson, Rachel Fyson, Nicola Wright , Rowland Seymour

In recent years there has been increasing attention to ‘modern slavery’, human trafficking and wider forms of exploitation both in the UK and internationally. There has also been growing awareness that people can be placed at risk of exploitation by a wide range of personal, social and economic circumstances, including physical and mental health issues. News stories have highlighted examples of people with different forms of cognitive impairment experiencing control and exploitation by those seeking to profit from their labour or property, sometimes over long periods of time. However, statistics on this issue remain elusive. This project aimed to provide the first robust description of the intersection between cognitive impairment and the exploitation of adults in England. We were interested mainly in cognitive impairment as a risk factor prior-to exploitation, rather than impairment caused by experiences of exploitation. Whilst we recognise that there is a wide spread of IQ and cognitive ability across populations, we define cognitive impairment broadly to include both developmental and acquired impairments including intellectual disability, dementia, brain injury, autistic spectrum disorders, ADHD, functional mental health disorders and substance misuse. We also examined a diverse spectrum of exploitation looking at a range of situations where one person, either opportunistically or premeditatedly, unfairly manipulates another person for profit or personal gain. Research methods Our multi—method study included the following methods of data collection and analysis. ■ A wide-ranging scoping review of existing literature. ■ Analysis of statistical information, including data on exploitation and support needs within the Safeguarding Adults Collection (SAC) from NHS England Digital between 2017 and 2022, as well as wider contextual data. ■ Quantitative and qualitative analysis of evidence extracted from Safeguarding Adults Reviews (SARs) featuring exploitation during the same period (2017-2022). SARs (formerly known as serious case reviews) are initiated in cases where an adult with care and support needs has suffered serious harm or death, and abuse or exploitation is suspected. From our initial search of a national library of SARs we identified and analysed 58 narrative SARs featuring exploitation involving 71 people. ■ An open online survey of practitioners who were working in roles relevant to safeguarding people with cognitive impairment, which gained 95 responses. ■ Semi-structured interviews with 24 practitioners and 26 people who had lived experience of cognitive impairments and exploitation. ■ Qualitative comparative analysis (QCA) to inform our understanding of how factors combine to increase risks for exploitation.

Key findings 1 Previous studies suggest that cognitive impairments can increase vulnerability to exploitation Academic literature looking at cognitive impairment and exploitation is sparse, but our scoping review found 20 studies published in English that related to the topic. These covered three types of exploitation (sexual, financial and criminal) with intellectual disability and mental health the most frequently discussed types of impairments. The literature indicated that cognitive impairment was a factor increasing vulnerability to exploitation, but the limited number of studies meant that it was difficult to disentangle complexities in the relationship between cognitive impairment and exploitation without further research. 2 Existing datasets and surveys miss important opportunities to publish intersecting data on cognitive impairment and exploitation. Building on the literature review, we went on to examine the data that was available in England relating to cognitive impairment and exploitation. A review of statistical information found that existing English surveys and datasets currently describe the prevalence of disability and exploitation separately. With minor adjustments these could collate and publish intersecting data on cognitive impairment and exploitation, but at present these opportunities are being missed. Safeguarding Adults Collection (SAC) Data from NHS England includes statistics on support needs (including cognitive impairments) and various forms of abuse and exploitation, but has some limitations. In particular, it does not yet publish data showing the intersections between different types of support needs and forms of abuse. There were also significant regional variations in recorded safeguarding investigations, as well as potential for conflation between abuse and exploitation, which could create data inconsistencies. The SAC data did show increased safeguarding investigations for people who were not previously in contact with services, indicating that more adults with support needs may not be known to services until a crisis occurs. There were also a small but increasing number of reports of modern slavery. 3 Cognitive impairments are present within 96% of individuals in Safeguarding Adults Reviews that include exploitation Analysis of Safeguarding Adult Reviews (SARs) on exploitation showed clearer connection between cognitive impairment and exploitation. Approximately 96% of individuals in reviews that included exploitation between 2017 and 2022 focussed on adults who had some form of cognitive impairment. 4 People are often exploited in multiple ways, and alongside other abuses The relationship between cognitive impairment and exploitation is complex, with multiple forms of exploitation and abuse often co-existing and overlapping, alongside diverse risk factors. Both data from SARs and our survey suggests that financial exploitation and ‘mate crime’ (being exploited by someone posing as a friend) were the most commonly-experienced forms of exploitation. However, these more frequently observed forms often co-occur alongside others, such as sexual, labour or criminal exploitation. People with experience of living with cognitive impairment also identified ‘everyday exploitation’ as part of their regular experience, including issues like being targeted for phone and online scams. 5 Risks for exploitation arise not just from cognitive conditions, but their social impacts. The presence of a coercive and controlling relationship is a key factor. Factors identified as contributing to vulnerability included substance misuse, intellectual disabilities, mental health and dementia or cognitive decline, though in many cases there were multiple diagnoses. Complex and developmental trauma in earlier life was frequently evident. A lack of diagnosis was also a frequent challenge for practitioners seeking to support individuals at risk of exploitation. Beyond clinical factors, a range of social drivers impacted on vulnerability to exploitation, including limited or absent family support, harmful social networks, trauma and isolation. People with lived experience also described the impact of discrimination and hate-crime, and social precarity, sometimes driven through factors such as irregular immigration status or unemployment. Factors such as a history of abuse and/ or other adverse experiences such as bullying could also be present. Coercive and controlling relationships were also a significant factor predicting exploitation alongside the existence of social networks used to target a potential victim.

Nottingham, UK: University of Nottingham, Rights Lab, 2024. 58p.