SlideShare a Scribd company logo
1 of 33
Download to read offline
Can Positive Community Practice 
Models Help Prevent Abuse?
European Psychiatric Association Symposium:
Psychiatric Care in Europe for People with 
Intellectual Disabilities: How to Prevent Abusive 
Practices 
Can Positive Community Practice 
Models Help Prevent Abuse?
Dr Ian Hall
Consultant Psychiatrist and Lead Clinician, East London NHS Foundation Trust
Associate Dean, Royal College of Psychiatrists
Dr Niall O’Kane
Specialty Registrar in Psychiatry of Intellectual Disability, Camden and Islington 
NHS Foundation Trust
Overview
• Historical background
• Abuse in institutions
• Community service models
• Abuse in community settings
– Case examples
• Preventing abuse in the community
• Concluding points
Historical background
• Learning disability services can be seen in 
terms of three periods
– Rise of institutions
– Fall of institutions 
– Balancing of community services, residential care 
and inpatient services
Historical background
Historical background
Types of abuse reported in Community 
Settings
• Physical abuse
– Restrictive practices
• Financial exploitation
• Sexual abuse
• Neglect
Paternalism v Autonomy
What is abuse?
Deprivation of Liberty 
• Deprivation of Liberty can only be lawful if 
there is a proper procedure in law
• Daniel was deprived of his liberty in a care 
home using the DOLS procedures under the 
English Mental Capacity Act
• An independent expert found he did have 
capacity to decide residence and care
Staying indoors
• Jason is 18 and has a severe learning disability 
and autism.
• He has not attended school for the last 2 years, 
after one day the bus took a different route.  
Now he doesn’t go out of the house.
• His family employ 2 workers though direct 
payments who are family friends
• Psychology have been asked to help but the 2 
workers are not engaging in the PBS plan
A wife’s duty?
• Amina got married to Foaz a few years go, after 
their parents introduced them.  She has three 
young children
• Foaz helps Amina with looking after the children 
and manages the family’s bills.  She often asks his 
advice and support.
• Foaz likes to have sex with her a couple of times 
a week.  Amina doesn’t really like this but goes 
along with it as Foaz is good in other ways 
Challenging behaviour
• Kwame, a 19 year old man with a severe 
learning disability and autism, is presenting 
with increasing challenging behaviour over the 
past few months.  He has been destroying 
furniture, repeatedly flushing the toilet, and 
pulling light fittings off the wall.
• You see him with one of his care workers who 
asks you to prescribe him risperidone
Admitted to Hospital
Why did Martin die?
How can we prevent abuse?
How can we prevent abuse?
• Safeguarding procedures
• Legislation
– Criminal
– Civil/mental capacity
• Integrated working
– Health and social services
• Maximising communication
• Promoting access to health
How can we prevent abuse?
• Personalised services
• Positive Behavioural Support
• Teaching and training
• Advocacy
• Regular review
• Implementing clinical guidelines
• Positive risk taking
How can we prevent abuse?
• Open culture: duty of candour and 
whistleblowing
• More effective inspection of services (by 
councils/ID services/independent regulators)
• Ensuring more local community based 
services
Can Positive Community Practice 
Models Help Prevent Abuse?
Can Positive Community Practice 
Models Help Prevent Abuse?
• Community based services have improved the 
lives of people with intellectual disability
• Need to balance individual's rights with 
protecting from harm
• Identifying abuse: systemic and cultural issues
• Prevention of abuse requires a broader and 
more evidence-based response
References and further information
Building the right support: A national plan to develop community services and 
close inpatient facilities for people with a learning disability and/or autism 
who display behaviour that challenges, including those with a mental 
health condition; ADASS & NHS England, October 2015. Available at: 
https://www.england.nhs.uk/wp-content/uploads/2015/10/ld-nat-imp-
plan-oct15.pdf. Last accessed 26 March 2017 
Department of Health (DoH) (2008) Michael J. Healthcare for All – Report of 
the independent Inquiry into Access to Healthcare for people with 
Intellectual Disabilities, July, HMSO, London.
MENCAP (2007), Death by Indifference, MENCAP, London, available at: 
www.mencap.org.uk/campaigns/take-action
Marsland D., Oakes P., Bright N. (2015). It can still happen here: systemic risk 
factors that may contribute to the continued abuse of people with 
intellectual disabilities TIZARD LEARNING DISABILITY REVIEW j VOL. 20 NO. 
3 pp. 134-146, Emerald Group Publishing Limited
References and further information
Marsland D., Oakes P., Bright N. (2015). It can still happen here: systemic risk 
factors that may contribute to the continued abuse of people with 
intellectual disabilities TIZARD LEARNING DISABILITY REVIEW j VOL. 20 NO. 
3 pp. 134-146, Emerald Group Publishing Limited
National Institute for Health and Care Excellence. Challenging behaviour and 
learning disabilities: prevention and interventions for people with learning 
disabilities whose behaviour challenges. NICE, 2015
National Institute for Health and Care Excellence. NG54 Mental health 
problems in people with learning disabilities: prevention, assessment and 
management. NICE 2016
Sheehan, R., Hassiotis, A., Walters, K., Osborn, D., Strydom, A., & Horsfall, L. 
(2015). Mental illness, challenging behaviour, and psychotropic drug 
prescribing in people with intellectual disability: UK population based 
cohort study. BMJ, 351, h4326 

More Related Content

Similar to Can Positive Community Practice Models Help Prevent Abuse?

RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...
RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...
RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...Marco Muscroft
 
forignsic_nursing__8th_april_2013.ppt
forignsic_nursing__8th_april_2013.pptforignsic_nursing__8th_april_2013.ppt
forignsic_nursing__8th_april_2013.pptNeelofur Neelu
 
Disability hate crime presentation - 21 September
Disability hate crime presentation - 21 SeptemberDisability hate crime presentation - 21 September
Disability hate crime presentation - 21 SeptemberFaye Savage
 
The feminist school of criminology
The feminist school of criminologyThe feminist school of criminology
The feminist school of criminologySagnikChakraborty25
 
Living with Historical Childhood Sexual Abuse
Living with Historical Childhood Sexual AbuseLiving with Historical Childhood Sexual Abuse
Living with Historical Childhood Sexual AbuseBASPCAN
 
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016Fairfax County
 
Putting Fuel on the Fire - Advocacy in the North
Putting Fuel on the Fire - Advocacy in the NorthPutting Fuel on the Fire - Advocacy in the North
Putting Fuel on the Fire - Advocacy in the NorthCitizen Network
 
279765231-criminal-psychology- in real s
279765231-criminal-psychology- in real s279765231-criminal-psychology- in real s
279765231-criminal-psychology- in real sAbelObosi1
 
Sexual abuse
Sexual abuse Sexual abuse
Sexual abuse francob1
 
Trends and issues in Psychiatric Mental Health Nursing- Pradeep
Trends and issues in Psychiatric Mental Health Nursing- PradeepTrends and issues in Psychiatric Mental Health Nursing- Pradeep
Trends and issues in Psychiatric Mental Health Nursing- PradeepPradeep Murthy
 
Sexual abuse
Sexual abuse Sexual abuse
Sexual abuse francob1
 
Putaroofonpoverty dr. turnbull 's presentation adapted
Putaroofonpoverty  dr. turnbull 's presentation adaptedPutaroofonpoverty  dr. turnbull 's presentation adapted
Putaroofonpoverty dr. turnbull 's presentation adaptedPutARoofOnPoverty
 
Ppttrendsandissues 130711111203-phpapp01
Ppttrendsandissues 130711111203-phpapp01Ppttrendsandissues 130711111203-phpapp01
Ppttrendsandissues 130711111203-phpapp01sheelamom
 
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...Dr Justin Varney
 
Tabloski ch10 lecture
Tabloski ch10 lectureTabloski ch10 lecture
Tabloski ch10 lecturestanbridge
 
Neighbourhood approaches to loneliness
Neighbourhood approaches to lonelinessNeighbourhood approaches to loneliness
Neighbourhood approaches to lonelinessEdenProjectWebTeam
 
Julian le grand #pp40 slides
Julian le grand #pp40 slidesJulian le grand #pp40 slides
Julian le grand #pp40 slidesPP40
 
Julian le grand #pp40 slides
Julian le grand #pp40 slidesJulian le grand #pp40 slides
Julian le grand #pp40 slidesPP40
 

Similar to Can Positive Community Practice Models Help Prevent Abuse? (20)

RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...
RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...
RIWC_PARA_A195 the issues pertaining to being disabled whilst incarcerated in...
 
Janet Ortega
Janet OrtegaJanet Ortega
Janet Ortega
 
forignsic_nursing__8th_april_2013.ppt
forignsic_nursing__8th_april_2013.pptforignsic_nursing__8th_april_2013.ppt
forignsic_nursing__8th_april_2013.ppt
 
Disability hate crime presentation - 21 September
Disability hate crime presentation - 21 SeptemberDisability hate crime presentation - 21 September
Disability hate crime presentation - 21 September
 
The feminist school of criminology
The feminist school of criminologyThe feminist school of criminology
The feminist school of criminology
 
Living with Historical Childhood Sexual Abuse
Living with Historical Childhood Sexual AbuseLiving with Historical Childhood Sexual Abuse
Living with Historical Childhood Sexual Abuse
 
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016
Diversion First: Progress-to-Date, and a Look to the Future: Fall 2016
 
Putting Fuel on the Fire - Advocacy in the North
Putting Fuel on the Fire - Advocacy in the NorthPutting Fuel on the Fire - Advocacy in the North
Putting Fuel on the Fire - Advocacy in the North
 
279765231-criminal-psychology- in real s
279765231-criminal-psychology- in real s279765231-criminal-psychology- in real s
279765231-criminal-psychology- in real s
 
Sexual abuse
Sexual abuse Sexual abuse
Sexual abuse
 
Trends and issues in Psychiatric Mental Health Nursing- Pradeep
Trends and issues in Psychiatric Mental Health Nursing- PradeepTrends and issues in Psychiatric Mental Health Nursing- Pradeep
Trends and issues in Psychiatric Mental Health Nursing- Pradeep
 
Sexual abuse
Sexual abuse Sexual abuse
Sexual abuse
 
Putaroofonpoverty dr. turnbull 's presentation adapted
Putaroofonpoverty  dr. turnbull 's presentation adaptedPutaroofonpoverty  dr. turnbull 's presentation adapted
Putaroofonpoverty dr. turnbull 's presentation adapted
 
Ppttrendsandissues 130711111203-phpapp01
Ppttrendsandissues 130711111203-phpapp01Ppttrendsandissues 130711111203-phpapp01
Ppttrendsandissues 130711111203-phpapp01
 
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...
Understanding the mental health and wellbeing of lesbian, gay, bisexual and t...
 
Tabloski ch10 lecture
Tabloski ch10 lectureTabloski ch10 lecture
Tabloski ch10 lecture
 
Neighbourhood approaches to loneliness
Neighbourhood approaches to lonelinessNeighbourhood approaches to loneliness
Neighbourhood approaches to loneliness
 
HCS103 Topic 11
HCS103 Topic 11HCS103 Topic 11
HCS103 Topic 11
 
Julian le grand #pp40 slides
Julian le grand #pp40 slidesJulian le grand #pp40 slides
Julian le grand #pp40 slides
 
Julian le grand #pp40 slides
Julian le grand #pp40 slidesJulian le grand #pp40 slides
Julian le grand #pp40 slides
 

More from Yasir Hameed

في النفس والانسان The human and the soul
في النفس والانسان The human and the soulفي النفس والانسان The human and the soul
في النفس والانسان The human and the soulYasir Hameed
 
Integrating the findings from boundary sciences for development of the DSM/IC...
Integrating the findings from boundary sciences for development of the DSM/IC...Integrating the findings from boundary sciences for development of the DSM/IC...
Integrating the findings from boundary sciences for development of the DSM/IC...Yasir Hameed
 
Radicalisation and violent extremism
Radicalisation and violent extremismRadicalisation and violent extremism
Radicalisation and violent extremismYasir Hameed
 
Lack of legal coercion – an ethical challenge
Lack of legal coercion – an ethical challengeLack of legal coercion – an ethical challenge
Lack of legal coercion – an ethical challengeYasir Hameed
 
Are we using mass media to raise awareness about psychiatric disorders?
Are we using mass media to raise awareness about psychiatric disorders?Are we using mass media to raise awareness about psychiatric disorders?
Are we using mass media to raise awareness about psychiatric disorders?Yasir Hameed
 
Smartphone For Mental Health Patients: A Double Edged Weapon?
Smartphone For Mental Health Patients: A Double Edged Weapon?Smartphone For Mental Health Patients: A Double Edged Weapon?
Smartphone For Mental Health Patients: A Double Edged Weapon?Yasir Hameed
 
The experience of developing a platform for online psychotherapy sessions
The experience of developing a platform for online psychotherapy sessionsThe experience of developing a platform for online psychotherapy sessions
The experience of developing a platform for online psychotherapy sessionsYasir Hameed
 
TELEMEDICINE HOW DOES IT WORK IN PRACTICE
TELEMEDICINE HOW DOES IT WORK IN PRACTICETELEMEDICINE HOW DOES IT WORK IN PRACTICE
TELEMEDICINE HOW DOES IT WORK IN PRACTICEYasir Hameed
 
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...Yasir Hameed
 
Determinants of functioning in euthymic patients with bipolar disorder: A str...
Determinants of functioning in euthymic patients with bipolar disorder: A str...Determinants of functioning in euthymic patients with bipolar disorder: A str...
Determinants of functioning in euthymic patients with bipolar disorder: A str...Yasir Hameed
 
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...Yasir Hameed
 
Inflammation And Neurodegeneration Findings In Early Stage Bipolar Disorder
Inflammation And Neurodegeneration Findings In Early Stage Bipolar DisorderInflammation And Neurodegeneration Findings In Early Stage Bipolar Disorder
Inflammation And Neurodegeneration Findings In Early Stage Bipolar DisorderYasir Hameed
 
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...Yasir Hameed
 
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...Thyroid Profile and its Relationship with Response to Treatment with Lithium ...
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...Yasir Hameed
 
Analysis of genome-wide association studies uncovers genetic loci shared betw...
Analysis of genome-wide association studies uncovers genetic loci shared betw...Analysis of genome-wide association studies uncovers genetic loci shared betw...
Analysis of genome-wide association studies uncovers genetic loci shared betw...Yasir Hameed
 
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERS
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERSGENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERS
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERSYasir Hameed
 
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...The 4-Hour Window - Government targets and clinical challenges in A&E and psy...
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...Yasir Hameed
 
Postictal psychosis - a complex challenge
Postictal psychosis - a complex challengePostictal psychosis - a complex challenge
Postictal psychosis - a complex challengeYasir Hameed
 
Profile of depression in women attending antenatal clinics in Blantyre distri...
Profile of depression in women attending antenatal clinics in Blantyre distri...Profile of depression in women attending antenatal clinics in Blantyre distri...
Profile of depression in women attending antenatal clinics in Blantyre distri...Yasir Hameed
 
Clinical Differences Between Unipolar And Bipolar Depression
Clinical Differences Between Unipolar And Bipolar DepressionClinical Differences Between Unipolar And Bipolar Depression
Clinical Differences Between Unipolar And Bipolar DepressionYasir Hameed
 

More from Yasir Hameed (20)

في النفس والانسان The human and the soul
في النفس والانسان The human and the soulفي النفس والانسان The human and the soul
في النفس والانسان The human and the soul
 
Integrating the findings from boundary sciences for development of the DSM/IC...
Integrating the findings from boundary sciences for development of the DSM/IC...Integrating the findings from boundary sciences for development of the DSM/IC...
Integrating the findings from boundary sciences for development of the DSM/IC...
 
Radicalisation and violent extremism
Radicalisation and violent extremismRadicalisation and violent extremism
Radicalisation and violent extremism
 
Lack of legal coercion – an ethical challenge
Lack of legal coercion – an ethical challengeLack of legal coercion – an ethical challenge
Lack of legal coercion – an ethical challenge
 
Are we using mass media to raise awareness about psychiatric disorders?
Are we using mass media to raise awareness about psychiatric disorders?Are we using mass media to raise awareness about psychiatric disorders?
Are we using mass media to raise awareness about psychiatric disorders?
 
Smartphone For Mental Health Patients: A Double Edged Weapon?
Smartphone For Mental Health Patients: A Double Edged Weapon?Smartphone For Mental Health Patients: A Double Edged Weapon?
Smartphone For Mental Health Patients: A Double Edged Weapon?
 
The experience of developing a platform for online psychotherapy sessions
The experience of developing a platform for online psychotherapy sessionsThe experience of developing a platform for online psychotherapy sessions
The experience of developing a platform for online psychotherapy sessions
 
TELEMEDICINE HOW DOES IT WORK IN PRACTICE
TELEMEDICINE HOW DOES IT WORK IN PRACTICETELEMEDICINE HOW DOES IT WORK IN PRACTICE
TELEMEDICINE HOW DOES IT WORK IN PRACTICE
 
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder Traits...
 
Determinants of functioning in euthymic patients with bipolar disorder: A str...
Determinants of functioning in euthymic patients with bipolar disorder: A str...Determinants of functioning in euthymic patients with bipolar disorder: A str...
Determinants of functioning in euthymic patients with bipolar disorder: A str...
 
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...
CORTICAL INHIBITION IN SYMPTOMATIC AND REMITTED MANIA COMPARED TO HEALTHY SUB...
 
Inflammation And Neurodegeneration Findings In Early Stage Bipolar Disorder
Inflammation And Neurodegeneration Findings In Early Stage Bipolar DisorderInflammation And Neurodegeneration Findings In Early Stage Bipolar Disorder
Inflammation And Neurodegeneration Findings In Early Stage Bipolar Disorder
 
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...
OBESITY AND OBSTETRIC COMPLICATIONS ARE ASSOCIATED WITH RAPID-CYCLING IN ITAL...
 
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...Thyroid Profile and its Relationship with Response to Treatment with Lithium ...
Thyroid Profile and its Relationship with Response to Treatment with Lithium ...
 
Analysis of genome-wide association studies uncovers genetic loci shared betw...
Analysis of genome-wide association studies uncovers genetic loci shared betw...Analysis of genome-wide association studies uncovers genetic loci shared betw...
Analysis of genome-wide association studies uncovers genetic loci shared betw...
 
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERS
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERSGENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERS
GENETICS OF SUDs AND NEURODEVELOPMENTAL DISORDERS
 
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...The 4-Hour Window - Government targets and clinical challenges in A&E and psy...
The 4-Hour Window - Government targets and clinical challenges in A&E and psy...
 
Postictal psychosis - a complex challenge
Postictal psychosis - a complex challengePostictal psychosis - a complex challenge
Postictal psychosis - a complex challenge
 
Profile of depression in women attending antenatal clinics in Blantyre distri...
Profile of depression in women attending antenatal clinics in Blantyre distri...Profile of depression in women attending antenatal clinics in Blantyre distri...
Profile of depression in women attending antenatal clinics in Blantyre distri...
 
Clinical Differences Between Unipolar And Bipolar Depression
Clinical Differences Between Unipolar And Bipolar DepressionClinical Differences Between Unipolar And Bipolar Depression
Clinical Differences Between Unipolar And Bipolar Depression
 

Recently uploaded

Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...
Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...
Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...Miss joya
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableNehru place Escorts
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Miss joya
 
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...narwatsonia7
 
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safenarwatsonia7
 
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune)  Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune)  Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls ServiceMiss joya
 
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...Neha Kaur
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...narwatsonia7
 
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune)  Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune)  Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls ServiceMiss joya
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...narwatsonia7
 
Call Girl Coimbatore Prisha☎️ 8250192130 Independent Escort Service Coimbatore
Call Girl Coimbatore Prisha☎️  8250192130 Independent Escort Service CoimbatoreCall Girl Coimbatore Prisha☎️  8250192130 Independent Escort Service Coimbatore
Call Girl Coimbatore Prisha☎️ 8250192130 Independent Escort Service Coimbatorenarwatsonia7
 
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patna
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service PatnaLow Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patna
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patnamakika9823
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliRewAs ALI
 

Recently uploaded (20)

Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...
Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...
Call Girls Service Pune Vaishnavi 9907093804 Short 1500 Night 6000 Best call ...
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
 
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
Low Rate Call Girls Pune Esha 9907093804 Short 1500 Night 6000 Best call girl...
 
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Servicesauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
sauth delhi call girls in Bhajanpura 🔝 9953056974 🔝 escort Service
 
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...Bangalore Call Girls Hebbal Kempapura Number 7001035870  Meetin With Bangalor...
Bangalore Call Girls Hebbal Kempapura Number 7001035870 Meetin With Bangalor...
 
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Majestic 📞 9907093804 High Profile Service 100% Safe
 
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune)  Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune)  Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
 
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
VIP Russian Call Girls in Varanasi Samaira 8250192130 Independent Escort Serv...
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
 
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune)  Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune)  Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
 
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCREscort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
Escort Service Call Girls In Sarita Vihar,, 99530°56974 Delhi NCR
 
Call Girl Coimbatore Prisha☎️ 8250192130 Independent Escort Service Coimbatore
Call Girl Coimbatore Prisha☎️  8250192130 Independent Escort Service CoimbatoreCall Girl Coimbatore Prisha☎️  8250192130 Independent Escort Service Coimbatore
Call Girl Coimbatore Prisha☎️ 8250192130 Independent Escort Service Coimbatore
 
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patna
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service PatnaLow Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patna
Low Rate Call Girls Patna Anika 8250192130 Independent Escort Service Patna
 
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ludhiana Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Darjeeling Just Call 9907093804 Top Class Call Girl Service Available
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas Ali
 

Can Positive Community Practice Models Help Prevent Abuse?