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Background: Research suggests that people with intellectual disabilities have a higher risk for cardiovascular disease than the general population. The aim of this study was to identify barriers for the prevention, diagnosis, and treatment of cardiovascular disease for people with intellectual disabilities. Method: We conducted individual interviews with relatives and general practitioners and focus group interviews with staff working at an assisted home facility, a cardiac ward, an obesity clinic and two rehabilitation centres (n = 33) in Norway. Inductive approach and thematic analysis were used to analyse the data. Results: We identified barriers on an individual and a structural level. The underlying reason for these barriers is that health problems, such as cardiovascular disease, are regularly overlooked as the condition of intellectual disability "overshadows" other possible diagnoses. Conclusion: This focus on intellectual disability rather than other explanations leads to shortcomings in the prevention, diagnoses, and treatment of cardiovascular disease in this group.

Background: People with intellectual disabilities commonly experience multiple barriers to 'going out'. Aims: This paper explores what barriers prevented people from going out, and if the extent and nature of going out changed over time for people with intellectual disabilities as the COVID-19 pandemic progressed. Methods: Data are drawn from a wider study that explored, at four time points, the experiences of people with intellectual disabilities through the COVID-19 pandemic in the United Kingdom. Findings: The number of people leaving the house for almost all reasons increased over time through the pandemic, except for some outdoor participation and exercise. However, there was a significant decrease in outdoor exercise at the final time point of the study. Reliance on other people and a lack of availability of support were identified as barriers. Conclusion: A combination of factors restricted the extent to which people were going out even after COVID-19 protections were lifted.

Background: People with intellectual disabilities are rarely involved in research on quality of life. The study sought to answer the question: what do people with intellectual disabilities believe improves or hinders their quality of life? Method: Using an inclusive, accessible research design, 18 participants met in small groups to answer the study's question using their choice of arts-based media. Participants completed the analysis collaboratively, identifying key themes among their responses. Results: The participants concluded that supports, well-being, hobbies, and activities contribute to quality of life. Lack of accessibility, assumptions, negative behaviours, stress, and negative people (staff, roommates, people in general) were identified as detractors of quality of life. Conclusions: To continue to make progress in improving the quality of life of individuals with intellectual disabilities, the voice of those with intellectual disabilities is key. The results suggest key areas of focus to make these improvements.

Background: Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care. Method: Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire. Results: Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions. Conclusions: The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.

Background: Little is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self-manage their health in between AHCs, and what support they receive. This research aimed to explore this. Methods: People with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross-sectional thematic analysis was undertaken. Results: Five main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self-management of health, the personal context, and addressing health inequities. Four main themes emerged from follow-up interviews: follow-up, supporting the self-management of health, the need for reasonably adjusted health services, and going for another health check. Conclusion: A broader system of support around the AHC is required if people are to achieve or maintain the best possible health.

Background: Despite growing recognition of their right for inclusion in society, people with intellectual disabilities are often excluded from mainstream services, or experience poor service outcomes. Method: Taking a relational approach that considers the interpersonal relations and interactions that occur in mainstream service settings in Australia, this paper examines the features of services that research participants considered more inclusive. Results: Relations between service users with and without intellectual disabilities, mainstream service staff and disability support workers in inclusive mainstream services were characterised by; respect; warm, welcoming and convivial interpersonal engagement; active listening; proactive assistance; flexibility; mediation to create a safe environment; and collaboration and shared responsibility by both mainstream staff and disability support workers in supporting a service user with intellectual disability. Conclusions: Building on these results, we put forward a set of principles for facilitating inclusion of people with intellectual disabilities in mainstream services.

Background: People with intellectual disabilities (ID) experience many health and social inequalities. Increasing physical activity is a proven intervention to address such inequalities, yet the physical activity rates of this population are substantially lower than the general population. Aim: Research has been growing to understand why this is and how to intervene to increase the physical activity levels of people with ID. Method: Using a behavioural epidemiological framework, the research in this area from barriers and facilitators of physical activity to translational research testing interventions within natural settings is reviewed. Findings from a total of 14 reviews and eight empirical studies and protocols were included. Results: Whilst there are multiple investigations into what promotes or enhances physical activity for people with ID, findings from intervention studies show few successful outcomes. Gaps within the existing research are identified and recommendations about how intervention efficacy might be improved are provided to inform future research and practice. Conclusion: Findings from previous research on barriers and facilitators can be further capitalised on and intervention studies should be underpinned by better links to theory and more systemic approaches.

Background: People with intellectual disabilities (IDs) and their caregivers face difficulties during the COVID-19 pandemic. However, limited studies have comprehensively investigated their challenges, especially in Japan. We aimed to clarify the concerns and needs of people with IDs and their caregivers during the COVID-19 pandemic in Japan. Method: From March to August 2021, 27 in-depth interviews were conducted with principal caregivers of people with moderate to profound IDs in Japan. We then transcribed the interviews and conducted deductive coding using predetermined codes focused on their daily life difficulties. Inductive coding was used to ensure that no important themes were overlooked. Results: We found four concerns and four needs among people with IDs and their caregivers as significant themes. Conclusions: Our results provide useful information for supporting people with IDs and their caregivers, especially among those who need medical or social care in accordance with the infection control and social-distancing policies.

Background: People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. Method: This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. Results: Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. Conclusions: The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.

Background: This study explores the perceptions of supported accommodation staff and their managers of the support needs of residents ageing with intellectual disabilities, and their experiences of adjusting services for this group in the context of individualised funding. Method: Qualitative interviews were conducted with 21 staff working in Australian supported accommodation services. Findings: Four themes emerged. The first captured the staff's limited understanding of ageing and the medicalisation of support needs. The second identified staff practices and adjustments to service provision to facilitate residents' healthy ageing. The third described staff commitment to facilitating ageing residents to age in place, and the fourth identified staff challenges and opportunities in supporting ageing residents in the context of the National Disability Insurance Scheme (NDIS). Conclusions: Findings may inform the development of practice guidelines and training for supported accommodation staff, protocols for intersections between disability, aged care and health sectors, and adequate policy responses to support older residents' healthy ageing.

The COVID-19 pandemic has had significant consequences for all areas of human life. This particularly applies to people with intellectual disability (ID) whose functioning and living environment are associated with many specific risk factors. The review is to determine what difficulties and changes in the psychosocial functioning of people with ID have been brought about by the COVID-19 pandemic and what factors may be important in dealing with them. Twenty studies focused on the experiences of people with ID during the COVID-19 pandemic were analyzed. All of these were qualitative (n = 16) and mixed-method studies (n = 4). The COVID-19 pandemic has caused significant changes in the lives of people with ID, mainly in the organization of support and services. This has had important consequences for their psychosocial functioning. There has been a decrease in competencies and social integration, and an increase in difficult behaviors and mental problems. The challenges related to the COVID-19 pandemic have also resulted in positive changes: people with ID have developed technology skills and personality traits such as responsibility for themselves and others. People with ID have mastered safety habits to a varying degree. It is important to support them in the time of the COVID-19 pandemic, maintaining a balance between protecting them from risk and ensuring their autonomy.

Spanish universities still face many barriers to the training of people with disabilities, especially with intellectual disabilities (ID). In general, continuing higher education courses are the main training response for the latter. Knowing the impact that confinement by COVID-19 has had on the students of these courses is a relevant element. The present investigation focused on analyzing the case of the confinement experience of 12 young students with ID who attended the continuing training program called Unidiversidad at the University of Alcalá (Spain). In particular, the implications on their emotional well-being, interpersonal relationships, and individual training were analyzed. Information was collected through a semi-structured interview with the students and a questionnaire with their relatives. The results reflect changes in emotional well-being linked to the increased concern of students for the health of their families. Interpersonal relationships were also affected, although participants tried to compensate for the lack of face-to-face interaction with instant messaging applications and video calls. The change in training to the online modality generated concern and uncertainty in students, although it also provided learning opportunities, which have been supported by peer tutoring and support from teachers.

Access to equal healthcare is a priority for people with intellectual disabilities. Most studies have focused on primary care providers; however, the administration of inclusive healthcare also relies on medical specialists, who should be considered a specific group because their practice varies significantly in this regard. Semi-directive interviews were conducted with 12 medical specialists to explore their representations regarding the care of people with intellectual disabilities. An inductive thematic analysis was applied to the data. The results highlighted a significant heterogeneity between practitioners' representations of people with intellectual disabilities in healthcare, current practices, and their perceptions and expectations in the process of ensuring quality care. This study highlights the importance of considering medical specialists' awareness raising and training to handle consultations with people with intellectual disabilities. From a broader perspective, a clear political framework to guide healthcare practices at the national level should be developed.

Background: Government restrictions enforced globally in response to COVID-19 necessitated changes to the delivery of mental health services, with many psychology professionals (PPs) forced to transfer their face-to-face practice to virtual means (telephone/video therapy) overnight. This review explores what is known about the experiences of PPs providing psychological support to people with intellectual disabilities (PWID) during the pandemic. Method: Literature was systematically searched and 11 papers were identified, critically appraised and thematically synthesised. Results: Four themes were synthesised from findings: (1) 'Impact at Service Level', (2) 'The Emotional Impact on PPs', (3) 'The Limitations of Virtual Support', (4) 'Unexpected Gains'. Conclusions: This review highlights the challenges and positives in experiences of PPs, whilst acknowledging the inequalities experienced by PWID. It is hoped that the findings can be used to aid education and training, and inform future practice and policy. Future research is recommended.

Background: There is a need for online learning programmes to be accessible for students with intellectual disabilities. Online learning has become an important means of continuing educational activities during the COVID-19 pandemic. Students with intellectual disabilities need to have access to online learning programmes that are suitable for non-readers and those with different literacy levels. Methods: This study looked at The My Blossom Channel online learning assertiveness course and assessed the perceived increase in levels of confidence for 51 students with an intellectual disabilty. Pre and post programme self and support person reports were analysed for all the students along with direct observation data collected by the course facilitators. Findings: The results indicate that increased levels of assertiveness were shown for participants who completed the course. Both the young person and their support person reported the experience was overall very positive and generalisation of some the skills to other settings were noted. Conclusion: The model of online learning outlined in this paper demonstrates an example of an accessible online learning model for people with intellectual disabilities. A number of factors were shown to be important in the success of this model including, role-play activities, modelling, scenarios, debate, immediate feedback, and peer interaction which emphasises praise and encouragement.

The inclusion of people with disabilities, intellectual in the case that concerns this research, has been one of the main concerns of society in recent years. The University of Murcia has launched the "We are all Campus" program in order to facilitate the inclusion of this group from a training perspective. Being aware of the influence of self-concept in such inclusion, this research aims to analyze the influence of the self-concept of people with intellectual disabilities in their expectations of inclusion. For this purpose, 18 subjects were asked to carry out a SWOT analysis, assessing the situation in which they find themselves through a qualitative perspective and a phenomenological design. The research reveals, among other conclusions, how important personal development is to them, especially by generating autonomy in their daily routines, and also the relevance of their relationships to feel socially included.

Background: People with intellectual disabilities can be exposed to sexual abuse and they can display harmful sexual behaviour. This study aimed to identify barriers to preventing harmful sexual behaviour in people with intellectual disabilities within the support sector and the justice system. Method: We conducted focus group interviews with 20 participants from hospital-based habilitation centres, community residences, schools and the criminal justice system. Results: The interviews identified a lack of education and guidelines for stakeholders or carers on regulating the sexual behaviour of people with intellectual disabilities. The criminal justice system faces challenges related to prioritising, understanding and communicating. People with intellectual disabilities may lack an understanding of the concepts of sexual consent and acceptable sexual behaviour. Conclusion: There is a need to improve knowledge about intellectual disability and how to prevent harmful sexual behaviour for professional caregivers in the support sector and the criminal justice system.

Background: This study reports the findings from a Dutch study, exploring care workers' challenges and approaches in guiding young people with intellectual disabilities in their online lives. Method: Using an inductive research design 33 semi-structured interviews were conducted with care workers. Results: Care workers report challenges that revolve around three themes: (1) the perceived intangibility of the online lives of clients and (2) Risk perception: feeling stuck between control and freedom. (3) Differences in guiding approach between care workers. Based on these results a conceptual model is presented that aims to show the connection between these challenges and guiding approaches. Conclusion: Perceptional processes may influence care workers' guiding approaches. This raises important questions about the implications of these guiding approaches on the level of support clients with intellectual disabilities receive and the effectuation of their rights and liberties under the 2006 United Nations (UN) Convention on the Rights of Persons with Disabilities.

Background: This research aimed to investigate the views and experiences of specialist mental health professionals working with adults with intellectual disabilities and mental health problems in Singapore in order to gain insight into the functioning of the local specialist intellectual disability mental health service and how it may be improved. Methods: Eight staff members from specialist service were interviewed. The transcriptions of the interviews were analysed using thematic analysis. Results: Analysis revealed four themes (1) Identifying their roles; (2) Ensuring continuity of care; (3) Disempowerment of service users and (4) Improving clinical practice. Conclusions: Participants identified the challenges they faced working with this population. They highlighted the importance of building therapeutic relationships during the treatment process and discussed the stigma that people with intellectual disabilities face in the community. Recommendations and implications are discussed in relation to service provision, improving staff knowledge and recruiting more staff to work in this field.

Background: Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. Method: A focus group interview model was used, with a semi-structured interview guide initiating group discussions. A thematic analysis methodological approach was selected to analyse the data. Results: This paper reports on the theme of Service Delivery, which has three sub-themes of Availability; Distance; and Individual Access. The key findings are presented and supported by the use of exemplar quotes. Conclusions: This research indicates a poor intersection of general and specialist services is inhibiting post-parental transitional care for rural people. Simply allocating money to the individual does not resolve the issues, and the interface between different services needs to be better considered at government level.

The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were "Residential care," "Daily activities" and "Contact person." "Home help" and "Security alarm" increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65-79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing.

Background: Staff members' views can have a significant impact on sexuality issues of people with intellectual disabilities. Research on the impact of sociocultural factors in this area in the Chinese context is sparse. Methods: Semi-structured interviews were conducted with seven professionals (social worker, nurse, life skills trainer and manager) to explore their experiences of and attitudes towards the sexual needs of people with intellectual disabilities by applying interpretative phenomenological analysis. Results: The study identified two major themes, each with two sub-themes: 1. Professional handling of the sexual needs of people with intellectual disabilities (sex education and intervention); 2. Barriers (incompatible approaches and parental resistance). Participants also experienced feelings of resignation facing the barriers they encountered. Collectivism and cultural view about sex are potentially the influencing factors. Conclusion: This study highlights the need to adopt an evidence-based sex education programme whose content and delivery should take account of cultural factors.

Literature pertaining to open disclosure predominantly refers to acute care settings; this is the case in, for example, the UK, Republic of Ireland, Australia, Korea and the USA. There is, however, a dearth of literature regarding open disclosure related to people with intellectual disabilities. A practice example of open disclosure is presented here, following a serious adverse event in an organisation supporting adults with intellectual disabilities. The aim of the process was to openly disclose in a meaningful way to adults with significant intellectual disabilities and communication difficulties. An apology pathway was developed by a multidisciplinary team based on individual communication needs. A suite of resources was developed including easy read-picture agendas and sign language to support increased understanding of the apology. Service users received the apology first, followed by meetings with their families. This practice example has positive implications for service providers for people with intellectual disabilities.

Ghana has designated special schools with the mandate of training and equipping persons with intellectual disabilities with social functioning and vocational skills needed to promote their social inclusion. This study investigates the nature and extent of healthcare provision for persons with intellectual disabilities in their respective special schools. This research adopted a qualitative, but participatory approach to collect data from respective stakeholders. The findings reveal that some of these special schools do not have professional health workers, and most healthcare providers have challenges diagnosing and prescribing medication for this population due to the health workers' limited understanding of their healthcare needs, coupled with communication barriers. The researchers have suggested setting up of a special health department with personnel who have received training on intellectual disabilities. This department must undertake training for the housemothers in special schools, parents in the communities, and teachers in special schools.

Background: Sexual health remains at risk for people with an intellectual disability. Attitudes towards sexuality, its support and education have an important role in promoting sexual health. The current review aims to provide an overview of the current research on supportive and restrictive attitudes towards sexuality and its support of people with intellectual disabilities themselves. Method: A systematic review was conducted, searching across eight databases. The quality of the studies was assessed with the Mixed-Method Appraisal Tool. Results: Six themes emerged from the data: sexual behaviour, sexual identity, intimate relationships, barriers to sexual expression, sex education and support by caregivers. Supportive and restrictive attitudes were reported throughout. Conclusions: Attitudes regarding sexuality of people with intellectual disabilities are heterogeneous and people with intellectual disabilities seem to be able to express their sexual desires, needs and attitudes. Findings allow for improved individual support and in-depth research questions.

Background: During the initial phase of the COVID-19 pandemic, many people with disabilities living in home care facilities could not receive visitors. The use of virtual social contact has been recommended by health authorities. This systematic review examined the scientific evidence of the use and feasibility of information and communication technology (ICT) for social contact by people with intellectual disabilities living in care facilities, and potential effects on well-being. Methods: Five databases were searched using traditional systematic screening and machine-learning supported screening. Findings are presented in a narrative synthesis using thematic analysis. Results: Nine studies were included. We described three themes: means of ICT used for social contact; effects on well-being; and benefits, barriers, and preconditions. Conclusions: Engaging in virtual social contact may be feasible for people with severe to mild intellectual disabilities, but there is little concrete evidence that this can be used as an alternative for in-person contact.

Background: Microenterprises are very small businesses requiring little capital and can be an employment pathway for people with intellectual disabilities. This systematic review aims to identify the facilitators, barriers and outcomes from microenterprise. Method: Web of Science, Scopus, EconLit, PsycINFO and ProQuest were searched to identify peer-reviewed studies on microenterprises owned by people with intellectual disability published up to and including 1 October 2019. Results: A total of 1080 papers were independently screened by two reviewers. Six papers met the inclusion criteria. Barriers included lack of access to business expertise and resources, and the tension between growing microenterprises and maintaining eligibility for welfare payments. Formal and informal supports were key facilitators. Outcomes experienced included additional income, skills development, increased confidence and engagement in meaningful activities. Conclusion: Additional research is required to develop an evidence base which may support investment in this employment pathway, making microenterprise more accessible to people with intellectual disabilities.

Background: Interactions with professional caregivers affect the quality of support and life of people with intellectual disabilities and contribute to the occurrence of challenging behaviour. The present literature review provides an overview of factors facilitating or hindering meaningful staff-client interactions in people with borderline to profound intellectual disabilities and challenging behaviour. Method: Database searches, reference list and citation screening, and expert consultations were undertaken. A thematic synthesis of 28 studies was performed. Results: Factors were identified at the client (i.e. behaviour, emotions and (dis)abilities), staff (i.e. interactive principles, knowledge, psychological resources, attributions, attitudes and (coping with) emotions) and context levels (i.e. group size, team and organization). Conclusions: The present overview provides insights into factors that facilitate or hinder meaningful staff-client interactions with people with intellectual disabilities and challenging behaviour. The results support the need to combine client, staff and contextual factors when considering staff-client interactions in research and practice.

Background: People with intellectual disabilities can experience homelessness, and some of the reasons differ from the general homeless population. Specific policy and practice responses are required. Method: A systematic review of studies examining homelessness among people with intellectual disabilities utilizing CINAHL, MEDLINE, PsycINFO and Sociological Abstracts databases from inception to November 2019. Results: The search produced 259 papers, and following screening, a total of 13 papers were included in the review. The themes identified were (i) pathways into homelessness, (ii) experiencing homelessness and (iii) routes out of homelessness. Conclusions: People with ID become homeless due to multifactorial issues. The identification of people within homeless services and their care and support concerns remains challenging, impacting upon the provision of assessments, interventions, care and supports. Psychosocial assessments, interventions and supports are necessary to assist people with ID to leave homelessness.

Background: The present study aimed to explore the experiences and needs of direct support staff during the initial stage of the COVID-19 lockdown in the Netherlands. Method: Overall, eleven direct support staff were recruited from five intellectual disability services to participate in this descriptive qualitative study. They recorded 34 audio messages during the considered period. Thematic analysis was used to analyse these audio recordings. Results: Four themes emerged: (1) Emotional impact, which pertained to various emotions they experienced in their work; (2) Cognitive impact, which referred to challenges and changes they had undergone in their work; (3) Practical impact, which centred on the practical impact of the pandemic on their work; and (4) Professional impact, which concerned their experiences with other professionals. Conclusions: This study provides valuable insights into the experiences and needs of direct support staff during the COVID-19 pandemic, which, in turn, can help inform practice in preparation for a second wave of COVID-19 or another future pandemic.

This study examines perceptions and understandings of self-determination in the context of relationships between people with intellectual disabilities and social care professionals. We held focus group discussions to explore the views and experiences of 10 residents and 10 professionals at three facilities for people with intellectual disabilities located in Western Switzerland. Participants perceived and understood self-determination in terms of decision-making, social skills, procedures, identity, self-consciousness, autonomy, freedom, barriers, and facilitators. The research process highlighted the shifting and situational nature of the concept, as well as the importance of self-determination for people with intellectual disabilities. The findings also highlight the importance of discussion and reflection on the concept of self-determination and its benefits for people with intellectual disabilities.

Full and equal access to sex education for all citizens is ensured by international legal acts. Research shows, however, that people with intellectual disabilities (ID) receive neither support in understanding their sexual rights, nor access to sex education tailored to their needs. Sex education classes at a special school in Poland are not compulsory for students with ID, therefore they can be omitted from the curriculum. The research aims to learn the state of knowledge about human sexuality and to analyse the needs, barriers, and expectations of adult students with ID as regards their sex education. The methodology used included a qualitative approach (Participatory Action Research) using group interviews (FGI) with 24 ID students ages 18-24. The results of the study indicate that students taking part in the study possess fragmentary and incomplete knowledge about sexuality. They listed TV, the Internet, and friends as sources of information, leaving out school (teachers) and parents. However, their interest and willingness to talk was very high. A didactic tool for sex education was designed together with the student and is being used in schools.

Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.

This study aims to explore the psychosocial experiences of the ageing of middle-aged people with intellectual disabilities in Korea. Data were collected through 28 face-to-face interviews with Korean individuals with intellectual disabilities, aged between 40 and 50. This study identified several key factors faced by middle-aged people with intellectual disabilities. First, they experience financial constraints due to a lack of economic self-determination. Second, they have a very narrow range of social connections. Typically, they have small and weak networks consisting of only a few social workers, personal assistants, or group home workers, or their peers at group home or workshops. This is often due to a lack of information, money, and age-appropriate services. Third, those who have jobs in middle age have positive opportunities acquired through work. Fourth, study participants experienced considerable unspecified anxiety about ageing, as well as fear of death and uncertainty regarding the future. Recommendations are made to improve active ageing in an appropriate setting for middle-aged people with intellectual disabilities. Improved training and education about economic self-determination are needed for these individuals and their families, as well as improved information about community services. Moreover, enhanced community services for them must be developed. These individuals would benefit from improved employment opportunities as well. Workshops regarding active ageing and death should be developed. Finally, future plans for living placement must be in place.

Background: People with from minority ethnic communities face inequalities in health and health care. This systematic review considers the question of what we know about the health and health care of children and adults with intellectual disabilities from ethnic minority communities in the UK. Method: Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes. Results: Twenty-three studies were identified, most commonly focusing on South Asian communities. Very little information was identified on physical health or physical health care, with the identified evidence tending to focus on mental health care, access to specialist intellectual disability services, and inpatient services. Conclusion: Little is known about the health status of people with intellectual disabilities from minority ethnic groups in the UK. It is clear that they may experience barriers to accessing specialist intellectual disability services and other forms of health care.

Background: People with intellectual disabilities in staffed group homes often need lifelong support and dependency on others. Thereby, special demands are placed on staff and service managers to ensure opportunities for participation in everyday life. This study aims to explore how service managers promote participation in Swedish group homes for adults with intellectual disabilities. Method: A qualitative research design involving individual interviews with 14 service managers was used to gain an understanding of how the participation of adults with intellectual disabilities can be promoted in Swedish group homes. Results: The results comprise two main themes; Creating preconditions for participation and Barriers for promotion of participation. Conclusions: Service managers experienced that promoting service user participation in group homes was an important part of their responsibility. The findings indicate that structural strategies such as coaching, supervision and reflection are important and should be further developed.

The Convention on the Rights of Persons with Disabilities recognises the right to independent living. Given the lack of studies carried out in Spain, the aim of this research is to explore the barriers and supports that people with intellectual disability (ID) themselves believe affect their exercising of this right. To this end, an in-depth individual interview was designed and administered to 22 people with ID following various personal pathways. Thematic data analysis was conducted. According to the results, people with ID have highlighted the barriers and supports in different areas of their lives that affect their opportunities to exercise control over their lives, live and participate in ordinary and inclusive spaces within the community. In conclusion, this study helps to identify areas for improvement that are key to exercise the right to independent living.

Background: People with intellectual disability experience higher rates of mental health disorders than the rest of the population, and expert opinion holds that multiple barriers prevent people with intellectual disability from accessing appropriate services. Methods: A qualitative study was designed to explore the lived experience of barriers and enablers to access to mental health services among people with intellectual disability. Interviews and focus groups were conducted with people with intellectual disability, carers and service providers. Results: Barriers and enablers were identified across four key dimensions of access--utilization of services, service availability, relevance, effectiveness and access, and equity and access. These factors operated at both systemic and personal levels. Conclusions: The findings from this study provide empirical evidence of anecdotal experiences of access to mental health services and provide insight into the ways users, carers and service providers navigate an often hostile system and indicate further directions for research.

During the COVID-19 pandemic, many people with intellectual disabilities living in care facilities could not receive visitors. Health authorities suggested the use of digital social contact as an alternative for in-person visits. We examined how people with intellectual disabilities living in care facilities experienced the use of digital social contact with their informal social network throughout 2020. Residents, their relatives, volunteer visitors, direct support staff, and care facility managers (N = 283) completed an online questionnaire, of whom 35 participated in an interview. Video calling and in-person visits were among the most common forms of staying in touch. Experiences with digital social contact depended on residents' abilities and support needs, and on preconditions, such as staff availability. The first phases of the pandemic led to experiences of possibilities and benefits of using digital social contact as complementary to in-person contact for people with different levels of intellectual disability, also after the pandemic.

Background: A policy commitment to social inclusion has brought about some positive changes in the lives of people with intellectual disabilities; yet many also continue to experience social isolation, poverty and abuse. The authors introduce a framework for belonging from the literature and then present a study exploring the views of people with intellectual disabilities about belonging. These are discussed in relation to the framework identified from the literature. Method: Three focus groups with 24 participants with intellectual disabilities were conducted in New South Wales and Victoria (Australia). The authors used inductive content analysis to identify four meanings of belonging: (i) belonging in relation to place, (ii) as being part of a community, (iii) as having relationships and (iv) as identity. Also discussed are commonly experienced barriers to belonging identified by participants. Conclusions: Implications for policy, service provision and practice are discussed.

Background: The World Health Organisation has launched a programme to promote Global Cooperation on Assistive Technology. Its aim is to increase access to high-quality affordable assistive products (AP) for everybody in need. People with intellectual disabilities (ID) are a specific group that could benefit from AP, but use less AP compared to their non-intellectual disabled peers. Method: A systematic literature search was carried out to identify barriers and potential facilitators for access to AP for people with ID globally. The search strategy terms were 'Intellectual Disability' and 'Assistive Technology' with the following electronic literature databases PubMed, Embase, ASSIA, Web of Science, Medline, CINAHL complete, PsycInfo, Scopus and ERIC. The quality and relevance of the studies were assessed. Factors associated with access were identified thematically, categorised into barriers and facilitators and mapped into themes. Results: In all, 22 key studies were retrieved, describing 77 barriers and 56 facilitators. The most frequently reported barriers were related to lack of funding and cost of AP, lack of awareness about AP and inadequate assessment. An increase of knowledge and awareness about AP and the need of AP for people with ID were most often extracted as factors that could potentially facilitate access. Conclusions: This review proposes actions linked to the barriers and facilitators that have a particular importance for people with ID to access AP. Yet, only limited research is available describing factors that influence access to AP for people with ID in low and middle income countries and rural areas.

Background: The health-related behaviours of people with intellectual disabilities may be determined by organisational influences. This innovative study aimed to explore managers' and staffs' perspectives on organisational influences on the promotion of healthy behaviours for this population. Method: A qualitative methodology was employed. Four focus groups with staff and eleven telephone interviews with managers were undertaken across three residential services in one region (Northern Ireland) of the UK. Transcripts were analysed thematically. Findings: The organisations involved in this study did not have the cultural ethos or capacity to sustain consistent support for staff involvement in health promotion. Organisational support and outcome-focused strategies are recommended for encouraging staff involvement in health promotion activities. Conclusion: These findings have implications for some organisations that support people with intellectual disabilities in improving the way they facilitate health promotion. They highlight the need for organisational cultures to facilitate knowledge translation and embrace evidence-based health promotion interventions.

Background: Many people with intellectual disabilities are affected by death, yet conversations about death are often avoided by staff working with them. This study aimed to assess staff training needs and to develop, trial and evaluate a training course on communicating about death and dying. Method:(i) Semi-structured interviews with 20 staff in residential/supported living services to establish training needs; (ii) three-one-day courses were attended by 114 staff and evaluated through questionnaires. The course consisted of World Café sessions, presentations and feedback by people with intellectual disabilities, and an expert teaching session. Results: Staff fear, cultural influences and inexperience with death-related conversations were major communication barriers. Evaluation of the course was overwhelmingly positive. Conclusions: Intellectual disabilities services must have clear staff training strategies around death, dying and communication. More work is needed to assess the resource implications and impact on practice of different training methods and other support strategies.

Background: Despite experiencing health inequalities, people with intellectual disabilities are under-represented in health research. Previous research has identified barriers but has typically focused on under-recruitment to specific studies. This study aimed to explore care staff's attitudes to health research involving people with intellectual disabilities, identify barriers to conducting such research and consider solutions to those barriers. Materials and Methods: Eight members of care sector staff took part in a focus group or telephone interview, to explore their views on health research involving people with intellectual disabilities. The transcriptions were analysed using thematic analysis; 50% were double-coded, and the emerging themes were agreed by three researchers. Results: Three themes were identified: perceptions of research; barriers to conducting research; solutions to maximise recruitment and project success. Benefits to research were identified, but there were concerns that the time and effort required may outweigh these benefits. Barriers were identified including organisational policy and following the Mental Capacity Act 2005. There was some indication that such barriers may differ according to the severity of intellectual disabilities and the type of care setting. Solutions were proposed that involved greater collaboration between researchers and the care sector, and a more flexible approach to research. Conclusions: Care staff are largely supportive of research that is appropriate and relevant to their service users. However, there is a need for clear communication from researchers and flexible recruitment and data collection strategies. This is likely to be facilitated by closer collaboration between researchers and the social care sector.

Background: The prevalence of obesity, inactivity and related morbidity and mortality is higher amongst people with intellectual disabilities than in the population in general, an issue of global concern. This research examined the perspectives of people with intellectual disabilities and their carers, on exercise and activity. Materials and Methods: Qualitative data were collected via interviews and a focus group with people with intellectual disabilities and their paid and family carers, recruited via state-funded community-based day centres in Scotland. Results: Three barriers hindered service users with intellectual disabilities from regular involvement in physical activity: (i) acceptance of an inactive lifestyle by carers; (ii) restrictions on activity due to paid carer preferences and resource limitations; (iii) communication issues between family carers and paid carers. Barriers were based on assumptions made by paid and family carers, so there is potential to increase activity by changing attitudes, improving communication and reconceptualising activity as integral to everyday living, rather than as additional exercise requiring special resources. Conclusions: Carers should be supported to promote physical activity in a variety of ways to enhance the motivation of service users, to encourage them to engage with physical activity as an integral part of a healthy lifestyle and to transfer this to their lives beyond day care.

This research aims to present proposals that can improve the transition to adulthood of young people with intellectual disabilities (ID). Four focus groups were set up in three different cities in Spain, each comprising education and social work professionals, people with ID and family members. In total, 32 participants were included in the study. The discussions were recorded, transcribed and analysed using thematic content analysis. Improvements proposed by participants were organised into six themes: coordination between services and professionals; curricular approaches; participation by young people with ID; peer-relationship networks; family and administration. Participants highlighted the need to make the curriculum more flexible and foster curricular experiences related to social and workplace inclusion, as well as establish more continuity in guidance processes throughout the different stages of education and especially at the end of secondary education. Participants also suggested the need for young people with ID to have a more prominent role in their educational process, and strengthening their social networks by promoting their participation in community activities.

Introduction: Solution-focused brief therapy (SFBT) has a growing evidence base and several authors have recognized the advantages of applying this approach with people with intellectual disabilities (ID). The purpose of this review is to summarize and critique the literature that has used solution-focused (SF) approaches in ID, and consider future directions. Methods: A literature review was carried out, identifying 12 studies; six with individuals, and six with staff and families. Results: There is preliminary evidence for the effectiveness of SFBT for individuals with mild ID and Solution-Focused Coaching or Consultation (SFC) for staff working with individuals with moderate and severe ID. However, the current evidence base consists primarily of case studies. Recommended adaptations include shortened scales and more concrete approaches to eliciting exception-seeking. Conclusions: Solution-focused techniques should be modified to accommodate the cognitive abilities of people with ID and carers should be involved in sessions where possible. There is a need for further controlled studies, with valid and reliable outcome measures, larger samples, and longitudinal data.

Background: People with intellectual disabilities (ID) should be able to access the Improving Access to Psychological Therapies (IAPT) programme, currently a main provider of mainstream mental health services in England. IAPT offer cognitive behavioural therapy (CBT) to individuals experiencing mental health problems, although its effectiveness for people with ID, when delivered within IAPT, is unclear. Method: Ten high-intensity therapists took part in semi-structured interviews, analysed using thematic analysis, regarding their experiences of delivering CBT to people with ID in IAPT. Results: The rigidity of the IAPT model appears to offer a poor fit with the needs of people with ID. Therapists appeared uncertain about how to modify CBT and highlighted training and service development needs. Conclusions: Findings suggest barriers to accessing IAPT largely remain unaddressed where people with ID are concerned. Services may need to reconsider what constitutes appropriate reasonable adjustments to ensure equitable access.

Background: There is a lack of health promotion programming designed to change the physical activity environment of the group home setting. The Menu-Choice programme assists staff in creating physical activity goals alongside residents with intellectual disabilities and provides strategies to incorporate activity into the group home schedule. The purpose of this study was to complete a process evaluation of Menu-Choice utilizing qualitative methods. Methods: Twelve participants, who completed a 10-week pilot intervention (n = 7 staff, mean age 42; n = 5 residents, mean age 52), participated in face-to-face interviews. Participants represented five group home sites involved in the intervention. Results: Meta-themes included: (i) Programme training, (ii) Programme implementation, (iii) Programme physical activity, (iv) Programme barriers, (v) Programme facilitators and (vi) Programme feedback. Conclusions: Changes in programme training and simplified programme materials are needed to accommodate identified barriers for implementation. The importance of obtaining increased agency support and policy change is highlighted.

Services available for people with disabilities in Bolivia tend to be fragmented and costly. Children and adults with intellectual disabilities are more likely to have a related communication disability and are thus both literally and metaphorically excluded from having a voice. The following research aimed to explore the experiences of accessing services by people with communication disabilities in Bolivia through semi-structured interviews and one focus group carried out with family members, professionals, service providers, educators and policymakers. It aimed to establish the nature of current services in Bolivia where knowledge, information and resources are scarce. Findings indicated the need to consider an alternative to a medical model approach through a focus on empowering other stakeholders to participate more fully in meeting communication support needs. Conclusions plot ideas for future service delivery and emphasize the central power of sharing practical and expert knowledge.