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Purpose: This paper aims to outline the initial pilot use of the client complexity matrix (CCM), an outcome measure developed for an NHS Adult Intellectual Disabilities Intensive Support Team (IST) in the West Midlands of England. Design/methodology/approach: A mixed method approach was used to report the results and evaluate the use of the CCM within this IST. The CCM was trialled for six months between January 2022 and June 2022. CCM scores pre and post IST intervention were analysed via t-test, and qualitative feedback from clinicians is detailed. Findings: Analysis suggests the CCM captures service success showing a significant decrease in complexity and risk post-intervention. Qualitative comments from clinicians were generally positive; however, there were requested changes regarding specific presentations, use of labels/language and for a digital version. Research limitations/implications: The tool is not co-constructed with the client. Because of this IST's caseload, the sample size was small. Only one clinician was asked to complete the CCM pre and post intervention. Future use of the measure will encourage two clinicians to complete the measure to evidence its inter-rater reliability. Each client's specific presentation was not explicitly analysed here. Practical implications: The CCM will be updated using the feedback from clinicians and from the peer review process. Research that examines the generalisability of this measure to other IST services would be beneficial. Originality/value: The CCM appears to fill a gap in outcome measurements for this IST service which looks at breadth and depth of client complexity and risk. [ABSTRACT FROM AUTHOR]

Purpose: Primary care psychological interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. People with learning disabilities within IAPT have poorer key clinical outcomes than people who do not identify as having a learning disability. During the global COVID-19 pandemic remote consultations have accounted for nearly 90% of all contacts in IAPT services; this paper aims to report the effects of these on outcomes for people with learning disabilities. Design/methodology/approach: Publicly available national data from the COVID-affected period are compared to the most recent available comparison periods that are not during the COVID pandemic. Data are presented graphically. Findings: People with learning disabilities differ little from those with no disabilities on several key process and outcome variables, although their clinical recovery is very much lower than those without disabilities. People with learning disabilities appear to have been affected by the changes in service delivery in a similar way to those without learning disabilities. Originality/value: Despite the shift to predominantly remote therapy delivery, outcomes for people with learning disabilities have not been differentially affected compared to those who have no recorded disability. The potential to learn what has worked and not worked in the delivery of remote interventions for people with learning disabilities is highlighted. [ABSTRACT FROM AUTHOR]

Purpose: The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID). Design/methodology/approach: Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID. Findings: For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services. Practical implications: Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution. Originality/value: This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England. Design/methodology/approach: The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed. Findings: Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions. Originality/value: This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities. Design/methodology/approach: As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities' community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs. Findings: Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature. Originality/value: This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience.Design/methodology/approach The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed.Findings Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service.Research limitations/implications This paper summarises recent advances and research regarding mental health services for people with ID in Ireland.Practical implications The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally.Originality/value This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to provide a description of a trauma sensitive intervention for men who have committed sexual offences. The intervention aims to support men to process and make sense of their own experience of trauma before inviting them to acknowledge their role in causing harm to others. The intervention draws on compassion focussed therapy (CFT) as the overarching therapeutic modality. Design/methodology/approach: As part of a service evaluation changes in routine repeat measures completed by service users were analysed prior to joining the intervention and after 12 months of intervention. Service users were encouraged to provide regular feedback relating to their experience of the intervention at regular intervals. This feedback was collated and patterns were identified collaboratively to understand the context for assessed change in the measures. Findings: Prior to the intervention men reported high levels of shame and limited experiences of guilt (as compassion for others). Early findings indicate that men experience less shame and increased experiences of guilt after 12 months. An increase in insight into risk was also evident. Service user feedback pointed towards a more engaging therapeutic style and highlighted the importance of both a collaborative and trauma sensitive approach. Originality/value: This is the first evaluative description of forensic CFT for sexual offending. Findings offer insight into potential future directions for forensic interventions with this population. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present information on the health care system in Germany with the focus on mental health care in people with intellectual disabilities (ID).Design/methodology/approach The paper is descriptive providing an overview of the general structure of the German health care system with historical and economic background. The paper also provides further information on the general social and health care in Germany for people with ID and medical education in the field of ID is used.Findings There is a highly developed health care infrastructure in Germany but health care for people with ID is not co-ordinated or universal. Mental health care for people with ID is predominantly in in-patient services. Only in recent years, out-patient services for people with ID have been developed. There is a little emphasis in medical education on the health care needs of people with ID.Originality/value The value of this paper is its description of health care in Germany and services for people with ID. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group. Design/methodology/approach – A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served. Findings – Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research. Research limitations/implications – This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions. Practical implications – The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently. Originality/value – The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the place of medication in the management of challenging behaviour in people with intellectual disability by considering it in the context of the whole system around the person and by considering the challenges of implementing best practice guidance. Design/methodology/approach – The paper identify factors that are barriers to implementing appropriate best clinical practice guidelines (such as "Challenging behaviour: a unified approach") in relation to medication intervention. The paper explores current policy and recommendations on how to improve services for people with intellectual disability and challenging behaviour and make suggestions about how to ensure better compliance with existing guidelines and improve service delivery. Findings – Better integration of services, access to specialist interventions including applied behavioural analysis and understanding communication are all essential to reducing the use of medication, as is the need for reactive, personalised and skilled social care provision. Originality/value – The paper will help professionals and those involved in the provision of service to people with challenging behaviour to focus on areas of improvement and ensure that available resources are maximised to deliver the best outcome for them. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to give an overview of the exposure of abusive practices in services for people with intellectual disabilities, and the resulting inquiries and reports. It also aims to consider the common findings and recommendations and what difference they have made to support and services for people with intellectual disabilities whose behaviour is described as challenging. Design/methodology/approach - The paper briefly reviews the main inquiries, subsequent reports and the recommendations made. The common themes are discussed and considered in the light of the most recent Department of Health Review following the Panorama Undercover Care documentary (unpublished at the time of writing). Findings - The paper highlights the recurrent themes which persist through a series of inquiries and reports. Originality/value - The paper suggests what needs to happen to ensure that recommendations translate into action on the ground, to deliver better outcomes for individuals. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss outcomes of a service redesign, involving an Intensive Support Team (IST) for adults with learning disabilities and challenging behaviour, working in conjunction with a Community Learning Disability Service (CLDS). Design/methodology/approach: Two IST staff were physically based as "Inreach workers" within a CLDS for six months. Inreach workers provided support with existing resources and consultation for specific clients presenting with challenging behaviour. CLDS staff confidence, understanding and implementation of existing challenging behaviour resources was evaluated before and after service redesign. An online questionnaire was used to gather further data relating to experiences of the Inreach project. Findings: CLDS staff confidence, understanding and implementation of existing challenging behaviour resources increased over the six-month inreach period. Questionnaire results indicated CLDS staff found Inreach support to be beneficial, having a perceived positive impact for clients, and providing clarity on the skills and resources provided by the IST. Research limitations/implications: The long-term effects of this pilot have yet to be established. Consideration is given to how demand characteristics may have influenced CLDS responses. Practical implications: Careful consideration should be given in terms of how ISTs interface with CLDSs. ISTs may consider being based physically within CLDSs, to provide more readily accessible support. Originality/value: Providing CLDS staff with more accessible support from ISTs may increase the effective implementation of available resources for adults with learning disabilities and challenging behaviour. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.Design/methodology/approach The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual's support team who made this life changing event possible.Findings This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.Originality/value This is an original case study that has not been published previously and has been written for the sole purpose of this journal. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

Purpose -- This paper seeks to present the viewpoint of a family carer of a young man with autism. Design/methodology/approach -- The paper presents the author's views and experiences of caring for a family member with autism. It is a personal account of the impact that "autism" can have on family carers. Findings -- It is a long, arduous, lonely and silent journey that carers travel, long before any recognition comes with diagnosis. Originality/value -- The paper provides a unique insight into the day to day experiences of a family carer of a person with autism. [ABSTRACT FROM AUTHOR]

Purpose – There is significant literature to demonstrate that people with intellectual disabilities are at higher risk of premature death, however there is relatively little evidence of research carried out on risk assessment in hospital for this patient group. This paper aims to share the outcomes from a patient safety project conducted in an acute hospital by the Trust's intellectual disabilities team. Design/methodology/approach – A project structure was used, supported by the Trust patient safety team through association with the National Institute for Innovation and Improvement: leading improvement in patient safety (LIPS) programme. The aim of the project was to bring together the current evidence, to understand the risk issues for this group and develop a robust risk assessment tool that could be embedded into the care processes in acute hospitals. Findings – A six month pilot concluded that a short assessment in a familiar format was more likely to be used by nurses. Risk assessment on its own does not deliver better and safer care. It must be accompanied by a series of clear, evidence based actions that used together ensure the patients' total safety and care needs are met. This tool is used throughout the Trust and in a number of other hospitals across the eastern region. Its use has contributed to reducing length of stay and improving health outcomes. Research limitations/implications – The paper shows the need for further research and data gathering. Originality/value – This study demonstrates that risk for patients with intellectual disabilities in hospital is complex. Education is essential to underpin new assessment tools for clinical practice. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach -- The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings -- There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications -- This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications -- There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications -- An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value -- This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to investigate how service managers perceive their service prior to, and following the delivery of a cognitive-behavioural therapy (CBT) anger management group for individuals with an intellectual disability. Design/methodology/approach - Telephone interviews were conducted with seven service managers, before and after a CBT group intervention. The interviews were recorded, transcribed and analysed using thematic analysis to identify common and/or contrasting themes. Findings - Before the intervention took place managers observed a lack of consistency in how their staff dealt with challenging incidents and the serious consequences these incidents had for service users as well as staff. They spoke about the importance of multi-disciplinary working and good quality staff selection, support and training. After the group intervention managers commented on a positive "spilling-out effect" whereby the whole organisation was influenced by the intervention, a greater willingness on the part of service users to talk about their problems, and an increased confidence in the staff members who had co-facilitated the group work. Research limitations/implications - The implications of the themes raised are discussed and recommendations for further research are suggested. Originality/value - This research provides a unique contribution of managers' views and insight into how hosting a CBT group intervention impacted on their wider services. [ABSTRACT FROM AUTHOR]

Purpose – There is ongoing discussion around how to structure psychiatric services to meet the needs of people with intellectual disability and co-morbid mental illness and several different models have been suggested. With research evidence lacking, there is a lack of consensus as to the best model of service provision. This paper aims to review the current knowledge in this area and discuss the salient issues. Design/methodology/approach – This is a review article summarising the current debate. Evidence from original research is presented and combined with opinion from clinical experience. Findings – The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co-morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach. Originality/value – This article will be of benefit to clinicians working in the field of intellectual disability and mental illness, and to managers and commissioners with responsibility for providing services. It will also be useful for those new to the discipline to gain an overview of the current issues and debate within service planning for this population. [ABSTRACT FROM AUTHOR]

Purpose – This case study seeks to explore the differences between carer and professional perspectives in the assessment and treatment of a young man with intellectual disabilities, autism and mental health problems. Design/methodology/approach – The opinions and perspectives of psychiatrists involved in the care and treatment of "S" and "S"'s mother about the aetiology, course, treatment and prognosis of "S"'s condition, are explored using "explanatory models". Findings – This paper shows the similarities and the differences of opinions and perspectives about the mental health care of a person with intellectual disabilities. Originality/value – It shows how the explicit comparison of notions about a person's condition, assessment and treatment may help all involved to work together for the common ground of achieving the best outcomes for service users. [ABSTRACT FROM AUTHOR]

The aim of the project was to evaluate the short-term treatment outcomes of patients treated in a medium secure service for people with intellectual disability. A total of 138 patients, 77 discharged and 61 current inpatients, treated over a six-year period were included in the audit. Information on demographic and clinical variables was collected on a pre-designed data collection tool and analysed using appropriate statistical methods. The median length of stay for the discharged group was 2.8 years. About 90% of this group were discharged to lower levels of security and about a third went directly to community placements. None of the clinical and forensic factors examined was significantly associated with length of stay for this group. There was a 'difficult to discharge long-stay' group which had more patients with criminal sections, restriction orders, history of abuse, fire setting, personality disorders and substance misuse. However, when regression analysis was done, most of these factors were not predictive of the length of stay. Clinical diagnosis or offending behaviour categories are poor predictors of length of hospital stay, and there is a need to identify empirically derived patient clusters using a variety of clinical and forensic variables. Common datasets and multi-centre audits are needed to drive this. [ABSTRACT FROM AUTHOR]

There is over-use of psychotropic medication with people with intellectual disabilities. Many of these individuals do not have the capacity to understand and retain the relevant information about the use and effectiveness of medication. Professionals and health care practitioners need to be fully aware of the ethical and legal issues in the use and administration of psychotropic medication. [ABSTRACT FROM AUTHOR]