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Background: Research into befriending for people with intellectual disabilities is limited. This study aimed to explore the impact, mechanisms of change, and limitations of a befriending scheme for adults with intellectual disabilities and/or autism. Methods: Participants were recruited using convenience sampling. Thirteen individuals with intellectual disabilities and/or autism were interviewed and data thematically analysed. Results: Four themes were generated: 'Something fun for me'; 'A good connection'; 'Increasing independence'; and 'A life less quiet'. Befriending had direct benefits through the activities undertaken and the befriending relationships themselves being fun and reducing isolation. Befriending facilitated belonging, improved access to mainstream activities, and fostered independence by providing safety and support. The importance of shared interests and external support for the relationship was highlighted. Conclusions: Positive outcomes of befriending were found, supporting existing literature and revealing new information from the voices of participants with intellectual disabilities themselves. [ABSTRACT FROM AUTHOR]

Background: There has been extensive research into adverse childhood experiences (ACEs), however, less consideration has been given to the prevalence and impact of ACEs for staff working with people with intellectual disabilities. Method: Participants were staff employed by agencies that care for people with intellectual disabilities. An online survey collected demographic information and measures of ACEs, resilience, trauma‐informed organisational climate, burnout and secondary traumatic stress. Correlation, regression, mediation and moderation analyses were used. Results: 81.7% of 109 participants had experienced at least one ACE. Burnout, secondary traumatic stress and resilience were greater in the present study than in comparable samples. Trauma‐informed organisational climate significantly predicted burnout and secondary traumatic stress. Resilience significantly predicted burnout. Conclusions: Staff working with people with intellectual disabilities are likely to have experienced ACEs. Working in a trauma‐informed organisational climate and resilience may be effective avenues for reducing burnout and secondary traumatic stress. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disabilities experience significant health inequities. The aim of this report is to understand the circumstances leading to death from COVID‐19 in people with intellectual disabilities. Method: Local areas in England prioritised reviewing 200 deaths of adults with intellectual disabilities. Of these, approximately 80% were required to be deaths from suspected or confirmed COVID‐19 as this was the focus of the study; the remainder from other causes. All deaths occurred between 2 March2020 and 9 June 2020. Results: People with intellectual disabilities differed from the general population in their symptoms of COVID‐19 and age at death. The overall quality of care was rated similar to other deaths of people with intellectual disabilities. Concerns were raised relating to recognising acute deterioration and do not attempt cardio‐pulmonary resuscitation decisions. Conclusions: Service improvements are indicated in the ways in which people with intellectual disabilities encounter COVID‐19 and experience the disease. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background At present, there is limited statistical information about mortality of people with intellectual disabilities in England. This study explores the data that are currently available. Materials and methods Four recent sources of data about mortality of people with intellectual disabilities in England are reviewed: the Confidential Inquiry into Premature Deaths of People with intellectual disabilities ( CIPOLD); the 2013 Joint Health and Social Care Intellectual Disability Self-assessment Exercise; local registers of people with intellectual disability; and analysis of Cause of Death certificates. Results Available data confirm that people with intellectual disability have a shorter lifespan and increased risk of early death when compared with the general population. The standardized mortality rate for people with intellectual disabilities is approximately twice that of the general population in England, with little indication of any reduction in this over time. Conclusions Comprehensive data about mortality of people with intellectual disabilities that take account of the age and sex distribution of the population are currently lacking in England. Existing data suggest persistent inequalities between people with intellectual disabilities and the general population. There is an urgent need for better monitoring mechanisms and actions to address these. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities experience serious health inequalities (e.g. they die younger than people without intellectual disabilities). Medical students' attitudes towards health care for this population warrant empirical attention because, as tomorrow's doctors, they will affect the health inequalities that people with intellectual disabilities experience. Materials and Methods This study investigated these attitudes by interviewing 17 medical students about medical students' attitudes towards people with intellectual disabilities and thematically analysing resultant qualitative data. Results Key themes were identified, such as medical students' worries about working with patients with intellectual disabilities, and their wish for more medical teaching on, and direct experience with, this patient group. Conclusions This study suggests that medical schools need to better prepare medical students for their roles as providers of health care to people with intellectual disabilities by, for example, enhancing their attitudes towards health care for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background: This article is about interactions that occur when someone with intellectual disabilities is engaged in everyday activities with a personal assistant (PA) or a support worker. Method: We examine the detail of nine hours of naturally occurring video‐recorded interactions, to explore how "relational autonomy" is done in practice. Nine people with ID and seven staff took part in the research, which took place in England from 2016–17. Results: We selected six extracts to illustrate different types of joint decision‐making. Informed by inclusive research with a drama group of people with intellectual disabilities, we focus on the ways in which (a) future plans are discussed; (b) choices are offered during an activity; (c) people reflect on their decisions. Conclusion: The article concludes with discussion about the teaching and learning content of choice‐making, on relational autonomy, and the practice learning for PAs, support workers and for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background Care management is the formal mechanism for linking people with intellectual disabilities with public services but little is known about these arrangements. This paper present findings from a national survey. Materials and Methods The questionnaire covered aspects of care management arrangements and was specific to services for people with intellectual disabilities. They were sent to all social services departments in England. Results The response rate was 81%. Variations were found in organizational arrangements, the performance of key care management tasks, and the degree of differentiation in approach according to need. Local authorities also differed in arrangements for person centred planning. Conclusions Further review of the relative efficiency and effectiveness of different care management approaches is needed to inform policy development and promote consistency in services for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background The use of physical intervention (PI) with people with intellectual disabilities continues to cause concern. This study sought to clarify the frequency and circumstances of PI use and gather data on the characteristics of individuals subject to PI. Method Data on individuals subject to PI were gathered by postal questionnaire completed by service providers from three samples: people who (i) had attended a PI conference and/or purchased a PI policy document; (ii) operated in a specific geographical area of England and (iii) operated specialist assessment and treatment settings for children/adults with intellectual disabilities throughout the UK. Results Frequent PI use was reported. Restraint was most commonly reported – monthly or more frequently with most individuals. Overall, those receiving PI were more likely to be young, male, not legally restricted and identified as having an autistic spectrum disorder than those who did not receive PI. Conclusions The relatively frequent use of PI is consistent with routine rather than last resort use. Such use carries risk of physical and psychological damage. Service providers should systematically reduce the frequency of use of PI. [ABSTRACT FROM AUTHOR]

Background There is insufficient evidence to guide decisions around (non-)disclosure of bad news of life-limiting illness and death to people with intellectual disabilities. Aim The aim of this study was to develop guidelines for decisions about (non-)disclosure of bad news around life-limiting illness and death to people with intellectual disabilities, by examining stakeholders' preferences (and reasons) around disclosure and non-disclosure. Materials and methods Focus groups and interviews were held with 109 participants: people with intellectual disabilities, family carers, intellectual disabilities professionals and medical healthcare professionals. Results People with intellectual disabilities had wide-ranging views about disclosure. Reasons for non-disclosure included: preventing distress; too difficult for the bearer of bad news; the bearer of bad news lacks knowledge; inability to understand; no sense of time; conflicting views among stakeholders. Reasons for disclosure included: a right to know; knowledge helps the person cope; need for involvement. Conclusion Disclosure of bad news could cause harm in some situations, but this needs careful assessment. The authors present guidelines for disclosure that now need to be tested in practice. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities face attitudinal and service barriers when attempting to form intimate relationships. To date, their experiences and views are under-represented in the existing evidence base. Method The aim of this study was to carry out an interpretative phenomenological analysis exploring the experience of intimate relationships for nine adults with intellectual disabilities. Results Four main themes were identified: desiring relationships; expressing sexuality; having relationships; and who has control? Together these themes demonstrated that intimate relationships were desired and important to all participants, fulfilling a variety of their needs. In addition, participants faced a number of challenges related to intimate relationships. Conclusion The findings raise questions about how best to support people with intellectual disabilities with sexuality and intimate relationships. Implications for caregivers and services are discussed. [ABSTRACT FROM AUTHOR]

Background The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour. Method Interviews, primarily focussed upon staff practice, were conducted with 19 managers of staffed group homes in SE England. Transcripts were analysed using interpretive phenomenological analysis. Results Five groups of themes emerged: monitoring staff performance, supporting new ways of working, shaping staff performance, influence of external and employing agencies, and importance of participants' personal values and experiences. Conclusion The themes identified contribute to a conceptual framework for thinking about front-line management/practice leadership. The limitations, and potential implications, of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background: A common factor in the abuse of people with intellectual disabilities in residential settings has been the failure of care staff and frontline managers to recognise poor practice at an early stage and prevent its development into a culture of abuse. In this context, staff understandings of abuse and poor practice in residential services for people with intellectual disabilities were explored. Method: Semi‐structured interviews (n = 56) were undertaken with care staff and frontline managers working across England. Interviews included the use of vignettes, based on real‐life experiences of people with intellectual disabilities, to prompt discussion. Results: Staff struggled to define either "abuse" or "poor practice", focussing more on individual acts or omissions than on institutional practices. When faced with vignettes, staff demonstrated a lack of agreement regarding what constitutes either abuse or poor practice. Conclusions: The implications for practice in residential care settings and for safeguarding training are discussed. [ABSTRACT FROM AUTHOR]

Background: With increasing reductions in funding for social care across many countries, the need to ensure that resources are used to best effect is becoming increasingly important, in particular for those with severe and complex needs. Methods: In order to explore the outcomes and costs of skilled support for this group of people, quality of life was assessed for 110 people in 35 services in England. Information on costs was also collected. Results: People who received consistently good active support experienced better outcomes in terms of several quality of life domains. Good support did not require significantly more staff time, and there was no evidence of higher total costs for those receiving good support. Conclusions: The inclusion of active support in government guidance and local commissioning practices related to people with severe intellectual disabilities is likely to improve user outcomes. Observation should be an important element in measuring service quality. [ABSTRACT FROM AUTHOR]

Background As institutions for people with intellectual disabilities have been replaced with community services, health care provision has developed to provide assessment and treatment, low and medium secure units for people with challenging behaviour or mental health problems. These include both public and private sector provision. Little is known about these services. The aim of this study was to describe the characteristics of the services studied and to compare the different types of service. Methods A survey was carried out of National Health Service (NHS) and independent sector (IH) health settings providing specialist inpatient services for people with intellectual disabilities. Data were collected on setting and patient characteristics, staffing and management and care processes and outcomes. Results Services were very unevenly distributed across England. There were differences between NHS and IH settings. IH assessment and treatment units were bigger, had higher occupancy and lower staff ratio. In all three types of unit, IH units had fewer visits to patients, used more seclusion, physical restraint and had more locked areas. They had more complaints in more services from users and (for assessment and treatment units and low secure units only) from relatives. In low secure units, they had more adult protection referrals. On the other hand, IH units used fewer agency staff in assessment and treatment units (though more in medium secure units) and provided more appraisals, more visits from commissioners, more consultations with GPs and dentists and more use of whistleblowing procedures by staff. A quarter of people in NHS assessment and treatment units had finished treatment but had no plan for discharge. Conclusions Further research is required to determine the reasons for differences observed between IH and NHS units. The large number of people who have finished treatment emphasizes the importance of developing housing in the community with sufficiently skilled support. The large number of patients in low secure services raises the question whether this type of service is recreating the intellectual disability institutions which government policy intends to close. [ABSTRACT FROM AUTHOR]

Background Research on staffed housing for people with intellectual disability has identified the challenges in achieving postitive quality of life outcomes. However, a less well considered dimension of such services is that they are places of living and dying. This paper looks at the experiences of staff in dealing with issues of death and dying. Method In depth qualitative interviews were held with 22 staff in 5 different providers and who had experienced, in total, 27 deaths of people with intellectual disability. Results The data highlight that staff felt providing a good quality of care at the end of life was an important but unrecognised dimension of their work. This work could be broken down into several different phases, dying, death and beyond death. Bad deaths were felt to be those deaths which prevented staff from 'being there' with individuals over those phases. [ABSTRACT FROM AUTHOR]

Background The experience of caring for a son or daughter with an intellectual disability has long been recognized as stressful. The long-term health costs for parents of people with intellectual disability have attracted some recent research attention, but mortality has not been studied. Methods The present authors examined mortality as measured by the standardized mortality ratio (SMR), and cause of death for parents of people with intellectual disability, identified through an intellectual disability register in Merton, south London. Results Although there was a trend for lower SMRs particularly for mothers, SMRs were not significantly different from unity. Subgroups of parents whose child was cared for predominantly in an institution, or in the family home were analysed and similarly showed no significant difference from unity. The same applied to cause of death analyses. Conclusions These findings offer some reassurance to parents of people with intellectual disability. There is an urgent need for further research in this area. [ABSTRACT FROM AUTHOR]

Background: The move to community support for all people with intellectual disabilities is an aspiration with international significance. In this article, we draw on rich accounts from women with intellectual disabilities detained under the Mental Health Act (E&W) 1983 and staff at an National Health Service secure setting in England to explore how "moving on" is defined and perceived. Methods: The study reports on an ethnographic study using the field‐notes and the 26 semi‐structured interviews with detained women and staff on three wards. Results: We first explore staff conceptions of moving on, which include behavioural change and utilizing coping strategies. Then, we discuss the areas of analysis that women discussed: taking back responsibility, success in arranged relationships, acceptance of regime and resistance to progression. Conclusion: The concepts of moving on were not determined by the women but by the service. We recommend further research which explores women's own rehabilitation requirements. [ABSTRACT FROM AUTHOR]

Background People with intellectual disabilities are more likely to have hearing loss than the general population. For those unable to self-advocate, the responsibility of detection and management falls to their caregivers. Methods This is the first cycle of a project using action research methodology to improve services. Twenty care workers were interviewed to understand their knowledge of hearing loss and hearing aids. Themes were generated using thematic analysis. Findings This group was better qualified than their peers but received minimal training in hearing loss. They were unable to accurately estimate expected prevalence and had a negative perception of hearing aids. Only 7% of service users were known to have hearing loss. Conclusions Current training is not sufficient to provide the skills for detection and management of hearing problems. This group had clear ideas on methods of learning. Working in collaboration is necessary to achieve long-term change to practice. [ABSTRACT FROM AUTHOR]

Background English policy argues that people with intellectual disabilities should be supported in their local communities. There is considerable evidence that this aspiration is not being achieved. This paper seeks to look at the subsection of people with intellectual disabilities who have expensive care needs because of challenging behaviour, to identify the decision-making processes that have led to current service provision and expenditure and to suggest improvements. Materials and Methods We carried out a survey within five North London boroughs to investigate the characteristics of a cohort of people with intellectual disabilities and challenging behaviour in high-cost accommodation (over £70 000/annum). Postal questionnaires and face-to-face interviews were conducted with stakeholders with intellectual disabilities and patterns of current costs were estimated from existing data provided by the commissioning authorities in the five boroughs. Results Two hundred and five individuals with intellectual disabilities and challenging behaviour were identified. They were accommodated in placements provided by 97 separate providers, both in and out-of-area. Those more likely to be placed out-of-area were younger, had multiple health problems, significant challenging behaviour and mental health problems including autistic spectrum disorders. The local community intellectual disabilities teams identified a number of difficulties in meeting the needs of those service users. Conclusions Expenditure on all placements for service users with intellectual disabilities is significant. There is a notable lack of investment in local service development. A coherent approach is required, often across service boundaries. The authors suggest a model for targeted investment aimed at supporting effective local services, and reducing the need for and expense of out-of-area placements. [ABSTRACT FROM AUTHOR]

Background: Little is known about the lives of parents with intellectual disabilities from minority ethnic communities. Previous research suggests that what it means to live with intellectual disabilities varies across cultural contexts. The current research aimed to explore how cultural values and practices impact upon the experiences of parents with intellectual disabilities within the Bangladeshi community in London, England. Method: Six members of the Bangladeshi community, four Bangladeshi parents with intellectual disabilities and four of their family members were interviewed. Thematic analysis was used to identify key themes. Results: Both parenting and intellectual disability are thought about in this community in ways that make parenting more accessible for people with learning disabilities, but also create tensions to be negotiated. Conclusions: Bangladeshi family carers face dilemmas balancing the benefits and risks of promoting parenting for sons and daughters with intellectual disabilities, particularly in the context of service principles of autonomy and informed consent. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to investigate the relationship between depression, hopelessness, problem-solving ability and self-harming behaviours amongst people with mild intellectual disabilities ( IDs). Methods Thirty-six people with mild IDs (77.9% women, M age = 31.77, SD = 10.73, M IQ = 62.65, SD = 5.74) who had a history of self-harm were recruited. Participants were asked to complete measures of depression, hopelessness and problem-solving ability. Results Cutting was most frequently observed, and depression was prevalent amongst the sample. There was a significant positive relationship between depression and hopelessness, while there was no significant relationship between self-harm and depression or hopelessness. Problem-solving ability explained 15% of the variance in self-harm scores. Conclusions Problem-solving ability appears to be associated with self-harming behaviours in people with mild IDs. [ABSTRACT FROM AUTHOR]

Background: Children and young people with learning disabilities experience poor health outcomes and lengthier hospital admissions than those without learning disabilities. No consistently applied, systematic approach exists across the NHS to identify and record this population. This paper describes practices in English hospitals to identify children and young people with learning disabilities. Method: Interviews: 65 NHS staff. Questionnaire: 2,261 NHS staff. Conducted across 24 NHS hospitals in England. Results: No standardized approach exists to identify children or young people with a learning disability or for this information to be consistently recorded, communicated to relevant parties within a hospital, Trust or across NHS services. Staff reported a reliance on parents to inform them about their child's needs but concerns about "flagging" patients might be a significant barrier. Discussion: Without an integrated systematic way across the NHS to identify children with learning disabilities, their individual needs will not be identified. [ABSTRACT FROM AUTHOR]

Purpose To explore caregiver perceptions of the socio-environmental issues around evening meal ('teatime') which influence choking. Mealtime difficulties for people with intellectual disabilities and/or mental illness may be underdiagnosed. Difficulties affect quality of life with social aspects impacting on service-users and caregivers. Reporting of choking incidents has increased locally following widespread training. Analysis of reports showed most incidents were occurring around evening meal. Methodology A qualitative study of caregivers witnessing a choking incident was undertaken. Semi-structured interviews explored perceptions of the causes. Data were analysed using thematic analysis. Findings Thematic analysis elicited individual service user characteristics, and social and contextual factors implicated in choking. The findings will facilitate risk assessment for service-users and inform mealtime practice. Staff familiarity is a key factor. Further research involving service-users is indicated to complement these findings. This study widens the focus of recent studies which have considered physical more than socio-environmental aspects of mealtime difficulties. [ABSTRACT FROM AUTHOR]

Background Prisoners with intellectual disabilities are known to be disadvantaged in prisons and to be more susceptible to bullying, segregation, depression and anxiety than other prisoners. Method In this study, nearly 3000 new prisoners entering three English prisons were offered screening for intellectual disabilities, using the LDSQ. Results On average, 75% of all new prisoners entering prison were offered screening, and only 14% refused screening. Overall, just less than 7% were screened positive on the LDSQ and prisons made some reasonable adjustments as a result. Conclusions It is argued that it is feasible to screen for intellectual disabilities in prisons and, given the inequalities to which prisoners with intellectual disabilities are subject in prison, it is time for such screening to be rolled out to all prisons. [ABSTRACT FROM AUTHOR]

Background: Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio‐economic factors and adversity partly accounting for this. Fewer data are available for adolescents. Methods: Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self‐report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records. Results: Adolescents with mild/moderate intellectual disabilities were more likely than non‐disabled peers to experience socio‐economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities. Conclusions: These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio‐economic factors, family and peers on mental health. [ABSTRACT FROM AUTHOR]

Background To describe the characteristics of those with autism spectrum disorder (ASD) treated within a forensic intellectual disability hospital and to compare them with those without ASD. Method Service evaluation of a cohort of 138 patients treated over a 6-year period. Results Of the 138, 42 had an ASD. Personality disorders and harmful use or dependence on drugs were significantly lower in the ASD group. The ASD group was less likely to be subject to criminal sections or restriction orders. Self-harm was significantly higher in the ASD group. There were no differences in the length of stay and direction of care pathway. Conclusions Although the ASD and non-ASD groups differ on clinical and forensic characteristics, their treatment outcomes appear similar. This suggests that the diagnostic category of ASD alone may be inadequate in predicting the treatment outcome. There is a case to identify distinct typologies within the ASD group. [ABSTRACT FROM AUTHOR]

Background This paper tells the story of Central England People First's ( CEPF) History Project. Method This was an inclusive research project, owned and controlled by members of CEPF which sought to chart its 21-year history, 1990-2012. Results It illustrates both the strengths of such a project and some of the challenges. Conclusion It concludes that using inclusive research methods enabled the story to be told, but that it was less successful in addressing questions about why the organization grew and prospered in the 1990s, only to struggle in its later years, and what this tells us about the conditions which enable self-advocacy to flourish. The paper was collaboratively written by the CEPF History Project team and an academic ally. Different fonts differentiate the contributions, although it is acknowledged that lots of the ideas were shared. Accessible Abstract This paper explores issues in telling the history of self advocacy using inclusive research methods. It explains how and why CEPF recorded its history, what we found out, and some of the questions we have had to think about: whose voices we hear, what to include, what to leave out, what parts of the research people with learning difficulties can do, what self advocacy means to different people, how to make use of research other people have done., It raises some new questions about directions for inclusive research. The Paper was written by the CEPF History team - Craig Hart, Ian Davies, Angela Still and Catherine O'Byrne - working with Jan Walmsley. We wanted to make it clear what were Jan Walmsley's ideas and what were our ideas. We have done this by writing our ideas in a different font. BUT lots of the ideas belong to all of us. [ABSTRACT FROM AUTHOR]

Background: Research suggests that a better awareness of how staff who directly support people with intellectual disabilities experience their working relationships, will contribute to understanding staff wellbeing and the quality of care they offer. This study aimed to gain insights into the lived experiences of support workers in supported living services in England. Method: Six support workers participated in semi‐structured interviews, about their working relationships with service‐users and colleagues. Data was analysed using interpretative phenomenological analysis. Results: Six interconnected themes emerged: The essence of good relationships; a trusting relationship as the vehicle for meeting service‐users' needs; belonging to the support team; the organisational context of relationships; the social context of relationships; 'a fine balancing act'. Conclusions: The findings provide insights into staff wellbeing, indicating that developing supportive, trusting relationships with both service‐users and colleagues, plays an important role in delivering effective care. Potential implications for service providers are discussed. [ABSTRACT FROM AUTHOR]

An introduction is presented wherein the author discusses various reports within the issue on topics including worker's qualities desired by service users with Intellectual Disabilities (ID), human rights-based approach to health care for people with ID, and attachment and intellectual disabilities.

Background The Equipping Youth to Help One Another Programme ( EQUIP) was designed for young offenders to address a developmental delay in moral reasoning, distorted cognitions and social skills. Methods The present authors undertook a single case series study and piloted an adapted version of the EQUIP programme with three men with intellectual disabilities and four men with a diagnosis of Asperger Syndrome, all of whom were detained in a medium-secure forensic unit for people with intellectual disabilities. Treatment was delivered over a 12-week period, and participants took part in four-one-hour sessions per week. Results The results suggested that treatment was successful at increasing moral reasoning ability, reducing distorted cognitions and improving ability to choose effective solutions to problems. However, treatment did not have a significant effect upon anger. Conclusions The EQUIP programme is a promising treatment, but further research is needed to investigate its effectiveness with men with intellectual or other developmental disabilities. [ABSTRACT FROM AUTHOR]

Background: Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. Method: Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). Results: Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. Conclusions: ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community. [ABSTRACT FROM AUTHOR]

Objectives To describe the rates of anti-social behaviour ( ASB) among adolescents with/without mild/moderate intellectual disability ( MMID). To estimate whether any differences could be attributable to differences in exposure to extraneous risk factors. Design Secondary analysis of the Longitudinal Study of Young People in England. Methods Participants with MMID were identified through data linkage with educational records. Results Parents of children with MMID were more likely to report police contact, children with MMID were more likely to self-report fighting/public disturbance, shoplifting and graffiti. When controlling for differences in exposure to extraneous risk factors, MMID was associated with increased rates of police contact and self-reported graffiti, no difference in self-reported shoplifting, reduced rates of self-reported fighting/public disturbance and vandalism. Conclusions Differences in the rates of exposure to extraneous risk factors play an important role in accounting for the differences in the prevalence of self-reported ASB among adolescents with and without MMID. [ABSTRACT FROM AUTHOR]

Background Concern has been expressed repeatedly about the cost and quality of residential placements for adults with learning disabilities and additional needs. This study sought to identify characteristics of the highest cost placements in the South-East of England. Method Lead learning disability commissioners in the South-East of England were asked to provide information about the five highest cost residential placements that they commissioned for adults with learning disabilities. Results The average placement cost of £172k per annum disguised wide variation. Individuals placed were mainly young and male with high rates of challenging behaviour and/or autism spectrum disorder. Most placements were in out-of-area residential care. The highest costs were associated with hospital placements and placements for people presenting challenging behaviour. Conclusions Young, male adults with learning disability, challenging behaviour and/or autism continue to receive very high cost residential support, often in out-of-area residential care. There remains limited evidence of plans to redirect resources to more local service developments. [ABSTRACT FROM AUTHOR]

Background Little research has been conducted on the mental health needs of adolescents with intellectual disability, despite the severity and rates of such needs being high throughout childhood and in adulthood. We have investigated the prevalence and predictors of mental health needs and service use in adolescents with intellectual disabilities. Materials and Methods Service-based sample ( n = 75) in one catchment area. Individual assessments were carried out. The main outcome was the presence of mental health needs measured by the Developmental Behaviour Checklist. Results Prevalence of mental health needs increased from 51% as reported by parents to 67% as judged by clinical interviews. Caseness was associated with low adaptive functioning, diagnosis of autism and family history of mental illness. High scores on parent reports of participant mental ill-health showed negative correlations with adaptive functioning scores. Most individuals were in receipt of social and health care. Half of the participants had sought help for mental health needs. Almost half of those receiving medication were on psychiatric medication. Conclusions Adolescents with intellectual disabilities may have considerable mental health problems which are functionally impairing yet frequently unidentified and hence untreated. Identification of those at risk and undertaking of a comprehensive needs assessment are essential to maximize potential and quality of life and to reduce further deficits and social exclusion. [ABSTRACT FROM AUTHOR]

Background Information about the health of people with ID is usually obtained from professionals and carers. Little is known about what health problems people with ID report they experience, and whether this differs from their carers' reports. Method A secondary analysis of health information provided by participants with ID and/or their matched carers as part of a health intervention RCT using inclusive methodology. Results Health information from 98 participants with ID is presented. Less than three quarters of participants said they had someone to talk to about their health (68/93). Pain was reported by 67% (66/98) with 18% (17/95) saying they did not tell anyone when in pain, and 27% (26/97) they did not take pain relief medication. Matched carer data for 59 participants indicated similar numbers of health problems reported by participants as by their carers when prompted with specific problems. Participants reported more headaches and allergies, but fewer weight problems than their carers. Concordance was poor for many problems. Conclusion Participants reported experiencing a lot of health and mental health problems including pain. This information from adults with ID is rarely collected, either in research or in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background Studies of engagement in meaningful activity often focus on a short period during the afternoon. The question arises whether this produces different results from studies covering the whole day. Methods Data collected for 18 individuals using a 20-s momentary time-sample from 08:00 to 19:00 over a number of days for each person were analysed. Duration of behaviours was compared when estimated from a 2-h period between 16:00 and 18:00 and the period 08:00-16:00 and 18:00-19:00. Results No significant differences at P < 0.01 were found for engagement in meaningful activity, two-way interaction or 24 of the 26 behaviour codes used. Longer duration during the period 16:00-18:00 was found for personal care, which includes eating, and for neutral staff contact in institutions only. No differences were found for any code in housing. Conclusion Observation of activity during the period before and during the evening meal by momentary time-sampling can be used to estimate overall levels of engagement in meaningful activity, two-way interaction and total staff contact, together with other behaviours, with the exception of personal care and neutral contact from staff in institutional settings. Further research is needed to confirm this result. [ABSTRACT FROM AUTHOR]