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This Australian study compared perspectives of family quality of life (FQOL) of parents of preschool children attending early childhood intervention services (ECIS) with parents of school‐aged children with disability. It examined the relationships between disability‐related services, parent occupations, and FQOL. Two mixed‐methods studies with 122 participants and 24 in‐depth interviews were conducted. The first study included 72 parents attending ECIS. The second study included 50 parents of school‐aged children with disability. The quantitative aspect (N = 122) used the Beach Center FQOL survey and a demographic questionnaire. Twelve semistructured interviews were conducted for each study. Spearmann's Rho correlations for quantitative data analysis and thematic analysis for qualitative data were used for each study. A two‐way analysis of variance along with a qualitative comparative analysis were conducted to compare the findings from both studies. Results indicated lower scores on FQOL in parents with school‐aged children when compared with the ECIS group. Loss of work, lack of time for caregiver health, lack of respite, and interim residential care had detrimental impacts on parents' long‐term well‐being. Based on the results, it can be concluded that the hardships and challenges of caregiving increase as the child gets older; however, positive adaptations, beliefs, and positive transformations help FQOL. Family‐centered care and supportive practitioners assist FQOL and are highly recommended. [ABSTRACT FROM AUTHOR]

Some service providers use restraints and seclusion with people with an intellectual disability, and policies that permit such practices usually state that their use is primarily to prevent the risk of self-injury or risk to others. However, the use and effectiveness of restrictive practices have been questioned due to the negative impact on the service user and staff and may also be considered a contravention of the human rights of the service user. Consequently, policies are now trending toward limiting restraint use or on the prevention of or safe elimination of the use of restraint. In Ireland, new legislation has attempted to formalize the definitions of restraint and seclusion, as well as place restrictions on such practices. However, issues have been raised with respect to the implementation of the new policies, particularly in operationalizing a definition of restraint and applying it to widely heterogeneous clinical groups considering the autonomy that service providers have in devising their own service-level policies. The authors use legislation from Ireland and Victoria, Australia, to illustrate restraint practices and the issues emanating from its use. The authors argue that a gap remains between our understanding of the place of implementing restrictive practices with respect to service provision and their actual applications by providers. They conclude that such discordance between policy and practice needs to be addressed by stronger regulation. [ABSTRACT FROM AUTHOR]

In the Netherlands, physical/mechanical restraints in the care provided to people with intellectual disabilities are still in use, with the case of 'Brandon' being a recent and illustrative example. The public debate that this case triggered raised questions concerning the policy proposal in the Care and Coercion Bill ( Wetsvoorstel Zorg en dwang) and efforts to reduce the use of restraints. Thus, the authors undertook an inventory of government legislation and institutional regulations in order to obtain an insight into practices applying in other countries and to provide recommendations for developing policy on reducing the use of restraints in the care of people with intellectual disabilities in the Netherlands. Using a literature study, they observed that although the use of restraints in the care for people with intellectual disabilities is internationally regulated by the criterion of ultimum remedium, policy is clearly not always in line with practice. Various studies of best practices have identified some common elements in seeking to limit restrictive interventions, including strong leadership in care facilities based on national policy, trained staff, a strict monitoring system, and changes in attitudes on the use of restraints, with restraints being identified as treatment failure. The authors noted that the use of restraints, and efforts to reduce their use, is a dilemma internationally. In the Netherlands, the public debate on the use of restraints has not so far led to any significant political action. While decisions on a new legal framework still have to be made, it would be advisable to include a section on jurisdiction in the policy framework and to ratify the UN Convention on the Rights of Persons with Disabilities, which has many implications for both policy and practice. In the meantime, care facilities can start working on implementation plans, including the best practices described in this study. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability do not have adequate access to mental health services and have worse mental health outcomes than the broader community. Access to information about mental health, treatment, and services has been advocated as one strategy to address these inequities. This article presents findings from a policy analysis of how the right to accessible information is represented in Australian mental health policy, with a focus on information access for people with intellectual disability. Method: An analysis of Australian and New South Wales state policies relevant to mental health services 2007–2017, in current use and available online (49 documents) was conducted. Principles in the United Nations Convention on the Rights of Persons with Disability 2006 and an integrated health literacy framework were used to frame a content analysis. NVivo 11 (QSR 2015) was used to search the policy documents and themes were identified according to the policy type and purpose. Findings The right to information is expressed in Australian and New South Wales state policy documents. However, the mental health policies do not refer to the communication needs of people with intellectual disability or incorporate strategies to address their needs. Many of the mental health policy directives incorporate the need for tailored communication. Some documents mention the needs of other groups of people with specific communication needs, but not people with intellectual disability. Implications: The inconsistency between the right to information expressed in policies and processes to communicate information with people who have intellectual disability needs to be addressed. The longstanding disparities in health outcomes, and difficulties accessing mental health service experienced by many people with intellectual disability underline the pressing need for policy to require accessible information practices. [ABSTRACT FROM AUTHOR]

As the largest public health crisis within a century, the COVID‐19 pandemic has caused long‐term disruption in the support systems of people with intellectual and developmental disabilities (IDD) across the globe. The purpose of this study was to investigate challenges and ameliorative strategies to supporting the basic care needs of people with IDD 1 year into the pandemic, as experienced by nurses who specialize in IDD nursing. We surveyed a convenience sample of 369 nurses from across North America, Europe, and Australasia using a 52‐item online questionnaire. Descriptive statistics were used to rank the greatest challenges and the degree of support available to nurses, and manifest content analysis was used to analyze open‐ended responses related to ongoing challenges and ameliorative strategies. Results of descriptive analyses revealed consistent findings across global regions in terms of the challenges faced by nurses; the greatest challenges related to supporting or enabling socialization with family/friends, ensuring adequate day programming or educational services, identifying/planning alternative entertainment activities, ensuring adequate staffing of familiar support workers and caregivers, and managing challenging behaviors related to change in daily routine and activities. Nurses described a considerable degree of support offered by their organizations in terms of flexibility in scheduling related to family obligations and paid time off for COVID‐19‐related isolation and quarantine. Content analysis of open‐ended survey responses revealed numerous challenges related to: (1) client socialization, meaningful activity, and mental/behavioral health; (2) interpreting, keeping up with, and helping others to understand COVID‐19 guidelines; (3) access to, quality of, and continuity of care; and (4) COVID‐19 fatigue and the influence of time. Overall, our study highlights ongoing issues with access to care and support, exacerbated by the pandemic, and the importance of having meaningful activity and socialization for overall well‐being of people with IDD during a long‐term public health crisis. [ABSTRACT FROM AUTHOR]

Dental caries and obesity‐associated chronic diseases are an additional burden to people with intellectual disabilities and one which can be reduced. To determine the association between dental caries and body mass index (BMI) among Special Olympics (SO) athletes. At the National SO Games (2014), three volunteer dentists screened consenting SO athletes (n = 116; 15–57 years old) and recorded decayed (D), missing (M), filled (F) teeth and caries experience (DMFT > 0). Volunteer‐accredited sports dietitians measured BMI as underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9), and obese (≥30) or used World Health Organization (WHO) classification of BMI‐for‐age for those under 19 years of age. The prevalence of decayed teeth was 16% and the mean DMFT was 4.0. About 40% of SO athletes had one or more missing and filled teeth. A third of the SO athletes had normal weight (33%), and the rest were overweight (40%) or obese (27%). Missing teeth and caries experience were significantly associated with higher BMI (χ2, p < .05). A more efficient common risk factor approach that simultaneously targets both dental caries and obesity should be adopted to improve the oral health and general health of SO athletes and the larger, more vulnerable population of people with intellectual disability. [ABSTRACT FROM AUTHOR]

Australia's national legislation and policy have affirmed the right of children with disability, including developmental disabilities to inclusive education. Yet, policy reviews and empirical research have raised concerns about the misalignment between inclusive policy and practice across Australian states. Drawing from these sources, this article endeavors to reflect upon the divide between the Australian policy on inclusive education and inclusive practice by considering the advances, obstacles, and challenges in achieving systemic inclusive education in the Australian education context. In the last part, we offer four propositions that could close the gap between policy and practice and enable students with developmental disabilities to have access and be successful learners in their local mainstream school. [ABSTRACT FROM AUTHOR]

The provision of appropriate education, training, and employment supports for incarcerated people is pivotal to mitigating the risk of recidivism, to improving rehabilitative outcomes, and to securing employment upon release. People with cognitive disability are disproportionately represented in prisons internationally. The vast majority of this group have significantly low levels of education, are unable to participate meaningfully in mainstream prison programs, are more likely to return to prison than their nondisabled peers and are generally excluded from the labor market. There is thus a significant need for specialized in‐prison education, training, and employment programs for this group. However, in Australia and internationally such programs are scant. There is also very little known about good policy and practice in this domain. We present findings from qualitative research conducted on one of the few specialist education, training, and employment program models for prisoners with cognitive disability in Australia. The findings suggest that a practice model informed by and delivered from a well‐considered theoretical base by a collaborative multidisciplinary team capable of adapting mainstream education, training, and employment programs in a flexible and culturally sensitive manner offers an opportunity to provide improved outcomes and greater equity for this highly disadvantaged group. The implications for policy and practice in this domain are discussed. We conclude that the expansion of appropriately designed education, training, and employment programs for prisoners with cognitive disability is critical to protecting the human rights and improving the life trajectories of this highly disadvantaged group. [ABSTRACT FROM AUTHOR]

Abstract: Evidence‐based practice (EBP) has not been well established in the area of intellectual disability (ID) and comorbid mental ill health. Some attempts in the form of policies and practice guidelines have been made. The aim of this study was to investigate assessment practices of Australian psychologists working with adults from this specialist population and explore barriers to best practice implementation. One hundred and two psychologists completed a self‐report online survey exploring barriers to EBP implementation. Sixty‐one psychologists completed questions relating to their practice including diagnostic practices, application of special considerations, and use of specialist resources. Psychologists reported many assessment practices that were in line with current national and international guidelines including utilization of specialist assessment resources, interdisciplinary collaboration, and application of reasonable adjustments to standard practice to suit the needs of individuals with dual disabilities. However, the sample also reported a number of barriers to implementing best practice recommendations such as diagnostic issues, limited access, and awareness of clinical resources and limited access to mental health services. Findings from this study have implications for best practice guidelines and policies in how mental health services for individuals with IDs and their families are delivered in Australia. This includes facilitating collaboration between health and disability services, adequate training, and access to specialist resources and access to mental health services equipped to support the needs of this specialist population. [ABSTRACT FROM AUTHOR]

Abstract: People with intellectual disability in Australia experience poor mental health, are underrepresented in mental health policy, and encounter major barriers in accessing mental health services and treatments. This study interrogated the current representation of people with intellectual disability and recommended strategies to enhance the inclusion of intellectual disability in mental health policy. A policy analysis framework was developed that included context, stakeholders, process, and content. Nine pieces of Australian mental health legislation and 37 mental health policy documents were analyzed using the framework. Fifteen of the 37 documents included mention of intellectual disability with limited attention to the specific mental health needs of people with intellectual disability and mental illness. Only two documents identified specific strategies or measurable actions and targets to improve the access of people with intellectual disability and mental illness to mental health services. The documents’ strengths that may be applied to develop inclusive intellectual disability mental health policy included being values‐based, recognizing diversity, taking a life‐course approach, focusing on workforce development, and ensuring checks and balances. An inclusive approach to the development and implementation of intellectual disability mental health policy will best meet the mental health needs of individuals with intellectual disability. An inclusive policy approach will be based on a sound evidence‐base and include a comprehensive understanding of the context in which the policy is developed; consultation with key stakeholders including people with intellectual disability and mental illness, their family and carers, and those who work with them; cross‐sector collaboration and workforce training. An inclusive approach to the development and implementation of intellectual disability mental health policy using an integrated knowledge translation approach will address the current lack of attention to the important area of how to best meet the mental health needs of individuals with intellectual disability. [ABSTRACT FROM AUTHOR]

A number of practice guidelines are available to set the benchmark for best practice when working with individuals with intellectual disabilities and co‐morbid mental health concerns. However, dissemination and implementation of such guidelines in the context of psychologists' work settings has received little attention. The aim of this qualitative study was to investigate adherence to current practice guidelines by Australian psychologists working with this specialist population and explore organizational factors that may facilitate or hinder evidence‐based practice implementation. Thirty‐eight Australian psychologists from government disability and non‐government disability organizations working primarily with individuals with intellectual disability participated in eight semistructured focus groups. Psychologists were presented with a summary of a current Australian practice guideline in dual disabilities and asked about their views of best practice adherence and implementation of the guideline including facilitative and hindering factors influencing implementation. Psychologists reported views consistent with current Australian best practice standards but noted a number of barriers impacting on adherence. Facilitators and hindrances to best practice implementation were discussed in relation to views on applicability of current guideline, organizational level considerations, organizational resources and training, organizational operations, and systemic considerations. Findings highlight the importance of a collaborative and systemic approach in order for practice guidelines to be effectively implemented for psychologists working with disabilities. Implications for policy development and training are discussed. [ABSTRACT FROM AUTHOR]

The Delphi method has been previously used to define and reach consensus on core workforce attributes. However, limitations of the traditional Delphi method have been identified. A modified online Delphi method, which aims to address these limitations, was used as one part of the intellectual disability mental health core competencies project. The authors assess the utility of a modified online Delphi method to define and reach consensus on the core intellectual disability mental health workforce attributes and the lessons learned from using this approach. Thirty-six intellectual disability mental health experts from across Australia participated in a modified online Delphi. At the end of each Delphi round the research team completed descriptive analyses for the quantitative data, and content and thematic analyses for the qualitative data. The research team subsequently critiqued the method in terms of its utility in defining workforce attributes. Authors identified several lessons from using this method to define core workforce attributes. In particular, it has highlighted the potential benefit of initiating the Delphi process with a developed framework that is familiar to the workforce; the benefit of using quantitative and qualitative methods; and the need to reconsider how to define participant consensus. This study confirmed the utility of a modified online Delphi method to identify and describe core workforce attributes, provided insights into the benefits and challenges of this method, and identified strategies for overcoming some of the commonly documented limitations of the Delphi method. However, it has also highlighted some additional challenges of the Delphi method that researchers have not commonly described within the published literature. The lessons provide useful insights for others planning to use the Delphi method. [ABSTRACT FROM AUTHOR]

The W orld R eport on D isability identifies employment as an important element of social participation. The Report also points to the need for research that crosses national boundaries to identify and address central areas of concern. However, such efforts are hampered with respect to intellectual disability ( ID) by inconsistencies in the population definitions used, the definition of employment or employability, and metrics of employment participation. The authors explore the varied ways in which employment participation rates for people with ID are determined and reported in jurisdictions around the world, and note that with respect to employment metrics, there remains substantial variation in the methods used in data collection and reporting across agencies and countries. They also note that close inspection of methodologies is required in order to interpret data from any official statistical agency (as even when methods and definitions are explicit, the variations in approaches make comparisons difficult). Recommendations for harmonizing disparate definitions and metrics include a systematic analysis of the terminology and methods used in national surveys that would assist in identifying which data are comparable, agreement on a protocol and process for examining employment outcomes in the ID population, and the creation of an international panel on employment and ID charged to identify common terminology and population parameters to be specified in sample selection and description in localized research and studies. [ABSTRACT FROM AUTHOR]

The practices of effective primary school teachers including students with Down syndrome in their mathematics classes are largely unexplored and many teachers feel unprepared to teach students with an intellectual disability. The authors sought to find out what these specific professional learning (PL) needs were and if they changed over time. A mixed methods study was undertaken to investigate the practices of primary mathematics teachers including students with Down syndrome in regular class lessons in two Australia educational jurisdictions. A variety of approaches was used to gain an understanding of their practices. Findings are based on responses to a questionnaire administered to teaching teams at the beginning and end of the school year. There was a strong endorsement of inclusion as an appropriate practice in primary mathematics. The PL needs of teaching teams changed across the teaching year. Early requirements concerned understanding Down syndrome and its impact on learning and behavior. As the school year progressed, PL needs changed toward a greater focus on the need for specific resources and strategies for teaching mathematics. The PL requirements of teachers included the need for 'in-time' support. The authors conclude that even if it may be infrequent when a teacher has a student with Down syndrome in a mathematics class, teachers still need access to PL that evolves across the school year, from less focus on syndrome-specific information to greater emphasis on teaching mathematics through adjusting learning outcomes and teaching approaches. [ABSTRACT FROM AUTHOR]

Described and discussed are comparative employment policies and programs for people with intellectual and other disabilities in Australia, Finland, and Sweden. The dominant economic and social policies of many Western countries are such that they continue to place considerable pressure on the development and maintenance of employment programs for people with intellectual and physical disabilities, particularly for those with high support needs. The authors note that these policies often result in tension between the simultaneous achievement of person-centered principles for people with disabilities and a desire for improved service efficiencies and accountability. In addition, a concern raised by specialists in all three countries is the demise of low skilled jobs, which traditionally have attracted people with intellectual disabilities. It is proposed that improving the level of education and training available for people with intellectual disabilities may improve their employment opportunities. In this vein, key aspects of these countries’ respective support programs were identified as an aid to policy-makers and service providers reconciling the disparities between employment needs and opportunities. [ABSTRACT FROM AUTHOR]

The life expectancy of persons with intellectual disability is increasing, and this is often occurring concurrently with the aging of their long‐term parental carers. Research in both Australia and around the world indicates that proactive post‐parental care planning is not widely implemented, and transitions primarily happen suddenly following a personal crisis for the primary caregiver. Little focus in Australia has been placed on identifying the barriers that inhibit post‐parental care planning in rural areas, specifically in the context of the newly implemented National Disability Insurance Scheme. This paper examines the factors that limit disability services and their staff in supporting successful post‐parental care planning for individuals with intellectual disability and their aging carers in rural South Australia. Small focus groups were conducted with three groups of rural disability support workers using online technologies to assist with the participants' geographic disparity. A semi‐structured interview guide was developed prior to commencement and was used to initiate discussions on key points. A thematic analysis methodological approach was used for data analysis. There were three themes identified through the analysis; Recruitment; Provision of Care; and Retention. The key findings relating to these themes are presented and supported with exemplar quotes. This research proposes three recommendations for policy or practice change: developing a national advertising campaign for new disability staff that positively emphasizes the high‐level skillset need for proactive planning; supporting rural disability providers to collaborate to establish shared teams of staff with expertise in post‐parental care planning; and, using incentive payments to retain staff with these invaluable skillsets in the disability sector. [ABSTRACT FROM AUTHOR]

Persons with cognitive disabilities such as intellectual disability, borderline intellectual disability, and acquired brain injury are overrepresented in Australian criminal justice systems both as victims and as offenders. Data obtained in Australia and internationally indicate that up to 12% of the prison population has an intelligence quotient ( IQ) of less than 70, with up to 30% having an IQ of between 70 and 80, indicating substantially higher representation of intellectual disability and borderline intellectual disability than in the general population. Indigenous Australian adults in prison are significantly more likely to have intellectual disability than their non-Indigenous counterparts. Points of intervention throughout individuals' trajectories into and through the criminal justice and human service system are investigated, allowing new ways of understanding how persons with intellectual and other cognitive disabilities are vulnerable to the harms of control-and-punishment systems. Using an innovative data-linking and data-merging method, the authors compiled longitudinal administrative data from all criminal justice and human service agencies in New South Wales, Australia, to create life-course pathways for 2,731 persons who had served time in prison in New South Wales and whose mental health and cognitive disability diagnoses were available. Mapping service agency responses and institutional trajectories of these persons from an early age reveal a picture of early police contact and enmeshment in juvenile and adult corrections with high frequency, but often of low duration. Poor recognition of cognitive disability coupled with the presence of mental disorders and substance use disorders is associated with multiple and compounding social disadvantage and vulnerability to harm. This group is subject to multiple, simultaneous, and continuing human service agency interventions, which have only limited impact on their offending and (re)incarceration. Provision of appropriate support before, during, and after imprisonment is likely to reduce these individuals' vulnerability to harm and improve their experiences of community integration. [ABSTRACT FROM AUTHOR]

Recent weather-related disasters (i.e., floods, fires) impacting Australia may potentially increase in frequency and severity as a result of predicted climate variability. The dearth of literature pertaining to school emergency response planning for vulnerable students with disabilities (including those with intellectual disabilities) when such disasters occur and the lack of evidence-based support for school guidelines addressing the needs of such students led the authors to investigate the presence and extent of governmental policies and guidelines underpinning disaster management in schools in Australia. In the absence of routine policies and procedures, students with disabilities may be placed at risk to ill-advised evacuation efforts or neglected during severe emergencies. The study's results indicate that insufficient consideration has been given to the emergency preparedness planning and management with respect to meeting needs of vulnerable students with disabilities. The findings suggest that disaster preparedness is underresourced and possibly neglected. Although the particular needs of vulnerable students with disabilities are briefly noted in the various state governments' education policies, they have not been systematically considered in the context of overall disaster planning for Australian schools, with the ambiguity of student characterization terms such as 'special needs' adding to the problem. The study also scrutinized the terms with respect how they might impact school plans that relate to emergency management. The authors conclude that processes already embedded in local schools for students with disabilities may be possible vehicles to appropriate statewide emergency management planning. They recommend that education authorities worldwide review current emergency management policies in a consultative manner with schools, researchers, first responders, and carers so as to minimize risk for students with disabilities in natural disaster emergencies. [ABSTRACT FROM AUTHOR]

International covenants and domestic social policies in most developed countries regard people with intellectual disability as citizens with equal rights, suggesting they should have the similar aspirations of a healthy and active old age as the general community, and an expectation of the necessary supports to achieve this. This article compares the development and implementation of accommodation support policies for people aging with intellectual disabilities in five liberal welfare states. It describes the limited development of policies in this area and suggests possible reasons why this is the case. A review of the peer reviewed and grey or unpublished advocacy and policy literature on aging policies for people with intellectual disability was conducted which covered Australia, Canada, Ireland, the UK, and the U.S. Despite consistent identification of similar broad policy issues and overarching goals, little progress has been made in the development of more specific policies or implementation strategies to address issues associated with accommodation support as people age. Policy debates have conceptualized the problem as aging in place and the shared responsibility of the aged-care and disability sectors. This may have detracted from either sector leading the development of, or taking responsibility for, formulating, implementing, and resourcing a strong policy framework. [ABSTRACT FROM AUTHOR]