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Purpose Research into culture within intellectual disability services, has predominantly focussed on small group homes in Australia. The current investigation aimed to explore the transferability of the dimensions of culture identified in the literature, to a residential Intellectual Disability service in the UK. The purpose of this study was to better understand the impact of informal culture upon the behaviour of direct care staff, particularly around managing behaviour that challenges. Design/methodology/approach Semi-structured interviews were conducted with direct care staff. Interview transcripts were analysed thematically using template analysis. Findings Themes regarding leadership, perceptions of managers, team functioning, and relationships between direct care staff and service users, were identified, corroborating the existing literature. Additional themes relating to being aware of the risks posed by service users, and the emotional impact of behaviour that challenges, also emerged. Originality/value To the best of the authors’ knowledge, this is the first qualitative study to explore informal culture within a community residential Intellectual Disability service in the UK.

Purpose The purpose of this paper is to summarise the current state of empirical knowledge pertaining to online risk and cybercrime relating to people with intellectual disabilities (ID). Design/methodology/approach This narrative review summarises, synthesises and critically evaluates the current literature and state of knowledge and offers suggestions for extending current knowledge and practice. Findings Evidence regarding risk for people with ID is limited but growing. Existing findings highlight that: risk may increase contingent upon higher levels of sociability, loneliness, anxiety and depression, poorer insight, judgement, discrimination and ability to detect deception online and reduced experience and life opportunities; people without ID perceive high online risk for people with ID, which may lead to gatekeeping restrictions and controlling digital access; restriction may potentially impede online self-determination, participation and development by people with ID; and experience of risk may enhance awareness, independence and resilience in managing future online risk amongst people with ID. Further research work is needed in this area to enhance understanding of risk experience and effective support strategies. Originality/value This review of current knowledge has highlighted the necessity for more research to better understand the propensity for engagement in different risky online behaviours and to better inform support practices to help people with ID to manage risk whilst maintaining digital inclusion.

Purpose – The purpose of this paper is to reflect on the response to the scandal of abuse in services for people with intellectual disabilities in the light of research evidence and analysis. Design/methodology/approach – Critical reflection and review of literature. In particular, recent research into possible indicators that a service is at risk of becoming abusive is used to test the hypotheses and implied solutions that are currently being adopted. Findings – That some of the responses to recent scandals are necessary but not sufficient to prevent future harm. Furthermore, some of the proposed solutions may actually increase the likelihood of further abuse. Prevention of abuse requires a broader and more evidence-based response. Originality/value – The synthesis of research and analysis presented here has not been presented previously in the published literature.

Purpose– This commentary takes Marslandet al.’s paper about services at risk of becoming abusive to the people they support, as a platform to consider issues around implementation science and its role in minimising this risk. The paper aims to discuss this issue.Design/methodology/approach– The commentary is a selected review of implementation science. The research is used to define implementation, identify prerequisites, selectively review methods and comment on fidelity.Findings– The commentary proposes that implementation science has an important role in ensuring evidence-based practice transfers from research to disability services.Originality/value– The commentary offers a viewpoint based on combined research evidence and clinical practice.

Purpose – The purpose of this paper is to present early outcomes and case examples from the Ealing Intensive Therapeutic and Short Break Service. Design/methodology/approach – The service was piloted over a period of 3.5 years during which clinical data were collected for young people at risk of a move to residential care. Findings – There were positive outcomes for young people with intellectual disabilities and challenging behaviour who were seen through the service with residential placements prevented in the vast majority of cases. Originality/value – These early outcomes highlight the importance of providing intensive therapeutic intervention with short breaks in order to prevent family placement breakdown.

This article starts with a brief overview of the history of housing for people with intellectual disability in Austria. The system of care and Austrian disability policy are also examined, focusing on implementation of deinstitutionalisation and community living. The following analysis of services provided in the field of housing for people with intellectual disabilities shows that support is provided in undistinguished, generalised service packages based on a competency model. Academic research on community living is quite rare in Austria, and fails to take into account the subjective perspective of people with intellectual disabilities.

It has been suggested that the emotional needs of people with intellectual disabilities have been neglected (Kroese, 1998). More recently there has been evidence of increased clinical and research activity in this area (Beail, 2003; Bouras & Holt, 2007; Foundation for People with Learning Disabilities, 2004). Currently much of the focus in this area is on mental ill‐health. This article will consider briefly the literature on mental ill‐health, with particular emphasis on the development of individual treatment approaches. From this discussion it will be evident that much of the research and theory in this area focuses on deficits and disadvantage. I will go on to suggest that a clinical and research focus that explores strengths and resilience will offer a more positive agenda for developing understanding of emotional well‐being and mental ill‐health in people with intellectual disabilities.

Purpose – Active support (AS) influences the way staff support people with intellectual disabilities to take part in everyday activities. Changes in work practices may affect job satisfaction. The impact of AS on job satisfaction has not, however, been widely studied. Job satisfaction is linked with levels of staff turnover and the overall quality of services provided to people with intellectual disabilities (Coomber & Barriball, 2007; Hatton et al., 2001). The purpose of this paper is to describe an evaluation of job satisfaction amongst 38 direct care staff working in intellectual disability services before and after AS was implemented. Design/methodology/approach – A single group, repeated-measures design was used. In total, 38 members of direct care staff received AS training. Data on job satisfaction were collected before, and after, AS was implemented. In total, 19 members of staff took part in a follow-up 12 weeks later. Findings – There was a significant increase in reported job satisfaction following the implementation of AS. Subscale analysis revealed that the most significant increases in job satisfaction were related to areas directly targeted by AS, including satisfaction with skill level and satisfaction with amount of time spent with service users. Originality/value – Implementing AS may provide an added benefit for direct care staff, who feel more satisfied at work. While a significant number of papers have been published focusing on the benefits of AS, no papers have specifically looked at the impact that the intervention can have on job satisfaction.

Purpose – The purpose of this paper is to evaluate the impact of assistive technology (AT) on social care services and on the quality of life (QOL), particularly the independence, of people with intellectual disabilities. In addition, to make recommendations about an ethical approach to implementing AT. Design/methodology/approach – The evaluation is based on consideration of relevant research, particularly, research undertaken at the Welsh Centre for Learning Disabilities at Cardiff University. Findings – AT can promote independence and prevent harm. There also appear to be benefits to social care services in terms of changes in staff input levels and reduced costs. However, the data are limited and existing studies have shown mixed results. Research limitations/implications – This is not a systematic review. Revised research methods may be needed to detect key outcomes from AT. Practical implications – A focus is needed on individual planning and robust and transparent processes to balance organisational and user benefits. There are implications for care management, person-centred planning and care commissioning to ensure good QOL outcomes are targeted by AT and that the delivery of these outcomes is monitored and ensured. Originality/value – Based on the existing literature on the impact of AT on people with intellectual disabilities, recommendations are made about an ethical approach to implementing AT.

Purpose The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”. Design/methodology/approach The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed.

PurposeThe purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like.Design/methodology/approachThis paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance.FindingsPeople admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital.Originality/valueService providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGillet al.(this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld.

Purpose Having paid work, relationships and a choice of where to live are common policy priorities for adults with intellectual disabilities. The purpose of this paper is to compare outcomes with respect to these three priorities between adults with intellectual disability and the general population in Jersey. Design/methodology/approach Data were collected from 217 adults with intellectual disability known to services, and 2,350 adults without intellectual disability using a stratified random sample. Data on employment, marital status and accommodation profiles were compared. Findings In sum, 87 per cent of adults with intellectual disability were currently single vs 16 per cent of adults without intellectual disability; 23 per cent of working-age adults with intellectual disability were in paid employment vs 92 per cent of working-age adults without intellectual disability; and 57 per cent of adults with intellectual disability lived-in sheltered housing vs 2 per cent of adults without intellectual disability. Social implications Very few adults with intellectual disability are in paid employment or intimate relationships, and the majority live in sheltered, supported housing, with very few owning their own home. There is a significant disconnect between policy and reality. Considerable work is required to make an ordinary life the reality for adults with intellectual disability. Originality/value This study adds to the body of evidence that suggests people with intellectual disabilities are less likely to experience an ordinary life. Furthermore, it illustrates that despite Jersey being an affluent society, the same difficulties and barriers exist there for persons with an intellectual disability as in other jurisdictions.

Purpose The purpose of this paper is to consider issues around obesity and overweight for people with intellectual disabilities (IDs). Design/methodology/approach A review of the literature is provided looking at issues around overweight and obesity for adults with IDs. Both prevalence studies and intervention studies were considered. Findings The prevalence of overweight and obesity is considerably higher for adults with IDs when compared to the general population. Intervention studies focusing on multiple components seem to be the most effective. However, future research should focus on randomised control trials taking into consideration the views of people with IDs. Originality/value This paper synthesizes some of the available evidence on obesity and overweight for adults with IDs providing clear recommendations for the future.

Purpose The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID). Design/methodology/approach A review of the literature was conducted, followed by a discussion. Findings No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ. Research limitations/implications Research is needed to further current understanding of these issues. Practical implications An awareness of these issues amongst practitioners and other key members of a PWID’s system is important. Originality/value This is the first review and commentary on these issues.

Purpose The purpose of this paper is to provide a commentary on issues raised in the paper “A family’s battle to understand ‘challenging behaviour’”. Design/methodology/approach Drawing on literature associated with issues identified in the paper this commentary will reflect on the evidence associated with providing specialist support to people with intellectual disabilities and challenging behaviour. Findings Families, individuals and services are unable to access timely and appropriate specialist support for individuals with intellectual disabilities and challenging behaviour. As individuals go on to develop behaviours associated with a lack of intervention their levels of vulnerability increase due to their exclusion from services and their local communities. Originality/value The commentary provides a discussion on the issues faced by individuals and their families in relation to intellectual disabilities and challenging behaviour.

Purpose – The purpose of this paper is to serve as a commentary on the work reported by Hilary Johnson and her colleagues, which used partnership working as a lever for developing community inclusion for people with complex communication needs. Design/methodology/approach – The commentary uses the wider literature on social inclusion as well as narrative from current policy in England on the development of “Transforming Care Partnerships” to explore some of the issues raised by the research. Findings – The conclusion is that physical integration is only the starting point for a vision where people with the most complex needs live the “included life” which evolves by developing partnership working and reciprocal relationships between people with and without disabilities. Originality/value – This paper attempts to highlight relevant key research in the area of social integration as a way of reviewing the likely impact of recent policy on the lives of people with intellectual disabilities and the most complex needs.

Purpose – The purpose of this paper is to provide a commentary on “An audit of an Intensive Interaction service”. Design/methodology/approach – Drawing on the literature regarding other related person-centred approaches and clinical and research experience, an argument is made that people with profound intellectual and multiple disabilities are particularly at risk when service innovation does not account for their unique needs. Findings – Practice and service models need to specifically account for the needs of people with profound intellectual and multiple disabilities. Originality/value – The commentary draws attention to the importance of implementation and seeks to draw lessons from well established, service wide approaches for people with intellectual disabilities.

Purpose – The purpose of this paper is to reflect on Rebecca Monteleone’s paper “Employment for all: United States Disability Policy” and provides a commentary on its implications for the UK. Design/methodology/approach – The approach is to provide a comparison of the situation described in the article for the USA with that of the UK. Findings – There has been significant progress in legislation and policy relevant to the employment of people with intellectual disabilities (IDs) in the USA. They have achieved higher employment rates than the UK, but are still at lower levels of employment than other citizens. The importance of collecting data on the employment rates of people with ID to monitor policy effectiveness is clear. The US has a more comprehensive approach to transition to employment that the UK could learn from. The importance of job coaching to community-based employment is highlighted. The balance of investment between community and sheltered jobs appears to be the key to further growth of community-based employment rates. The detailed impact of welfare benefit regulation is important to motivation to work and changes need to be monitored from an ID perspective. Originality/value – This paper contributes to cross-cultural policy comparisons and underlines the value of comparing and contrasting legislation, policy and outcomes across countries.

Purpose – The diagnosis and management of cancer in people with intellectual disabilities (PWIDs) are fraught with difficulties. The purpose of this paper is to present a case study to highlight these difficulties. Design/methodology/approach – The present case analysis describes the presentation of a 56-year-old man with a profound intellectual disability, who developed recurrent chest infections and died as a result of obstructive pneumonitis. Findings – Despite a presentation over several years and numerous chest X-rays demonstrating a consistent lung abnormality, it was only on postmortem examination that a right-sided lung carcinoma was detected. Originality/value – The papers have provided an update on the topic in light of recent legislations and management strategies which need to be applied to clinical practice if any improvement is to happen in the care of PWID.

PurposeThe purpose of this paper is to provide a commentary on the previous paper in this issue “Changes in the provision of residential care for adults with an intellectual disability: a national longitudinal study”.Design/methodology/approachThe commentary outlines some of the challenges and potential drivers of deinstitutionalisation and community living including the United Nation's Convention on the Rights of Persons with Disabilities.FindingsThe paper finds that the UN Convention and the practice of international organisations that fund investments in social care can potentially drive the replacement of institutions with community‐based services for people with intellectual disabilities.Originality/valueThe argument for deinstitutionalisation and community living needs to be maintained more broadly rather than being focused on certain countries or regions. Community living for people with intellectual disabilities should be a global agenda with an emphasis on the human rights of people.