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Background: Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. Aims: To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. Method: The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. Results: Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8–32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. Conclusions: PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care. [ABSTRACT FROM AUTHOR]

Purpose - It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this paper is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists. Design/methodology/approach - The development of a structured clinical exam "station" designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process. Findings - The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists. Practical implications - The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles. Originality/value - Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the Department of Health to involve service users in the training of healthcare professionals. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to illustrate the difficulties patients with intellectual disabilities face when they present to a general hospital with ambiguous symptoms and highlights the importance of adequate training for general staff in caring for people with learning disabilities. Design/methodology/approach - The authors describe the pathway of a person with a learning disability and mental health problems from A&E, through a general hospital, to discharge and the problems encountered in terms of diagnostic clarity and subsequent treatment. Findings - Delay in recognising a psychiatric cause for his symptoms and wrongly attributing his symptoms to his learning disability may have led to a protracted admission and invasive tests. Originality/value - Education of healthcare professionals and proactive liaison work can help improve outcomes for people with intellectual disabilities when they are admitted to generic services. [ABSTRACT FROM AUTHOR]

Background: Ethnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories.Aims: To explore ethnic differences in the nature and duration of pathways into early intervention services.Method: In a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services.Results: Duration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies.Conclusions: Variations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP. [ABSTRACT FROM AUTHOR]