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Background: Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. Method: Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. Results: The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. Conclusions: The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.

Background: Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. Method: Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. Results: The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. Conclusions: The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.

BACKGROUND: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

BACKGROUND: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self-help therapies for depression. METHOD: Twenty-one purposively sampled supporters were interviewed. The semi-structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. RESULTS: Supporters were positive about both therapies and reported both therapy-specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. CONCLUSIONS: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population.

BACKGROUND: Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE: The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN: A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING: Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS: Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS: BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES: The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS: There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points)

BACKGROUND: Depression is the most prevalent mental health problem among people with learning disabilities. OBJECTIVE: The trial investigated the clinical effectiveness and cost-effectiveness of behavioural activation for depression experienced by people with mild to moderate learning disabilities. The intervention was compared with a guided self-help intervention. DESIGN: A multicentre, single-blind, randomised controlled trial, with follow-up at 4, 8 and 12 months post randomisation. There was a nested qualitative study. SETTING: Participants were recruited from community learning disability teams and services and from Improving Access to Psychological Therapies services in Scotland, England and Wales. PARTICIPANTS: Participants were aged ≥ 18 years, with clinically significant depression, assessed using the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities. Participants had to be able to give informed consent and a supporter could accompany them to therapy. INTERVENTIONS: BeatIt was a manualised behavioural activation intervention, adapted for people with learning disabilities and depression. StepUp was an adapted guided self-help intervention. MAIN OUTCOME MEASURES: The primary outcome measure was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD). Secondary outcomes included carer ratings of depressive symptoms and aggressiveness, self-reporting of anxiety symptoms, social support, activity and adaptive behaviour, relationships, quality of life (QoL) and life events, and resource and medication use. RESULTS: There were 161 participants randomised (BeatIt, n = 84; StepUp, n = 77). Participant retention was strong, with 141 completing the trial. Most completed therapy (BeatIt: 86%; StepUp: 82%). At baseline, 63% of BeatIt participants and 66% of StepUp participants were prescribed antidepressants. There was no statistically significant difference in GDS-LD scores between the StepUp (12.94 points)

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI –2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change –4·2 GDS-LD points [95% CI –6·0 to –2·4], p<0·0001; StepUp, mean change –4·5 GDS-LD points [–6·2 to –2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants’ total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our know

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI −2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change −4·2 GDS-LD points [95% CI −6·0 to −2·4], p<0·0001; StepUp, mean change −4·5 GDS-LD points [–6·2 to −2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our kn

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI –2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change –4·2 GDS-LD points [95% CI –6·0 to –2·4], p<0·0001; StepUp, mean change –4·5 GDS-LD points [–6·2 to –2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants’ total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our know

Background Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). Methods We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Findings Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI −2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change −4·2 GDS-LD points [95% CI −6·0 to −2·4], p<0·0001; StepUp, mean change −4·5 GDS-LD points [–6·2 to −2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported. Interpretation This study is, to our kn

The research that informed this paper asked: how can we work as allies of groups of which we are not a part? This question is particularly focused on work with people who have experienced colonisation by those who are aligned (by race, class, gender, culture or position) with the colonisers or oppressors. The research brings together literature in the fields of community work, adult education, and feminist and postcolonial theory, with Indigenous viewpoints and experience. An analysis of Indigenous viewpoints identified a range of key ideas about achieving social change. These ideas are developed into several frameworks, two of which will be discussed here. The first framework offers a way of conceptualising work against oppression and proposes that it must involve a focus on fostering emancipatory agency. Emancipatory agency involves the capacity to know and to act towards social justice ends via meaning making which follows ethical criteria. An ethics of meaning making is proposed which includes a focus on: multiplicity and difference; the partial nature of all knowings; the context / situatedness of meaning; and the critical / reflective attitude in meaning making. This type of agency is dependent on the process of transformative dialogue which is inherently communal and is based on four micro processes: affirming the O/other; encountering, exploring and experiencing of multiple and partial views; moving between positions of self and others; and enacting meaning into the world. A second framework operationalises these ideas in the field of community development, and offers a method of practice.

This collection of essays, co-edited with Katie Scott, redefines the study of the decorative arts in eighteenth-century France. It includes broader accounts of the impact of Enlightenment philosophy in shaping the understanding of the 'decorative arts' alongside case studies of silks, furniture, and architecture, drawing on recent theories of the body and space. Alive to the everyday pleasures found in objects, furnishings and dress, the volume illuminates the material worlds of consumers, from the extravagance of the court to the more modest taste of middle-class families, linking these material worlds to political and social life. The culture of luxury goods is considered alongside the changes to dress and design in the Revolutionary period

This collection of essays, co-edited with Katie Scott, redefines the study of the decorative arts in eighteenth-century France. It includes broader accounts of the impact of Enlightenment philosophy in shaping the understanding of the 'decorative arts' alongside case studies of silks, furniture, and architecture, drawing on recent theories of the body and space. Alive to the everyday pleasures found in objects, furnishings and dress, the volume illuminates the material worlds of consumers, from the extravagance of the court to the more modest taste of middle-class families, linking these material worlds to political and social life. The culture of luxury goods is considered alongside the changes to dress and design in the Revolutionary period

This collection of essays, co-edited with Katie Scott, redefines the study of the decorative arts in eighteenth-century France. It includes broader accounts of the impact of Enlightenment philosophy in shaping the understanding of the 'decorative arts' alongside case studies of silks, furniture, and architecture, drawing on recent theories of the body and space. Alive to the everyday pleasures found in objects, furnishings and dress, the volume illuminates the material worlds of consumers, from the extravagance of the court to the more modest taste of middle-class families, linking these material worlds to political and social life. The culture of luxury goods is considered alongside the changes to dress and design in the Revolutionary period

As a contribution to the development of a National Prevention Agenda, the Department of Health and Ageing commissioned a consortium comprising the National Drug Research Institute (Curtin University) and the Centre for Adolescent Health (Melbourne University) to consolidate national and international evidence on best practice in prevention of substance misuse. The researchers examined international and national data, literature and programs that provide evidence of good practice in preventing or delaying the onset of drug use and that address the risk and harm known to be associated with drug use. The resulting monograph is a comprehensive document which outlines patterns of substance use and harm, considers risk and protective factors predictive of harmful drug use and extensively reviews the evidence available on national and international prevention strategies and approaches. The monograph is so extensive that it was decided to also produce a summary of the monograph's research and findings for use be people who require an overview of the findings on research into prevention

As a contribution to the development of a National Prevention Agenda, the Department of Health and Ageing commissioned a consortium comprising the National Drug Research Institute (Curtin University) and the Centre for Adolescent Health (Melbourne University) to consolidate national and international evidence on best practice in prevention of substance misuse. The researchers examined international and national data, literature and programs that provide evidence of good practice in preventing or delaying the onset of drug use and that address the risk and harm known to be associated with drug use. The resulting monograph is a comprehensive document which outlines patterns of substance use and harm, considers risk and protective factors predictive of harmful drug use and extensively reviews the evidence available on national and international prevention strategies and approaches. The monograph is so extensive that it was decided to also produce a summary of the monograph's research and findings for use be people who require an overview of the findings on research into prevention

Coastal protection structures have historically been the most common approach to dealing with the problem of shoreline erosion in the United States. Three potential impacts of these structures have been identified, and include: (1) impoundment or placement loss, (2) passive erosion, and (3) active erosion. The first two are relatively straight forward and predictable. The third has been the subject of considerable discussion and debate, but until recently, has not been systematically investigated in the field. This report presents the results of 7 years of biweekly to monthly monitoring of beaches adjacent to seawalls along the central California coast. These surveys have allowed evaluation of both the seasonal beach changes due to the presence of seawalls as well as any longer term effects. Although active erosion during winter months has been documented at seawalls in this study, erosion has been seasonal and temporary in nature. A comparison of summer and winter beach profiles on beaches with seawalls and on adjacent control beaches reveals no significant long-term effects or impacts of seawalls in this location during this 7-year period. After 7 years of surveying, however, the question of how the seawall-backed beach would behave compared with the control beaches during a period of severe winter storms had still not been answered. During the eighth, and final, year of surveying an opportunity to answer this question was presented. In January and March of 1995, two winter storms struck the central coast causing extensive flooding and beach erosion. This report includes the results of surveys from January to September 1995, and reveals that the behavior of the seawall beach during these storms was consistent with the conclusions reached after the previous 7 years of surveying this site.