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We describe a computer-assisted program for conducting well-body assessments of children with neurodevelopmental disabilities attending a private special education school. Classroom instructors completed daily assessments to detect the presence of bodily injuries and other skin trauma, determine the need for medical treatment, and monitor healing status. Evaluations performed with the classroom instructors revealed that they implemented the program with high integrity and rated several procedural components favorably. Compared to "paper form" data recording, clinicians and supervisors judged the computer-assisted program to track student injuries more thoroughly and record student injuries more accurately. The importance of health monitoring among persons with neurodevelopmental disabilities, advantages of technology-based assessment methods, and practice considerations are discussed. [ABSTRACT FROM AUTHOR]

Many people with an intellectual and developmental disability (IDD) are biologically, socially, and economically/politically vulnerable to developing SARS‐COV‐2 (COVID‐19) compared to the general population. Most governments have developed public‐health policies and strategies to address the challenges that COVID‐19 has presented. These policies and strategies have been based upon the general population and in fact could be detrimental to the health and well‐being of people with IDD. This paper provides a review of the key learning points emerging from the COVID‐19 literature, together with guidance for the provision of services and government interventions for people with an IDD for future pandemics. Using guidance from the Joanna Briggs Institute, a scoping review was used to explore the current literature (scientific and grey) on IDD and COVID‐19. Three core themes emerged from the review. Prevention/protection: User‐friendly accurate accessible information, handwashing and social distancing, Personal Protective Equipment, shielding, track and trace, testing, vaccine compliance/hesitancy, and training. Mitigation: Making reasonable adjustments both to where people live, and to community healthcare/clinical practice; and the use of technology as a pandemic‐response strategy. Treatment/Management: Access to acute hospitals and lifesaving equipment, using a suitable clinical fatality assessment instrument, stopping Do Not Resuscitate notices, individualised care plans and hospital passports, family/paid carers to support people in hospitals; and use of telehealth in clinical care. This is the first international scoping review that provides a narrative synthesis of emerging themes related to the COVID‐19 pandemic and people with an IDD. This paper highlights themes related to preventing, mitigating, and treating/managing the care of this population during the COVID‐19 pandemic, which can inform future public‐health policies. This paper also exposes the negative impacts of public‐health interventions in both High‐Income Countries and Low‐Middle Income Countries for this population including lapses in upholding human rights. These data provide a basis for learning from the COVID‐19 pandemic in planning for future pandemics. [ABSTRACT FROM AUTHOR]

Purpose: Community-based forensic support services (CBFSSs) were commissioned nationally by National Health Service (NHS) England in 2017 in response to "Building the Right Support" (NHS England, 2015). CBFSSs provide multidisciplinary support to adults with intellectual disabilities and/or autism who are in (or at risk of) contact with the criminal justice system and those transitioning from inpatient secure care. This paper aims to highlight potential systemic barriers to accessing community forensic services for people from an ethnic minority background. in one CBFSSs in Northern England. Design/methodology/approach: This paper provides preliminary reflections on potential systemic barriers within the criminal justice system and health-care services that have implications for service users from ethnic minority backgrounds accessing CBFSSs. Findings: There is a paucity of data, policy and literature that focuses on people with intellectual disabilities and autism with forensic needs from ethnic minority backgrounds. This lack of data obstructs further reforms to meet the needs of this population. Originality/value: CBFSSs are commissioned across England. While some regional variation is to be expected, services should be aware of the systemic barriers people from ethnic minority backgrounds within their region face. These barriers should be considered and addressed when evaluating service efficacy and delivery. Recommendations are made to review and address issues of under-representation of ethnic minorities within CBFSSs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a commentary on Banks et al. and sets the wider context. Design/methodology/approach: It provides a brief narrative review of the literature on the factors that determine the quality of life of people with intellectual disabilities, including the impact of culture. Findings: Key to ensuring good quality of life outcomes is support that is facilitative, enabling and empowering which can compensate for severity of disability and improve people's experiences. This approach is called Active Support. Improving quality of life is a key part of preventing and responding to behaviours that challenge. Culture is an important factor in ensuring staff are motivated to work in such ways but is likely to be intertwined with many other factors. Originality/value: This paper summarises the key literature on what is needed to improve outcomes for people with intellectual disabilities. It introduces the importance of exploring how the different dimensions of culture interact and how culture, practice, processes and structures might work in a much more complex and intertwined fashion than previously conceptualised. [ABSTRACT FROM AUTHOR]

Experience Based Co-Design (EBCD) and co-production are interdisciplinary collaborative approaches to improve health care services by involving all stakeholders. These approaches capture the experiences of all stakeholders who come in contact with services and use experiences as evidence to promote and implement service changes. The use of psychotropic medications for behaviours that challenge (BtC) in people with intellectual disabilities (ID) is a complex issue because of its off-licence use and use in combination with other medications for physical and psychiatric comorbidities, which leads to overmedication of people with ID. As support staff plays a pivotal role in the prescribing for people with ID, we have developed a staff training programme, SPECTROM, to help reduce overmedication. A project team developed SPECTROM under the guidance of a Programme Development Group (PDG) consisting of 21 stakeholders. The PDG analysed data from a literature review, four focus groups and a co-design event day involving 26 stakeholders. In this paper, we have presented data based on the findings from the co-design event day, primarily on the issue of support staff effectively liaising with professionals such as doctors, nurses, and other community learning disability team members. In-depth information and recommendations were proposed at the co-design event, which helped develop the draft SPECTROM. The draft was finalised after receiving feedback from 56 stakeholders. Co-production and a modified EBCD can be successfully used to create training interventions and improve health care services. More research should utilise co-production and EBCD and use service users' experiences to develop interventions and improve health care services. [ABSTRACT FROM AUTHOR]

Purpose: Primary care psychological interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. People with learning disabilities within IAPT have poorer key clinical outcomes than people who do not identify as having a learning disability. During the global COVID-19 pandemic remote consultations have accounted for nearly 90% of all contacts in IAPT services; this paper aims to report the effects of these on outcomes for people with learning disabilities. Design/methodology/approach: Publicly available national data from the COVID-affected period are compared to the most recent available comparison periods that are not during the COVID pandemic. Data are presented graphically. Findings: People with learning disabilities differ little from those with no disabilities on several key process and outcome variables, although their clinical recovery is very much lower than those without disabilities. People with learning disabilities appear to have been affected by the changes in service delivery in a similar way to those without learning disabilities. Originality/value: Despite the shift to predominantly remote therapy delivery, outcomes for people with learning disabilities have not been differentially affected compared to those who have no recorded disability. The potential to learn what has worked and not worked in the delivery of remote interventions for people with learning disabilities is highlighted. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID). Design/methodology/approach: Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID. Findings: For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services. Practical implications: Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution. Originality/value: This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Copyright of Art of Healing / Sztuka Leczenia is the property of Jagiellonian University Medical College and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services. Design/methodology/approach: The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services. Findings: There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services. Research limitations/implications: Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda. Practical implications: This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff. Social implications: Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings. Originality/value: This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research. [ABSTRACT FROM AUTHOR]

This paper presents current information on policy developments, service design, best practices, and approaches to empower the users of health and medical care services for people with intellectual disabilities in Poland. Polish regulations allow systemic support to be provided for all people with disabilities. However, Polish patients with intellectual disabilitiy (PwID) and their caregivers face many barriers. Although a key obstacle is the lack of a standard definition that approaches disability in an interdisciplinary way, PwID are also more likely to experience difficulties in personal communication in medical settings and less likely to encounter specialists prepared to work with this group. There is also a need to pay greater attention to the expectations of PwID. To facilitate a holistic approach to diagnosis and therapy, there needs to be coordination between different specialists, including medical staff, paramedics, psychologists, and teachers. Providing personal communication training for medical personnel, as well as developing dedicated procedures for PwID in primary health care, clinics and hospitals, will improve equal access to health and health literacy for all in Poland. Even so, it is important to respect the autonomy of PwID and the commitment of caregivers. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities. Design/methodology/approach: As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities' community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs. Findings: Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature. Originality/value: This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability. [ABSTRACT FROM AUTHOR]

This is an official position paper of the National Joint Committee on Learning Disabilities (NJCLD), of which the Council for Learning Disabilities has been a long-standing, active member. Response to intervention (RTI) is a critical component of a multi-tiered service delivery system. This NJCLD paper presents concerns related to the implementation of RTI and its use as the sole method of evaluation to determine the identification and eligibility for special education as a student with a specific learning disability (SLD) and implications for transition. [ABSTRACT FROM AUTHOR]

Accessible summary: To feel safe and to keep well, all of us need to stay in touch with our friends—most of all in the pandemic, and even more if we have a disability.In these times of COVID‐19, we have kept a community group for men with learning disabilities going online.In the gaps between lockdowns, we have met in a mixed online and face‐to‐face group—with the face‐to‐face part happening in a library.The men say that they have been helped by both kinds of meeting, but that they liked the mixed or "hybrid" one the best.This article shows what we have learned from running the group in these ways, and it gives advice for anyone who might want to have a go themselves. Background: Social contact and belonging are among the most important keys to health and wellbeing, especially for the most vulnerable during the current global pandemic. Method: This reflective paper describes the authors' efforts to sustain an online version of a well‐established community psychology‐oriented group for men with learning disabilities, in challenging times. Drawing upon the learning disability literature and upon theories from community and embodied‐dialogical psychology, it explores the most salient shared issues, our joint efforts to address them and possible implications for future clinical practice. Findings: To take advantage of the discovered benefits of online working, we envisage that, post‐lockdown, the group will continue to meet in a "hybrid" (combined face‐to‐face and online form) as described herein: and with some pointers for anyone who might wish to create a similar group. [ABSTRACT FROM AUTHOR]

Background: The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method: A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results: A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion: Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to investigate the experiences of staff during the development and implementation of an Australian-first, family-focussed service addressing the mental health needs of young people (aged 12–25 years) with an intellectual disability. This study aims to understand the challenges and successes of the staff team when navigating their way in a new program working with a complex client group. Design/methodology/approach: This study used a thematic analysis on data collected from focus groups at two time points in the implementation phase of the new program. Thematic analysis of the data was conducted to identify important themes relating to the staff's challenges, successes and learning. Findings: The findings showed that there was a lot of adaptation needed for staff members trained in either mental health, or disability, but not both. Another key finding was the importance of working with the young person's family system as well as their existing system of support services. This major focus of the work for staff could be challenging due issues arising in the family unit and a lack of collaboration between services. Working with this complex client group was viewed as challenging and stress inducing; however, the motivation and attitudes of staff were found to be positive factors in the running of the program. Originality/value: This paper makes an original contribution to the field, as it provides a unique look at staff experiences when needing to adapt to a new and challenging workplace that was the first-of-its-kind in Australia. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities. Findings: Many people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal. Practical implications: People in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics. Originality/value: This is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline the work of the Supported Loving Network from its origin in academic research to the practical development of a national Network supporting relationships for people with learning disabilities.Design/methodology/approach First, the need for the Network is established through a review of the research literature. The paper goes on to critically discuss the Network's progress to date including its limitations and difficulties encountered, concluding by considering plans for future growth and development.Findings There is evidence that having a national Network is helpful in supporting intimate relationships for people with learning disabilities. The Network is having a positive impact on professionals who support people with learning disabilities by providing a space for discussion, inspiration and to share positive practice. However, an increase in resources would enable Supported Loving to have a wider reach and possibly a greater influence on organisations that provide social care to adults with learning disabilities.Originality/value The research indicates that people with learning disabilities are still less likely to have a loving relationship. The level of interest and engagement with Supported Loving implies that the Network is of value to people with learning disabilities and the professionals who work with them. [ABSTRACT FROM AUTHOR]

Accessible summary We wanted to know what people with learning disabilities know about dementia. We asked service users what the word meant to them, if they knew anyone with dementia, and what it was like to share a house with someone who has dementia. We learnt that: • Service users can know a lot about dementia. • Living with someone with dementia can be really hard – and staff do not always have enough time for everyone else. • Services should think more about how dementia affects everyone – not just the person who has the dementia. This paper reports on research that illuminates how people with a learning disability understand dementia and indicates the implications of these understandings for developing appropriate models of care. As this new policy and practice area struggles to provide appropriate and effective models of care for people with a learning disability and dementia, an awareness of service users’ understandings of dementia leads to a number of important insights. The wider research programme from which this paper is drawn aims to identify best practice in supporting people with learning disabilities to stay in their own homes as they grow older and develop dementia. A combination of focus groups, ethnography and individual interviews were conducted at eight sites across England. Participants were people with a learning disability who had dementia, and those who have lived with someone with dementia. The findings have the potential to improve support to this population as they grow older. [ABSTRACT FROM AUTHOR]

This paper describes the experience of mitigation experts in first degree murder cases in the penalty phase of the trial. The first author, who is a sociologist, has worked in capital murder cases since 1988, as a mitigation expert in over 200 such cases. The second author assists in the mitigation process by analyzing mental health and educational records. The focus of the paper is a discussion of a specific case in which the defendant committed suicide before the case went to trial. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore some of the themes identified by Wark et al.’s paper and to highlight commonalities and differences between the Australian and the UK social and health care regimes. It also points to evidence about other implications for policy and practice of the increasing numbers of people growing older who have learning disabilities. Design/methodology/approach – The commentary analyses some policy and practice documents and identifies a range of other research and commentary on this topic. Findings – Wark et al. have identified areas of importance for supporting older people with learning disabilities, particularly access to suitable and acceptable services and the importance of sufficient support worker time. They also identify gaps in the research on people’s needs and service responses. The commentary also highlights other factors for consideration in work with this group of people, particularly the implementation of personalisation policies in social care and integration between health and social care services. Research limitations/implications – There is a need for further research into developing policy and practice for health and social care for older people with learning disabilities. Some of the evidence supports the case for specialist involvement, particularly by nursing professionals. Originality/value – The paper and this commentary highlight the challenges associated with the increasing number of older people with learning disabilities in contemporary debates about the role of the state and professional specialists. [ABSTRACT FROM AUTHOR]

Aim: To determine if walking ability and presence of intellectual disability and epilepsy change from childhood to 50 years of age in individuals with cerebral palsy (CP), and if such changes are related to age, sex, or CP subtype.Method: This was a population-based follow-up study of 142 adults born from 1959 to 1978 (82 males, 60 females; mean age 48y 4mo, range 37-58y; 44% unilateral, 35% bilateral, 17% dyskinetic, and 4% ataxic CP) listed in the CP register of western Sweden. We compared childhood data with a follow-up assessment in 2016.Results: At follow-up, walking ability had changed significantly (p<0.001). The proportion of participants walking without aids had decreased from 71% to 62%, and wheelchair ambulation increased from 18% to 25%. Walking ability was related to subtype (p=0.001), but not to age, sex, pain, fatigue, or body mass index. The proportion classified as having intellectual disability had increased from 16% to 22% (p=0.039) and the proportion with epilepsy from 9% to 18% (p=0.015). Of those with childhood epilepsy, 46% were seizure-free without medication.Interpretation: Walking ability and the presence of intellectual disability and epilepsy had changed significantly since childhood. Life-long access to specialized health care is warranted for re-evaluation of impairments, treatment, and assistance. What this paper adds Changes in impairments in individuals with cerebral palsy (CP) over time are related to CP subtype. After 50 years, walking ability in CP may have deteriorated or improved. Intellectual disability in CP may not always be detected in early childhood assessments. Epilepsy in CP may develop after childhood or may be outgrown. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present information on the health care system in Germany with the focus on mental health care in people with intellectual disabilities (ID).Design/methodology/approach The paper is descriptive providing an overview of the general structure of the German health care system with historical and economic background. The paper also provides further information on the general social and health care in Germany for people with ID and medical education in the field of ID is used.Findings There is a highly developed health care infrastructure in Germany but health care for people with ID is not co-ordinated or universal. Mental health care for people with ID is predominantly in in-patient services. Only in recent years, out-patient services for people with ID have been developed. There is a little emphasis in medical education on the health care needs of people with ID.Originality/value The value of this paper is its description of health care in Germany and services for people with ID. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group. Design/methodology/approach – A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served. Findings – Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research. Research limitations/implications – This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions. Practical implications – The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently. Originality/value – The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for. [ABSTRACT FROM AUTHOR]

Purpose: Inspired by the work of the Keep Safe Advisory Group, this paper aims to explain and make the case for co-production as a powerful model for working alongside people with learning disabilities. Design/methodology/approach: The collaborative approach of the Keep Safe advisory group is the authors' springboard for a deep dive into the power and potential of co-production as a model. As organisational leaders – one with and one without a learning disability – the authors draw on their personal experience to argue that co-production is essential to recognising the adulthood of people with learning disabilities. Findings: Co-production means the equal sharing of power and responsibility from the start, best served by the leap of faith of a blank agenda. Co-production values different kinds of expertise as complementary – broadly considered as expertise from lived experience and professional expertise. When working co-productively, a deep investment of time to understand people pays dividends in outcomes and everyone's personal and professional growth. Co-production enriches the lives of everyone taking part. Originality/value: Co-production, though common currency in health and social care, remains too rarely understood and practiced. Readers will benefit from this reflective viewpoint, which aims to clarify and deepen what co-production really means. In particular, enabling people with learning disabilities to take responsibility for themselves and others is rarely considered but is presented here as foundational to human maturity and adulthood. [ABSTRACT FROM AUTHOR]

Background Transition to adulthood might be a risk period for poor health in people with intellectual disabilities. However, the present authors could find no synthesis of evidence on health and well-being outcomes during transition in this population. This review aimed to answer this question. Method PRISMA/ MOOSE guidelines were followed. Search terms were defined, electronic searches of six databases were conducted, reference lists and key journals were reviewed, and grey literature was searched. Papers were selected based on clear inclusion criteria. Data were extracted from the selected papers, and their quality was systematically reviewed. The review was prospectively registered on PROSPERO: CRD42015016905. Results A total of 15 985 articles were extracted; of these, 17 met the inclusion criteria. The results of these articles were mixed but suggested the presence of some health and well-being issues in this population during transition to adulthood, including obesity and sexual health issues. Conclusion This review reveals a gap in the literature on transition and health and points to the need for future work in this area. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to draw attention to the need for a more holistic approach to mental health training that brings together the medical and the social knowledge and skills required by today's practitioners.Design/methodology/approach - The paper is based on the authors' experience of developing, delivering and evaluating a joint mental health programme at London South Bank University between 2004 and 2008.Findings - The authors suggest some advantages of the model as indicated by the scant literature, the findings of a small pilot evaluation study and from information recorded and shared by other university providers of joint programmes - the Joint Programmes Forum. Further investigation is recommended.Research limitations/implications - The absence of systematic evaluation of joint programmes over the 20 years of their existence and the limitations of the evaluation undertaken by the authors is acknowledged.Originality/value - It is suggested in the paper that a specialist holistic training that incorporates nursing, social work (and in the future possibly occupational therapy and psychology) knowledge and skills would create well-prepared professionals to work with mental health and learning disability service user groups (and a similar model could equally be explored for older people and people with physical disabilities or long-term health conditions). This may be considered as a more successful solution to the effective integration of interprofessional education than the current struggles to superimpose it on uni-professional courses. [ABSTRACT FROM AUTHOR]

Background: There is strong evidence about the effectiveness of Active Support. Recent research has established predictors of good Active Support as staff training, practice leadership, and service setting size. This paper explores features of organisational leadership and structures predictive of Active Support. Methods: Multilevel modelling with data from surveys, observations and interviews was used to identify predictors of Active Support at the levels of service users (n = 253), services (n = 71) and organisations (n = 14). Results: Good Active Support was predicted by: (1) positive staff perceptions of management, (2) prioritisation of practice and Active Support by senior managers, (3) strong management support for practice leadership, (4) organisation of practice leadership close to everyday service delivery, and (5) concentration of practice leadership with frontline management. Conclusion: These findings extend understanding of predictors of Active Support and provide indicators of service quality, with important implications for service providers, service users and those monitoring the quality of services. [ABSTRACT FROM AUTHOR]

Résumé: Les personnes avec une déficience intellectuelle ont un risque plus élevé de développer un cancer colique ; le cancer du sein survient plus tôt et est plus souvent disséminé. Le taux de réalisation du dépistage organisé des cancers reste inférieur à la population générale. Cet article tente de comprendre les particularités du dépistage organisé des cancers chez les personnes avec une déficience intellectuelle et d'effectuer un focus sur une action de promotion en Auvergne-Rhône-Alpes. A higher risk of developing colorectal cancer is observed in people with intellectual disability; breast cancer occurs earlier and more often disseminated. However, the rate of organized cancer screening remains below the general population. This paper aims to understand the particularities of organized cancer screening for people with intellectual disability and to focus on a promotional action in Auvergne-Rhône-Alpes. [ABSTRACT FROM AUTHOR]

There is an increasing interest in the notion of health disparities, inequities and inequalities in Canada and elsewhere. In Canada, individuals with disabilities represent one of six groups identified as particularly vulnerable to health disparities.This paper combines the literature related to the concepts of inequity and inequality with the body of knowledge on health disparities faced by individuals with intellectual disabilities.The value of distinguishing inequity from inequality, particularly as it relates to the experience of individuals with intellectual disabilities, is highlighted.A framework for the study of health inequities based on intellectual impairment is proposed. [ABSTRACT FROM AUTHOR]

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/ strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general in its applicability to other areas of practice. [ABSTRACT FROM AUTHOR]

Psychiatric social work began in the early twentieth century as a result of a movement for community care of the mentally ill. Formerly preoccupied with institutional care of the mentally ill, psychiatrists now became interested in the control and prevention of mental illness in the community. This paper reviews the contemporary literature on early psychiatric social work. The paper then discusses the mental hygiene movement and early psychiatric social work practice. It concludes with a consideration of the changes in psychiatric social work which accompanied World War I. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss outcomes of a service redesign, involving an Intensive Support Team (IST) for adults with learning disabilities and challenging behaviour, working in conjunction with a Community Learning Disability Service (CLDS). Design/methodology/approach: Two IST staff were physically based as "Inreach workers" within a CLDS for six months. Inreach workers provided support with existing resources and consultation for specific clients presenting with challenging behaviour. CLDS staff confidence, understanding and implementation of existing challenging behaviour resources was evaluated before and after service redesign. An online questionnaire was used to gather further data relating to experiences of the Inreach project. Findings: CLDS staff confidence, understanding and implementation of existing challenging behaviour resources increased over the six-month inreach period. Questionnaire results indicated CLDS staff found Inreach support to be beneficial, having a perceived positive impact for clients, and providing clarity on the skills and resources provided by the IST. Research limitations/implications: The long-term effects of this pilot have yet to be established. Consideration is given to how demand characteristics may have influenced CLDS responses. Practical implications: Careful consideration should be given in terms of how ISTs interface with CLDSs. ISTs may consider being based physically within CLDSs, to provide more readily accessible support. Originality/value: Providing CLDS staff with more accessible support from ISTs may increase the effective implementation of available resources for adults with learning disabilities and challenging behaviour. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore perceptions of quality of life (QoL) of people with a dual diagnosis of learning disability and autism to facilitate a better understanding for clinical practice and service provision. Design/methodology/approach: Mixed methods were used to gain perceptions of QoL from 20 individuals referred to their local diagnostic service. Individuals completed questionnaires and participated in in-depth interviews which were thematically analysed. Findings: Subjective wellbeing scores were lower than those found in previous research. Social interaction was raised extensively with participants describing both positive and negative perceptions. The need for tailored social support and the value of individual control over environment were raised. Research limitations/implications: The study was small in scale and limited to subjects who had been referred for a diagnostic service. The study identified the need for further investigation, particularly in relation to the social relationships domain of QoL, and the impact of stress and anxiety. Originality/value: This study demonstrated that it is possible to access views from this group and that these views are nuanced. It suggests differences between reported QoL in people with learning disabilities who are and who are not autistic. Service design and individual approaches could be improved by a better understanding of these differences. [ABSTRACT FROM AUTHOR]

The concurrent ageing of parental care-givers and people with intellectual disabilities is driving academic and social welfare concern for a post-parental care 'crisis'. The 'crisis' typically pertains to a transition from primary care in the family home precipitated by the death or incapacity of older parents without a pre-planned pathway to post-parental care. This crisis is amplified in rural communities given low service engagement with families and a deficit of disability-supported accommodation and services. Academics, service providers and policy makers have responded through a problematisation of post-parental care planning. This focus continues to normalise informal care, burdens families with responsibility for planning, and diverts attention from structural deficits in the socio-political carescape. This paper attends to the Australian policy landscape in which long-term care-giving for families living with intellectual disability is enmeshed. It contends that the dyadic and didactic model of informal long-term care has profound implications for social service support and post-parental care planning. Problematisation of carers' 'need' to relinquish primary care and for people with intellectual disabilities to transition to independent and supported living is necessary to unsettle the dominant policy and service discourse around the provision of services to sustain informal care-giving. Innovation is then needed to forge pathways of support for families in rural communities planning on continuing, transitioning and transforming care arrangements across the lifespan. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.Design/methodology/approach A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.Findings There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.Practical implications The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.Originality/value This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism. [ABSTRACT FROM AUTHOR]

Current policy in UK health services emphasizes that, where possible, people with intellectual disabilities should access the same services as people without intellectual disabilities. One of the barriers to this is the confidence of clinicians and therapists. In this paper, we report on the development of a scale to describe the confidence of therapists in working with people with intellectual disabilities (the Therapy Confidence Scale-Intellectual Disabilities [TCS-ID]). One-hundred and eighty-one therapists who provided talking therapies but who did not work primarily with people with intellectual disabilities completed the scale; 43 people completed the scale twice for test-retest reliability purposes. One-hundred and seven people also completed a scale of general therapy self-efficacy. The TCS-ID has a single factor structure accounting for 62% of the variance, Cronbach's alpha for the scale is 0.93 and test-retest reliability is 0.83. There are significant differences in confidence based upon participants experience in working with people with intellectual disabilities and their therapeutic orientation, and there is a significant association between the TCS-ID and the General Therapy Self-efficacy Scale. Sixty clinicians working in mainstream mental health services received training on adapting their therapeutic approaches to meet the needs of people with intellectual disabilities. The TCS-ID was used pre-training and post-training and demonstrated a significant increase in confidence for all group. We suggest that the scale has good psychometric properties and can be used to develop an understanding of the impact of training for mainstream therapist in working with people with intellectual disabilities. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message There is increasing emphasis on people with intellectual disabilities receiving services from mainstream mental health services., There is no research describing the experiences and outcomes of people with intellectual disabilities receiving mainstream talking therapy services., The confidence that clinicians have in working with people with intellectual disabilities may be a barrier to them receiving mainstream services., The Therapy Confidence Scale-Intellectual Disabilities is a psychometrically sound scale for measuring the confidence of therapists in working with people with intellectual disabilities and is a useful outcome measure for training clinicians to work with people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals’ experiences of such tensions in the context of decision‐making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision‐making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users’ subjective experiences in the decision‐making process to challenge the definition of people with mental health problems as risky. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to raise issues about Transforming Care (TC) and discuss possible solutions.Design/methodology/approach Reflections and commentary on Transforming Care following Painter et al.’s article on correlates for the risk of admission to specialist hospitals.Findings Concerns are raised about the initial assumptions of TC, in particular the composition of the inpatient group and impact of the existing legal framework on reducing this population. The lack of cohesion between Care and Treatment Reviews and Care Programme Approach reviews is noted, and combining meetings is suggested.Originality/value The relevance of Wolfensberger’s social devaluation analysis is explored and O’Brien’s Personal Futures Planning is recommended as a potential way of drawing these currently disparate approaches together around the individual client. [ABSTRACT FROM AUTHOR]

Purpose: This narrative review aims to examine how trans people with intellectual disabilities are perceived and discussed in the academic literature. Design/methodology/approach: A narrative review was carried out to better understand the positioning of people with intellectual disabilities who identify as trans. Findings: There was a lack of clear terminology, an over medicalization of both people with intellectual disabilities and trans people and evidence that identifying with a non-conforming gender identity was seen as a problem by services. Services need to be better informed about issues around gender identity so that they are able to better support trans people with intellectual disabilities. Originality/value: To the best of the authors' knowledge, no previous literature review has focused only on trans people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – There is significant literature to demonstrate that people with intellectual disabilities are at higher risk of premature death, however there is relatively little evidence of research carried out on risk assessment in hospital for this patient group. This paper aims to share the outcomes from a patient safety project conducted in an acute hospital by the Trust's intellectual disabilities team. Design/methodology/approach – A project structure was used, supported by the Trust patient safety team through association with the National Institute for Innovation and Improvement: leading improvement in patient safety (LIPS) programme. The aim of the project was to bring together the current evidence, to understand the risk issues for this group and develop a robust risk assessment tool that could be embedded into the care processes in acute hospitals. Findings – A six month pilot concluded that a short assessment in a familiar format was more likely to be used by nurses. Risk assessment on its own does not deliver better and safer care. It must be accompanied by a series of clear, evidence based actions that used together ensure the patients' total safety and care needs are met. This tool is used throughout the Trust and in a number of other hospitals across the eastern region. Its use has contributed to reducing length of stay and improving health outcomes. Research limitations/implications – The paper shows the need for further research and data gathering. Originality/value – This study demonstrates that risk for patients with intellectual disabilities in hospital is complex. Education is essential to underpin new assessment tools for clinical practice. [ABSTRACT FROM AUTHOR]

This paper explores some of the issues and barriers to service user involvement for people with learning disability in mental health settings. In particular the paper focuses on barriers to involvement including staff attitudes and the involvement of service users in their own assessment and treatment. The issue of getting people involved in their own care is addressed and is highlighted using examples of good practice. [ABSTRACT FROM AUTHOR]

A common criticism of academic activity, including that of social work faculty, is that it does not fully engage in interaction with the realities of community life. This paper discusses an innovative partnership that seeks to address this criticism, describing collaboration between a graduate level school of social work in the United States and the National Alliance for the Mentally Ill, North Carolina Chapter (NAMI‐NC). NAMI‐NC is an advocacy organization for family members of people with severe mental illnesses, with a particular interest in system change in public mental health care. The partnership between the School of Social Work and NAMI‐NC has to date resulted in collaborative activities in three areas: (1) the development of a class project to provide NAMI‐NC with information needed for system reform; (2) the involvement of a group of students in the analysis of policy documents of interest to NAMI‐NC; and (3) the participation of a field placement intern (student placement) in gathering family input and opinion and infusing it into system reform efforts. [ABSTRACT FROM AUTHOR]

There is an enduring association between socioeconomic position and health, both over time and across major causes of death. Children and adults with intellectual disabilities are disproportionately represented among the poorer and less healthy sections of the population. But research on health inequalities, and on the broader societal influences on health, has yet to be integrated into perspectives and policy for people with intellectual disabilities.The paper reviews evidence on the patterns and causes of socioeconomic inequalities in health.It points to evidence that socioeconomic position is the fundamental determinant of health, drawing on longitudinal studies to highlight how it exerts its influence on health from before birth and across the lifecourse. The factors shaping an individual's socioeconomic position are also discussed.The paper concludes by identifying research and policy challenges. [ABSTRACT FROM AUTHOR]

The article presents the findings of a study on a selected group of 240 women admitted to the Asylum for the Insane in Kingston, Ontario, between 1878 and 1884, in order to build on the understanding of the role of asylum care and its benefit to patients. The study examines the asylum's treatment program during the late nineteenth century and its influence on the outcomes of committal. An examination of the moral treatment program illustrates the forms of health care and social assistance provided in the institution. A subsequent discussion of the outcome of asylum treatment and the rates of discharge demonstrates that Kingston's moral treatment program facilitated a curative experience for many women patients; several were confined for short periods to convalesce from emotional breakdowns, puerperal depression, and poor physical health. Yet the therapy program provided at Kingston also benefited the long-term care sector of the asylum's patient population. By accounting for this too-often forgotten group, the paper offers a complex analysis of the asylum's function, questioning the role of moral treatment in the long-term care of the mentally ill.

Much of the social scientific work on psychiatry and mental health, from a variety of competing perspectives, has focused upon power and the social construction of 'mental illness'. Very little attention has been paid to resistance or to the various ways in which 'patients' or 'survivors' (as some now prefer to refer to themselves) have sought to socially deconstruct 'mental illness'. This paper seeks to redress that balance by way of a detailed examination of some of the key practices of resistance which have developed within the context of the UK mental health survivors movement. Using key concepts from Bourdieu's theory of practice, it examines the challenge which survivors have mounted to the symbolic power of psychiatry, and the resistance habitus which their opposition has given rise to. [ABSTRACT FROM AUTHOR]

This review of British government policy on accommodation for people with learning disability compares two White Papers: Better Services for the Mentally Handicapped (DHSS, 1971) and Valuing People (DOH, 2002). NHS employment issues muted the influence of Better Services. Statistics show a slow transfer from the NHS to other providers, but little development of independent living alternatives since 1971, despite a policy emphasis on social inclusion themes in recent policy. Promotion of housing choice, where residential care provision dominates, inhibits inclusive housing. Valuing People does not address the potentially conflicting choices of disabled people and their families and is critical of local authorities for not supporting large-scale residential care. Supported living alternatives cannot receive sufficient support where residential care agencies' interests predominate. Better incentives are needed for local authorities to provide support for people with learning disabilities to safely live in a home of their own rather than in residential care. [ABSTRACT FROM AUTHOR]