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An introduction is presented in which the editor discusses various articles related to the researches associated with the mental health problems, conducted in several countries including Canada, Australia and the U.S. with in the issue.

Background Subjective wellbeing (SWB) in people with intellectual disabilities has been the focus of increased interest in the identification of support needs and as an outcome measure for interventions and service delivery evaluations. It is therefore important to conduct further research in this area, and to develop appropriate scales to measure SWB. Methods A new scale, the Personal Wellbeing Index-Intellectual Disability (PWI-ID) was administered to 114 adults with mild ( n = 82) or moderate ( n = 32) level ID in Victoria, Australia. Results The PWI-ID demonstrated good reliability and validity. A comparison of the findings with previous research indicates that participants’ SWB levels are within the normative range, and are similar to those reported by the general population. Conclusions The results support the notion that individuals with ID do not experience life quality lower than normal, which can be explained theoretically by the Theory of Subjective Wellbeing Homeostasis. The use of the PWI-ID may ultimately assist in ensuring that the needs of people with ID are being met and inform the planning and delivery of congruent resources and services. [ABSTRACT FROM AUTHOR]

People with a mental health or cognitive disability are vastly over-represented in the Australian prison system. Investigatory reports by Ombudsmen and similar organisations reveal that there is considerable scope for improving the treatment of this cohort. One avenue for doing so is using a human rights framework, given that Australia's international human rights law obligations require (among other things) that imprisoned people be treated with respect for their human dignity and, furthermore, recent international research demonstrating that fair and respectful treatment in prison may improve psychological well-being. However, there are considerable challenges involved in implementing this requirement in overcrowded and hierarchical prison settings. It is even more difficult to comply with the legal requirements given the web of provisions at the international, national and State/Territory levels, causing complexity and a lack of clarity as to their interrelationship. This article condenses the requirements into four principles and discusses how these have been applied by courts in relevant international and domestic cases. This analysis aims to assist correctional managers and policy makers seeking to comply with these legal requirements. Such compliance should form part of a multifaceted approach to protecting these vulnerable individuals from further harm. [ABSTRACT FROM AUTHOR]

Rates of offending peak in adolescence and associations between mental ill health and criminal behaviour have been well documented. Despite this, few studies have examined the nature or correlates of offending behaviours in young people with mental health problems, particularly in community settings. This study examined salient risk markers associated with police contact in a cohort of 802 young people (aged 12–25 years) seeking help from youth mental health services in Australia. Explanatory factors for analysis were obtained using validated clinical and psychosocial measures that participants completed via both interview and self-report. Regression analyses were conducted to determine which factors demonstrated the strongest associations with self-reported criminal charges. The results indicated that male gender, not being engaged in education, employment or training, frequent drug use and having experienced multiple adverse life events were related to police contact. This study indicates that the risk factors for offending commonly found in the general criminological literature are also those associated with offending in young people with mental health problems. The findings denote the need for a comprehensive therapeutic approach for such patients that accommodate both their clinical as well as criminogenic needs. [ABSTRACT FROM AUTHOR]

Purpose – While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The purpose of this paper is to gain feedback directly from staff regarding the problems they experience in daily work, and to evaluate whether any changes to legislation or practice could potentially alleviate identified areas of concern. Design/methodology/approach – A Delphi project was conducted over three rounds with participants from rural areas of New South Wales (NSW). The panel was composed of support workers who assist people ageing with a learning disability. Participants were asked their perceptions of the main practice issues facing them while they provide support. Findings – The panel identified 29 issues that were considered problematic in the provision of support to people ageing with a learning disability. A thematic analysis indicated three main themes of access to services; time constraints; and funding. Research limitations/implications – The participants in this study were all disability workers employed by non-government organisations in rural NSW, and as such, many of the issues identified may be specific to this population cohort and geographic setting. Any generalisation of these results to other locations or populations must be considered within these limitations. Originality/value – Identification of the issues facing disability staff may facilitate government, health care providers and disability organisations to proactively plan to address current and future problem areas. The consequent effect of improving practices can assist individuals to receive better support and lead to a corresponding improvement in their quality of life. The current implementation of the National Disability Insurance Scheme in Australia is an ideal opportunity for cross-sectoral collaboration to change practice to facilitate better support for a highly vulnerable group of the community. [ABSTRACT FROM AUTHOR]

Background Informed policy and service provision often relies on a sound statistical picture of a population and its geographical dispersion. Such a picture does not presently exist for Indigenous Australians with intellectual disability (ID) and co-occurring challenging behaviour (CB). Method Population statistics for 18- to 64-year-old Australians were sourced from the 2008 National Aboriginal and Torres Strait Islander Social Survey and 2007–2008 National Health Survey. CB was not directly counted; however, it has been linked to higher severity of intellectual impairment. Results National prevalence of ID for Indigenous adults was 7.6% and 2.5% for non-Indigenous. ID with profound or severe core activity limitation was 2.1% for Indigenous adults and 0.8% for non-Indigenous. Conclusion Population statistics afforded a broad picture of ID and severity of intellectual impairment. Policy and service provision for Indigenous peoples will likely benefit from methodologies that supplement population statistics and provide greater understanding of group dispersion. [ABSTRACT FROM AUTHOR]

Background Personality dimensions such as openness and agreeableness have been found to be associated with prejudice levels towards several minority groups. Yet these variables have been mostly ignored by existing research into attitudes towards people with intellectual disability ( PWID), which has primarily focused on contact and demographic variables. The current study investigated the relationship between personality dimensions and attitudes toward PWID. Methods An online survey was completed by 466 adult participants recruited through a variety of sources. The survey consisted of a well-validated attitude survey, the Big Five inventory, contact related and demographic questions. Results The hypothesis that higher levels of the personality dimensions openness and agreeableness would be significantly associated with positive attitudes towards PWID was supported. However the effect was relatively weak and the strongest predicting factor of positive attitudes was increased quality of contact with PWID. More positive attitudes were also associated with females, more highly educated and younger participants. Conclusions Results provide support for an integrated (including person and situational factors) theoretical approach to attitudes research in this field. Practically, results support programmes that stimulate and promote quality interactions between PWID and the wider community. [ABSTRACT FROM AUTHOR]

The author of this conceptual article was awarded a Churchill Fellowship to travel to the United States, Ireland, and United Kingdom to meet with researchers, practitioners, and community agencies and review how support for people with intellectual disability is provided. A specific focus was upon provision of care for individuals who were either ageing or requiring palliative care. The project took place from June to August 2013 and involved face-to-face interviews and site visits with key academics, government representatives, and community providers in Los Angeles, Chicago, New York, New Jersey, Dublin, Edinburgh, London, Oxford, Cambridge, Bath, Bristol, Birmingham, and Stoke-on-Trent. A priority was placed upon examining how the key features of leading practice models could be implemented within the Australian environment featuring a National Disability Insurance Scheme (NDIS). On the basis of the observations of practice, key points are discussed regarding the potential for improvements to the support of people with intellectual disability within the Australian context of the NDIS. [ABSTRACT FROM AUTHOR]

Background The impact of music therapy on the communicative behaviours of young people with profound intellectual and developmental disability has not yet been established. Method Four adolescents participated in individual music therapy (MT) and toy play sessions with the same therapist in a 6-month period. Sessions were video-recorded and analysed based on The Inventory of Potentially Communicative Acts (Sigafoos, J., Arthur-Kelly, M., & Butterfield, N. (2006). Enhancing everyday communication for children with disabilities. Baltimore, MA: Brookes) to compare the communicative behaviours within each condition. Results Both conditions successfully engaged the young people, with slightly more communicative behaviours observed in MT in response to singing, and more rejecting behaviours in toy play. MT was therefore considered equivalent to toy play in terms of quantity, but distinctive in eliciting more mutually enjoyable interpersonal encounters. Conclusion MT creates engaging and motivating conditions for interactions with others, which suggests the need for greater integration of music therapy into special education classrooms. [ABSTRACT FROM AUTHOR]

Deinstitutionalisation must extend beyond the closure of institutions to individualised support to people with intellectual disabilities and societal change. Castellani suggests that closure processes may be incompatible with effective deinstitutionalisation. This article draws on findings from two Australian studies of institutional closures to explore tensions in the closure process that occur in the policy context of applying managerialist principles to the delivery of services, and examines how these processes hindered or furthered the aims of deinstitutionalisation. It suggests closure can divert attention from planning for individualised support, the needs of staff may conflict with those of residents, transition plans may be disrupted by organisational imperatives and that little attention may be paid to broader community development strategies or micro‐level planning of the nature of staff support. The article reiterates the danger of equating institutional closure with deinstitutionalisation and the need to focus beyond the imperatives of closure. [ABSTRACT FROM AUTHOR]

Background: People with intellectual disability and chronic and complex support needs often require unique models of care that are intensive and expensive. How these supports can be continued within a rapidly changing policy and funding context in Australia, has not been fully determined. Method: This descriptive study utilised a retrospective electronic case-file audit design. Demographic details, chronic health conditions, medications, behaviours of concern, and overall support needs profile were mapped for 41 participants. Results: The profile is one of an ageing cohort, with high levels of chronicity and polypharmacy that requires a specialised workforce to fully meet their support needs. Conclusion: As the people with ID in this cohort age, the training needs of the current and future workforce will need to adapt as different issues become more prominent. How the national disability health and policy settings can best accommodate these support needs remains unclear. [ABSTRACT FROM AUTHOR]

This study describes the understanding, experiences and expectations of families living in rural and remote Australia regarding core concepts relating to disability service provision, including person‐centred practice (PCP), family‐centred practice (FCP), transdisciplinary practice (TDP), choice, control, inclusion, and equity. Thirteen parents or carers, each with a child with an intellectual disability aged between 6 and 16 years, living in rural and remote areas as described by the Australian Standard Geographical Classification – Remoteness Area (ASGC‐RA) and Modified Monash Model (MMM) – were recruited through distribution of flyers (hard copies or by email) to clinicians, schools, and advocacy agencies. Semi‐structured interviews were conducted with participants either in‐person or via telephone between July and October 2015. Data were analysed using thematic analysis. Participants reported that their understanding of many of the disability principles (PCP, FCP, choice, control, inclusion, and equity) was different from providers, and that many providers struggled to understand families, and therefore they did not share meaning of the principles of best practice disability supports. Families did not identify transdisciplinary practice as a core issue or tenet of effective service delivery. Families also reported experiences of missing out on services, feeling a sense of isolation in their communities, struggling to access skilled therapists, and difficulty finding supports and goals that were relevant to their child. The quality of supports that these families accessed was often below the standard that they expected. They did not expect that support standards will change in rural and remote Australia, so many have very low expectations of the National Disability Insurance Scheme (NDIS) in the future. Although more data will need to be collected as the NDIS and its markets mature, these data show that many rural and remote participants and their supporters have a variety of concerns about how they will access quality allied health services through the Scheme. [ABSTRACT FROM AUTHOR]

Background: Children and adolescents with intellectual disability are at risk of developing psychiatric symptoms and disorders; yet, the estimates reported in the literature have been inconsistent, presenting a potential barrier for service planning and delivery. Sources of variability could arise from differences in measurement instruments as well as subgroup membership by severity of intellectual disability, gender and age. This systematic review aimed to address these gaps. Method: MEDLINE and PsycINFO databases were searched from inception to 2018 and selected studies were reviewed. Studies were included if they reported point prevalence estimates of mental health symptomology or diagnoses in a general population of 6- to 21-year-old individuals with intellectual disability. The Joanna Briggs Institute Prevalence Critical Appraisal Checklist was applied to eligible papers to appraise their scientific strength. Pooled prevalence for mental health symptomology was determined using a random-effects meta-analysis. Results: A total of 19 studies were included, including 6151 children and adolescents. The pooled prevalence estimate captured by the Developmental Behaviour Checklist was 38% (95% confidence interval = [31, 46]), contrasting with 49% (95% confidence interval = [46, 51]) captured by the Child Behaviour Checklist; both rates were higher than a non-intellectual disability population. Severity of intellectual disability did not significantly influence the Developmental Behaviour Checklist risks. Insufficient data were available to conduct statistical analyses on the effects of age, gender and socioeconomic status. Of diagnosed psychiatric disorders, attention deficit/hyperactivity disorder (30%), conduct disorder (3–21%) and anxiety disorders (7–34%) were the most prevalent conditions. Conclusion: This review consists of the largest sample hitherto evaluated. In the intellectual disability population, mental health comorbidities could be better detected by a symptom phenotype than a psychiatric diagnostic phenotype. Crucially, future research needs to address the effect of measurement validity in the intellectual disability population. Estimated prevalence rates were high compared to the general population, indicating the importance of systematic screening, case detection and appropriate management. [ABSTRACT FROM AUTHOR]

Objective: Children with intellectual disability and marked feeding difficulties may undergo gastrostomy insertion to assist with their nutritional and medication needs. Use has increased recently for younger children, and it is intended to provide long-term support. This study explored the perceived value of gastrostomy for the quality of life (QOL) of children with intellectual disabilities and their families.Methods: Twenty-one primary caregivers of children with intellectual disability aged 2-18 years participated in semistructured telephone interviews. Data were analysed using directed content analysis, and data were coded to existing QOL domains relevant to children with intellectual disability and their families.Results: Benefits in each of the child and family QOL domains were represented in the interview data. For children, the impacts of gastrostomy for the physical health domain were predominant, supplemented by experiences of value for emotional well-being, social interactions, leisure activities and independence. For families, gastrostomy was integrated into multiple aspects of QOL relating to family interactions, parenting, resources and supports, health and safety, and advocacy support for disability. Shortcomings related to difficulties with equipment and complications.Conclusions: Our comprehensive overview of the value of gastrostomy for children with intellectual disability and their families was classified within a QOL framework. Gastrostomy was mainly supportive over long time periods across many QOL domains. Findings will be of use to patient counselling and education and the development of family support resources. [ABSTRACT FROM AUTHOR]

Background: Little is known about how older parent caregivers from culturally and linguistically diverse (CALD) backgrounds experience caring for their family member with intellectual disability into late life. Method: In‐depth semi‐structured interviews were carried out with N = 19 family caregivers aged 50–91 from ten Italian and four Greek families. The Sociocultural Stress and Coping Model was used as a framework to interpret their experiences. Results: A number of stressors including the need to make sacrifices, physical and emotional demands, uncertain futures and challenges associated with "the system" were identified. While family members play a key role in providing support, changing values around filial responsibility were evident. Discussion: Further attention needs to be given to CALD families to address challenges associated with caring for their family member with intellectual disabilities as they age. This study also challenges assumptions that CALD families prefer to keep caring within the family long‐term. [ABSTRACT FROM AUTHOR]

People with a mental illness may be exposed to stigma which, when internalised, negatively influences self-esteem, personal goal attainment and quality of life. Avoiding the use of stigmatising language and using terminology that does not exclude the positive characteristics of the individual may play an important role in challenging stigma. This study involved a mixed method approach to identify the terminology preferences of people with a mental illness in Australia. N = 173 participants were recruited via convenience sampling. The humanistic terms 'individual' and 'person with lived experience' were identified as the preferred terms. Qualitatively there was a wide variation in how the terms made the respondents think or feel, with only one of the terms – 'survivor,' having solely negative themes. When contrasting the two most commonly used clinical terms, 'client' was significantly preferred to 'patient'. The term 'consumer' was one of the least preferred terms. This suggests that the use of this term, which is in regular use in Australia, should be reconsidered. [ABSTRACT FROM AUTHOR]

Introduction: Conceptualisation of occupation requires understanding of subjective wellbeing and experiences of occupation. Opportunities for participation in productivity activities, such as employment, may be limited for people with intellectual disability (ID). An occupational wellbeing framework was recently re‐imagined to focus on the subjective meaning of a person's occupational life rather than occupational performance. This study analysed experiences and possible benefits to occupational wellbeing of young adult men with ID in an intergenerational mentoring program based on Australian Men's Sheds using this revised occupational wellbeing framework. Methods: A qualitative approach was used to gather individual semi‐structured interviews at the end of an intergenerational mentoring program to explore occupational wellbeing experiences. Eight individual mentees and five parents of mentees (n = 13) from the different Men's Sheds sites agreed to participate in an individual interview about their experiences of the program. All mentees were male aged between 17 and 24 years. Family members included four female mothers and one male father. Data were highlighted, selected and deductively coded using content analysis according to the five occupational wellbeing domains of the framework. Results: Mentees reflected upon their experience with their mentor, the program, activities and environment of the Men's Shed. Findings were organised in relation to each of the five domains of occupational wellbeing, including contentment, competence, belonging, identity and autonomy. Experiences of mentees and their family members reflected the positive impact of participation on each domain and occupational wellbeing, including opportunities for socialisation outside of the program, mastery of skills and knowledge and validation of belief in self. Conclusion: Mentees involved in an intergenerational mentoring program in Australian Men's Sheds report benefits of participation in activities that foster and increase occupational wellbeing experiences. The experience of such domains should be considered when attempting to understand the quality of life and function for people with disabilities. [ABSTRACT FROM AUTHOR]

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

Background: Research into parents' experiences of living with a family member with intellectual disability and challenging behaviour does not specifically address what parents say about themselves and their lives. This paper explores "I-statements" parents made about their day-to-day actions in life with their family member. Methods: Semi-structured interviews were conducted with 26 parents, of which 91% were mothers. "I-statements" were analysed using process analysis from systemic functional linguistics and thematic analysis. Results: "I-statements" showed that parents enacted a range of complex and sometimes extreme activities across a variety of life domains. Parents spoke about: managing relationships with services; educating themselves and others; seeking support; resisting poor service delivery; assisting others; and making both small and significant changes. Conclusion: The paper provided insights into the complex lives of these families and offered observations on the implications of the potential misalignment between the supports the data suggests are needed and those that, in reality, are available to them. [ABSTRACT FROM AUTHOR]

Background: Children with intellectual disability (ID) frequently have significant educational, social and health care needs, resulting in caregivers often experiencing a wide range of negative effects. This paper aims to determine the impact of childhood ID on caregivers' health‐related quality of life (HRQoL) across co‐morbid diagnostic groups. The second aim of this study is to determine the risk factors associated with lower HRQoL in this population. Methods: Caregivers of a child with ID aged between 2 and 12 years old completed an online survey to determine their HRQoL using the EQ‐5D‐5L measure. They were also asked demographic questions and about their dependent child's level of behavioural and emotional difficulties. Results: Of the total sample of 634 caregivers, 604 caregivers completed all five questions of the EQ‐5D‐5L. The mean age of caregivers was 39.1 years and 91% were women. Caregivers spent on average 66.6 h per week caring for their child related to their child's disability. The mean EQ‐5D‐5L score of caregivers was 0.80 (95% confidence interval: 0.79, 0.82), which is below the estimated Australian population norms (mean utility score of 0.92) for the age‐equivalent population. Caregivers of children with autism spectrum disorders reported the lowest HRQoL (0.77, 95% confidence interval: 0.74, 0.79) of the five included co‐morbid diagnostic groups. Caregivers with a lower income, a perceived low level of social support and children with higher degree of behavioural and emotional problems were likely to have a statistically lower HRQoL. Conclusions: This is the first study to produce utility values for caregivers of children with ID. The utility values can be used to compare health states and can be used to inform comparative cost‐effectiveness analyses. Demonstrating that caregivers of children with ID have reduced HRQoL and that this is associated with the degree of behavioural and emotional problems has important policy implications, highlighting the potential for policy interventions that target behavioural and emotional problems to improve outcomes for caregivers. [ABSTRACT FROM AUTHOR]

Objectives Psychologists play a pivotal role in meeting the mental health needs of people with intellectual disabilities. The aim of this study was to investigate the perceptions of Australian psychologists who work with adults with intellectual disabilities and mental ill health regarding their clinical competencies, workplace supports and training needs. Method One hundred and nine psychologists in Australia completed a self-report online survey exploring clinical attitudes and practices when working with adults with intellectual disabilities and mental ill health. Provisional, generalist and clinical psychologists from a range of disability and non-disability work settings were recruited. Results Findings revealed that provisional, generalist and clinical psychologists reported no significant differences in levels of agreement on self-perceived clinical competencies in conducting mental health assessments. Psychologists in private practice and in non-government organisations reported more adequate workplace resources to support mental health assessments for people with intellectual disabilities than did psychologists in government settings. Psychologists across work settings expressed similar views in self-perceived clinical competencies and workplace training supports. The majority of psychologists reported limited formal academic training in intellectual disabilities and expressed a need for continual and specialised training in mental health and intellectual disabilities. Conclusions Implications for further training in mental health and intellectual disabilities highlight the need to cater to the specific needs of psychologists in the field. [ABSTRACT FROM AUTHOR]

Data linkage holds great promise for generating new information about people with intellectual and developmental disabilities (IDD) as a population, yet few centers have developed the infrastructure to utilize this methodology. Two examples, from Canada and Australia, describe their efforts in building data linkage capabilities, and how linked databases can be used to identify persons with IDD and used for population-based research. The value of data linkage is illustrated through new estimates of prevalence of IDD; health service utilization patterns; associations with sociodemographic characteristics, and with physical and mental health conditions (e.g., chronic diseases, injury, fertility, and depression); and findings on equity in medical treatments. Examples are provided of findings used for governmental policy and program planning. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. Method: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. Results: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. Conclusions: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross‐agency service response remains paramount. [ABSTRACT FROM AUTHOR]

Background: Associations between oral and aural problems among children have been explored, but not among adults with intellectual disability (ID), where often, oral and ear pain can be difficult to diagnose.Methods: Data included Special Smiles and Healthy Hearing screenings from two Special Olympics (SO) events held in Australia (2013-2014).Results: The SO athletes had poor oral health with a high prevalence (56.8%) of gingival signs and unmet dental needs (66.9%). Over one-third (33.9%) had partially/completely blocked ear canals, over one-fifth (20.7%) had possible middle ear problems, and almost one quarter (23.8%) had some hearing loss. No associations between oral and aural problems were found in the small sample (n = 130) of SO athletes.Conclusions: Although SO athletes have unmet needs for both oral and aural health, access to appropriate hygiene care is an important preventive factor that athletes, families, and carers should be made aware of. Regular oral and aural screenings are recommended to identify problems early, because ability to communicate pain and discomfort can be different for this population. A larger sample of SO athletes with tooth and sextant level data could clarify the association between oral and aural problems in people with ID. [ABSTRACT FROM AUTHOR]

Adolescence is a period of elevated stress for many young people, and it is possible that the challenges of adolescence are different for vulnerable groups. We aimed to document the depressive and anxiety symptoms, emotional–behavioural difficulties and suicidal/self-harming behaviours among adolescents with borderline intellectual functioning (BIF) or a disability, compared to those with neither disability nor BIF. Data were drawn from the nationally representative Longitudinal Study of Australian Children. Participants were 2950 adolescents with complete data for waves 3–6 (years 2008–2014), aged 14–15 years in 2014. Anxiety and depression symptoms and self-harming/suicidal thought/behaviours were self-reported. Emotional–behavioural difficulties items came from the Strengths and Difficulties Questionnaire, and were parent-, and adolescent-reported. Results of logistic regression analyses indicate that the emotional–behavioural difficulties of adolescents with either a disability or BIF, were worse than for those with neither disability nor BIF. While adolescents with a disability reported more anxiety symptoms, no clear associations were observed for self-harming/suicidal thoughts/behaviours or depressive symptoms for those with either BIF or a disability. Adolescents with BIF or a disability are at higher risk of poor mental health than those with neither disability nor BIF, and it is vital that factors contributing to these differences are identified in order to reduce these mental health inequalities. [ABSTRACT FROM AUTHOR]

The number of older parents ageing in tandem with their adult children with intellectual disability (ID) is increasing. This unique situation calls for greater research that investigates how older parents experience this extended care-giving role, including the extent to which they are engaging in futures planning. Participants were recruited via disability service providers in South Australia. Using the theoretical perspective of hermeneutic phenomenology to understand lived experiences, semi-structured in-depth interviews were carried out with older parents (N = 17, mean age 70 years). Six offspring were living in the family home while the remainder were in supported accommodation. Main themes to emerge from the data were: (a) perpetual parenting, (b) costs and rewards and (c) planning to plan. Parents were providing care across a range of areas, regardless of whether their offspring lived at home or in supported accommodation. While aware of the need to plan for the future, most did not have a firm plan in place. Parents are providing a high level of support to their adult children with ID regardless of whether they live in supported accommodation or the family home. While some have started to think about future care arrangements, most appear unclear over what the future holds. [ABSTRACT FROM AUTHOR]

Aims: Life expectancy for both sexes in Australia exceeds 80 years, with individuals with intellectual disability also increasingly living into older age. This research aimed to comparatively examine perceptions of staff supporting either older adults or age peers with lifelong intellectual disability. Methods: This project asked 420 medical, health, and support workers about training adequacy, health services access, and trigger points for premature institutionalisation. This paper is based on a subsample of 196 respondents who provided quantitative and qualitative responses. Results: There was considerable variation in confidence in supporting ageing individuals, while only 23.7% of doctors reported their training was adequate to support adults ageing with intellectual disability. A lack of services and poor carer health were identified as triggers for premature institutionalisation. Conclusions: The study revealed key differences in staff perceptions of support provision and training adequacy when comparing ageing individuals with intellectual disability to the general ageing population. [ABSTRACT FROM AUTHOR]

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Background: Planning is a key mechanism by which the Australian National Disability Insurance Scheme (NDIS) ensures individuals with disability have choice and control over supports. People with intellectual disability will comprise the largest NDIS participant group and many will need assistance to engage in planning. In order to respond effectively, NDIS planners must understand the decision-making support required by individuals. Method: Focus groups were conducted with 9 adults with intellectual disability living in an NDIS trial site to explore their experiences of NDIS planning. Results: Thematic analysis identified 6 themes related to good planning experiences for people with intellectual disability: preparation, learning from mistakes, personal growth, and having a credible, consistent, and disability-aware planner. Conclusions: Participants who developed a trusting relationship with a planner used planning to increase independence and social participation. Planner skills, particularly communication and sector knowledge, and attributes such as warmth and openness created trust. [ABSTRACT FROM AUTHOR]

Australian data suggest up to 15% of people with intellectual disability (ID) have asthma. The inhaled route of administration is optimal for the management of obstructive airways diseases; however, correct inhaler use requires dexterity and particular breathing patterns and potentially represents a problem in this population due to physical and cognitive deficits. Understanding the nature and extent of inhaler use in persons with ID is important, as correct inhaler technique is imperative for optimal clinical outcomes; however, currently no evidence base exists to inform health professionals. This study describes respiratory medication use, reported prevalence of asthma, and asthma management practices undertaken in a clinic sample of Australian adults with ID. Results showed a prevalence of retrospectively reported asthma of 6%, with 86% of asthma patients prescribed inhaled medication. A review of patient records also indicated omission of some recommended asthma management strategies. [ABSTRACT FROM AUTHOR]

Background Doctors have the potential to influence opportunities for normative life experiences in the area of sexuality for individuals with intellectual disability (ID). Method In Study One, 106 doctors completed the Attitudes to Sexuality Questionnaire (Individuals with an Intellectual Disability). In Study Two, 97 doctors completed a modified form of the questionnaire that included additional questions designed to assess their views about sterilisation. Results Attitudes were less positive about parenting than about other aspects of sexuality, and less sexual freedom was seen as desirable for adults with ID. A surprising number of doctors agreed that sterilisation was a desirable practice. Study Two provided data about the conditions under which sterilisation was endorsed. Most doctors reported they had not been approached to perform sterilisations. Only 12% believed medical practitioners receive sufficient training in the area of disability and sexuality. Conclusions The findings have implications for training and professional development for doctors. [ABSTRACT FROM AUTHOR]

Background News media frames public perceptions. As such, news media becomes a useful source of analysis to understand the presence (or otherwise) of people with disabilities, particularly intellectual disabilities, within parenting discourses in Australia. Method Using Critical Discourse Analysis, this article examines major Australian newspapers over the period from January 2004 to December 2008, critiquing the construction of parenting and disability. A small number of articles are examined in close depth for tone, polarity syntactic and paradigmatic choice, deconstructing the underlying discourses that shape the article and thereby popular perceptions of parenting and disability. Discussion Discourses of care and child protection are emphasized in news articles about parenting, creating perceptions that negate the role of people with disabilities as parents. Such perceptions result in a systematic symbolic castration of people with intellectual disabilities from the role of parent in Australian society. Conclusion By providing a framework for understanding the public perceptions of parents with disabilities (particularly intellectual disabilities), this paper demonstrates that changes are necessary in Australian media reporting on parents with disabilities to bring such reporting more closely in line with the United Nations Convention on the Rights of Persons with Disabilities, 2006. [ABSTRACT FROM AUTHOR]

In this article the authors discuss data on Australians from a non-English speaking background that have intellectual disabilities. They are critical of a lack of data which has been published on non-English speaking Australians with intellectual disabilities and of the impact that the lack of research has on people with disabilities and on Australian government policy on disabilities.

People with intellectual and/or developmental disability (I/DD) commonly have complex health care needs, but little is known about how their health information is managed in supported accommodation, and across health services providers. This study aimed to describe the current health information infrastructure (i.e., how data and information are collected, stored, communicated, and used) for people with I/DD living in supported accommodation in Australia. It involved a scoping review and synthesis of research, policies, and health documents relevant in this setting. Iterative database and hand searches were conducted across peer-reviewed articles internationally in English and grey literature in Australia (New South Wales) up to September 2015. Data were extracted from the selected relevant literature and analyzed for content themes. Expert stakeholders were consulted to verify the authors’ interpretations of the information and content categories. The included 286 sources (peer-reviewed n = 27; grey literature n = 259) reflect that the health information for people with I/DD in supported accommodation is poorly communicated, coordinated and integrated across isolated systems. ‘Work-as-imagined’ as outlined in policies, does not align with ‘work-as-done’ in reality. This gap threatens the quality of care and safety of people with I/DD in these settings. The effectiveness of the health information infrastructure and services for people with I/DD can be improved by integrating the information sources and placing people with I/DD and their supporters at the centre of the information exchange process. [ABSTRACT FROM AUTHOR]

Access to adequate, safe, secure, accessible and affordable housing is a fundamental human right and one stipulated in the United Nations Conventions on the Rights of Persons with Disabilities. Australian adults with disabilities experience housing disadvantage including homelessness, poor-quality housing and housing unaffordability; however, we lack a comprehensive comparison of the housing circumstances of people with and without disabilities and differences by impairment type. We analysed data from a nationally representative sample of 11,394 working-aged Australians collected in 2011. We found that people with disabilities experienced disadvantage across all housing indicators, and people with intellectual and psychological disabilities fared worst. These findings suggest that there is a housing crisis for Australians with disabilities, which may intensify with the introduction of the National Disability Insurance Scheme. There is a need to develop long-term housing solutions that promote independence, are accessible and affordable, and that consider location and neighbourhood context. [ABSTRACT FROM AUTHOR]

Background: Australian publicly funded mental health services play a significant role in the assessment and management of mental illness for people with intellectual disability. However, there is limited knowledge on their preparedness to meet the needs of this population. Method: Public mental health professionals (n=566) completed an online survey that explored their attitudes, confidence, and training needs in the area of intellectual disability mental health. Descriptive analyses were undertaken. Results: Participants agreed that people with intellectual disability have the right to receive good mental health care, and have the same access to their service. They viewed treating them as part of their role, but given the resources available it was not possible to provide comprehensive care. Participants reported low confidence in key clinical areas and insufficient training. Conclusions: A comprehensive workforce development strategy is required to facilitate the engagement and capacity of public mental health professionals in this area. [ABSTRACT FROM AUTHOR]

People with intellectual disability and complex support needs challenge human rights in the current disability policy and practice framework in Australia. With the implementation of the National Disability Insurance Scheme (NDIS) in Australia, it is pivotal to understand how human rights can offer a framework for understanding these challenges. There are complex issues and challenges in operationalising support for the human rights of people with intellectual disability. Their experience is characterised by overlapping and compounding forms of discrimination, abuse and vulnerability in their social and systemic interactions. This article uses qualitative content analysis to describe and articulate disadvantages and challenges of this group, and maps this onto the United Nations Convention on the Rights of Persons with Disabilities and current policies and practices in Australia. The article concludes that utilising human rights instruments helps to recognise the multiple disadvantages faced by people with intellectual disability and complex support needs and focus on the specific areas that need to be addressed in policy and practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is report on a study exploring the views of service providers, both within disability service sectors and in mainstream violence response sectors, about ways of effectively supporting people with intellectual disability who may be experiencing abuse and violence.Design/methodology/approach Semi-structured interviews were conducted with seven participants and analysed both thematically and in more depth from a socio-ecological perspective.Findings Participants highlighted five key factors facilitating or hindering professionals working with individuals with intellectual disability who may be experiencing abuse and violence: connecting clients with services and establishing a rapport; access to information about histories of trauma; policy context; inaccessibility and unavailability of mainstream violence response services; client understanding of what happens “next” after identification of harm.Originality/value Overall the study indicates a strong need for the development of resources, information and tools designed to educate and enhance the understanding of professionals supporting people with ID and to better facilitate learning and understanding for people with ID regarding what happens “after” disclosure of sexual violence or other experiences of harm. [ABSTRACT FROM AUTHOR]

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

Background: Despite existing literature identifying the organisational drivers and constraints of employing people with disability, little research has explored how organisations embed disability-inclusive recruitment practices to facilitate ongoing employment opportunities for people with intellectual disability (ID). Method: An embedded case study methodology was used to explore how supervisors and co-workers within a large Australian retail organisation legitimise disability recruitment practices for people with ID and how different operating environments can influence ongoing employment opportunities. Results: Future employment opportunities for people with ID were limited by centralised recruitment process, the availability of suitable roles, and productivity and efficiency demands of the local operating environment, despite the presence of organisational diversity strategies supporting disability employment. Conclusions: The future employability of people with ID is influenced by technological changes to work environments and an increasing focus on efficiency. Future research should address innovative task modifications to enhance employment opportunities for people with ID. [ABSTRACT FROM AUTHOR]

Background: Supported living is perceived as more flexible than group homes for people with intellectual disability. This study identified costs and factors associated with quality of life (QOL) in supported living and compared this with group homes. Method: Thirty-one residents in supported living participated in a survey incorporating measures of service user characteristics and QOL. Participants in supported living were compared to a sample of 397 people in 96 group homes, and QOL outcomes compared for a matched sample of 29 people in supported living and group homes. Results: QOL differed little, supported living was cheaper, and 30-35% of both groups had similar support needs. Being younger, having autism, better health, family support, and participation in structured activities were associated with better outcomes in supported living. Conclusions: Supported living holds potential for group home residents, but greater support is required in domains such as health and interpersonal relationships. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to summarise the initial experiences of Australia’s National Disability Insurance Scheme (NDIS). It highlights some of the main challenges being faced by participants, service providers and government, and demonstrates how research can contribute to the ongoing implementation and success of the scheme.Design/methodology/approach The historical basis for the need for a new approach to disability funding in Australia is explored. The opportunities that exist and the difficulties that are being encountered by those entering and working within the new scheme are discussed.Findings Several problems were identified including difficult transitions between existing support frameworks to new “NDIS plans”, and the risk of market failure. Both the problems and their solutions are discussed and it is hoped that collaboration between the Commonwealth Government, service users, their families, service providers and universities can lead to a number of lasting improvements.Practical implications The new funding framework provides exciting opportunities for increasing the funding of people with intellectual and physical disabilities in Australia. Developments in technology, service provision in rural and remote areas and the opportunity to meet aspirational life goals exist alongside a number of challenges, including the need to ensure that those with multiple and complex disabilities retain existing levels of support.Originality/value The implementation of the NDIS is still underway, and opportunities exist to implement changes to the scheme where required. Research findings have an important role to play in the national debate regarding how best to improve quality of life for people with a disability in Australia. [ABSTRACT FROM AUTHOR]

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

Background Studies incorporating staff-rated or observational measures of practice leadership have shown that where practice leadership is stronger, active support is better implemented. The study aim was to compare measures of practice leadership used in previous research to determine the extent of their correspondence.Method A subset of data from a longitudinal study regarding 29 front-line managers working across 36 supported accommodation services in Australia was used. An observed measure of practice leadership, based on an interview and observation of a front-line manager, was compared with ratings of practice leadership completed by staff. The quality of active support was rated after a 2-hour structured observation.Results Correlations between staff-rated and observed measures were nonsignificant. Only the observed measure was correlated with the quality of active support.Conclusions This study provides evidence to support using an observational measure of practice leadership rather than reliance on staff ratings. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study sought to compare the prevalence of bullying victimization between adolescents with and without a disability and between adolescents with and without borderline intellectual functioning or intellectual disability (BIF/ID). We also sought to assess whether the relationships between either disability or BIF/ID and bullying victimization vary by gender and parental education. Methods: The sample included 3,956 12‐ to 13‐year‐old adolescents who participated in Wave 5 of the Longitudinal Study of Australian Children. Three indicators of bullying were used: physical bullying victimization, social bullying victimization, and “any bullying victimization.” We used Poisson regression to obtain the prevalence risk ratios (PRR) of bullying by disability status adjusting for potential confounders. Results: In adjusted models, we found evidence that social bullying victimization was more prevalent among adolescents with a disability than those without a disability (PRR 1.29, 95% confidence interval [CI] 1.06–1.42) and between adolescents with BIF/ID than those without (PRR 1.24, 95% CI 1.07–1.44). Adolescents with BIF/ID were also more likely to experience “any bullying victimization”(PRR 1.10, 95% CI 1.00–1.22). Having a disability and living in a family with low parental education were associated with an elevated risk of social bullying victimization BIF/ID. Conclusions: Adolescents with disabilities and BIF/ID are at elevated risk of social bullying victimization. School‐based antibullying initiatives should concentrate on enhancing the inclusion of adolescents with disabilities, with an emphasis on adolescents from disadvantaged backgrounds. [ABSTRACT FROM AUTHOR]

Issue Addressed: Intergenerational mentoring is emerging as a way to provide meaningful engagement and improve wellbeing for older adults in retirement. However, there is little, if any, Australian research concerning the benefits for older mentors involved in such mentoring. This study aims to investigate the experiences of older male mentors involved in an intergenerational mentoring program with young men with intellectual disability and identify any benefits to physical and mental health and generativity.Methods: This study used a mixed methods concurrent triangulation design. Quantitative outcomes data were collected pre and postintervention using the SF-36 and Loyola Generativity Scale. Qualitative data were collected using a single-interview approach. Mentors and mentees took part in a 6-month mentoring program based in Australian Men's Sheds.Results: No significant changes were seen in physical health and generativity. Investigation of mental health scores revealed a significant improvement in scores on the mental health subscale. Qualitative analysis revealed the main theme as "Learning together through a relational and practical routine" and four sub-themes.Conclusion: Men's Shed intergenerational mentoring programs present an environment for older, retired men to express generativity, improve their mental health and bond with younger generations.So what? The potential wellbeing implications for older men through intergenerational mentoring should form the basis of future research and intervention. [ABSTRACT FROM AUTHOR]

Background Quality of life for people with intellectual disabilities has been reported in the research literature across differing demographics. There has been, however, little research that has examined in-depth the experiences of women with intellectual disabilities aged 40 years or older. Materials and methods Fifty-five women from Sydney, Australia, and Prague, Czech Republic, were recruited to the study. Participants were recruited through agencies known to the researchers, ensuring ethical conduct of all procedures. Results Each participant completed a semi-structured interview, and using a grounded theory approach, a series of themes were identified common across all women. The strongest theme identified throughout the interviews was the lack of control participants perceived they had over their lives. Conclusions The results of this study further the call for people with intellectual disabilities to be provided the opportunity to participate in decisions about their life choices. [ABSTRACT FROM AUTHOR]

Aim: To explore family member and staff perceptions of clients' experiences of stigma and discrimination, in those living with severe and persistent mental illness in an Assertive Community Treatment Team. Method: This qualitative study used the Discrimination and Stigma Scale to conduct structured face-to-face and telephone interviews of family members and healthcare professionals, working with the Assertive Outreach Team (AOT) (an Assertive Community Treatment Team) of a northern inner suburban catchment of Sydney, New South Wales, Australia. Results: Forty-one people participated in the study (23 AOT clinical staff members and 18 family members). Family and clinical staff commonly reported stigma and discrimination amongst their relatives and clients, respectively. Four overarching themes emerged from the data: (1) appearance and behaviour, (2) avoidance and being shunned, (3) key areas of life affected by discrimination and (4) impacts of discrimination and skills to cope with discrimination. Conclusion: Reports of stigma and discrimination were common, yet varied between groups with clinical staff commonly witnessing experiences and impacts of discrimination in everyday life, with families' reports being substantially less. Due to the strong advocacy and support provided by the AOT model, clinical staff often buffered experiences of stigma and discrimination. Further research is needed to explore effective interventions to reduce experiences of discrimination in this population group. [ABSTRACT FROM AUTHOR]

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

Background: General anaesthesia (GA) remains a vital modality to facilitate dental treatment for patients with special needs but there is limited literature to describe the types of patients requiring this form of care and the treatment they receive. Method: A cross-sectional clinical audit was conducted of patients treated under GA at the Day Surgery Unit of the Royal Dental Hospital of Melbourne during August 2015. Results: The majority of patients had an intellectual disability and were referred due to their inability to tolerate conventional dental treatment. These patients demonstrated high levels of treatment need requiring an average of two fillings and six extractions. Conclusions: Although these results demonstrate the value of GA in treating patients with intellectual disabilities, the level of treatment need identified raises concerns about current approaches to oral health for this cohort. Greater efforts are required towards preventive oral care for patients with special needs. [ABSTRACT FROM AUTHOR]