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Abstract\nPoints of interestPrevious research demonstrates that living in residential aged care (RAC) has negative effects on the wellbeing of younger people (<65 years). This research reports on the barriers and enablers to avoiding or leaving RAC for younger people in Australia who do not have access to individualised disability funding packages. Interviews and focus groups were conducted with 18 staff who worked in an Australia-wide Program supporting younger people, and 24 stakeholders. Participants reported barriers to avoiding or leaving RAC that included a lack of funding, lack of appropriate housing, lack of transitional and rehabilitation services, and the preferences of family members. Enablers included having help to navigate alternative options, and effective collaboration across services. Participants reported that some younger people wanted to remain in RAC because they had no other option, were hesitant of change, or felt safe there. Funding and housing are required, as well as long-term, complex case management.Barriers for younger people who do not have access to individualised funding packages leaving or avoiding residential aged care include lack of funding for services (including palliative care), as well as lack of housing and assistance to help with the move to community living. The preferences of family members can also present a barrier.Enablers to leaving or avoiding residential aged care include having help to navigate alternative options, and effective collaboration across services.Without change to policy and practice in Australia, younger people who do not have access to individualised funding packages will continue to face a poorly funded and complicated service system, leaving them with little hope of living outside of residential aged care.Funding and housing are required, as well as long-term, complex case management to support younger people to avoid or move out of residential aged care.Barriers for younger people who do not have access to individualised funding packages leaving or avoiding residential aged care include lack of funding for services (including palliative care), as well as lack of housing and assistance to help with the move to community living. The preferences of family members can also present a barrier.Enablers to leaving or avoiding residential aged care include having help to navigate alternative options, and effective collaboration across services.Without change to policy and practice in Australia, younger people who do not have access to individualised funding packages will continue to face a poorly funded and complicated service system, leaving them with little hope of living outside of residential aged care.Funding and housing are required, as well as long-term, complex case management to support younger people to avoid or move out of residential aged care. [ABSTRACT FROM AUTHOR]

There is growing recognition that people with disability have the right to be involved in making decisions that affect their lives. Decision-making support has emerged as one way to support people with cognitive disability to make decisions, however, there is a paucity of research that explores how disability support workers can be upskilled to provide decision-making support to this group. The aim of the research was to explore the impact of an evidence-based online training course on disability support workers of adults with cognitive disability. Changes in knowledge about decision-making support and confidence in providing decision-making support were explored, attitudes towards decision-making support, and facilitators and barriers. Participants completed an online training course and responded to a survey on three occasions: baseline, post-training, and at 2-month follow-up. Ninety-nine disability support workers across Australia participated in the online training and completed the baseline and post-training surveys. Thirty-six participants completed the training and all three surveys. The results revealed that there were statistically significant improvements in knowledge, confidence, and attitudes from baseline to post-training, which were maintained at 2-month follow-up. Barriers to decision-making support included service providers or other supporters, including the family of the person with cognitive disability, whilst a key enabler was knowing about the decision-making support principles. This research demonstrates that an evidence-based online training course about decision-making support can be effective in building capacity in disability support workers. There are, however, several barriers that must be addressed to facilitate the implementation of decision-making support. [ABSTRACT FROM AUTHOR]

In 2007 the Australian Commonwealth Government announced the Medicare Health Assessment for People with an Intellectual Disability as part of the Enhanced Primary Care (EPC) program (Department of Health and Ageing, 2008). The annual health assessment is a structured framework for general practitioners (GPs), which enables an annual comprehensive assessment of the physical, psychological, and social function of patients with ID, and the identification of any medical intervention and preventative health care that may be required (Department of Health and Ageing, 2008). The health assessment items carry with them significant financial incentives designed to encourage GPs to enhance the quality of detection and management of health concerns of people with ID. In May 2010, however, health assessment items for different groups, including people with ID, were combined into four time-based items (Department of Health and Ageing, 2010b). This change prevents the tracking of item usage as a means of determining the frequency with which individuals with ID receive annual health assessments. This paper reports trends in uptake of ID health assessment items while the data could be differentiated. (Contains 3 tables.)

The authors investigated secondary conditions in people with developmental disabilities in terms of (a) the average number of conditions experienced and overall health and independence, (b) their degree and nature, and (c) gender differences. Information was obtained by a questionnaire completed by the caregivers for 659 people with developmental disabilities. Participants experienced an average of 11.3 secondary conditions. Secondary conditions causing significant limitations were reading difficulties, communication, physical fitness-conditioning, personal hygiene-appearance, weight, dental and oral hygiene, and memory problems. Some gender differences emerged in overall health scores and limitations due to secondary conditions.

The effects of secondary conditions across adults with autism, Down syndrome, and cerebral palsy were explored in terms of overall limitation in life participation and independence, changes over time, and the degree and nature of limitation in specific secondary conditions. Information was obtained for 35 adults with autism, 49 with Down syndrome, and 29 with cerebral palsy (N = 113). Caregivers completed a questionnaire exploring secondary conditions on two occasions. Participants with cerebral palsy experienced the greatest overall limitations of the three groups. This finding is due to several secondary conditions. There were no changes in limitation scores over time. Implications related to health care for these groups are discussed.

Background: The aim of this study was to evaluate active support (AS) training and to investigate changes to perceived engagement in domestic tasks, opportunities for choice, frequency of challenging behaviour, and level of support needs. Method: Participants were 12 adults with ID aged 27-57 years (M = 37 years) residing in three group homes, and their support workers. The support workers completed assessments on three occasions (at baseline, post-training, and at follow-up). Results: Residents' engagement in domestic tasks increased over time, and overall choice increased, although perceived choice in two life domains initially increased, but decreased to baseline levels at follow-up. Residents exhibited an overall decrease in anxiety, self-absorbed behaviour, disruptive behaviour, and problem behaviour in general. There was also an overall decrease in perceived support needs for five activity domains, with no change for one domain. Conclusions: The results contribute to a growing body of evidence demonstrating favourable outcomes of AS in terms of engagement and challenging behaviour in people with ID. Surprising results are presented for choice and perceived support needs, warranting further investigation. (Contains 4 figures.)

Pain is often unrecognised and untreated in people with ID. In the absence of self‐report, the use of structured behavioural pain assessment tools is best practice for identifying pain in this group. The aim of this research was to explore the utility of the Abbey Pain Scale and The Distress and Discomfort Assessment Tool (DisDAT) for use by residential support workers and family members of adults with severe or profound ID who live in group home settings. Participants were 17 residential support workers and six family members and provided information about 23 adults with severe or profound ID. Participants completed one of the two tools every 2 weeks for 3 months and indicated whether they thought the individual was content, distressed or experiencing pain. In total, 131 completed tools were returned (80 Abbey Pain Scales and 51 DisDATs). The results indicated that higher total pain scores on the Abbey Pain Scale appear to correspond to a report of pain or distress. A range of behaviours from the Abbey Pain Scale were reported to be present when the individuals with ID were reported to be in pain, such as vocalisations and facial expressions, but these and other behaviours were also observed when the individual was reported to be distressed. Similarly, using the DisDAT, there were behaviours that were present when individuals were reported to be experiencing pain which, for the most part, were also reported when individuals were reported to be distressed. Although neither of the tools appeared to distinguish between pain and distress, it is evident that both tools have utility in the assessment of distress. This is a promising finding as it may be that the tools can be used to signal that an individual with severe or profound ID is distressed and that pain is a factor to be considered. [ABSTRACT FROM AUTHOR]

Living in residential aged care (RAC) can have deleterious effects on the health, well‐being and social participation of younger people (<65 years of age). This research examined the barriers and enablers to leaving or avoiding RAC for Australian younger people who are not National Disability Insurance Scheme (NDIS) participants. It reports on the findings from semi‐structured interviews with 16 younger people living in, or at risk of entering RAC and 12 family members. The research revealed that most participants were opposed to younger people living in RAC, and many of those who were already living in RAC were dissatisfied with their lives. However, some in RAC reported feeling satisfied, and expressed fear that their needs would not be met elsewhere. The barriers and enablers to leaving or avoiding RAC related to funding to access services, help to navigate funding and services, and the availability of services in rural and regional areas. To best support younger people, there is a need for increased funding for the services required to live outside RAC, and assistance to navigate funding and services. Initiatives that address hesitancy to move from RAC, and to build capacity to help younger people imagine life outside RAC are required. [ABSTRACT FROM AUTHOR]

There are few outcome measurement tools that can be accessed directly by people with intellectual disability (ID) and that can be readily used in service delivery settings. Developed to address these limitations, the Measuring Outcomes in Services and Supports – Short Form is a measure of the extent to which a person's goals are realized in the context of service and supports delivery. Specific aim is to establish initial evidence for the face and content validity of the tool, an essential step in the first stage of developing evaluation tools. Face validity was explored via an on‐line survey eliciting information from an "expert group" about the purpose, adequacy, clarity, and attractiveness of the tool. Content validity was examined by comparing goals for people with disability against a framework for categorizing personal outcomes and their influencers, to gauge the tool's relevance, and representation for measuring whole of life disability outcomes. Participants gave positive support overall for aspects of face validity surveyed. Suggestions for further improvements were provided, most of which were accommodated. Other issues raised reflected themes general to the field of outcomes measurement in disability populations (e.g., complexity for people with ID), with strategies suggested for attenuating their impact. Participant goals were representative of outcome domains reflecting the current policy environment in disability, as were their influencing factors. With limited tools to measure goal realization for people accessing a range of disability supports, the tool has acceptable face validity and content validity and is sufficiently practical for use in disability services. [ABSTRACT FROM AUTHOR]

The study had two aims. The first aim was to examine the relationship between final year medical students' ethnicity and their attitudes towards consultation skills. The second aim was to investigate the relationship between ethnicity and final year performance. A cross-sectional study was undertaken of all final year medical students in 1995 and 1996, both before and after their attachment through the Department of General Practice at Monash University, Australia. A questionnaire was designed to assess students' attitudes (views of importance and confidence) towards consultation skills. Also, records of final year performance were obtained from the University. Five clusters of consultation skills were formed through factor analysis: communication skills, difficult consultations, traditional diagnostic methods, routine management and life threatening conditions. There were no significant differences in students' attitudes towards these consultation skills based on country of birth, language, or student status preattachment. The only significant postattachment difference was that students born in non-Western countries placed a significantly higher importance on communication skills and the traditional diagnostic method than students born in Western countries. There were significant differences in final year performance between students across all three parameters of ethnic diversity. Non-Western born students performed worse than Western born students. Students who preferred using a language other than English also performed worse than those students preferring English. International students performed worse than students with Australian citizenship or permanent residency., The only significant difference regarding attitudes to consultation skills was that non-Western born students placed significantly greater importance on communication skills and the traditional diagnostic method postattachment than Western born students. No significant differences were found in attitudes preattachment. There were significant differences in performance, with students of ethnic background performing consistently poorer in all the final year assessment parameters analysed. [ABSTRACT FROM AUTHOR]

Background: This study explored the impact of work related violence on general practitioners' work performance., Method: A postal survey of 1000 randomly selected GPs about work related violence. Those GPs reporting incidents of work related violence in the past 12 months were asked to write about its effect on them in response to an open question., Results: Eighty-five GPs responded. Seventy-three percent of GPs who had experienced work related violence answered an open question about its effect on their work performance. The effect was negative for most, respondents citing poor concentration, difficulty listening to patients, rumination and intrusive thoughts when in an enclosed space in subsequent consultations, particularly in consultations with the patient who had perpetrated the violence, or their families or coworkers, or with similar patients., Discussion: General practitioners have reported that work related violence has a continuing impact on their work performance. Future research should include psychometric testing of cognitive functioning and mental health testing to quantify this.