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Little is known about OCD in people with learning disabilities (LD) in general and in terms of current and professional support. In this study, we examined caregivers' perceived challenges and strategies practiced in institutionalized settings in managing OCD in people with LD and derived implications for research and practice. We studied individual cases of people with LD (n = 7). Each case included group discussions (n = 28) and semistructured interviews with caregivers (n = 20). We used qualitative content analysis to analyze the data. Our findings reveal the following challenges for caregivers: recognizing and classifying ambiguous behaviors, recognizing emotional well-being and needs through nonverbal signals, finding and applying effective strategies, being unqualified regarding additional needs, managing inappropriate institutionalized conditions, and lacking external specialization. We identified five strategies for dealing with compulsive behavior: tolerating and allowing, accepting and supporting, involving, limiting the compulsive act, and stopping the act. Collaboration among psychiatric, therapeutic, and caregivers in institutionalized settings is critical for early identification and support of OCD. Challenges arise from caregivers' lack of training on the additional needs of people with LD and OCD, highlighting the urgent need for disorder-specific guidelines for identification and support.

Background: Implementation issues often hinder reaching the potential of care technology to improve daily lives of people with intellectual disabilities. We investigated barriers to and facilitators of implementing different technology modalities (app/social robot/sensor/domotics) in long-term care. Method: Care professionals (N = 83) from 12 Dutch disability care organisations completed a customised measurement instrument for determinants of innovations (MIDI) questionnaire. Results: Out of 27 determinants, 20 were identified as facilitators and 16 as barriers. We highlight common barriers: few colleagues who work with the technology; no (awareness of) formal ratification of technology use; no arrangements regarding turnover of staff using the technology; unsettling organisational changes; technological defects and limited IT preconditions. Conclusions: The results, which could be combined and compared across study sites, provide insight into which implementation determinants were already well addressed, and where there is ground to gain when implementing care technology in disability care organisations.

Background: Research suggests that a better awareness of how staff who directly support people with intellectual disabilities experience their working relationships, will contribute to understanding staff wellbeing and the quality of care they offer. This study aimed to gain insights into the lived experiences of support workers in supported living services in England. Method: Six support workers participated in semi-structured interviews, about their working relationships with service-users and colleagues. Data was analysed using interpretative phenomenological analysis. Results: Six interconnected themes emerged: The essence of good relationships; a trusting relationship as the vehicle for meeting service-users' needs; belonging to the support team; the organisational context of relationships; the social context of relationships; 'a fine balancing act'. Conclusions: The findings provide insights into staff wellbeing, indicating that developing supportive, trusting relationships with both service-users and colleagues, plays an important role in delivering effective care. Potential implications for service providers are discussed.

Introduction: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Results: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience.

Numerous studies show that children and young people in out-of-home care (OOHC) face significant disadvantage in completing high school and accessing post-secondary education. The current research involved a two-round Delphi survey which aimed to identify educational challenges and school reforms to improve the educational experiences of children and young people in OOHC. A total of 45 participants from three OOHC stakeholder groups (carers of children in OOHC, professionals/educators, and young people with lived experience of OOHC) completed the round one survey which consisted of open-ended questions analysed using thematic analysis. In the second survey round, 19 participants completed a Likert scale questionnaire which drew on themes from the round one thematic analysis. Using a consensus threshold of 70% for the round two survey, participants agreed that students in OOHC face a myriad of educational challenges, such as dealing with a history of trauma, frequent home and school transitions, mental health issues and stigma as a result of being in OOHC. It was agreed that teachers lack knowledge and experience, and schools lack support for students in OOHC. Stakeholders recommended provision of greater mental health support, coordination of services and more autonomy for OOHC students regarding their education.

Background: People with learning disabilities following a long-term stay in forensic settings may experience difficulties reintegrating in the wider community. Indirect interventions can be helpful for care providers and family members to reflect on their practices and improve the quality of life of people with learning disabilities. Although indirect interventions are being implemented in learning disability settings, research is limited. Methods: This clinical case study recounts an indirect intervention with care providers of a male with mild learning disability. Findings: We recount the referral and assessment processes, the initial hypotheses and formulation of the service users' presenting difficulties. We demonstrate how a systemically informed indirect intervention with staff can be used to improve the living conditions of a man with mild learning disability and provide reflections on working with multiple interdependent systems surrounding vulnerable individuals in a specialist learning disability setting. Conclusion: Indirect interventions with the care networks supporting an individual with a learning disability can be a useful way to conceptualise the barriers and facilitators for community integration. Indirect interventions can also offer a reflective space for staff to share their own difficulties and prevent burnout.

Background: Communicating with people with severe/profound intellectual disabilities is essential for person-centred, rights-based support. Despite a proliferation of research around COVID-19, there is a dearth of evidence exploring its impact on communication with people with severe/profound intellectual disabilities. This study aimed to explore disability support staff experiences of communicating with people with severe/profound intellectual disabilities through the COVID-19 pandemic. Methods: A qualitative descriptive study was undertaken. A purposive sample of six disability support staff who supported people with severe/profound intellectual disabilities through the pandemic in four Irish residential services participated in online, semistructured interviews. Data were analysed thematically. Findings: Six themes were generated including unwavering commitment; running on empty; being a safe haven; empathic understanding; heightened sensitivity and new insights. Participants discussed the impact of COVID-19 on communicating with people they support, the contextual challenges, how these were managed/overcome and new learning that emerged. Although communication challenges did present because of COVID-19 restrictions, communication remained a priority. Conclusions: Despite the challenges experienced by disability support workers, their unwavering commitment to ensuring the well-being of people with severe/profound intellectual disabilities was identified. This was a small-scale qualitative study but highlights areas warranting further research and makes recommendations for practice and service planning.

Background: We explored the experiences of staff working in Norwegian community-based living facilities, caring for people with intellectual disabilities during the Covid-19 pandemic, and what self-regulatory strategies staff used to maintain health and care service delivery and contribute to organisational resilience. Methods: A qualitative design was utilized. Data were collected from September 2021 to April 2022 with individual and focus group interviews. In this study, 25 staff members participated. Thematic analysis was conducted. Findings: Five main themes were identified regarding the experiences of staff during the pandemic: Lockdown of facilities, social isolation of residents, lack of health follow-up, high sick leave rates and communication challenges. Only some of the strategies to mitigate pandemic-related challenges were based on current Norwegian infection control guidelines. Some strategies were successful while others were not and some were negligent and challenged the delivery of health and care services for the residents. Conclusions: Our study shows that people with intellectual disabilities living in the community-based living facilities were subjected to human rights violations and violations of the Norwegian infection control law. This was caused by a lack of several important organisational qualities in the facilities.

Background: People with intellectual disabilities are living longer and are increasingly diverse, with health and care needs that are varied and complex. Without changes to funding, services have found it difficult to respond to needs and wishes. Method: A descriptive mixed methods design study, data were collected through questionnaire, focus groups and individual interviews from intellectual disability service managers, direct care staff and older people with intellectual disabilities and family members. Results: Continued reticence on the part of some community healthcare providers to treat people with intellectual disability was noted. Although some service innovations were noted, housing, staffing levels, staff mix and the timely provision of equipment were all reported to impact the ability of services to respond to changing needs. Current per-capita funding practices were reported as unresponsive to growing age-related complexity and fundamentally unsustainable. Conclusions: The health inequalities experienced by people with intellectual disabilities are compounded as they age with complex age-related health needs. There is an urgent need for revision of the service model in Ireland and instigation of flexible and responsive approaches to funding.

During the COVID-19 pandemic, drastic measures to interrupt SARS-CoV-2 infection chains were implemented. In our study we investigated the consequences of pandemic related restrictions on the social, psychological, and physical well-being of institutionalized adults with intellectual and developmental disabilities. Methods: Online survey among professional caregivers in 71 residential groups, caring for 848 residents. Findings: (i.) A lack of participation concerning infection protection measures of the residents, their relatives, and their caregivers; (ii.) A 20% increase in doctor contacts during the pandemic; (iii.) A considerable deterioration in at least one item of the subdomains mood (49%), everyday skills (51%), social interaction (29%), exercise and coordination skills (12%), behavior (11%) and cognition and communication (7%); (iv.) A deterioration of the overall condition in 41%; Summary: Intensive attempts should be made to find individual and less categorical contra-infectious measures without questioning the basic everyday needs of people with intellectual and developmental disabilities.

Background: Toothbrushing, limiting intake frequency, and scheduled visits to an oral healthcare professional (OHP) are key for good oral health. We aimed to explore factors influencing these oral health behaviours in Dutch adolescents with mild to borderline intellectual disabilities (MBID) in residential care. Method: Using a qualitative, descriptive approach, we conducted focus groups and interviews with 12 adolescents, 9 counsellors, and 6 OHPs. Thematic analysis mapped factors influencing adolescents' knowledge, attitude, planning, and execution of oral health behaviours to oral care stakeholders. Results: Of nine identified influencing factors, three were pivotal: Structure (influencing toothbrushing and intake frequency), Anxiety (impeding dental visits), and Support (provided by counsellors). Conclusions: Counsellors should provide structured daily guidance on oral hygiene and diet for adolescents with MBID, while respecting the adolescents' autonomy. As intermediaries between adolescents and OHPs, counsellors are key in reducing dental anxiety. Counsellors need clear oral health policies within care facilities to address competing priorities.

In Thailand, 408 campuses of the Buddhist Scripture School provide education to orphans, minorities, and disadvantaged children. Approximately 34,000 students are enrolled on the campuses nationwide. These students were ordained as novices and monks. In addition to studying their religious curriculum, they take courses in the general education, including English classes, and can obtain a high-school certificate. However, learning is disrupted regularly due to duties in the Buddhist communities, serving as the officiants of ceremonies, including merit making, funerals, weddings, etc., so their English achievement may not be satisfactory. This qualitative research investigated circumstances, challenges, and approaches to inclusive English education for novices and monks by adopting a critical pedagogy as the theoretical and analytical framework and a phenomenological approach as the methodological framework. The researcher visited a rural temple school to observe classes, inspect documents, and interview students, teachers, and abbots. The results show that most students resided in temples where people speak the Khmer dialect, and there were not enough opportunities to use English. The number of monks had decreased because of migration. Teachers had added responsibilities. Inclusive English education could be achieved by revitalizing the local economy and establishing a mentoring program to motivate them and inculcate student agency.

Background: Moving out of the family home is a key transition for people with intellectual disabilities and their families. Yet there has been little research about parents' experiences of planning the move of their young adult offspring to residential settings offering 24-hour support. Method: Interviews were conducted with eleven parents whose offspring moved to residential settings within the past 5 years (five fathers; six mothers). They consisted of structured questions about planning their offsprings' moves and semi-structured questions about parents' experiences. Results: Content analysis of the structured questions revealed reasons parents began thinking about the moves and routes to finding information. The thematic analysis highlighted the emotional challenges parents faced. Conclusions: The findings highlight the need to address this neglected topic and ensure that practical and emotional support is put in place to plan positive futures, rather than relying on families to use their own initiative or waiting until a crisis occurs.

This paper outlines the outcomes from three rounds of action learning sets with a charity that supports vulnerable adults and those with learning disabilities in supported living and residential care. The action learning sets focused on safeguarding cases and how they had been managed by 11 leaders at various levels of the charity (the team). The findings demonstrate that using a reflective process and the 'fishbowl' model of action learning sets in this context is effective in evaluating the actions taken by the team in the safeguarding case, but also the awareness of the perspectives -- or lenses -- the team had used when reflecting on the roles of the various stakeholders included. We outline the development and application of the Multiple Lens View Model (Table 1) which was designed during the research and which helps to analyse the perspectives the participants were taking when focusing on the issues in each case. We conclude with an exploration of how this charity can more critically engage in debate around assumptions made in safeguarding incidents. We discuss how The Multiple Lens View Model can be developed further as a conceptual framework for this charity and for critical action learning in other institutions.

Background: Persons with profound and multiple learning disabilities (PMLD) risk exclusion, both in research and as members of society. Because of their embodied communication, they face the challenges in being understood. Oftentimes, others speak on their behalf making inferences on what their perspective might be. Methods: Empathy is suggested as an approach to grasp the perspective of a person with profound and multiple learning disabilities through engaging with embodied communication. The account of empathy suggested by Stein will be unfolded through an ethnographic study including persons with profound and multiple learning disabilities and their professional supporters. Given this background, the intent is to discuss the potential empathy can have in recognising persons with these disabilities as subjects of knowledge. Findings and Conclusions: The characteristics of persons with profound and multiple learning disabilities provide energy to empathic situations in ways that advocate for the possibility of being recognised as subjects of knowledge. This is related to the competencies of the individual, ambiguous communication and the dependency relations in which they are involved. It is of utmost importance to respect the alterity of the other.

Background: Shared Lives (adult placement) is a model of community-based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer. It is an established but small-scale service used mainly by adults with learning disabilities. However, little research has been conducted about whether and in what ways this model can support people to live well. Method: This article presents findings from outcome measures focused on well-being for a sample of 39 people supported by Shared Lives in England. Fifteen semistructured interviews were also conducted by peer/coresearchers to supplement the quantitative data. Data collection took place between June 2017 and September 2018. Findings: Findings indicated that people using Shared Lives generally had good outcomes across all of the measures. All of those interviewed identified areas of their life where Shared Lives had made a positive difference, particularly with relationships and activities. Conclusions: Limitations to the research mean that more work is needed to fully understand the role Shared Lives plays in supporting people to live well and in comparison to other forms of community support.

Background: People with learning disabilities have the right to choose where they live. However, evidence suggests people's choices are limited due to a shortage of housing. Methods: 200 Lives was a mixed methods research project, which evaluated supported living and residential care for people with learning disabilities in England; 107 people with learning disabilities took part, 77 from supported living and 30 from residential care. Findings: Two-thirds of people in supported living compared to half of those in residential care chose the place they were currently living in; however, less than half of all participants looked at another property before moving to their current house. People in supported living were significantly more likely to have chosen who they lived with. Reasons for moving mainly consisted of reactive moves following an issue with the previous living situation. Many people had not considered moving in the future. Conclusion: Findings suggest that people's choices about where to live were constrained regarding the properties on offer and who to live with. This suggests that people's housing rights were not being upheld. Support and housing providers should ensure that housing can adapt to people's changing needs and wishes over the course of their lives.

Background: Effects of staff provided positive behaviour support (PBS) for individuals with intellectual disabilities are unclear. Method: Using a multicentre non-randomised cluster controlled design, 26 teams of residential group homes, including 245 staff members of 167 individuals with intellectual disabilities, were allocated to a PBS or control group. Conducting multilevel analyses (n = 123) we examined individuals' changes in irritability, other challenging behaviours and quality of life. Results: Compared to controls, irritability did not significantly decrease more in the intervention group, but lethargic behaviours did. Personal development and self-determination significantly increased. Irritability of individuals in the PBS group with higher levels of irritability or lower levels of intellectual disability significantly reduced more compared to controls. Conclusions: PBS was effective in reducing irritability of individuals with severe levels of irritability or intellectual disabilities. Moreover, PBS decreased lethargic behaviours and improved several domains of quality of life.

Background: This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase. Methods: Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities. Results: Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging. Conclusion: Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.

Background: People with intellectual disabilities have the right to live in the community. As social workers have an important role in decisions regarding residential settings, this study examined their recommendations regarding residential living arrangements of individuals with intellectual disabilities. Method: Using a factorial survey approach 174 social workers were presented with true-to-life vignettes and asked to provide their recommendations regarding housing in community apartments, hostels (large group homes) and meonot (large institutions). Results: Higher likelihood of recommending housing in a community apartment was associated with mild intellectual disability, lack of daily support needs, no sexual abuse history, and stated preference for a community apartment. Social workers' experience in working in a specific residential setting was associated with recommending it. Conclusions: Ongoing training on rights-based ethics and the importance of community inclusion should be provided to social workers. Further, community alternatives should be made available to all individuals with disabilities.

Background: In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory--Revised (GCI-R) is a new measure to assess group climate perceptions. Method: Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI-R. Results: The results indicate support for the five-factor structure of the GCI-R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good ([alpha]: 0.72-0.87; [omega]: 0.76-0.86). Conclusion: The GCI-R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities.

Background: Staff-client relationships impact the quality of support and life of people with severe to profound intellectual disabilities and challenging behavior, but are challenging to build due to clients' intense, complex and varying support needs. The present study explores the perspectives of professionals and relatives on what affects these interpersonal relationships. Method: 17 professionals and 11 relatives participated in focus groups and interviews. Data collection and analysis was performed in collaboration with a co-researcher. Data were synthesized thematically. Results: Interpersonal relationships constituted equivalence, striving for mutual understanding, trust and exploring clients' potential. The combination of staff characteristics (enthusiasm/passion, patience, resilience, creativity/humor, flexibility) and expertise (knowledge, vulnerability/sincerity, self-reflection) enabled staff to build these relationships. The importance of involving relatives was addressed. Contextual influences included the team (cooperation, flexibility, culture), organization (cooperation, boundary conditions) and setting (predictability, interior/atmosphere). Conclusions: The findings make practical knowledge explicit and scientifically underpinned for this specific population.

To complement previous research investigating the educational attainment of young people in out-of-home care reporting lower educational outcomes and risk factors, a more comprehensive approach is necessary. Our objective with this article is to better understand the learning careers of young people in residential care. That includes documenting their experience and the meaning they attribute to learning in formal settings over time and identifying critical turning points in each young person's learning career. Based on an interpretative paradigm, we conducted a qualitative study using biographical interviews with young people aged 14-18 in residential care in Quebec, Canada. We first demonstrate that the learning careers of young people in residential care are unique and non-linear. Second, by studying turning points, we highlight the critical role that institutions, teachers and youth workers can play in fostering a positive or negative learning career. Finally, we noted learners' different responses to these circumstances and differences in learners' perception of their measured performance and their influence on their engagement with formal learning. We discuss why considering young people as the main actors and producers of meaning regarding their educational experience and learning careers appears necessary.

Introduction: Emotional and behavioral problems are common in adolescents with mild to borderline intellectual disabilities (MBID). Basic Psychological Needs Theory connects fulfillment of basic psychological needs (autonomy, relatedness, competence) to ill-being (mental health problems). The associations between the frustration and satisfaction of basic psychological needs and indicators of mental health problems are the subject of this study. Method: Adolescents with MBID (N = 324, mean age 15.2 years), filled out questionnaires on basic psychological needs (BPNSFS-ID) and on anxiety (SCARED), depression (CDI) and aggression (Externalizing Problems scale of YSR). A subgroup of adolescents with MBID and severe behavioral problems (MBID-SBP) was compared to a general subgroup (MBID-G). Results: Outcomes for adolescents with MBID-SBP were worse than for adolescents with MBID-G on most measures. BPNSFS-ID frustration was positively associated with mental health problems. Correlations for the BPNSFS-ID satisfaction scales were positive but weaker. Associations within the MBID-SBP subgroup were stronger than for the MBID-G subgroup. Discussion: Frustration of BPN in particular is associated with mental health problems. Attending basic psychological needs may potentially help to counter ill-being.

Purpose: This article seeks to provide a fresh perspective on the methodological approach to studying caregiving in a transnational context by analysing, local caregiver's lifeworld, informal interpreting/translation and professional communication with foreign retirees. Design/methodology/approach: This project explores the complex and multifaceted meanings of everyday objects through diffractive vignettes to illuminate the communicative entanglements that arise between caregivers and foreign retirees receiving care in Thailand. To identify intra-actions in caregiving, we collected data through informal interviews, observations and various artefacts before combining them in a group of potential communicative relationships by creating a narrative summary of situations. Findings: Communicative relationships in the vignettes are multidimensional, with diverse logics underlying choices, rapport formation and communication effectiveness. This premise also illuminates how caregivers perceive and intra-act with their accommodation strategies, considering trust, comfort and comprehension. Our findings were also discussed with the concept of communication accommodation theory. Originality/value: As an extension of the post-humanist approach to the diffractive reading of vignettes, this study sees its value in studying agent-related informal translation/interpreting and human-to-human relationships.

While supportive relationships are important for probably everyone and while research indicates that supportive relationships contribute towards improved care-leaving outcomes for young people who grew up in care, there is no research that shows their contribution year by year over the first several years out of care. The aim of this study is to fill this gap, drawing on a sample of 100 residential care-leavers in South Africa, who were followed-up annually for as long as seven years. This paper presents quantitative findings from this study, viz. measures of 13 relational resilience resources just before aging out of care and 19 care-leaving outcomes (such as self-supporting accommodation, criminal activity and well-being) collected annually for up to seven years. Findings show that supportive relationships are particularly influential on care-leaving outcomes over the first three years out of care, and that their impact continues to be evident up to seven years. The study also shows the importance of the relational capacity of young people, such as empathy and teamwork. In light of these findings and other longitudinal studies on the contribution of supportive relationships to adult outcomes, a triangle of support is proposed, involving the relational capacity of young people, the availability of supportive others and the role of formal social services. When these three sides of the triangle operate optimally, sustained resilient outcomes are evident.

Introduction: Having a neurodevelopmental disorder (NDD) can impact the abilities of an individual in many areas of life, including the ability to live independently. The environment of an individual impacts their day-to-day life throughout their lifespan. To improve supported housing experiences, it is important to map the evidence, especially relating to quality and satisfaction with the environment (as defined by the International Classification of Functioning, Disability and Health (ICF) framework). This has been exacerbated by COVID-19 pandemic restrictions, therefore more insight is needed in measuring this. Objective and methods: This scoping review searched 5 health and social science databases with the objective to identify and examine the outcome measures that integrate aspects of the environment that examine supported housing in individuals with NDD. Results and discussion: Fifteen studies met the inclusion criteria. We found that most measures targeted the satisfaction of individuals about their environment, with the ICF Support and Relationships factor of the environment assessed most. Measures were most often completed by a proxy through an interview. This work enhances our understanding of aspects of the environments of supported housing that are currently measured, laying an essential base for future research to improve the lives of individuals with NDDs.

Background: Children and adolescents in residential care have more adverse childhood experiences (ACEs) than those living in any other type of care. However, there is scant research on risk factors accounting for this accumulation. Objective: To establish the prevalence of ACEs in child residential care and to explore predictors of accumulation and clustering patterns. Method: A cluster-randomized sample of 1275 children ages 5-18 years was drawn from 78 residential care facilities across Romania. Clinical psychologists from Child Protective Services (CPS) aided in the collection of ACEs, family, health and history data. Network analysis was used to explore ACE clustering patterns, while a Zero-Inflated Negative Binomial regression provided insights into covariate risk factors. Results: Within the network, influential ACEs were found to be consistent with previous research. However, using expanded ACEs on a high exposure sample, two new clusters emerged: (1) ACEs reported by children at the highest mean ages (abused by a romantic partner, arrested or incarcerated, sexually abused), (2) ACEs pertaining to social exclusion (seriously medically ill, discriminated, bullied). Several risk factors significantly predicted ACE accumulation: craniocerebral trauma, prenatal exposure to drugs, cognitive delay, conduct disorder and frequent change of homes. Institutional placement and special education were found as protective factors. Conclusions: A child in residential care that was institutionalized for reasons other than neglect or abuse had 80% probability of not being ever exposed to any ACEs. Nevertheless, CPS can utilize important risk factors and influential past ACEs to detect children at higher risks of further adversity.

Background: It is unclear whether the limitations of young persons with a mild intellectual disability or borderline intellectual functioning preclude feasibility of the daily diary method. Method: For 60 consecutive days, 50 participants (M[subscript age] = 21.4, 56% male) who receive care in an ambulatory, residential, or juvenile detention setting, self-rated both standardised and personalised diary questions through an app. Diary entries were used for feedback in treatment. Interviews were used to explore acceptability. Results: Average compliance was 70.4%, while 26% of participants dropped out. Compliance was good in ambulatory (88.9%) and residential care (75.6%), but not in the juvenile detention setting (19.4%). The content of self-selected diary items varied widely. Participants deemed the method acceptable. Conclusions: Daily monitoring is feasible for individuals with a mild intellectual disability or borderline intellectual functioning receiving ambulatory or residential care, and can provide scientists and practitioners with important insights into day-to-day behavioural patterns.

Background: We aimed to gain more insight into autonomy of older people with intellectual disabilities in a residential care facility in making choices. Methods: We performed a descriptive ethnographic study in a residential facility in the Netherlands for 22 persons, aged 54-89 years, with mild to moderate intellectual disabilities (IQ <70) and low social-emotional development levels. We combined participant observations and qualitative interviews. Results: Based on the observations, the main themes for the interviews were established. Residents indicated to be free to make independent choices, and experienced less autonomy with regard to health issues and finances. Support staff stated that residents' level of autonomy depends on residents' characteristics, needs, preferences, the attitude of support staff and the rules of the care institution. Conclusion: Residents had a clear view on their autonomy in making independent choices. Support staff is mindful of preserving residents' autonomy, which in practice is limited.

This paper examines the changes in infant homes for children under the age of three in West Germany after the Second World War by combining two research perspectives. First, it will show that the increase in institutional care in the decade after 1945 was not simply dictated by a growing number of orphans. Instead, it primarily resulted from the way how authorities dealt with single mothers and their children. In a second step, the adverse influence of "Maternal Care and Mental Health," the WHO report by British psychiatrist and psychoanalyst John Bowlby, will be analysed. It will become clear that this monograph from 1951 was enormously influential within West German infant home education, such that institutional care for children under the age of three was almost completely abolished only a few years later. Thus, the paper contributes to the historization of residential childcare and of attachment theory.

Background: Although the current preventive measures relating to COVID-19 can lead to challenges in the daily work of direct support workers (e.g. keeping 1.5 m distance), it remains vital to uphold the principles of person-centred care when working with older people with intellectual disabilities. The current study explores the extent to which direct support workers have been able to apply a specific form of person-centred care (i.e. integrated emotion-oriented care, or IEOC) when working with older people with intellectual disabilities during the COVID-19 pandemic. Method: Six direct support workers from five facilities serving older people with intellectual disabilities in the Netherlands participated in this qualitative study. They participated in a two-hour focus group, which was transcribed verbatim, and the transcript was analysed thematically. Results: Three themes emerged: (i) the negative impact of changes due to the COVID-19 measures on service users; (ii) the adaptation of direct support workers to changes due to the COVID-19 measures; and (iii) putting the needs and wishes of service users first. Conclusion: This study provides first impressions into the experiences of direct support workers providing person-centred care to older people with intellectual disabilities during the COVID-19 pandemic.

Background: Individuals with neurodevelopmental disorders (NDD) are facing unprecedented challenges due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Congregate living, and conditions associated with NDD place increased challenges during infectious disease outbreaks and there is a need to understand evidence-based response procedures. The aim was to (1) map and synthesize literature regarding emergency response protocol in supported living environments for individuals with NDD and (2) identify gaps in the literature of response protocols in supported living environments for individuals with NDD. Methods: A scoping review was conducted to understand the published literature on emergency response across supported living environments for individuals with NDD during emergency situations and infectious disease outbreaks. Results: The ten studies included in the review detailed protocols including treatment, testing, isolation, surveillance, improved cleaning, use of protective equipment, and contact with public health professionals. The environment of supported living settings, and symptoms associated with NDD impacted the spread and severity of disease. Conclusion: The research findings highlight the susceptibility, severity and impact of infectious disease outbreaks for individuals with NDD in supported living environments. This research will promote the establishment and development of appropriate care and response during emergency situations in supported living environments.

Background: Australian research indicates that post-parental care transitions are rarely planned and primarily occur following a crisis for a primary carer. This paper examines disability staff perceptions of transitions for people with intellectual disability and their ageing carers in rural South Australia. Method: A focus group interview model was used, with a semi-structured interview guide initiating group discussions. A thematic analysis methodological approach was selected to analyse the data. Results: This paper reports on the theme of Service Delivery, which has three sub-themes of Availability; Distance; and Individual Access. The key findings are presented and supported by the use of exemplar quotes. Conclusions: This research indicates a poor intersection of general and specialist services is inhibiting post-parental transitional care for rural people. Simply allocating money to the individual does not resolve the issues, and the interface between different services needs to be better considered at government level.

Objective: This study investigated the role of cognitive flexibility and temperament as predictors of academic performance, in children in care and children from a community sample, longitudinally. Also, it examined the mediating role of child's temperament in the relationship between cognitive flexibility and academic performance, as well as between-group differences. Method: Participants were 46 children in care and 48 children from a community sample, aged 6 to 10 years. Cognitive flexibility, temperament, and academic performance were assessed with the Raven's Colored Progressive Matrices set B (RCPM-B), the Portuguese version of School-Age Temperament Inventory (SATI), and the competence academic scale (CAS) of the Portuguese version of the Social Skills Rating System -- Teacher Form (SSRS-T), respectively. Results: Cognitive flexibility was a significant predictor of academic performance only for children in care. In both groups, negative reactivity and task persistence predicted academic performance, and children's task persistence mediated the relationship between cognitive flexibility and academic performance. However, a between group difference was observed in this mediation: in addition to the mediation effect observed in both groups, a direct effect was also found in the in-care group. Conclusions: These findings highlight the importance of promoting cognitive and task persistence competencies in normative and at-risk populations.

Purpose: This paper aims to introduce the Empatia video reflection method, designed to enhance care workers' awareness of empathic care. The method makes the quality of care visible, which is needed when digitalization efforts in elder care focus on the efficiency and adequacy of care work. Design/methodology/approach: The Empatia method leans on previous studies of the interaction between care professionals and clients and elaborates further previous video reflection methods. In empathic care work, the care worker sees the client on their life continuum, rather than focusing on only medical treatments. Findings: The empirical example demonstrates how a care worker gained awareness of their empathic interaction habits. Within the work community, the reflection process sparked discussions on values: the purpose of care work and how to conduct empathic care. Focusing on empathic relationships in care fosters both the client's and the care worker's well-being. Practical implications: The strength of the Empatia method is that it makes empathy visible in interaction and something that is individually and collectively learnable. The Empatia includes an analytical tool for researchers to reveal empathy in client interaction. It can be developed further into a reflection tool for service work to learn how to be empathic in service encounters. Originality/value: Compared to other video-stimulated recall methods, the Empatia involves contextual understanding of care work. Empowering positive interactions instead of detecting errors and solving problems is a novel concept and is scantily used in studies of organizational learning. The Empatia provides a detailed method description that allows for the replication of the method by anyone.

This paper argues that Aboriginal children's engagement with education in the central Australian region of the Northern Territory in the mid-twentieth century can be understood as strategic engagements with formal western education systems and assimilation policies. It addresses a methodological problem stemming from a project that focuses on the work of the Finke River Mission (FRM) and its head missionary Friedrich Wilhelm Albrecht who, during the 1950s and 1960s, initiated an education scheme that targeted 'half-caste' Indigenous girls living on pastoral stations in central Australia. The scheme demonstrates the key concern of this special issue in that it is an example of the entanglements of transnational forces with local expressions of Indigenous education in Australia.

The research investigates the processes and characteristics of community-valued undergraduate community service-learning (CSL) initiatives that are housed within long-term community-university partnerships (CUPs). Using a case study design, the study used in-depth, semi-structured interviews, document review, and observation to understand three CSL/CUPs within a small, liberal arts university in Atlantic Canada. In total, 54 interviews were conducted with individuals involved with the partnerships, including the community organization partners, staff/volunteers of the community organizations, community residents, students, faculty, and university administrators. Part of the analysis process involved co-writing the stories of each of the CSL/CUPs with the community organization partner and the faculty member partner from each CSL/CUP. From the three CSL/CUP stories and current literature, a conceptual model was developed. This model depicts the processes (development, co-creation, implementation, and care) and key characteristics (reciprocity, dialogue, and praxis) of long-term CUPs that are committed to a shared domain and community-valued development outcomes.

Very rarely is one considered ahead of his/her time. Janusz Korczak has been described by so many as being such a person. His criticism of the educational system in his time served as a motivational force for his innovative pedagogy. His beliefs, techniques and methods have been echoed by experts in special education as well as in gifted education a few decades after his lifetime. The analysis of Korczak's relevant criticism, as well as his unique ideas is chosen as a prototype for the question raised in the title. A short analysis of the work of Feurstein and Renzulli is provided, both of whom reflect the main principles of Korczak.

The aim of this study was to describe the social care provided for different age groups of people with intellectual disability, 55 years or above, and to investigate the association between such care and frailty factors for those with diagnosed level of intellectual disabilities. Descriptive and logistic regression analyses were used. Commonest forms of social care among the 7936 people were "Residential care," "Daily activities" and "Contact person." "Home help" and "Security alarm" increased with age. The frailty factors significantly associated with increased social care were age, polypharmacy and severe levels of intellectual disabilities. Persons most likely to be in residential care were in the age group 65-79 with polypharmacy and severe disability. The results indicate a need for further research of how frailty factors are considered in social care and longstanding medication, especially then severe intellectual disability hinders communication. A national strategic plan for preventive interventions should be developed to ensure the best possible healthy ageing.

Background: Despite a global policy push toward the advancement of family- and community-based care, residential care for children and youth remains a relevant and highly utilized out-of-home care option in many countries, fulfilling functions of care and accommodation as well as education and treatment. Objective: As part of a larger project involving five European countries (Finland, Germany, Italy, Lithuania, and Spain), the objective was "to map" the context and content of residential care in each country, thereby building a foundation for meaningful comparisons and deepened understanding of each system's inherent logic. Within the context of global deinstitutionalization efforts, the study also aimed to understand factors that hinder or enhance the transformation of residential care. Method: Using an embedded multiple-case design, data was gathered by each country on its residential care macro context as well as salient variables related to three units of analysis--residential care system/program features, residential care training and personnel, characteristics of youth. Cross-case synthesis was used to summarize and compare cases across relevant dimensions. Results: The analysis highlighted areas of overlap and singularity, particularly with regard to utilization rates, concepts and methods, workforce professionalization, and characteristics of youth. Conclusions: Findings provide a more nuanced understanding of how residential care continues to be viewed and utilized in some countries, challenging the 'residential-care-as-a-last-resort-only' rhetoric that is currently dominating the discourse on residential care. It further provides an understanding of historical and sociocultural factors that need to be considered when trying to transform services for children, youth, and their families.

Background: "Adverse Childhood Experiences" (ACEs) have been linked to negative outcomes for adult behavioural, physical and mental health. There is limited research into the prevalence of ACEs experienced by children and young people in the children and young people secure estate, and specifically, a lack of research into England's secure children's homes (SCH) population. Objective: To explore the reported prevalence of ACEs experienced by young people admitted to an SCH in the North of England between January 2018 and March 2020. Methods: A retrospective file review was used to explore ACEs experienced by young people. Data was collated for a convenience sample of 58 young people. Descriptive analysis was completed. Results: 81.1 % of the sample yielded an ACE score of [greater or less than] 4. The average ACE score was 5.55, and the most common ACEs experienced by the sample were exposure to parental separation, physical neglect and emotional abuse. Females were significantly more likely to have experienced sexual abuse and emotional neglect. Children and young people entering the secure estate were 1.85 times as likely to have experienced [greater or less than] 1 ACE and 13.08 times as likely to have experienced [greater or less than] 4 ACEs compared to the general population. Conclusions: This unique population are likely to have experienced multiple and significant developmental trauma. These findings spotlight the vulnerabilities and complex needs of the SCH population, and have implications both for the young people's physical and mental health trajectories and for policies and care approaches within SCHs. Study limitations are discussed, along with recommendations for future research.

Behaviour support plans (BSPs), if accurately implemented, have been found to increase skills and decrease challenging behaviour of individuals with intellectual and developmental disabilities. Training is essential for staff to acquire the skills necessary for accurate implementation. The aim of this systematic literature review was to evaluate procedures used to train staff in Positive Behaviour Support (PBS), on both knowledge of PBS and implementation of BSPs. Systematic searches of 4 databases identified 18 studies as meeting criteria. Findings indicate that description alone was not consistently effective in increasing knowledge and should be used in combination with other training strategies. Staff's implementation of BSPs were increased by different combinations of the following training components: description, feedback, modelling, role-play, monitory incentive, and escape contingency. To identify evidenced based practice when training staff on BSPs, it is necessary to evaluate active and feasible training components from current training models.

Background: Taking a trauma informed care approach has demonstrated positive outcomes for services for people in the general population. Given the increased vulnerability to psychological trauma for adults with an intellectual disability, this study explores what residential staff know about trauma and trauma informed care. Methods: Thirty-two staffs representing three staff groups: direct care staff; managers; and specialist practitioners, were interviewed using semi-structured interviews, which were analysed following a structured framework. Findings: Each staff group held different perspectives in their knowledge of trauma and trauma informed care. Limitations were noted in staffs' knowledge of trauma, implementation of evidence-based supports, and access to specialist services for adults with an intellectual disability. All participants highlighted their training needs regarding trauma. Conclusion: Increased training on recognising and responding to trauma is needed among community staff supporting those with a trauma history if organisations are to move towards trauma informed care.

Background: Living arrangements is an essential component of the social environments for autistic adults. The need to understanding the status and experience of living arrangements has been highlighted. Aim: This study examined living arrangements and satisfaction with current arrangements of autistic adults reported by autistic adults or caregivers of autistic adults. Methods: This study used data from a statewide survey of autistic adults or caregivers. Results: Older autistic adults and those employed and had higher financial resources were more likely to live alone or with a roommate or spouse than to live with family or in a supervised setting. Correlates of greater satisfaction included being young, either men or women (vs. non-binary adults), public insurance, fewer service needs, no or one mental health diagnosis (vs. two or more), no psychiatric emergency room or hospitalisation history, and living with a roommate or spouse (vs. living with family). Conclusion: This cross-sectional study adds to the literature on the status of living arrangements and satisfaction with living arrangements among autistic adults. Future research is needed to investigate contributing factors to the satisfaction of living arrangements and quality of life among autistic adults.

Background: Requiring adults with intellectual and developmental disabilities to go on community outings with co-residents and staff is contrary to community-living policy's focus on person centredness and choice of activities/companions. Method: We analysed 2018-19 National Core Indicators data from 36 US states concerning 7968 adults living in staffed, non-family, multi-client settings. The focus outcome was being able to stay home if you want when others in your home go out. Results: The 42.0% of participants who could stay home were more likely to go out with friends, family or alone, and less likely to go out with staff. Those who could stay home participated in a similar variety of community activities and went out more often to shop or for errands. Conclusions: Individuals who could stay home likely had more choice about where, when and with whom they went out. Strategies for greater person-centredness are proposed.

Persons with serious mental illnesses experience high rates of medical comorbidity, especially diabetes. This study examined initial implementation feasibility, acceptability, and appropriateness of a new 6-month Multicomponent Intervention for Diabetes risk reduction in Adults with Serious mental illnesses (MIDAS) among persons in residential care facilities (RCFs). We conducted a mixed-methods study using four types of quantitative and qualitative data sources (administrative data; structured facility-level observations; resident assessments including blood-based biomarkers, 24-h dietary recalls, and self-report physical activity; and focus groups/interviews with staff and participants), to assess evidence of and factors affecting intervention feasibility, acceptability, and appropriateness. It was feasible to provide a high percentage of MIDAS class sessions (mean 50 of 52 intended sessions delivered) and make nutrition-related RCF changes (substitutions for healthier food items and reduced portion sizes). Class attendance rates and positive feedback from residents and staff provided evidence of MIDAS acceptability and appropriateness for addressing identified health needs. The residents who attended [greater than or equal to] 85% of the sessions had greater improvement in several desired outcomes compared to others. Implementing a fully integrated MIDAS model with more extensive changes to facilities and more fundamental health changes among residents was more challenging. While the study found evidence to support feasibility, acceptability, and appropriateness of individual MIDAS components, some challenges for full implementation and success in obtaining immediate health benefits were also apparent. The study results highlight the need for improving health among RCF populations and will inform MIDAS adaptations designed to improve intervention fit and effectiveness outcomes.

Purpose: Individual-randomized trials are the gold standard for testing the efficacy and effectiveness of drugs, devices, and behavioral interventions. Health care delivery, educational, and programmatic interventions are often complex, involving multiple levels of change and measurement precluding individual randomization for testing. Cluster-randomized trials and cluster-randomized stepped-wedge trials are alternatives where the intervention is allocated at the group level, such as a clinic or a school, and the outcomes are measured at the person level. These designs are introduced along with the statistical implications of similarities among individuals within the same cluster. We also illustrate the parameters that have the most impact on the likelihood of detecting intervention effects, which must be considered when planning these trials. Conclusion: Cluster-randomized and stepped-wedge designs should be considered by researchers as experimental alternatives to individual-randomized trials when testing speech, language, and hearing care interventions in real-world settings.