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Transition for adolescents and young adults with learning disabilities and mental health problems/challenging behaviours: the parent carers' views
- Authors:
- UNWIN Gemma, et al
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 2(1), March 2008, pp.22-28.
- Publisher:
- Emerald
The aim of this research was to scope issues of concern at transition for young people with learning disabilities and mental health problems/challenging behaviour from the perspective of parent carers, using a focus group interview consisting of ten participants, including on facilitator and administrative support. The interview was tape-recorded, transcribed and thematically coded using Microsoft Word and NVivo. Two case vignettes were used to simulate the discussion. Several themes emerged from analysis of the transcripts: access to information about rights and the services available for their sun or daughter, and conflicts between carers and professionals. The experience of parent carers of people with learning disabilities is still not well understood. By understanding the views and experiences of parent carers, transition can be facilitated and concerned parties can work together to achieve better results.
Your guide to taking medicine for behaviour problems: easy read
- Authors:
- UNWIN Gemma, DEB Shoumitro
- Publisher:
- University of Birmingham
- Publication year:
- 2006
- Pagination:
- 15p.
- Place of publication:
- Birmingham
This guidance provides advice for patients who are receiving medication to manage behaviour problems with a learning disability. It aims to facilitate the care process and to improve the way that behaviour problems are managed, thus leading to a better quality of life for people with a learning disability.
The use of medication to manage behaviour problems in adults with an intellectual disability: a national guideline
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 4(3), September 2010, pp.4-11.
- Publisher:
- Emerald
This article provides an overview of the development and contents of a national guideline for the use of medication in the management of problem behaviours in adults with an intellectual disability. MENCAP commissioned the University of Birmingham Neuropsychiatry and Intellectual Disabilities Research Group to develop the guideline and it was produced in association with the Royal College of Psychiatrists’ Learning Disability Faculty and the College Research and Training Unit. The guideline was produced following the methods used by the National Institute for Health and Clinical Excellence, and included a systematic literature review. This guide neither recommends nor rejects the use of psychotropic medications for the management of problem behaviours in adults with learning disabilities, but concentrates on good practice such as employing clear rationales following thorough assessments of individual patients and careful monitoring and recording of use and withdrawal. Twenty-five main recommendations for practice which are provided in the ‘Quick Reference Guide’ are listed in the article. The importance of access to ‘easy-read medication information leaflets’ for people with learning disabilities to be able to make choices is also highlighted.
A multi-centre audit of the use of medication for the management of behavioural problems in adults with intellectual disabilities
- Authors:
- UNWIN Gemma L., DEB Shoumitro
- Journal article citation:
- British Journal of Learning Disabilities, 36(2), June 2008, pp.140-143.
- Publisher:
- Wiley
The aim was to investigate prescribing practices surrounding the use of medication for the management of behavioural problems in adults with intellectual disabilities with reference to a national guideline development project. A case note review methodology was employed to explore adherence to the audit criteria that were derived from the recommendations made in the guideline. A total of 154 cases were identified as meeting the inclusion criteria. There was some variation in adherence to the examined audit criteria with some areas achieving high compliance whereas others were deemed as lacking. Such areas achieving high compliance included assessment of the behaviour, assessment of surrounding behavioural, medical, psychological/psychiatric and social issues and communication of the treatment plan to other relevant professionals. However, the assessment of capacity issues and acquisition of consent or assent were rarely documented. The results highlighted certain areas of clinical practice that may need to be formally documented in patient case notes in order to provide evidence of the quality of healthcare an individual has received.
An exploration of costs of community-based specialist health service provision for the management of aggressive behaviour in adults with intellectual disabilities
- Authors:
- UNWIN Gemma, SHOUMITRO Deb, DEB Tanya
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 30(2), 2017, pp.316-325.
- Publisher:
- Wiley
Background: In the UK, people with intellectual disabilities who exhibit aggressive behaviour often receive community-based specialist health services from a community learning disability team (CLDT). The aim of this study was to estimate costs associated with this provision and to identify predictors of higher costs. Method: Costs were estimated for 60 adults with intellectual disabilities and aggressive behaviour who attended specialist psychiatric outpatient clinics in the West Midlands region of the UK, including contact time with members of the CLDT and use of psychotropic medication over a 12-month period. Results: Mean total cost of 12-month service provision was £418 (95% confidence interval [CI] £299–557). Mean total cost of 12-month psychotropic medication was £369 (95% CI £256–492). Amongst individual members of the CLDT, mean costs were highest for psychiatrists (£181) and relatively lower for community nurses (£70) and clinical psychologists (£30), and lowest for physiotherapists (£13). Male sex, presence of expressive verbal communication and presence of epilepsy were independently associated with 12-month medication and service use costs, accounting for 23% of the variance in cost. Conclusions: It seems that in terms of costs, there is an overreliance on medication and psychiatrists and a relatively lesser reliance on other CLDT members such as community nurses and clinical psychologists for the management of aggressive behaviour in adults with intellectual disabilities within community settings. Health commissioners may wish to explore this relative cost discrepancy further and try to redress the balance where appropriate. (Edited publisher abstract)
Using medication to manage behaviour problems among adults with a learning disability: quick reference guide
- Authors:
- DEB Shoumitro, CLARKE David, UNWIN Gemma
- Publisher:
- University of Birmingham
- Publication year:
- 2006
- Pagination:
- 43p.
- Place of publication:
- Birmingham
This quick reference guide has been produced to provide advice to people who are considering prescribing medication to manage behaviour problems among adults (aged 18 years and over) with a learning disability. It does not consider in any detail the indications for choosing specific medication to manage behaviour problems among adults with a learning disability. Rather, it provides recommendations for clinical practice surrounding the use of medication to manage behaviour problems among adults with a learning disability. All relevant medication and related issues are considered. The guide is divided into the following sections: initiation of treatment (assessment, formulation, and treatment plan); monitoring of treatment; discontinuation of treatment; high-dose medication; poly-prescribing; intramuscular (IM) medication; rapid tranquilisation; as required (PRN) prescribing; communication and information sharing; interdisciplinary working; consent and capacity; and the referral pathway.