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Journal article

Physical interventions for adults with intellectual disabilities: survey of use, policy, training and monitoring

Authors:
DEVAU Roy, MCGILL Peter
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.145-151.
Publisher:
Wiley-Blackwell

Perceived problems around the use of physical intervention (PI) to manage challenging behaviour have led to UK initiatives to encourage policy development and accredited training. However, information on PI use and the impact of these initiatives remains limited. Adult residential services within an English region were sent a questionnaire regarding PI use, policy, staff training and monitoring/management. Physical intervention use was reported by 47% of the services. Of services using PI, 65% reported having a policy governing its use and 79% reported providing staff training. Where restrictive PI was used, comparable figures were 82% for policy and 84% for training. PI use was reported to be monitored in some way by 94% of services. Opinions offered supported the reduction of PI use. Physical intervention use is widespread. National guidance on policy and training is widely followed though unimplemented by a minority. The time may be right to more explicitly aim for a reduction in PI use within services.

Journal article

Representation of people with intellectual disabilities in a British newspaper in 1983 and 2001

Authors:
WILKINSON Penny, MCGILL Peter
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 22(1), January 2009, pp.65-76.
Publisher:
Wiley-Blackwell

Articles from The Guardian newspaper in 2001 were analysed and compared to a previous analysis of material published in 1983 the examine the media representation of people with intellectual disabilities. There was much more coverage of people with autism or Down syndrome than expected from their actual frequency in the British population of people with intellectual disabilities. Newspaper reports continued to be about children more often than expected when about autism or Down syndrome, but not when about people with other intellectual disabilities. Medically related representations were less than in the past but juxtaposition with other client groups continued. More 'people-first' terminology was now used except in respect of people with autism. Articles systematically under-represented complexity and severity of need. Policy and service changes may have contributed to the decline of medically- and child-related representations within non-specific intellectual disabilities. The continued over-representation of children in articles about autism and Down syndrome, and the generally increased reference to people with those syndromes, suggests growing differentiation within the population of people with intellectual disabilities. The focus on people with less severe or complex disabilities echoes criticisms of Valuing People.

Journal article

Models of community care in the UK: past and present

Author:
MCGILL Peter
Journal article citation:
Tizard Learning Disability Review, 10(1), February 2005, pp.46-51.
Publisher:
Emerald

Summarises the model of community care proposed by Jack Tizard more than 40 years ago, considers the extent to which it has been implemented and developments since, and reviews the strengths and weaknesses of current models as exemplified by 'Valuing people', considering them in their historical context.

Journal article

Commentary: reflections on developing and managing community services for people with learning difficulties

Author:
MCGILL Peter
Journal article citation:
Tizard Learning Disability Review, 3(4), October 1998, pp.24-27.
Publisher:
Emerald

Comments on a previous article by Linda Steele on pages 19-23, which sought to define the critical features of community services for people with learning difficulties. This article considers the degree to which these lessons are supported by the more general academic and professional literature.

Journal article

An analysis of the representation of people with mental handicaps in a British newspaper

Author:
MCGILL Peter
Journal article citation:
Mental Handicap Research, 3(1), 1990, pp.60-69.
Publisher:
BIMH Publications
Journal article

The topographies and operant functions of challenging behaviours in fragile X syndrome: a systematic review and analysis of existing data

Authors:
HARDIMAN Rebecca Lyndsey, MCGILL Peter
Journal article citation:
Journal of Intellectual and Developmental Disability, 42(2), 2017, pp.190-203.
Publisher:
Informa Healthcare

Background: Challenging behaviour, such as self-injury and physical aggression, is an issue of concern regarding a high proportion of individuals with fragile X syndrome. The aim of this review was to provide a comprehensive overview of the topographies and operant functions of challenging behaviours within the syndrome. Method: Five electronic databases were searched, identifying 18 manuscripts. Overall proportions of individuals with particular topographies of behaviour, or behaviour serving different functions, were calculated. Results: Across all participants, biting was the most common form of self-injury for males but not females. A pattern of behavioural function was observed, characterised by high levels of social-negative reinforcement, such as escape from demands. Conclusion: The existence of within-syndrome biases in the manifestation of behavioural challenges is supported by our review. (Publisher abstract)

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Developing better commissioning for individuals with behaviour that challenges services: a scoping exercise

Authors:
MCGILL Peter, COOPER Vivien, HONEYMAN Gemma
Publisher:
Tizard Centre; Challenging Behaviour Foundation
Publication year:
2010
Pagination:
35p., bibliog.
Place of publication:
Canterbury

The main problems faced by people with learning disabilities whose behaviour presents challenges are community placements breakdown, increasing use of out of area placements, and persistence of poor quality institutional solutions. The Department of Health commissioned this report and the work it describes as part of the delivery plan for the Government's strategy for people with learning disabilities. As a scoping exercise, the overall aim was to map out the issues and determine where future work was most likely to be useful. The report draws on 3 sources: in-depth consultations with the families of 6 individuals with behaviour that challenges services to provide a picture of the outcomes of services for individuals and families, extended interviews with 8 local authority and health commissioners of learning disability services to identify obstacles to progress and the kinds of supports that might assist local service development, and the literature on both challenging behaviour and commissioning. It provides an overview of the problems, and presents the findings from the family consultation and commissioner interviews. It makes recommendations about national action and support for commissioners.

Journal article

How much will it cost? Characteristics of the most expensive residential placements for adults with learning disabilities

Authors:
MCGILL Peter, POYNTER Jo
Journal article citation:
Tizard Learning Disability Review, 16(2), April 2011, pp.54-57.
Publisher:
Emerald

The high cost of residential services for some adults with learning disabilities is of concern, especially in a period of financial retrenchment in publicly funded services. Valuing People Now (DH, 2009) acknowledged that too often people are sent to expensive out-of-area placements. This collaborative research between the Valuing People Now Team, the Challenging Behaviour National Strategy Group and the Tizard Centre aimed to identify the characteristics of the highest-cost placements in the South-East of England. Between November 2009 and June 2010 commissioners in 19 local authority areas were asked to provide information on their 5 most expensive adult placements. Information was provided on 70 placements from 14 of the areas. The mean placement cost was £172,000 per annum, with a range from £83,000 to £333,000. The article discusses the individual characteristics, placement characteristics, differences between in-area and out-of-area placements, and predictors of higher costs. The article concludes that a small number of placements consume a significant amount of local authority resources. On average the authorities surveyed spent £0.9 million annually on their 5 most expensive placements. Suggestions for further research are provided.

Journal article

Supporting people with learning disabilities who self-injure

Author:
MCGILL Peter
Journal article citation:
Tizard Learning Disability Review, 16(1), January 2011, pp.16-17.
Publisher:
Emerald

Previous research suggests that self-injurious behaviour and self-harm are different phenomena, involving different behaviours exhibited by different groups of people. As such, this article offers a counterpoint to “Supporting people with learning disabilities who self-injure” (Pauline Heslop, Tizard Learning Disability Review, January 2011) which suggests that self-injurious behaviour and self-harm are essentially equivalent. Here, the author argues that it is valuable to recognise the differences, and commonalities, between self-injurious behaviour in both the disabled and non-disabled population. This would allow better personalised support for the individuals in question.

Journal article

Frequency of use and characteristics of people with intellectual disabilities subject to physical interventions

Authors:
MCGILL Peter, MURPHY Glynis, KELLY-PIKE Amanda
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 22(2), March 2009, pp.152-158.
Publisher:
Wiley-Blackwell

This study sought to clarify the frequency and circumstances of physical intervention (PI) use and gather data on the characteristics of individuals subject to PI. Data on individuals subject to PI were gathered by postal questionnaire completed by service providers from three samples: people who (i) had attended a PI conference and/or purchased a PI policy document; (ii) operated in a specific geographical area of England and (iii) operated specialist assessment and treatment settings for children/adults with intellectual disabilities throughout the UK. Frequent PI use was reported. Restraint was most commonly reported – monthly or more frequently with most individuals. Overall, those receiving PI were more likely to be young, male, not legally restricted and identified as having an autistic spectrum disorder than those who did not receive PI. The relatively frequent use of PI is consistent with routine rather than last resort use. Such use carries risk of physical and psychological damage. Service providers should systematically reduce the frequency of use of PI.

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