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Journal article

Naming, defining and classifying the condition (formerly?) known as mental retardation

Authors:
THOMPSON James R., EZELL Dan
Journal article citation:
Journal of Social Work in Disability and Rehabilitation, 4(3), 2005, pp.5-23.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

In this American article key controversies and diverse perspectives are summarized regarding terminology, definition, and classification issues in the field of mental retardation. Six questions are provided to guide consideration of critical issues. Conclusions are drawn and implications for professional practice are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

Journal article

Health and social care practitioners’ experiences of assessing mental capacity in a community learning disability team

Authors:
RATCLIFF Daniel, CHAPMAN Melanie
Journal article citation:
British Journal of Learning Disabilities, 44 (4), 2016, pp.329-336.
Publisher:
Wiley-Blackwell

Background: The study explored experiences of health and social care practitioners within a community learning disability team in undertaking mental capacity assessments with people with learning disabilities. Materials and Methods: Eight practitioners were interviewed using a semi-structured interview schedule. Results: The information gained was analysed using thematic network analysis. Twelve basic themes emerged which fit into five organising themes labelled: ‘systemic barriers to assessment’; ‘capacity assessing as a process’; ‘person-specific challenges’; ‘protective practices’; and ‘protection of a fundamental human right’. A global theme, ‘freedom of action versus restrictions on action’, was identified. Conclusions: The themes highlighted that there were a range of organisational, systemic and person-specific factors that impacted on the perceived quality of and assessors’ confidence in their assessments of mental capacity. Furthermore, these factors appeared to create a range of tensions for assessors increasing the likelihood of cognitive dissonance. Practice implications surround maintaining knowledge, ensuring adequate skills in the practical application of knowledge and reducing organisational barriers. (Publisher abstract)

Journal article

The utility of the Montreal Cognitive Assessment as a mental capacity assessment tool for patients with a learning disability

Authors:
EDGE Daniel, et al
Journal article citation:
British Journal of Learning Disabilities, 44(3), 2016, p.240–246.
Publisher:
Wiley-Blackwell

Objective: To determine the psychometric properties of the Montreal Cognitive Assessment (MoCA) in patients with a learning disability and examine it's utility for conducting mental capacity assessment. Method: This study was a cross-sectional, instrument validation study in an inpatient hospital setting, located in the East of England. The sample consisted of two groups: (i) 31 consecutively admitted hospital patients and (ii) 10 multidisciplinary team members who served as a comparison group. The MoCA, a 12-item screen for mild cognitive impairment and the Dysexecutive Questionnaire (DEX), were used in this study. Item analysis was conducted by comparing item endorsement for all participants that had a learning disability utilising Difficulty and Discrimination Indices for each item on the MoCA. The authors examined the internal consistency of a revised scale derived from item analysis and used a one-way ANOVA to determine concurrent validity by comparing scores between two patient subgroups and the comparison group. Results: A 7-item scale, ‘MoCA-LD’ (alpha coefficient = 0.82) emerged from item analysis. A statistically significant negative correlation was observed between MoCA-LD and DEX (Pearson correlation = −0.66, P < 0.01). As expected, participants in the borderline category scored higher on MoCA-LD than those with mild learning disability, as did those with no learning disability (P < 0.001). Conclusion: The MoCA-LD has the potential to be a useful tool for mental capacity assessment in patients with a learning disability. (Edited publisher abstract)

Journal article

Criterion-related validity of challenging behaviour scales: a review of evidence in the literature

Authors:
TURTON Raistrick W., et al
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 28(2), 2015, pp.81-98.
Publisher:
Wiley-Blackwell

Background: Behaviour that challenges has negative impacts on physical and emotional well-being and quality of life. Challenging behaviour scales are used to identify needs and evaluate interventions and must be valid measures. Criterion-related validity is important, and the best quality assessment uses direct measures of behaviour as criteria. Previous reviews of scales affirm their validity but present little supporting evidence. The current review examines the evidence presented in studies of validity. Methods: Searches of MEDLINE and PsycINFO to identify scales that focus on challenging behaviour and find publications that assess their criterion-related validity. Results: Searches identified twelve scales and 21 publications that assess validity. One assessment used direct measures of behaviour, and the remainder used indirect measures that themselves have limited evidence of validity, including membership of diagnostic or service groups and other scales. Conclusions: Little firm evidence of validity was found, but what was found is encouraging. (Publisher abstract)

Journal article

Supporting primary healthcare professionals to care for people with intellectual disability: a research agenda

Authors:
LENNOX Nicholas, van DRIEL Mieke L., van DOOREN Kate
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 28(1), 2015, pp.33-42.
Publisher:
Wiley-Blackwell

Background: People with intellectual disability experience health inequalities. Over two decades after the only review of supports for primary healthcare providers was published, this paper contributes to an evolving research agenda that aims to make meaningful gains in health-related outcomes for people with intellectual disabilities. Methods: The authors update a previous review existing review by searching the international literature for developments and evaluations of multinational models of care. Results: Based on the review, three strategies are presented to support primary healthcare providers: (i) effectively using what we know, (ii) considering other strategies that offer support to primary healthcare professionals and (iii) researching primary health care at the system level. Conclusions: Strengthening primary care by supporting equitable provision of health-related care for people with intellectual disability is a much needed step towards improving health outcomes among people with intellectual disability. More descriptive quantitative and qualitative research, as well as intervention-based research underpinned by rigorous mixed-methods evaluating these strategies at the primary care level, which is sensitive to the needs of people with intellectual disability will assist primary care providers to provide better care and achieve better health outcomes. (Edited publisher abstract)

Journal article

I-CAN: the classification and prediction of support needs

Authors:
ARNOLD Samuel R.C., RICHES Vivienne Catherine, STANCLIFFE Roger J.
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 27(2), 2014, pp.97-111.
Publisher:
Wiley-Blackwell

Background: Since 1992, the diagnosis and classification of intellectual disability has been dependent upon three constructs: intelligence, adaptive behaviour and support needs (Luckasson et al. 1992. Mental Retardation: Definition, Classification and Systems of Support. American Association on Intellectual and Developmental Disability, Washington, DC). While the methods and instruments to measure intelligence and adaptive behaviour are well established and generally accepted, the measurement and classification of support needs is still in its infancy. This article explores the measurement and classification of support needs. Method: A study is presented comparing scores on the ICF (WHO, 2001) based I-CAN v4.2 support needs assessment and planning tool with expert clinical judgment using a proposed classification of support needs. A logical classification algorithm was developed and validated on a separate sample. Results: Good internal consistency (range 0.73–0.91, N = 186) and criterion validity (κ = 0.94, n = 49) were found. Conclusions: Further advances in our understanding and measurement of support needs could change the way disability is assessed, described and classified. (Edited publisher abstract)

Journal article

The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications

Authors:
LAVIGNA Gary W., WILLIS Thomas J.
Journal article citation:
Journal of Intellectual and Developmental Disability, 37(3), September 2012, pp.185-195.
Publisher:
Informa Healthcare

Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. However, questions have been raised as to PBS effectiveness, costs, and accessibility. This review examined the efficacy of 12 outcome studies encompassing 423 cases. Findings indicated that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community. The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment. Implications for practice are discussed.

Journal article

The PAS-ADD assessments and their continuing conceptual development

Author:
MOSS Steve
Journal article citation:
Advances in Mental Health and Intellectual Disabilities, 6(1), 2012, pp.5-16.
Publisher:
Emerald

The PAS-ADD assessments (Psychiatric Assessment Schedules for Adults with Developmental Disabilities) have been in continuous development since the mid-1980s. Although originally developed through work on the health status of older people with intellectual disability they now encompass children as well as adults. The author discusses the theoretical and practical issues that have shaped the development of the assessments. The fundamental aim of the modern PAS-ADD system is to improve case detection and assessment by supporting and enhancing the skills of clinical staff, rather than attempting to replace the need for those skills. The assessor makes the final judgement about diagnosis. The PAS-ADD assessments are based on existing psychiatric classification and diagnostic rules for the general population and are conceptually different from instruments derived from psychometric principles. It is suggested that these factors have major implications, both for instrument design and for the evaluation of effectiveness.

Journal article

Identification and assessment of children with developmental disabilities in child welfare

Authors:
SHANNON Patrick, TAPPAN Christine
Journal article citation:
Social Work: A journal of the National Association of Social Workers (NASW), 56(4), October 2011, pp.297-305.
Publisher:
Oxford University Press

This study investigated the capability of a Child Protective Services (CPS) screening and investigation process to identify children with developmental disabilities. A total of 33 interviews were conducted with foster families, administrators, intake screeners, special investigators, and workers in one local CPS office in the north eastern state in the US. An allegation of maltreatment made to CPS sets a very confusing and complex chain of events in motion which involves the courts, law enforcement, medical providers, schools, families, and children. Participants in this study described the process as being even more challenging when the child had a developmental disability. Participants highlighted important concerns about the prevalence of developmental disabilities in CPS, understanding of what constitutes a developmental disability, the impact of developmental disability on screening and assessment, and perceived supports to improve the system’s ability to identify and assess the needs of children with developmental disabilities and their families. The authors concluded that improved screening was required in CPS settings.

Journal article

Learning disability classification: time for re-appraisal?

Author:
LEYIN Alan
Journal article citation:
Tizard Learning Disability Review, 15(2), April 2010, pp.33-44.
Publisher:
Emerald

This paper examines the nature of the classifications of learning disabilities as circulated within the diagnostic manuals. It suggests that, by leaving aside all doubts and controversies that surround the concept and measurement of intellectual functioning, weaknesses are exposed from within those manuals' own frames of reference. The difficulties arising from using the international sub-classifications of learning disabilities when the national classifications should apply are discussed. Three main conclusions are drawn: there are inherent difficulties with the measurement of the fine-grained classification system which leads to a best guess approach; there are difficulties resulting from the incursion of the internationally promoted classification into the national context; and without acknowledging these two failings, problems will compound, appearing in unlikely places. The difficulties fundamentally arise from trying to mould the categories of learning disabilities into a strict medical diagnostic framework.

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