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Enhancing capacity to make sexuality-related decisions in people with an intellectual disability
- Authors:
- DUKES E., McGUIRE B.E.
- Journal article citation:
- Journal of Intellectual Disability Research, 53(8), August 2009, pp.727-734.
- Publisher:
- Wiley
An intervention was applied to the area of sexual knowledge in order to determine if capacity for people with learning disabilities to make sexuality-related decisions could be improved. The study adopted a single subject design using multiple baseline method with four adults with a moderate intellectual disability. The intervention consisted of individually tailored sex education. Treatment was offered to each participant twice weekly for a 10-week period on a one-to-one basis. The Sexual Consent and Education Assessment was used for measurement purposes. The SCEA K-Scale (knowledge) and the S-Scale (safety practices) were administered weekly throughout the baseline, treatment and post-treatment phases of the study. Staff concerns were also assessed using the SCEA Inappropriate Sexual Behaviour Scale. All four participants improved their decision-making capacity in all targeted areas as measured by improvements in K-Scale and S-Scale scores. Staff concerns were not increased as indicated by results on the Inappropriate Sexual Behaviour Scale. Six-month follow-up data for three of the participants showed maintenance of scores on the S-Scale and some decay in scores on the K-Scale from post-intervention performance.
Choice as an aspect of quality of life for people with intellectual disabilities
- Authors:
- BROWN Ivan, BROWN Roy I.
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 6(1), March 2009, pp.11-18.
- Publisher:
- Wiley
Drawing on conceptual considerations and research reports, the authors review and extend what is known about choice, and set out a conceptualization of its two main components: available opportunities and choice-making. The most important characteristics of opportunities are breadth and familiarity, and the most important characteristics of choice making are freedom, initiative, and skill. The authors consider the application of choice to supports and services by discussing numerous practical issues and providing suggestions for application. These are summarized as an overall four-step strategy for moving forward that sets the scene for more specific strategies to be developed and evaluated.
Best interest
- Authors:
- JUMPCUTS, BIGGERHOUSE, (Producers)
- Publisher:
- JUMPcuts
- Publication year:
- 2009
- Pagination:
- (17 mins.), DVD
- Place of publication:
- Bridgwater
This film follows three characters' interweaving stories as they cope with issues arising from learning disability, mental health and dementia. The DVD also features three stories dealing with issues concerned with Least Restrictive Practice. It can be used in staff training to discuss issues raised by the Mental Capacity Act.
Decisions, decisions – establishing a legal framework around decision making
- Authors:
- ELSMORE Susan, PICTON Alison
- Journal article citation:
- Community Living, 23(2), 2009, pp.20-23.
- Publisher:
- Hexagon Publishing
The first of two articles by SCIE staff on the Mental Capacity Act 2007 (MCA), this is an overview of key provisions relating to the practice of health and social care, by staff and unpaid carers, with people who have learning disabilities. Previously, there was no dedicated legislation on mental capacity in England and Wales and dependence on good practice and common law led to inconsistencies. MCA safeguards decision making by defining a legal framework which empowers people to make their own decisions, while people who lack capacity are protected by the framework’s flexibility to place them at the heart of decision making, managed by others. Equally important is MCA’s emphasis on planning ahead for when an individual might lack capacity, thereby ensuring their decision is honoured in the future. A lack of capacity can be caused by, stroke or brain injury, mental health problems, dementia, learning disabilities, substance misuse and confusion, drowsiness or unconsciousness because of an illness or it’s treatment. Five key principles of MCA, a two-stage functional test of capacity, ‘best interests’, new roles, bodies and powers such as LPAs (lasting powers of attorney), the Court of Protection and Deputies and the new criminal offence that is the wilful neglect or ill treatment of a person who lacks capacity and three case studies illustrating good practice within MCA are described.
Effect of playing computer games on decision making in people with intellectual disabilities
- Authors:
- STANDEN P.J., REES F., BROWN D.J.
- Journal article citation:
- Journal of Assistive Technologies, 3(2), June 2009, pp.4-12.
- Publisher:
- Emerald
People with intellectual disabilities have difficulty making decisions and this may hinder their independence and inclusion in society. Interactive computer software may give them the opportunity to practice the underlying components of this skill. This study analysed whether repeated sessions playing a computer game involving aspects of decision making, such as collecting relevant information and controlling impulsivity, would improve performance in two non-computer based tests of decision making. Twelve adults with intellectual disabilities were randomly assigned to either an intervention group or control group. They were all exposed to 10 twice-weekly sessions, playing either the intervention game or the control game, which involved simple reaction time only. After repeated sessions, the intervention group showed a significant improvement in game score, with researcher assistance significantly decreasing. At follow up, the intervention group showed a significant decrease from baseline in the number of guesses made before guessing correctly on both of the decision-making tests. The decrease observed in the control group failed to reach significance.
Impact of coercive tactics on the decision-making of adolescents with intellectual disabilities
- Authors:
- KHEMKA I., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 53(4), April 2009, pp.353-362.
- Publisher:
- Wiley
High rates of victimisation have raised concerns about the ability of adolescents with intellectual disabilities (ID) to avoid and escape from harmful situations and to make decisions in their own best interest. The present study was designed to assess the impact of specific coercive tactics on the decision-making of adolescents with ID. Forty-eight adolescents with ID participated in the study. They were asked to respond to a series of brief vignettes depicting equal numbers of situations involving coercion with a lure, coercion with a threat, and no specific coercive tactic. Performance was assessed in terms of independent, prevention-focused decisions, reporting decisions and responses to fact and inference comprehension questions. Overall, participants suggested independent, prevention-focused decisions only about half the time. They were more likely to suggest independent, prevention-focused decisions in situations with no specific coercive tactic or coercion with a lure than in situations involving a threat. However, reporting decisions were more likely in situations involving coercion with a threat than in the other two conditions and both fact and inference comprehension were best in situations involving coercion with a threat. Results indicated that adolescents with ID are not well-prepared to handle situations on their own that involve coercion, especially coercion with a threat. Because comprehension did not appear to be a key source of the decision-making difficulty in this study, further research is needed to examine all aspects of the decision-making process as a basis for the design of effective interventions.
The Mental Capacity Act: practicalities for health and social care professionals
- Authors:
- HARDY Steve, JOYCE Theresa
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 3(1), March 2009, pp.9-14.
- Publisher:
- Emerald
The Mental Capacity Act (2005) is now in full operation in England and Wales. In this article, some of the common questions that professionals face on a day-to-day basis are discussed, including how to assess capacity and decide whether or not someone has capacity, what to do if someone lacks capacity and what could happen if someone does not follow the Mental Capacity Act.
People with learning disabilities who have cancer: an ethnographic study
- Authors:
- TUFFREY-WIJNE Irene, et al
- Journal article citation:
- British Journal of General Practice, 59(564), July 2009, pp.503-509.
- Publisher:
- Royal College of General Practitioners
Cancer incidence among people with learning disabilities is rising. This study aimed to provide insight into the experiences and needs of people with learning disabilities who have cancer. A prospective qualitative study was carried out using ethnographic methods. The participants were 13 people with learning disabilities ranging from mild to severe, who had a cancer diagnosis. The main method of data collection was participant observation (over 250 hours). The median length of participation was 7 months. Participants' cancer experiences were shaped by their previous experience of life, which included deprivation, loneliness, and a lack of autonomy and power. They depended on others to negotiate contact with the outside world, including the healthcare system. This could lead to delayed cancer diagnosis and a lack of treatment options being offered. Most participants were not helped to understand their illness and its implications. Doctors did not make an assessment of capacity, but relied on carers' opinions. The authors conclude that urgent action is warranted by findings of late diagnosis, possible discrimination around treatment options, and lack of patient involvement and assessment of capacity in decision making. There are significant gaps in knowledge and training among most health professionals, leading to disengaged services that are unaware of the physical, emotional, and practical needs of people with learning disabilities, and their carers.
Brief guide to the Mental Capacity Act 2005: implications for people with learning disabilities
- Authors:
- HARDIE Elaine, BROOKS Liz
- Publisher:
- British Institute of Learning Disabilities
- Publication year:
- 2009
- Pagination:
- 43
- Place of publication:
- Kidderminster
This guide is for those who work with people who have a learning disability and will also be of use to parents and carers, friends and advocates. It aims to: explain the key points of the Mental Capacity Act 2005; explain what some of the choices and decisions might be; help carers support someone with a learning disability to plan ahead and talk about their future. Case studies are used to demonstrate key points of the act and how it might be applied in real life situations. (Edited publisher abstract)
Choices for people with intellectual disabilities: official discourse and everyday practice
- Authors:
- ANTAKI Charles, FINLAY W. M. L., WALTON Chris
- Journal article citation:
- Journal of Policy and Practice in Intellectual Disabilities, 6(4), December 2009, pp.260-266.
- Publisher:
- Wiley
Official policies on "choice" for people with intellectual impairments tend toward fundamental life choices (e.g., who to marry, what job to work at) at the expense of the minor but more frequent concerns of daily living (when to wash, what to eat, where to go in the evening). The authors undertook an examination of how choice policies are actualised in day-to-day activities in two group homes. Data were drawn from a broader ethnographic study of residential services for people with intellectual disabilities serviced by National Health Service Trust in the United Kingdom. Conversation analysis, used to explicate the interactions, showed how staff, although undoubtedly well-meaning, use the discourse of choice to promote institutional managerial objectives, thus demonstrating a gap between practice and overarching policy theory and recommendations.