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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
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)
The "forensicisation" of challenging behaviour: the perils of people with learning disabilities and severe challenging behaviours being viewed as "forensic" patients
- Authors:
- DOUDS Fergus, BANTWAL Ashwin
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 2(3), 2011, pp.110-113.
- Publisher:
- Emerald
Since the closure of long stay learning disability hospitals in 2005, focus in Scotland has shifted on to developing robust community services to cater for the healthcare needs of people with learning disabilities. A small number of individuals with learning disabilities and associated severe challenging behaviours do inappropriately get referred and sometimes admitted to forensic learning disability services. This study investigated this area of clinical practice in the context of referrals to the high secure forensic setting of The State Hospital, Carstairs, Scotland. Five referrals made to the State Hospital's forensic learning disability service between 2005 and 2010 were reviewed. Findings revealed that the identified determinants leading to the making of these referrals were classifiable into psychiatric, environmental and staffing themes. In conclusion, there is a requirement for a specialist in-patient service to meet the needs of this complex group of patients, which demonstrates ‘gaps’ within current services.
Bridging the gap
- Author:
- CASTLES Amy
- Journal article citation:
- Learning Disability Today, December 2012, pp.14-15.
- Publisher:
- Pavilion
- Place of publication:
- Hove
Since learning disability liaison nurse posts where first created 10 years ago, there has been little research to evaluate their effectiveness. This article presents findings from an evaluation of 36 stakeholders in the Queen Alexandra Hospital in Portsmouth. The study explored whether the liaison nursing services was improving the acute hospital experience of people with learning disabilities and their carers. Findings revealed that those who used the service understood the role of the liaison nurse, and felt it was a necessity in an acute hospital. All involved, including hospital staff felt that the liaison nurses had improved hospital services for people with learning disabilities and their carers, as well as improving the working experiences of hospital staff.
Does he have sugar in his tea? Communication between people with learning disabilities, their carers and hospital staff
- Author:
- BELL Ruth
- Journal article citation:
- Tizard Learning Disability Review, 17(2), 2012, pp.57-63.
- Publisher:
- Emerald
A consistent theme in the literature has been the detrimental and sometimes fatal consequences of poor communication in relation to the care of people with learning disabilities. This study sought to evaluate a hospital passport tool designed to provide information and improve communication between people with learning disabilities and hospital staff. The Traffic Light Hospital Assessment was designed to provide essential person-centred information in a user friendly format, including life-saving information such as whether a person has dysphagia. This qualitative study was designed to explore people's experiences of good and bad communication in hospital and their experiences of how the passport impacts on that process of communication. The study included: semi-structured interviews with 12 family carers and health and social care staff; a focus group of 8 adults with learning disabilities; and a reflexive journal analysis. The findings consistently reflected the view that the Traffic Light Hospital Assessment Passport can act as a useful multi-agency resource to improve communication and continuity of care for people with learning disabilities. The reasons for poor communication emerging from the study are discussed, together with recommendations for practice development.
Tales of Normansfield: the Langdon Down legacy
- Author:
- MERRIMAN Andy
- Publisher:
- Down's Syndrome Association
- Publication year:
- 2007
- Pagination:
- 256p.
- Place of publication:
- Teddington
Traces the history of Normansfield hospital for people with learning disabilities until its closure in 1997.
Brief report: changes in admissions to a hospital for people with intellectual disabilities following the development of alternative community services
- Author:
- ALLEN David
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 11(2), 1998, pp.156-165.
- Publisher:
- Wiley
Examines admissions to a hospital for people with intellectual disabilities over a 20-year period against the background of changes in community-based social and health care provision. Found the development of community support teams had no significant impact on the rate of overall hospital admissions but was associated with a reduction in long-stay admissions. The introduction of specialist services was associated with reductions in rates of both long-and-short-term admissions. The new infrastructure of community services appeared to reduce the dependency on hospital provision over the study period, although it had not proved possible to completely eradicate new long-stay admissions. Methodological problems with the study are discussed.
The role of 'carers' of people with mental handicaps: an observational study across contexts
- Authors:
- ABRAHAM Charles, et al
- Journal article citation:
- Mental Handicap Research, 4(1), 1991, pp.20-40.
- Publisher:
- BIMH Publications
Reports on an observational study in which the work activities of professional carers in four contexts (hospital work, rehabilitation hospital, social work hostel, community mental handicap nursing unit) were studies. Interpretations of the findings, and implications for the training of care staff concerned with the rehabilitation of people with mental handicaps are discussed.
Men with intellectual disabilities and sexual offending histories: an exploration of their experiences of living within a secure hospital setting
- Authors:
- HEPPELL Stacey, ROSE John
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 12(2), 2021, pp.84-97.
- Publisher:
- Emerald
Purpose: There is a national drive to transform services for individuals with intellectual disabilities (ID), to provide care within the community rather than hospital settings. However, there are limited community provisions for those with more complex care needs such as sexual offending. There has been limited research focussing on this client group’s experiences of inpatient services and the treatment they have received from their own perspective. This study aims to explore their experiences of living in a secure service focussing on treatment for sex offences. Design/methodology/approach: In total, 10 men with ID and sexual offending histories took part in an interview designed to explore their experiences of living within a secure hospital setting. The data were analysed using thematic analysis. Findings: Three key themes relating to the participants’ experiences within the hospital were identified. These were, namely, “hospital environment”, “personal journey through secure services” and “closeness to home”. Practical implications: Men’s experiences at a secure hospital were generally positive in terms of a supportive staff approach. Difficulties existed around the hospital organisation affecting the support they received. Originality/value: Some participants experienced a struggle to become more independent and move to less restrictive environments due to their perceived risk levels. Some participants found being away from home to be hard and longed to be closer to their families. Around half of the participants did not want to live near their hometown due to family difficulties, negative peer influences or fears of consequences for their sexual offending. Implications for community service planning are considered. (Edited publisher abstract)
Challenging behaviour, inpatient services and governance in England
- Author:
- JOYCE Theresa
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.125-132.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like. Design/methodology/approach: This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance. Findings: People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital. Originality/value: Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld. (Edited publisher abstract)
“LEARN”ing what is important to children and young people with intellectual disabilities when they are in hospital
- Authors:
- OULTON K., SELL D., GIBSON F.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 31(5), 2018, pp.792-803.
- Publisher:
- Wiley
Background: The need to review health service provision for children and young people (CYP) with disabilities and their families in the United Kingdom has been expressed in multiple reports: the most consistent message being that services need to be tailored to meet their individual needs. Our aim was to understand the hospital‐related needs and experiences of CYP with intellectual disabilities. Method: An ethnographic study of a neurosciences ward and outpatient department was conducted within a paediatric tertiary hospital setting. Results: Five themes, developed using the acronym LEARN, explained what is important to CYP with intellectual disabilities in hospital: (i) little things make the biggest difference, (ii) eliminate unnecessary waiting, (iii) avoid boredom, (iv) routine and home comforts are key and (v) never assume. Conclusions: It is imperative that the present authors continue to challenge the idea that it is acceptable to exclude CYP with intellectual disabilities from research because of their inability to participate. (Edited publisher abstract)