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‘Planning live’: using a person-centred intervention to reduce admissions to and length of stay in learning disability inpatient facilities
- Authors:
- BARTLE Janet, CROSSLAND Tom, HEWITT Olivia
- Journal article citation:
- British Journal of Learning Disabilities, 44 (4), 2016, pp.277-283.
- Publisher:
- Wiley
Background: Recent government policy has focused on reducing the number of people with a learning disability receiving treatment for challenging behaviour or mental health difficulties in hospitals (including in assessment and treatment units; ATU). People with a learning disability should be supported to remain in their community when receiving support for challenging behaviour or mental health difficulties whenever possible. Methods: This study considered a novel intervention based on person-centred planning practice, which aimed to coordinate a person's support, identify outstanding needs and increase communication. This intervention intended to reduce rates of inpatient admission, and support the person to remain in their community, whilst ensuring their needs are met. This intervention was assessed by considering the number of people admitted to the inpatient services before and after the intervention, the length of inpatient admissions before and after the intervention, and by analysing qualitative feedback from participants in the intervention. Results: ‘Planning Live’ meetings were held for 102 people. Forty-five meetings were held retrospectively following an emergency admission. Following the ‘Planning Live’ meeting, five people had a planned admission and 52 people did not have an inpatient admission. The median length of inpatient stay fell from 143.5 days before the introduction of ‘Planning Live’ to 66 days (a statistically significant reduction). Qualitative feedback shows that the process was largely seen as helpful by professionals, families and individuals taking part in the meetings. Conclusions: The results suggest this person-centred intervention contributed towards a reduction in the amount of time individuals stayed in hospital. However, the total number of hospital admissions rose following the intervention. (Publisher abstract)
Can active support improve job satisfaction?
- Authors:
- Rhodes Jennifer A., TOOGOOD Sandy
- Journal article citation:
- Tizard Learning Disability Review, 21(2), 2016, pp.54-60.
- Publisher:
- Emerald
Purpose: Active support (AS) influences the way staff support people with intellectual disabilities to take part in everyday activities. Changes in work practices may affect job satisfaction. The impact of AS on job satisfaction has not, however, been widely studied. Job satisfaction is linked with levels of staff turnover and the overall quality of services provided to people with intellectual disabilities (Coomber & Barriball, 2007; Hatton et al., 2001). The purpose of this paper is to describe an evaluation of job satisfaction amongst 38 direct care staff working in intellectual disability services before and after AS was implemented. Design/methodology/approach: A single group, repeated-measures design was used. In total, 38 members of direct care staff received AS training. Data on job satisfaction were collected before, and after, AS was implemented. In total, 19 members of staff took part in a follow-up 12 weeks later. Findings: There was a significant increase in reported job satisfaction following the implementation of AS. Subscale analysis revealed that the most significant increases in job satisfaction were related to areas directly targeted by AS, including satisfaction with skill level and satisfaction with amount of time spent with service users. Originality/value: Implementing AS may provide an added benefit for direct care staff, who feel more satisfied at work. While a significant number of papers have been published focusing on the benefits of AS, no papers have specifically looked at the impact that the intervention can have on job satisfaction. (Publisher abstract)
Intellectual disability and substance use/misuse: a narrative review
- Authors:
- DAY Christine, et al
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 7(1), 2016, pp.25-34.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a narrative review of the literature on substance use/misuse within an intellectual disability (ID) population. The paper is focused on the prevalence, motivation and implications of substance use as well as the interventions for misuse. Design/methodology/approach: Research focused on substance use and ID (IQ of 70 or less with onset in the developmental period) were considered. Findings: The findings indicate a disparity between research findings regarding the prevalence of substance use/misuse within ID populations. Previous research indicates that individuals with ID may use/misuse substances as a form of relief or respite from negative experiences. Although there is a clear need for intervention, many of the ID population do not engage with generic interventions for substance misuse. Additionally, professionals responsible for the provision of interventions identify a lack of training and support to meet the needs of ID populations. Research limitations/implications: The review highlights problems with the current evidence base and barriers this poses indicates a need for further research and intervention. It found minimal research in this area, with barriers to language and demographics being underreported. Originality/value: In order to build a greater understanding of this issue, a shared universal language and definition of ID must be implemented. Further research to improve the understanding of why those with ID misuse substances is imperative before designing and implementing useful interventions. (Edited publisher abstract)
Trauma-focussed cognitive-behaviour therapy for people with mild intellectual disabilities: outcomes of a pilot study
- Authors:
- KROESE Biza Stenfert, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(5), 2016, pp.299-310.
- Publisher:
- Emerald
Purpose: Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD. Design/methodology/approach: Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA). Findings: The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual. Research limitations/implications: A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice. Practical implications: This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD. Social implications: The findings indicate that a group intervention is both feasible for and acceptable to adults with ID. Originality/value: To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID. (Publisher abstract)
Social care intervention and human rights: a practitioner's guide
- Author:
- BRITISH INSTITUTE OF HUMAN RIGHTS
- Publisher:
- British Institute of Human Rights
- Publication year:
- 2016
- Pagination:
- 16
- Place of publication:
- London
This booklet provides information for social care practitioners about using the Human Rights Act and human rights approaches in social care settings, where mental capacity or mental health is a factor. The booklet is in three sections covering: removing people from their own home to a care setting, which includes a decision making flowchart; adult safeguarding interventions and ‘unwise’ decisions; rights of learning disabled people to marry and have a family. Each section outlines potential human rights issues for practice; suggestions for taking a human rights approach; information about the key rights most likely to be relevant to that area of practice; and worked examples. It is one of eight booklets developed as part of the British Institute of Human Rights (BIHR) project ‘Delivering Compassionate Care: Connecting Human Rights to the Frontline’, which aims to place human rights at the heart of mental health services and ensure frontline staff have the knowledge and skills uphold the dignity and human rights of the people using their service. The booklet is aimed at both qualified and unqualified staff. It also contains information that may be useful for people using services, their family, carers or advocates. (Edited publisher abstract)
Exorcising restraint: reducing the use of restrictive interventions in a secure learning disability service
- Author:
- RIDING Tim
- Journal article citation:
- Journal of Intellectual Disabilities and Offending Behaviour, 7(4), 2016, pp.176-185.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme. Design/methodology/approach: The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme. Findings: Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation. Originality/value: The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered. (Publisher abstract)
Supporting people with learning disabilities through a bereavement
- Author:
- BLACKMAN Noelle
- Journal article citation:
- Tizard Learning Disability Review, 21(4), 2016, pp.199-202.
- Publisher:
- Emerald
Purpose: There remains a lack of clarity regarding what constitutes “normal” or “complicated” grief within this client group. The purpose of this paper is to identify the factors that complicate grief and considers interventions which would be beneficial. Design/methodology/approach: The paper draws on previous research by the author and others to comment on some of the issues discussed by Hannah Young in her article. Findings: Three domains contribute to complicated grief in people with learning disabilities. These are the learning disability itself, environmental factors and the impact of disability on attachment. Practical implications: A relational approach to support is important in preventing complicated grief. If the grief becomes complicated, a relational psychotherapy is recommended as the preferable intervention. Originality/value: This paper gives important consideration to practical factors that can lower vulnerability to complicated grief for this client group. (Publisher abstract)
A survey of consultant psychiatrists in intellectual disability based in England
- Authors:
- GUINN Ashley, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(4), 2016, pp.258-270.
- Publisher:
- Emerald
Purpose: Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services. Design/methodology/approach The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets. Findings: In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services. Research limitations/implications: Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners. Originality/value: This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID. (Publisher abstract)
Staff ability to carry out behavioural strategies for individuals with intellectual disabilities and challenging behaviours
- Authors:
- KLAVER Marian, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(4), 2016, pp.248-257.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to give an overview of studies that focused on variables likely to affect staff ability to carry out behavioural strategies for challenging behaviours in individuals with intellectual disabilities. Design/methodology/approach: Literature review: studies that were published in a peer reviewed journal, between 1999 and 2016, were selected for this review. Findings: In total, 29 articles were selected. Several factors likely affect staff ability to appropriately carry out behavioural interventions were identified: staff assumptions, distressing emotions elicited by challenging behaviours, reciprocal reinforcement systems, service characteristics and cultural systems. Originality/value: These findings raise the question what staff need in order to be able to change their naturally occurring behaviours in response to challenging behaviours and to carry out behavioural interventions. Future research may identify barriers and facilitators underlying the provision of effective interventions, taking into account the possible role of staff beliefs, their emotions, service characteristics and cultural systems. (Publisher abstract)
Raising aspiration: widening participation in supported internships
- Authors:
- ALLOTT Susan, HICKS Tom
- Publishers:
- Remploy, Mencap
- Publication year:
- 2016
- Pagination:
- 12
- Place of publication:
- Leicester
Joint report by Mencap and Remploy which looks at the effectiveness of supported internships in providing a route into paid employment for young people with learning disabilities and special educational needs. Supported internships provide personalised study programmes based primarily at an employer’s premises, which include on-the-job training provided by expert job coaches. Job coaches provide support to employers, increasing their confidence of working with interns, and also provide support at the end of the internship for those young people not offered a paid job. The report also looks at some of the challenges of delivering and scaling up the provision of supported internships, which include employers not recognising supported internships as a model of good practice, lack of awareness of local authorities, and lack of long-term funding. It then puts forward proposals to help address these challenges. The report argues that supported internships could form a key part of Government aspirations to reduce the disability employment and calls for a cross-Government marketing campaign and a sustainable, ring-fenced funding stream to help agencies running and planning supported internships. (Edited publisher abstract)