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Social inclusion and people with intellectual disability and challenging behaviour: a systematic review
- Author:
- BIGBY Christine
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 37(4), December 2012, pp.360-374.
- Publisher:
- Taylor and Francis
Noting that the high risk of social exclusion for people with intellectual disability is compounded for those with challenging behaviour, this systematic literature review examined how social inclusion of people with intellectual disability and challenging behaviour has been researched and operationalised in the literature. It also aimed to explore the evidence about the extent of social inclusion of this group. 14 papers reporting community inclusion outcomes for people with challenging behaviour were identified through database searches, and thematic analysis was used to synthesise and interpret the findings. The article includes a table summarising the key features of the studies included in the review. It reports that the analysis found that social inclusion had been poorly defined and measured, and that the little research that had occurred in respect of people with challenging behaviour had demonstrated their potential to be socially included. The author discusses the implications of the findings, with particular reference to practice in Australia.
Use of ECT in patients with an intellectual disability: review
- Authors:
- COLLINS Jessica, HALDER Neel, CHAUDHRY Nasim
- Journal article citation:
- Psychiatrist (The), 36(2), February 2012, pp.55-60.
- Publisher:
- Royal College of Psychiatrists
Although adults with an intellectual disability display a higher prevalence of psychiatric disorders than in the general adult population, the existing literature on the use of electroconvulsive therapy (ECT) in patients with an intellectual disability is limited. This review examined articles on ECT published before March 2010. All age ranges, severity of disability and diagnoses were included. The review found 72 case reports, a retrospective chart review study and other reviews, but no controlled studies. Seventy nine per cent of patients showed a positive outcome following ECT. Complications were seen only in 13% and there were no reports of cognitive decline. Thirty two per cent of patients relapsed following ECT, and the majority were maintained with medication at follow-up (71%). Obstacles to its use include diagnostic difficulties, ethical and legal issues, a lack of objective measurements and uncertainty about its safety in this population. The authors concluded that ECT was a valuable treatment for this patient group and should be considered earlier as opposed to as a last resort.
Rapid risk assessment in acute hospital for patients with intellectual disabilities
- Authors:
- READ Stevie, JOHNSON Tristan
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 6(6), 2012, pp.321-322.
- Publisher:
- Emerald
People with intellectual disabilities have been shown to be at significantly higher risk, compared to the rest of the population, for adverse events happening to them in hospital. The authors share the outcomes from a patient safety project conducted in an acute hospital in England by the Trust's intellectual disabilities team. A project structure was used, supported by the Trust patient safety team through association with the National Institute for Innovation and Improvement: leading improvement in patient safety (LIPS) programme. The aim of the project was to bring together the current evidence, to understand the risk issues for this group and develop a robust risk assessment tool that could be embedded into the care processes in acute hospitals. A six month pilot concluded that a short assessment in a familiar format was more likely to be used by nurses. Risk assessment on its own did not deliver better and safer care. It must be accompanied by a series of clear, evidence based actions which used together ensure the patients' total safety and care needs are met. This tool is used throughout the Trust and in a number of other hospitals across the eastern region. Its use has contributed to reducing length of stay and improving health outcomes.
‘Standing up for my human rights’: a group’s journey beyond consultation towards co-production
- Authors:
- ROBERTS Amanda, et al
- Journal article citation:
- British Journal of Learning Disabilities, 40(4), December 2012, pp.292-301.
- Publisher:
- Wiley
In the UK, service user inclusion is a key component of human rights-based approaches to healthcare, and models of inclusion are developing rapidly. This article describes work with a small group of NHS service users, designed to increase their knowledge of human rights, as part of a broader set of initiatives focussing on changing organisational culture. During a mutual learning journey, ‘co-production’ emerged as a preferred model for promoting service user’s understandings of human rights. Co-production, or sharing service design and delivery more equally with service users, led to outcomes that were initially inconceivable. During the group, co-production appeared to be a vehicle for resolving dilemmas about services ‘empowering’ service users. This article considers how, when service user involvement and a HRBA are combined, a move towards collaboration, empowerment and redistribution of power is possible.
Managing sexually harmful behaviour in a residential special school
- Authors:
- PRITCHARD Duncan, et al
- Journal article citation:
- British Journal of Learning Disabilities, 40(4), December 2012, pp.302-309.
- Publisher:
- Wiley
Children and young people who present sexually harmful behaviour are marginalised and do not always participate in community activities. This is especially true for those with learning disabilities. This case study describes a multi-component intervention in Wales that successfully reduced the sexually harmful behaviour of a 16-year-old boy with a mild learning disability. The intervention was comprised of cognitive behaviour therapy, Social Stories™ and a behavioural programme that reinforced appropriate behaviour with social praise and access to preferred items and a range of community activities. Following the intervention, the study participant was able to join in a wide range of supervised community activities.
“Shared Pathway” national pilot project: the experience of a secure learning disability service
- Authors:
- ESAN Fola, et al
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 3(2), 2012, pp.98-110.
- Publisher:
- Emerald
The cost of secure care has been increasing over the past few years. Despite the increased spending on secure services, there continues to be difficulties relating to patient progression through the care pathway to safe integration in the community. The Shared Pathway project was developed by the North of England Specialist Commissioning Group, Yorkshire and Humber Office in partnership with service users, clinicians and commissioners. The aims of the Shared Pathway are to: reduce costs within secure services without reducing quality; meet individual need; and demonstrate efficiency. The purpose of this paper is to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services. It explores some background drivers to the project as well as the experience of service users and staff. Recommendations on service-wide implementation of the Shared Pathway are made. The findings show that the implementation of the Shared Pathway will lead to considerable changes in practice. It may be useful in ensuring evidence based outcomes are routinely used by clinicians in secure services in collaboration with patients. It may also clarify to patients what their role is in engaging in treatment that helps them in moving through secure services.
Childhood cognitive function and adult psychopathology: associations with psychotic and non-psychotic symptoms in the general population
- Authors:
- BARNETT Jennifer H., et al
- Journal article citation:
- British Journal of Psychiatry, 201(2), August 2012, pp.124-130.
- Publisher:
- Cambridge University Press
Lower childhood cognitive ability is associated with increased risk of future schizophrenia, but its relationship with adult psychotic experiences is less understood. This study aimed to investigate whether this childhood risk factor is shared with adult psychiatric phenotypes including psychotic-like experiences and general psychiatric morbidity. A population-based sample of participants born in Great Britain during 1 week in March 1946 was contacted up to 20 times between ages 6 weeks and 53 years. Cognition was assessed at ages 8, 11 and 15 years. At age 53 years, psychotic-like experiences were self-reported by 2,918 participants. Findings revealed that psychotic experiences were encountered 22% of participants, and were highly comorbid with other psychopathology. Their presence in adults was significantly associated with poorer childhood cognitive test scores at ages 8 and 15 years. The authors concluded that lower childhood cognitive ability was a risk factor for psychotic-like experiences in mid-life.
Families and personalisation project: key learning outcomes summary for families, local authorities and support providers
- Author:
- NATIONAL DEVELOPMENT TEAM FOR INCLUSION
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2012
- Pagination:
- 9p.
- Place of publication:
- Bath
The Better Lives programme was set up in response to concern about how families of people with learning disabilities were, or more commonly were not, becoming involved in and benefiting from the personalisation process. Specifically, the aim was to understand how to engage, inform and support families to achieve real personal outcomes beyond just a personal budget. The programme involved working with groups of families in 3 locations (Suffolk, Calderdale and Wolverhampton) over a period of 18 months. Despite each of the local authorities having people or departments responsible for engaging with and informing families, very few families who took part in the programme had previously been aware of the personalisation agenda and those few knew very little. The programme involved a variety of methods which included information sharing, planning, engaging with statutory services, and delivering real outcomes for the participating families. This document summarises the suggested learning outcomes from the programme for: working with families; local authorities; and support providers.
Evaluation of a therapeutic community intervention for men with intellectual disability and personality disorder
- Authors:
- MORRISSEY Catrin, TAYLOR Jon, BENNETT Charlene
- Journal article citation:
- Journal of Learning Disabilities and Offending Behaviour, 3(1), 2012, pp.52-60.
- Publisher:
- Emerald
This study evaluated a planned therapeutic community (TC) service intervention in Rampton Hospital, England, for 11 men with mild intellectual disabilities and personality disorder over a period of 12 months. The TC intervention group was compared on repeated measures of violent incidents, seclusion hours, and informant and self-report clinical outcome measures collected six months prior to, six and 12 months post the start of the intervention. Clinical changes in the predicted direction were evident, with the TC group showing comparatively less pathology. The mean number of violent incidents did not reduce over time. There was nevertheless a strong trend towards reduction in seclusion hours, with significant differences between groups also being observed at the six and 12 months stage. The authors concluded that this preliminary evaluation was promising in terms of the TC approach being a potential mode of treatment suitable for a proportion of patients with learning disability in secure conditions.
Cancer screening knowledge changes: results from a randomized control trial of women with developmental disabilities
- Authors:
- PARISH Susan L., et al
- Journal article citation:
- Research on Social Work Practice, 22(1), January 2012, pp.43-53.
- Publisher:
- Sage
It is well documented that women with learning disabilities are less likely to receive cervical and breast cancer screening likely than non-disabled women, according to published clinical guidelines. One barrier to receipt of screenings is a lack of knowledge about preventive screenings. This study examined this potential barrier by testing “Women Be Healthy”, an intervention designed to promote cervical and breast cancer screening for women with developmental disabilities. Participants included 175 women who partook in a randomised control trial. Those assigned to the experimental group participated in weekly health education programme for 8 weeks. Women assigned to the control group participated in their regular vocational training or educational activities. Results indicated modest gains for both groups in knowledge related to cervical and breast cancer screening. Analysis indicated modest but statistically significant knowledge gains for the experimental group related to breast cancer screening. The authors concluded that the findings showed that the Women Be Healthy curriculum was favourable, but needed to better address cervical cancer. Implications for practice are presented.