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Coming home: a report on out-of-area placements and delayed discharge for people with learning disabilities and complex needs
- Author:
- MacDONALD Anne
- Publisher:
- Scotland. Scottish Government
- Publication year:
- 2018
- Pagination:
- 71
- Place of publication:
- Edinburgh
This two-year project, commissioned by the Scottish Government, collected national data on people with learning disabilities who have additional complex needs, and who are either placed out-of-area, or are within hospital-based assessment and treatment units, classed as delayed discharge. It aimed to gather information on the issues and suggest support solutions and actions that could improve outcomes for people with learning difficulties who have been unable to receive appropriate support in their communities. The project found that there were 705 people out-of-area in Scotland from 30 HSCPs, Of the group, 79 were placed out of Scotland and 453 were identified as being placed out-of-area not through choice. Challenging behaviour, and the impact that challenging behaviour has on service breakdown or hospital admission was a key issue for people with learning disabilities and complex needs. This was partly due to a lack of coordinated responses. Key elements contributing to good support for people with learning disabilities and complex needs were identified as: person-centred approaches, environments which support communication, active support and full lives, positive behavioural support, suitable accommodation, skilled and motivated staff, and good management and practice leadership. The report makes recommendations for Integrated Health Authorities, Health and Social Care Partnerships and the Scottish Government. It calls for a transformational change approach, with all stakeholders working together to address the issue. (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.
Investigation into the care and treatment of Ms L
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2008
- Pagination:
- 16p.
- Place of publication:
- Edinburgh
This report relates to the investigation into the care and treatment of Ms L. Several recommendations are made both for the services responsible for Ms L and for other services who may be able to learn from this individual case. This MWC investigation was instigated following reports of a number of incidents involving Ms L, a young woman with a severe learning disability and severe challenging behaviour, in an independent assessment and treatment resource for people with a learning disability (Unit A). The final incident, where Ms L was apparently bitten by a fellow resident overnight, resulted in a Vulnerable Adults Case Conference being called. Ms L had already been assessed as ready to move on and a place identified for her to go to. This move was therefore brought forward by about 2 weeks.
Adults with intellectual disabilities: prevalence, incidence and remission of self-injurious behaviour, and related factors
- Authors:
- COOPER S., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 53(3), March 2009, pp.200-216.
- Publisher:
- Wiley
This study investigates the point prevalence, incidence and remission rates of Self-injurious behaviour (SIB) among the adult population with intellectual disabilities (ID), and explores which factors are independently associated with SIB. A prospective cohort study design was used in a general community setting. The participants were all adults (16 years and over) with ID in a defined geographical area. Individual assessments were conducted with all participants. The point prevalence of SIB (as defined by DC-LD) was 4.9%, the two-year incidence was 0.6%, and two-year remission rate was 38.2%. Independently related to SIB were: lower ability level, not living with a family carer, having attention deficit hyperactivity disorder, visual impairment, and not having Down syndrome. Other factors, including communication impairment, autism, and level of deprivation of the area resided within, were not related. SIB is not as enduring and persistent as previously thought; a significant proportion gains remission in this time period.
Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors
- Authors:
- COOPER S., et al
- Journal article citation:
- Journal of Intellectual Disability Research, 53(3), March 2009, pp.217-232.
- Publisher:
- Wiley
This study investigates point prevalence, 2-year incidence and 2-year remission rates for aggressive behaviour (physically aggressive, destructive and verbally aggressive), and it investigates which factors are independently associated with aggressive behaviour. All adults with ID – within a geographically defined area of Scotland, UK – were recruited to a longitudinal cohort. At baseline, assessments were undertaken of demography, lifestyle, supports, development, problem behaviours, disabilities and physical and mental health. These were repeated for a 2-year period. At baseline, the participation rate was 1023 (65.5%). After 2 years, the cohort retention was 651 adults. The point prevalence of Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) aggressive behaviour was 9.8%, 2-year incidence was 1.8%, and 2-year remission rate from all types of aggressive behaviour meeting DC-LD criteria was 27.7%. The factors independently associated with aggressive behaviours were lower ability, female gender, not living with a family carer, not having Down syndrome, having attention-deficit hyperactivity disorder and having urinary incontinence. Incidence of aggressive behaviour meeting DC-LD criteria in adult life is similar to that for each of psychotic, anxiety and organic disorders. Aggressive behaviour is common among adults with ID, but contrary to previous suggestions, more than a quarter remit within the short to medium term.
Challenging and inappropriate sexual behaviour in people with learning disabilities: a literature review
- Author:
- BROWN Louise
- Publisher:
- Great Britain. Scottish Office
- Publication year:
- 1998
- Pagination:
- 67p.,tables,bibliog.
- Place of publication:
- Edinburgh
Literature review aiming to: describe and assess the quality of evidence from recent research literature relevant to challenging and inappropriate sexual behaviour among people with learning difficulties; to comment on the extent to which current literature adequately addresses the issues surrounding these behaviours; to describe current policy and practice guidance documentation; and to compare the findings of research with policy and practice guidance in Scotland and discuss any implications which this might have for research on this topic.
The use of seclusion: good practice guide
- Author:
- MENTAL WELFARE COMMISSION FOR SCOTLAND
- Publisher:
- Mental Welfare Commission for Scotland
- Publication year:
- 2014
- Pagination:
- 21
- Place of publication:
- Edinburgh
The Mental Welfare Commission first published guidance on the use of seclusion in 2007, focusing on restrictions placed on people in a hospital setting and the authorisation, regulation and monitoring required to safeguard the rights of the individual. As assessments and treatment are increasingly provided by community services, similar restrictions are now being applied in a variety of community settings. This reviewed guidance reflects these changes and attempt to address the implications of current practice. The use of seclusion can place severe restrictions on an individual’s freedom of movement and lead to untoward physical and psychological consequences for the person. Seclusion should only be considered where there is a clear and identified risk that the person who is to be secluded presents a significant degree of danger to other people; and that the situation cannot be managed more safely or appropriately by any other means. It should only take place in the context of a clear care plan, with a concern for the safety of the individual and ensuring that the restriction is not perceived as a punishment. (Edited publisher abstract)
Staff responses to behaviour that challenges: The role of knowledge, attributions, and emotion regulation style
- Author:
- WISHART Judith
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 38(3), 2013, pp.205-214.
- Publisher:
- Taylor and Francis
Background: In this study, the authors explored the extent to which the knowledge and attributions of support staff predicted their reported helping behaviour in relation to people with an intellectual disability who displayed challenging behaviour (CB), and whether emotion regulation style moderated the relationship between attributions and this helping behaviour. Method: Participants (N = 107) completed self-report measures of knowledge of the meaning and management of CB, causal attributions and behavioural response to CB, and emotion regulation style. Results: Knowledge and helpful attributions were significantly correlated with reported helping behaviour; however, in a regression analysis with both predictors, only knowledge significantly contributed to the variance. No moderating effect was found for emotion regulation styles on the relationship between attributions and reported helping behaviour. Conclusion: Knowledge was the only significant predictor of reported positive staff approaches in managing CB, giving some support for the provision of staff training aimed at increasing knowledge, rather than changing attributions. (Publisher abstract)
Effect of music on mealtime disruptions
- Authors:
- HOOPER Jeff, CARSON Derek, LINDSAY Bill
- Journal article citation:
- Nursing Times, 27.11.12, 2012, pp.22-24.
- Publisher:
- Nursing Times
People with learning disabilities may display anxiety-driven behaviours that disrupt mealtimes. This study examined how delivering calming background music through headphones affected anxiety-driven behaviours that disrupted mealtimes of people with learning disabilities. A convenience sample of 30 adults with mild, moderate or severe learning disabilities was videotaped during mealtimes on two consecutive days. On the first day, half the group age without any calming music, while the other half sat opposite wearing earphones. On the second day, the non-music and music groups were swapped around. The final sample size was 24, as some would not tolerate the headphones. Of these 24 only three showed disruptive behaviour. There were signs that calming music has a positive effect on disruptive mealtime behaviours, though the sample was too small to conduct meaningful analysis.
Working out of the box: an evaluation of short breaks and intensive support services to families and disabled young people whose behaviour is severely challenging: summary report
- Author:
- McCONKEY Roy
- Publisher:
- Action for Children
- Publication year:
- 2011
- Pagination:
- 46p.
- Place of publication:
- London
This summary report brings together the main findings from an evaluation of three Action for Children services in Cardiff, Glasgow and Edinburgh. These services provide specialist short breaks and intensive support services to families and learning disabled young people with severely challenging behaviours. The report provides a literature review and a detailed analysis of the model of service that has evolved at the three locations. An overview of staff employed by the services shows that most have some form of higher qualification and access to regular training. Families using the service tend to be from poor backgrounds, with many being lone parent families, and many living in rented accommodation and dependent on benefits. More boys than girls accessed the services. Most were teenagers and most attended special schools, with many also being diagnosed with autism. About a quarter were dependent on others for feeding, dressing and toileting. Key workers rated the changes in children and families over the preceding six months and reported that a sizeable proportion had shown some improvements in communication and personal care. Interviews with stakeholders involved with a sample of children revealed a very positive evaluation of the services. The children benefitted from participating in a range of activities, but their social inclusion remains limited. The report concludes with recommendations on the future developments of these services.