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Incidence, types and characteristics of aggressive behaviour in treatment facilities for adults with mild intellectual disability and severe challenging behaviour
- Authors:
- TENNEIJ N. H., KOOT H. M.
- Journal article citation:
- Journal of Intellectual Disability Research, 52(2), February 2008, pp.114-124.
- Publisher:
- Wiley
Inpatient aggression in treatment facilities for persons with intellectual disability (ID) can have aversive consequences, for co-clients and staff, but also for the aggressors themselves. To manage and eventually prevent inpatient aggressive incidents, more knowledge about their types and characteristics is necessary. In four facilities, totalling 150 beds, specialized in the treatment of adults with mild ID or severe challenging behaviour, aggressive incidents were registered during 20 weeks using the Staff Observation Aggression Scale-Revised. Characteristics of auto-aggressive and outwardly directed incidents and differences in their incidence in male and female clients in these facilities were compared. During the observation period of 20 weeks, 639 aggressive incidents were documented. Most of these (71%) were outwardly directed, predominantly towards staff, while most of the remaining incidents were of an auto-aggressive nature. Of the 185 clients present during the observation period, 44% were involved in outwardly directed incidents (range per client 1–34), and 12% in auto-aggressive incidents (range per client 1–92). Auto-aggressive and outwardly directed incidents differed regarding source of provocation, means used during the incident, consequences of the incident and measures taken to stop the incident. The proportion of men and women involved in each type of incident was comparable, as well as the majority of the characteristics of outwardly directed incidents caused by men and women. Although approximately half of all clients were involved in aggressive incidents, a small minority of clients were responsible for the majority of incidents. Therefore, better management and prevention of aggressive incidents for only a small group of clients could result in a considerable overall reduction of aggressive incidents in treatment facilities. Comparability of aggressive behaviour in these facilities shown by men and women and differences in characteristics of auto-aggressive and outwardly directed incidents are discussed.
Meaningful choices: consent to treatment in general health care settings for people with learning disabilities
- Author:
- HART S.L.
- Journal article citation:
- Journal of Learning Disabilities for Nursing Health and Social Care, 3(1), March 1999, pp.20-26.
Reports on a small scale qualitative research project that explores the experiences of learning disabled people receiving care and treatment in general hospital settings. Using grounded theory to analyse the data, the question of consent to treatment emerged as an area of significantly varying practice. Evidence suggests that consent is primarily being sought as a legal requirement, and rarely as a strategy for ensuring people with learning difficulties understand the nature of their forthcoming treatment. Argues for the introduction of practices that respect the wishes of people with learning disabilities, and are enabling, at the same time ensuring that action is taken, where necessary, in the best interest of others. Recommendations include the need for additional training for general hospital staff and, where possible, the involvement of learning disability nurses in preparing people for planned admissions.
Psychotropic drugs in a hospital for intellectual disability: the story of 18 years
- Author:
- ETHERINGTON J.
- Journal article citation:
- Mental Handicap Research, 8(3), 1995, pp.184-193.
- Publisher:
- BIMH Publications
Psychotropic prescribing was surveyed over an 18-year period in an intellectual disability hospital between 1972 and 1990. The article looks at the number of inpatients in the hospital, the numbers receiving psychotropic drugs, and the percentage of the population receiving neuroleptics and lithium. Concludes that the changes in prescribing may be partly related to the increased proportion of individuals with more severe psychiatric symptomatology in the population.
Attitudes of healthcare staff in the treatment of children and adolescents with intellectual disability: a brief report
- Author:
- ONG Natalie
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 42(3), 2017, pp.295-300.
- Publisher:
- Taylor and Francis
Background: Children with an intellectual disability (ID) have complex health needs that extend beyond the expected cognitive deficits, affecting a myriad of developmental domains. These children frequently receive inadequate health care such that their needs remain poorly managed. Methods: Staff from the Sydney Children’s Hospital Network (N = 160) completed a survey on attitudes, experiences, and training satisfaction when working with patients with ID. The 48-question needs analysis survey was distributed electronically to staff from a variety of disciplines and experience levels. Results: Although staff considered themselves broadly competent in caring for children with ID, they were less confident in specific skills, such as managing associated challenging behaviours in the clinic. As confidence in skills such as these decreased, the desire for further training increased. (Publisher abstract)
A five decade retrospective review of admission trends in a NHS intellectual disability hospital
- Authors:
- WONG Yim Lun, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(3), 2015, pp.108-115.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to examine the trend of admissions and inpatient characteristics in a NHS intellectual disability hospital from 1975 to 2013, in particular looking at the effect following the Winterbourne View scandal. Design/methodology/approach: A retrospective review of all admissions over a three-year period (January 2011-January 2013) was completed. This information was compared with admissions to the same hospital in three-year period over the last four decades (1975-1977, 1985-1987, 1995-1997, and 2003-2006). Number of admissions, gender, age, source of admission, length of stay, reasons for admission, type of admission, and diagnosis of psychiatric illnesses were included. Findings: There were 87 admissions (including 29 from out of area) in the study period of 2011-2013. The number of admissions had varied over the years but male admissions were consistently higher than female. A majority of people stayed over six months. For the first time in five decades, there were more formal inpatients than informal ones. The diagnosis of Autism Spectrum Disorder (ASD) and of Attention Deficit Hyperactivity Disorder had increased. Originality/value: This study has examined admission trends over five decades. It has highlighted that the Mental Health Act legislation is being used more frequently and that co-morbid mental disorders, such as ASD are commonly associated with those admitted to hospital. A well planned-out community health care system, as well as adequate social provision are keys to maintain people with intellectual disability in the community. Furthermore, a better understanding of the symptomology of challenging behaviours, and appropriate use of mental health legislation are crucial in providing a high-quality service that has clear treatment goals and values. Some of these issues have contributed to the failure of the recent initiative to reduce the size of the inpatient intellectual disability following Winterbourne View scandal. (Publisher abstract)
Avoiding delays in diagnosis: the importance of proactive liaison and education of staff in the general hospital
- Authors:
- WALDER Anna, GREEN Robert, SONI Sujata
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(6), 2014, pp.399-402.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to illustrate the difficulties patients with intellectual disabilities face when they present to a general hospital with ambiguous symptoms and highlights the importance of adequate training for general staff in caring for people with learning disabilities. Design/methodology/approach: The authors describe the pathway of a person with a learning disability and mental health problems from A&E, through a general hospital, to discharge and the problems encountered in terms of diagnostic clarity and subsequent treatment. Findings: Delay in recognising a psychiatric cause for his symptoms and wrongly attributing his symptoms to his learning disability may have led to a protracted admission and invasive tests. Originality/value: Education of healthcare professionals and proactive liaison work can help improve outcomes for people with intellectual disabilities when they are admitted to generic services. (Publisher abstract)
A preliminary report on the closure of the Challinor centre
- Authors:
- YOUNG Louise, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 25(2), June 2000, pp.119-126.
- Publisher:
- Taylor and Francis
Reports on preliminary data for 32 individuals with intellectual disability who were relocated from a large state institution in Australia to small community-based group homes. These results suggest the relocation has enabled a more active and normalised lifestyle. However, community-based services may need to incorporate more effective active treatment programmes if adaptive behaviour gains are to occur.
Court of appeal ruling on unlawful detention: R v Bournewood Community and Mental Health NHS Trust ex p L. CA (1998) 1AllER 634
- Author:
- BRAMMER Alison
- Journal article citation:
- Tizard Learning Disability Review, 3(3), July 1998, pp.28-31.
- Publisher:
- Emerald
Reports on a recent Court of Appeal decision which ruled that where a persons is admitted to hospital on an 'informal' basis, but is unable to give valid consent to admission, then it is an unlawful detention.
Signposts for success
- Author:
- -
- Journal article citation:
- Viewpoint, 27, April 1998, p.6.
- Publisher:
- Mencap/Gateway
The NHS Executive has published Signposts for Success to promote good practice, and to clarify the role of the NHS in providing services in the community for people with learning disabilities. Summarises the main message.
Continence promoting in adults with learning disabilities
- Authors:
- BRADLEY Mary, FERRIS Wendy, BARR Owen
- Journal article citation:
- Nursing Times, 27.9.95, 1995, pp.38-39.
- Publisher:
- Nursing Times
Helping to reduce rates of incontinence among people with severe learning disabilities can have profound effects on their self-esteem and on unit running costs. Describes a hospital-based continence promotion programme for people with severe learning disabilities using a behavioural approach.