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Significant therapy events with clients with intellectual disabilities
- Authors:
- WILLS Sarah, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(5-6), 2018, pp.173-183.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore significant events in psychotherapy with clients with intellectual disabilities (IDs). Design/methodology/approach: Four therapy dyads, each consisting of one client and one therapist, were recruited. Following the brief structured recall procedure (Elliott and Shapiro, 1988), semi-structured interviews focused on helpful events in psychotherapy, using video of particular sessions as a stimulus to help prompt recall of that session. Findings: Using interpretative phenomenological analysis, five super-ordinate themes were identified: “The Uniqueness of the Therapeutic Relationship”; “Using adaptations to Express Emotions”; “Client Behaviour/Therapist Behaviour”; “Hope and Paternalism”; and “Meaning-Making”. The results provide additional evidence that significant therapy events occur for clients with IDs. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event. Research limitations/implications: This study highlights the need for therapists to work in such a way as to facilitate significant events in therapy. Whilst this study was a necessary first step, owing to the non-existence of research in this area, the sample size and qualitative design may limit any wider generalisation of the findings. Originality/value: Significant events have not previously been explored in psychotherapy with clients with IDs. This research could therefore make an important contribution to our understanding of the process of psychotherapy for this client group. (Publisher abstract)
Building the Right Small Supports: evaluation report
- Author:
- MASON-ANGELOW Victoria
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2021
- Pagination:
- 10
- Place of publication:
- Bath
- Edition:
- Updated version
This document explores the costs and benefits of individuals with a learning disability, mental health condition and/or autism receiving support from a Small Support organisation in England. Small Support organisations are unique support providers that have a number of things in common, including: planning and delivering support in a truly person-centred way; person-led staff recruitment and training; structuring and using funding around the person; a separation of housing and support; strong partnerships between the individual and family, commissioners, and providers; and staying small. Reducing costs to the public purse is not the primary aim of any Small Support organisation. Each organisation’s purpose is to improve the lives of people with a learning disability, mental health condition and/or autistic people, through bespoke support – and that can come at a cost. However, consideration of whether something represents value for money is of inevitable interest to those providing and commissioning services. In the absence of sufficient data to conduct a full cost-benefit analysis of a Small Support organisation in England, the five costed case studies outlined in this paper provide an illustration of the fiscal and social value of such organisations. The case studies represent a saving of over half a million pounds to the public purse a year; particularly to health, social care and police budgets in England. This information suggests that Small Support organisations offer both good value for money as well as improved outcomes for those they support. As a result, Small Support organisations should be considered more widely as an option for individuals with learning disabilities, mental health condition and/or autism. (Edited publisher abstract)
Young people leaving care with intellectual disabilities or mental health problems: strengths and weaknesses in their transitions
- Authors:
- CROUS Gemma, MONTSERRAT Carme, BALABAN Ana
- Journal article citation:
- Social Work and Society: International Online Journal, 18(3), 2020, Online only
- Publisher:
- University of Bielefeld
Ageing out of the child protection system involves many difficulties for youth leaving care. Care leavers with intellectual disabilities or mental health problems are at even greater risk. The aim of this study is to know how both care leavers and practitioners evaluate the transition to emancipation. Conducted within the framework of a program directed at care leavers with intellectual disabilities or mental health problems, this study is aimed at understanding the factors that facilitate and hinder their process of emancipation in order to make the necessary changes. Using qualitative research methods, interviews were conducted with 14 youngsters living in supported housing and 16 practitioners – mainly social educators - working with them. Results indicated that both parties were highly satisfied with the housing program. For the care leavers, it was an opportunity adapted to their circumstances; they spoke of personal growth and receiving support to meet their needs. However, weaknesses, dilemmas and challenges were also discussed, such as the temporary nature of the program and the type of support available on leaving, or the dependence of the young people on their educators. (Edited publisher abstract)
Effectiveness of a life story intervention for adults with intellectual disability and depressive and trauma‐related complaints
- Authors:
- BEERNINK Janny, WESTERHOF Gerben J.
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 33(6), 2020, pp.1340-1347.
- Publisher:
- Wiley
Introduction: People with intellectual disability have a higher chance of developing mental disorders than the general population. Yet, few evidence‐based interventions exist. This article evaluates My Lifestory, a narrative intervention tailored to people with intellectual disability and depressive or trauma‐related complaints. Method: A quasi‐experimental research design was adopted with an experimental condition (My Lifestory) and a matched control condition (care as usual). Measurements took place before the intervention, at the end of the intervention and at follow‐up two months later. Measurements focused on psychiatric complaints, well‐being, life satisfaction, mastery, and purpose in life. Results: Participants in the intervention condition improved more in psychiatric complaints, well‐being, life satisfaction, and purpose in life, but not in mastery, than participants in the control condition. Effect sizes were large in the intervention condition and small in the control condition. Discussion: Despite some limitations, this study adds to the evidence base of this narrative intervention. (Edited publisher abstract)
Experiences of service users with a mild intellectual disability or borderline intellectual functioning with Flexible Assertive Community Treatment: a qualitative study
- Authors:
- NEIJMEIJER Laura, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 33(5), 2020, pp.1005-1015.
- Publisher:
- Wiley
Background: In the Netherlands, Flexible Assertive Community Treatment (FACT) teams have been established for people with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and mental health problems or challenging behaviour. Little is known yet about service users’ experiences with FACT. Method: An inductive grounded theory approach was used to explore how service users valued the treatment and their own functioning, and which factors were perceived as supportive. Semi‐structured interviews were held with 15 service users. Results: Most service users highly appreciated the contact with the staff and the practical and emotional support. Persistent involvement, availability and humanity, and respect for autonomy were distinguished as core values in the relationship with the staff. Most service users experienced improvement in time and attributed this to intrapersonal changes and/or less stress in life. Conclusions: From the perspective of service users with MID/BIF, FACT appears to have an added value. (Edited publisher abstract)
An open trial of psychodynamic psychotherapy for people with mild-moderate intellectual disabilities with waiting list and follow up control
- Authors:
- SKELLY Allan, McGEEHAN Caoimhe, USHER Robert
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(5-6), 2018, pp.153-162.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base. Design/methodology/approach: The study is a systematic open trial of flexible-length psychodynamic therapy offered in an urban community to 30 people with mild and moderate ID, presenting with significant emotional distress on the Psychological Therapies Outcome Scale for people with intellectual disabilities (PTOS-ID). Allocation to therapy was made according to an established stepped care approach according to need, and the mean number of sessions was 22.03 (range 7–47). Treatment fidelity was checked via notes review and cases excluded from analysis where there were other significant psychological interventions. Findings: On both self-report (PTOS-ID) and independent ratings (Health of the Nation Outcome Scales-Learning Disability (HoNOS-LD)) recipients of therapy: did not improve while waiting for therapy; improved significantly during therapy, with large pre–post effect sizes; and retained improvements at six-month follow-up. Research limitations/implications: While it is important to conduct further controlled trials, the findings provide support for previous studies. High rates of abuse and neglect were found in the sample, suggesting that more trauma-informed and relational approaches should be explored for this client group. Originality/value: No other study of this size has been completed which used dedicated standardised outcome measures, with this therapy type, with both waiting list and follow-up control and with account of model fidelity. (Publisher abstract)
Disability hate crime reporting
- Author:
- SMITH Lauren
- Publisher:
- IRISS
- Publication year:
- 2017
- Pagination:
- 19
- Place of publication:
- Glasgow
This literature review covers types of interventions that have been effective in increasing reporting of hate crimes motivated by perceptions of learning disabilities and mental health problems. It also looks at interventions that have been effective in supporting people through the process of reporting disability hate crimes and areas of potential areas of unmet need. It draws on academic literature, online resources and knowledge from key organisations, providing links to examples of good practice. The review identified a shortage of evidence around the efficacy of interventions designed with the explicit aim of increasing disability hate crime reporting. However, reports from several projects indicate several promising areas, which include: awareness raising; befriending links; third party reporting centres; safe places initiatives, support for reporting and disabled people's user-led organisations. The review also identifies gaps in the evidence to suggest potential areas for future interventions and research. (Edited publisher abstract)
Towards employment: what research says about support-to-work in relation to psychiatric and intellectual disabilities
- Authors:
- LOVGREN Veronica, MARKSTROM Urban, SAUER Lennart
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 16(1), 2017, pp.14-37.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article presents an overview of research about support-to-work in relation to psychiatric and intellectual disabilities. The overview shows that support-to-work services are multifaceted, and that work can be seen as a tool for individual rehabilitation or as a set of goals to achieve. Providers are presented with specific components, which are characterised by systematic, targeted, and individualised interventions. The overview illustrates a need for long-term engagement and cooperation of and between welfare services and agents within the labour market to dissolve the Gordian knot that the transition from welfare interventions to employment seems to be. (Edited 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)
Psychological treatments in intellectual disability: the challenges of building a good evidence base
- Authors:
- BHAUMIK Sabyasachi, et al
- Journal article citation:
- British Journal of Psychiatry, 198(6), June 2011, pp.428-430.
- Publisher:
- Cambridge University Press
While psychological treatments are common interventions in the treatment of people with learning disabilities, the evidence base for their clinical efficacy, and cost-effectiveness, is limited. This editorial describes the strengths and limitations of the evidence base for a range of psychological treatments available. It focuses on behavioural interventions, cognitive-behavioural therapy and psychodynamic therapies. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward. The author concludes that developing a research-based evidence base is critical to the establishment of new services and interventions, and is necessary in supporting the value of existing services.