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Purpose: Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach: A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings: When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value: This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article "A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service". Design/methodology/approach: The author's reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings: The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value: The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline a service evaluation that gathered feedback from people with a learning disability on their experience of lockdown in Jersey and Guernsey. This feedback was intended to guide planning for service provision during any future lockdown and for life as we exit lockdown. Design/methodology/approach: An accessible survey was sent to everyone accessing learning disability services across the two islands and Mencap in Jersey. Data was analysed quantitatively and qualitatively to identify patterns in the data and key themes. Findings: Most respondents felt safe, calm and happy and valued support from services. Key themes emerging from the data included the importance of relationships, messages of safety, keeping busy and communication. Originality/value: This survey has been undertaken at a time where there is a paucity of research and consultation with individuals with a learning disability self-reporting on their experiences of lockdown, during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Direct care staff may be resistant to the use of behavioural interventions. Whilst some research suggests that resistance to the cost of behavioural interventions is one factor of influence, there is lack of research exploring why staff are influenced by the cost. The purpose of this paper is to explore this issue. Design/methodology/approach: In this paper, the phenomenon of resistance is analysed with the help of behavioural economics and of the behavioural perspective model (BPM). Findings: The resistance to the cost of behavioural interventions is correlated with the low quality of the working environment and ways in which staff might attend to factors which protect their own well-being. Practical implications: Services might need to focus on the ways in which behavioural interventions protect staff's well-being. Originality/value: This paper explores the use of the BPM and of behavioural economics as conceptual tools for the analysis of the factors leading to non-adoption of behavioural interventions. [ABSTRACT FROM AUTHOR]

Purpose – This commentary takes Marsland et al.’s paper about services at risk of becoming abusive to the people they support, as a platform to consider issues around implementation science and its role in minimising this risk. The paper aims to discuss this issue. Design/methodology/approach – The commentary is a selected review of implementation science. The research is used to define implementation, identify prerequisites, selectively review methods and comment on fidelity. Findings – The commentary proposes that implementation science has an important role in ensuring evidence-based practice transfers from research to disability services. Originality/value – The commentary offers a viewpoint based on combined research evidence and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose – Narrative therapy is aligned with government priorities for learning disabilities as it promotes inclusion and seeks to empower. While research on narrative therapy in learning disability services is emerging, it has not been critically evaluated. The purpose of this paper is to identify, summarise and critique the extant literature that has explored narrative therapy for adults with learning disabilities, and consider the implications for research and clinical practice. Design/methodology/approach – A literature search identified seven relevant case studies that described individual narrative therapy interventions for adults with learning disabilities. A qualitative review of these studies was carried out. Findings – Overall, the reviewed studies offer tentative evidence for the short-term usefulness of narrative therapy for difficulties with anger and qualitative benefits for ritualistic behaviour, social anxiety and stealing behaviour. Research limitations/implications – A number of methodological issues are identified, particularly concerning the use of outcome measures and the generalisability of findings. The research is limited due to a reliance on case study evidence and outcome measures that lack validity and reliability. Both larger scale and more robust research, and high quality practice-based evidence, are required. Practical implications – Learning disability services could consider providing narrative therapy for people with learning disabilities experiencing anger problems and other psychological difficulties. Clinical practice suggestions are identified, such as choosing relevant metaphors and including the individual’s wider system. Originality/value – This paper provides an up-to-date, comprehensive review of the literature on narrative therapy for people with learning disabilities that will be of use to clinicians providing therapeutic support and to people commissioning such services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a synthesis of current and previous government policies and strategies, in relation to people with learning disabilities and employment, to facilitate a better understanding of the current situation and future challenges. Design/methodology/approach – A search was completed to identify government policies relating to the employment of people with learning disabilities. Key policies were identified and their impact was discussed in the paper. Findings – It appears there is a necessity to identify how successful pilot projects can be replicated on a national scale, with clear targets and measures and initial financial support to set up these services. Alongside this there is a need for interventions targeting not just employers, but the general population, educating people about the importance of including and valuing people with learning disabilities in the workforce. Originality/value – It is important that policy is analysed and the impact of it is assessed to determine whether more action is necessary. This paper adds updates to some of the issues discussed in Melling et al.’s (2011) paper about “Supported employment for people with learning disabilities”. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on “Narrative therapy in a learning disability context: a review”. Design/methodology/approach – This commentary reflects on the use of Narrative therapy and considers it in the wider context of assisting people with learning disabilities to develop self-understanding. The commentary makes connections between the use of Narrative therapy and narrative approaches to research reporting. Findings – The use of Narrative therapy can assist in the development of positive personal stories for individuals with learning disabilities. Case study research provides a useful reference point from which to develop future work. Reporting of case studies sometimes omits data that might be useful for others attempting to replicate findings. Originality/value – This paper highlights the need for authors to ensure that the “small details” are included in research reporting. A narrative approach, rich in detail of research participants might enable authors to tell a “thicker” story, thus improving generalisability. [ABSTRACT FROM AUTHOR]

Purpose -- Learning Disability Statistics Scotland collects information on adults with learning disabilities who are known to local authorities in Scotland and the services they use. The data collection supports national and local government policy making and is focused on monitoring the implementation of learning disability policy. The paper aims to discuss these issues. Design/methodology/approach -- Individual level data are requested from all 32 local authorities on adults aged 16-17 who are not in full-time education and those aged 18 and over . Annual data guidance is developed in conjunction with local authorities prior to the collection and is issued to standardise the process and manage avoidable error . The collated data are extracted from local authority administrative data and records are provided on each adult regardless of whether they are currently receiving a service. Anonymisation takes place prior to upload and strict guidelines are followed to ensure it is not possible to identify individuals. Findings -- The paper provides insights to the project's processes, uses, challenges and future plans. It details the position of the data outputs within a policy context and the role these might play within a broader research agenda. Research limitations/implications -- This data includes only adults known to local authority services. Originality/value -- The value of the project lies in its strength as a national social care data set comprised of individual level data. This methodology increases the analytical potential of the data set. This paper will be of interest to those interested in data on learning disability and those with an interest in the analytical potential of an individual level national data set. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a commentary on “Learning disability services: user views on transition planning”.Design/methodology/approach The commentary provides a discussion of the concept of continuity of care (Forbes et al., 2001; Freeman et al., 2000) in relation to transition from children’s to adults’ services for young people with intellectual/developmental disabilities.Findings Continuity of care is an important consideration for this population and is emphasised in recent policy initiatives in England, as well as being highlighted by young people and their families as a significant aspect of their transition experience. Despite this, evidence suggests it is not currently achieved for many young people and their families, and a number of challenges that may contribute to this are highlighted.Originality/value The commentary emphasises that continuity of care should be a key consideration for services supporting young people and their families at transition. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the views of people with learning disabilities on issues associated with continuity of care in the transition from full-time education to adult care and support.Design/methodology/approach Data collection was undertaken with people with learning disabilities and staff in two advocacy organisations in one area of England in 2012. In total, 19 participants attended three focus groups. Analysis focussed on continuity of care and was guided by the framework approach to qualitative analysis.Findings Teachers, social workers in children’s services and youth workers were identified as making important contributions to the transition process. Information relating to learning and social development was identified as most important to inform transition planning with less priority accorded to health, communication, and self-care and independence. Participants appeared to value principles which underpin continuity of care.Research limitations/implications This study provides insights into attributes of continuity of care valued by people with a learning disability. Possibilities of translating these attributes into practice within localities are explored. Findings could be used to inform strategic planning locally to promote service integration thereby contributing to continuity of care within transition planning.Originality/value Continuity of care in the transition planning process is highlighted in policy guidance with recognition that both practice and procedures require improvement. This research explores areas for development from the perspective of people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions. Design/methodology/approach – Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment. Findings – Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients. Research limitations/implications – As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area. Originality/value – The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on the findings from Koski et al.'s (2014) research around training staff to communicate effectively. Design/methodology/approach – This commentary reflects on the needs of people with profound intellectual and multiple disabilities (PIMD). It uses the Five Good Communication Standards (Royal College of Speech and Language Therapists, 2013) as a framework for thinking about good communication. Findings – Ongoing support is certainly important in enabling staff to develop and maintain good communication partnerships with the people they are working with. This first requires agreement from all involved regarding what good communication partnerships look like and how they can be measured. Originality/value – This paper focuses on the Five Good Communication Standards and how these might be interpreted with people with PIMD. It uses information from Goldbart and Caton's (2010) review of communication and people with the most complex needs to reflect on what is known from research and practice about each of these five standards. It concludes that more research is needed and greater implementation is needed where evidence is strong. We need to know what “good” could look like with people with PIMD so services support staff can then be facilitated to build successful communication partnerships and maintain these over time. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to comment on Brown and Marchant's analysis of the complexity that can arise when applying the Mental Capacity Act 2005 (MCA) to the care and support provided to people with learning disabilities. Design/methodology/approach – A theoretical approach to explore the implications of Brown and Marchant's paper for the relationship between the law and practice in this area. Findings – The complexity accounted for by Brown and Marchant lies in the tension between the procedural requirements of the MCA and the practical realities of the support provided to individuals with complex and long-term needs. This tension cannot be addressed simply by focusing on improving training or better implementing the law in practice. Originality/value – It is important to further examine and explore the relationship between new legal principles to govern decision making and the complex ways in which people with learning disabilities and other individuals need to be supported in practical situations. [ABSTRACT FROM AUTHOR]

Purpose -- The paper's aim is to explain the development of the concept of personalisation and its dependence upon prior innovations such as independent living, person-centred planning and individual budgets and explore its meaning, limitations and future prospects. Design/methodology/approach -- The paper takes the form of an analytical and historical review of ideas that have been important in the recent history of public policy for people with learning disabilities. Findings -- People with learning disabilities, along with other disabled people, have been engaged in a struggle to achieve full citizenship. The recent reforms that go by the name of "personalisation" may mark an important stage in the development of a fairer system, but on their own they will be insufficient to achieve that objective. Originality/value -- Personalisation is placed, with all its strengths and limitations, within the wider context of the development of policies for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to discuss and examine the implications of holding mental health tribunals in public. Design/methodology/approach -- The paper discusses the functioning of tribunals, compares tribunals with other legal processes in the UK and elsewhere, and reviews the legal reasoning for holding tribunal hearings in public. Findings -- The first tribunal hearing has already been held in public and another public hearing is agreed. Public hearings should allow for greater transparency and scrutiny than has thus far been possible, and may change the behaviour of attendees. Originality/value -- Public tribunal hearings have not yet been widely discussed in the academic literature, yet are expected to have implications for all involved. [ABSTRACT FROM AUTHOR]

Purpose – This paper seeks to provide a commentary on the previous paper in this issue, "Love is simply not enough". Design/methodology/approach – The commentary draws on research findings and recent policy about personalisation to consider those factors influencing the development of effective family and professional partnerships. Findings – The paper notes the way in which families have often been undermined by those authorities responsible for providing support. While a lifelong caring role will be a positive choice for some families, it should not be a requirement. Originality/value – The commentary draws attention, in particular, to the importance of local authorities working more effectively with family carers. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to provide a commentary on the previous paper in this issue "A qualitative exploration of the life experiences of adults diagnosed with mild learning disabilities from minority ethnic communities".Design/methodology/approach - The commentary outlines the Valuing People White Paper and The Health Care Commission report Tackling the Challenge: Promoting Race Equality in the NHS in England, among others, as they relate to the author's research.Findings - Developing cultural knowledge is of fundamental importance in working towards race equality in mental health services for children and young people with learning disabilitiesOriginality/value - Cultural competence refers to the ability to work effectively with individuals from different cultural and ethnic backgrounds, or in settings where several cultures co-exist. It includes the ability to understand the language, culture and behaviours of other individuals and groups, and to make appropriate recommendations. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on the response to the scandal of abuse in services for people with intellectual disabilities in the light of research evidence and analysis. Design/methodology/approach – Critical reflection and review of literature. In particular, recent research into possible indicators that a service is at risk of becoming abusive is used to test the hypotheses and implied solutions that are currently being adopted. Findings – That some of the responses to recent scandals are necessary but not sufficient to prevent future harm. Furthermore, some of the proposed solutions may actually increase the likelihood of further abuse. Prevention of abuse requires a broader and more evidence-based response. Originality/value – The synthesis of research and analysis presented here has not been presented previously in the published literature. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the characteristics of individuals with intellectual disability in psychiatric hospitals in England who have been referred from the courts following charge or conviction for imprisonable offences. Design/methodology/approach -- Further analysis of data from the national census of psychiatric inpatients with intellectual disability or autism. Findings -- In total, 31 per cent of psychiatric inpatients with intellectual disability or autism were detained on a court order . In comparison to others they were older but fewer appeared to have severe disabilities. Fewer were hospitalised for mental illness or challenging behaviour, more for personality disorder . Rates in relation to numbers with intellectual disability in the population varied widely between regions of the country. Research limitations/implications -- The census was weak on exploring the nature of the risk posed by patients. As with all censuses it is always possible that the day chosen was unusual. Groups of patients characterised by longer stays inevitably appear more prominent. Practical implications -- Staff with expertise in the forensic mental health skills of risk assessment and management in the context of intellectual disability will be needed to resettle these patients satisfactorily. Originality/value -- The study draws attention to wide variations around the country in rates of use of hospital beds. This applies as much to detention under court orders, including restriction orders, as to informal admission, raising questions about the consistency of court judgements around the country. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to provide a commentary on "Adults with learning disabilities known to local authorities in Scotland: a national dataset" by Claire Stuart and colleagues. Design/methodology/approach -- Drawing on experiences with the National Intellectual Disability Database in Ireland, the authors identify the key elements to be addressed such as the uses to which information from the database will be put; the definition of intellectual disability for inclusion of individuals; defining the information to be gathered; the systems for gathering information; checking and auditing the information that is collected, and the types of reports emerging from the analyses. Findings -- A national database of persons with an intellectual disability is at least desirable -- if not essential -- to the delivery of equitable and effective service supports. The advent of computerised data management tools makes this a realistic option in most European countries although debates continue around the protection of personal data and the costs involved in establishing and maintaining dedicated databases. Originality/value -- National data sets on intellectual disability can make a significant contribution to equitable and effective service planning. However, major challenges need to be overcome so that the information collected is reliable and valid. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present early outcomes and case examples from the Ealing Intensive Therapeutic and Short Break Service. Design/methodology/approach – The service was piloted over a period of 3.5 years during which clinical data were collected for young people at risk of a move to residential care. Findings – There were positive outcomes for young people with intellectual disabilities and challenging behaviour who were seen through the service with residential placements prevented in the vast majority of cases. Originality/value – These early outcomes highlight the importance of providing intensive therapeutic intervention with short breaks in order to prevent family placement breakdown. [ABSTRACT FROM AUTHOR]

Purpose – The Zone of Parental Control (ZPC) is a concept that has been introduced in the Code of Practice for the revised Mental Health Act 1983, but guidance on its scope remains scanty. The purpose of this paper is to bring together recent rulings from case law and the original guidance, and make suggestions for clinicians when deciding if an intervention is within the Zone. Design/methodology/approach – Review and examination of case law, legislation and legal guidance. Findings – Deprivations of liberty fall outside the ZPC, but restrictions of liberty lie within; parental disagreement with care correlates strongly with care that lies outside the ZPC. Originality/value – The findings of this article should aid clinicians in deciding whether a treatment regime lies within the ZPC. [ABSTRACT FROM AUTHOR]

Purpose - This paper considers the applicability of the Improving Access to Psychological Therapies (IAPT) initiative in meeting the mental health needs of people with learning disabilities.Design/methodology/approach - The author considers the nature of the IAPT service, the potential benefits, the potential barriers and how local services could be better adapted to meet the needs of people with learning disabilities.Findings - Although the IAPT service is well established for the mainstream population, for people with learning disabilities there are deficits and barriers at many levels. Increased attention should be given to removing barriers to access; the provision of "reasonable adjustments" in treatment; and to the monitoring of uptake and outcomes. Even with these issues addressed, the service will not meet the mental health needs of all people with learning disabilities.Originality/value - Whilst acknowledging the potential value of IAPT, without specific consideration being given, mainstream approaches to mental health will not be applicable to all people with learning disabilities: "reasonable adjustments" need to be made not only at the direct clinical level but also throughout the system, from service commissioning to outcomes. [ABSTRACT FROM AUTHOR]