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Purpose: This paper aims to underline the importance of using a collaborative approach when designing and adapting a post diagnostic psychosocial intervention of cognitive stimulation therapy (CST) for people with intellectual disability and dementia. Design/methodology/approach: As part of a service improvement, a manual of CST was adapted, for delivery in clinical practice. A qualitative co-production method allowed participants with a lived experience to provide regular feedback relating to the development of the adapted CST manual and intervention programme. This feedback was used to make continual development changes to the CST manual. Findings: The study demonstrated co-production with those who provide care is valuable in adapting psychosocial therapies for people with an intellectual disability and dementia. Additional findings identified the need for carer education in ageing, dementia care and the physical health needs for older people with intellectual disability. Originality/value: To the best of the authors' knowledge, this is the first study that has used a co-production approach with families and carers in adapting a group therapy programme for people with an intellectual disability. This paper underlines the need for post diagnostic clinical interventions for people with dementia and those who provide care. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach: Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings: All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value: To the best of the authors' knowledge, this is the first paper to compare dementia assessment provision between different services in England. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Concerns about the overuse, misuse and potential abuse of restrictive interventions used to manage people who may exhibit behaviour described as challenging led to revised guidance in England. The purpose of this paper is to examine the implementation of this guidance in organisations providing services for people with learning disabilities. Design/methodology/approach: A survey collected data from professionals, on leadership, data use, staff issues and post-incident review. Findings: Most senior leaders were seen as acting on the guidance. Data collected were regarded as generally accurate, but less than half of the managers were seen as likely to respond to consistently high or increasing use of restrictive practices. Frontline staff and managers were seen as very significant for reducing restrictive practices. Uncertainty was shown regarding the goals and activities needed to provide post-incident review. Research limitations/implications: This exploratory survey may be useful for organisations wanting to audit their implementation of government policy and/or for research on a wider scale to indicate how well societies are implementing policy to reduce restrictive practices. Further research on the survey's validity and reliability is required. Practical implications: Further action is needed to encourage all organisations to implement best practice and government policy. This survey showed that some organisations appear to be committed to and potentially achieving reductions in restrictive practices. Originality/value: This paper describes the first survey designed to evaluate organisational efforts to implement an important policy initiative. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities. Findings: Many people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal. Practical implications: People in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics. Originality/value: This is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach: A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings: Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value: This is the only study to the authors' knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the issue of types of assessment offered by services for people with learning disabilities from the research study "A Comparison of Dementia Assessment Services for People with Intellectual Disabilities". Design/methodology/approach: The commentary is based on a review of the associated literature. Findings: Assessment for possible dementia is a complex activity. The gold standard is to ensure that the assessment process is comprehensive including both direct assessments with the person and gathering information from key informants. The issues in not adopting this methodology are considered, as are issues in what services and assessments are called. Originality/value: The commentary considers the studies presented from a practitioner perspective. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a commentary on the paper "Specialist community teams for adults with learning disabilities: referrals to a countywide service in England" by Isabel Clare and colleagues. Design/methodology/approach: This paper reviews some themes presented in this paper relating to the practice and management of community teams for adults with learning disability within the context of recent national service initiatives. Findings: There is a limited literature on the practice, purpose and service caseload management of community teams. Taken in the context of recent national service initiatives, the paper by Clare et al. illustrates the gaps between the way community teams are currently processing demands and how these services will likely need to behave in future. Originality/value: There is little recent literature examining the purpose of, and management approaches in, community teams and this addition should stimulate some further consideration of how community teams need to adjust to meet changing demands. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine trends over time in social care usage and expenditure for adults with learning disabilities in England. Design/methodology/approach: Returns from councils with social services responsibilities in England concerning social care usage and expenditure were analysed to examine the national picture and trends over time for adults with learning disabilities. Findings: In 2017/2018, 147,915 adults with learning disabilities were receiving long-term social care, an increase of 5.7 per cent from 2014/2015. Social care expenditure increased by 10.2 per cent from 2014/2015 to £5.54bn in 2017/2018; adjusted for inflation this was a 2.7 per cent increase. For adults with learning disabilities who receive social care, increasing numbers of people are living with families or in supported accommodation/living, with gradual declines in the number of people living in residential or nursing care. The number of adults with learning disabilities in temporary accommodation is small but increasing. Social implications: While councils appear to be attempting to protect social care for adults with learning disabilities in the face of cuts to council expenditure, social care expenditure and coverage are not keeping pace with likely increases in the number of adults with learning disabilities requiring social care. Originality/value: This paper presents in one place statistics concerning long-term social care for adults with learning disabilities in England. [ABSTRACT FROM AUTHOR]

Purpose The STOMP programme – stopping the over-medication of people with an intellectual disability, autism or both is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants. Part 1 presented the historical background to the use of psychotropic drugs for people with an intellectual disability, autism or both. The purpose of this paper (Part 2) is to present the approach adopted to reduce over-medication (the "Call to Action") and the progress so far at the half way stage.Design/methodology/approach The "Call to Action" methodology is described in a Manchester University report – mobilising and organising for large-scale change in healthcare "The Right Prescription: A Call to Action on the use of antipsychotic drugs for people with dementia". Their research suggested that a social mobilising and organising approach to change operates could provide a mechanism for bringing about change where other approaches had failed.Findings The adoption of the "Call to Action" methodology has resulted in widespread acknowledgement across intellectual disability practice that overuse of psychotropic medication and poor review was resulting in over-medication. Many individual local programmes are underway (some are described in this paper) however to what extent the overall use of psychotropic drugs has changed is yet to be evaluated.Originality/value STOMP is part of an English national agenda – transforming care. The government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities autism or both who have a mental illness or whose behaviour challenges services. This paper describes a new approach to stopping the over-medication of people with an intellectual disability, autism or both. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine data on absences and exclusions from school amongst children with learning disabilities and autistic children in England in 2016/2017. Design/methodology/approach: Data were drawn from Department for Education statistics for the school year 2016/2017 on school absences (authorised and unauthorised) and school exclusions (fixed-period and permanent) for children in the primary special educational needs categories of moderate learning difficulty (MLD), severe learning difficulty (SLD), profound and multiple learning difficulty (PMLD) and autistic spectrum disorder (ASD). Findings: Authorised school absence rates were higher for all groups of children investigated compared to children without special educational needs, primarily due to illnesses and health-related appointments. Rates of unauthorised school absences were low. Rates of fixed-period and permanent school exclusions were higher for children with MLD and ASD compared to children without SEN, and lower for children with SLD and PMLD. Reasons given for exclusions were similar across children (persistent disruptive behaviour, physical assault against a pupil, verbal abuse against an adult), although physical assault against an adult was also commonly mentioned for children with SLD, PMLD or ASD. Social implications: Reducing school absences for children with learning disabilities and autistic children will involve co-ordination of health and social care support arrangements to ensure they are convenient and efficient for children and families. In terms of exclusions, schools need to consider the extent to which they are making reasonable adjustments for children with learning disabilities and autistic children. Originality/value: This paper presents in one place statistics concerning school absences and school exclusions for children with learning disabilities and autistic children in England. [ABSTRACT FROM AUTHOR]

Purpose: Amongst other actions the Care Act 2014 emphasised the duties of local authorities (LA) to assess the needs of carers, as well as those they care for and to meet all eligible needs for support. This paper aims to report the findings of a study which explored the experiences of older carers of people with learning disabilities as they navigated LA assessment processes and personnel. Design/methodology/approach: Using an explorative design, 21 older carers were interviewed about their experiences. Interview transcripts were qualitatively analysed. Findings: Three main themes were identified, namely, needs assessments as ambitions, not outcomes; the effects of funding-cuts projected onto carers; and challenges with social care personnel. Originality/value: The study findings attracted a high level of engagement with public awareness and mainstream news and social media. The LA also immediately responded with interventions to address some of the findings, including carer "drop-in" sessions. They are also adapting their carer's needs assessment processes as a result of the study. It is hoped that the issues raised will be of interest to other social care providers and practitioners. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine trends over time and geographical variation in rates of paid employment amongst working age adults with learning disabilities receiving long-term social care in England.Design/methodology/approach Data were drawn from NHS Digital adult social care statistics examining paid/self-employment for working age (18-64 years) adults with learning disabilities known to social care (2008/2009 to 2013/2014) or receiving long-term social care (2014/2015 to 2016/2017).Findings In 2016/2017, councils reported that 5.7 per cent of working age adults (7,422 people) with learning disabilities receiving long-term social care were in paid/self-employment, with higher employment rates for men than women and most people working less than 16 hours per week. Paid employment rates seem to be slightly declining over time, and there is wide variation across councils in reported paid/self-employment rates.Social implications Despite good evidence for the cost effectiveness of supported employment support, employment rates for adults with learning disabilities receiving long-term social care remain extremely low.Originality/value This paper presents in one place statistics concerning the paid employment of working age adults with learning disabilities in England. [ABSTRACT FROM AUTHOR]

Purpose This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community learning disability teams in the east of England. The purpose of this paper is to explore some of the background to psychotropic drug prescribing for people with intellectual disability, review important contextual factors that influence prescribing decisions, and consider how we might make the best use of psychotropic drugs in this group.Design/methodology/approach Narrative summary and opinion, supported by reference to recent research literature.Findings Psychotropic drug use for people with intellectual disability raises complex issues, not least because of the lack of research evidence that exists on the topic. Psychotropic drugs can be an important part of treatment for people with mental illness but further research is needed to support prescribing for challenging behaviour. Medication optimisation is a framework within which individual preferences and values are considered alongside the evidence base and clinical judgement in order to inform safe, effective, and collaborative management decisions.Practical implications Prescribing decisions should be individualised and reviewed regularly, incorporating evidence from patients and carers. Improving the use of psychotropic medication requires concerted action, adequate social support, and the provision of alternative, non-pharmacological interventions that are acceptable and effective.Originality/value This paper reviews some of the current concerns about the use of psychotropic drugs and opens up new avenues of discussion. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales.Design/methodology/approach The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance.Findings The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings.Research limitations/implications There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings.Practical implications The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently.Social implications For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings.Originality/value While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the existing evidence base regarding community services for people with learning disabilities in the context of transforming care (TC).Design/methodology/approach Reflections and commentary on the provision of community services for people with learning disabilities following Washington et al.'s article on admissions and discharges from assessment and treatment units in England.Findings The existing evidence base pertaining to community learning disability teams in the UK is dated, sparse and methodologically weak. A greater focus on researching community services for people with learning disabilities is needed in order to inform best practice guidelines.Originality/value The success of the TC agenda is contingent on the provision of high quality community services. However, the focus has been on discharging individuals from hospital, rather than the support available to them once they leave. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.Design/methodology/approach A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.Findings There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.Practical implications The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.Originality/value This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism. [ABSTRACT FROM AUTHOR]

Purpose The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.Design/methodology/approach The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.Findings The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.Originality/value STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both. [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 -- Winterbourne and Mid-Staffordshire scandals have had a significant impact on how Care Quality Commission inspects and regulates intellectual disability services (IDS). The purpose of this paper is to describe the changes and development of regulation of these services and future work. Design/methodology/approach -- The paper is a descriptive paper. Findings -- A new regulatory model is currently implemented for IDS. It has been developed in consultation with patients, carers, providers and other stakeholders. There will be ongoing development and refinement of the inspection methodology. Originality/value -- This is an original descriptive paper which will provide useful information to readers on how the regulatory process works in IDS. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to give a brief background to the Deprivation of Liberty Safeguards (DoLS), and studies which factors Best Interests Assessors consider when making a judgement on Deprivation of Liberty. It examines some of the reasons why professionals may be under-using DoLS, including lack of knowledge, complex processes and paperwork, and the pejorative nature of the word "deprivation", and looks at a possible way forward. Design/methodology/approach -- The paper looks at the evidence to the House of Commons and House of Lords Committees on the Mental Health Act and Mental Capacity Act, as well as previous and current research papers. It examines the nuances of difference between restriction and deprivation, and the cumulative impact of several restrictions, which may, in fact, amount to a deprivation, illustrated by case studies from the author's own practice. Findings -- It makes the case that health and social care professionals should err on the side of caution, by making precautionary DoLS applications, arguing that MCA DoLS is a forerunner of good practice, and that good care planning allied to judicious application of the MCA leads to better, more robust and more defensible decision making. Originality/value -- And it points the way to a possible future, citing the recommendations of the Select Committee on the MCA for a clearer link between DoLS and the principles underpinning the MCA, and for simplifying and clarifying the legislative provisions and the associated paperwork. [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 Little is known about the characteristics of residential educational settings for young people with intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics and experiences of the young people attending such settings rather than the setting itself; therefore, an overview of national provision is needed. The paper aims to discuss these issues.Design/methodology/approach As part of a larger project, data were collected for all residential schools and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for 30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of the main project, settings offering placements only to young people aged under 16 were excluded. Data were collected from a range of sources, including school/college websites, Ofsted and Department for Education resources, and liaison directly with the setting.Findings In total, 342 residential educational settings were identified with 57 of these offering post-16 provisions only. A range of data is presented about these settings, including location, placement numbers and types available, age range catered for, special educational needs categories registered for, governance arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings.Originality/value These data provide a national overview of residential educational settings for young people with IDD. This enables a clearer picture of the location and type of provision offered and allows comparisons both within and between areas. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to summarise the findings of a desk-based international review investigating the checking of staff and volunteers working with adults who are vulnerable or at risk (or similarly defined) receiving social care in their own homes, or in day centres or residential care. Design/methodology/approach – In England, as part of the government’s attempts to prevent harm to vulnerable people, employers must check if their staff or volunteers are barred from working with vulnerable adults in the health and care sectors or if they have a relevant criminal record. This review sought to explore practices elsewhere, with a view to informing policy and practice debates. The review was undertaken in winter 2014-2015. It mainly involved a search of internet-based material and databases. This was further informed by communications with experts and practitioners from different countries. Findings – The review found a variety of practices, ranging from no checks to substantial checks involving fingerprinting. Reasons for checks identified in different national contexts extend from efforts to stop fraudulent use of government subsidies to minimising the risk of harm to vulnerable adults, and more positively to enhance user and public trust in care providers. A small number of countries place particular emphasis on the rights of individuals to privacy and rehabilitation and this moral imperative overrides other policy goals. This review highlighted a lack of clarity in publicly available documents about the potentially multiple policy goals of different schemes and suggests that there may be advantages to clarifying the options available from other countries. Research limitations/implications – This review was confined to English language material and to material located through internet searching. Some material may not have been updated on internet sites. Originality/value – The details of the processes have not previously been collated to the best of the authors’ knowledge. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the development and work of the “Can you understand it?” group, which supports services in developing accessible information for people with intellectual disabilities. Design/methodology/approach – Members describe their experiences of working with the “Can you understand it?” group. Findings – Group members found the group to be a positive experience. They report that they have supported a range of services in making information easier for people with intellectual disabilities to understand. Originality/value – This paper will reinforce the importance of making information accessible to people with intellectual disabilities and that people with intellectual disabilities themselves should be involved in the process to assure quality. [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 – Following the development of the post of Trust Intensive Interaction Co-ordinator, it was decided to assess the state of provision of Intensive Interaction within the social care provision of an NHS Trust in the South of England. The purpose of this paper is to: map strengths and weaknesses of current provision; identify successful provision; identify obstacles to successful provision or factors associated with the maintenance of provision throughout the organisation. Design/methodology/approach – Feedback after training sessions offered by the Trust Intensive Interaction Co-ordinator was reviewed; data about teams supporting people needing Intensive Interaction was analysed to ensure the recommended number of people within a team had received training; opinions of managers and support workers on the provision of Intensive Interaction were gathered. Findings – In total, 96 per cent of Trust employees thought training was right for them; 81 per cent of house teams/services had at least three staff and a manager who had received Intensive Interaction training; three areas of concern were identified from the opinions of managers and support workers: discussion of Intensive Interaction in supervision; responsibility for Intensive Interaction happening; and sharing knowledge of successful Intensive Interaction with those connected to the service user. Originality/value – This is one of the first published audits of an Intensive Interaction service. For the Trust, it provides a baseline to allow monitoring of the maintenance of current levels of service provision over time and, following action taken to address areas of concern, whether future provision has been improved. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a commentary on “An audit of an Intensive Interaction service”. Design/methodology/approach – Drawing on the literature regarding other related person-centred approaches and clinical and research experience, an argument is made that people with profound intellectual and multiple disabilities are particularly at risk when service innovation does not account for their unique needs. Findings – Practice and service models need to specifically account for the needs of people with profound intellectual and multiple disabilities. Originality/value – The commentary draws attention to the importance of implementation and seeks to draw lessons from well established, service wide approaches for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach -- The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings -- There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications -- This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications -- There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications -- An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value -- This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to explain a decision of the Court of Appeal about the duty an Approved Mental Health Professional (AMHP) will sometimes have to consult a patient's nearest relative, and to set that decision in the context of an earlier one. Design/methodology/approach -- Each decision is examined in detail and one is compared with the other . Reference is made to the Mental Health Act 1983 Code of Practice. Findings -- It will be harder for an AMHP to establish that consultation is not reasonably practicable, and it will be correspondingly easier, in some cases, for a nearest relative to obtain information about a patient or achieve proximity to her . Originality/value -- This is thought to be the first time the two cases have been considered together or in their true context. [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 – Previous studies have shown that support workers often have difficulties in recognising mental health problems in service users with intellectual disabilities. In the context of improved UK training programmes, the purpose of this paper is to explore the factors that can predict support workers’ knowledge and confidence in this respect. Design/methodology/approach – In total, 80 support workers (40 residential and 40 community-based) completed a questionnaire about their length of work experience, exposure to service users with additional mental health needs, training, general and specific mental health knowledge, and confidence in working with mental health issues. It was hypothesised that length of work experience, extent of training, and level of exposure would predict knowledge about mental health problems, and also predict confidence in working with people with mental health problems. It was further predicted that residential support workers would be more knowledgeable and confident than community workers. Findings – Results showed that level of exposure could predict knowledge about schizophrenia, but not about depression, anxiety, or dementia, while length of experience could predict overall mental health knowledge and confidence. Extent of training could only predict knowledge about anxiety, and work setting (residential or community) had no effect to on knowledge or confidence. Implications for practice and training are discussed. Originality/value – In the context of improved UK training programmes, this study aimed to explore the factors that can predict support workers’ knowledge and confidence in this respect. [ABSTRACT FROM AUTHOR]

Purpose – Positive behaviour support has been positioned by current government policy as an important intervention for people with intellectual disabilities who display behaviours that challenge services. However, little is known about service user or carer opinions towards the use of this kind of model. The paper aims to discuss this issue. Design/methodology/approach – Opinions and experiences of 25 carers and six service users were collected through semi-structured interview as part of the evaluation of an enhanced service, Complex Behaviour Service, based on positive behaviour support principles. Findings – Content analysis indicated that the service was seen as acceptable and useful and that positive experiences of the service linked to: frequency and availability of the service; talking about behaviour and being listened to; understanding, and change in, the service user, carer and behaviour. Originality/value – This adds to the small but growing literature on service user and carer opinions towards specific interventions and highlights themes that future services could consider in delivering evidence-based care. [ABSTRACT FROM AUTHOR]