• Forensic issues in intellectual disability

      Johnston, Susan J. (2000)
      Recent publications on forensic-related issues in intellectual disability have addressed the experiences and outcomes of a wide range of service styles. The evolving core factors for assessment of the offender and determinants of service provision are being clarified. Particular attention has been given to the clinical issues of sexual offending and abuse and consent and capacity. Many authors have highlighted the paucity of the generally available expertise and appropriate services for this minority, but highly complex group. (C) 2000 Lippincott Williams and Wilkins.
    • Friend or foe? A selective review of literature concerning abuse of adults with learning disability by those employed to care for them

      Moore, Debra (2001)
      Adults with learning disabilities are often the targets of acts of violence, aggression, bullying and humiliation. This review of the literature considers as problematic the prevention and detection of abuse, and the effect it has on relationships between carer and client, the therapeutic environment and the culture of wider society. This article seeks to inform prevention strategies by identifying not just the characteristics of the abusers and the victims but the reality of relationships between them and how this can be the most effective safeguard against abuse. The article suggests that at the core of a valuing relationship between a carer and a person with learning disabilities is a concept of humanness, and a willingness to see reciprocity and warmth in their alliance with one another. The article concludes that a challenge facing leaders and managers of services is how to replicate, cherish and maintain that connection and interdependence between 'carer' and 'cared for'. © 2001 Sage Publications.
    • Severe intellectual disability and transition to adulthood

      Clegg, Jennifer (2001)
      Institutional and psychological aspects of transition were explored with parents and staff involved with five young adults with severe intellectual disability whose challenging behaviour diminished after they made the transition, and five whose challenging behaviour remained high. They were selected from a previously surveyed cohort. Grounded theory analysis of interviews suggested little connection between the perspectives of parents and staff. The impact these differences have on communication about challenging behaviour was explored, and recommendations for service changes are made.
    • Bullying and people with severe intellectual disability

      Clegg, Jennifer (2001)
      Although bullying has been shown to reduce quality of life in many spheres, anti-bullying strategies have yet to be incorporated into services for adults with severe intellectual disability (ID). The present study employed a survey of staff and parent concerns about 54 previously surveyed students who had left a school for pupils with severe ID. A content analysis of follow-up interviews was performed in 10 cases. Staff identified 19% of the survey sample as bullying others and 11% as being picked on. Neither gender nor communication ability had an impact. There was no significant change in bully or victim status over time, although some people did change. Parents or staff raised bully/victim problems in more than half of the interviews. There is sufficient evidence of bullying behaviour to warrant the adoption of anti-bullying strategies.
    • Evaluating care delivery: The application of dementia care mapping in learning disability residential services

      Persaud, Michelle; Jaycock, Sue (2001)
      Explored how good practice in relation to quality of care initiatives in dementia care transpose into learning disability settings. Dementia care mapping (DCM), an evaluation method that measures quality of care from the service user's perspective, was applied in learning disability environments to evaluate its effectiveness and efficiency in this setting. 22 Ss (aged 20-63 yrs) with severe mental impairment (excluding dementia) and communication difficulties were observed to test the assertion that DCM could help to evaluate their experiences of receiving care which they could not describe for themselves. Three residential care areas were observed. Observations recorded a behavior category code, a well-being/ill-being score, personal detractions, and positive events. Results demonstrate the application of the method to be partially successful. The data produced compare favorably in quality, quantity, and detail with those collected in dementia care areas. The authors conclude that an analysis of data reveals great potential for DCM; however, they add that modification and adaptation of result indices and coding frameworks should be considered as possibilities for future work. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Ethical issues

      Robertson, John P. (2001)
    • Parents' experiences of having children with a significant developmental disability: Commentary

      Frankish, Pat (2002)
      QUESTION: What are experiences of parents who have children with significant developmental disability?DesignHermeneutic phenomenology.SettingPenrith, New South Wales, Australia.Participants6 parents (2 couples and 2 single mothers) of 4 children (age range 3-6 y, 3 boys and 1 girl) participated in the study. Participants were recruited from the first author's practice experience.MethodsAn initial series of individual face to face interviews with parents were conducted Parents were asked to talk about their experiences of living with a child with a developmental disability. The couples completed subsequent joint interviews. Interviews were audiotaped and transcribed. Transcripts and contextual notes were coded and then indexed against various starting categories. Patterns in the coding system allowed for reconceptualisation of data into fewer and denser categories. Relationships between the categories were developed. Themes, patterns, and relationships were reviewed with participants to check for intent and validation.Main findingsParents' experiences were interpreted as dynamic moving between jay and sorrow. Contributing to parents' sorrow were the possibility of the child dying, finding out about the child's changed potential, being treated as if there was a death in the family, being left on their own by others and the healthcare system, being vulnerable, having many fears and worries, and grief. Negativity from others contributed to parents' feelings of hopelessness, despair, helplessness, and powerlessness. Contributing to parents' joy were their children not dying, the little things their children do, new perspectives following changes in beliefs and values, and becoming stronger in the face of adversity. Their children became a source of joy and inspiration. Parents were optimistic and hopeful, and defiant of their children's imposed prognoses. They, showed an understanding of their children's impairments and possible functional outcomes. They reported they had learned to live without expectations, but could riot function without hopes and dreams. Their joys and sorrows were held in tension and mediated by feelings of confusion, doubt, and ambiguity. Parents spoke of confusing information and advice, ambiguous prognoses, and their own observations often conflicting with information they were given. The results show the paradox of the existence of joy because of the sorrow experienced.ConclusionsParents not only experienced sorrow when they have a child with a disability but also a sense of joy and gratification. Clinicians working with these families need to be cognisant of this dynamic tension and can be helpful in focusing on hope rather than pathology.
    • Great idea - but how do we do it?

      Money, Della (2002)
      Great government ideas can be quite a challenge to put into practice - particularly when accompanied by a short timescale. This article describes how the Trent Region special interest group worked on a consensus framework for developing communication strategies to benefit people with learning difficulties. Principles and processes agreed for each of the key elements of management, training, and networks and resources are listed. The definition of a communication strategy was a major task, and the resulting collaborative framework is given in the article.
    • Inclusive communication - coming soon near you?

      Money, Della (2002)
      The white paper "Valuing People" committed speech and language therapy services to the promotion of choice, inclusion, independence and civil rights. This article describes how the Means, Reasons and Opportunities model was developed and used for teaching staff working with people with learning disabilities. Five core roles for the service were identified as: 1. Managing health needs; 2. Making information accessible; 3. Using shared means of communication; 4. Promoting reasons for communication; and 5. Creating opportunities for communication. Developing communication policies and strategies to address these issues was essential for the individual, those in his/her immediate environment, and the local community. The Means, Reasons, Opportunities model was used to introduce the idea of "real-world understanding" to distinguish the differences between verbal and situational understanding, and introduce the concept of functional understanding. This has been used as a framework for inclusive or total communication as part of the communication strategy across Nottinghamshire. The use of inclusive communication is increasingly recognised as best practice and effective use of speech and language therapy services.
    • Speech and language therapy management models

      Money, Della (2002)
      Historical and theoretical perspectives; Communication environment; Communication partners; A shared model of communication; Intervention - Models of speech and language therapy management; Practical application of management models; Research supporting management models
    • Risk assessment in offenders with intellectual disability: The evidence base

      Johnston, Susan J. (2002)
      A review of the current literature on risk assessment and management in offenders with intellectual disability (ID) revealed little direct evidence for the specific population. Theoretical models and non-ID populations have been abstracted and adapted, but not validated, for those with ID. The varying conceptual frameworks of risk, and its assessment and management, must be considered in context. Difficulties remain with the consideration of offences versus offence-like behaviour, offender versus those with similar needs, and indeed, what is regarded as 'intellectual disability'. Mainstream forensic assessment has moved towards a more dynamic appreciation of risk and risk management, as opposed to risk elimination. This development is more in line with the normalization principles of 'risk-taking' in ID. Consideration is given to future research and development priorities.;
    • Challenging behaviour and insecure attachment

      Clegg, Jennifer (2002)
      The present authors previously investigated a database about people with severe intellectual disability (ID) to explore whether secure/insecure attachment plays a role in challenging behaviour. This study took the form of a survey of staff and carers involved with a cohort of 54 school-leavers with severe ID. 34% percent of students were rated by placement staff as "overinvesting in one or a few relationships which become a source of jealousy". Students without such problems were significantly less likely to show challenging behaviours, while those with them were significantly more likely to be living outside the family home. These preliminary results justify more detailed and longitudinal research into the relationship between attachment status and challenging behaviour. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Death, disability, and dogma

      Clegg, Jennifer; Lansdall-Welfare, Richard (2003)
      Mourning exists at the nexus between individual experience, professional discourses, research, and culture, making it a complex issue for health services that has shown vibrant change in recent years. By contrast, bereavement discourse in intellectual disability is suffused by dogmatic assertions about correct intervention: we describe four vignettes to illustrate bereavement issues in intellectual disability. Suggestions concerning issues and management are made, but the article focuses primarily on the conceptual issues that underpin clinical intervention. The analysis shows how challenges to the meaning of the disabled life, and to the understandings carers and staff draw on, tend to be resisted. We hypothesize this is most likely to surround issues that evoke cultural uncertainty, such as bereavement. The thesis is that the field of intellectual disability tends to be isolationist because meaning is difficult to create and easily dissolved, especially when addressing culturally contested topics. Dialogue with other disciplines is necessary to stop the field from atrophying, but needs to be carried out in ways that enable carers and clinicians to continue providing the support that people with intellectual disability require. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Living with contested knowledge and partial authority

      Clegg, Jennifer; Lansdall-Welfare, Richard (2003)
      Responds to comments by S. Colman (see record 2003-07847-012), G. Casenave (see record 2003-07847-013), and H. Reinders (see record 2003-07847-014) to the authors' original article (see record 2003-07847-011) which considers issues and approaches particular to those helping the intellectually disabled understand and cope with bereavement. J. Clegg and R. Lansdall-Welfare defend their view that ambiguities associated with meaning in the disabled life make it more likely that professional service providers will make dogmatic responses to bereavement, responses that are defended by isolationism. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Bereavement: Helping a patient with a learning disability to cope

      Gault, John (2003)
      Our case study is of a 55-year-old man who has a moderate learning disability. He has been diagnosed as having bipolar disorder and is currently in remission. At Christmas six years ago while Dave Croft was on home leave from an NHS unit, his father died suddenly. His mother, acting in what she felt were Mr Croft's best interests, arranged the funeral and did not inform her son until after the ceremony had taken place. Mr Croft appeared to have adjusted to his loss, until November 2001 when he became increasingly upset and agitated at the mention of death. A multidisciplinary team approach and the use of a 'life event book' helped Mr Croft come to terms with his bereavement and allowed staff at the unit to put a strategy in place to help him prepare for future family bereavements.;
    • The use of the PCL-R in forensic populations with learning disability

      Morrissey, Catrin (2003)
      Although the PCL-R is used widely for assessing forensic populations in general, there has been no published research on the reliability and validity of such assessments with offenders with a learning disability. The problems with applying the PCL-R with this population are discussed. The results of a pilot study analysing data collected for clinical purposes on a high-security hospital LD admission ward are described, and recommendations for further development and research are made.
    • Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

      Marshall, Tom (2004)
      Aims and method. The aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author. Results. A total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs more used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started. Clinical implications. Challenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.
    • Practice in focus: A hermeneutic approach to research ethics

      Clegg, Jennifer (2004)
      This article argues that the interpretative and negotiating approach of hermeneutic ethics can inform research into the experiences of people with learning disability more usefully than bioethics. Terms and ideas are defined; philosophers and researchers who have employed them are described; arguments for and against the proposition are considered; it concludes by summarizing the position and its implications. Two final reflections pose questions researchers may find it fruitful to consider, or to discuss with users, carers and professionals. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)