bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing interactions in two hospital wards for people with mental handicaps: A PILOT STUDY
Authors: Wood James R. A.
Published: August 2010

Interactions between primary care‐givers and people with mental handicaps have been a focus of eco‐behavioural studies. Many of these have classified verbalisations by staff and the people resident in long‐stay settings to indicate the nature of the linguistic environment and show that there is a low level of high quality interaction in these settings. A comparison between two separate wards in the same hospital was carried out to obtain baselines as part of a study of the efficacy of staff training procedures. The wards were identified as being very different from each other in management practices, level of communication ability, and degree of support required by the people living in them.

The present study examined the use of an observational schedule which yielded data for fine‐grained analysis of the patterns of interaction between residents and staff; according to population density and by staff grade. The results of the baseline measures indicated very few differences in interaction patterns between the wards despite other differences in régime. While much previous research has suggested that different management approaches, such as staff training, are important factors in setting differences, it is only in‐depth investigations which examine these aspects in terms of the patterns of language use and activity that highlight the extent of the effects of institutionalisation on staff and the people in their care.

The implications are that training needs to be targeted at communication to overcome some of the features of existing interaction patterns. Replacing large institutions by smaller facilities, where changes in management or physical features only replicate the activity, staffing, and systemic patterns of large hospitals, could lead to very little fundamental change in interaction patterns for the people who live in them unless effort is directed towards facilitating their development of socially interactive skills.
The effects of deinstitutionalisation on people with mental handicaps: A REVIEW
Authors: Allen David
Published: August 2010

The deinstitutionalisation of people with mental handicaps has given rise to a considerable literature regarding the effects of this policy on service users. This review describes the major findings in relation to changes in adaptive behaviour, activity levels, social interaction, community integration, disruptive behaviour, and quality of life. Individual and environmental influences are discussed, together with possible foci for future research.
Behavioural treatment of anxiety and related disorders in adults with mental handicaps: A REVIEW
Authors: Allen Elizabeth A.
Published: August 2010

This paper comprehensively reviews studies relating to the prevalence, assessment, and behavioural treatment of anxiety and related disorders in adults with mental handicaps. It is considered that the paucity of research in this area, relative to work with adults who are not mentally handicapped, is an example of neglect by mainstream psychology rather than a belief that people with mental handicaps do not often experience such disorders. The lack of assessment measures is noted and discussed in the context of studies of treatment outcome. Such studies are sparse and generally poorly designed, although most indicate the potential benefit of behavioural interventions. Future areas of research are discussed and their necessity is outlined in the context of the principles of normalisation.
Assessing the challenge: development of the Challenging Behaviour Scales
Authors: Wilkinson Julie
Published: August 2010

The author devised the Challenging Behaviour Scales (CBS) in response to the task of evaluating how much impact a ward‐based intervention had on the challenging behaviour of the men who lived there. They were used as one of a “battery” of ten research methods; adding a quantitative assessment to what were largely qualitative techniques. This paper aims to describe the CBS, as opposed to project outcomes, in the belief that it has potential for wider application within areas of evaluational research. The background and objectives of the CBS are outlined, along with a description of the construction of its two parts: the Frequency and Intensity sections.

Production of the accompanying Manual is also described, as well as the reliability checks, scoring methods, and staff comments obtained after application of the CBS. Finally, suggestions are made about ways in which data produced from this model of scale development can be analysed, and the author clarifies the position that she believes this type of behavioural assessment has in evaluational work. Additional suggestions are made for people who may wish to use the model of construction underlying the CBS elsewhere.
Dimensions of social competence in a population of adults with mental handicap
Authors: Walsh Patricia Noonan , McConkey Roy
Published: August 2010

When scores across 29 of the 36 areas of personal and social skill on the Pathways to Independence checklist were analysed, a multidimensional structure with one large factor, personal independence, emerged. Results suggest that, as some basic skills were loaded on single factors, and more complex skills emerged as conglomerates, two types of competence were apparent.

Implications for the provision of functional teaching strategies in natural settings are discussed. Replication among other client groups is proposed. The usefulness of social competence measures in ascertaining intellectual development as well as adaptive functioning should be tested in future studies.
The social and behavioural functioning of people with mental handicaps attending adult training centres: A COMPARISON OF THOSE WITH AND WITHOUT EPILEPSY
Authors: Gillies John B. , Espie Colin A. , Montgomery James M.
Published: August 2010

This controlled study investigates possible psychosocial deficits associated with the “double handicap” of mental handicap plus epilepsy in a sizeable sample of adults with mental handicaps living in the community. Results indicate that social and behavioural problems, additional to those associated with mental handicap in itself, are largely confined to the relatively small sub‐group of people who have poorly controlled epilepsy. These results are discussed in relation to deficiencies in the socialisation process.
Short‐term generalised effects of relaxation training on adults with moderate and severe mental handicaps
Authors: Lindsay William R. , Richardson Isobel , Michie Amanda M.
Published: August 2010

Over the past few years there has been an increasing interest in the treatments for anxiety in people with mental handicaps. Some authors have found poor results in using relaxation treatments with this client group but the present authors have adapted and developed techniques which have shown excellent immediate effects.

The present study investigated the generalised effects of two forms of relaxation training: Behaviour Relaxation Training (BRT) and Abbreviated Progressive Relaxation (APR). Both were found to produce reductions in anxiety at times of the day other than those in which treatment was being conducted. BRT produced quicker effects, but although people receiving this form of treatment showed less anxiety than those receiving APR, these differences were not significant by the end of treatment and at follow‐up. It was concluded that both treatments can be effective in helping people with mental handicaps reduce their anxiety outside of treatment sessions.
Identification and description of adults with mental handicaps showing physically aggressive behaviours
Authors: Reed Julie
Published: August 2010

Eleven adults showing physically aggressive behaviour were drawn from the population of a small hospital for people with mental handicaps. They were identified by means of Criterion 1, an operational definition specifying tissue damage. High inter‐rater agreement between ward staff members was obtained for this criterion. A second inclusion criterion, which specified any act of physical aggression resulting in verbal or vocal reports of pain from another person, resulted in low inter‐rater agreement. Analysis, therefore, was focused on the 11 adults identified by Criterion 1.

It is proposed that, for the purposes of planning for future service provision and resource allocation, the identification of people whose physical aggression is likely to present challenges to those with whom they live and work should also consider the influence of additional factors, such as predictability, emotional arousal, and topographical differences. These may be important variables in staff perceptions and management of physically aggressive behaviour.
Beyond the single sign: the significance of sign order in a matrix‐based approach to teaching productive sign combinations
Authors: Light Paul , Watson Julia , Remington Bob
Published: August 2010

The authors report two experimental studies which looked at the effects of a matrix training procedure designed to teach children with mental handicaps to use two‐sign combinations. Matrix training involves teaching a specific subset of sign combinations which correspond to the overlapping diagonal cells in a matrix of possible sign combinations. Each study used a matrix of object and location combinations.

In the first study, two children were successfully taught to make correct two‐sign combinations, following the teacher's placement of an object in a location. The skill was acquired as a generalised response class, but neither child fully acquired the ability to use sign order to convey meaning.

The second experiment showed that only two of four children, who used signs in combination in the natural environment, were sensitive to the linguistic information carried by sign order. An attempt was made to teach the meaning of sign order to the children who were not sensitive to it. A matrix of sign combinations was used, in which the signs functioning as objects could be transposed with those which functioned as locations. These procedures were not successful.

The results are discussed with respect to the complex relationships between sign learning and natural language.
Employers' attitudes to the employment of people with mental handicaps: an empirical study
Authors: Harrison Barbara , Tomes Anne
Published: August 2010

Supported employment services for people with mental handicaps are being developed in many parts of the country. These aim to provide them with the levels of job‐finding assistance, training, and support required to enter and remain in employment. Finding jobs is crucial to the success of these ventures. This study examines the problem of marketing the labour of people with mental handicaps to employers. The research is based on interviews with 57 employers in Sheffield. It investigates the attitudes, perceptions, and practices of employers in relation to the employment of people with mental handicaps.

The findings show that the label “mental handicap” is not always understood accurately by employers. It often communicates negative images. Several concepts were found to underlie employers' perceptions of their employees. People with mental handicaps were expected to perform better than their non‐handicapped counterparts on four of these: job satisfaction, genuineness, grafting, and loyalty; but less well on productive capacity, supervision and risk, and learning capacity. The results indicate that small organisations with a low rate of recruitment are the most sympathetic employer groups. The survey also showed that problems envisaged by employers with no experience of employing people with mental handicaps were not reported by those experienced in doing so, especially with respect to safety and co‐worker acceptance.

The findings will be used to develop a more effective marketing strategy for the supported employment services organisation, Intowork, which is based in Sheffield.
Beyond the single sign: a matrix‐based approach to teaching productive sign combinations
Authors: Remington Bob , Watson Julia , Light Paul
Published: August 2010

The authors report two experimental studies which addressed the question of how children with mental handicaps can be taught to generate productive, two‐sign combinations; that is, correctly to recombine signs in a way not previously taught. The basic approach, matrix training, involved teaching a specific subset of sign combinations corresponding to the overlapping diagonal items in a matrix of all possible combinations.

In Experiment 1, the matrix items consisted of stimuli produced by combining character and facial expression elements. In Experiment 2, the matrix was formed from colour and object elements. In both studies, matrix training was successful in teaching children to use multiple signs to label the multiple attributes of training items. However, the productive recombination of signs only occurred in Experiment 2, with children who, prior to matrix training itself, had acquired sign labels for the elements which made up the matrix.
Training mothers with mental handicaps to understand behavioural and developmental principles
Authors: Tymchuk Alexander J. , Andron Linda , Tymchuk Marilyn
Published: August 2010

Eight mothers with mental handicaps were trained to understand and apply behavioural and developmental principles. The results of three questionnaires administered showed that where mothers with mental handicaps did significantly more poorly before training than a comparison group of mothers without handicaps from similar backgrounds, after training there were no differences. These results were maintained at a month's follow‐up. Suggestions are made for further studies.
An analysis of the representation of people with mental handicaps in a British newspaper
Authors: McGill Peter , Cummings Richard
Published: August 2010

Articles from a British newspaper were analysed in terms of: the roles into which they cast the people with mental handicaps to whom they referred; and the frequency of their juxtaposition with other devalued groups. Results suggested that the articles were not representative in their description of people with mental handicaps, describing them as being children and patients more frequently than would be expected. Juxtapositions, particularly with people having mental health problems, occurred in about a third of the articles. Comparative analysis of the articles written by staff reporters and those written by non‐staff suggested that the newspaper's own reporters were more likely to misrepresent the population of people with mental handicaps than other writers.
Use of mental health and support services among families of children with disabilities: discrepant views of parents and paediatricians
Authors: Urey Jon R. , Viar Vicki
Published: August 2010

Viewing families of children with disabilities in terms of normative coping responses to stress is a relatively recent trend. This investigation examined differences between parents of children with spina bifida and paediatricians in their views of families' mental health support service needs. The study involved 21 parents and 23 paediatricians who completed a needs assessment instrument.

Although the views of the two groups were similar in regard to a perceived need for services, discrepancies were evident in the type of mental health support service providers thought to be most appropriate, and the perceived severity of families' psychosocial problems. Results are discussed in relation to family compliance in paediatric health care settings, and the need to consider parental attitudes when family mental health support service issues are raised.
Staff‐staff and staff‐resident verbal interactions in a community‐based group home for people with moderate and severe mental handicaps
Authors: Orlowska Danuta , McGill Peter , Mansell Jim
Published: August 2010

Verbal interactions involving direct care staff in a group home for people with moderate and severe mental handicaps were observed. The total amount of interaction staff had with residents and with each other was compared. The existence of interaction under different configurations of staff and residents was also examined. Overall, the care staff were involved in interactions across 71.1 per cent of observed intervals. They were almost twice as likely to be involved in interactions to or from residents (47.3 per cent) than to or from other staff (25.9 per cent). However, when compared across different configurations, interactions with residents were less frequent when other staff were present, suggesting that interactions with staff were preferred. Examination of staff‐staff interactions suggested that these were largely work‐related, so to dismiss them as detrimental to people's work is premature. Ways in which staff‐staff interaction may be important are discussed.
Changing staff attitudes to the sexuality of people with mental handicaps: an evaluative comparison of one and three day workshops
Authors: Rose John , Holmes Sophie
Published: August 2010

This paper reports on an evaluation of two workshops designed to change the attitudes and behaviour of staff towards the sexuality of people with mental handicaps. The workshops were of different duration, one day and three days respectively. They had some activities in common, but the three day workshop allowed a more extensive coverage of the issues.

Evaluation of the workshops was generally positive, both in terms of staff feedback and attitude change, as measured using an attitude inventory. On completion of both workshops staff expressed attitudes that indicated they would be more willing than before to assist the people in their care in making informed sexual choices. The three day workshop was significantly more effective in changing attitudes than die one day workshop.

The difficulties in making any conclusions beyond immediate attitude change are discussed, and suggestions for further research are made. However, it is suggested that this type of workshop can form an important part of basic training for staff and that such work should be developed and extended.
Socio‐economic factors: their relationship with child and family functioning for children with Down's syndrome
Authors: Turner Stephen , Sloper Patricia , Knussen Christina , Cunningham Cliff C.
Published: August 2010

The families of 118 children with Down's syndrome, aged from six to fourteen years, took part in a study which sought to clarify the relationships between a large number of descriptor variables and a range of child and parental outcome measures. Previous studies had suggested that socio‐economic factors may be related to both child and parental outcomes, and a number of such variables were included in the present study.

By using multiple regression analysis, it was possible to discriminate between single variable associations and those which remained significant when other associated variables were taken into account. In this way, parental educational qualifications were found to be associated with the children's IQ and mental age scores, and with the extent to which they participated in organised activities. Social class was related to the extent of the children's play contacts and to changes in their mental age scores. More specific aspects of social and economic disadvantage, such as inadequate housing and finance, unemployment, and lack of a car, were related to child behaviour problems and to measures of parental stress and satisfaction. Mothers in manual social classes were more likely to have increasing levels of stress.

The implications of these findings for service providers are discussed.
The implementation of the All‐Wales Mental Handicap Strategy
Authors: Beyer Stephen , Todd Stuart , Felce David
Published: August 2010

The All‐Wales Mental Handicap Strategy was received in 1983 as a forward looking policy designed to deliver a range of community services to people with mental handicaps and their families guided by a clear articulation of principles. A ten‐year period was set, in which constituent counties would begin the process of developing local services to replace those traditionally available, aided by additional central finance especially allocated for the purpose. The commitment to achieve considerable service change in a way that accorded with a set philosophy led the Welsh Office to take concerted action to manage the Strategy and monitor its progress, attending to the planning infrastructure in counties, the basis for estimating needs, the content of plans, the formulation of progress reports, and the setting of priorities for action.

This paper describes the way the Welsh Office has revised mechanisms for implementation of the Strategy in its first five years. It also reports changes in service provision achieved between 1983 and 1988. There is evidence of positive change in line with the aspirations of the Strategy, although progress in the initial years has been less good than may have been hoped. Time has been required for counties to make an effective response to the Strategy initiative. An acceleration of service development in designated core areas is anticipated over the second half of the ten‐year period.
Adulthood and people with mental handicaps: report of a research project
Authors: Walmsley Jan
Published: August 2010

This paper describes a small project which used research interviews to discover the meaning of adulthood to the research participants, five adults with mental handicaps. The project set out to design a research process which would respect their status as adults. The paper focuses on this research process, though for the sake of clarity some of the content findings are also discussed. The merits and difficulties of the approach are discussed in the context of research methodologies which emphasise the need to redress the power imbalance inherent in more traditional methods.
INCREASING INDIVIDUAL TUITION OF ADULT STUDENTS WITH MENTAL HANDICAPS: A COMPARISON OF ROOM MANAGEMENT AND INDIVIDUAL TEACHING
Authors: Crisp A. G. , Sturmey Peter
Published: August 2010

The two experiments in this study compared the effectiveness of individual teaching and room management conditions in increasing the amount of time spent providing individual tuition to two groups of adult students with mental handicaps. Although such tuition was increased in the individual teaching condition, this was at the expense of other important aspects of staff and student performance. Suggestions are made for overcoming some of these difficulties, and a call for further examination of current reliance on small group situations as the primary vehicle for student teaching is made.
SERVICE CONTACT: CHANGES OVER FIVE YEARS IN A TOTAL POPULATION SAMPLE
Authors: de Paiva Siobhan , Lowe Kathryn
Published: August 2010

Abstract  The impact of a new community based service (NIMROD) on generic service contact was assessed for people living in different residential settings: supported accommodation in ordinary housing; mental handicap hospitals, and private family homes. 1 Results over five years indicated considerable variability in patterns of generic service usage and provided evidence of a limited impact of NIMROD on the frequency and type of services used. While receipt of NIMROD may have effected an increase in service usage for some people living in family homes, findings also indicated an opposite effect for those who moved into supported accommodation. Doctors and dentists were used by a consistently high proportion of people over time. The most marked change in service usage during the study was an increase in the use of chiropody services by hospital residents. The central role played by General Practitioners in community based care is discussed and the importance of examining client need in conjunction with extent of service usage is highlighted.
INDIVIDUAL CHARACTERISTICS AND SERVICE SUPPORT OF OLDER PEOPLE WITH MODERATE, SEVERE AND PROFOUND LEARNING DISABILITY WITH AND WITHOUT COMMUNITY MENTAL HANDICAP TEAM SUPPORT
Authors: Moss S.C. , Hogg J. , Home M.
Published: August 2010

A demographic survey of a single Metropolitan Borough identified a sample of people with moderate severe and profound learning disability (LD) 50 years of age and over. Seventy five of the sample were known to the Community Mental Handicap Team (CMHT), while 25% were identified through other referrals obtained through an intensive ‘outreach’ study. The most common avenue of identification for outreach group members was via the social work team for elderly people; many of these individuals were in Local Authority (Part III) staffed accommodation for elderly persons. The two groups did not differ in competence, though those in the CMHT were significantly younger and, as assessed through the Adaptive Behavior Scales Part 2, demonstrated more challenging behaviours than their outreach peers. With respect to all forms of provision studied, i.e. Individual Programme Plans, educational opportunities, and community leisure experiences, the CMHT group received a significantly greater input. Our findings lend support to Wolfensberger's (1985) concern regarding the appropriateness for those with LD of generic services for elderly people. While integration remains a valued goal with respect to service provision for older people, the present study argues for caution and careful monitoring to ensure that there is no reduction in quality of service arising from the differing philosophy and resourcing of services for elderly people compared with provision for those with LD.
DO SMALLER HOMES RESULT IN INCREASED INTEGRATION?
Authors: Ballinger Claire
Published: August 2010

One of the best publicised consequences of the policy of community care is the resettlement of people with a mental handicap from large institutions into homes in the community. Normalisation dictates that smaller residences have greater potential for integration than larger ones. The aim of this study was to investigate whether there is a difference in the number of community contacts made by residents with a mental handicap living in small and large community units. Community contacts of 40 individuals with a mental handicap were recorded by care staff for a period of four weeks. Twenty one of the subjects lived in three flats, with seven, ten and eight beds respectively and the remaining 19 lived in a large unit with 24 beds. Results show that people residing in the smaller units experienced significantly more community contacts than those in the large unit (p < 0.05). Areas for further study are identified.
PEOPLE LIVING IN COMMUNITY HOMES: THE INFLUENCES ON THEIR ACTIVITIES
Authors: Holland Angela , Meddis Ray
Published: August 2010

The study investigated the activities of people with learning disabilities in community‐based residential services. The research used a multiple case study design which enabled processes leading to outcomes, such as participation and interaction to be identified. Six people in different services took part in detailed case studies. The data collected included an observational measure of engagement. It was found that the people who spent more time engaged in household activities lived in services which used identified procedures to encourage participation, e.g. rotas of household tasks, carers actively supporting people in meal preparation. Domestic style environments which had been planned to encourage participation in household activities did not achieve this, when such operational guidelines were not put into practice. In services in which people lived in larger groups, it was found that either activities could become repetitive or the size of the group prevented regular participation. Household activities were usually enjoyed, and for some people were a clear source of pride. Group size was found to be an influence on interaction. Interaction was highest in small groups at mealtimes (e.g. four people and a carer), or when people were in groups of two or three participating in a task. Such opportunities are more likely to occur in smaller services. It was concluded that services need to develop strategies to actively encourage both participation in household activities and interaction, but that these can be designed to avoid rigid practices.
MENTAL AND PHYSICAL ACTIVITY BENEFITS IN ADULTS WITH MENTAL HANDICAP
Authors: Brown Janet I. , Chamove Arnold S.
Published: August 2010

During a 2‐hour observation period after 1 hour of mental or physical activity, negative behaviour presented by 11 institutionalised adults with a mental handicap decreased by 24% and positive behaviour increased by 66%. Improvement in behaviour increased over time following mental activity, especially in men. Behavioural improvement was greatest immediately after physical activity and decreasing with time, especially in women. Fatigue can not account for these beneficial effects.
MUNCHAUSEN SYNDROME PRESENTING AS MENTAL HANDICAP
Authors: Craddock Nick , Brown Nick
Published: August 2010

We describe a young women with Munchausen syndrome whose repertoire of simulated presentations includes mental handicap, bereavement, suicidal ideation, psychosis, epilepsy and acute abdominal emergency. Although this is the first report of Munchausen syndrome presenting as learning disability, there may be many similar unrecognised cases. Mental health professionals need to be aware of the possibility of this diagnosis. Studies are needed to determine the frequency of such presentations and to assess the implications for service planning and provision.
EARLY INTERVENTION: PLANNING FUTURES, SHAPING YEARS
Authors: McConkey Roy
Published: August 2010

The achievements of early intervention during the last quarter of a century are built on family‐based services with a whole‐child focus. Their influence has been far‐reaching but knowing what needs to be done increases the frustrations in making effective interventions available to all families and children, irrespective of where they live. Among the service transformations reviewed are the shift in focus from children to families; the recasting of service personnel from specialists to family supporters; the development of therapies into child‐led transactions as the preferred means of promoting development, and new approaches to evaluating service effectiveness. Examples are given of low‐cost service strategies to meet the needs of the developing world, new styles of training opportunities for parents and communities, and the promotion of policies at a community and national level that nurture the wellbeing of children and families. The primary requirements for successful interventions remain the age‐old values of love, self‐sacrifice and respect for the dignity and worth of each person. Sustaining these in modern society is arguably our greatest challenge.
WHAT DO ATCs OFFER IN WALES?: A SURVEY OF WELSH DAY SERVICES
Authors: Beyer Stephen , Kilsby Mark , Lowe Kathy
Published: August 2010

A survey of the organisation and activities offered by all adult training centres (ATCs) in Wales was carried out in 1990. Activities were categorised under 10 headings, and the total number of ‘person hours’ allocated to each was calculated. The location of activities, within the ATC or elsewhere, was also noted. Over a third operated small satellite units, but the pattern of activity in these was similar to that of main centres. Only 11% of registered attenders had all their activities in the ATC, while the activities of 15% occurred elsewhere. The remainder (74%) experienced a mixture of centre based and external activities. However, across the timetable, 70% of person hours were spent inside the ATC. The vast majority of ATCs (88%) said they carried out formal reviews of client progress. The most common activity was arts and crafts, accounting for 25.3% of all person hours. Just over half (53%) of ATCs offered centre based contract work, and this represented 20.2% of all person hours. The proportion of person hours spent in the three other categories relating to work was 15.5%, the largest being work experience at 9.8%. Comments of managers suggested that increased activity in the community and work related activity were positive developments yielding significant benefits for those involved. Over £7 million of expenditure was identified, the largest elements being staff salaries (71%), and transport (15%). The mean cost per person across all reporting ATCs was £3,252 p.a. Variations in the balance of activity were found across ATCs. A cluster analysis identified four models of ATC operation, characterised as Recreation, Recreation and Personal Development, Occupation, and Employment. The models identified could not be fully attributed to such organisational factors as county of origin (implying local day service policy) or size of ATC. The paper suggests that not all activities hold the same benefits for people with a mental handicap, points to a lack of consensus on what activities should take place, and calls for an informed debate between consumers and providers.
MENSTRUAL MANAGEMENT: THE MOTHER'S PERSPECTIVE
Authors: Carlson Glenys , Wilson Jill
Published: August 2010

It is suggested in the service provision literature for people who have a learning disability (LD) that menstrual management should be addressed proactively on the basis of least restrictive approaches. In this study, detailed information about menstrual management decision‐making on behalf of 30 young women with LD and high support needs was obtained through interviews with their mothers. Analysis of the interview data suggests that although menstrual suppression or elimination was often preferred, parental decision‐making appeared to be occurring without access to practical support or comprehensive information. Some parental perspectives are identified and briefly discussed. It is concluded that service provision organisations need to make available information and practical support to young women, their families, and staff members, in the areas of menstrual and fertility management.
COST EFFECTIVENESS AND PROVISION FOR SPECIAL EDUCATIONAL NEEDS
Authors: Thomson G.O.B. , Ward K.
Published: August 2010

Interest in school effectiveness and performance indicators has been a major concern of educational research in developed educational systems throughout the 1980s, although little of this activity has been translated to the area of special educational needs. Drawing upon data from a national survey of school leavers with significant special educational needs (n = 618), indicators of successful post‐school outcomes are hypothesised. A model developed in the field of health economics (McGuire et al., 1988) is described and adapted to provide a theoretical framework against which effective provision for special educational needs may be judged. Ordinal scales on seven key variables are described and applied to representative case studies from the above data set. The hypothesised outcome variables are employment; economic self‐sufficiency; personal autonomy; role‐taking in the family; role‐taking in society; uptake of post‐secondary education and qualifications gained at school. The paper concludes with an evaluation of the health economics model (known as QALYs — Quality Adjusted Life Years) as a potentially useful method of considering the value‐added benefit of differing forms of provision for differing disability groups.
PARENTS' VIEWS OF DIFFERENT RESPITE CARE SERVICES
Authors: Stalker Kirsten , Robinson Carol
Published: August 2010

This paper focuses on one part of a three‐year study into respite care services to disabled children. Relevant literature in the field is first reviewed and the aims and methods of the research are outlined. The main findings from semi‐structured interviews with 160 parents using different types of respite care—family based schemes, local authority residential homes and health authority provision, including hospitals—are reported and discussed. Certain differences emerged between the characteristics of children using different services, notably in terms of age, weight, and level of dependency. Uneven access to services was identified, with black and low income families apparently having limited choice. Significant variation was found in the perceptions of the various service users. Important features of family based schemes were the child‐centred nature of the service, the good relationships generally enjoyed by parents and carers and the informality of arrangements. Some benefits were reported for children receiving respite care in residential homes but widespread difficulty in obtaining bookings and instances of poor physical care were significant drawbacks. Parents using health authority provision reported a range of dissatisfactions, mostly associated with the institutional nature of the service.
A CHECKLIST OF CHALLENGING BEHAVIOUR: THE DEVELOPMENT OF A SURVEY INSTRUMENT
Authors: Harris Philip , Humphreys Jacky , Thomson Graham
Published: August 2010

The Checklist of Challenging Behaviour (CCB) was developed as a survey instrument in a study of aggressive behaviour amongst people with learning difficulties from a single health district within the UK. The content of the CCB was generated by service providers from a review of the literature and through an analysis of hospital records of violent incidents. The resultant behaviours were separated into two checklists; the first was a list of aggressive behaviours involving harmful, physical contact with others and, the second, a list of other types of challenging behaviour. Five‐point scales were used to rate the behaviour for frequency, management difficulty and severity. The CCB appeared to have an acceptable level of content validity. Reliability checks supported the use of the CCB as a survey instrument for identifying the range and type of aggressive and challenging behaviours. The data did not support the use of the CCB as a reliable measure for change at the individual level. The difficulties of measuring changes in aggressive behaviour are discussed.
A CROSS‐CULTURAL STUDY OF PARENTAL ATTITUDES AND BELIEFS ABOUT LEARNING DISABILITY (MENTAL HANDICAP)
Authors: Fatimilehin Iyabo A. , Nadirshaw Zenobia
Published: August 2010

The literature suggests that Asian families have attitudes and beliefs about learning disability (mental handicap) which differ from those of white British families, and that these attitudes may have an influence on service utilisation. A structured interview schedule addressing these issues was piloted on 12 Asian and 12 white British families to determine its effectiveness in identifying attitudinal differences between the two groups. In this study, the differences in attitudes and beliefs were found to be unrelated to descriptive variables such as the characteristics of the son/daughter with a learning disability, and characteristics of the parents. However, attitudinal differences and service utilisation patterns were more related to religious and cultural differences. A further major influence on attitudes and service utilisation in Asian families was a lack of knowledge about the cause and concept of learning disability, and of the services available. The findings of this study highlight the short‐comings of services for black and ethnic minority people with learning disabilies, and have major implications for future service provision.
OUTCOMES OF ORDINARY HOUSING SERVICES IN WALES: OBJECTIVE INDICATORS
Authors: Perry Jonathan , Felce David
Published: August 2010

Outcome data were collected on fourteen, recently provided staffed houses for people with mild, moderate, severe or profound learning disabilities in order to assess the quality of service provided. Quality indicators reflected the quality of the housing provision, social and community integration, social relationships within the houses, resident engagement in activity, developmental progress over time and opportunities for autonomy and choice. The data show that the quality of the houses investigated was broadly similar to that reported for other housing services in British research which has accompanied deinstitutionalisation. Quality levels on many indicators were related to the ability of residents and the data illustrate the difficulty in providing services for people with more severe or profound learning disabilities, which are capable of achieving outcomes comparable with those attained in services for more able residents. This research provides further evidence that the extent of staff support for resident activity is critical to how much residents are able to participate fully in the everyday activities which arise in the conduct of their lives.
GENETIC AND BEHAVIOURAL ASPECTS OF PRADER‐WILLI SYNDROME: A REVIEW WITH A TRANSLATION OF THE ORIGINAL PAPER
Authors: Clarke D. J. , Boer Harm , Webb Tessa
Published: August 2010

An English translation of the 1956 paper in which Prader, Labhart and Willi originally described the syndrome which now bears their name is followed by a discussion of the advances in understanding regarding genetic and behavioural aspects which have occurred during the intervening years.

Prader‐Willi syndrome is associated with an absence of a paternal contribution to a defined area of the long arm of chromosome 15, and with maladaptive behaviours which are more common than among people of the same age and sex, who have equivalent cognitive impairments. The syndrome is associated with an excessive appetite which may lead to the consumption of unusual items (such as frozen or discarded food) and to extreme obesity. The association between genetic and behavioural abnormalities offers an opportunity to explore the mediating effect of environmental variables on specific maladaptive behaviours.
DO OUTPATIENT PHYSIOTHERAPISTS IN WALES HAVE ADEQUATE KNOWLEDGE AND EXPERIENCE OF INTELLECTUAL DISABILITY
Authors: Lipscombe Hilary , Hall Elizabeth Ann
Published: August 2010

As people with an intellectual disability are resettled from institutions, the likelihood increases that physiotherapists working in outpatient departments will have patients who have an intellectual disability. This study, therefore, sought to establish from a sample of 88 outpatient physiotherapists the degree of their knowledge of the All Wales Strategy for the Development of Services for the Mentally Handicapped, die adequacy of their experience and knowledge to treat this particular client group effectively and their attitudes towards people with intellectual disabilities. Although physiotherapists were generally aware of the principles of the AWS, 88% did not know its specific objectives. They had very little experience and knowledge of intellectual disability, 77% believing themselves inexperienced. Nevertheless, a large majority held positive attitudes towards this client group and agreed in principle with integration into the community. Training with respect to people who exhibit challenging behaviour was identified as necessary.
OFFENDING BY ADULTS WITH LEARNING DISABILITIES: IDENTIFYING NEED IN ONE HEALTH DISTRICT
Authors: Lyall I. , Holland A.J. , Collins S.
Published: August 2010

The extent to which adults in one health district with intellectual disabilities engaged in offending behaviour and the nature of their need was investigated in a series of three studies. First, the number of adults who reported having learning difficulties or who had attended special needs schools, in a consecutive series of adults charged at a city police station over a two‐month period, was identified. Secondly, the extent and nature of offending by those living in residential placements for people with learning disabilities was ascertained retrospectively for the year 1992. In addition, the policies and responses of the residences' managers to offending behaviour were ascertained. Thirdly, a case control study of the outcome in the criminal justice process of those with self‐reported learning disabilities identified in Study One was undertaken. Twelve (4.4%) of the 251 people arrested and screened at the city police station had been to a special school for children with mild or severe learning disabilities. Seven (2%) of 358 adults living in residential placements for adults with learning disabilities had been interviewed by police because of an alleged offence. None of this group appeared in Court despite the seriousness of some offences. In Study One, seven (58%) were sentenced by the Courts. None received a prison sentence or were diverted to the health service. The lack of established links between the criminal justice agency and other services and the experience and attitudes of staff in the different agencies both hindered the recognition of the presence of a possible learning disability and also prevented referral across agencies. These and social factors, such as homelessness, all contributed to a failure to provide for the needs of this minority of adults with learning disabilities who became involved in the criminal justice system.
THE VULNERABILITY OF SUSPECTS WITH INTELLECTUAL DISABILITIES DURING POLICE INTERVIEWS: A REVIEW AND EXPERIMENTAL STUDY OF DECISION‐MAKING
Authors: Clare Isabel C.H. , Gudjonsson Gisli H.
Published: August 2010

The Police and Criminal Evidence Act 1984 (England and Wales) recognised that suspects with intellectual disabilities were ‘vulnerable’ during interviews with the police. However, no attempt was made to specify the disadvantages which might contribute to this vulnerability. This paper reviews the experimental evidence relating to two possible areas of disadvantage—impaired understanding of the caution and legal rights, and susceptibility to acquiescence, suggestibility, compliance and confabulation. A pilot study relevant to a third area, that of decisionmaking, is presented. A fictional film was made of a police interrogation, depicting a male suspect making a true and a false confession. At scheduled pauses during, and just after, the film, items from a semistructured interview schedule were presented. Compared with their average intellectual ability counterparts, the participants with intellectual disabilities (Full Scale IQ: 60–75) were less likely to think that a police interview and false confession might have serious consequences for the suspect. Their views reflected the importance they placed on the suspect's actual, rather than professed, guilt or innocence. Moreover, they believed that an innocent suspect might be protected because his or her innocence would be evident to others. The possible impact of these views on the decision‐making in police interviews of suspects with intellectual disabilities is discussed.
POLICE INVOLVEMENT WITH CLIENTS HAVING INTELLECTUAL DISABILITIES: A PILOT STUDY IN SOUTH LONDON
Authors: McNulty Craig , Kissi‐Deborah Rosamund , Newsom‐Davies Imogen
Published: August 2010

Following the increasing trend for de‐institutionalisation of people with learning disabilities, community services are increasingly being utilised to support those who also display challenging behaviours. Where severely challenging behaviours are involved community service providers may require additional support from die police service. The authors undertook a retrospective pilot study among two major community care providers in South London, and looked at the reasons for calling the police, the frequency with which die police were called; staff expectations in calling the police and the outcomes for die clients in terms of further involvement with the criminal justice system. The authors note that the police were generally used as additional support when clients became too difficult for the immediate service providers to manage. It is also noted that police action on behalf of victims was generally low and that the police were never called in response to clients with learning disabilities reporting having witnessed crime. The authors note that further research is required.