bluuebunny/crossref_metadata_2025 huggingface dataset:
Deinstitutionalisation and Community Services in Greater Glasgow
Authors: Dalrymple John
Published: September 2011

Knowledge of what makes for quality in adult learning disabilities services does not cascade directly down into grassroots practice. It is instead severely filtered and variously diluted through layers of national policy, local strategy and administrative complexity. In the current difficult climate, quality is not obtained without exposure to the strains and stresses inherent in the dynamics of the health and welfare bureaucracies and their attempts at partnership. Following a largely chronological and descriptive account of attempts to change and develop services in the Greater Glasgow area in the mid‐1990s, consideration is given to the effect of these ‘filters’ in the context of the Greater Glasgow Joint Learning Disability Project.
Adults with Learning Disabilities and Mental Health Needs: Conceptual and Service Issues
Authors: Gravestock Shaun
Published: September 2011

This paper introduces service changes impacting on adults with learning disabilities, defines the concepts of learning disability, needs and need assessments, dual diagnosis and mental health needs and considers their service implications. Between 25% and 50% of adults with learning disabilities have mental health needs, and the main clinical types are outlined. The findings from a national multi‐professional survey of services for adults with learning disabilities and mental health needs are summarised and the difficulties of meeting the complex needs of these adults are demonstrated. Recent developments in clinical diagnostic assessment, needs assessment, care planning, outcome monitoring, staff training and service evaluation are discussed, including the possible advantages of the care programme approach (CPA). Recommendations are given for services for adults with learning disabilities and mental health needs and points for discussion with service users and carers are suggested.
Treatment and Therapeutic Interventions: The Use of Medication
Authors: Clarke David
Published: September 2011

Medication may be used to treat two broad types of mental health problem: psychiatric disorders (such as depression, schizophrenia or obsessive‐compulsive disorder) and challenging behaviours (such as self‐injury, impulsive aggression or inappropriate sexual behaviour). The effectiveness of medication in the treatment of psychiatric disorder is well established for the non‐learning‐disabled population. In clinical practice, medication seems to be broadly as effective for people with learning disabilities. The effectiveness of medication in the treatment of challenging behaviours is less well established, although evidence for effectiveness is accumulating for some types of problem behaviour. When treating behavioural problems, medication is often used in combination with other management strategies. Knowledge of side effects is important, because people who have difficulty communicating may not be able to Report problems before they become severe. When using medication, it is important to try to achieve the best benefit: risk ratio, taking into account the person's other health problems and disabilities. It may be necessary to measure treatment effects, using standardised assessments or individual measures of target symptoms or behaviours.
Mental Health Services for Children and Adolescents with Learning Disabilities
Authors: Bernard Sarah
Published: September 2011

Children with learning disabilities are recognised as being at increased risk of developing mental health problems or challenging behaviour. The need for mental health services for this group of children, while acknowledged, has been inadequately addressed by child mental health services and adult services for people with learning disabilities and mental health problems. Services designated for this group of children have to be able to offer a comprehensive assessment of the problems that the children present with, on‐going short‐ and long‐term management and dissemination of information to other professionals. This paper outlines a model of service provision for these children.
Individual Programme Planning: Where is the 'Individual'?
Authors: Carnaby Steven
Published: September 2011

Individual programme planning (IPP), or person‐centred planning, is widely recognised as a tool for assisting learning disability services to structure and co‐ordinate the support offered to service users. This paper reviews the research evidence, to assess the extent to which planning processes are considered person‐centred, and how services ensure that users have a major say in planning and determining the help they receive (Blunden et al., 1987). It is suggested that services need to take a more flexible and creative approach, using working groups to make decisions with or on behalf of service users. A case study describes the role of working groups and the importance of communication in determining specific person‐centred planning processes.
Changes in the Quality of Life of People with Learning Disabilities Six Months after Transfer from Long‐Stay Hospital into the Community
Authors: Srivastava Angela , Cooke Zana
Published: September 2011

This paper outlines the significant interim findings of a three‐year longitudinal study of the effects of resettlement on people with learning disabilities. Positive changes are seen in engagements and management practice, negative changes in rates of challenging behaviour, depression and autism and a mixed picture in health, skills, leisure, quality of home life and staffing. Overall, trends are generally positive, particularly in areas related to environmental factors, and it is hoped that the findings will suggest pointers to monitoring quality in community integration, of use to commissioners and providers alike.
Towards Equity in Service Provision
Authors: Reading John
Published: September 2011

This paper focuses on recent research and a series of field studies looking at the issue of learning difficulties among the Black and minority ethnic population. The research considers the hypothesis that Black and minority ethnic people experience the same levels of learning difficulty as the rest of the population. Some studies suggest that general prevalence may actually be higher, and that multiple incidence may be more frequent among certain minority ethnic communities. The literature indicates that Black and minority ethnic communities are much less aware of what services are available, take‐up is lower still, and there is a common view that services are unwelcoming or inappropriate.
Gender, Ethnicity and Challenging Behaviour: a Literature Review and Exploratory Study
Authors: Di Terlizzi Michele , Cambridge Paul , Maras Pam
Published: September 2011

Assessment, care management and service planning for people with challenging needs should be sensitive to gender and ethnicity for equitable and appropriate service provision. This paper explores the relevant literature to map and identify the issues, and profiles a exploratory study of special schools, adult residential services and community support teams, to identify the gender and ethnic characteristics of people with learning disabilities and challenging behaviours. The findings suggest that gender stereotypes contribute to the attribution of maladaptive behaviour in boys, significant in severe and moderate learning disabilities in schools. The findings on ethnicity are discussed with reference to staff training and the implications of providing gender‐sensitive and culturally appropriate service responses and support.
Approaches to Residential Support: A Case Study
Authors: McGuire Mary
Published: September 2011

The Kingwood Trust has developed a range of approaches to supporting people with challenging behaviour living in small group homes. Using an essentially eclectic model of practice, The Kingwood Trust believes in ‘empathic interactions’ drawing on a range of methodologies including TEACH, LOVAAS, Higashi Daily Life Therapy, active support and behavioural analysis. The Kingwood Trust has found that it is able to support individuals with complex needs and achieve positive changes in the way people express themselves, and in their lifestyle. The approach is rooted in an understanding of autism and the triad of impairment, along with the three guiding principles which reduce the difficulties that these impairments create for individuals. This paper describes these three guiding principles with examples of practice situations within the services provided by The Kingwood Trust. Discussion of organisational culture and management style and their critical role in the motivation of support staff and the quality of decision‐making is also included.
Evidence on Service Quality for the Social Services Inspectorate Inspection Process: Piloting the Application of Research
Authors: Fruin David , Felce David
Published: September 2011

This paper describes the piloting of an approach to social services inspection using a range of objective research evidence as part of the Social Services Inspectorate's inspection process in 1997, in eight local authorities in England. The Welsh Centre for Learning Disabilities Applied Research Unit worked with the Social Services Inspectorate to collect details on residential and day services in advance of the inspection process. The paper repeats the findings of this Report and of the collaboration.
Is Sex a Good Thing for Men with Learning Disabilities?
Authors: Thompson David
Published: September 2011

Sex has increasingly been constructed as a problem for men with learning disabilities. Research has focused on their vulnerability to abuse and their capacity to exploit. There are also the additional fears of their sexual activity leading to HIV infection or pregnancy. Notions of sexual rights and sexual pleasure are lost in such a discourse. This paper looks in detail at the actual experience of sex for men with learning disabilities, based on qualitative interviews. It paints a very uncomfortable picture, leading to the title question: is sex a good thing for men with learning disabilities?
Sexuality: Policies, Beliefs and Practice
Authors: Murray James , MacDonald Raymond , Levenson Victor
Published: September 2011

This paper summarises three empirical studies investigating staff attitudes towards client sexuality, with special consideration of issues surrounding HIV infection. A questionnaire survey design was employed, with 585 participants completing three separate questionnaires. Between 1990 and 1998 staff attitudes towards client sexuality became more positive, with a significant reduction in the number of staff agreeing with mandatory HIV testing over the three studies. In the final study, a significant number of staff Reported being unaware of, or uninfluenced by, organisational sexuality policy. The interaction between policy, staff beliefs and practice is discussed. When staff are aware of the policies on sexuality, their beliefs and attitudes appear to filter these policies, with staff behaviour influenced by an interaction between policies and beliefs. In conclusion, policy development needs to involve inter‐agency collaboration, as well as staff and client user input, for best practice in sexuality.
Communication Partnerships with People with Profound and Multiple Learning Disabilities
Authors: Bradshaw Jill
Published: September 2011

There are many definitions of profound and multiple learning disabilities. Most definitions include having a high degree of learning disability in conjunction with at least one other severe impairment, such as visual, auditory or physical impairments (Male, 1996; Ware, 1996; Lacey, 1998). Bunning (1997) adds that people with such disabilities are very reliant on others for support, including support in taking part in communicative events. Establishing reliable and consistent methods of communication may be exceptionally difficult (Florian et al, 2000). However, it is important to consider the individuality and extreme diversity of this population (Detheridge, 1997; Hogg, 1998), which includes variability in communication strengths and needs (Granlund & Olsson, 1999; McLean et al, 1996). Communication is often given little attention when services are planning ways of supporting individuals to participate, develop independence and make choices (McGill et al, 2000). While the individual's communication strengths and needs should remain central within any discussion, the significant others and the environment will also have an important influence. This article explores some of the communication issues experienced by people with profound and multiple learning disabilities and highlights the importance of the communication partnership within interventions.
The Ignored Minority: Meeting the Needs of People with Profound Learning Disability
Authors: Samuel Judith , Pritchard Marie
Published: September 2011

This paper describes how one specialist learning disability health service has attempted to increase its focus on meeting the complex needs of people with profound learning disability (PLD) both with and without additional physical, sensory and medical impairment. Through individual assessment and intervention, carer consultation, training and supervision, research, and audit and advice to management, a multi‐disciplinary group has influenced the development of more proactive community teams for people with learning disability. This is in the context of both the publication of Signposts for Success (NHSE, 1998) and of a changing organisational culture which has embraced essential lifestyle planning, person‐centred teams, supported living and direct payments. The challenge remains of ring‐fencing sufficient resources (of time, skill and equipment), given the high‐profile and competing demands of people with milder learning disabilities but with complex mental health needs and/or challenging behaviour.
Developing a Procedure for Evaluating Quality of Life for People with Profound and Multiple Disabilities
Authors: Petry Katja , Maes Bea , Vlaskamp Carla
Published: September 2011

Quality of life and quality of care have become dominant themes in planning and evaluating services for persons with learning disabilities. There are, however, few conceptual models and assessment instruments that are geared to people with profound and multiple learning disabilities. This article presents an ongoing research project aimed at developing and implementing a valid and reliable procedure for evaluating the quality of life of people with profound and multiple learning disabilities in several European countries. This objective will be realised in three subsequent stages, each of which is divided into several steps. The research project presented has the potential to develop theory as well as good practice in the care of people with profound and multiple learning disabilities.
Intensive Interaction with a Woman with Multiple and Profound Disabilities: A Case Study
Authors: Elgie Sarah , Maguire Nick
Published: September 2011

Intensive interaction (II) recognises the pre‐verbal nature of adults with profound learning disabilities and mimics the early attachment process to develop the very beginnings of communication and sociability. This paper Reports on the use of II with a remote and withdrawn adult with severe learning disabilities and visual impairments, who engaged in serious self‐injurious behaviour. The results indicate that the intervention was successful in facilitating the development of the first stages of social and communication skills.
Improving Service Quality through Linked Services Development
Authors: Bradshaw Jill
Published: September 2011

The University Affiliated Programme (UAP) aims to improve service quality by working in partnership with local services. This article Reports on the establishment and development of linked services: three services for people with learning disabilities, living in small community houses that opened in late 1999 and early 2000. The focus of resources on a small number of linked services was designed to maximise the effectiveness of the involvement of the Tizard Centre, along with the Subscriber Network. It was intended that work in the linked services would be disseminated through this network. The UAP has worked with service users and providers since 1996, during which time users have moved from a long‐stay NHS hospital to community services. The service provider is also now a private organisation. The article outlines some of the projects which have been introduced or developed in these linked services and discusses some of the issues that have arisen while working in partnership with them. The benefits of working through a UAP will also be identified.
Active Support and Person‐Centred Planning: Strange Bedfellows or Ideal Partners?
Authors: Sanderson Helen , Jones Edwin , Brown Kathy
Published: September 2011

Valuing People (DoH, 2001) proposes person‐centred planning (PCP) as a way for service users to exercise more power and control. Active support (AS) is also an approach designed to improve the quality of life of people with severe disabilities by enabling them to participate as fully as possible in daily activities. PCP and some of the components of AS are complementary rather than mutually exclusive. While PCP can generate ideas, AS can help implement them, and used together PCP and AS can provide a way to facilitate user participation and improve users' quality of life. This paper uses a case history to illustrate this potential, and describes how a particular form of PCP, essential lifestyle planning (ELP), was used in conjunction with some of the planning and programming components of AS.
Involving Service Users in the Process of Revising a Policy on Personal Relationships
Authors: Coldham Sue , Marler Richard
Published: September 2011

The authors were involved in the revision of a multi‐agency policy on personal relationships and adults with learning disabilities. People with learning disabilities had been largely excluded from this process, and an effort was made to redeem matters by commissioning groups of service users to write a booklet explaining what could be expected from staff as a result of the new policy. Although successful in terms of staff and service user interest in the booklet, evaluation showed the need to develop additional ways to get important messages across to service users. Reflection by the authors has increased awareness of the need for creative ways to involve people with learning disabilities in policy formulation and revision.
Training for Competence: The New Certificates in Working with People who have Learning Disabilities
Authors: Alcoe Jan , Carnaby Steven , Duerdoth Nigel
Published: September 2011

The paper provides an overview of the new learning disability awards and an account of a joint project by the Foundation for People with Learning Disabilities (part of the Mental Health Foundation), Pavilion and the Tizard Centre, University of Kent to develop training and learning materials to support them.
The Choice Initiative
Authors: Morgan Hazel
Published: September 2011

This paper provides an overview of the Choice Initiative at the Foundation for People with Learning Disabilities. It describes the work of the Initiative, the projects represented and the overall findings and conclusions. It is followed by a report on one of the projects included in the Initiative.
Living Safer Sexual Lives: Research and Action
Authors: Johnson Kelley , Frawley Patsie , Hillier Lynne , Harrison Lyn
Published: September 2011

In spite of changes in the way people with learning disabilities are perceived, issues of sexuality and personal relationships remain particularly problematic for them. Living Safer Sexual Lives1 was a three‐year Australian action research project which sought to address how people with learning disabilities view these issues. During the first stage of the project, 25 people with learning disabilities told their life stories, with a focus on sexuality and human relationships, to experienced qualitative researchers. In the second stage of the project, these stories were used to provide people with learning disabilities, families and service providers with workshops and resources designed to help people with learning disabilities to live safer sexual lives.
Researching Valuing People
Authors: Grant Gordon , Ramcharan Paul
Published: September 2011

Prior to the launch of Valuing People, Gordon Grant and Paul Ramcharan were appointed by the Department of Health as co‐ordinators of the learning disability research initiative People with Learning Disabilities: Services, Inclusion and Partnership, which was intended to inform the implementation and outcome of the White Paper Valuing People during its crucial early years. In this paper they describe the genesis of the research initiative, the research commissioning process and intentions for a research communication strategy.
STEPS ‐ Structures Towards Emancipation, Participation and Solidarity: A European Project to Combat Discrimination against People with Learning Disabilities
Authors: Ernst Anne
Published: September 2011

People with learning disabilities are one of the most marginalised groups in European society, rarely recognised as full citizens with equal rights. The European action research programme STEPS focuses on structures, instruments and methods to combat discrimination against people with learning disabilities and aims at full participation and free access to material, cultural and social resources. Partnerships between providers, social welfare administrations, universities and groups of people with learning disabilities in five European countries are defining the project. From England, the Tizard Centre, Parkside NHS Trust, and Kensington and Chelsea Social Services are partner members in the network, and the overall project is financed by the EU community action programme to combat discrimination.
Direct Payments: Commentary and Review
Authors: Holman Andrew
Published: September 2011

Local authorities have a duty to listen to service users but, with notable exceptions, have not done so in relation to the provision of direct payments to people with learning disabilities. The paper proposes some measures that would help raise the level of such provision, and discusses the use of Independent Living Trusts.
Preliminary Findings: An Anglo‐Swedish Psychoanalytic Psychotherapy Outcome Study using PORT and DMT
Authors: Carlsson Barbro , Hollins Sheila , Nilsson Alf , Sinason Valerie
Published: September 2011

Historically, professionals did not consider that people with learning disabilities could make use of psychoanalytic psychotherapy because of limitations of intelligence (Symington, 1981; Symington, 1993; Sternlicht, 1965). Additionally, many believed that people with learning disabilities enjoyed immunity from emotional stress and psychiatric disturbances (Fletcher, 1993). Maladaptive behaviours were perceived as a manifestation of the condition of learning disability and not as a possible sign of psychiatric disorder or emotional problems. However, over the last decade there has been a growing realisation that people with learning disabilities have emotional problems in the same way as others, but are in some ways more vulnerable to developing psychiatric and psychological disturbances. Psychoanalytic practitioners wishing to undertake outcome research have experienced difficulties in finding a measuring device that understands the subtleties of change in the internal psychological structure over time. PORT and DMT (the Percept‐genetic Object Relation Test and the Defence Mechanism Test) are two projective tests that have been extensively validated in Sweden. This paper explores the use of the PORT and DMT outcome measures in the context of Anglo‐Swedish psychotherapy research.
Response to ‘Progress with Learning Disability Hospital Closures in Scotland’
Authors: Hunter Susan , Stalker Kirsten
Published: September 2011

The paper comments on the preceding Service Feature, drawing on research carried out by the authors, and finds that there is still a long way to go to achieve two SAY objectives.
Living to Learn, Learning to Live ‐ Learning Difficulties and Lifelong Learning
Authors: Macaskill Donald
Published: September 2011

This paper presents part of the debate and developments which have taken place in relation to lifelong learning and its relationship to adults with learning difficulties. It relates the work of the Common Knowledge programme in Glasgow, and in particular the programme's emphasis on partnership, participation, mainstreaming and e‐learning. As well as offering a methodological overview, the paper also suggests some indicators for future work and development.
Developing Local Area Co‐ordination in Scotland ‐ Supporting Individuals and Families in their own Communities
Authors: Curtice Lisa
Published: September 2011

Following its development and evaluation in Western Australia, local area co‐ordination (LAC) has been included as an integral part of the strategy for people with learning disabilities in Scotland. LAC responds to the wishes of people with learning disabilities and family carers for more direct access to services and for continuity and co‐ordination of support. Local area co‐ordinators (LACs) work directly with individuals and families to help them find the information and local supports they need.
A Survey of Dental Services Provided to People with Learning Disabilities in the Northern Health and Social Services Board Area
Authors: Barr Michaela , Kane Molly , Keenan Kevin , Cullen John
Published: September 2011

A survey of dental services for people with learning disabilities was undertaken as part of the Board's ongoing programme of service monitoring. The choice of topic was influenced by changes within dentistry regarding the administration of general anaesthetics, and by proposed changes in the patient population of Muckamore Abbey Hospital (North and West Belfast Health and Social Services Trust). Information was obtained primarily through questionnaires from people with learning disabilities who were living in the community and from general dental practitioners. Information was also sought from the three trusts providing a dental service in the area. The survey found that both patients with learning disability and dentists treating them would benefit from more specialist information and training.
Improving the Quality of Life of Adults with More Severe Learning Disabilities by Increasing their Interactions with their Immediate Environment
Authors: Brennan Andrew , Chamberlain Paul , O'Brien Alex , McEvoy John
Published: September 2011

The nature and level of engagement in activity for 51 adults with severe learning disability living in 13 houses were assessed. The individual profiles and environmental characteristics which appeared to contribute to low levels of engagement were identified. The implications for service delivery for this vulnerable group of people are discussed. In addition, ways of increasing levels of engagement and service characteristics which support ‘good practice’ are identified.
‘Please don't let it Happen on my Shift!’ Supporting Staff who are Caring for People with Learning Disabilities who are Dying
Authors: Brown Hilary , Burns Sophie , Flynn Margaret
Published: September 2011

This paper reports some preliminary lessons from a qualitative study of services that have cared for a person with learning disabilities during a terminal illness. It reflects current concern about access to health care as well as the national priority being placed on improvements in cancer services for all patients. The study documents how the service learned of the person's illness, how they mobilised services and made decisions, how agencies worked together (or not!) and what support staff needed in the person's last months and weeks. It also considers the way staff, as individuals and as teams, made sense of their experiences and evaluated the input of other professionals.
Count Us In: The Inquiry into Meeting the Mental Health Needs of Young People with Learning Disabilities
Authors: Morgan Hazel
Published: September 2011

Young people with learning disabilities are at risk of developing mental health problems. The Foundation for People with Learning Disabilities conducted a one‐year inquiry into meeting their mental health needs. This paper explores ways of supporting emotional resilience and the response of services when young people with learning disabilities experience mental distress.
Adults with Down's Syndrome and Alzheimer's Disease
Authors: McQuillan Sharna , Kalsy Sunny , Oyebode Jan , Millichap Dave , Oliver Chris , Hall Scott
Published: September 2011

Adults with Down's Syndrome are at risk of developing Alzheimer's disease in later life. This paper gives an overview of the current research in the area and discusses the implications it raises for individuals, carers and service providers. Information on the link between Down's Syndrome and Alzheimer's disease and prevalence rates are given. The clinical symptoms of Alzheimer's disease and a stage model documenting the progression of the disease are presented. Attention is drawn to the problems inherent in assessing and diagnosing Alzheimer's disease in a person with a pre‐existing learning disability. The importance of a thorough assessment procedure and guidelines for assessment methods are highlighted. The paper also discusses the management of Alzheimer's disease and focuses on care management practices and recommendations for service provision. Guidelines for supporting individuals include maintaining skills, adopting a person‐centred approach, implementing psychosocial interventions and multidisciplinary care management. Finally, high prevalence rates of Alzheimer's disease in adults with Down's Syndrome and increasing life spans are highlighted as a particular concern, and recommendations for the future include increasing education and awareness, implementing screening services, improving assessment methods and developing appropriate services.
Transition: The Experiences of Young People with Learning Disabilities and their Families in England
Authors: Ward Linda , Heslop Pauline , Mallett Robina , Simons Ken
Published: September 2011

Transition to adulthood can be a difficult time for all young people and their families, but young people with learning disabilities face additional stresses. Transition for young people with learning disabilities is highly topical, in relation to both policy and practice. Legislation and guidance offer various mechanisms for improving transition, including transition planning, health action planning and Connexions personal advisers. This study of 283 families with youngsters with learning disabilities found that existing legislation and guidance were largely failing youngsters with learning disabilities and their families at transition. There were substantial discrepancies between what ought to have been provided and what young people and their families experienced in practice, and significant difficulties as youngsters moved between children's and adult health and social services. Other difficulties experienced at transition are also reviewed, along with possibilities for improvements in practice.
Developing and Evaluating Personal Health Records for Adults with Learning Disabilities
Authors: Turk Vicky , Burchell Sarah
Published: September 2011

This article argues for the introduction of patient‐held health care records for people with learning disabilities. The evidence reviewed demonstrates that people with learning disabilities have more health care needs than other adults in society but receive less health care than others. The rationale for implementing hand‐held records is considered from three perspectives: a consumer point of view, an analysis of how personal health profiles can help to overcome existing barriers to health care and the existing evidence. The initial experiences of introducing personal health records are described.
Sweden
Authors: Ericsson Kent
Published: September 2011

This article illustrates the Swedish experiences of working with people with intellectual disabilities and their support. During the last three decades in Sweden residential institutions have been dissolved and community‐based services have been developed. People's lives have changed dramatically. The beginning of this development was marked by the implementation of a new socio‐political idea: the normalisation principle, which was introduced in 1946. The realisation of this principle through four Acts of Parliament goes along with a shift between the institutional and the community‐based traditions of support, with deinstitutionalisation as the logical consequence for development. Nowadays, people with disabilities in Sweden are well aware of their right to participate in community life. They are encouraged to use services offered to the general public, which therefore need to be made available for everybody, while special services become supplementary.
The Netherlands
Authors: Vlaskamp Carla , Poppes Petra
Published: September 2011

The Netherlands is a country where much is regulated, and several departments have made rules, regulations, memoranda and even laws related to people with intellectual disabilities. Large organisations that offer different forms of support dominate the system of care and support. The policy on care for people with intellectual disabilities has, generally speaking, developed away from segregation and towards integration and inclusion. Changes have led to improvement for people with mild and moderate disabilities, although the process is slow. At the same time, the situation for people with profound and multiple disabilities has deteriorated. For a real change in the support system, client‐held budgets are believed to be of primary importance. However, this is still a slow development. This article describes the current organisation of care and support.
New Guidance on the Use of Restrictive Physical Interventions
Authors: Harris John
Published: September 2011

In June 2002 the Government issued long‐awaited guidance on the use of restrictive physical interventions. The need for the guidance was recognised in the White Paper, Valuing People, and its publication is anticipated in both the recently published National Care Standards and the 1996 Education Act. It represents a clear and unambiguous commitment by government departments to work together to improve practice across a range of services for adults and children with learning disabilities and autistic spectrum disorders, and for pupils with a range of special educational needs. The guidance is particularly addressed to staff working with adults and children with learning disabilities (including those with autistic spectrum disorders) and to those in special school settings responsible for pupils with severe behavioural difficulties associated with learning difficulties and/or autistic spectrum disorders. It will also be relevant to staff in schools which make provision for pupils with severe emotional and behavioural difficulties. This article describes the development of the guidance, the areas of practice it covers and its implications for managers, professionals, staff working directly with service users and family carers. It will do this by attempting to answer six questions. Why do we need new guidance on the use of restrictive physical interventions? Who will be affected by the guidance? How was the guidance developed? What does the guidance say? What needs to be done to implement the guidance? What still needs to be done?
The Frequency and Potential Consequences of the Failure to Visit Learning‐Disabled Adults in Out‐of‐Area Placements
Authors: Pring John
Published: September 2011

This article describes one of the issues that arose from my research into the Longcare abuse scandal: how local authorities place learning‐disabled adults in out‐of‐area settings far from their original homes, and then fail to visit them regularly to check on their welfare. It describes the failings of three local and health authorities in the Longcare case, and then reveals that the problem was not confined to those authorities that placed adults at the Longcare homes. It also suggests that placing vulnerable adults in out‐of‐area homes puts them at a greater risk of abuse. The article concludes that, ten years on from the exposure of the Longcare regime, many local authorities are still placing vulnerable adults in out‐of‐area homes and failing to visit them. It calls for a national audit of out‐of‐area placements and for measures to be introduced to allow learning‐disabled adults to live in placements closer to their families and friends… and care managers.
The Empowering Practice Programme at the University of the West of England
Authors: Vatcher Adrian , Coles Jonathan
Published: September 2011

This article outlines the Empowering Practice programme at the University of the West of England ‐ its content and its educational approach. Students are staff working in local residential and day care services for people with learning difficulties. Many of them do not have the standard entry requirements for entry to higher education. An evaluation of the programme is described and its findings presented. Students' academic performance has been good. More important, students reported significant improvements in their self‐confidence and ability to implement the principles of rights, independence, choice and inclusion set out in Valuing People. This was confirmed both by immediate line managers and by senior managers in their employing agencies. Further, the higher education setting of the programme was seen by all stakeholder groups as contributing to stronger outcomes of this kind than NVQ programmes. The programme closely matches a range of LDAF units at Level 3.
Life Skills for Young Adults with Learning Disabilities
Authors: Dereka Maria
Published: September 2011

This study looks at the influence of normalisation on the practice of teachers in adult training centres (ATCs) in Greece and more specifically at the curricula used in ATCs in Greece for young adults with learning disabilities. It examines whether the centre curriculum emphasises the teaching of social and life skills through activities outside the learning environment, and the kinds of difficulty that teachers face during the teaching of these skills. Data were gathered through interview and questionnaire, and are presented by content analysis, for the interviews, and analysed by descriptive quantitative methods wherever possible. A total of 44 Greek teachers from ATCs were interviewed. Results suggest that teachers avoid teaching life and social skills that relate to activities outside the ATC. Students visit mainly local shops and far fewer theatres, cinemas and public buildings. Additionally, in most of the visits students remain passive attendants without learning much in the way of life skills. Teachers' obstacles to teaching life and social skills outside ATCs are mainly lack of assistants, lack of time and lack of parents' co‐operation. Generally, it is difficult for teachers to reduce teaching time in the classroom and give the students the opportunity to apply their knowledge outside the classroom.
Putting Person‐Centred Planning in its Proper Place?
Authors: Routledge Martin , Gitsham Nicola
Published: September 2011

This review reflects on current progress with person‐centred planning from the perspective of the Valuing People Support Team, and raises some of the challenges being faced. It reminds us that planning is not a panacea and must be used as part of broader strategies to bring about person‐centred services and supports which can help people get the lives they want. Finally, suggested priorities for key groups are proposed and linked to future assistance from the Valuing People Support Team.
Supporting a Person with Learning Disabilities for Criminal Injuries Compensation
Authors: Mellan Bryan , Mauladad Farrah
Published: September 2011

Despite growing awareness of abuse of people with learning disabilities and prospective legal improvements, it is still uncommon for people with learning disabilities to obtain justice for experiences of abuse. It has been recognised that recent legislation pertaining to the Sexual Offences Act, as well as the Mental Health Act, has been little used and has not provided effective protection for people with learning disabilities, especially if abuse is perpetrated by another person with learning disabilities. This can leave the abused person feeling, among other things, disempowered and silenced, which can be compounded if they are believed by professionals and others and still no justice is evident. This paper is an account of supporting a man with learning disabilities, both therapeutically and legally, to obtain recognition of his experience of sexual abuse by using the Criminal Injuries Compensation Authority (CICA) as an alternative to the criminal justice system.
Human Rights and the Failure of Policy to Deliver: Women with Learning Disabilities and Mental Health Needs
Authors: Lawson Annette
Published: September 2011

Human rights figure largely in both rhetoric and practice, and government policy seeks to value and enhance individual equality and quality of life. This paper draws on recent work, some funded by the Judith Trust, to illustrate gaps in the achievement of these ideals. The proposed new single body, a Commission on Equality and Human Rights (CEHR), may offer an improved framework for implementation of policy goals and more fulfilled lives. The Judith Trust aims to improve the lives of people with both learning disabilities and mental health needs.
Mental Health Needs of Women with Learning Disabilities: Services can be Organised to Meet the Challenge
Authors: Kohen Dora
Published: September 2011

Women with learning disabilities have many social, personal and psychological problems that stem from being neglected, as well as from being doubly disadvantaged by their gender and their learning disability. Most of these psychosocial problems are not addressed as they arise, and lead to psychiatric diagnosis and medicalisation of non‐medical issues. It is important to recognise parenting in women with learning disabilities, as well as concerns such as sexual and emotional abuse and violence, and to address them by appropriate agencies. Research suggests that trained mental health staff with a good understanding of gender as well as of disabilities would be able to address the needs before they turn into crises. International and national surveys give a good understanding of where the needs lie and how services could be structured most effectively. Recognition of the problems, a robust gender‐sensitive approach and management skills at community level seem to be most important in dealing with women with learning disabilities. Most women with learning disabilities need local, generic, gender‐sensitive non‐stigmatising services. Only a very small minority of women with behavioural problems will need the highly specialised psychiatric learning disabilities team.
Understanding our Bodies, Understanding Ourselves: The Menstrual Cycle, Mental Health and Women with Learning Disabilities
Authors: Ditchfield Hedy , Burns Jan
Published: September 2011

The paper reviews the evidence for vulnerability in women with learning disabilities to a range of physical and mental health problems, with special emphasis on menstruation. It goes on to describe a qualitative research project on the experience of learning‐disabled women in relation to menstruation, and concludes by emphasising the need for services to communicate information on this subject in more sensitive and appropriate ways.
A Rights‐Based Approach to Abuse of Women with Learning Disabilities
Authors: Brown Hilary
Published: September 2011

This paper provides a brief overview of abuse and protection, with a particular focus on women with learning disabilities. Women with learning disabilities face double oppression at the intersection of gender and disability, which makes them particularly vulnerable to sexual violence and exploitation. The paper reviews some useful models of abuse, to guide practice and frame further research. It also reflects guidance issued by the Department of Health in 2000 (No Secrets), which has resulted in a coherent framework for use throughout local authorities and other statutory agencies to address abuse against all vulnerable adults.
A Turning Point in the Struggle to Replace Institutions
Authors: O'Brien John
Published: September 2011

Published in 1969 Changing Patterns in Residential Services for the Mentally Retarded, which reflected important contributions by Jack Tizard, marked a turning point in North American attitudes towards institutional reform from a simple call for more staff and new buildings to a much more powerful understanding of the limits of institutions and the need for a comprehensive system of supports based on systematic commitments to human dignity, positive models expressing the potential for human development, and an experimental approach to creating a comprehensive system of community supports.
The Work of Jack Tizard ‐ II: 1965 to 1979
Authors: Williams Paul
Published: September 2011

This article lists the publications of Jack Tizard from 1965 to 1979, with commentary on the development of his interests through that time, and his major contribution to research and social policy.
Models of Community Care in the UK: Past and Present
Authors: McGill Peter
Published: September 2011

In this article I will first summarise the model of community care proposed by Jack Tizard more than 40 years ago. I will consider the extent to which this model has been implemented and developments since and review the strengths and weaknesses of current models, as exemplified by Valuing People, considering them in their historical context.
A Positive Behavioural Support Model for Breaking the Barriers to Social and Community Inclusion
Authors: LaVigna Gary , Willis Thomas
Published: September 2011

A key objective of the community care movement has been to achieve greater opportunities for people with learning disabilities to integrate and interact within their normal communities. Major barriers remain, however, for those individuals who are disabled and who also exhibit significant challenging behaviour. In addition to the unacceptability of the behaviours themselves, the support strategies used to remediate these challenges have also acted as a barrier to inclusion, because of their social unacceptability. The paper presents a model for supporting people who challenge that addresses these concerns by providing an effective, socially valid intervention approach.
The Management and Treatment of Challenging Behaviours
Authors: Lowe Kathy , Allen David , Brophy Sam , Moore Kate
Published: September 2011

The paper considers the kinds of treatment available for people with learning disabilities and challenging behaviour. It draws on research data on the use of reactive strategies and behaviour plans for 235 children and adults rated by carers as extremely challenging, and 276 rated as very challenging, to identify any trends in the management and treatment of challenging behaviour. It finds an increase in written plans for adults but not for children, and no information on the extent to which plans are based on sound functional analyses and contain proactive as well as reactive strategies. Only half the plans were said to have been drawn up with any support from behavioural specialists, and there was no discernible change in the use of reactive strategies.
Learning with Families: Involving Families in Staff Training
Authors: Davies Jill
Published: September 2011

Valuing People calls for a new relationship between families and staff in learning disability services. It proposes that the voices of family carers be heard, and that they should be treated as partners in policy development and implementation, including their involvement in staff training and development. The Foundation for People with Learning Disabilities has developed a tool to help staff and families to work better together. The result is a training resource called Learning with Families ‐ a training resource with a difference: the contents were developed by family carers, who are also being encouraged to deliver the training, alongside professionals, to staff who work in learning disability services, in order to improve their understanding of the experiences of families.