bluuebunny/crossref_metadata_2025 huggingface dataset:
England
Authors: Beadle‐Brown Julie , Mansell Jim , Cambridge Paul , Forrester‐Jones Rachel
Published: September 2011

This article focuses on the development and current situation of services for people with learning disabilities in England. Deinstitutionalisation started in the 1960s, when a series of scandals in hospitals were brought to public attention. In response, the 1971 government White Paper Better Services for the Mentally Handicapped was published, and the first community‐based services were introduced. Further policy papers attempted to modernise social services in the following period. The 2001 White paper Valuing People is the most recent policy framework specific to people with intellectual disabilities. It identifies rights, independence, choice and inclusion as the four leading principles for services and support, and will be of primary importance for future development. However, at present implementation is in the very early stages. Not least, the intense implementation of market mechanisms by the Thatcher Government in the 1980s and 1990s has led to a situation that is hard to grasp, the organisation of care and support varying from authority to authority.
Spain
Authors: Salvador‐Carulla Luis , Poole Miriam , Melero Teresa , Novell Ramon , García‐Ibañez José
Published: September 2011

In Spain, three parallel processes have taken place during the last 20 years: decentralisation, a health reform and a mental health reform. These processes have produced an extremely complex situation in support and care for people with mental retardation. The decentralisation process was not accompanied by a clear definition of the co‐ordination mechanisms among local authorities, and as a result many different health and social care systems have emerged at different times. This makes the description of the current care organisation difficult. An important characteristic of the Spanish system is the major role of NGOs in care and policy‐making and planning in this area. A shift from institutional to community care has begun for both psychiatric patients and people with mental retardation, but compared with neighbouring countries and published standards, the provision of intermediate services and non‐hospital residential care is very low, and the situation is worst for people with mental retardation and psychiatric problems.
Grouping People with Learning Disabilities and Challenging Behaviour in Residential Care
Authors: Mansell Jim , Beadle‐Brown Julie
Published: September 2011

Grouping people with learning disabilities and challenging behaviour in residential care has been the focus of several recent research studies. This paper describes these studies and what they found. In general, they show negative effects of grouping people with challenging behaviour together in terms of the quality of staff interaction with them and the outcomes they experience.
Referrals to a Learning Disability Service and Consent to Treatment
Authors: Carlson Tracy , Hames Annette , English Sue , Wills Caroline
Published: September 2011

This study investigates the current practice of referrers with regard to consent to treatment of adult patients who have learning disabilities. It addresses specifically referrers' awareness of any guidelines on consent, whether they obtain consent before referral and, if so, whether and how they keep written records on gaining consent. Professionals who had referred an adult patient to the Community Team Learning Disability (CTLD) in Newcastle in the last two years were sent a postal questionnaire. The results of the questionnaire are being used to gain better understanding of present practice among referrers and to provide local guidelines on gaining consent in line with recommendations from the Department of Health.
The Development of a Protocol for the Joint Investigation of Crimes Committed against Vulnerable Adults
Authors: Bailey A , McAllister A , McAuley W
Published: September 2011

This paper describes the development and implementation of a joint protocol for the investigation of crimes against vulnerable adults. The protocol was piloted in Northern Ireland by the Police Service and Homefirst Community Health and Social Services Trust. The paper explains the aims of the protocol, examines the training involved in implementing it and explains the operational arrangements with special attention to capacity and consent, joint investigation, liaison points and review methods. It concludes with an examination of potential future developments.
Progress on Participation? Self‐Advocate Involvement in Learning Disability Partnership Boards
Authors: Fyson Rachel , McBride Gordon , Myers Brian
Published: September 2011

The aim of the research described was to gather information about both the objective and the subjective experiences of self‐advocates who had attended learning disability partnership boards, in order to promote effective practices. Findings show that, although people with learning disabilities were present at meetings, a variety of barriers limited their ability to participate actively. Problems included lack of financial and practical help as well as the limited availability of accessible information. There were also, however, examples of good practice, and many self‐advocates were pleased at how their local authorities were beginning to implement effective partnership working practices. Ways of supporting self‐advocates and other people with learning disabilities to fulfil a truly representative, rather than a merely symbolic, function at partnership board meetings are discussed.An accessible summary of these findings is available to download from the project website: www.bris.ac.uk/Depts/NorahFry/Strategy/papers.htm
New Legislative Proposals for Women with Learning Disabilities and Mental Health Problems
Authors: McNamara Eileen , Hall Ian
Published: September 2011

There are several proposed changes to the law in England and Wales that will particularly affect women with learning disabilities. The Sexual Offences Act 2003, the draft Mental Health Bill and the draft Mental Incapacity Bill all highlight the tension between state paternalism and individual autonomy. This paper uses a fictional case scenario in order to consider the practical implications of this proposed legislation, and dilemmas that may arise.
Deinstitutionalisation and Community Living: An International Perspective
Authors: Mansell Jim
Published: September 2011

This paper reviews progress in deinstitutionalisation and community living for people with learning disabilities. The effects of replacing institutional care on residents are summarised and some emerging problems identified.
Valuing People, Not Institutions
Authors: Greig Rob
Published: September 2011

I recently experienced an interesting juxtaposition of two meetings. The first, with a self‐advocate‐led organisation, was concerned with helping it to expand and make use of its work on three key issues: advice on parenting skills for parents with a learning disability, accessible information on health for people with a learning disability, and training in the use of accessible information. The second was with a group of senior service managers who were seeking advice on how to re‐organise and restructure their service organisations. The question, to which this article will return, is which of those sets of concerns and actions had the potential for the greatest impact upon the lives of people with learning disabilities.
Deinstitutionalisation
Authors: Emerson Eric , Hatton Chris
Published: September 2011

Over the last 50 years deinstitutionalisation has dominated the development of social policy for people with learning disabilities in most of the world's richer countries. In this commemorative issue we will attempt to place what we have learned about the successes and failures of deinstitutionalisation in the light of three themes that are clearly evident in the work undertaken by Tizard and his close colleagues: the unrealised potential of people with learning disabilities, the importance of measuring and analysing quality in residential services and the value of applied research.
Life Without Walls ‐ Stories of Successful Deinstitutionalisation
Authors: Kinsella Peter
Published: September 2011

This collection of stories captures the lives of people whose lives have changed as a consequence of the policy to close long‐stay hospitals. Not everyone lived in a long‐stay hospital, but those who haven't probably would have if they were still around. They give a snapshot of the impact of probably the most important public policy in the UK to affect people with learning difficulties over the last 40 years.
Positive Behavioural Support: Definition, Current Status and Future Directions
Authors: Allen David , James Wendy , Evans Jayne , Hawkins Sarah , Jenkins Rosemary
Published: September 2011

This article summarises the historical development of positive behavioural support. The main features of this approach are described, and the evidence for its effectiveness outlined. Despite clear empirical support for its use, relatively few people with learning disabilities and challenging behaviour appear to have access to this form of therapeutic intervention. Reasons for this are discussed, along with recommendations for future development.
A Model for Training Staff in Positive Behaviour Support
Authors: Dench Caroline
Published: September 2011

Although front‐line staff are the key agents in delivering positive behavioural support in care services, effective technologies for staff training in key behavioural competencies are not very well developed. The paper describes a training model that demonstrates effective outcomes for service users, participating staff and the host organisation. The critical elements of the training are outlined and principal outcomes described.
Maximising Capacity to Make Financial Decisions
Authors: Suto W , Clare I , Holland A
Published: September 2011

This paper provides some guidance on how recent research into decision‐making capacity can be used in clinical practice to maximise financial independence among adults with learning disabilities. Its key messages are (i) that capacity is changeable rather than fixed and static, and (ii) that an assessment of capacity is just a starting point for identifying and enhancing a person's strengths and addressing weaknesses. The first half of the paper contains an overview of some recent developments in social policy, capacity legislation and research. We highlight some of the most important issues for clinicians and other health and social care practitioners to consider. In the second half, a case study is discussed. We outline some potential interventions for maximising financial capacity in different ways, as well as identifying some broad strategies for addressing difficulties in decision‐making.
In‐patient Psychiatric Care: What we can Learn from People with Learning Disabilities and their Carers
Authors: Scior Katrina , Longo Silvia
Published: September 2011

There has been much debate about the most appropriate site for in‐patient psychiatric care for people with learning disabilities. The evidence base for service delivery for this group is very scant. Even less is known about the experiences of service users and their carers, as their voices have been largely absent from this debate among service providers and policy makers. This article summarises results from a study into the experiences of adults with learning disabilities who were admitted for in‐patient psychiatric care. Their carers' views were also investigated. Differences between generic and specialist provision are considered, and implications for service delivery are discussed. Generic services in particular would appear in need of considerable improvements if they are to meet the needs of people with learning disabilities in line with current policy guidelines. Recommendations for improvement include greater sensitivity of staff to the needs of this group, increased provision of accessible information about treatment options and medication, and more careful consideration of the need to involve regular carers during the admission.
Supported Work‐Based Training as a Route into Employment for Adults with Learning Disabilities
Authors: Swan Sally , Newton Derek
Published: September 2011

This is a case study of an employment strategy for adults with learning disabilities developed in a local authority in a rural area in the South West of England. It describes a structured approach to work‐based training modelled on principles and practices associated with supported employment. It argues that this represents a more effective route into employment than day‐centre training or unstructured work experience. It provides a detailed account of the experience of one service user, based on interviews. It places this development in the context of the authority's strategic response to Valuing People.
Too Far to Go: Out‐of‐Area Placements for People with Intellectual Disabilities
Authors: Beadle‐Brown Julie , Mansell Jim , Whelton Beckie , Hutchinson Aislinn , Skidmore Claire
Published: September 2011

This mainly exploratory study was a one‐point‐in‐time survey of the situation in one English county. This study involved a survey of all social care homes in the county, followed by measures of quality of life/service for a random sample of 30 people identified by the survey, interviews with home managers, service users, family carers and care managers, and focus groups with members of four community learning disability teams. The total number of people placed from out‐of‐area was estimated to be close to 2,000 (1,500 were placed by the local authority within the county). The main reason for such placements was lack of good local services, but cost also seemed important. For many of those who had been in long‐stay hospital, locality appeared not to be important. Effects varied, but at least a third of people were experiencing very poor service quality and quality of life. Family carers generally felt their relative was happy, but fear of losing the placement was a strong theme. Distance was a major difficulty for both family and care manager involvement. For local community learning disability teams, the main problems included increased workload, reduced provision for local residents, difficulty in dealing with placing authority and the poor quality of the homes. Challenges for public agencies include provision of better local services, management of the cost incentives, especially for London Boroughs, and a system where funding follows the person wherever they chose to live.
Out of Area, Out of Sight: Review of Out‐of‐Area Placement Arrangements made by Social Services and Health for People with Learning Disabilities from the West Midlands
Authors: Goodman Nicholas , Nix Jane , Ritchie Fiona
Published: September 2011

In 2004/2005 local partnership boards requested West Midlands South and Birmingham & The Black Country Strategic Health Authorities (SHAs) to review and report back on the circumstances of adults with a learning disability placed out of area. There are currently 623 known adults with learning disability living out of area at an annual cost to commissioning services of £35 million. In 1993 the Mansell Report predicted major problems and potential consequences relating to future planning of services for people with learning disabilities and complex needs. Twelve years on this has become a reality, as more people are living in highercost services away from their original district and families. There is no evidence from this review that out‐of‐area services are any worse or any better than local services. The review does not set out to make a direct comparison of out‐of‐area placements and services provided locally, nor does it reflect on the number of people being imported into the West Midlands. With lack of monitoring and reviewing of placements, many people have been left solely to the care of provider organisations. Commissioners of services are becoming reliant on the Commission for Social Care Inspection (CSCI) to raise any concerns with them. This review calls for specific action to be taken now to reverse this trend of increasing out‐of‐area placements and to make more cost‐effective local solutions.
A Relationship Support Service for People with Learning Disabilities
Authors: Jenner Phillip , Gale Tim
Published: September 2011

This paper describes the background to, and process of, setting up a Relationship Support Service for individuals with learning disabilities. The service was funded as a pilot project in response to the unmet needs of service users with learning disabilities and their carers. Superficially, the service functions like a conventional dating agency but without any discrimination of sexual orientation or preference. However, unlike a conventional dating agency, this is a learning disability service, providing opportunities for personal development. For individuals who meet the application criteria and safety checks, the service may provide an opportunity to meet potential friends and partners. However, a crucial aspect of the service is that, aside from offering introductions, it provides continued support in maintaining friendships and relationships over time. This paper outlines the rationale behind the service, the obstacles that have been overcome, the application procedures and the safeguards that are in place, and reports some preliminary data on service uptake. This pilot study emphasises both the feasibility and potential benefits of setting up this much‐needed service.
Activity Planning for Inclusion: The Somerset Approach
Authors: Neil Liz , Wilmot Lynne
Published: September 2011

Activity planning was introduced in Somerset in 2004, to support modernising day services. We called it My Day. It is a structure for care staff to ensure they support people with learning disabilities to engage in everyday activities both at home and in the wider community, and a way to arrange individualised daily household tasks, personal self‐care, hobbies, social arrangements and other activities with people with learning disabilities. A recording process is integral to My Day to enable statistical returns to be produced that inform service delivery at the point of delivery. Its main purpose is to ensure that people with learning disabilities remain at the centre of daily activity planning and that their wishes and aspirations are recognised. My Day is one of the ways in which outcomes can be measured for people with learning disabilities in Somerset.
Defining and Measuring Rapport: Implications for Supporting People with Complex Needs
Authors: Guthrie Kamisha , Beadle‐Brown Julie
Published: September 2011

The aim of the research presented here was to identify behavioural cues of rapport and warmth, in order to enable the construction of a valid measurement tool that would support existing methods of behavioural analysis. A number of general research questions were put to six focus groups. Participants were individuals with learning disabilities, professionals working for the NHS or a local authority, and support workers. Data obtained was qualitative in nature and was examined using content analysis and comparisons between participants' experiences. Methods of interaction and communication with people who were either liked or disliked were generally similar across groups, although this varied by specific category. Behavioural cues of rapport were identified and categorised. Most of these would be of use in the creation of an assessment tool, although some adjustment is required so that they can be measured. Implications of the findings are discussed.
Filling the Emotional Gap at Transition: Young People with Learning Difficulties and Friendship
Authors: Williams Val , Heslop Pauline
Published: September 2011

Young people with learning disabilities frequently experience mental health support needs, especially at the transition stages as they move into adulthood. The Count Us In inquiry (Carpenter, 2002) suggested that the prevalence rate for mental health needs in young people with learning disabilities may be as high as 40%, four times as high as for young people in general. This paper reports on an action research study in Somerset which was funded by the Foundation for People with Learning Disabilities. The study followed young people and practitioners in adopting a largely social model of mental health distress. It focused on positive emotional support, and worked with young people themselves to find new ways of tackling these issues. Young people in the study said that the support they most valued was that gained through friendships. A small, self‐selecting group of students worked with the project, and they designed and piloted a short course about emotional support for other young people. The findings show that this was effective in helping the young people talk more freely about their feelings, and build their confidence and mutual trust. This article argues that, by developing their own self‐determination, young people with learning disabilities can build their resilience to emotional problems and take more control over their own lives.
The Relationship Support Service: An Update
Authors: Jenner Phillip , Gale Tim
Published: September 2011

In a previous paper (LDR 11.2) we described the process of developing and implementing a relationship support service for people with learning disabilities. This was a pilot project funded for one year. In this paper, we update some of the outcomes of the project and focus on some case studies illustrating the challenges and benefits of setting up a service of this nature. Although the success of a relationship support service will undoubtedly be judged by the number of successful introductions made, there are many less tangible benefits and experiences for service users, including some valuable learning experiences in communication and respecting the view of others. Attracting funding for the service continues to be the biggest challenge.
More Than One Victim: When People with Learning Disabilities Make False Allegations of Sexual Abuse
Authors: Jones Chris
Published: September 2011

Three recent cases of false allegation of sexual abuse are described and compared. Neither the needs of alleged perpetrators nor the people with learning disabilities are adequately addressed by current practices. Key issues for service development are discussed.
Sinking or Swimming? Supporting Parents with Learning Disabilities and their Children
Authors: Ward Linda , Tarleton Beth
Published: September 2011

According to government policy, parents with learning disabilities should be provided with the support that they need to bring up their children successfully. In practice, however, their risk of having their children removed from them is high. This article reports on findings from a study designed to identify and map positive practice in supporting parents with learning disabilities and their children. It reviews the barriers confronting adults with learning disabilities who want to have and look after their children. It also describes a range of examples of positive practice, demonstrated by professionals and supporters of different backgrounds across the UK, aimed at helping adults with learning disabilities to parent successfully so that they can keep their children with them. It concludes with a discussion of what is needed to facilitate the spread of such examples of positive practice in the future.
Mothers with Learning Disabilities: Experiences and Meanings of Losing Custody of their Children
Authors: Baum Sandra , Burns Jan
Published: September 2011

Women with learning disabilities are at high risk of losing their children, yet their experience of this process remains under‐investigated. This study looks at the experiences of eight mothers with learning disabilities who lose custody of their children. In‐depth, semi‐structured interviews were conducted to explore their experiences. Findings suggest that concern about the women's parenting tend to be raised by other people, rather than the women themselves. Many of the women appeared not to understand the process of their children's removal, and said that they felt bullied and victimised by it. All blamed their violent partner or the social workers for what had happened, while some blamed their ‘learning disabilities’. All commented that they had received inadequate support from both services and their families before and after their children were removed. All described intense feelings of loss. The psychological impact seemed to reinforce their feelings of powerlessness and brought the salience of their learning disabilities into focus. Service and clinical implications are addressed.
Investigating the Experiences of Professionals Working with People who are Homeless and in Contact with Learning Disability Services
Authors: Colman Mark , Hebblethwaite Amy , Hames Annette , Forsyth Alison , Donkin Martin
Published: September 2011

People who are homeless and have a learning disability tend to be more vulnerable and have greater health needs than homeless people who do not have a learning disability (Leedham, 2002). However, the literature on the experiences of this population is very limited. This paper investigates the experiences and views of professionals from a range of settings who work with people who are homeless and have a learning disability. Semi‐structured interviews were conducted with 23 professionals working for health, social care, probation, employment and voluntary agencies. Professionals described how people who are homeless and have a learning disability have a range of complex personal, health and social needs that are often not met by current accommodation and support provision. Improvements to the quality of temporary accommodation and the on‐site support offered are needed in order to react effectively to episodes of homelessness. In addition, improvements in the quality of outreach support and a greater choice of suitable housing might help to prevent homelessness among this client group. Another paper on a difference aspect of this research (Hebblethwaite et al, this issue) will report on the personal experiences of homeless people with a learning disability.
Billy's Story: A Game of Snakes and Ladders
Authors: Burton John
Published: September 2011

Billy's story is told as an experience of care provided by health and social services; the events are taken from the stories of several clients. The story illustrates the failures of a system of care that is not person‐centred. Nor is it integrated. It is a system that has been cobbled together from the stretched and patched remains of old, incompatible systems. Billy's story was used as a central part of a system‐wide review commissioned by Kent's new joint services for people with learning disabilities. By examining the real experiences of a small number of clients and (in the second part of the paper) testing the outcomes against the principles underpinning the plans for a new integrated and person‐centred service, Kent has been able to pinpoint areas of failure and consequently priorities for development and change. The paper ends with a summary of the questions Billy's story raises and the proposals stemming from it.
Investigating Four Evaluation Measures that Aim to Capture the Impact of Service Intervention for Children being Seen by a Community Learning Disability Team
Authors: Hebblethwaite Amy , Denyer Nigel , Hames Annette , Wharton Sarah
Published: September 2011

Government guidelines state that health services must measure outcomes for patients. However, there is only limited evidence on outcome measures for children with learning disabilities. This paper reports on a study designed to investigate the suitability and effectiveness of four outcome measures (Health of the Nation Outcome Scales for Children and Adolescents ‐ HoNOSCA, Children's Global Assessment Scale ‐ C‐GAS, Strengths and Difficulties Questionnaire ‐ SDQ, and Commission for Health Improvement Experience of Service questionnaire ‐ CHI) for a community team working with children with learning disabilities. The paper highlights the difficulties in capturing the impact of service intervention in a multidisciplinary community setting. The implications of the research for clinical practice are discussed.
Staff Support, Staff Stress and Job Satisfaction in Working with People with Learning Disabilities and Challenging Behaviours
Authors: Leyin Alan , Wakerly Eleanor
Published: September 2011

In the context of a staff development programme, the relationships between work‐related stress, staff support and job satisfaction were explored among staff groups in two residential assessment and treatment facilities for people with learning disabilities and challenging behaviour. Although overall support was relatively high for both formal and informal supports, only the informal supports from colleagues were negatively correlated with ratings of work‐related stress. Work‐related stress and job satisfaction were shown to be independent factors, and thus levels of stress could not be inferred from overall ratings of job satisfaction, or vice versa. The study identified a potentially vulnerable group of staff who reported relatively high job satisfaction but also some degree of stress.
Psychological and Emotional Health and Well‐Being of People with Intellectual Disabilities
Authors: Dagnan Dave
Published: September 2011

It has been suggested that the emotional needs of people with intellectual disabilities have been neglected (Kroese, 1998). More recently there has been evidence of increased clinical and research activity in this area (Beail, 2003; Bouras & Holt, 2007; Foundation for People with Learning Disabilities, 2004). Currently much of the focus in this area is on mental ill‐health. This article will consider briefly the literature on mental ill‐health, with particular emphasis on the development of individual treatment approaches. From this discussion it will be evident that much of the research and theory in this area focuses on deficits and disadvantage. I will go on to suggest that a clinical and research focus that explores strengths and resilience will offer a more positive agenda for developing understanding of emotional well‐being and mental ill‐health in people with intellectual disabilities.
Education for the Future: The Changing Nature of Education for Staff in Learning Disability Services
Authors: Barr Owen , Gates Bob
Published: September 2011

The importance of effective education for staff working in services for people with learning disabilities has been highlighted regularly as a key strategy for improving the quality of care and services. However, there has also been debate about how this could be taken forward for unqualified staff, within and across professional boundaries. This paper explores the perceived need for education to make a reality of the visions of future services that have been presented in the current learning disability policies in the United Kingdom. It is argued that increased attention needs to be given to recruitment, selection and retention, revised curriculum to reflect policy objectives, shared learning, and partnership between educational and service providers. It is also noted that it is not enough to prepare people who can work competently in existing services; they must also have a contemporary combination of knowledge, skills, values, motivation and commitment that will enable them to develop services over the next 10‐15 years, in line with the vision of existing service policy documents.
Teachers' Resistance to the Implementation of Functional Behaviour Assessment: Implications for School Administrators
Authors: Ntinas Konstantinos
Published: September 2011

The aim of this paper is to analyse the factors which explain teachers' resistance to the implementation of functional behaviour assessment (FBA). The implications for provision of adequate administrative support that will reduce or prevent resistance are identified and briefly discussed.
Social Care Governance within a Community Team Setting
Authors: Dixon Lizzy
Published: September 2011

The Health and Personal Social Services, Improvement and Regulation (NI) Order 2003, provides a legal framework that places a statutory requirement on health and personal social services in Northern Ireland to provide good quality services. Social care governance underpins the execution of this requirement, and relates to the delivery of safe and appropriate services for people with learning disabilities. The Directors of Social Services asked DHSSPSNI to fund a project worker through the Clinical and Social Care Governance Support Team to take this work forward. They asked for learning materials to be developed. A partnership was formed with the Social Care Institute for Excellence, and they provided the knowledge base for the workbook. The process of developing the workbook involved working with five pilot sites throughout Northern Ireland. The community learning disability team based in the Newry and Mourne Locality of the Southern Health and Social Care Trust participated in the pilot. This paper details the experiences of the team, the work done to date and the ongoing process of maintaining a focus on governance issues.
Personal budgets in social care: the challenge of scaling up
Authors: Routledge Martin , Porter Zoe
Published: September 2011

Personal budgets are part of the Putting People First agenda in England and are at the heart of the biggest change in social care for decades. This article discusses the rationale and evidence base behind their introduction and focuses on the challenges to moving from small scale pilots to nationwide implementation.
Supported employment for people with learning disabilities: the case for full‐time work
Authors: McInally George
Published: September 2011

North Lanarkshire Council's supported employment service has achieved a reputation for delivering full‐time work for people who have learning disabilities. Since 1999, the service has accessed 175 jobs, and currently supports 127 individuals who work more than 16 hours a week. These are people who were receiving, or else would have gone on to receive, traditional day services. Some people, through choice or circumstances, are in their second or third job. This article describes how the approach taken by North Lanarkshire can be adopted by other authorities.
Achieving equal citizenship: meeting the challenges of the UN Convention on the Rights of Persons with Disabilities
Authors: Towell David
Published: September 2011

The recent UN Convention on the Rights of Persons with Disabilities provides a powerful vision of the opportunities and support which should be available to intellectually disabled people and their families, based on a principled commitment to equal citizenship. When ratified nationally, this wide‐ranging Convention has the force of law. Nevertheless there is a long road to travel in securing its successful implementation. Looking across different aspects of the Convention (concerned for example with education, community living or employment) we can identify three common ‘building blocks’ for progress, focused respectively on strengthening self‐determination, promoting mainstream inclusion and providing personalised support. Experience in many countries of the ‘North’ suggests 12 key elements in national and local strategies to address these three requirements. It also points to the need for active partnership between civil society organisations, government and the current service system in which managers and other professional staff can play an important catalytic role. One priority is to invest in developing the capacity for the whole‐system leadership required to bring together the other 12 elements of strategy so as to create a virtuous spiral of positive change. We need to find effective ways of sharing experience across countries on how all this can best be done.
Social inclusion: life after ‘day services’
Authors: Leyin Alan , Kauder Natalie
Published: September 2011

Traditionally, participation in the local community has been considered a crucial component of community living for people with learning disabilities. Highlighted in Valuing People (DH, 2001) and in Valuing People Now (DH, 2007), this concept ‐ now appearing as ‘inclusion’ ‐ has retained its prominence, and is an important area for service development and monitoring. Monitoring of community activities was undertaken pre‐ and post‐closure of two small day service facilities. The findings indicate that for this group of people (generally older with higher support needs) the closure of the day service facilities did not, overall, result in a significant increase in community activities. The availability of the time that the person had previously spent in specialist day services was not, by and large, used to develop social inclusion. Even though, for some individuals, some gains were recorded, overall these gains were considered a poor return for the hours released from the closure of the day service facilities.
Valuing People and research: outcomes of the Learning Disability Research Initiative
Authors: Grant Gordon , Ramcharan Paul
Published: September 2011

Prior to the launch of Valuing People (DH, 2001), Gordon Grant and Paul Ramcharan were appointed by the Department of Health as co‐ordinators of the Learning Disability Research Initiative (LDRI). The LDRI was a £2m research initiative, funded through the Department of Health's Policy Research Programme, linked to the implementation of Valuing People. The LDRI was brought to a conclusion in November 2007 with a final conference at which an overview report and accessible summary of the findings were launched (Grant & Ramcharan, 2007a, 2007b). In this paper we summarise the main findings of the LDRI with reference to Valuing People's main principles of rights, choice, inclusion and independence. In conclusion we consider how to build on the evidence base.
The empathising‐systemising theory of autism: implications for education
Authors: Baron‐Cohen Simon
Published: September 2011

The education of children with autism spectrum conditions deserves a fresh look, for several reasons. First, it is unclear whether some approaches ‐ such as applied behavioural analysis (ABA) ‐ are simply shaping behaviour but not fundamentally leading to conceptual development. Second, educational methods which depend on external reinforcement or reward are ethically questionable so methods that are intrinsically rewarding would be preferable. Third, many educational approaches to autism have proceeded without a clear theoretical rationale. This article summarises a new two‐factor psychological theory of autism spectrum conditions, presents some examples of educational methods that are based on this theory, and that are intrinsically rewarding and argues that such methods may be more autism‐friendly.
Person‐centred approaches to supporting children and adults with autism spectrum disorders
Authors: Beadle‐Brown Julie , Roberts Rachel , Mills Richard
Published: September 2011

The editorial for this issue sets out the context of increasing awareness of the need for better services for children and adults with autism spectrum disorders, and highlights the importance of policy to maintain awareness and provide incentives while recognising that more would be needed to ensure that people with autism have a good quality of life and reach their full potential. There are two sections to this paper. The first is a case study written from a parent's perspective and highlighting the need for good joint working and supporting families, as well as the importance of understanding how autism affects a child and his/her family. The second part considers good practice in supporting children and adults with autism to increase social inclusion, independence, choice and autonomy.
A positive approach to risk requires person‐centred thinking
Authors: Neill Max , Allen Julie , Woodhead Neil , Sanderson Helen , Reid Stephen , Erwin Lori
Published: September 2011

This article discusses the question of risk in the lives of people who are supported by human services. It responds to the way in which risk, as it has traditionally been approached by these services, imposes a barrier to social inclusion and to an interesting and productive life. The article proposes an alternative person‐centred risk process. We argue that, by beginning with a focus on who the person is, their gifts and skills, and offering a positive vision of success, it could be possible to avoid the implied aversion to any form of risk embedded in the traditional approaches and attitudes.
Establishing a context to reduce challenging behaviour using procedures from active support: a clinical case example
Authors: Toogood Sandy , Drury Gemma , Gilsenan Karen , Parry Dave , Roberts Kevin , Sherriff Simon
Published: September 2011

Client engagement increases substantially when staff teams implement active support. The impact of active support on challenging behaviour is less clear. There are grounds for believing that active support procedures could in some cases neutralise environmental conditions known to evoke challenging behaviour. We implemented a three‐phase clinical intervention to increase engagement and reduce passive and challenging behaviour. In phase 1 we trained staff to deliver inviting activity‐based instruction at eye level. In phase 2 we introduced activity support plans to increase client choice and control. In phase 3 staff used peer‐monitoring procedures to consolidate implementation. We measured staff behaviour and client outcome across the three phases of intervention and at follow‐up. Staff provided warm and inviting activity‐based instruction at eye level more frequently after participating in phase 1 on‐site training. The proportion of activity‐based interactions with choice increased when activity plans were introduced in phase 2. Engagement replaced passive and challenging behaviour. Staff observations suggested changes were maintained over the short run. Our own observations indicated decay at 22 months. Our data suggest that active support procedures can make challenging behaviour less likely by altering antecedent conditions that reliably evoke such behaviour. Without sustained effort, interventions are susceptible to decay.
Callous/unemotional conduct disorder as a learning disability
Authors: Mackenzie Robin , Watts John
Published: September 2011

Cruelty has often been understood as the result of incurable bad character by those able to distinguish right from wrong. Recent research suggests a way of thinking about it as a form of disability in which people are unable to learn empathy, cognitive social skills and associated behaviour, which qualifies it as a form of learning disability. It is suggested that accepting this classification opens up the possibility that selected interventions might be successful in enabling people to understand, practise and appreciate affiliative behaviour.
User Action — The Last Ten Years
Authors: Campbell Peter
Published: September 2011

Peter Campbell is a mental health system survivor. This article is based on a presentation given at the conference User Empowerment: Ten Years On, in Nottingham in March 1996.
Employment as Part of the Recovery Continuum
Authors: Roddis Tony
Published: September 2011

This case study examines the role of employment and training schemes for adults with a severe and enduring mental illness from the perspective of Psychiatric Support & Aftercare Workshops (PSAW), a registered charity providing services in the south‐east of England for that client group. Employment and training schemes have the potential to damage clients unless they are part of integrated and progressive community‐based services.
Feathers in the City of Steel: A co‐operative project in a comprehensive mental health system
Authors: Cooney Paddy , Malcolm Katy
Published: September 2011

The approach of an NHS Trust in identifying the components of a comprehensive adult mental health service, the role of a co‐operative approach as one component and the attractions of the Feathers model as the provider of that component are set out.
Workplace Stress: An Organisational Approach
Authors: Lancaster Rebecca , Butler Maria , Pilkington Adele
Published: September 2011

Following the Health and Safety Executive's (HSE) proposal that the assessment and control cycle approach, already applied to physical health and safety risks, be adopted to manage stress at work, the Institute of Occupational Medicine (IOM) developed an Organisational Stress Health Audit (OSHA). The OSHA has three tiers: stage one involves the identification of sources of stress and opportunities for risk reduction; stage two investigates areas of major concern and generates further recommendations for risk reduction; and stage three evaluates the effectiveness of the recommendations in reducing risk. This paper presents the application of the OSHA in three organisations in a study commissioned by the Health Education Board for Scotland (HEBS) and outlines the aims of the study, the methods used and the main results and conclusions of the work.
The Expert Patients Programme (EPP): A Resource for GPs Treating Chronic Disease and Co‐existing Common Mental Health Problems?
Authors: Turner Andy , Barlow Julie
Published: September 2011

This article considers the potential of a self‐management programme for primary care treatment of patients with chronic disease and co‐exisiting mental health problems such as depression and anxiety. The authors conclude that a growing body of evidence suggests that such a resource should be high on the list of referral options for GPs and other health professionals.
Developing Partnerships with Carers through Good Practice in Information‐sharing
Authors: Pinfold Vanessa , Rapaport Joan , Bellringer Sophie
Published: September 2011

This article highlights the importance of information‐sharing in mental health care and in particular the difficulties that can follow when practitioners do not perceive lay carers as ‘partners in care’. The findings of a survey, in which views were sought on poor information‐sharing as a barrier to engagement in mental health services, are reported. The authors conclude with a number of recommendations on improving the way information is shared.
Moving Towards Smoke‐free Mental Health Services
Authors: Bauld Linda , Ferguson Janet , Kerr Ann , McKenzie Kerry , McNeill Ann
Published: September 2011

Scotland's smoke‐free legislation, introduced in March 2006, included an exemption for psychiatric hospitals. However, following the successful implementation of smoke‐free laws in almost all other workplaces in Scotland, important questions have been raised about why mental health facilities should be excluded. This study aimed to explore a move towards mental health settings becoming smoke‐free in Scotland by reviewing relevant literature, seeking the views of stakeholders and examining a number of case study hospitals who had recently or were in the process of going smoke‐free. The study found that stakeholders were overwhelmingly in favour of moving towards smoke‐free environments. Allowing smoking to continue in these settings when almost all other workplaces are smoke‐free was perceived as reinforcing the stigma attached to mental health, exacerbating inequalities in health, damaging the health of mental health professionals and potentially contributing to staff recruitment problems. Evidence from the international literature and from the case studies suggested that smoke‐free policies can be successfully implemented in mental health settings. This article discusses these findings and examines the factors that need to be considered if implementation is to be successful.
Working with the Independent Sector and Managing Out of Area Treatments
Authors: Ryan Tony , Rayne Mark
Published: September 2011

Successive government policies over the past 15 years have encouraged the growth of the independent sector (not for profit and for profit) and its involvement in the delivery of mental health care. Not for profit and for profit sectors are currently working both alongside and in competition with NHS provider organisations. How all parts of the service system interconnect will in future be crucial for service users and carers. This paper describes the developmental approach in response to many of these issues by agencies in the West Midlands.