bluuebunny/crossref_metadata_2025 huggingface dataset:
Goal scaling for low back pain in primary care: development of a semi‐structured interview incorporating minimal important change
Authors: Mullis Ricky , Hay Elaine M.
Published: August 2010

Rationale, aims and objectives  Goal attainment scaling was an individualized assessment technique developed to evaluate the provision of complex public services. However, this produced a measure which was driven more by the need to demonstrate clinical efficacy rather than reflecting a patient's own aspirations. People with low back pain have problems ranging from functional daily activities to areas which impinge upon their wider role in society and quality of life. Commonly used scales to measure back pain‐related disability may not capture domains of relevance to patients. The aim of this project was to develop a goal‐based individualized assessment tool capable of defining meaningful change in condition from the patient perspective for use in longitudinal clinical studies.

Methods  We developed a semi‐structured interview to elicit patient important goals. We refined our initial framework by conducting consecutive rounds of interviews with patients and reviewing the feedback. Within this approach, we included a point identified as the minimum level of change needed within each goal that would be considered a meaningful improvement in condition by the patient.

Results  Fifteen patients with low back pain took part in the study. Three rounds of interviews were held to refine the questions used to develop the goal scales. Overall, the participants identified a total of 59 problem areas, reducing these to the 45 most important goals (three for each patient). The minimal significant improvement was identified on 31 (69%) of these, with all except one patient able to identify this marker on two or more of their goal scales.

Conclusions  The formation of individualized goal scales was successful in all of the participants in this study. Patients were able to understand the concept of ‘minimal important change’, and identify a specific target to reflect this for two‐thirds of their chosen goals.
Quality of life and psychological distress in patients with Peutz–Jeghers syndrome
Authors: Van Lier MGF , Mathus‐Vliegen EMH , Van Leerdam ME , Kuipers EJ , Looman CWN , Wagner A , Vanheusden K
Published: August 2010

van Lier MGF, Mathus‐Vliegen EMH, van Leerdam ME, Kuipers EJ, Looman CWN, Wagner A, Vanheusden K. Quality of life and psychological distress in patients with Peutz–Jeghers syndrome.

Little is known about psychological distress and quality of life (QoL) in patients with Peutz–Jeghers syndrome (PJS), a rare hereditary disorder. We aimed to assess QoL and psychological distress in PJS patients compared to the general population, and to evaluate determinants of QoL and psychological distress in a cross‐sectional study. PJS patients completed a questionnaire on QoL, psychological distress, and illness perceptions. The questionnaire was returned by 52 patients (85% response rate, 56% females, median age 44.5 years). PJS patients reported similar anxiety (p = 0.57) and depression (p = 0.61) scores as the general population. They reported a lower general health perception (p = 0.003), more limitations due to emotional problems (p = 0.045) and a lower mental well‐being (p = 0.036). Strong beliefs in negative consequences of PJS on daily life, a relapsing course of the disease, strong emotional reactions to PJS, and female gender were major determinants for a lower QoL. PJS patients experience a similar level of psychological distress as the general population, but a poorer general health perception, more limitations due to emotional problems, and a poorer mental QoL. Illness perceptions and female gender were major predictors for this lower QoL. These results may help to recognize PJS patients who might benefit from psychological support.
Melanotropins: aldosterone‐ and corticosterone‐stimulating activity in isolated rat adrenal cells
Authors: LI CHOH HAO , NG TZI BUN , CHENG CHRISTOPHER H.K.
Published: August 2010

Stimulation of corticosterone and aldosterone production in rat adrenal decapsular and capsular cells respectively by α‐ and β‐melanotropins (α‐ and β‐MSH) have been investigated. Although they are considerably less potent than corticotropin (ACTH), the dose‐response curves are parallel to those for ACTH except in the case of aldosterone stimulation by β‐MSH where the dose‐response curve is biphasic. The steroidogenic actions of ACTH, β‐MSH and α‐MSH are antagonized by corticotropin‐inhibiting peptide in both capsular and decapsular cells. A synthetic analog of β‐MSH ([Gly10]‐βe1‐MSH) inhibits both β‐MSH and ACTH in aldosterone output in capsular cells, but it does not inhibit their corticosteroidogenic actions in decapsular cells.
Biofunctional evaluation of two hydrogen bonds stabilizing the β‐turn in the acyclic component of oxytocin
Authors: ROY UMA , GAZIS DIANA , SCHWARTZ I.L. , ROY J.
Published: August 2010

The depsipeptide [8‐α‐hydroxyisocaproic acid, 9‐glycolic amide]‐oxytocin, which has ester linkages replacing the peptide linkages between the 7th and 8th and the 8th and 9th residues of oxytocin, has been synthesized by a (6 + 3) condensation of Boc‐tocinoic acid with Pro‐0‐HyIc‐0‐Glyc‐NH2, followed by deprotection of the resulting product. The analog exhibited the following activities in rats: 258 ± 11 and 28 ± 5 U/mg, uterus in vitro in the absence and presence, respectively, of Mg+2; 54 ± 4 U/mg, uterus in vivo; 19.3 ± 2.1 U/mg, milk ejection; 0.153 ± 0.026 U/mg, antidiuretic activity; and no pressor activity. The need for the presence of the peptide linkages mentioned above as sources for internal hydrogen bonds to stabilize the “biologically significant” conformation is discussed.
Synthesis and conformation of the amino‐terminal hexapeptide of histone H2B from gonads of the starfish Asterias rubens
Authors: HELBECQUE N. , BERNIER J.L. , HÉNICHART J.P. , MARTINAGE A. , SAUTIÈRE P.
Published: August 2010

This paper describes the synthesis and the physico‐chemical characterization of N‐(di‐CH3)‐l‐Pro‐l‐Pro‐l‐Lys‐l‐Pro‐l‐Ser‐Gly‐OH by conventional methods of peptide chemistry. This peptide corresponds to the amino‐terminal moiety of histone H2B from gonads of the starfish Asterias rubens.
Trends of diabetes according to body mass index levels in Iran: results of the national Surveys of Risk Factors of Non‐Communicable Diseases (1999–2007)
Authors: Esteghamati A. , Ashraf H. , Khalilzadeh O. , Rshidi A. , Mohammad K. , Asgari F. , Abbasi M.
Published: August 2010

Diabet. Med. 27, 1233–1240 (2010)

Aims  The prevalence of diabetes is increasing dramatically worldwide. Less is known about whether this trend is similar among obese and lean individuals.

Methods  We analysed the data sets of three cross‐sectional national surveys in adults aged 25–64 years: the National Health Survey‐1999 (n = 21 576), and the national Surveys of Risk Factors of Non‐Communicable Diseases (SuRFNCD)‐2005 (n = 70 981) and SuRFNCD‐2007 (n = 4233). Diagnosed diabetes was ascertained, and height and weight were measured in all surveys. In SuRFNCD‐2005 and SuRFNCD‐2007, fasting plasma glucose was used to identify subjects with newly diagnosed diabetes (≥ 7 mmol/l) and impaired fasting glucose (5.6 ‐6.9 mmol/l) among individuals not reporting diabetes.

Results  The prevalence of diagnosed diabetes (after adjustment for age, sex and residential area) was 2.5, 4.0 and 4.6% in 1999, 2005 and 2007, respectively. The total prevalence of diabetes increased from 7.7% in 2005 to 8.7% in 2007, about half of which was attributed to newly diagnosed disease (in both surveys). The prevalence of diabetes increased in all categories of obesity, with the most evident trend being among subjects with body mass index < 25 kg/m2.

Conclusions  The prevalence of diabetes among Iranian adults has increased more than 1.8‐fold in a period of only 8 years since 1999. This is the first report from Iran, and urgent measures need to be taken in order to prevent the progression and worsening of the problem and emergence of its undesired consequences.
Identifying additional patients with diabetic nephropathy using the UK primary care initiative
Authors: Magee G. M. , Hunter S. J. , Cardwell C. R. , Savage G. , Kee F. , Murphy M. C. , Fogarty D. G.
Published: August 2010

Diabet. Med. 27, 1372–1378 (2010)

Aims  The aim of this study was to use general practice data to estimate the prevalence of diabetic nephropathy within the registered diabetes patients and examine variation in practice prevalence and management performance since introduction of this initiative.

Methods  Reported quality indicators from the Northern Ireland General Practice Quality and Outcomes Framework were analysed for diabetes and diabetic nephropathy prevalence and management in the period 2004–2008. Variation in prevalence at practice level was assessed using multiple linear regression adjusting for age, practice size, deprivation and glycaemic control.

Results  In 2006–2007, 57 454 (4.1%) adult diabetic patients were registered in the denominator population of 1.4 million compared with 51 923 (3.8%) in 2004–2005 (mean practice range 0.5–7.7%). Diabetic nephropathy prevalence was 15.1 and 11.5%, respectively (8688 and 5955 patients). Documented diabetic nephropathy prevalence showed marked variation across practices (range 0–100%) and was significantly negatively correlated with diabetes list size, albumin creatinine ratio testing rates and renin–angiotensin–aldosterone system blockade use and positively correlated with exception reporting rates. Specifically, for every increase in 100 diabetic patients to a register, documented diabetic nephropathy prevalence reduced by 40% (P = 0.003). On the positive side, median albumin‐creatinine ratio testing rates doubled to 82% compared with figures in the pre‐Framework era.

Conclusions  Implementation of the Northern Ireland General Practice Quality and Outcomes Framework has positively benefitted testing for diabetic nephropathy and increased numbers of detected patients in a short space of time. Large variation in diabetic nephropathy prevalence remains and is associated with diabetes registry size, screening and treatment practices, suggesting that understanding this variation may help detect and better manage diabetic nephropathy.
RETAIL SALES DURING THE WAR: B. CHANGES IN GROCERY SALES
Authors: SCHULZ. T.
Published: August 2010

Summary

We can now summarize the main findings of our analysis: It seems that during the first eighteen months of the war the number of ‘full’ customers in our sample shops increased by at least 10 per cent. We have reason to assume that during the same period the number of casual customers—which for certain commodities was very large1 —became insignificant. A rough correction for expenditure due to casual custom of the average figures of total turnover for 1938‐39, gives the outlays on all items per ‘full’ customer as approximately 41d. a head a week.2 In January 1941, this outlay was up to about 46d. This, however, represents the average expenditure during a week when it was probably abnormally high (for various reasons, which have been discussed above) and, moreover, most likely accompanied by an exceptional decrease in the expenditure on meat. Hence our data give us little cause to think that as regards the families typical for the customers of our sample shops, money outlay per head on groceries had risen during the first eighteen months of the war. As the price index of all groceries rose by 43 per cent, the cut in real consumption must have amounted to about 30 per cent. Part of this ‘saving’ was, however, represented not by a cut in the actual quantities consumed but by a decline in quality.3

The two food groups the prices of which increased most steeply were those of first class protein and of carbohydrate foods. If we subdivide the groceries into two main classes of ‘rationed’ and ‘unrationed’ foods we find the average rate of increase of the prices of ‘unrationed’ foods to have been 1 1/2 times that of the prices of ‘rationed’ foods, for which latter group price control was more comprehensive.
SIZE AND SUCCESS IN RETAIL DISTRIBUTION
Authors: BELLAMY. R.
Published: August 2010

Summary.

1. The Measurement of Success.

The problem of measuring success by direct and indirect evidence is discussed. It is proposed to examine the advantages of the large stores and organizations under two broad heads—those which arise from a monopolistic or monopsonistic position, and those which arise from economies of scale.

2. Monopolistic and Monopsonistic advantages.

Evidence is produced to show that no advantage in respect either of higher prices or higher Percentage Gross Margins is enjoyed by large enterprises. They are, however, undoubtedly able to buy more cheaply.

They are also able to afford higher per unit ‘ selling costs ’ (Publicity, Delivery and other services) which should enable them to attract and maintain a greater volume of sales.

3. Economics of sale.

These higher unit selling costs are possible because the other Operating Expenses of large enterprises are lower. They are lower firstiy because of the rising productivity of labour with size, and secondly because the cost of holding stocks does not increase proportionately with sales.

4. Conclusion.

Thus the trends towards greater concentration portrayed in our first article are given a basis in the greater profitability of large enterprises. It remains to discuss whether that profitability is achieved at the expense of the consumer.
Sex roles and mentally handicapped people
Authors: LUNDSTRÖM‐ROCHE FRANCESCA
Published: August 2010

Over the past few years there has been a growing awareness of the sexual needs of mentally handicapped people (Craft and Craft, 1978). In many instances programmes of sex education have been set up for them. But has society in general come to any kind of acceptance of the sexual needs of the mentally handicapped, or even the fact that these people are men and women?
SOUTH WALES EARLY LANGUAGE RESEARCH PROJECT: the development of a practicable, assessment‐linked language training curriculum for use with the handicapped child
Authors: Jones Clare , Clements John , Evans Christina , Osborne Kate , Upton Graham
Published: August 2010

SUMMARY: This article describes the development and evaluation of a practicable, assessment‐linked, early language training programme ‐ comprising the Early Language Profile (ELP) and an itemised set of training ideas ‐ suitable for mentally handicapped children from the earliest stages of development up to the emergence of a more complex syntax.
Does the community care?
Authors: Hutchinson Roger
Published: August 2010

This article seeks to direct attention towards the need to educate the community to care for mentally handicapped people prior to the establishment of further community care systems. It is argued that mentally handicapped people living in the community are isolated in terms of both social contacts and occupation; and that certain assumptions are made, without supportive evidence, about the community's willingness to care.
Who can live alone?
Authors: Staite Susan , Torpy David M.
Published: August 2010

This report describes the process by which mentally handicapped people were chosen for the Priory Court Scheme in Bristol. This is a semi‐independent living scheme where residents live alone or in groups with a warden on site. Candidates were chosen following a two‐week observation period in a simulated home. “Chosen” and “unchosen” people were compared using the Adaptive Behavior Scale and the criteria of age, IQ, and length of hospitalisation.
The law and mental handicap: 1. How law is determined
Authors: Gunn Mike J.
Published: August 2010

This article is the first in a series, written by Mike Gunn, on the law and its effects upon mentally handicapped people and those who care for them. The series will deal with some common problems faced by handicapped people and will discuss some of the implications of the new legislation.

Readers are invited to ask questions, either of a general nature or in regard to a specific problem, which Mr. Gunn will answer either as part of the article series or on the journal's new Legal page which starts in this issue (page 174). All correspondence should be addressed to: The Editors, Mental Handicap Journal, BIMH, Wolverhampton Road, Kidderminster, Worcs DY10 3PP.
Initial findings concerning a sexual knowledge questionnaire
Authors: Bender Michael P. , Aitman Jeffrey B. , Biggs Simon J. , Haug Ursula
Published: August 2010

SUMMARY: The authors describe a 69 item sexual knowledge questionnaire that covers the areas: physiology, pregnancy, the sex act, masturbation, contraception, types of sexuality, and venereal disease. There is also a ‘Belief in Myths’ scale. Mean scores for delinquent boys and young mentally handicapped adults are given, with the latter having lower scores. All areas correlate with total score. The handicapped group showed increased sexual knowledge when re‐tested after a human relations course. A control group, tested after the same interval, showed only random changes. Further research is suggested.
“Special care” in 19 adult training centres
Authors: Crawford Nick , Taylor Peter , Thobroe Edwin
Published: August 2010

For several years the British Institute of Mental Handicap has organised courses for staff working with children and adults who have been described as being in need of “special care”. This term, however, is often used to describe individuals with widely differing needs. (There is a useful discussion and excellent review of the literature in Presland, (1980).) Before beginning the courses BIMH carried out a survey of schools and adult training centres in the West Midlands to establish the needs of the pupils, students, and staff. The results of the schools' survey have already been published (Taylor, Crawford, and Thobroe, 1981). This article summarises findings in respect of the adult training centres.
Training and supervision of counsellors
Authors: Gomersall James D.
Published: August 2010

SUMMARY. The awareness of anxiety and vulnerability of counsellors can be helped by trained and sensitive supervisors. Recognition is required that in all relationships there must be two way communication. Counsellors may avoid this by concentrating only on the giving aspects. Supervisors may be too positive and reassuring, and be tempted into omnipotence. If such pitfalls are avoided counsellors can develop an open and enabling situation with their clients, linking the unique personal resources which exist in people who are handicapped and those who live and work with them.
Communication and language in mental handicap
Authors: Bell Ian
Published: August 2010

This is the second of two articles on the communication and language curriculum for children with severe learning difficulties. The curriculum development model followed is:

STEP 1. Specify the underlying philosophy and general aim for educating children who are mentally handicapped

STEP 2. Select the core areas of the curriculum

STEP 3. Specify the aims for each core area

STEP 4. Divide each core area into component parts

STEP 5. For each component select and sequence the skills the children are to acquire

STEP 6. For each component devise or select a means of assessment and record‐keeping.

Steps 1–4 were covered in the previous article. This article deals with Steps 5 and 6. It is suggested that a seventh step should be added:

STEP 7. Constantly review and revise the curriculum.
The law and mental handicap:
Authors: Gunn Mike
Published: August 2010

This article attempts to set out, impartially, the proposals for reform of sexual offences legislation put forward by the Criminal Law Revision Committee. The existing law was described in a previous article (Ment. Hand., 1984; 12: 3, 104–106). The proposals are currently under consideration. Any views or comments readers may have on the proposals would be warmly welcomed. These should be addressed to: The Editors, Mental Handicap Journal, BIMH, Wolverhampton Road, Kidderminster, Worcs. DY10 3PP and should be received NO LATER THAN 21st JANUARY, 1985.
Communication and language in mental handicap 5. DON'T TEACH — INTERVENE
Authors: Bell Ian
Published: August 2010

There are reasons for believing it is inappropriate to refer to teaching communication and language skills. This article explains why this is so; argues that “facilitators” can accelerate communication and language acquisition in children with mental handicaps by “intervening” in their environment; and outlines the principles on which intervention should be based.
Integrating mental handicap registers with service provision
Authors: Cubbon John
Published: August 2010

SUMMARY. There is growing support for specialist social workers and other CMHT members to have contact with all the people in their area who are mentally handicapped, and for widespread use of regular multidisciplinary reviews. As well as having preventive and other functions, these processes provide the basis for a mental handicap register which can hold all the data needed in planning. If there is contact with the great majority of people with mental handicap in a district or if the users of mental handicap services are regularly reviewed, registers can be set up at almost no extra expense. However, many districts do not yet have the necessary contact or review system. The possibility of integrating registers with service provision should be considered by the many authorities planning to set up registers.
Communication and language in mental handicap
Authors: Bell Ian
Published: August 2010

SUMMARY. In the second of the two articles outlining the communication and language curriculum for children with severe learning difficulties (Bell, 1984b), it was suggested that imitation might be better included as a component in a learning skills core area rather than in the communication and language core area. This article and the next in the series explain this assertion: the present article defines imitation and discusses its role in language acquisition; the next article examines the problems with using imitation in communication and language intervention.
Room management activity sessions for adults in long‐stay hospitals
Authors: Wood James R. A.
Published: August 2010

SUMMARY. Activity periods using room management procedures can be adopted to raise the levels of activity for adult long stay hospital residents. The approach can be valid as part of longer term change strategies. Concern is expressed about its use, the demands placed on staff, training needs, and the function it serves. Consideration should be given to the wider context and development encouraged in other ways according to the setting. Room management can provide opportunities for interdisciplinary approaches to common problems.
Interviewing people with mental handicaps for the Community Aide Programme
Authors: Rock Patricia
Published: August 2010

SUMMARY. The Community Aide Programme is a new scheme in Britain designed to employ people with mild mental handicaps as paid assistants undertaking personal and domestic tasks for people with physical handicaps. The usual form of verbal dialogue is inappropriate when interviewing potential assistants. A new technique was used in a pilot scheme to help applicants participate constructively in interviews.
Evaluation of a teaching approach for children with profound multiple handicaps
Authors: Rooke‐Cottam Philippa
Published: August 2010

SUMMARY. The results of a research project, evaluating the effectiveness of a teaching programme based on Conductive Education principles for children with profound multiple handicaps, are presented. Conclusions drawn from the study are discussed and their wider implications are considered.
STAFF IN‐SERVICE TRAINING
Authors: McGinley Patrick , Vickerman Brian A.
Published: August 2010

A one‐week in‐service staff training course was given on two successive weeks at a residential and day centre for adults with mental handicaps in Ireland; and a year later at a similar centre in England. A total of 44 staff attended. The course included lectures on the philosophy underlying the care and training of people with mental handicaps and a detailed review of behavioural techniques in learning. Course members then applied what they had learned in a series of practical exercises. Course evaluation indicated a significant improvement in members' technical knowledge of training procedures.
WARD SIZE AND COSTS: a study of a large mental handicap hospital
Authors: Johnes Geraint , Haycox Alan
Published: August 2010

Costs per patient day are explained with reference to the age, dependency, and sex mix of residents, their degree of physical handicap and behavioural disturbance, and ward size. The number of occupied beds is found to be a significant determinant of costs, and becomes increasingly important as the residents become younger or more dependent. In general, a ward in which the majority of residents are young or dependent minimises its costs when 24 beds are occupied; but the least cost size for wards in which all residents are heavily dependent may be less than 10 beds.
Sexual offences involving children: a suggested treatment for adolescents with mild mental handicaps
Authors: Hames Annette
Published: August 2010

Whilst there is increasing concern about the number of sexual attacks upon young children, and a growing fear of the perpetrators of such offences, there are a few people who occasionally interfere with young children through ignorance and lack of confidence. These people are often adolescents with a mental handicap who associate and play with children much younger than themselves, and then one day find they have done something which they did not realise was illegal.

This article describes some techniques which have begun to be used in the treatment of adolescents who are mildly mentally handicapped and who have been convicted of such offences.
The views of parents and carers: 1. Some pleasures, stresses, and strategies
Authors: Swain John , Eagle Paul
Published: August 2010

Two meetings for parents and carers of people with mental handicaps were held in order to assist in the development of the new Open University course P555 Mental Handicap: Patterns for Living. Parents' and carers' views on a variety of issues were sought and recorded.

This is the first of two articles which highlight some of the main points discussed at the meetings and report participants' views in their own words. This article covers the pleasures, stresses, and strategies of caring, and then draws out some general impressions.

The meetings seemed to be successful for all concerned. They brought out many factors in the lives of people who have a family member with a mental handicap, and illustrated a wide variety of experiences and views.
Involving parents in teaching reading: a project with nine children with Down's syndrome
Authors: Greene Kay
Published: August 2010

This project involved parents of nine young children with Down's syndrome, who were all enrolled in St. Michael's House Early Services programme. The parents were given support and guidance by means of fortnightly visits by the home teacher who had worked with their children on other developmental activities since infancy.

All the children learned to read some single words, ranging from 10 to 131. The mean for the group was 69 words. Eight children were reading these words in books. The number of completed books read ranged from one to five. The mean for the group was 2.7.

There was wide variation within the group on the time taken to learn new words and on fluency in reading. All the parents agreed that the effort involved in teaching their children to read was well worth it.
Using the “Wessex” behaviour rating system: a four‐year outcome study in a mental handicap hospital
Authors: Gilleard Esen , Tsesmelis Christos , Whoriskey Margaret
Published: August 2010

A survey and four‐year follow‐up of 381 people living in a 420‐bedded mental handicap hospital was carried out in order to examine the relationship between “Wessex” dependency categories and subsequent outcome. The relationship between outcome and dependency level was examined for children and adults separately. Although the majority of people remained in hospital four years after the initial survey, significant associations could be observed between the “Wessex” classifications and outcome for adults. Possible implications of these findings are discussed.
Adults with mental handicaps who can read
Authors: Alexander Barbara
Published: August 2010

Little has been written about adults with mental handicaps who can read. A surprising number were found in institutions in South‐East London (68 who were at least semi‐literate, of whom 11 were literate). No explanation of this ability, associated with IQ's as low as 40, was found in the literature or in this study. Comprehension scores were on average more than a year lower than Accuracy scores, giving support for the notion of “barking at print”. A recommendation is made that reading for use should be extended beyond the Social Sight Vocabulary.
Implementing quality assurance: the design and operation of codes of practice
Authors: Joyce Theresa , Carle Nan
Published: August 2010

As services become more dispersed and increasing emphasis is given to ensuring that they are of good quality, concern has been expressed as to how this can be achieved. Achievement of quality services must not be at the expense of staff: imposition of standards from “above” is likely to reduce morale and motivation and create rigid practices which could reproduce in smaller settings some of the worst features of institutional life. This paper outlines a strategy which requires staff and user participation in the active pursuit of quality and suggests how quality may be looked at in a practical way in services. It suggests that pursuit of quality is an important and major task which must be given real priority by service providers and managers.
Getting on with the real work
Authors: Macdonald Ian
Published: August 2010

This article is an analysis of the work of professionals providing a service to people with mental handicaps and their families in the Rhondda Valleys (Macdonald et al., in press; Rhondda Vanguard Service, 1986). It attempts to show that a critical part of providing an integrated community service involves more than valuing or even carrying out direct service work. Although the direct delivery is sometimes seen as the only “real” work, other work which is less immediately rewarding is necessary if the service is to be delivered in a coherent way. Further, it seeks to demonstrate that in order to enhance the actual service delivery great care and effort is required in the design of systems which make sense to the service users, their families, and the service providers. This article does not attempt to summarise the entire Rhondda Vanguard Service or the Research Project.
CHALLENGING BEHAVIOUR AND COMMUNITY SERVICES 3: Planning individualised services
Authors: Toogood Alexander , Emerson Eric , Hughes Heather , Barrett Sheila , Cummings Richard , McCool Christine
Published: August 2010

This paper describes the process of individual service planning used by the South East Thames RHA's Special Development Team to develop comprehensive, locally based services for people with severe mental handicaps and challenging behaviours. The framework described is used as a basis from which to begin to address the question: What will it take to design and implement a high quality, locally based service programme for this person under these conditions in this particular organisation?
Assessing the service needs of people with mental handicaps: METHOD USED IN THE JAY PROJECT
Authors: Freedman David
Published: August 2010

This article sets out the method used in the Jay Project for assessing the service needs of people with mental handicaps over the major areas of life. Detailed interviews were conducted with the individuals themselves, their close family and/or friends, and the professional workers who knew them well. Available records were also consulted. A summary of the perceptions and opinions of the people interviewed was drawn up and presented under key headings, followed by a list of “service needs” as seen from the point‐of‐view of the service users.

The assessments were discussed by the Project's multi‐agency Steering Group where recommendations for action were made, the aims being to try to obtain better services for individuals and to indicate to service planners the degree of service need in a geographical area.

The method demonstrated that broad‐based assessments could be produced in a relatively short time. The structure of the Project created a forum for multi‐agency dialogue and helped to foster inter‐agency cooperation.
THE PARTNERS PROJECT: community based recreation for adults with mental handicaps PART 1
Authors: Walsh Patricia Noonan , Coyle Kevin , Lynch Christy
Published: August 2010

Twelve adults with mental handicaps, who attended day services, were selected randomly and introduced to a range of community based recreational activities with the help of young people from the community who acted as their partners. The activities took the form of a summer project which aimed to offer a variety of recreational experiences to each adult, and to test the benefits of working alongside community helpers.

The implications for identifying ways to increase participation levels of individuals and for providing for the carryover of any new levels of activity achieved are discussed. The outcome of the project suggests that a partnership of professional, frontline, and voluntary workers can effectively promote the integration into the community of adults with mental handicaps.
PRIDE AND PREJUDICE? Factors influencing “uptake” of family based respite care services
Authors: Robinson Carol
Published: August 2010

The research findings described in this article are drawn from a large‐scale evaluative study of one of Britain's largest family based respite care schemes for families with a child who is handicapped (Robinson, 1986). It looks at the evidence which helps to answer the question: “Why don't all families eligible to use this respite service do so?”.

The findings suggest that a number of social and demographic characteristics found to influence “uptake” of respite care services in America are equally relevant in Britain, but that a number of other variables are also important. These additional factors are associated with a lack of information about the services on offer, families' past experiences of family based services, and parents' attitudes towards their parenting role.
“AN ORDINARY LIFE”: the early views and experiences of residential staff in the Wells Road Service
Authors: Ward Linda
Published: August 2010

Residential staff working in the first two staffed homes of a local service for adults with mental handicaps were interviewed in‐depth at regular intervals over several years about their experiences, as part of a “formative evaluation” of the service overall. Certain key issues emerged, including: coping with some people's aggression and mental problems; difficulties with helping people learn new skills; the need for good staff support; and the importance of involving staff in reviewing service progress and plans. On the basis of this material, and more recent experience of this and similar services, the need for positive action (for example, the introduction of positive monitoring and quality action groups) to maintain and improve the quality of new community services is advocated.
Integrating adults with mental handicaps into ordinary housing: THE THURLOW CLOSE PROJECT
Authors: Rawlinson Steve
Published: August 2010

This article portrays the culmination of several years' planning and preparation by a Support and Training Team committed to providing suitable community‐based accommodation for adults with mental handicaps. It is evidence of what can be achieved when several agencies combine in a spirit of partnership to put into practice the concept of community care.

An attempt has been made to describe the rehabilitation training provided, starting from the initial assessment at a training unit and ending with the frequency, nature, and provision of follow‐up support once the adults had been re‐housed. It is important to stress the need for continuing collaboration between parents and professionals.
Stammering in adults with mental handicaps: A PILOT STUDY
Authors: Stansfield Jois
Published: August 2010

A pilot study was undertaken to establish the prevalence of stammering in adults with mental handicaps, as identified by their carers. Possible differences between those attending adult training centres and those living in hospital were noted. It was found that the prevalence of speech problems, especially stammering, was significantly higher in both groups than would be expected in the “normal” population.
Sex education for pupils with severe learning difficulties: A SURVEY OF PARENT AND STAFF ATTITUDES
Authors: Squire Joan
Published: August 2010

In April 1987 a survey of parental and staff attitudes was undertaken into the question of providing a personal and social education curriculum at an all‐age day school for pupils with severe learning difficulties.

The results show that, while questions of appearance, health, hygiene, and social behaviour were almost unanimously agreed to be relevant, areas of explicitly sexual knowledge and behaviour were not thought to be relevant by the majority of parents. Staff views differed from those of the parents, favouring a much more wide‐ranging approach to the content of such a curriculum.

Parents of young pupils were more positive than parents of older pupils in their views of what should be included in the curriculum and in their overall expectations of the pupils.
“When are we going to move?”
Authors: Davison Hilary , Saxton Karen
Published: August 2010

Recent reports have indicated that many rehousing projects, moving people out of hospitals large and small, suffer periods of delay. This article relates the frustrations and delays experienced by one such project and, in particular, the effects on five people who were the first due to move into a home of their own within the project. The article argues that staff working on such schemes should acknowledge that such delays are very likely and do all they can to minimise the effects on the residents involved.
Which approach? The education of pupils with severe learning difficulties
Authors: Smith Beryl
Published: August 2010

The influences on current educational practice in schools for children with severe learning difficulties are considered in the light of various influential approaches to education over recent decades. Possible avenues of development are explored and a plea is made for practitioners to understand and make use of the interdependence of basic skills and thinking skills; that is, cease to maintain the often artificial distinction between “behavioural” and “cognitive” approaches.
“I just don't want to walk”— overcoming refusal to walk by means of reinforcement procedures
Authors: Lalloway Eithne , Walsh Peter G.
Published: August 2010

Refusal to walk, whilst not a particularly frequent problem presented by people with mental handicaps, can when it occurs severely curtail the level of a person's interaction with the environment. The present study describes a behavioural reinforcement procedure that was used to overcome refusal to walk by a young woman with a severe mental handicap and a severe visual impairment. The procedure was effective in that she will now walk willingly in the company of staff. The study highlights the need, when introducing behavioural programmes, to plan for generalisation and long‐term maintenance of effects.
Education in India
Authors: Reddy S. H. K. , Narayan Jayanthi , Menon D. K.
Published: August 2010

This is a report of a questionnaire‐based survey undertaken by the National Institute for the Mentally Handicapped, Secunderabad, India. The objective was to compile information about the existing educational facilities for children with mental handicaps in the country. The study revealed that the majority of the educational facilities were managed by voluntary organisations and were found in urban areas. It was observed that there were more facilities in the southern states, and fewer in most of the northern and the northeastern regions.
Sexual abuse: special considerations when teaching children who have severe learning difficulties
Authors: Martin Nicola , Martin Bob
Published: August 2010

This article considers why children with severe learning difficulties may be vulnerable to sexual abuse, and what teachers may be able to do to minimise the risk of them becoming victims in abusive sexual relationships. Sexual abuse is defined and some information is given on its prevalence. Characteristics which may leave children with severe learning difficulties particularly at risk are related, and the negative effects on those who are abused are outlined. The responsibility of teachers to report suspected cases of abuse and to teach children safety rules is considered. Special ethical and practical considerations when teaching children with severe learning difficulties about sexual abuse are discussed.
Challenging behaviour: introducing a preadmission checklist, problem analysis flow chart, and intervention flow chart to guide decision‐making in a multidisciplinary team
Authors: Bridgen Patricia , Todd Margaret
Published: August 2010

This paper explores one possible approach to caring, in a community setting, for people with mental handicaps who exhibit challenging behaviour. The advantages and disadvantages of a special unit and the flying squad approach are addressed. One model of care which attempts to use both approaches is discussed, with the emphasis on individual case management.

The model suggested is underpinned by the philosophy of normalisation which seeks to enable service users to participate in community activities as fully as possible. One method of preventing unnecessary admission to a special unit is explored, and the use of a checklist and flowcharts suggests alternative methods of managing individual service users.
A psychotherapy group for young adults with mental handicaps: PROBLEMS ENCOUNTERED
Authors: Humphreys Martin , Hill Lena , Valentine Shona
Published: August 2010

This article describes briefly how the authors set up and ran a psychotherapy group for eight young adults with mental handicaps to look at interpersonal and sexual relationships. At the outset an attempt was made to anticipate possible problems and to identify ways in which these might be avoided. Despite this, a wide variety of minor difficulties were encountered relating to all aspects of the group. The identification and discussion of these problem areas has been one of the major ways in which the authors have learned from this work, and from which others wishing to set up similar groups might benefit.
The Personal Development Programme: GROUP PSYCHOTHERAPY FOR PEOPLE WITH MENTAL HANDICAPS
Authors: McGoveran Patrick
Published: August 2010

There have been few reports in the literature of long‐term group psychotherapy programmes for people with mental handicaps. This paper describes a coordinated package of such programmes which have been in operation for over three years. It looks briefly at the function of verbal and art therapy groups, client selection and allocation, staff development, and administration. Some of the considerations for staff working with people who have mental handicaps in psychotherapy are discussed, together with the benefits of group psychotherapy for everyone involved.
An evaluation of the effects of relocation within institutions Part 4. A case study approach
Authors: Mayor Janet , Holtom Rebecca , Firth Hugh , Wood Andy
Published: August 2010

This is the last article in the four‐part series on relocation. Part 1 reviewed the literature and proposed guidelines for good practice. Part 2 described the implementation procedures used at Prudhoe Hospital to minimise the adverse effects of relocation. Part 3 reported on a study that looked at changes in the health and behaviour of 89 residents who moved between wards at that hospital. Part 4 tackles the issue of evaluation, using a qualitative, person‐centred approach. It is hoped that lessons may be learned by managers and professionals from the insight this article provides into what actually happens to individuals, and their relationships, when they are relocated.
Group Therapy With Offender Patients Who are Mentally Handicapped
Authors: McGinnity Maria , Curran Michael
Published: August 2010

Nine Offender patients, who are mentally handicapped and detained in a secure environment were included in a psychotherapy group, which met weekly for sixteen weeks. The patients demonstrated an ability to interact within a group setting and to use the milieu in a therapeutic way. The therapists gained an insight into the dynamics of patient relationships and the subculture of life in a hospital.

There was no evidence that running such a group in a secure unit undermined staff authority or caused any deterioration in other staff patient relationships. We would recommend group therapy be included in the range of treatments offered to patients with a mental handicap, including those living in a secure setting.
Specialised Treatment Units for People With Challenging Behaviours
Authors: Newman Ian , Emerson Eric
Published: August 2010

This paper reviews the debate surrounding the value of specialised treatment facilities for people with seriously challenging behaviours. Distinctions are made between advantages and disadvantages resulting from specialisation, and those resulting from specalised services being unit based. Distinctions are also made between the inherent disadvantages of services and observed but remediable disadvantages arising from inadequate implementation. Results from a survey of specialised units in England and Wales are presented.
The Sociosexual Needs of People with a Mental Handicap: The Development of a Structure for Discussion
Authors: Jones Jo , Kitson Deborah , Craft Ann , Zadik Tom
Published: August 2010

A format is presented for the discussion and assessment of the sociosexual needs of an individual living in a residential setting. It has a three‐fold purpose: firstly to focus on interpersonal skills and sexuality, particularly during the preparation of individual programme plans, and highlighting areas where help is required; secondly to heighten direct care staff's awareness of clients' sociosexual needs; thirdly to consider their social environment. It is at an early stage of development and is put forward here as a pilot project which might be adapted for use in a variety of situations and developed by other workers. It is not presented as a comprehensive tool for assessment but a means of exploring the dynamics of the situation.
An Intensive Toilet Training Programme for a Boy with a Profound Mental Handicap Living in the Community
Authors: Smith Linda J. , Bainbridge Guy
Published: August 2010

Many people with a profound degree of mental handicap remain wet by day despite routine attempts at toilet training and despite favourable environments. Some recent work, which attempted to replicate Azrin and Foxx's (1971) intensive toilet training programme, but in a community setting, concluded that this programme is not feasible in such a setting. The present paper presents data for just such an intensive toilet training programme carried out with an eleven‐year‐old boy with a profound mental handicap in the community. The programme has been found to be highly effective, both in institutional and community settings. Differences between the use of parents as trainers and ‘professional’ trainers are discussed, as are problems of generalisation and maintenance of newly learned skills in a community setting.