Towards an understanding of profound mental handicap

A brief introduction to profound mental handicap (PMH) is given. Problems in identifying the population to be studied are described, and detailed criteria, based upon behavioural characteristics, are proposed. A comprehensive survey of research literature relevant to people with profound mental handicap is presented, and inadequacies discussed. Frameworks within which to place the behaviour of the profoundly mentally handicapped are also discussed, and a modified developmental framework is suggested. An argument is made for the usefulness of conducting research which is informed by mother-infant studies and which examines the naturally occurring behaviour of the profoundly mentally handicapped, paying particular attention to communicative and emotional characteristics.The behaviour of a representative sample of 66 people with profound handicap, living at home or in one of three institutions, is investigated using micro-analysis of filmed sessions between carer and subject, and information gathered from two oral questionnaires administered to carers. A reliable profile of the behavioural characteristics of this sample of people with profound handicap is therefore obtained.Important findings include: a high level of awareness and engagement to the carer indicating a general responsiveness amongst people with profound handicap to aspects of the environment, and the ability to communicate with other people; evidence of a wide variety of social and emotional behaviours, in particular a discriminating sense of humour; evidence of spontaneous learning; and the presence of a 'responsiveness' factor underlying the behaviour of people with profound handicap, and dividing the subjects into distinct subgroups.The implications of these findings for the day-to-day care of people with profound handicap, and for an improved understanding of the nature of profound mental handicap are discussed

Real-World Training for Real-World Benefits: Exploring the Impact of Practice-Based Service Evaluation Training

Service evaluation is a major part of delivering effective healthcare. It is important that the future workforce of clinical psychologists is equipped with the skills required to complete evaluations of the services that they deliver. This article investigated the extent to which practice-based Service Evaluation Projects (SEPs) completed by trainee clinical psychologists at the University of Leeds had an impact on the real-world services that commissioned them. Descriptive analysis was used to summarise the characteristics of SEPs completed over the past thirteen years and to explore feedback from semi-structured interviews held with a sample of commissioners. Thematic analysis was used to identify key themes relating to the impact of SEPs. 230 SEPs have been completed in the past thirteen years. Interviews with 15 commissioners concerning 38 individual SEPs found that the majority had a positive impact (n = 33), most of which were able to bring about a change independently of other initiatives within the service (n = 20). Almost all would have been impossible without the opportunity for clinicians to commission SEPs via the university. Three key themes emerged in terms of impact: improving processes; improving knowledge; and improving resources. Practice-based service evaluations completed by trainee clinical psychologists can lead to a positive impact on real-world services. This suggests that providing training experiences ‘in the field’ is a helpful pedagogical strategy, adding value to services as well as trainee health professionals

The development of the Acceptance and Commitment Therapy Fidelity Measure (ACT-FM) : a delphi study and field test

Being able to assess whether psychological therapies are delivered according to their own principles is helpful for assuring treatment quality in research and training. We aimed to develop and preliminarily test a measure of therapist fidelity to Acceptance and Commitment Therapy (ACT) that is concise in measuring key therapist behaviours, reliable, practicable and potentially applicable across therapy contexts. This measure was developed via expert consensus in a Delphi study (Study 1). Here, thirteen expert ACT practitioners (average of 11 years’ experience with ACT, including 6 ACBS Peer Reviewed ACT Trainers) participated in three iterative rounds of online questionnaires. A preliminary draft of the measure was used to initiate discussion. In the first two rounds, participants rated and commented on existing items, the manual, and structure of the measure, and generated new items for consideration. In a third round, participants commented on the emergent draft of The ACT Fidelity Measure (ACT-FM). The Delphi study resulted in a 24-item measure with items structured around the three-part model of psychological flexibility (“Tri-flex”) alongside Therapist Stance. Eighty-three percent of the chosen items met the specified criteria for consensus. In Study 2, to investigate usability and preliminary psychometric properties of the ACT-FM, a separate group of nine clinicians used the ACT-FM to rate a video of an ACT therapy session. Inter-rater reliability was moderate to excellent. Based on clinician feedback, the measure was expanded to 25 items. To reach the stated aims, further work is required – particularly evaluating the utility of the ACT-FM across therapy contexts

Identity change and the human dissection experience over the first year of medical training

The aim of this study is to explore identity change in medical students over their first year of medical training, particularly in relation to their experience of human dissection. Each of our four participants completed two repertory grids at the end of term one and, again, towards the end of term three. One grid tapped their identity construction, and the other, their experience of human dissection. Our participants were optimistic about becoming similar to a doctor they admired and, towards the end of term three, began to develop a stable identity as a medical student. Their identity constructs involved three common themes: dedication, competence, and responsibility. However, the data also revealed negative reactions to the demands of training, such as feeling driven and stressed. Three major themes were apparent in their experience of human dissection: involvement, emotional coping, and ability. Our participants’ dedication to their studies was reflected in their appreciation of the need to become involved actively in the process of dissection but some experienced an erosion of their self-confidence and perceived some of their colleagues to have lost much of their enthusiasm for learning. Emotional coping could be an additional challenge within this context and their reaction tended to reflect distancing processes previously identified in the literature. In all, we see a development of a vulnerable sense of professionalism alongside a frustration of losing out potentially on wider aspects of personal development due to the high work demands

Supported self-management for adults with type 2 diabetes and a learning disability (OK-Diabetes): study protocol for a randomised controlled feasibility trial

Background: Individuals with a learning disability (LD) are at higher risk of developing type 2 diabetes, but LD is not straightforward to define or identify, especially at the milder end of the spectrum, which makes case finding difficult. While supported self-management of health problems is now established, current material is largely educational and didactic with little that facilitates behavioural change. The interaction between the person with diabetes and others supporting their care is also largely unknown. For these reasons, there is considerable work needed to prepare for a definitive trial. The aim of this paper is to publish the abridged protocol of this preparatory work. Methods/Design: Phase I is a prospective case-finding study (target n = 120 to 350) to identify and characterise potential participants, while developing a standardised supported self-management intervention. Phase II is a randomised feasibility trial (target n = 80) with blinded outcome assessment. Patients identified in Phase I will be interviewed and consented prior to being randomised to (1) standard treatment, or (2) supported self-management. Both arms will also be provided with an ‘easy read’ accessible information resource on managing type 2 diabetes. The intervention will be standardised but delivered flexibly depending on patient need, including components for the participant, a supporter, and shared activities. Outcomes will be (i) robust estimates of eligibility, consent and recruitment rates with refined recruitment procedures; (ii) characterisation of the eligible population; (iii) a standardised intervention with associated written materials, (iv) adherence and negative outcomes measures; (v) preliminary estimates of adherence, acceptability, follow-up and missing data rates, along with refined procedures; and (vi) description of standard treatment. Discussion: Our study will provide important information on the nature of type 2 diabetes in adults with LD living in the community, on the challenges of identifying those with milder LD, and on the possibilities of evaluating a standardised intervention to improve self-management in this population. Trial registration: Current Controlled Trials ISRCTN41897033 (registered 21 January 2013)

Identity change and the human dissection experience over the first year of medical training

The aim of this study is to explore identity change in medical students over their first year of medical training, particularly in relation to their experience of human dissection. Each of our four participants completed two repertory grids at the end of term one and, again, towards the end of term three. One grid tapped their identity construction, and the other, their experience of human dissection. Our participants were optimistic about becoming similar to a doctor they admired and, towards the end of term three, began to develop a stable identity as a medical student. Their identity constructs involved three common themes: dedication, competence, and responsibility. However, the data also revealed negative reactions to the demands of training, such as feeling driven and stressed. Three major themes were apparent in their experience of human dissection: involvement, emotional coping, and ability. Our participants' dedication to their studies was reflected in their appreciation of the need to become involved actively in the process of dissection but some experienced an erosion of their self-confidence and perceived some of their colleagues to have lost much of their enthusiasm for learning. Emotional coping could be an additional challenge within this context and their reaction tended to reflect distancing processes previously identified in the literature. In all, we see a development of a vulnerable sense of professionalism alongside a frustration of losing out potentially on wider aspects of personal development due to the high work demands.Medical education Professional identity Human dissection Repertory grids Gross anatomy UK