Positive behavioural support in schools for children and adolescents with intellectual disabilities whose behaviour challenges: an exploration of the economic case

Decision-makers with limited budgets want to know the economic consequences of their decisions. Is there an economic case for positive behavioural support (PBS)? A small before–after study assessing the impact of PBS on challenging behaviours and positive social and communication skills in children and adolescents with intellectual disabilities and behaviours that challenge was followed by an evaluation of costs. Results were compared with the costs of alternative packages of care currently available in England obtained from a Delphi exercise conducted alongside the study. Children and adolescents supported with PBS showed improvement in challenging behaviours and social and communication skills, at a total weekly cost of GBP 1909 (and GBP 1951 including carer-related costs). PBS in schools for children and adolescents with intellectual disabilities and behaviours that challenge may help to support them in the community with potential improvements in outcomes and also cost advantages

Residential school placements for children and young people with intellectual disabilities: their use and implications for adult social care

Out of area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. In recent years there has been an increased drive to reduce such placements at as early a stage as possible. In this context the current review collates research and policy regarding use of residential schools for children and young people with intellectual disabilities and transition from these settings to adult services. The review highlights that relatively little is known about both use of, and transition from, residential schooling for children and young people with intellectual disabilities in the UK. Thirteen articles are identified: 7 examining the child or families’ experiences before placement, 4 examining outcomes during the placement, and 4 examining the process of transitioning from the placement and longer term outcomes. The methodological quality of articles was often limited. A lack of control groups, independent samples, or adequate sample sizes was particularly notable. Results are discussed in relation to factors that lead to a child’s placement in a residential school, children and families’ experiences of the placement, and outcomes following placement, including the transition process. A number of research priorities are highlighted based on gaps in the literature. Examples of alternative forms of support from clinical practice are provided, with recognition that a multi-element model is likely to be needed to provide high quality support to this group of young people

Implementing evidence-based practice: the challenge of delivering what works for people with learning disabilities at risk of behaviours that challenge

There is an apparent disconnect between the understanding of best practice and service delivery in the support of people with learning disabilities at risk of behaviours that challenge. We suggest, is a problem of implementation. The purpose of this paper is to explore reasons why this might be the case: a failure to recognise the collective works of successive generations of research and practice; and a failure to address the macro-systems involved and systems changes needed to support implementation. Design/methodology/approach: This paper reviews the consensus that exists in respect of best practice. Drawing upon ideas from implementation science the paper highlights the complexities involved in the implementation of all evidence-based practices and uses this as a framework to propose ways in which an infrastructure that facilitates the delivery of services in the learning disabilities field might be built. Findings: This paper highlights core recommended practices that have been consistent over time and across sources and identifies the systems involved in the implementation process. This paper demonstrates that many of the necessary building blocks of implementation already exist and suggests areas that are yet to be addressed. Critically, the paper highlights the importance of, and the part that all systems need to play in the process. Originality/value: In the absence of any generalised implementation frameworks of evidence-based practice in the learning disabilities field, the paper suggests that the findings may provide the basis for understanding how the gap that exists between best practice and service delivery in the support of people with a learning disability at risk of behaviours that challenge might be closed

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

The Acceptance and Commitment Therapy (ACT) diary 2021: a guide and companion for moving toward the things that matter in your life

Life is often busy, demanding and full of challenges that can cause us to lose sight of what really matters. Designed for anyone seeking to live a life in the coming year that is aligned to their values, The Acceptance and Commitment Therapy (ACT) Diary 2021 combines space for reflection with gentle guidance to help individuals stay true to what really matters. It is especially helpful for those currently engaged in Acceptance and Commitment Therapy; however, the principles are relevant to anyone seeking to increase their psychological flexibility - the ability to connect fully with experiences, including difficult thoughts and feelings, and pursue an authentic life. Values clarification exercises at the outset of the year help users to define what broad directions they want to pursue, and include lists of sample values to stimulate ideas. Accessible weekly pieces by the authors then discuss aspects of psychological flexibility, present helpful metaphors, and suggest exercises for the week ahead that will help to identify core values, clarify issues and record goals. Reflection spaces offer regular opportunities to record thoughts, identify barriers and track progress. Filled with expert guidance and inspirational quotations for the year ahead, The Acceptance and Commitment Therapy (ACT) Diary 2021 puts values centre-stage where they can best guide actions and decisions

The Acceptance and Commitment Therapy (ACT) diary 2020: a guide and companion for moving toward the things that matter in your life

Life is often busy, demanding and full of challenges that can cause us to lose sight of what really matters. Designed for anyone seeking to live a life in the coming year that is aligned to their values, The Acceptance and Commitment Therapy (ACT) Diary 2020 combines space for reflection with gentle guidance to help individuals stay true to what really matters. It is especially helpful for those currently engaged in Acceptance and Commitment Therapy; however, the principles are relevant to anyone seeking to increase their psychological flexibility - the ability to connect fully with experiences, including difficult thoughts and feelings, and pursue an authentic life. Values clarification exercises at the outset of the year help users to define what broad directions they want to pursue, and include lists of sample values to stimulate ideas. Then, accessible weekly pieces by the authors discuss aspects of psychological flexibility, present helpful metaphors, and suggest exercises for the week ahead that will help to identify core values, clarify issues and record goals. Reflection spaces offer regular opportunities to record thoughts, identify barriers and track progress. Filled with expert guidance and inspirational quotations for the year ahead, The Acceptance and Commitment Therapy (ACT) Diary 2020 puts values centre-stage where they can best guide actions and decisions

Spoken rules

None- this was a magazine article

The science of children's wellbeing: Practical sessions to support children aged 7 to 11

This essential book is packed full of comprehensive guidelines and practical resources for running wellbeing intervention sessions for children aged 7 to 11, drawing from the scientifically grounded Six Ways to Wellbeing and the DNA-V model. Each chapter focuses on one of the Six Ways to Wellbeing, six patterns of action known to correlate highly with aspects of positive mental health and wellbeing. These principles have been translated into 36 step-by-step sessions to develop children’s wellbeing and psychological flexibility and support those struggling with aspects of their mental health. The sessions can be delivered by educators with the whole class, with small groups as targeted wellbeing interventions or easily adapted to fit one-to-one contexts