Health and social care workers’ understanding of the meaning and management of challenging behaviour in learning disability services.

The present study sought to investigate the relationship between professional background, length of experience, understanding of the term “challenging behaviour” and opinions of factors important in managing challenging behaviour in people with a learning disability. Health Workers identified significantly more definition criteria than Social Care Workers, yet no significant difference was found between their overall scores for management criteria. Rather the emphasis of their knowledge of management principles appeared to be different. A significantly greater percentage of Health Workers identified management criteria relating to psychological principles, while a greater percentage of Social Care Workers identified that of reactive responses. Health Workers seemed more likely to identify challenging behaviour in terms of its impact on the service while Social Care Workers appeared to concentrate on the type of behaviour evident. Finally, the longer the experience of the Social Care Worker, the higher their overall scores for the definition and management criteria. However, no significant relationship was found between experience and overall scores amongst Health Workers. Implications of the findings are discussed

Knowledge of learning disabilities: the relationship with choice, duty of care and non-aversive approaches

The present study examines the relationship between the knowledge of the diagnostic criteria for a learning disability (based on DSM IV criteria), care practices and experience in health care and social care staff. Responses to a questionnaire were analysed in terms of participants emphasis on: recognizing duty of care; enabling choice; non-aversive and aversive strategies. Results indicated that the knowledge of the criteria for a learning disability was limited, with only I6% of the sample correctly identifying all three criteria. There were no significant differences between the two groups in relation to experience or level of knowledge. No clear cut differences were found between the groups in relation to tendency to emphasize a particular management approach, with the strategies adopted appearing to be influenced by vignettes used in this study. Participants tended to give responses that identified both a recognition of their duty of care to clients and the need to enable choice. Limitations of this study are discussed

The Assessment of Behavioural Decline in Adults with Down's Syndrome

The present study examines two methods of using the Vineland Adaptive Behaviour Scales as a measure of behavioural change in people with Down syndrome who are at risk of developing Alzheimer’s disease. The first method uses the Vineland scales as the basis of a semi-structured interview and notes all areas of behavioural change identified by staff; the second method scores the Vineland scales using the basal rule outlined in the manual. The comparison of these two methods illustrated that using the second method highlighted a significant decline in scores for the group meeting the criteria for ‘probable Alzheimer’s disease’ on a number of domains between baseline and 12–24 months. However, this scoring method also appeared to miss more subtle changes in behaviour, which may be important early indicators of Alzheimer’s disease, which were picked up by the first method. The implications of the study are discussed

Emotional understanding in aggressive and non-aggressive individuals with a mild and moderate learning disability, and research portfolio

This study provides a systematic review of the evidence concerning identification of facial emotion of adults with a learning disability. Sixteen studies were reviewed, and grouped in terms of experimental procedures employed. The highest quality studies were consistent in finding that emotion identification is impaired in individuals with a learning disability relative to non-learning disabled peers. This deficit appears to be specific to emotion and cannot be fully explained by general cognitive deficits. However, comparisons with mental age matched controls have produced conflicting results. Further, the findings suggest a differential pattern of responding across emotions, with some studies identifying no impairment for particular emotions, such as happiness. The results are discussed in terms of their practical and research implications

An Examination of the Severe Impairment Battery as a Measure of Cognitive Decline in Clients with Down's Syndrome

The present study examined the validity of the Severe Impairment Battery (SIB) as a tool for measuring cognitive decline in clients with Down syndrome. Two groups participated: 10 clients who showed behavioural decline over at least a 2 year period as measured by the Vineland Adaptive Behaviour Scales, and 14 clients who showed no decline on this measure over the same period. No differences were found between the two groups in relation to health or life factors which may have impacted on functional and cognitive decline. The deteriorating group were found to be significantly older than the non-deteriorating group. The comparison of the SIB scores indicated that the deteriorating group showed a significant decline between baseline and 12 months and baseline and 24 months on the orientation factor. By contrast, for the non-deteriorating group, significant increases were found for praxis, orientating to name and total scores

Health and social care staff responses to working with people with a learning disability who display sexual offending type behaviours

This study found that 59% of social care staff were currently supporting a client with a learning disability who had offended or displayed an offending type behaviour. The range of behaviours was similar to that displayed by clients in a secure health facility and included rape, sexual assault and exposure. Only 22.9% of social care staff had received training in this area, while none of the health stuff had. Both groups expressed low levels of confidence in supporting this client group. The areas of difficulty were common to both groups and included personal attitudes and attitudes of others to the behaviour, and concern over risk, responsibility and safety. In respect of attitudes, social care staff were found to be significantly more likely to hold negative attitudes towards the person's behaviour, while health staff were significantly more likely to feel negatively towards the person. Health staff were significantly more likely to identify training as a means of further support, while social care staff identified professional input. Both groups identified the need for theoretical training about working with this client group. Despite this no significant differences were found between those who had and had not received training and confidence, attitudes and the need for further support

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

An Examination of the Importance of Aspects of Services to People with a Learning Disability

The present study examined the importance of some aspects of services received by individuals with a learning disability. All of the items were rated as important by over 85% of respondents. Only two significant differences were found among the participants in relation to (a) length of hospitalisation and (b) degree of learning disability, suggesting a consensus view. The relevance of evaluating the importance of aspects of service provision in relation to consumer satisfaction and quality of life research is discussed

Impact of group training on emotion recognition in individuals with a learning disability

The present paper outlines the impact of group training on the emotion recognition of six individuals with a moderate learning disability. The accuracy of identifying emotions depicted by line drawings and photographs with and without an emotional context was examined before and after group training. The results indicated that there was a significant overall increase in accuracy in identifying emotions following group training. In addition, a significant increase was found in the ability to correctly label emotions depicted by line drawings typically used in symbol-based communication systems. The implications of the results are discussed

Health and social care workers' knowledge and application of the concept of duty of care

This study used vignettes to examine the understanding and application of the concept of duty of care by health and social care staff working in learning disability services, and the relationship of this to promoting client choice. The study found that health care staff had a significantly broader understanding of the concept of duty of care than social care staff, and were significantly more likely to emphasise client safety. Implications of the findings are discussed