Providing services in the United Kingdom to people with an intellectual disability who present behaviour which challenges: A review of the literature

There is ongoing debate about the best model of service provision for people with an intellectual disability who present severe behavioural challenges. The present paper reviewed research which evaluated a range of UK service provision in terms of impact on challenging behaviour and other quality of life indices. A literature search was carried out for English language papers from 1990 to 2010 using a range of databases. Secondary searches were carried out from references of relevant papers. Very few evaluations were found. The available research indicates that, on the whole, specialist congregate services for individuals with challenging behaviour appear to use more restrictive approaches which have limited effect on reducing challenging behaviour. The evidence for peripatetic teams is somewhat unclear. The two studies reviewed showed positive outcomes, but both had limitations that made it difficult to generalize the results. A similar limitation was found with the sole evaluation of a community based service. It is unlikely that one model of service provision will meet the needs of all individuals, however, more robust evaluations are required of existing service models to allow commissioners, service users, their families and carers to make fully informed choices about effective services for those who challenge

The Application of the Theory of Planned Behaviour to Diet in Carers of People with an Intellectual Disability

Background - The utility of the theory of planned behaviour (TPB) in predicting the intentions of care staff to encourage healthy eating behaviour in those they supported was examined. Method - A quantitative, within-participant, questionnaire based design was used with 112 carers to assess the performance of two TPB models. The first contained the variables: attitude, subjective norm and perceived behavioural control. The second had additional variables of self efficacy and self identity. Results - Model 1 accounted for 31% of the variance with all three variables being significant predictors. Adding variables increased the overall predictive power of the model by 4%, but resulted in a reduction in the predictive power of the individual variables. Conclusion - The results suggests the TPB is a useful model for predicting carer intentions in relation to the diet of those they support, with their perceptions of the attitudes of others towards healthy eating being a key influential factor. Ways in which this may inform interventions to improve the overall health of people with intellectual disabilities are discussed

Sex Differences and Promotion Prospects in Clinical Psychology in Scotland

The following paper compares the gender bias in the Clinical Psychology profession in Scotland between 1990 and 1997. A larger proportion of females as compared with males are found both at the post-graduate training stage up until 1996 and at all levels of the profession, with the exception of B-grades where there were more males, in 1990. The study gives some evidence of a shift towards parity of the sexes between 1990 and 1996. A more equal ratio of males to female clinical psychology graduates is found in 1996 and a similar ratio of male to female B Grade clinical psychologists was found in 1997. However, the latter suggests that a disproportionate number of males hold B Grade posts when taken in the context of the demographics of the Scottish Clinical Psychology profession as a whole. A number of implications of these findings are discussed

Confirmatory factor analysis of the Adult Asperger Assessment: The association of symptom domains within a clinical population

Autism Spectrum Disorder (ASD) is a behaviourally defined disorder characterised by impairments in three domains of social interaction, communication, and repetitive, stereotyped behaviours and activities. Proposed changes to diagnostic criteria suggest that the diagnostic triad may no longer fit as the best way to conceptualise ASD, and that social and communication impairments should be considered as a single domain. The aim of this study was to examine the structure of symptom domains within the Adult Asperger Assessment (AAA; Baron-Cohen, Wheelwright, Robinson, & Woodbury-Smith, 2005), a diagnostic tool for high functioning adults. As theoretical models already exist, confirmatory factor analysis was used to examine data from a clinical population of adults (n = 153) diagnosed with Asperger Syndrome (AS) and High Functioning Autism (HFA). Confirmatory factor analysis was used to fit different models based on the structure proposed by the authors of the AAA, the traditional triad and the newly proposed diagnostic dyad. Analysis suggested that none of the tested models were a good fit on the AAA dataset. However, it did highlight very high correlations between social and communication factors (r > 0.9) within unmodified models. The results of the analysis provide tentative support for the move towards considering ASD as a dyad of 'social-communication' impairments and repetitive/restricted interests behaviours and activities, rather than the traditional triad

Screening for Intellectual Disability in Children: A Review of the Literature

BACKGROUND: Early identification of possible intellectual disability can help children and families access appropriate services and support more quickly. There has been an increasing interest in the use of screening tools for this purpose. This study reviews the literature in relation to such tools. METHODS: A literature search was carried out for English language articles from 1990 to 2009 using a range of databases. Secondary searches were carried out from references of relevant articles. RESULTS: Only one article was identified which examined the ability of an assessment to specifically identify children with a potential intellectual disability; however, no information was provided about sensitivity, specificity or cut-off points. CONCLUSIONS: There is not, as yet, a screening tool that can reliably identify children with a probable intellectual disability. Further research in this area is needed

An Examination of the Factors That Facilitate and Hinder the Care Planning Process for Very Young Children in Scotland

The study reported here by Linda Davidson and Karen McKenzie examined the care planning process for very young children in Scotland using both quantitative and qualitative approaches. Data were gathered from existing case files on 18 looked after children aged 0–2 years. A qualitative approach was used to explore the views of six randomly selected social workers about current practice in relation to care planning. The social workers identified a number of factors which both facilitated and hindered the care planning process and in a number of cases the same factor was identified as doing both. The most commonly identified factor was waiting for an expert assessment. This could cause serious delays but once completed, was often the catalyst for change. The participants identified a further number of factors which they felt could improve the process, including additional training. Their responses are discussed in the context of recent legislative changes in Scotland

An Examination of the Factors That Facilitate and Hinder the Care Planning Process for Very Young Children in Scotland

The study reported here by Linda Davidson and Karen McKenzie examined the care planning process for very young children in Scotland using both quantitative and qualitative approaches. Data were gathered from existing case files on 18 looked after children aged 0–2 years. A qualitative approach was used to explore the views of six randomly selected social workers about current practice in relation to care planning. The social workers identified a number of factors which both facilitated and hindered the care planning process and in a number of cases the same factor was identified as doing both. The most commonly identified factor was waiting for an expert assessment. This could cause serious delays but once completed, was often the catalyst for change. The participants identified a further number of factors which they felt could improve the process, including additional training. Their responses are discussed in the context of recent legislative changes in Scotland

Attracting psychologists to learning disability services: starting with assistants

Assistants employed in a split support worker/psychology assistant post rated the experience of working with people with a learning disability positively and as an opportunity to increase knowledge of clinical psychology theory and its direct application to practice. Drawbacks included role ambiguity

Self-awareness and reflection: exploring the 'therapeutic use of self'

Assesses what the participants gained from a pilot partnership course set up to help social care staff to explore new therapeutic ways of working with people with learning disabilities. Therapeutic use of self; Empathy as a cornerstone of therapeutic work; Presencing; Illustration that all the participants felt that the course had increased their awareness in the areas addressed by the course