Associations between mental health problems and challenging behavior in adults with intellectual disabilities: A test of the behavioral equivalents hypothesis

Introduction Current research findings in the field of intellectual disabilities (ID) regarding the relationship between mental health problems and challenging behavior are inconclusive and/or contradictory. The aim of this study was to further investigate the putative association between these two, highly prevalent phenomena, in people with ID and specifically to explore the hypothesis that challenging behaviors may be behavioral equivalents of mental health problems. Methods A sample of 160 adults accessing secondary care ID health services were assessed using five validated measures. These included ratings of severity of disability, mental health problems, Autism behaviors, physical health problems, and four different aspects of challenging behavior. In conjunction with demographic information, four multiple regression analyses were undertaken to examine the interaction between mental health problems (moderated by severity of disability) and ratings of overall challenging behavior, aggression, self-injurious behavior, and stereotypy. In each case; age, gender, Autism, and physical health problems were included as covariates. Results There was a statistically significant association between mental health problems and ratings of overall challenging behavior, as well as the moderating effect of severity of disability. Importantly, the positive association between mental health problems and challenging behavior was only significant at more severe levels of disability. Conclusions These findings support the 'behavioral equivalents' hypothesis for mental health problems and challenging behaviors. However, further longitudinal research is required before this hypothesis can be considered unequivocally supported

The extension of a set of needs-led mental health clusters to accommodate people accessing UK intellectual disability health services

Background: A development of a needs-led mental health classification system based on the Health of the National Outcome Scales (HoNOS) has previously been developed. Aims: To extend the needs-based mental health (MH) clusters to accommodate the additional needs of people accessing UK intellectual disabilities health services. Method: Hierarchical cluster analysis was performed on assessment data from 18 National Health Service (NHS) provider organisations. The statistical results were clinically shaped through multi-disciplinary workshops. The resulting clusters were combined with six independently rated measures for a second data collection exercise. Based on these data, refinements were made before performing internal and external validity checks. Results: Eight additional clusters for people with health needs associated with their intellectual disabilities were produced. Three described primarily physical health (PH) needs, four described needs arising from behaviours which challenged (with/without autism) whilst one described people with generally low needs. Together, these covered 83.4% of cases with only a 10% overlap. The clusters were replicable and had clinical utility and validity. Conclusions: It was possible to extend the needs-led mental health classification system to capture the additional needs of people accessing UK intellectual disability services

Correlates for the risk of specialist ID hospital admission for people with intellectual disabilities: development of the LDNAT inpatient index

Purpose: The aim of this study was to analyse ratings data from the recently developed Learning Disability Needs Assessment Tool (LDNAT) to identify factors associated with specialist intellectual disability (ID) hospital admissions. Design/methodology/approach: Ratings from 1,692 individuals were analysed and the LDNAT items differing significantly between inpatients and non-inpatients were identified. Statistical analyses on total scores derived from these items were used to calculate an optimal cut-off. This LDNAT Inpatient Index score was also confirmed via an alternative statistical technique.. Findings: On average, 18 of the 23 LDNAT item ratings were significantly higher in people with ID assessed as inpatient compared to those rated in community settings. Using the total of these items, the resulting LDNAT Inpatient Index was analysed. A cut-off score of 22.5 was calculated to be the optimal balance between sensitivity (.833) and specificity (.750). This was confirmed by calculating the Youden index (j= .583). At this level 68% of inpatients and 81% of non-inpatient cases were correctly identified. Practical implications: Currently there is a national (UK) programme to radically reduce the amount of specialist inpatient care for people ID. This will necessitate early identification of individuals most at risk of admission together with investment in improved, proactive community services if admissions to a diminishing bed-base are to remain manageable. Originality/value: This study confirms the associations between mental health difficulties, challenging behaviour and specialist hospital admissions for people with ID, extending existing research by translating these findings into a clinically usable risk index

‘Shades of Grey’: The Ethics of Social Work Practice in Relation to Un-prescribed Anabolic Androgenic Steroid Use

© 2018, © 2018 British Association of Social Workers. This paper reflects on some of the ethical dilemmas that social workers face when assessing risk in relation to those using substances. It explores how legislation and societal factors can impact not just on people’s choices and decisions but also on their ‘vulnerability’ and access to services. Vulnerability, a contested term, is linked, in this paper, to assessment of risk. There are ethical issues that arise when assessing risk with people who use Anabolic Androgenic Steroids (AAS) from both service user and professional perspectives. These ethical issues concern a person’s right to choose and make potentially harmful decisions. The paper argues that using substances such as AAS in and of itself does not suffice to make a person vulnerable but this does not mean that people using AAS are not in need of support. It suggests that there may be some groups of people who are more at risk to starting AAS use and that social workers should be aware of these. It also recommends the need for further qualitative research to understand the reasons for starting use and support to help people stop using AAS

Conflicting outlooks: the background to the 1924 deposing of the six nations hereditary council

Bibliography: p. 116-12

A Random Controlled Trial to Examine the Efficacy of Blank Slate: A Novel Spaced Retrieval Tool with Real-Time Learning Analytics

Learner-centered coaching and feedback are relevant to various educational contexts. Spaced retrieval enhances long-term knowledge retention. We examined the efficacy of Blank Slate, a novel spaced retrieval software application, to promote learning and prevent forgetting, while gathering and analyzing data in the background about learners’ performance. A total of 93 students from 6 universities in the United States were assigned randomly to control, sequential or algorithm conditions. Participants watched a video on the Republic of Georgia before taking a 60 multiple-choice-question assessment. Sequential (non-spaced retrieval) and algorithm (spaced retrieval) groups had access to Blank Slate and 60 digital cards. The algorithm group reviewed subsets of cards daily based on previous individual performance. The sequential group reviewed all 60 cards daily. All 93 participants were re-assessed 4 weeks later. Sequential and algorithm groups were significantly different from the control group but not from each other with regard to after and delta scores. Blank Slate prevented anticipated forgetting; authentic learning improvement and retention happened instead, with spaced retrieval incurring one-third of the time investment experienced by non-spaced retrieval. Embedded analytics allowed for real-time monitoring of learning progress that could form the basis of helpful feedback to learners for self-directed learning and educators for coaching

Geographical and spatial disparities in the incidence and survival of rare cancers in Australia

Rare cancers collectively account for around a quarter of cancer diagnoses and deaths. However, epidemiological studies are sparse. We describe spatial and geographical patterns in incidence and survival of rare cancers across Australia using a population-based cancer registry cohort of rare cancer cases diagnosed among Australians aged at least 15 years, 2007 to 2016. Rare cancers were defined using site- and histology-based categories from the European RARECARE study, as individual cancer types having crude annual incidence rates of less than 6/100 000. Incidence and survival patterns were modelled with generalised linear and Bayesian spatial Leroux models. Spatial heterogeneity was tested using the maximised excess events test. Rare cancers (n = 268 070) collectively comprised 22% of all invasive cancer diagnoses and accounted for 27% of all cancer-related deaths in Australia, 2007 to 2016 with an overall 5-year relative survival of around 53%. Males and those living in more remote or more disadvantaged areas had higher incidence but lower survival. There was substantial evidence for spatial variation in both incidence and survival for rare cancers between small geographical areas across Australia, with similar patterns so that those areas with higher incidence tended to have lower survival. Rare cancers are a substantial health burden in Australia. Our study has highlighted the need to better understand the higher burden of these cancers in rural and disadvantaged regions where the logistical challenges in their diagnosis, treatment and support are magnified.</p