Emerald Group Publishing Limited
Article Type: Editorial From: Tizard Learning Disability Review, Volume 20, Issue 3.
As readers well know, people with learning disabilities are a heterogenous group whose differences are as important as their similarities. In the first paper of the current issue, Cecily Donnelly, Julie Elsworth and Jules McKim describe one organisation’s attempts to ensure that those of its clients who have a profound and multiple learning disability are well-served through the provision of Intensive Interaction. In the second main paper, James McParland reviews published work on the use of narrative therapy with a number of individuals, probably all of whom had a mild or moderate learning disability. It would be hard to imagine two more different approaches but, limited research evidence notwithstanding, their variations are intended to match with the needs and characteristics of quite different individuals – people with a profound and multiple learning disability are very different to people with mild/moderate disabilities. Of course, it is important to remember that such disparate groups also have many shared needs. Peter Baker’s commentary draws attention to approaches, such as active support, which are potentially applicable with all people with learning disabilities. Consideration of the two articles also draws attention to the importance of clearly describing the people involved. This is an issue that Angela Olsen picks up in her commentary. The way people are described, and the way they describe themselves, are clearly very important and can have a huge influence for good or ill. But this is also, as Olsen notes, a very important research issue. If we do not know enough about the participants in a research study (and often we do not), it will be very difficult to judge what researchers call the “external validity” of the study, i.e. the extent to which its findings can be generalised to the groups and settings in which we are interested.
As is often the case in TLDR, two articles focused on approaches to work with individuals are followed by two articles more aimed at understanding the social, service and policy contexts surrounding people with learning disabilities. The paper by Dave Marsland, Peter Oakes and Naomi Bright reviews some of the professional and government responses to England’s Winterbourne View scandal and concludes that the action taken so far is likely to be insufficient to prevent future abuse. Given the amount of work carried out since 2011, this is a potentially chastening conclusion. Michele Wiese’s commentary draws particular attention to the importance of implementation, suggesting that at least part of the problem is the failure to implement potentially effective approaches such as positive behaviour support. Note the connection here between the broader context and what happens to individuals. Approaches such as Intensive Interaction, Narrative Therapy, Active Support, Positive Behaviour Support and so on, are potentially very useful in work with people with learning disabilities but, to say the obvious, they have to be used to be useful and, as we all know, rhetoric is not reality. Also, even when they are used they are likely to be insufficient. Technical solutions of any kind, however, well-supported by research, are never enough when not supplemented by a favourable context in which carers interact positively and respectfully, organisations deliver what people want, and governments provide the necessary clear aims and funding to achieve them.
The final main article, by Kate Blamires, picks up a number of these themes. In particular, it tells the story of what almost seems like a crescendo of policy making around employment in the UK while noting the failure, at least to date, to demonstrate any impact on the rate at which people with learning disabilities are actually employed. As Kathy Melling notes in her commentary, there are clearly issues of implementation (or lack of it) here. Kathy also brings an optimistic note, however, identifying a number of positive changes that have been achieved and that may now lead to real impact. This business of achieving positive outcomes for individuals is not easy even when confined to relatively technical 1-1 therapeutic approaches. It becomes even harder when the influences on outcomes are more wide ranging. Only by taking a perspective that integrates more “clinical” and more “systemic” approaches can we hope to succeed.
I note with regret the recent death of Ann Clarke (1928-2015). Ann Clarke was an eminent psychologist in her own right (see obituary at www.tandfonline.com/doi/pdf/10.3109/13668250.2015.1025680). She was also married to Alan Clarke (1922-2011) and much of their work was jointly carried out. Both were founding members of the International Association for the Scientific Study of Intellectual and Developmental Disabilities and co-editors of the four editions of the book Mental Deficiency: The Changing Outlook, that made a major contribution to the education of academics and professionals for some 30 years.