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Article
Publication date: 24 October 2023

Lucy Jade Jones and Ceri Woodrow

The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment

Abstract

Purpose

The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.

Design/methodology/approach

Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.

Findings

An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.

Originality/value

There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 17 no. 4
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 1 August 2018

Gareth Hickman, Su Thrift and Chénelle Taylor

The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium and low secure intellectual disability (ID) service. Over the preceding five…

Abstract

Purpose

The purpose of this paper is to describe in detail the treatment pathway utilised in a male medium and low secure intellectual disability (ID) service. Over the preceding five years, service users have followed the outlined treatment pathway. The current paper offers case study material to illustrate the care pathway.

Design/methodology/approach

The treatment pathway is described and two case examples are provided, illustrating participation in the pathway. Evaluative data are provided on length of hospitalisation, direction of pathway at discharge and risk reduction as assessed by the HCR-20, SVR-20 and HONOS Secure measures.

Findings

The case examples provided document the assessment and treatment of two male offenders with ID, outlining their treatment pathways, subsequent reductions in assessed risk and their successful community discharge.

Originality/value

A comprehensive treatment pathway is outlined together with the theoretical rationale, with illustrative case examples.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 9 no. 2
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 4 October 2019

Anna Leonie Wark

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment…

Abstract

Purpose

Legislative guidance stipulates that people with a learning disability have the right to receive local provision of personalised support within the least restrictive environment. On these bases there is a growing emphasis on the requirement for local authorities to develop appropriate services for people who are currently in a hospital setting. The purpose of this paper is to examine the literature addressing factors influencing the provision of effective community-based forensic services.

Design/methodology/approach

The six articles were analysed separately using the evaluation tool – Currency, Relevance, Authority, Accuracy, Purpose. The six articles used divergent sample groups and employed both qualitative and quantitative methods to collate data. The articles shared a purpose of examining forensic community service provision with an aim to improve services.

Findings

There were three themes that emerged consistently across the literature these included: balancing risk management vs individual autonomy; multi-disciplinary and multi-agency working; service improvement. There is a growing emphasis on the need to replace long-term hospital placements with specialist, community provision, employing least restrictive methods and positive responses to crisis situations. In this climate, it is crucial that multi-disciplinary agencies from local authority, health and the charitable and private sector continue to work collaboratively on the integration of service provision in order to bring about the development of effective and responsive community services.

Research limitations/implications

Research limited to peer reviewed and published research papers focusing on the subject of community forensic services with publications specifically made within the time frame of the Transforming Care Agenda.

Practical implications

This paper looks to examine the practical solutions to providing effective community forensic services for a person with an intellectual disability and makes recommendations for research into improving service specific training for support staff.

Social implications

Following the Winterbourne View Hospital scandal (BBC One, 2011) instigations were made to make legislative change under the Transforming Care Agenda. Despite a renewed conviction in the rights of people to be a part of their local community without segregation or discrimination, professionals in the field continue to report a failure to reduce numbers of people in long stay hospitals and secure settings. With commissioning under pressure to make these intentions a reality it is a really good time to reflect on practice and evaluate service models to establish the factors that bring about positive outcomes for individuals enabling inclusion within community settings.

Originality/value

This review will focus on the literature evidencing positive intervention and outcome focussed methods of supporting people with a forensic history in the community. This is an entirely original piece of work analysing peer reviewed and published research.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 10 no. 3
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 22 June 2023

Daisy Alicia Gibson, Holly Eick, Susanne Meddings and Ceri Woodrow

This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line…

Abstract

Purpose

This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.

Design/methodology/approach

This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.

Findings

Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.

Originality/value

This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

Details

Tizard Learning Disability Review, vol. 28 no. 1/2
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 2 January 2018

Neil Sinclair

The purpose of this paper is to raise issues about Transforming Care (TC) and discuss possible solutions.

Abstract

Purpose

The purpose of this paper is to raise issues about Transforming Care (TC) and discuss possible solutions.

Design/methodology/approach

Reflections and commentary on Transforming Care following Painter et al.’s article on correlates for the risk of admission to specialist hospitals.

Findings

Concerns are raised about the initial assumptions of TC, in particular the composition of the inpatient group and impact of the existing legal framework on reducing this population. The lack of cohesion between Care and Treatment Reviews and Care Programme Approach reviews is noted, and combining meetings is suggested.

Originality/value

The relevance of Wolfensberger’s social devaluation analysis is explored and O’Brien’s Personal Futures Planning is recommended as a potential way of drawing these currently disparate approaches together around the individual client.

Details

Tizard Learning Disability Review, vol. 23 no. 1
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 3 February 2020

Faye Bohen and Ceri Woodrow

The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate…

Abstract

Purpose

The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England.

Design/methodology/approach

A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement.

Findings

The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings.

Research limitations/implications

Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended.

Originality/value

The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 2
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 10 July 2017

Jo Jones, Kiran Jeenkeri and Peter Cutajar

The paper is a review, for the general adult mental health practitioner, of the issues to consider when managing a mental health presentation of a person with intellectual…

Abstract

Purpose

The paper is a review, for the general adult mental health practitioner, of the issues to consider when managing a mental health presentation of a person with intellectual disability (PWID). The paper aims to discuss these issues.

Design/methodology/approach

A neurodevelopmental model is outlined to assist practitioners in unravelling the wide range of potential factors relevant to intellectual disabilities (IDs). This includes an emphasis on complexity and interdisciplinary formulation within an individual’s context, and implications of the current policy changes.

Findings

In practice, managing the mental health of PWID can be challenging within usual mainstream services; there is more to consider than is usual for the general population.

Originality/value

The paper provides general mental health practitioners with a framework for a greater depth of understanding of the issues involved in the management of people with intellectual disability (ID). This includes discussion of the current policy context in ID, and some of its limitations.

Details

The Journal of Mental Health Training, Education and Practice, vol. 12 no. 4
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 28 December 2018

Francine Washington, Samantha Bull and Ceri Woodrow

The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of…

Abstract

Purpose

The purpose of this paper is to evaluate whether two regional intellectual disability (ID) assessment and treatment (A&T) units in England were meeting the recommended length of stay stipulated by the Learning Disability Professional Senate, in line with the Transforming Care (TC) agenda. A secondary purpose of the study was to evaluate the reasons for admissions and delayed discharges in order to inform how to reduce these.

Design/methodology/approach

A retrospective evaluation of 85 admissions across two A&T units was conducted over a three-year period (2013–2016) following publication of the TC agenda.

Findings

There were 85 admissions compared to 71 discharges. Of the 85 admissions, 11 were readmissions. The most common factors thought necessary to prevent admission were early support for care providers or alternative service provision. There were barriers to discharge in over half of admissions; the main reason was a lack of suitable service provision.

Practical implications

The study suggests that providing specific support or training to care providers could prevent (re)admission and ensure shorter admissions. Further research to establish reasons for the reported lack of suitable providers would be beneficial.

Originality/value

This study provides current admission and discharge rates for regional A&T units, as recommended by the TC national guidance. It also provides potential reasons underlying preventable admissions and delayed discharges and therefore indicates what might be necessary to prevent admissions and reduce the length of inpatient stays for people with ID and/or autism.

Details

Tizard Learning Disability Review, vol. 24 no. 1
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 20 August 2018

Ursula Turner

The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning…

Abstract

Purpose

The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.

Design/methodology/approach

The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual’s support team who made this life changing event possible.

Findings

This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.

Originality/value

This is an original case study that has not been published previously and has been written for the sole purpose of this journal.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 1
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 19 January 2023

Mizla Manandhar-Richardson, Ceri Woodrow and Georgia Cooper-Taylor

This study aims to understand the experiences of professional paid carers providing community support to people with intellectual disability “at risk of admission”. This study…

Abstract

Purpose

This study aims to understand the experiences of professional paid carers providing community support to people with intellectual disability “at risk of admission”. This study explores factors that were helpful or lacking in terms of the support the carers received from NHS health services during this time.

Design/methodology/approach

This study conducted semi-structured interview with eight participants. Thematic analysis was used to analyse the data.

Findings

Three main themes and ten subthemes were identified. The first main theme was “support systems” that were available or lacking for the client and their carers. The second main theme was “training and supervision” available to the carers and their team when the individual they supported needed additional support. The third theme was “change” clients encountered which included changes in the environment as well as changes because of COVID-19 pandemic.

Originality/value

To the best of the authors’ knowledge, this is the first study on experiences of carers during specifically high stress periods, such as when the clients they are supporting are at risk of hospital admission.

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