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Article
Publication date: 26 February 2021

Sarah Ashworth, Charlotte Robinson, Donna Harrison and Natalie Brotherton

This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT…

Abstract

Purpose

This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT programme facilitated at a low-security psychiatric hospital for men with intellectual disability. Through the presentation of programme development, evaluation and revision, a more thorough and transparent understanding of the process involved can be disseminated.

Design/methodology/approach

The programme lasted approximately 14 months and covered all four modules. N = 5, all-male, ages ranged between 23 and 57 years old. All detained under the MHA (1983) with a primary diagnosis of Mild ID with comorbid psychiatric diagnoses including mental illness, autism spectrum disorders and personality disorder. To evaluate routine effectiveness a pre-post comparison within groups design was used. A standardised GAS approach provided a template to score the degree to which identified goals were achieved over the intervention for participants.

Findings

Wilcoxon signed-rank tests were used due to data not meeting parametric assumptions regarding normal distribution. Except for the mindfulness module, all modules saw pre to post programme psychometric results in the desired direction, evidencing skills acquisition. Coping in crisis and managing feelings modules outcomes neared statistical significance, with the module of people skills demonstrating statistical significance (p < 0.05).

Originality/value

Upon examination of the results, it appears as though the second edition pilot programme, displayed initially promising results. The clinical and statistical aspects of the programme are explored, in the hope that clinicians may consider the programme’s application and utility within various clinical contexts, in addition to gaining insight into the process of programme development and refinement.

Details

Advances in Mental Health and Intellectual Disabilities, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 22 May 2019

Helen Walker, Lindsay Tulloch, Karen Boa, Gordon Ritchie and John Thompson

A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic…

Abstract

Purpose

A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues.

Design/methodology/approach

A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire.

Findings

Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning.

Research limitations/implications

Studies using cross-section can only provide information at fixed points in time.

Practical implications

The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility.

Originality/value

This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.

Details

Journal of Forensic Practice, vol. 21 no. 2
Type: Research Article
ISSN: 2050-8794

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Article
Publication date: 4 November 2013

Jonathan Lough and Kathryn Von Treuer

The purpose of this paper is to critically examine the instruments used in the screening process, with particular attention given to supporting research validation…

Abstract

Purpose

The purpose of this paper is to critically examine the instruments used in the screening process, with particular attention given to supporting research validation. Psychological screening is a well-established process used in the selection of employees across public safety industries, particularly in police settings. Screening in and screening out are both possible, with screening out being the most commonly used method. Little attention, however, has been given to evaluating the comparative validities of the instruments used.

Design/methodology/approach

This review investigates literature supporting the use of the Minnesota Multiphasic Personality Inventory (MMPI), the California Personality Inventory (CPI), the Inwald Personality Inventory (IPI), the Australian Institute of Forensic Psychology's test battery (AIFP), and some other less researched tests. Research supporting the validity of each test is discussed.

Findings

It was found that no test possesses unequivocal research support, although the CPI and AIFP tests show promise. Most formal research into the validity of the instruments lacks appropriate experimental structure and is therefore less powerful as “evidence” of the utility of the instrument(s).

Practical implications

This research raises the notion that many current screening practices are likely to be adding minimal value to the selection process by way of using instruments that are not “cut out” for the job. This has implications for policy and practice at the recruitment stage of police employment.

Originality/value

This research provides a critical overview of the instruments and their validity studies rather than examining the general process of psychological screening. As such, it is useful to those working in selection who are facing the choice of psychological instrument. Possibilities for future research are presented, and development opportunities for a best practice instrument are discussed.

Details

Policing: An International Journal of Police Strategies & Management, vol. 36 no. 4
Type: Research Article
ISSN: 1363-951X

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Article
Publication date: 20 February 2019

Owen Rye, Krysia Canvin, Suzi Harrison, Charlotte Couldrey and Clare Churchman

A high proportion of forensic mental health service users (FSUs) are recalled to secure hospitals from conditional discharge in the community. The limited research on…

Abstract

Purpose

A high proportion of forensic mental health service users (FSUs) are recalled to secure hospitals from conditional discharge in the community. The limited research on recall to date has preliminarily identified why FSUs are recalled, but not how they make sense of the process. The purpose of this paper is to develop a conceptual understanding of how FSUs make sense of being recalled to hospital.

Design/methodology/approach

A constructivist grounded theory approach was used. Semi-structured interviews were carried out with 11 FSUs from different levels of forensic service security who had been recalled varying numbers of times across a wide timeframe.

Findings

A theoretical model was constructed to illustrate the process of how FSUs make sense of being recalled. FSUs appraise being recalled on a continuum from negative to positive, based on their experiences when conditionally discharged and their reflections on the circumstances of being recalled. The nature of their appraisal appears to reciprocally influence their subsequent attitudes towards and their engagement with forensic services.

Research limitations/implications

The proposed mechanism of how FSUs make sense of being recalled, particularly their dynamic appraisal of it, should now be investigated longitudinally. Future qualitative research could explore forensic service staff perspectives on recall.

Practical implications

Enhancing the positivity of FSUs’ appraisals about being recalled may improve their attitudes about and engagement with forensic services.

Originality/value

This is the first research study to construct a theoretical model of recall.

Details

Journal of Forensic Practice, vol. 21 no. 1
Type: Research Article
ISSN: 2050-8794

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Book part
Publication date: 5 September 2018

Karen Landay and Rachel E. Frieder

Stress and the military go hand-in-hand, particularly in combat environments. While some personality traits or types weaken relationships between stress and performance…

Abstract

Stress and the military go hand-in-hand, particularly in combat environments. While some personality traits or types weaken relationships between stress and performance, others, such as psychopathy, may strengthen them. In the present chapter, we consider the ramifications of individuals with high levels of psychopathy or psychopathic tendencies in the military with regard to both their own stress and performance and that of those around them. We discuss different reactions to psychological and physical stress, as well as the implications of psychopathic tendencies as they relate to current military issues, including gender, leadership, teamwork, turnover, post-traumatic stress disorder, and suicide. By juxtaposing relevant research findings on stress and psychopathy, we conclude that psychopathic tendencies should have neither uniformly negative nor positive effects on stress and performance in the military. Rather, effects on such individuals and the peripheral others with whom they interact will likely vary greatly depending on numerous factors.

Details

Occupational Stress and Well-Being in Military Contexts
Type: Book
ISBN: 978-1-78756-184-7

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Article
Publication date: 9 December 2011

William Spence

The paper reports on the implementation of the Revised Elderly Persons' Disability Scale use – a 53‐item, seven sub‐scale functional assessment tool – in a range of older…

Abstract

Purpose

The paper reports on the implementation of the Revised Elderly Persons' Disability Scale use – a 53‐item, seven sub‐scale functional assessment tool – in a range of older adult care institutions. Staff education on the instrument's use is provided; patient assessments collated centrally; and results fed back to respective care facilities. This study explores the views of qualified and unqualified staff on the use of the scale in their respective UK National Health Service, Local Authority or Private Residential older adult care facilities.

Design/methodology/approach

An action research mode was adopted where the researcher was a member of a team responsible for planning, development, and co‐ordination of community care projects for adults leaving hospital care. Structured and semi‐structured interviewing was employed to explore personal experience of the instrument's use in older adult care institutions. A total of 20 care staff qualified in nursing or social work and nine unqualified staff participated in this research.

Findings

Participants reported that scale use contributed positively to the planning and delivery of care. Its use influenced the admission of individuals for care by the institutions studied and improvements in the quality of the transfer of clients between settings were reported. It proved straightforward to use and unqualified staff reported their greater involvement in the care planning process as a result of its implementation. Participants reported that instrument use contributed to the identification of staff training needs.

Originality/value

Evidence for functional assessment scale effectiveness is equivocal and little has been published on the experience of scale use by a range of elder care staff. This experience forms this study's sole focus and scale use is shown to have the potential to contribute to care improvement.

Details

Quality in Ageing and Older Adults, vol. 12 no. 4
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 27 June 2019

Ereny Gobrial

Children and young people with comorbid intellectual disabilities (ID) and autism spectrum disorders (ASD) are more likely to exhibit comorbid mental health disorders…

Abstract

Purpose

Children and young people with comorbid intellectual disabilities (ID) and autism spectrum disorders (ASD) are more likely to exhibit comorbid mental health disorders (MHD) and other significant behaviours (SB) in addition to the core symptoms of ASD. The purpose of this paper is to identify the prevalence of comorbid MHD and behaviours in children and young people with ID and ASD in Egypt.

Design/methodology/approach

The Reiss scale for children’s dual diagnosis was administered by parents and teachers of 222 Egyptian children and young people with mild/moderate ID and ASD to screen for MHD and SB. The mean age of children and young people was 12.3 years (SD = 3.64), with 75.6 per cent male.

Findings

The results revealed that 62.2 per cent of children and young people with ID and ASD had high rates of comorbid MHD and behaviour disorders were shown in 64.4 per cent of the participated children and young people. The results identified anger, anxiety and psychosis being the most frequently diagnosed disorders while crying spells and pica were the most SB. No differences were found between the male and female with ID and ASD in the current study.

Research limitations/implications

Mental health assessment of children and young people with ID and ASD will help to highlight the needs of these vulnerable children and develop the appropriate services.

Originality/value

The findings highlight the prevalence of MHD in children and young people with ID and ASD in Egypt. This has implications on the assessment of comorbid disorders and services needed for children with ID and ASD in Egypt.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 13 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 1 July 2014

Nikunj Agarwal and M.P. Sebastian

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized…

Abstract

Purpose

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

Design/methodology/approach

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

Findings

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

Practical implications

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Originality/value

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

Details

Clinical Governance: An International Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 5 January 2015

Sherva Elizabeth Cooray, Sab Bhaumik, Ashok Roy, John Devapriam, Rahul Rai and Regi Alexander

The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The…

Abstract

Purpose

The 11th revision of the International Classification of diseases which sets global standards for defining, reporting and managing health conditions is under way. The International Classification of Diseases (ICD) underpinning principle of clinical utility is currently poor for persons with Disorders of Intellectual Development (DID) and mental disorders. This impedes access to healthcare resources; services and social inclusion thereby further aggravating their vulnerability. The purpose of this paper is to present a critical overview and evidence informed recommendations within the context of an international collaborative programme, undertaken by the Faculty of Psychiatry of Intellectual Disability, Royal College of Psychiatrists, UK with support from the World Health Organisation (WHO).

Design/methodology/approach

The authors carried out: first, a systematic review (SR) of literature, using PRISMA guidelines regarding the reliability, validity and utility of the ICD-10/Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria in people with DID (PWDID); second, a national and international consultation exercise with partners, stakeholders and experts; third, a multicentric survey of problem behaviours in PWDID; and finally, information dissemination/dialogues including presentations and workshops at key scientific events, consultation networking, data gathering and consensus building.

Findings

The SR revealed a dearth of robust studies – most consisting of weak research methodologies. Significant difficulties were highlighted regarding the application of diagnostic criteria in the current classificatory systems – particularly in people with severe/moderate DID. Recommendations supported the introduction WHERE APPROPRIATE of modifications based on observed phenomena (signs) in PWDID in lieu of reported symptoms to facilitate DIAGNOSIS AND better access to healthcare and the community. Heterogeneity precluded quantitative pooling and meta-analysis. The consensus building exercise globally revealed that problem behaviours were the commonest reasons for referral to healthcare services with significant numbers without a diagnosed mental disorder being prescribed psychoactive medication.

Research limitations/implications

The consensus gathering exercise WAS SELECTIVE AND did not cover all of the 194 member states of WHO due to resource and time constraints and this constitutes the main limitation of our study. Based on the SR and expert consensus, the authors submitted evidence informed pragmatic proposals to the WHO aimed at addressing the shortcomings of the ICD-10. The key recommendations focused on improving clinical utility within the context of epistemic iteration which would consolidate and strengthen the future evidence base. It was also recommended that self-injurious behaviour should form a standalone sub category in view of its relevance for healthcare services and resources which underpin clinical utility.

Practical implications

The ICD-11 is a global, multidisciplinary and multilingual development for public health benefit with 70 per cent of the world's health expenditures assigned using this system for resource allocation. Currently mental disorders in PWDID can be misinterpreted, unrecognised and under reported resulting in barriers to access to treatment and healthcare resources. Conversely disorders may be over diagnosed when the inherent discrepancies between the chronological age and the developmental level of functioning are not considered. Conclusions and recommendations from this study will result in better diagnosis of mental disorders and healthcare resources in this population.

Social implications

PWDID are a vulnerable sector of the population with an increased prevalence of mental health problems who are marginalised and discriminated by society. Early detection, treatment and management of these conditions will prevent further decompensation and stigmatisation.

Originality/value

To the best of the authors knowledge this is the first comprehensive, large-scale study which evaluates the ICD classificatory system within the context of clinical utility for PWDID, including experts and stakeholders from both lower/middle- and high-income countries. The international consultation/consensus building process culminating in the formulation of evidence informed recommendations, aimed at improving the clinical utility of the ICD-11 for this population, has the potential to improve access to appropriate healthcare and treatment and consequent enhancement of their quality of life.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 9 no. 1
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 5 March 2018

Deanna Gallichan and Carol George

The purpose of this paper is to assess whether the Adult Attachment Projective (AAP) Picture System is a reliable and face valid measure of internal working models of…

Abstract

Purpose

The purpose of this paper is to assess whether the Adult Attachment Projective (AAP) Picture System is a reliable and face valid measure of internal working models of attachment in adults with intellectual disabilities (ID).

Design/methodology/approach

The AAPs of 20 adults with ID were coded blind by two reliable judges and classified into one of four groups: secure, dismissing, preoccupied, or unresolved. Inter-rater reliability was calculated using κ. Six participants repeated the assessment for test-retest reliability. Two independent experts rated ten cases on the links between the AAP analysis and the clinical history.

Findings

There was significant agreement between AAP judges, κ=0.677, p<0.001. Five out of six participants showed stability in their classifications over time. The majority of expert ratings were “good” or “excellent”. There was a significant inter-class correlation between raters suggesting good agreement between them r=0.51 (p<0.05). The raters’ feedback suggested that the AAP had good clinical utility.

Research limitations/implications

The inter-rater reliability, stability, face validity, and clinical utility of the AAP in this population is promising. Further examination of these findings with a larger sample of individuals with ID is needed.

Originality/value

This is the first study attempting to investigate the reliability and validity of the AAP in this population.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 12 no. 2
Type: Research Article
ISSN: 2044-1282

Keywords

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