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The potential for including patients in implementation processes has received limited attention in the literature. The purpose of this paper is to explore the different roles adopted by 63 patients that emerged during and after four participatory quality improvement interventions, and the nature of their impact upon implementation processes and outcomes.

A cross-case ethnographic comparison of Experience-based Co-design in two clinical pathways in two UK NHS Trusts.

Two key themes emerge from the data. First, the authors found a range of different roles adopted by patients within and across the four projects; some were happy to share their experiences, others also helped to identify improvement priorities alongside staff whilst others were also involved in developing potential solutions with the staff who had cared for them. A few participants also helped implement those solutions and became “experts by experience” through engaging in the whole co-design process. Second, in terms of the impact of patient engagement with the co-design process whilst the changes championed by patients and carers were often small scale, as co-designers patients provided innovative ideas and solutions. Through their involvement and contributions they also acted as catalysts for broader change in the attitudes of staff by providing a motivation for wider organisational and attitudinal changes.

The research was conducted in two clinical pathways in two NHS trusts. However, the findings complement and add to the growing body of knowledge on experience based co-design.

Patient engagement is likely to require support and facilitation to ensure that patients can play a meaningful role as partners and co-designers in service improvement and implementation. Different roles suited particular individuals, with participants stepping in and out of the co-design process at various stages as suited their needs, capacities and (albeit sometimes perceptions re) skills. In this context, facilitation needs to be sensitive to individual needs and flexible to support involvement.

Patients and carers can play active roles in service improvement, particularly where the approach facilitate active engagement as co-designers.

Analysis of the role patients and carers in implementation and improvement.

De‐institutionalisation and resettlement have had a significant impact on offenders with learning disabilities (LD) who are now more visible in the wider community than before. Perhaps because of the challenges presented by people who were previously contained in institutions, there has been a growth of interest in their characteristics, the services and clinical interventions required to support them.This narrative review presents and discusses recent developments concerning offenders with LD. It looks at the historical association between crime and low intelligence, and then examines the evidence concerning the prevalence of offending by people with LD and recidivism rates. Recent research concerning service pathways for this population is summarised and progress in the development of actuarial, dynamic and clinical assessments of the future risk of offending is outlined.The second half of the paper focuses on a review of the evidence for and recent developments in the treatment of offending behaviour (anger/aggression, sexual offending and fire‐setting), utilising broadly cognitive behaviourally‐based approaches. Finally, future directions for research and practice innovation are proposed.

This pilot study investigated three historical risk factors for pathological arson identified in Jackson's Only Viable Option theory (Jackson, 1994), which views the act as an adaptive response to circumstances that are difficult to tolerate and which the individual does not have the necessary skills to resolve by appropriate means. Twenty men with mild learning disabilities were recruited from inpatient forensic services. It was hypothesised that there would be a greater incidence of risk factors among individuals with an index offence of arson than those without, and that risk factors would significantly predict an index offence of arson. Significant differences were found between the groups for perceived inability to effect social change and childhood experiences of fire, but not for the family problems under investigation. However, the sample size was too small to draw reliable conclusions on the predictive ability of the risk factors. The findings suggest that perceived inability to effect social change and childhood experiences of fire are risk factors characteristic of men with learning disabilities who have set fires, lending support to elements of Jackson's theory and providing opportunities to develop evidence‐based practice. However, the underlying causes of these risk‐factor characteristics remain unclear. It is hoped that the present study will help inform the choice of risk factors under investigation and improve the design of a larger study.

Cognitive behavioural therapy (CBT) is being used increasingly with people with learning disabilities. The evidence base to support these developments comes from uncontrolled trials of CBT in a variety of psychological disorders and eight to nine controlled trials of CBT for anger (plus a single controlled study in depression). This paper reviews the evidence for the effectiveness of group‐based anger management and the acquisition of anger coping skills, and the effectiveness of individual anger treatment, with some discussion of the status of CBT for other indications and the difficulties of conducting outcome research in this area.

The purpose of this paper is to complement existing research of the relationship between concentrated ownership and firm performance by theoretically exploring the impact of outside blockholders on the firm, primarily from the perspective of voting power.

This paper proposes theoretical propositions based on analyses and logical extension of results of the existing theoretical and empirical studies.

This paper proposes three theoretical predictions: First, voting power provides outside blockholders a necessary condition to pursue shared and private benefits of control, and it is positively correlated with blockholders’ capability of influencing firm value. Second, everything else being equal, an outside blockholder is more (less) likely to pursue private benefits than shared benefits when the equity market is efficient and when the blockholder’s voting power is less (more) than 50 per cent. Third, controlling outside blockholders can capitalize on their voting power to appoint managerial delegates and board representatives to the invested firms for the purpose of pursuing private benefits of control.

This paper tries to make two contributions to the corporate governance literature. First, this research relies on a new perspective to explore the relationship between ownership structure and firm value. Second, this paper presents the first theoretical argument which states that controlling outside blockholders rely on their managerial delegates and board representatives to pursue their private benefits of control.

Widely varying rates for the prevalence of psychiatric disorder have been reported in the previous published literature. The aims of this study were to describe the prevalence of psychiatric disorders in a random sample of adults with moderate to profound learning disabilities living in the community, and to explore the socio‐clinical factors associated with psychiatric disorders.A process of active case finding was undertaken to identify adults with learning disabilities. A random sample of 240 was taken of whom 121 were found to have moderate to profound learning disabilities at interview. Information was collected on socio‐demographics, service use, physical health, medication use, and life events. Standardised instruments were used to assess psychiatric symptoms, problem behaviour, and severity of learning disabilities. Diagnoses were generated using four diagnostic systems: clinical, DC‐LD, DCR‐10 and DSM‐IV.Higher rates of psychiatric disorder are reported than in previous published studies in the general population and in studies with people with learning disabilities living in the community. Further investigation of the effect of diagnostic system on prevalence rates, and associations of psychiatric disorder are warranted.

There are few studies of quality but all indications are that mental illness is a common problem in people with autism spectrum disorders (ASD) of all ability levels. Anxiety and mood disorder are common as well as paranoia, but there are problems assessing the phenomenology of illness in people with ASD. Schizophrenia does not appear to be more common in people with ASD. Suggestions are made for assessment and treatment of co‐morbid mental illnesses.

In order to succeed in an action under the Equal Pay Act 1970, should the woman and the man be employed by the same employer on like work at the same time or would the woman still be covered by the Act if she were employed on like work in succession to the man? This is the question which had to be solved in Macarthys Ltd v. Smith. Unfortunately it was not. Their Lordships interpreted the relevant section in different ways and since Article 119 of the Treaty of Rome was also subject to different interpretations, the case has been referred to the European Court of Justice.

The assessment for and diagnosis of personality disorder (PD) continue to be contentious, with many prominent practitioner psychologists arguing against this specific label and providing a credible alternative framework to psychiatric diagnosis more generally. This paper aims to summarise the literature and support practitioners identifying PD in people with intellectual disabilities (ID).

Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide a service position on the assessment and diagnosis of PD in people with ID.

For people with intellectual disabilities, the PD label can be even less robustly applied and may be even more pejorative and obstructive. That said, there are people for whom a PD diagnosis has clear clinical utility and opens access to suitable specialist services.

Evidence suggests that a diagnosis of PD can be both facilitative and obstructive, and the assessment and diagnosis process should, therefore, be undertaken with caution.

This paper presents an account of NICE guidance and evidence on the assessment and diagnosis of PD in people with intellectual disabilities.

The purpose of this paper to synthesise much of the existing research on autistic spectrum disorder (ASD) and offending behaviour.

It considers three key areas, namely, first, a discussion about the nature of ASD and how it might be related to offending behaviour; second, a brief commentary about the prevalence of this population; and, finally, an exploration of the effective management and possible treatment outcomes.

Methodological limitations have resulted in variable findings which has hindered our understanding of this population. Some of the research is based on small, highly specialist samples making prevalence difficult to measure. The link between ASD and offending is still not well understood, and despite advances in staff training, awareness amongst practitioners remains an underdeveloped area, thus yielding variable treatment outcomes.

This review continues to demonstrate the urgent need for robust research in order to better understand the link between ASD and offending behaviour, to provide tailored, needs-led interventions, and reduce the risk of offending amongst this group as a whole.