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Article
Publication date: 17 May 2019

Isabel C.H. Clare, Kelly A. Wade, Nadine Ranke, Sarah Whitson, Alison Lillywhite, Elizabeth Jones, SallyAnne Broughton, Adam Wagner and Anthony J. Holland

While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their…

Abstract

Purpose

While “generic” community teams for adults with learning disabilities (CTs) are well-established in the UK, very little recent evidence is available about any aspect of their work. As part of a larger project about the role, structure and functioning of CTs, the purpose of this paper is to provide data about referrals.

Design/methodology/approach

Over three months, the authors obtained data about 270 consecutive new referrals to five CTs in a countywide integrated health (NHS) and care management (local authority) service.

Findings

The 270 referrals related to 255 individuals, mainly already service users, with almost a third (30 per cent, n=204) described as people with severe or profound disabilities. Consistent with the reported living arrangements (residential accommodation or with one or more family members (87 per cent, n=270)), referrals were most often made by social care staff, General Practitioners or carers. The referrals related to a wide range of issues including mental health and/or behavioural needs, physical health and skills, and independence. The major group, however, were requests about a person’s entitlement to specialist learning disability services and/or reviews of an existing social care package.

Research limitations/implications

The focus on new referrals and the exclusion of intra-team referrals mean that the data are not representative of a CT’s caseload and cannot be used as a basis for resourcing. Nevertheless, the findings emphasise the heterogeneity of the population, and the long-term and varied nature of their needs, meaning that CTs require access to a range of expertise and, often, an inter-agency approach. The implications for service design are considered.

Originality/value

This is the first empirical study of referrals to specialist integrated (health and care management) community learning disabilities teams in England.

Details

Tizard Learning Disability Review, vol. 24 no. 2
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 2 January 2018

Isabel C.H. Clare, Kelly A. Wade, Sorcha Bolton, Adam P. Wagner, Tatsiana Steven and Anthony J. Holland

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide…

Abstract

Purpose

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Design/methodology/approach

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

Findings

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

Research limitations/implications

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

Practical implications

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Originality/value

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

Article
Publication date: 9 March 2018

Isabel Clare Cornes and Brian Cook

The purpose of this paper is to provide empirical insights into urban household perceptions and (in)action towards the perceived impacts of climate change, based on a case study…

Abstract

Purpose

The purpose of this paper is to provide empirical insights into urban household perceptions and (in)action towards the perceived impacts of climate change, based on a case study in Kensington, Victoria, Australia. This case utilises households as sites of active agency, rather than as passive recipients of climate change or associated governance.

Design/methodology/approach

This research trialled an approach to engaging a community in the context of disaster risk reduction (DRR). It involved a two-stage quantitative door-knocking survey (reported elsewhere), followed by a qualitative interview with interested households. In total, 76 quantitative surveys contextualise 15 qualitative interviews, which are the focus of this analysis. The findings are presented comparatively alongside the current literature.

Findings

Heatwaves are understood to be the most concerning hazard for the households in this sample who associate their increasing frequency and severity with climate change. However, subsequent (in)action is shown to be situated within the complexities of day-to-day activities and concerns. While respondents did not consider themselves to have “expert” knowledge on climate change, or consider their actions to be a direct response to climate change, most had undertaken actions resulting from experience with heatwaves. These findings suggest there may be an under-representation of DRR, which includes climate change adaptation actions, within the existing research.

Research limitations/implications

While this sample justifies the arguments and conclusions, it is not a representative sample and therefore requires follow-up. It does however challenge traditional approaches to risk management, which focus on awareness raising and education. The research highlights the unique contexts in which households perceive and act on risk, and the need for risk “experts” to consider such contexts.

Originality/value

This research provides empirical evidence of urban household responses to perceived climate change-related risk, an often-neglected dimension of heatwave and adaptation studies in Australia. The findings also suggest promise for the methodological approach.

Details

Disaster Prevention and Management: An International Journal, vol. 27 no. 2
Type: Research Article
ISSN: 0965-3562

Keywords

Article
Publication date: 28 December 2018

Lawrence Patterson

The purpose of this paper is to provide a commentary on the paper “Specialist community teams for adults with learning disabilities: referrals to a countywide service in England”…

Abstract

Purpose

The purpose of this paper is to provide a commentary on the paper “Specialist community teams for adults with learning disabilities: referrals to a countywide service in England” by Isabel Clare and colleagues.

Design/methodology/approach

This paper reviews some themes presented in this paper relating to the practice and management of community teams for adults with learning disability within the context of recent national service initiatives.

Findings

There is a limited literature on the practice, purpose and service caseload management of community teams. Taken in the context of recent national service initiatives, the paper by Clare et al. illustrates the gaps between the way community teams are currently processing demands and how these services will likely need to behave in future.

Originality/value

There is little recent literature examining the purpose of, and management approaches in, community teams and this addition should stimulate some further consideration of how community teams need to adjust to meet changing demands.

Details

Tizard Learning Disability Review, vol. 24 no. 2
Type: Research Article
ISSN: 1359-5474

Keywords

Article
Publication date: 1 July 2005

W Suto, I Clare and A Holland

This paper provides some guidance on how recent research into decision‐making capacity can be used in clinical practice to maximise financial independence among adults with…

Abstract

This paper provides some guidance on how recent research into decision‐making capacity can be used in clinical practice to maximise financial independence among adults with learning disabilities. Its key messages are (i) that capacity is changeable rather than fixed and static, and (ii) that an assessment of capacity is just a starting point for identifying and enhancing a person's strengths and addressing weaknesses. The first half of the paper contains an overview of some recent developments in social policy, capacity legislation and research. We highlight some of the most important issues for clinicians and other health and social care practitioners to consider. In the second half, a case study is discussed. We outline some potential interventions for maximising financial capacity in different ways, as well as identifying some broad strategies for addressing difficulties in decision‐making.

Details

Tizard Learning Disability Review, vol. 10 no. 3
Type: Research Article
ISSN: 1359-5474

Article
Publication date: 8 June 2015

Marcus Redley, Sally Jennings, Anthony Holland and Isabel Clare

The purpose of this paper is to ascertain what efforts Adult Safeguarding Leads (ASLs), generic advocates, and Independent Mental Capacity Advocates are making to involve service…

1597

Abstract

Purpose

The purpose of this paper is to ascertain what efforts Adult Safeguarding Leads (ASLs), generic advocates, and Independent Mental Capacity Advocates are making to involve service users in decisions about protective measures, and to investigate whether the Adult Safeguarding service is delivering outcomes, which are valued by its users.

Design/methodology/approach

Semi-structured interviews with a sample of key stakeholders.

Findings

ASLs are making efforts to involve service users in the complex and demanding process of safeguarding. These efforts, however, are shaped by their understandings of the difference between “residential” and “community” settings.

Research limitations/implications

The study is based in a single County Council, albeit in a large county, and involves a limited number of service users.

Practical implications

Clarification is needed of what it may mean to adopt a person-centred approach to adult safeguarding, and the responsibilities of ASLs when individuals with capacity to make decisions about this aspect of their lives are unwilling to engage with the safeguarding process.

Originality/value

The findings improve the understanding of how ASLs understand their responsibilities towards the users of their services and endeavour to involve them in the adult safeguarding process. Based on this understanding, those with responsibility for managing Adult Safeguarding services should be better able to support improvements in professional practice.

Details

The Journal of Adult Protection, vol. 17 no. 3
Type: Research Article
ISSN: 1466-8203

Keywords

Article
Publication date: 2 January 2018

Rory Sheehan

This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community…

Abstract

Purpose

This commentary accompanies Clare et al.’s study investigating psychotropic drug prescribing for adults with intellectual disability who were referred to specialist community learning disability teams in the east of England. The purpose of this paper is to explore some of the background to psychotropic drug prescribing for people with intellectual disability, review important contextual factors that influence prescribing decisions, and consider how we might make the best use of psychotropic drugs in this group.

Design/methodology/approach

Narrative summary and opinion, supported by reference to recent research literature.

Findings

Psychotropic drug use for people with intellectual disability raises complex issues, not least because of the lack of research evidence that exists on the topic. Psychotropic drugs can be an important part of treatment for people with mental illness but further research is needed to support prescribing for challenging behaviour. Medication optimisation is a framework within which individual preferences and values are considered alongside the evidence base and clinical judgement in order to inform safe, effective, and collaborative management decisions.

Practical implications

Prescribing decisions should be individualised and reviewed regularly, incorporating evidence from patients and carers. Improving the use of psychotropic medication requires concerted action, adequate social support, and the provision of alternative, non-pharmacological interventions that are acceptable and effective.

Originality/value

This paper reviews some of the current concerns about the use of psychotropic drugs and opens up new avenues of discussion.

Details

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

Keywords

Article
Publication date: 4 February 2014

Fergus Gracey, Donna Malley, Adam P. Wagner and Isabel Clare

Needs of people following acquired brain injury vary over their life-course presenting challenges for community services, especially for those with “hidden” neuropsychological…

Abstract

Purpose

Needs of people following acquired brain injury vary over their life-course presenting challenges for community services, especially for those with “hidden” neuropsychological needs. Characterisation of subtypes of rehabilitation service user may help improve service design towards optimal targeting of resources. This paper aims to characterise a neuropsychologically complex group of service users.

Design/methodology/approach

Preliminary data from 35 participants accepted for a holistic neuropsychological rehabilitation day programme were subject to cluster analysis using self-ratings of mood, executive function and brain injury symptomatology.

Findings

Analysis identified three clusters significantly differentiated in terms of symptom severity (Cluster 1 least and Cluster 2 most severe), self-esteem (Clusters 2 and 3 low self-esteem) and mood (Cluster 2 more anxious and depressed). The three clusters were then compared on characteristics including age at injury, type of injury, chronicity of problems, presence of pre-injury problems and completion of rehabilitation. Cluster 2 were significantly younger at time of injury, and all had head injury.

Research limitations/implications

Results suggest different subgroups of neuropsychological rehabilitation service user, highlighting the importance of early identification and provision of rehabilitation to prevent deterioration, especially for those injured when young. Implications for design of, and research into, community rehabilitation service design for those with “hidden disability” are considered.

Originality/value

The paper findings suggests that innovative conceptual frameworks for understanding potentially complex longer term outcomes are required to enable development of tools for triaging and efficient allocation of community service resources.

Details

Social Care and Neurodisability, vol. 5 no. 1
Type: Research Article
ISSN: 2042-0919

Keywords

Article
Publication date: 1 April 1997

Jim Mansell

Abstract

Details

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

Article
Publication date: 1 July 1997

A. Holland

Abstract

Details

Tizard Learning Disability Review, vol. 2 no. 3
Type: Research Article
ISSN: 1359-5474

1 – 10 of 35