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Dual diagnosis poses particular challenges for inpatient mental health services. Workers have low levels of training, clinical experience and support to deliver integrated care that combines mental health and substance use interventions. In addition, inpatient workers have to balance being therapeutic with ensuring that illicit substance use does not occur on the wards. This often leads to confrontation and poor engagement.In order to improve the capabilities of the workers to deliver more effective interventions for this group of service users, dual diagnosis training should be a high priority for acute inpatient services. However, there are a number of challenges in the implementation of this including lack of resources to fund training and specialist roles, lack of time to attend training (and supervision), and lack of time to implement learning in routine care.This paper will describe the policy drivers for the improvement of dual diagnosis care in acute psychiatric inpatient services, and how two initiatives in London are overcoming some of the obstacles and showing some promising initial outcomes. This paper will make recommendations for future research and developments.

This chapter reviews qualitative research on parenting children with disabilities published over the last 50 years to explore whether shifts in academic discourse and changes in professional training have affected research on parenting and/or the experiences of parents who are the subject of such research.

An extensive literature search was conducted, and 78 peer-reviewed, qualitative studies on the experience of parenting a child with a disability were included in the sample. Themes were extracted from the reviewed literature and compared across decades.

The findings of the present review suggest that some aspects of the parenting experience have changed very little. In particular, parents continue to experience negative reactions such as stress and anomie, especially early in their children’s lives, and socially imposed barriers such as unhelpful professionals, and a lack of needed services continue to create problems and inspire an entrepreneurial response. In addition, stigmatizing encounters with others continue to be a common occurrence. In contrast to earlier decades, studies conducted in more recent years have begun to use the social model of disability as an analytic frame and also increasingly report that parents are questioning and challenging the concept of “normal” itself.

Additional improvements are needed in professional education and services to reduce the negative reactions experienced by parents of children with disabilities.

The findings of this meta-analysis can serve as a guide to future research on parenting children with disabilities.

Purpose – One-third of the world's population is infected with tuberculosis (TB) and there are two million TB-related deaths worldwide every year. Along the U.S.-Mexico border, migration patterns, and reduced access to health care contribute to high rates of TB. Delayed diagnosis of TB, the focus of this chapter, increases the likelihood that a patient will progress to more advanced stages of the disease and heightens the risk of TB transmission to others as patients are contagious for longer periods of time.

Approach – Despite the seriousness of these consequences, few sociological studies have examined delayed diagnosis of TB and why people affected by TB symptoms delay care. Because of this, we take a health narratives approach to understanding the experiences of 15 TB patients of Mexican descent in a high-risk border community (e.g., El Paso, Texas) in order to discover why delayed diagnoses happen and how they impact patients.

Findings – Fourteen of the fifteen patients experienced delayed diagnosis. Analysis of these fourteen narratives revealed two broad themes: (1) provider lack of awareness, including repeated misdiagnosis and TB test errors, and (2) patient disadvantage, including fear of U.S. immigration authorities and few economic resources for care.

Implications – Findings from this study suggest that prompt diagnosis of TB could be achieved if providers were more cognizant of TB and its symptoms and public health policies increased access to health care regardless of immigration status or socioeconomic status.

Hepatitis C virus (HCV) is highly prevalent in the United States, yet is largely culturally invisible. This study examines what people know about their illness, both before and after diagnosis, and the relationship to race. The data are from in-depth interviews in 2004 with 53 persons, mostly white or African American, with HCV in the southeastern United States. The respondents have varying educational backgrounds, family incomes, and possible modes of transmission of HCV. Regardless of whether the diagnosis of HCV came as a surprise, respondents had a range of reactions including fear, shock, sadness, and ambivalence. Knowledge of the disease postdiagnosis varies as some people have expert knowledge, moderate knowledge, or inaccurate to no knowledge of the disease. Minority respondents have less knowledge of HCV than whites. This racial disparity in knowledge has profound implications for people with HCV and the larger society.

In the last two decades, a proliferation of business process management (BPM) modeling languages, standards and software systems has given rise to much confusion and obstacles to adoption. Since new BPM languages and notation terminologies were not well defined, duplicate features are common. This paper seeks to make sense of the myriad BPM standards, organising them in a classification framework, and to identify key industry trends.

An extensive literature review is conducted and relevant BPM notations, languages and standards are referenced against the proposed BPM Standards Classification Framework, which lists each standard's distinct features, strengths and weaknesses.

The paper is unaware of any classification of BPM languages. An attempt is made to classify BPM languages, standards and notations into four main groups: execution, interchange, graphical, and diagnosis standards. At the present time, there is a lack of established diagnosis standards. It is hoped that such a classification facilitates the meaningful adoption of BPM languages, standards and notations.

The paper differentiates BPM standards, thereby resolving common misconceptions; establishes the need for diagnosis standards; identifies the strengths and limitations of current standards; and highlights current knowledge gaps and future trends. Researchers and practitioners may wish to position their work around this review.

Currently, to the best of one's knowledge, such an overview and such an analysis of BPM standards have not so far been undertaken.

This paper aims to examine the relationship between patterns of functioning in four domains (attention and concentration; social and communication; coordination and organisation; and literacy and numeracy) in women in prison. Also, to consider potential associations between functioning and previous Neurodevelopmental Disorder (NDD) diagnoses, previous mental health diagnoses and history of head injury, self-harm and attempted suicide.

Women in one Scottish prison were invited to participate; 87 consented. Women were screened for functional difficulties and asked about their relevant educational and medical history.

Half of participants reported difficulties in one or more domains. All possible combinations of functional difficulties were found. Only eight women reported previous NDD diagnoses. Functional difficulties were significantly associated with history of self-harm, history of attempted suicide and mental health diagnoses. In total, 32% of women reported at least one head injury, but this was not significantly associated with functional difficulties.

The sample was comparatively small and questions were self-report. Analyses were based on within-cohort comparisons due to a lack of appropriate general population data.

There is a clear need for timely, practical and comprehensive profiling of females in the Justice System. Current systems do not appear to adequately identify women with functional difficulties or other adversity. Greater use of interdisciplinary working and shared training is indicated, as is a move from categorical diagnostic systems towards dimensional approaches.

This study is the first to investigate associations between difficulties associated with NDDs, mental health difficulties and head injury in women in prison.

Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.

Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.

The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.

More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.

The aim of this study is to understand how social barriers might result in people with specific learning difficulties coming in contact with the criminal justice system in the UK. The study seeks to apply the social model of disability to conceptualise a statistical relationship between socio‐economic status and key life events for people with specific learning difficulties (i.e. diagnosis, educational achievements, and employment).

A cluster sample was used to obtain statistical data from a questionnaire based survey. The study collected quantitative and qualitative data on the life experiences of people with specific learning difficulties (n=77). The paper analyses the quantitative data and discovers statistically significant relationships (p≤0.05) concerning socio‐economic status, specific learning difficulties and crime.

Within the data findings age of diagnosis is significantly (p≤0.00) affected when comparing socio‐economic status with the offender and non‐offender group in the study. Furthermore, the educational achievements (p≤0.00) and employment/unemployment levels (p≤0.00) are dramatically altered by socio‐economic status specifically for offenders with specific learning difficulties. These relationships have been conceptualised using the social model of SpLD in terms of barriers to exclusion.

To date very few studies have used the social model of disability to understand pathways into offending for people with learning difficulties. To the author's knowledge this is the first study to apply a quantitative analysis to the concept of disabling barriers and criminality.

This is the first of two papers that aim to propose a revised model of care for dementia based on the combined findings of a number of projects undertaken by the authors.

The paper is a conceptual discussion based on the findings from a series of projects in which the key methodologies included listening to people with dementia and carers, non‐participant observation of services, and reviews of good practice, policy and literature.

This paper reports on key messages received from people living with dementia, a revised values‐base for service development and identifying the dementia journey from the perspective of those living with dementia. The framework moves away from the medical model towards understanding dementia as a long term condition that affects a number of dimensions.

Through understanding the dementia journey from the perspective of people living with dementia, it is possible to design and implement a range of services that help people plan for and manage their own journeys, provide interventions proactively and help prevent crises. Person‐centred outcomes can be identified, linked to, or cutting across, each of the phases the journey. Experiences are likely to improve, and resources can be targeted more efficiently and effectively.

The authors identify a six‐phase dementia journey from the perspective of people living with dementia, based on a set of values informed by people who have dementia and their carers.

Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue.

Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful.

The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability.

This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation.