Search results

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.

The purpose of this paper is to highlight the difficulties in identifying adults with autism spectrum disorder (ASD) and to illustrate the consequences of late diagnoses in forensic settings.

This paper presents an overview of the literature relevant to the topic and presents the details of three clinical cases.

Delayed diagnosis is not uncommon in forensic services. Cases may remain unidentified for considerable periods despite being under evaluation from clinical teams. Diagnosis in forensic settings is challenged by case complexity. Barriers to prompt diagnosis include time, resources and clinical competency. Timely diagnosis may lessen the risk of future offences, improves clinical risk management and can bring direct benefits to those with the condition.

This is the first case series which explores the issue of late diagnosis in forensic settings. The illustration of the extent to which a diagnosis can be missed may prompt clinicians to review and identify missed cases. The discussion of the issue may also support services to review their approach to screening and diagnosis of ASD.

This paper reports a social work student’s experience of a mental health rehabilitation placement. The term “dual diagnosis” in this context includes people who experience both a mental health diagnosis and a substance use disorder. The purpose of this paper is to highlight the student experience as the author learnt about some of the challenges that people with dual diagnoses face during the recovery process.

The author kept a journal during the placement. Critical reflection was used to interrogate the journal entries for key themes and events that contributed to the author’s learning about social work practice and dual diagnosis.

This study found that social workers are in a fortunate position to work in this multi-disciplinary setting and contribute the social work perspective to care for people with dual diagnosis. However, there are still some gaps in achieving optimal care.

Suggestions for further practice development include a more integrated approach between services, further training for clinicians and a focus on a community-based setting as opposed to an institutionalised one.

According to the author, the student experience is important because students see situations and settings with fresh eyes that can highlight things that experienced practitioners take for granted.

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.

Autistic children and their family caregivers are impacted widely by the social arrangements, which bring up a variety of problems and make their caregiving duties even more difficult. One of the main troubles family caregivers struggle with is the “Autism stigma” that eventually leads to social exclusion. This study aims to identify shreds of evidence of Autism stigma experienced by family caregivers of autistic children. The study also aims to present some general comparison between the findings in Iran and a few other countries’ available respective data to the “Autism stigma.”

This study is an inductive qualitative content analysis. Twelve family caregivers were purposefully selected. Data were gathered exercising semi-structured, in-depth interviews and scrutinized using content analysis method.

In the interviews with the participants, a new category called “Autism stigma” was discerned. This category includes three subcategories: “Diagnosis process,” “Lack of awareness” and “Presence in the society.”

In Iran, Autism is considered a kind of social stigma. It mainly happens due to a lack of public awareness about this psychological disorder. The family caregivers in the community suffer from the stigma of autism, which leads them to distance themselves from society. This paper aims to improve the social awareness in regard to the negative impacts of Autism stigma.

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.