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This study aims to investigate the prevalence and characteristics of dysphagia among adults with intellectual disabilities (ID) referred to speech and language therapy for swallow assessment, providing information on the demographic characteristics, referral trends, co-occurring health conditions and reasons for referrals highlighting the complex health-care needs of this population.

This study used a standardised patient data extraction method over a six-month period involving 74 adults with ID referred to speech and language therapy for swallow assessment.

This study revealed a high prevalence of dysphagia among adults with ID referred to speech and language therapy for swallow assessment. Increasing age and severity of ID were associated with an increased likelihood of swallowing difficulties. Co-occurring health conditions such as mobility difficulties, epilepsy and gastrointestinal conditions were prevalent, suggesting that adults with ID and swallowing difficulties are often living with complex health conditions. Choking incidents and hospital admissions were primary reasons for referral.

This study stresses the pressing need for strategies to mitigate risks associated with choking incidents and hospital admission among this vulnerable population. Possible limitations include a reliance on referral and the focus being on a single service over a short period which may limit generalisation to the wider ID population.

This study emphasises the need to understand each person’s unique profile of health needs and the value of a specialised speech and language therapy service.

The importance of increasing awareness among caregivers and medical experts is highlighted.

The findings underscore the importance of tailored assessment, caregiver involvement and heightened interdisciplinary awareness to effectively manage dysphagia in individuals with ID.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

This preliminary study aims to examine the use of a co-designed immersive virtual reality intervention programme in improving access to health care for people with intellectual disability.

A co-production approach was used to design a virtual reality intervention in collaboration with people with intellectual disability, their families and carers. A mixed-method single sample pre-test-post-test design examined using a virtual reality intervention simulating health-care environments to improve access of attending health-care appointments. Qualitative feedback was used to understand participants’ experience and opinions of using the digital technology.

The study found that the intervention did help people access health-care appointment and reduced their fear. Improvements were also found in quality-of-life post intervention. Positive feedback was provided from participants on using digital technologies indicating the novelty of the approach and potential further applications.

To the best of the authors’ knowledge, this is the first study which has used virtual reality to support people with intellectual disability access health care.

The paper presents the initial groundwork for the development of a research agenda around the management control implications of employing workers with intellectual disability.

The point of departure of this foundational enquiry is primarily prior analyses and critiques of empirical research into the employment of workers with intellectual disabilities.

The authors extend the management control framework advanced by Tessier and Otley (2012) by offering insights relating to the benefits and costs of both compliance as well as performance roles of management control systems (MCS). As such, the authors advocate potential avenues for further empirical investigation and also offer four broad ways in which the use of MCS is implicated in the employment of individuals with an intellectual disability by recognising that achieving compliance outcomes or achieving performance outcomes both carry associated benefits and costs.

The extent to which management control research has engaged with the context of workers with intellectual disability is limited. However, this paper identifies some of the salient considerations underlying an agenda for further research in this area.

The employment of workers with intellectual disabilities is by no means unprecedented. In many Western economies, there have in recent times been significant disability policy shifts, recognising the key role of employment in the financial security and social participation of people with disabilities, including those with intellectual disabilities. A key performance indicator stated in these policy positions is an increase in workforce participation for this group of people. However, an increase in the employment of such individuals is likely to represent significant implications in terms of prevailing conditions as well as new management control configurations that may be required.

The paper overviews existing knowledge about the employment of workers living with an intellectual disability and identifies areas relating to the management control implications of such arrangements within which more research is required.

People with intellectual disability die prematurely and from avoidable causes. Innovative solutions and proactive strategies have been limited in addressing this disparity. This paper aims to detail the process of developing a risk stratification tool to identify those individuals who are higher risk of premature mortality.

This study used population health management principles to conceptualise a risk stratification tool for avoidable deaths in people with intellectual disability. A review of the literature examined the existing evidence of causes of death in people with intellectual disability. A qualitative methodology using focused groups of specialist clinicians was used to understand the factors that contributed towards avoidable deaths in people with intellectual disability. Delphi groups were used for consensus on the variables for inclusion in the risk stratification tool (Decision Support Tool for Physical Health).

A pilot of the Decision Support Tool for Physical Health within specialist intellectual disability service demonstrated effective utility and acceptability in clinical practice. The tool has also demonstrated good face and construct validity. A further study is currently being completed to examine concurrent and predictive validity of the tool.

To the best of the authors’ knowledge, this is the only study that has used a systematic approach to designing a risk stratification tool for identifying premature mortality in people with intellectual disability. The Decision Support Tool for Physical Health in clinical practice aims to guide clinical responses and prioritise those identified as at higher risk of avoidable deaths.

A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.

Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.

Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.

To the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

This study introduces an ecological framework for disabilities meant to provide a new model of viewing and learning about disabilities and special education. This model projects a multi-systemic view of factors that influence a person's life, where people with disabilities are active actors in the development of the world. The increased awareness about interconnectedness, globalization, inter- and trans-disciplinarity, influences on human experience, greening, sustainability, inequality, inequity and lack of opportunities is shifting how people think about potential and growth.

The methodological approach is qualitative, interpretive research.

In disability studies, the Ecological Model of Disabilities helps reframe this uniqueness as part of the spectrum of human experiences. In special education, the Ecoducation Model helps reframe the learning experience.

This research is conceptual, but it is also all-inclusive, rendering itself to a wide application in educational settings.

The Ecoducation Model for Special Education is specific to the education of children and adults with disabilities, and it is directly compatible with the broader Ecological Model of Disabilities. These ecological models can be applied to all levels of the ecological system, and to different ecodemes of population. Nevertheless, the ecological models need to be locally implemented, with general principles tailored to national traditions, laws and resources.

Advocating for the pursuit of individual well-being within the larger society, both models call for practical changes in a multitude of areas, including legislation and policy, training of professional personnel, sufficient financial input in programs designed for the care of children and adults with disabilities, change in societal mentalities to fight discrimination, disempowerment and isolation. Because the scope of ecological frameworks is incommensurate, being both interdisciplinary and transdisciplinary, further research possibilities are countless. The ecological perspective opens the fields of disability studies and special education to new theoretical and empirical possibilities.

Two epistemological models are described as new frameworks in disability studies: the Ecological Model of Disabilities and the Ecoducation Model for Special Education. Both are original models that look into the education and inclusion of the person with disabilities.

This study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and outcome factors; to explore the process of what is done to and for the patient including identifying dysphagia, choking and pneumonia risk, typical interventions and management; examine clinical outcomes; and explore the relationship of outcomes with risk factors, satisfaction with the service and the impact of the service on the number of choking incidents and admissions to acute hospital with swallow concerns.

There were three specific work packages: (1) collecting and scrutinising patient data from the clinical record for adults with ID referred to the SLT swallow service over a six-month period. The researcher created aims, defined the limits to achieve the aims, designed a standardised data collection form, set out where data was in the clinical record, piloted, set limits for collection and trained reviewers; (2) gathering experience and satisfaction surveys from patients, caregivers and referrers over the six-month study period; and (3) monitoring choking adverse incident reports and hospital admission with swallow concerns for the whole ID population.

Choking and hospital admission were the main reasons for referral, and pneumonia risk significantly predicted dysphagia impairment. The research highlighted common dysphagia risk factors, interventions and recommendations for this population. The SLT swallow service is a quality service that is highly valued by patients, their caregivers and referrers. The service achieves significant clinical improvements, helps identify dysphagia and provides management to reduce associated risks.

This study found common dysphagia risk factors, interventions and recommendations; it also found that the therapy outcome measures/Royal College of Speech and Language Therapy online outcome tool was a meaningful outcome measure, and that pneumonia risk significantly predicted dysphagia impairment, all of which could inform the identified dysphagia research priorities for this population.

Naming usual care in treatment and recommendations could help ensure a fair service and could help form quality indicators. People with ID, their caregivers and staff generated valuable ideas for improvement, and further involvement work could create a logic model for the service. Other future work could explore the use of screening tools, increase multidisciplinary team working, improve access to instrumental assessments, raise awareness of swallowing and promote important oral health and medication reviews. By using this information to shape quality improvement work and policies, one can work toward addressing high health-related inequalities and preventable deaths associated with dysphagia in this vulnerable population.

It may be useful to raise awareness that adults with ID age earlier and that one should not exclude them from older people’s services because of an age threshold, often set higher than their life expectancy. This study highlighted a possible inequality of access issue for adults with ID who do not have direct care or day care staff. There is a need to increase access to awareness training so caregivers and general practitioners can recognise swallow difficulties and know how to make a referral for a swallow assessment.

Overall, the evaluation of the swallow service to adults with ID suggests that SLT have a quality service for adults with ID that is highly valued and provides significant clinical improvements. By building on these strengths, SLT could extend the reach, influence and impact of their services to help those adults with ID who have emerging swallow difficulties or who do not access the service.

This paper aims to explore how accounting is fostering neoliberal citizenship through the participants of Australia’s National Disability Insurance Scheme (NDIS). More specifically, this paper aims to understand how accounting discourse and the management accounting technique of budgeting, when intertwined with automated administrative processes of the NDIS, are giving rise to a pastoral form of power that directs people’s behaviour toward certain ends.

Publicly available data has been crafted into an autoethnographic case study of one fictitious person’s experiences with the NDIS – Mina. Mina is an amalgam created from material submitted to the Joint Parliamentary Standing Committee on the NDIS. Mina’s experiences are then analysed through the lens of Foucault’s concept of pastoral power to explore how accounting has contributed to marketising and digitising public disability services.

Accounting rhetoric appears to be a central part of rationalising the decision to shift to individualised disability funding. Those receiving payments are treated as self-governable, financially responsible subjects and are therefore expected to have knowledge of management accounting techniques and budgeting. However, NDIS’s strong reliance on the accounting concepts of funds, budgets, cost and price is limiting people’s autonomy and subjecting them to intervention and control.

This paper addresses calls to explore the interplay between accounting and current disability policies. The analysis shows that incorporating accounting into the NDIS’s algorithms serves to conceal the underlying ideology of the programs, subtly driving behaviours towards neoliberal objectives. Further, this research extends the Foucauldian accounting literature by revealing the contribution of accounting to reinforcing the authority of digital pastors in contemporary times.

The present paper answers two significant questions: (1) What are the relative consumer and firm-level effects of marketing through metaverse compared to conventional marketing endeavors? (2) What are the current trends in utilizing the metaverse as reported in the recent literature?

This study employs a systematic literature review methodology, utilizing a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart to synthesize existing research. Thirty-five articles written in English were selected and analyzed from two databases, Web of Science and EBSCO Host.

The findings indicate that consumer-level effects of the metaverse include consumer loyalty and brand attachment. The firm-level benefits are decentralization and cost reductions. The paper proposes a framework indicating variables that could attenuate or enhance the association between immersive components of the metaverse and their resultant effects.

This study contributes to understanding the role of metaverse in marketing practices related to the marketing mix components. The study conceptualizes a novel framework for the metaverse and its resultant effects.