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The purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services.

A cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.

There was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses.

Not having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism.

This large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

Destructive changes in body shape can happen slowly over a long period of time and may affect any person who has difficulty moving efficiently, irrespective of diagnosis or age. Supporting the body in symmetrical supine lying has been found to protect and restore body shape, muscle tone and quality of life for people who would otherwise be left to become static in destructive lying postures. Those described as having complex and continuing health care needs or profound and multiple learning disabilities are likely to be at risk of developing changes in body shape. This article will consider predictable patterns of chest distortion and reduction of internal capacity of the abdomen and thorax with key characteristics for those supporting individuals at risk, non‐invasive measurement of body symmetry as a relevant outcome measure in the effort to protect body shape, the consequences for individuals, their families and service providers, positive feedback from families about the benefits of night positioning, the preventable nature of changes in body shape and the practical steps that may be taken to ensure the safety of the individual. Case studies will be presented which demonstrate that the body is a mobile structure which is vulnerable to distortion but also susceptible to restoration as long as the correct biomechanical forces are applied. It is proposed that therapeutic night positioning is an effective intervention which should be made available to those at risk of body shape distortion from an early age, or as a matter of urgency for those with late onset or temporary immobility.

Wheelchairs and mobility devices are important to enable mobility for students who are unable to functionally walk by themselves to fully participate in daily life. However, they can be enablers or barriers to inclusion and participation for students. Children and adolescents, like other wheelchair users, have a varying number of reasons to use chairs, but what type of chair, how it is used and what type of participation it encourages or discourages is as individual as the child themselves. This is an area of practice that has little evidence on which to base decisions, leading to inconsistencies of provision practice and inclusion in mainstream environments. This chapter will discuss why children use wheelchairs in the first place, then outline some of the typical types of wheelchair available and discuss matching the child to their wheelchair. Barriers to appropriate use of wheelchairs include policy, funding, attitudes and perceived skill set. Children who use wheelchairs often do not gain the motor experiences that their peers do yet are expected to perform skilled wheeled mobility, often without training. Finally, inclusion in school is about inclusion not only in the classroom but also in all activities to do with their school-based communities.

The choice of what type of mobility a child needs is down to their self-defined goals in the context of their school environment, family and general ecosystem. Other forms of wheeled mobility included adaptive bicycles for children who are unable to utilise nonadapted bikes. The basis for assessment for wheeled mobility is the student. The most important part of adaptive seating is to match the student, their self-defined goals and their developmental needs. Barriers to inclusion are discussed. The final section of this chapter includes a discussion of where wheeled mobility is going into the future.

This article addresses the need for health checks for people with learning disabilities as a proven route to identifying and tackling health inequalities, what health checks should look like (covering physical and mental health) and how they should be followed up, and how practices and primary care trusts (PCTs) can implement health checks, involving people with learning disabilities and family carers and drawing on the expertise of community learning disability teams. Experience from Wales and England of offering health checks is described, and some key learning points are drawn out. In particular we recommend the appointment of a strategic health facilitator to lead the introduction of health checks and to ensure that the results are used to improve the health and health care of the population of people with learning disabilities.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.

Intellectual disabilities (ID) may complicate the experience of bereavement and loss, in those with communicative impairments compounded by complex healthcare needs and sensori-motor limitations. Whilst theorists have argued that the cognitive difficulties of people with profound ID impede mourning reactions, none have attempted to make sense of the responses they do exhibit. The current paper discusses this.

A select review considers the neurobiology underlying attachment bonds, complications in attachment formation and affect regulation in people with ID, and separation responses of people with profound ID.

The current paper demonstrates that by recognising the affective nature of separation distress, an understanding beyond a cognitive conceptualisation is possible.

It is worth questioning whether people with profound ID are incapable of any meaningful form of person permanence. A critical review could deal with this comparatively by drawing on research of person and object permanence in typically developing children.

Of specific interest, the bio-behavioural regulators of relationships may help us to appreciate the importance of routine physical health and social care for emotional wellbeing in this group.

It is argued that by appreciating the basic emotional and regulatory functions of relationships, we can achieve a greater insight into the loss experiences of people with profound ID that will offer therapeutic direction.

The Falls Exercise Prevention Programme for older people was introduced as a new project for North Bradford Primary Care Trust in 2002. The introduction of this new service was in response to an identified need to help reduce the incidence of falls, reduce serious injuries as a result of falling, and help improve and maintain the quality of life for those older people who had been identified as having had a fall or being at high risk of falling. The service was not established to be a front line service but to be incorporated into the falls referral pathway. The exercises undertaken are all evidence based and proven to be effective with this population. However, the Group promotes other aspects of quality of life for older people and promotes a holistic approach including health promotion and education. The group has now expanded to incorporate a ‘Walking for Health’ project; a ‘Walk From Home’ project and a ‘Buddy‐Up’ system. The Group is continually growing and future plans are to incorporate ‘Walks for Fallers’. Evaluation of the service provides information to continually improve and extend the services on offer.

THE fashionable topic today is management. Critics lay at its door many of the troubles from which we suffer. On the other hand there are those who laud it as the key which will open the door to future prosperity for this country. Government, Press, commerce and industry are as one in assuring us that by making management efficient we can say goodbye to many of our difficulties. That is a rather facile assumption. Prosperity depends on productivity and management is only one of the factors involved.

This systematic review paper aims to investigate seasonal ambient change’s impact on the incidence of falls among older adults.

The population, exposure, outcome (PEO) structured framework was used to frame the research question prior to using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Three databases were searched, and a total of 12 studies were found for inclusion, and quality appraisal was carried out. Data extraction was performed, and narrative analysis was carried out.

Of the 12 studies, 2 found no link between seasonality and fall incidence. One study found fall rates increased during warmer months, and 9 of the 12 studies found that winter months and their associated seasonal changes led to an increase in the incidence in falls. The overall result was that cooler temperatures typically seen during winter months carried an increased risk of falling for older adults.

Additional research is needed, most likely examining the climate one lives in. However, the findings are relevant and can be used to inform health-care providers and older adults of the increased risk of falling during the winter.