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This chapter sought to answer the following questions: (a) what does special education means for students with intellectual disability?, (b) what is being done, and (c) how do we maintain tradition? The answers, while complicated, suggest special education for students with intellectual disability historically and currently involves attention to what, how, and where, with the how being the key elements of special education for students with intellectual disability. This chapter discussed the what, how, and where for students with intellectual disability in a historical and current framework while also providing evidence-based practices for students with intellectual disability to implement to maintain the tradition of high-quality services.

This study aims to evaluate the dementia assessment and diagnosis care provided to adults with intellectual disability. The authors selected recommendations from the National Institute for Health and Care Excellence (NICE) standards which could be evidenced in clinical notes and aimed to identify characteristics which may be associated with improved adherence to these recommendations.

The study population was adults with an intellectual disability who were diagnosed with dementia between January 2019 and December 2022 by a UK-based intellectual disability service. Data to demonstrate adherence to selected recommendations and demographic and clinical characteristics were extracted from electronic patient records.

The authors identified 41 individuals. A mean of six of the eight recommendations were adhered to. There was low adherence with structural imaging to support dementia subtype diagnosis (9 individuals, 22%). This may be linked with the low percentage of people diagnosed with vascular dementia (1 individual, 2%) despite a national figure of 20%. No demographic or clinical characteristics were associated with level of adherence recorded. The authors found incomplete recording of diagnostic clinical coding in electronic patient records. This may disadvantage this population, as they cannot be readily identified for post diagnostic support or resource allocation.

To the best of the authors’ knowledge, this is the first study to examine adherence to these NICE guidelines in this population.

Evidence of overprescribing of psychotropic medicines to manage challenging behaviour in people with intellectual disabilities has led to national programmes within the UK to promote deprescribing, such as stopping the overprescribing of medication in people (with learning disabilities, autism or both). To successfully implement deprescribing initiatives, we need to understand how to engage stakeholders in the process.

In a published systematic review, we reported evidence about the process of deprescribing psychotropic medicines for people of all ages with intellectual disabilities and challenging behaviour. As a part of the original review, we searched for evidence about stakeholders’ experiences of the psychotropic deprescribing process, which was synthesised and reported within the current study.

Six studies were identified. Involving carers and people with intellectual disabilities, providing ongoing support and improving access to non-pharmacological interventions, including positive behaviour support, may contribute to successful outcomes, including reducing or stopping psychotropic medicines and improving quality of life. Implementing psychotropic deprescribing requires a multidisciplinary collaborative care approach and education for stakeholders.

There have been no previous reviews of stakeholder experiences of deprescribing psychotropic medications for people with intellectual disabilities and challenging behaviour. The existing literature is scant, and further research is needed.

Research with vulnerable groups is crucial to get their input into public policy design that will directly impact on them. However, there are many methodological and ethical challenges involved in encouraging participation from groups with a wide range of intellectual, cognitive and physical capacities while ensuring that the rights and well-being of participants are protected. Rather than exploring ethical theories, this chapter is a case study describing the practical ethical considerations that were involved in designing and holding a series of focus groups with adult health and social care service users from vulnerable cohorts. It is based on a series of focus groups which the Institute of Public Health (IPH) held with specified cohorts as part of a policy development process on adult safeguarding for the Department of Health (DOH) in Ireland. The four cohorts were people with intellectual disability, cognitive impairments, significant mental health challenges and nursing home residents. This chapter does not describe the findings of the focus groups but outlines the ethical and methodological considerations that arose in designing and conducting this research, and the practical ethical safeguards employed to mitigate risk and comply with Irish and EU General Data Protection Regulation (GDPR) legislation governing health research. It outlines the ethical issues around protecting confidentiality and using incentives to encourage participation, how individuals' capacity to give informed consent was maximized, the risk-assessment and mitigation procedures used to prevent harms arising and the measures put in place to provide follow-up emotional support to participants.

This study aims to identify the critical factors contributing to India-based non-governmental organizations (NGOs) capacity building and value creation for beneficiaries.

A total interpretive structural modeling technique has been used to develop a hierarchical model of critical factors and understand their direct and indirect interrelationships. The driving force and dependence force of these factors were determined by using cross-impact matrix multiplication applied to classification analysis.

This study identifies 12 critical factors influencing NGO capacity building in India’s intellectual disability sector across four dimensions. Internal organizational capabilities include infrastructure, staff qualifications, fundraising, vocational activities and technical resources. Second, coordination and stakeholder engagement highlight government and agency collaboration, dedicated board members and stakeholder involvement. Third, adaptability and responsiveness emphasize adjusting to external trends and seizing opportunities. Finally, impact and value creation emphasis on improving value for persons with disabilities (PWDs).

The findings of this study have practical implications for Indian NGOs working for PWDs. The study provides NGOs with a structural model for improving organizational capacity by identifying and categorizing critical factors into the strategic model.

There is a scarcity of literature on capacity building for disability-focused NGOs in India. This study seeks to identify critical factors and develop a hierarchical model of those factors to assist policymakers in India in building the capacity of NGOs.

The high and persistent unemployment rates of people with intellectual disabilities (PwID) reveal the wide gap that still remains to be bridged. Entrepreneurship combinedly with a high enterprising tendency could improve PwID's life satisfaction.

A mixed-method approach was used, based on questionnaires and structured face-to-face interviews on 37 PwID who had recently become entrepreneurs. Data were firstly quantitatively analyzed using partial least squares-structural equation modelling (PLS-SEM), and qualitative data were used to enable robust findings.

The entrepreneurial tendency of PwID who had recently become entrepreneurs was found to be a positive to their life quality (LQ), job satisfaction and life satisfaction.

This study revealed that entrepreneurship among PwID who had high enterprising tendency enhances their LQ, job satisfaction and life satisfaction. However, further research could evaluate whether becoming an entrepreneur is in itself enough to change PwID's life to better, such that a comparison could be done between PwID who become entrepreneurs and PwID who have a salaried job.

New aspects in the design of public social policies to improve PwID's life satisfaction are suggested. These include the facilitation of both entrepreneurship and enterprising tendency for PwID to enhance their life satisfaction.

There are very few occasions in which PwID set up businesses. This is one of the first studies to analyze the benefit of entrepreneurship and enterprising tendency on the LQ, the satisfaction at work and the life satisfaction of PwID.

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 study investigates the drivers of social innovation in disability services with specific reference to the context of nonprofit organizations of social farming. In addition, it highlights the role of stakeholder networks in enhancing the social innovation process and the characteristics of stakeholders and networks driving and supporting social innovation.

Following a qualitative methodology, research was conducted through a case study survey with interviews to 13 nonprofit organizations of social farming for people with disability located in the northeast of Italy.

Insights gained from the interviews revealed that individual, organizational and contextual factors drive social innovation in disability nonprofits. In addition, networks play a key role in enhancing the three drivers of social innovation through the social innovation journey, from opportunity recognition to implementation of the innovation, to its consolidation phases. Characteristics of the networks and the stakeholders involved are also outlined.

Practical implications for social entrepreneurs include the need to establish cross-sectoral partnerships with diverse stakeholders, including private companies.

Implications for policy makers stress the need for ongoing support for nonprofit disability organizations. Social implications are not limited to the inclusion of socially weaker groups; rather, the entire community benefits from the social innovation process.

Social farming represents a valuable solution to meet the needs of disadvantaged people. While much research has investigated the topic of social innovation in social entrepreneurship, only a few studies have addressed social innovation in the context of disability nonprofits involved in social farming.