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Antipsychotic drugs are frequently prescribed to people with intellectual disabilities (ID) to ameliorate psychotic symptoms and behavioural symptoms with and without mental condition. Guidelines recommend systematic evaluation of treatment effects and adverse effects, and limiting the treatment duration. Studies have shown that adherence to prescription guidelines is beneficial for clients’ outcomes. Therefore, the purpose of this paper is to investigate the adherence to antipsychotic drug prescription guidelines in two treatment settings.

A checklist, based on existing antipsychotic drug prescription guidelines, was used to evaluate the adherence of prescribers to guidelines in two settings in the Netherlands, i.e., in specialized intellectual disability (ID) care organizations and mental health care organizations. Data from medical records of clients who used antipsychotic drugs (n=299) were compared to the items of the checklist.

Treatment effects were measured with validated scales in both settings in only 2.7 per cent of cases. Prescriptions were for problem behaviour in the absence of a psychotic disorder or psychotic symptoms in 90 per cent (specialized ID care) and in 79 per cent (mental health care) of cases. In specialized ID care pipamperone (31.9 per cent) and in mental health care risperidone (48.5 per cent) was most often prescribed. Adverse effects were monitored more frequently in specialized ID care.

The adherence to guidelines for prescribing antipsychotic drug to people with ID is insufficient in the Netherlands, because of shortcomings in the evaluation of treatment and adverse effects.

National guidelines in the UK for emotionally unstable personality disorder and antisocial personality disorder (PD) do not recommend treatment with medication, suggesting instead psychotherapy. There is little evidence that medication has benefit from the literature. Despite this, many patients with PDs are prescribed medications. This study aims to quantify medication prescriptions within the therapeutic community for those with PD and assess if treatment led to changes in prescription.

An audit tool was designed in Microsoft Excel; 30 most recent patients discharged from the authors’ service since November 2018 were identified. Their discharge summaries were scrutinised for changes in medication comparing the beginning of treatment to the end. These were then analysed in terms of changes in class of medication and dose as well as total number of medications prescribed.

In total, 31 patients’ notes were scrutinised. Then, 25 patients were prescribed psychiatric medication at the start of their treatment, 24 had medications changed falling to 17 at the end of treatment. Antidepressants were the most commonly prescribed medications. By class, antidepressant prescriptions fell by 35 per cent, antipsychotics by 43 per cent, anxiolytics by 40 per cent. The prescription of mood stabilisers and Z drugs remained the same.

The assessment of medication changes during psychotherapeutic treatment within a therapeutic community is unique in the literature. Understanding and hypothesising the dynamics involved within this process has also received little attention in research. This study highlights the potential from which further research into this neglected but pertinent area could be conducted.

There is a significant body of evidence from small‐scale trials and pilot studies that show telecare services can be cost‐effective as well as popular with service users and their carers. However, the results of serious external audits and evaluations suggest that many services are inefficient and that telecare technology prescriptions are not always optimised. This appears to be the case especially when referral numbers are small and when many staff are asked to match technology to identified risk. The emerging best practice is for much greater emphasis on making professional staff and members of the public aware of the potential of the technology, and then using a small, highly‐trained and experienced team to ensure that telecare solutions are person‐centred and tailored to the individual's needs. A major gap in training for these teams has been identified.

The classic audit cycle has been applied to the prescribing practice to improve aspects of the quality of prescribing in the setting of a department of health care for older people in a district general hospital. Details the methods used both to increase the appropriate prescribing of drugs of proven benefit, and also to restrict the use of drugs which may prove hazardous. The latter provides an example of risk management. Also discusses the dilemmas posed in treating older people with multiple pathologies, on the one hand, trying to avoid an ageist approach, on the other, attempting to minimise the pitfalls of polypharmacy.

The purpose of this paper is to provide a commentary on the article by Lee and colleagues, entitled “Positive Behavioural Support as an alternative to medication”, from the perspective of Dimensions, a national provider of social care support to people with learning disabilities and/or autism. As a supporter of the NHS England STOMP campaign, Dimensions recognises that people with learning disabilities and/or autism who have displayed “challenging behaviours” are at risk of being wrongly or over prescribed psychotropic medications intended to control that behaviour, and encourages the use of non-medical support strategies as an effective alternative to psychotropic medications.

Dimensions surveyed the approximately 1,400 people with learning disabilities and/or autism for whom they provide 24-h support. The survey was intended to assess the extent of use of psychotropic medications and the level of adherence to NICE “best practice” guidelines. The survey was the precursor to an awareness raising campaign and development of an operational toolkit intended to inform and empower people supported, families and colleagues to take a more proactive role in the prescription and review of psychotropic medications.

In total, 54 per cent of people surveyed were being prescribed psychotropic medication, of whom 97 per cent had been prescribed one or more medications for at least six months. Around 51 per cent were having six monthly multi-disciplinary reviews and around 31 per cent had not had a multi-disciplinary review within the preceding 12 months. Only 13 per cent of people taking psychotropic medication had a plan in place that was specifically aimed at reducing or stopping the medication.

Empowering people to participate in and challenge clinical decision making can have a transformative effect on the lives of a group of people who have experienced a significant negative impact from prolonged use of psychotropic medications.

The purpose of this paper is to examine the extent to which, in the five integrated community teams for adults with learning disabilities (CTLDs) in an English county-wide service, the use of psychotropic medication for service users was based on the presence of an appropriate mental health condition or epilepsy.

Adult participants were recruited following referral to one of the CTLDs for assessment, treatment and/or support of a possible mental health and/or behavioural need. Data were collected about participant characteristics and psychotropic medication 12 months after recruitment.

While a total of 42 (78 per cent) of the 54 participants were apparently prescribed regular or PRN (as required) psychotropic medication, only 24 (57 per cent) of these individuals had a recorded past or current mental health condition or epilepsy for which such medicine could be appropriate.

There were several limitations: the sample size was small and its representativeness was uncertain; and data collection was compromised by barriers to explicit knowledge exchange within and across the learning disability service.

While recent guidance about the use of psychotropic medication is welcome, minimising inappropriate use requires more comprehensive person-centred interventions (including crisis management plans), underpinned by imaginative, but feasible, data collection methods and integrated formulations. Investment is needed in developments that support multi-disciplinary and inter-agency working to promote “good practice” by CTLDs in responding to referrals for possible mental health and/or behavioural needs.

Complementing recent large studies of primary care (General Practitioner) records, this is the first examination of the use of psychotropic medication by service users in English CTLDs.

Heslop, Folkes and Roger's article about the knowledge and experiences of people with learning disabilities and their carers of psychiatric drugs, and Lim's audit of prescription regimes in a hospital for people with severe learning disabilities in Hong Kong, add weight and substance to a substantial body of evidence which suggests that people with learning disabilities are often prescribed inappropriate, and at times excessive, amounts of psychotropic medication and that many staff/carers lack sufficient knowledge and skills to monitor and manage such medications (Singh et al, 1996). A number of years ago we wrote a review of the use of psychotropic drugs for people with learning disabilities (Stenfert Kroese et al, 2001) which included a number of recommendations. The Heslop et al and Lim papers bring up many issues which were relevant to these recommendations.

The purpose of this paper is to examine how test‐based accountability has influenced school and district practices and explore how states and districts might consider creating expanded systems of measures to address the shortcomings of traditional accountability. It provides research‐based guidance for entities that are developing or adopting new measures of school performance.

The study relies on literature review, consultation with expert advisers, review of state and district documentation, and semi‐structured interviews with staff at state and local education agencies and research institutions.

The research shows mixed effects of test‐based accountability on student achievement and demonstrates that teachers and administrators change their practices in ways that respond to the incentives provided by the system. The review of state and district measurement systems shows widespread use of additional measures of constructs, such as school climate and college readiness.

There is a clear need for additional research on the short‐ and long‐term effects of expanded systems of measures. In particular, currently little is known about how the inclusion of input and process measures influences educators’ practices or student outcomes.

The research suggests several practical steps that can be taken to promote effective systems of measurement, including providing supports for high‐quality teaching to accompany new measures, offering flexibility to respond to local needs, and conducting validity studies that address the various purposes of the measures.

The paper provides new information about how states and districts are expanding their systems of measures for various purposes, and informs accountability policy by highlighting the benefits and limitations of current outcomes‐based approaches to accountability and by clarifying the trade‐offs and decisions that should be considered.

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings for other jurisdictions.

Non-systematic review of literature from websites of national, state and territory health departments and interviews with key stakeholders for Australian strategies to reduce antimicrobial resistance.

In July 2015 all states and territories in Australia adopted the National Antimicrobial Resistance Strategy 2015-2019, which is built on the World Health Organization policy package to combat antimicrobial resistance. This strategy represents “the collective, expert views of stakeholders on how best to combat antimicrobial resistance in Australia. It will also support global and regional efforts, recognising that no single country can manage the threat of antimicrobial resistance alone”. It combines quantitative and qualitative monitoring strategies with frameworks and guidelines to improve management of the use of antimicrobial resistant drugs. Prior to this, health services and states developed and implemented initiatives aimed at monitoring and improving prescribing practices. Development of the national strategy has encouraged and fostered debate within the Australian health system and a raft of new policy initiatives.

Surveillance strategies are in place to monitor impact and trends at jurisdictional and sector levels. However, actual impact on antimicrobial resistance and prescribing practices remains to be seen as existing initiatives are expanded and new initiatives implemented.

This overview of key Australian initiatives balancing quantitative and qualitative surveillance, accreditation, research, education, community awareness and price signals on antibiotic prescribing practices may be valuable to health systems in developing local strategies.

The authors provide an up to date overview of the context, strategies and aims of antimicrobial stewardship in Australia.

The purpose of this paper is to investigate if positive behavioural support (PBS) can be an effective alternative to medication, and can aid medication reduction in people with a learning disability, autism or both who are prescribed psychotropic medication for behaviour thought to be challenging. STOMP is an initiative supported by NHS England which aims to reduce inappropriate prescribing of psychotropic medication, i.e. antipsychotics used for challenging behaviour in the absence of a documented mental health diagnosis. PBS has been described as the first line of intervention for behaviours which challenge, (NICE, 2015) and has been highlighted as a non-pharmacological alternative to, medication.

A two-group, experimental design was utilised. Both groups were considered for medication reduction. The experimental group of 25 people received input from a specialist PBS team, while the control group of 29 people underwent unsupported medication challenge.

There was a significantly higher success rate for medication reduction and discontinuation when PBS assessment and intervention was provided as an alternative to medication.

This study indicates that providing PBS is associated with decreased medication and if replicated should be become standard practice for specialist teams.

This is the first study to investigate the effect of PBS on medication reduction in patients prescribed psychotropic medication for behaviour thought to be challenging.