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Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”.

This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges.

It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again.

Standards in relation to care pathways are presented.

Following a series of inquiries and reports, health has become an increasingly high priority for the Valuing People Now programme and beyond, in local and regional health and social care systems. Programmes at national, regional and local levels are now in place and bringing the results described in this article, including health checks and the local self‐assessment framework, but much remains to be done to ensure that positive change is equitable and sustainable across and within the systems and continues to be driven by people with learning disabilities and their families. Changing current health inequalities will continue to require leadership at all levels.

The purpose of this paper is to introduce the social and scientific rationale for book clubs, whose members read wordless books together, and give examples of storytelling with picture books in libraries and other community settings for people with intellectual disabilities and autism.

The authors consider the impact of book clubs reading picture books without words, alongside an understanding of the underlying neuroscience (see Table I for search strategy). The authors compare differences in the neuroscience of information and emotion processing between pictures and words. Accounts from book club facilitators illustrate these differences in practice.

Many readers who struggle with reading and comprehending words, find pictures much easier to understand. Book clubs support community inclusion, as for other people in society. A focus on visual rather than word literacy encourages successful shared reading.

No research has been published about the feasibility and effectiveness of wordless books in community book clubs or shared reading groups. There is very little research on the impact of accessible materials, despite a legal requirement for services to provide reasonable adjustments and the investment of time and resources in developing storylines in pictures, or “translating” information into easy read formats.

Book clubs whose members read picture books without words are growing in number, especially in public libraries in the UK. Expansion is dependent on funding to pay for training for librarians and volunteer facilitators.

There is a shortage of fully accessible activities for adults with intellectual disabilities in mainstream community settings with a primarily social purpose.

To the authors’ knowledge, this is the first paper describing the theory and impact of wordless book clubs for people who find pictures easier to understand than words.

The aim of the project was to evaluate the short‐term treatment outcomes of patients treated in a medium secure service for people with intellectual disability. A total of 138 patients, 77 discharged and 61 current inpatients, treated over a six‐year period were included in the audit. Information on demographic and clinical variables was collected on a pre‐designed data collection tool and analysed using appropriate statistical methods. The median length of stay for the discharged group was 2.8 years. About 90% of this group were discharged to lower levels of security and about a third went directly to community placements. None of the clinical and forensic factors examined was significantly associated with length of stay for this group. There was a ‘difficult to discharge long‐stay’ group which had more patients with criminal sections, restriction orders, history of abuse, fire setting, personality disorders and substance misuse. However, when regression analysis was done, most of these factors were not predictive of the length of stay. Clinical diagnosis or offending behaviour categories are poor predictors of length of hospital stay, and there is a need to identify empirically derived patient clusters using a variety of clinical and forensic variables. Common datasets and multi‐centre audits are needed to drive this.

This paper gives a brief overview of the background to current efforts to help more people with learning disabilities take up direct payments. It reflects on some of the challenges involved for stakeholders, and describes the positive steps that many partnership board areas are beginning to take.

The purpose of this paper is to systematically identify, appraise and synthesise qualitative literature exploring the experience, both positive and negative, of clinical supervision from the supervisor’s perspective.

A systematic search of three databases, grey literature, reference lists and citations was conducted. Six articles met the inclusion criteria and their quality was critically appraised by using a modified version of the Critical Appraisal Skills Programme tool. Data extracted from the articles were synthesised using meta-ethnography.

Four key themes were identified: experiencing difficulties in clinical supervision, responsibility, similarities to therapy and capabilities as a supervisor. These demonstrated that the role of a supervisor has the potential to be both beneficial and harmful to personal and professional development.

The quality of the studies was variable. Further research is required to explore how supervisors manage difficult experiences to ensure personal development and growth.

Clinical implications include the need for employers to consider the additional pressure associated with providing clinical supervision and to ensure that appropriate support is available. Results complement previous research on the bi-directionality of parallel process in clinical supervision.

This review presents an original synthesis of the supervisor’s experience of delivering clinical supervision to qualified therapists. This is achieved by utilising a systematic methodology and appraising the quality of the studies included. The review highlights how the effects of clinical supervision are not limited to the supervisee, but also experienced by the supervisor. The competing demands and responsibilities associated with clinical supervision impact upon the supervisor’s experience, both positively and negatively. When beneficial, delivering clinical supervision can lead to personal and professional growth in addition to the acquisition of new skills.

The following is an introductory profile of the fastest growing firms over the three-year period of the study listed by corporate reputation ranking order. The business activities in which the firms are engaged are outlined to provide background information for the reader.