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1 – 10 of 458Rachel Mills, Rajan Nathan, Paul Soper, Felix Michelet, Alex G. Stewart and Sujeet Jaydeokar
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…
Abstract
Purpose
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.
Design/methodology/approach
A cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.
Findings
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.
Research limitations/implications
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.
Originality/value
This large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.
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Karen Bunning, Joseph Karisa Gona, Charles Richard Newton and Sally Hartley
Raising a child with learning and developmental disabilities in a low-income setting is challenged by inadequate resources, limited support and poverty. The impacts on caregivers…
Abstract
Purpose
Raising a child with learning and developmental disabilities in a low-income setting is challenged by inadequate resources, limited support and poverty. The impacts on caregivers include fatigue, distress and isolation. The purpose of this paper is to report on a programme (2008-2021) that was set up in Kilifi County, Kenya to investigate and address these difficulties.
Methodology
The programme used mixed methods through a series of interconnected studies, starting with a situation analysis, followed by a home-based intervention where the caregiver served as agent for change using augmentative and alternative communication (AAC) methods. This was followed by two community-based inclusive development initiatives: disability awareness training to community groups and empowering self-help groups for caregivers of children growing up with disabilities.
Findings
The situation analysis revealed scarce support services for caregivers and children with learning and developmental disabilities, with report of limited resources, inadequate coverage and poor professional practice. A home-based, AAC intervention was associated with improved caregiver well-being, significant positive changes to caregiver perceptions of the child’s communication and some expansion to the child’ social activities. However, questions around sustainability persisted. Disability awareness training led by persons with lived experience of disability showed positive changes to the views, values and attitudes of established community groups. Caregiver participation in self-help groups was associated with their greater personal agency, perceptions of increased social support and reduced severity of child’s disability.
Originality
The programme narrative demonstrates a rationalised and evidence-based process for community-based inclusive development that is low cost, culturally acceptable, with potential for sustainability.
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Usanun Intamas, Tassanee Rawiworrakul, Kwanjai Amnatsatsue, Sutham Nanthamongkolchai and Mary H. Palmer
This study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.
Abstract
Purpose
This study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.
Design/methodology/approach
A qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.
Findings
The majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.
Originality/value
This study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.
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Marzia Morena, Tommaso Truppi, Angela Silvia Pavesi, Genny Cia, Jacopo Giannelli and Marco Tavoni
This paper aims at investigating the possibility of effectively implementing the blockchain technology in the real estate environment, specifically applied to the Trust legal…
Abstract
Purpose
This paper aims at investigating the possibility of effectively implementing the blockchain technology in the real estate environment, specifically applied to the Trust legal instrument in Dopo di Noi (After Us) project, which is intended to guarantee assistance to persons with severe disabilities.
Design/methodology/approach
The paper is focused on how to apply the blockchain to the tool of Trust, analyzing the main features and characteristics of this technology.
Findings
The paper proposes two potential solutions for managing the Trust tool in the real estate sector, specifically within the Dopo di Noi project. The first simpler proposal is based on timestamping application. The second one radically changes the classical Trust model and introduces an automatization level in the process.
Social implications
The paper presents potential applications of the blockchain technology within the framework of Dopo di Noi project, which allows among other features, legal and tax facilitation for the institution of Trusts to benefit persons with severe disabilities.
Originality/value
This paper highlights the potentiality of the combination of the blockchain technology and the real estate environment and applies the blockchain technology to the Dopo di Noi project. Specifically, with the second solution, the paper proposes a platform that gathers, in a single network, various elements of the blockchain technology, such as timestamping, smart property, smart contract, and links them in order to provide services to persons with severe disabilities.
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This research explores lesson study as a way to enhance the quality of teaching for pupils with learning disabilities and autism spectrum disorder by observing changes to one…
Abstract
Purpose
This research explores lesson study as a way to enhance the quality of teaching for pupils with learning disabilities and autism spectrum disorder by observing changes to one pupil's (Wilma) active educational participation. The study also investigates if and in what ways the professional development impacted teaching practices.
Design/methodology/approach
Five teachers met with the author on four occasions. Between these meetings, the teachers delivered the lessons they had planned together. The author video recorded the meetings to discern how the teachers' expressions developed. The author shared their thoughts with another researcher to enable an interrater validity examination.
Findings
The implementation of the lesson study vehicle enabled the teachers to transform their thinking from mainly focusing on pupils' deficiencies to instead focusing on their strengths. A relationship was found between teachers' understanding of central coherence, their skills in adapting received instructions and pupils' abilities to process and contextualize information or discern the whole picture.
Research limitations/implications
Research that involves teachers in the learning process emphasizes the relation between teachers’ thinking and their potential to enable the contextualized inclusion of pupils with learning disabilities.
Originality/value
This research offers important insights into how school-day navigation for pupils with severe intellectual disability and autism can be understood through the lens of variation theory; the teachers' repeated and adjusted use of the frame on the schedule strip enabled Wilma to discern what would happen next during the school day.
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Jon Painter, Winola Chio, Liam Black and David Newman
This study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.
Abstract
Purpose
This study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.
Design/methodology/approach
This service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.
Findings
Most people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.
Originality/value
This study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.
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