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The development and evaluation of an integrated intensive support service 综合集约化支持服务的发展和评价
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-11-30 DOI: 10.1108/amhid-04-2021-0021
Karen Dodd, Victoria. Laute, Selven Daniel
PurposeThis paper aims to describe the development and evaluation of integrated intensive support service (ISS) for adults with learning disabilities who have complex needs and are at risk of admission to an inpatient unit.Design/methodology/approachExisting services were remodelled. The service explored external service models and established an integrated ISS comprising intensive community support and intensive support beds.FindingsData indicates that the majority of people referred to the service avoid both admission to an inpatient unit and placement breakdown. Most people admitted to the inpatient unit are not known to community services. Length of stay has significantly reduced.Practical implicationsOther services can use the information to remodel how to provide intensive support and avoid admission to an inpatient unit.Originality/valueIt demonstrates how remodelling can drive improvements to reduce placement breakdown and risk of admission.
目的本文旨在描述综合强化支持服务(ISS)对有复杂需求且有住院风险的成人学习障碍患者的发展和评估。设计/方法/方法对现有服务进行了改造。服务探索外部服务模式,建立集约化社区支援和集约化支援床位的综合服务系统。调查结果数据表明,大多数转介到该服务的人既避免住院,也避免了安置失败。大多数住进住院部的人都不知道社区服务。停留时间大大缩短。其他服务可以利用这些信息来改造如何提供强化支持和避免住院。原创性/价值它展示了重塑如何推动改进,以减少安置崩溃和入学风险。
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引用次数: 3
Exploring maintaining gains following therapy during the coronavirus pandemic with adults with an intellectual disability 探索在冠状病毒大流行期间对智障成年人进行治疗后保持收益
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-10-07 DOI: 10.1108/amhid-05-2021-0023
J. Purrington, Arthur Nye, N. Beail
PurposeThe novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic.Design/methodology/approachA mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews.FindingsOverall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy.Originality/valueThis is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase.
目的新型冠状病毒和相关的缓解措施显著增加了智障成年人的压力。这种生活压力的增加预示着心理治疗后复发的风险增加。这导致了常见的心理健康问题给全球带来的高疾病负担。因此,本文旨在探索在新冠肺炎大流行的背景下,维持治疗后收益的服务用户体验。设计/方法/方法在英格兰北部一家专门支持智障成年人的心理服务机构完成了混合方法评估。使用描述性统计和效应大小计算来检查治疗前、治疗后和随访时的治疗结果。这些发现为八次半结构化访谈的框架分析提供了依据。结果总体而言,治疗后的结果有所改善,随访时有所退步。框架分析显示,维持的促进者包括对治疗的特定方面的回忆以及策略和资源的定期利用。相反,维持的障碍包括专注于个人结果的回忆、对社会支持的依赖以及无法记住治疗。原创/价值这是唯一一项针对作者知识的研究,研究了新冠肺炎背景下服务用户在治疗后保持收益的体验。希望这些发现将为进一步的研究提供信息,并有助于在新冠肺炎大流行持续并进入大流行后阶段时,为服务用户出院做好准备。
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引用次数: 4
A survey of complex trauma in families who have children and adults who have a learning disability and/or autism 一项对有学习障碍和/或自闭症儿童和成人的家庭复杂创伤的调查
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-09-06 DOI: 10.1108/amhid-07-2021-0032
Peter Baker, Vivien Cooper, Winnie Tsang, Isabelle Garnett, N. Blackman
PurposeThere is an established literature supporting the idea that families who have children and adults who have a learning disability and/or autism have a greater vulnerability to mental health problems or poor psychological health. There are shortcomings in this literature in that there is a little consideration of the impact the families interaction with services has on their well-being. It is argued that complex post-traumatic stress disorder (CPTSD), with its focus on prolonged chronic exposure to trauma experiences and the recognition that this can occur in adulthood, may well be an appropriate framework to enable a better understanding of the experiences of families.Design/methodology/approachA total of 214 family members completed a co-produced online survey in relation to potential traumatic events, impacts and support.FindingsThe experiences of family carers of children and adults with a learning disability and/or who are autistic would appear to be multi-layered and complex, with many experiencing a wide range of traumatic events with the associated emotional and personal sequela. The reported responses are consistent with CPTSD with 10% of having received a diagnosis of PTSD. Their experience was that the system failed not only to provide support but also created additional trauma.Practical implicationsA trauma-informed approach needs to be adopted by agencies and professionals that serve families to ensure they understand their potential contribution to the trauma families experience.Originality/valueTo the best of the authors’ knowledge, this is the first study that has attempted to examine the experience of families using the framework of CPTSD.
目的已有文献支持这样一种观点,即有学习障碍和/或自闭症儿童和成人的家庭更容易出现心理健康问题或心理健康状况不佳。这篇文献的不足之处在于,很少考虑家庭与服务的互动对他们幸福感的影响。有人认为,复杂的创伤后应激障碍(CPTSD)专注于长期长期暴露于创伤经历,并认识到这种情况可能发生在成年后,很可能是一个适当的框架,可以更好地了解家庭的经历。设计/方法/方法共有214名家庭成员完成了一项联合制作的关于潜在创伤事件、影响和支持的在线调查。发现患有学习障碍和/或自闭症的儿童和成人的家庭护理人员的经历似乎是多层次和复杂的,许多人经历了各种各样的创伤事件以及相关的情感和个人后遗症。报告的反应与CPTSD一致,10%的人被诊断为PTSD。他们的经验是,该系统不仅未能提供支持,还造成了额外的创伤。实际含义为家庭服务的机构和专业人员需要采用创伤知情的方法,以确保他们了解自己对创伤家庭经历的潜在贡献。原创性/价值据作者所知,这是第一项试图使用CPTSD框架来检验家庭经历的研究。
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引用次数: 2
Change processes within team formulations in intellectual disabilities services: what do multi-disciplinary staff find helpful? 改变智障服务团队制定流程:多学科员工发现什么有用?
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-09-03 DOI: 10.1108/amhid-03-2021-0016
Gemma Hymers, D. Dagnan, B. Ingham
PurposeA biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events.Design/methodology/approachEight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis.FindingsThe key themes identified were: “gaining information”, “altered thoughts” and “focused goals”. These themes were supported by “collaborative working” and “time for reflection” and were hindered by “poor communication and interaction” and inconsistent “staff attendance”.Originality/valueMulti-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development.
目的生物-心理-社会案例表述是理解复杂性和指导智障患者治疗的重要工具。有人建议,制定会议应使工作人员了解他们所支持的个人。本研究旨在探讨专业团队制定会议所产生的变化过程,以及促进和阻碍这些事件的机制。设计/方法/方法八名临床医生参加了一项针对智障成年人的住院心理健康服务的多学科团队配方,他们接受了采访。访谈采用专题分析法进行审查。发现确定的主要主题是:“获取信息”、“改变想法”和“聚焦目标”。这些主题得到了“协作工作”和“反思时间”的支持,并受到“沟通和互动不力”和“工作人员出勤率”不一致的阻碍。独创性/价值多学科团队制定会议可能会有一些变化过程,影响工作人员对所支持人员的了解和看法。促进这些进程应当成为进一步发展的重点。
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引用次数: 2
Compassion in custody: developing a trauma sensitive intervention for men with developmental disabilities who have convictions for sexual offending 监禁中的同情:为有性侵犯前科的发育性残疾男性开发一种创伤敏感干预
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-09-02 DOI: 10.1108/AMHID-01-2021-0004
Jon Taylor
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引用次数: 4
Mitigating the impact of SARS-CoV-2 on residential facilities for persons with intellectual disability and/or autism spectrum disorder: two experiences from the Italian red zone 减轻严重急性呼吸系统综合征冠状病毒2型对智力残疾和/或自闭症谱系障碍患者居住设施的影响:意大利红区的两次经验
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-08-27 DOI: 10.1108/amhid-02-2021-0006
J. Santambrogio, M. Russo, S. Terrevazzi, Gianluca Peschi, M. Clerici, M. Bertelli
Purpose Persons with intellectual disability and/or low-functioning autism spectrum didorder are with high support need (ID/ASD-HSN) are among the people who are most vulnerable to the COVID-19 pandemic. The specific vulnerability and the protective factors for persons with ID/LF-ASD attending residential and rehabilitative facilities have however received little attention. This paper aims to describe how two facilities located in the Italian COVID-19 red zone faced the risks associated with the spread of the pandemic and the results they have achieved so far. Design/methodology/approach Interventions to contrast the spread of the pandemic and preserve clients’ health conditions have been systematically monitored and recorded since the very beginning of the pandemic. Findings 26/138 clients had to undergo clinical screening and laboratory tests for COVID-like symptomatology, but only one resulted affected by COVID-19 and survived. Considering that Lombardy had 89,595 cases and 16,262 deaths (January–May 2020), one COVID-19 case/138 clients is a good result. Temporarily limiting physical contacts with friends/family in favor of reducing the burden of risk and adopting a system of prevention/safety strategies directed for persons with ID/LF-ASD attending and their caregivers have been useful measures. Research limitations/implications Structured or semi-structured interviews (using professional caregivers as informant) to confirm behavioral and emotional changes in the clients could not be carried out because of lack of time and resources (which were captured by the management of the pandemic) and could be the next goal for our residential facilities to implement the management of epidemic acute phases in a research-oriented view. Originality/value This study is a service evaluation report about facing COVID-19 pandemic. Only few such studies are present in medical literature about ID/ASD.
目的患有智力残疾和/或低功能自闭症谱系障碍的人(ID/ASD-HSN)是最容易受到新冠肺炎大流行影响的人群。然而,入住住宿和康复设施的ID/LF-ASD患者的具体脆弱性和保护因素却很少受到关注。本文旨在描述位于意大利新冠肺炎红区的两个设施如何面临与疫情传播相关的风险,以及迄今取得的成果。自疫情一开始,就对对比疫情传播和保护客户健康状况的设计/方法/方法进行了系统监测和记录。发现26/138名客户必须接受新冠肺炎样症状的临床筛查和实验室检测,但只有一名患者受到新冠肺炎的影响并存活下来。考虑到Lombardy有89595例病例和16262例死亡(2020年1-5月),一例新冠肺炎病例/138名客户是一个好结果。暂时限制与朋友/家人的身体接触,以减轻风险负担,并采取针对ID/LF-ASD患者及其护理人员的预防/安全策略体系,这些都是有用的措施。研究局限性/含义由于缺乏时间和资源(这是疫情管理层所掌握的),无法进行结构化或半结构化访谈(使用专业护理人员作为线人)来确认客户的行为和情绪变化,这可能是我们住宅设施实施疫情管理的下一个目标以研究为导向的急性期。原创/价值本研究是一份关于面对新冠肺炎大流行的服务评估报告。在关于ID/ASD的医学文献中,此类研究很少。
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引用次数: 1
Using clinical audit to improve the quality of mental health-care services for people with learning disabilities 利用临床审计提高对学习障碍者的精神保健服务质量
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-08-14 DOI: 10.1108/amhid-03-2020-0006
Edward da Costa, D. Adams, Munzer Salmeh, O. Mahmoud, Ekim Yetkili
PurposeThe over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to discuss the application of the methodology of clinical audit within community learning disability mental health services to adapt interventions including optimising prescribing practice and behavioural interventions aiming to reduce behaviour that challenges in people with learning disabilities.Design/methodology/approachQuestionnaire-based review of documentation in electronic patient records, covering relevant audit standards in line with NICE and Royal College of Psychiatrists, was carried out in the North Essex Community Learning Disability Service, Hertfordshire Partnership NHS Foundation Trust. The audit included patients on the caseload of consultant psychiatrists.FindingsThe audit demonstrated that the prescribing of psychotropic medication was within BNF maximum limits for all patients, evidence of “consent” procedures was being followed in the majority, and there was some evidence of deprescribing attempts.Improvement was required in several areas e.g. undocumented off label prescribing in a significant proportion of patients. Objective measures to record the severity of behaviours and the effects of the medication were being used by clinicians in only a small proportion of patients. A significant proportion of patients have prescribed medication in the absence of appropriate psychological or environmental interventions.Originality/valueAs a result of the audit findings, the action plan made recommendations such as the development of a database for tracking the prescribing of psychotropic medicines and routine use of standardised measures. This action has been supported by the pharmacy team. Positive developments include a clinical psychologist taking on the role of leading the development of behavioural intervention strategies.
目的过度依赖精神药物治疗具有行为挑战的学习障碍患者的情况已得到充分记录。本文旨在讨论临床审计方法在社区学习障碍心理健康服务中的应用,以适应干预措施,包括优化处方实践和行为干预措施,旨在减少学习障碍患者的行为挑战。设计/方法/方法:在赫特福德郡合作伙伴NHS基金会信托的北埃塞克斯社区学习障碍服务中,对电子病历中的文件进行了基于问卷的审查,涵盖了符合NICE和皇家精神病学家学院的相关审计标准。审计对象包括精神病顾问的病人。审计结果表明,所有患者的精神药物处方都在BNF最大限度内,大多数患者都遵循了“同意”程序的证据,并且有一些证据表明他们试图减少处方。需要在几个方面进行改进,例如,相当大比例的患者未记录标签外处方。临床医生仅在一小部分患者中使用客观措施来记录行为的严重程度和药物的效果。很大一部分患者在没有适当的心理或环境干预的情况下服用处方药。独创性/价值根据审计结果,行动计划提出了一些建议,例如建立一个数据库,以跟踪精神药物的处方和常规使用标准化措施。这一行动得到了药房团队的支持。积极的发展包括临床心理学家承担领导行为干预策略发展的角色。
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引用次数: 1
Impressions about people with intellectual disability of Polish high school students who participated in a workshop led by self-advocates 参加由自我倡议者主持的工作坊的波兰高中生对智障人士的印象
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-08-10 DOI: 10.31234/osf.io/82ry4
Iwona Nowakowska, E. Pisuła
PurposeThe aim of the paper is to assess whether participation in a two-session workshop led by self-advocates with mild intellectual disability (ID), supported by professional staff, affects high school students’ impression of people with ID, measured by a self-report questionnaire based on a semantic differential.Design/methodology/approachThe study was paper-pencil questionnaire-based and anonymous, conducted in Warsaw, Poland. Three measurements were performed using two semantic differentials – two weeks before the workshop, one day and three months afterward. In total, 50 high school students in the workshop group and 43 students in the control group took part in the study.FindingsAfter the workshop, people with ID were perceived as more calm, compliant and adult and this change was not observed in the control group.Research limitations/implicationsThe picture of people with ID after the workshop may probably have been even more complex than before. However, the study focuses on a specific intervention and does not include data about other, similar meetings led in another school and by other self-advocates.Practical implicationsIt is worthy to design anti-discriminatory workshops led by the self-advocates to impact the perceptions of people with ID. The particular intervention would benefit from alterations.Social implicationsWorkshops performed by self-advocates with ID may be promising in terms of limiting stereotype formation in target groups of workshops.Originality/valueThis research fills the gap in the longitudinal studies on the changes in the impressions about people with ID following an intervention based on personal contact.
目的通过基于语义差异的自我报告问卷,评估在专业人员的支持下,由轻度智障自我倡导者(self-advocates with mild intelligent disability, ID)领导的两节研讨会是否会影响高中生对轻度智障人士的印象。设计/方法/方法本研究采用纸笔问卷和匿名方式,在波兰华沙进行。使用两种语义差异进行了三次测量-研讨会前两周,一天和三个月后。总共有50名高中学生在车间组和43名学生在对照组参加了这项研究。研究结果:工作坊结束后,患有ID的人被认为更冷静、更顺从、更成熟,而在对照组中没有观察到这种变化。研究局限/启示讲习班结束后,有身份证的人的照片可能比以前更复杂。然而,这项研究关注的是一项具体的干预措施,并不包括其他在另一所学校和其他自我倡导者组织的类似会议的数据。实践启示:设计由自我倡导者领导的反歧视研讨会,以影响对身份证人士的看法是值得的。这种特殊的干预将受益于改变。社会意义由自我倡导的ID患者举办的讲习班在限制讲习班目标群体的刻板印象形成方面可能是有希望的。原创性/价值本研究填补了基于个人接触干预后对ID患者印象变化纵向研究的空白。
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引用次数: 0
The impact of Covid-19 on access to psychological services 新冠肺炎对获得心理服务的影响
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-08-04 DOI: 10.1108/AMHID-03-2021-0017
J. Purrington, N. Beail
PurposeThe novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy.Design/methodology/approachA quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores.FindingsReferral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size.Originality/valueThis is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic.
目的新型冠状病毒和相关的缓解措施对智障成年人获得服务造成了障碍。本文旨在评估新冠肺炎对获得心理服务的影响。该论文评估了等待治疗的服务用户的每月转诊率和心理困扰评分。设计/方法/方法在英格兰北部一家专门为智障成年人提供支持的心理服务机构完成了定量服务评估。采用单例实验设计来检验2020年3月事件对转诊率的影响。使用描述性统计和效应大小计算来检验延长等待时间对心理困扰评分的影响。调查结果对12名患者的5年滚动平均月转诊率进行了比较 2020年3月之前的12个月 接下来的几个月。调查结果表明,从2020年3月开始的事件对转诊率产生了相当大的影响,转诊率尚未恢复。联系了八名服务用户,以确定延长等待时间的影响,结果显示,大影响范围的心理困扰增加。原创性/价值这是作者所知的唯一一篇研究冠状病毒对智障成年人获得服务和心理困扰的影响的论文。希望随着服务业继续应对疫情,这些发现将能够为政策和实践提供信息。
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引用次数: 11
A systematic review of adverse childhood experiences (ACEs) with people with intellectual disabilities: an unsafe gap in the literature 对智障人士不良童年经历(ace)的系统回顾:文献中的不安全空白
IF 1.1 Q4 PSYCHIATRY Pub Date : 2021-07-01 DOI: 10.1108/AMHID-10-2020-0024
Chloe Crompton, Bethany Duncan, G. Simpson-Adkins
PurposeThis paper aims to systematically review the available evidence that explores adverse childhood experiences (ACEs) in people with intellectual disabilities (PwID). It is important to systematically review this literature as, to date, there is little known about the number of studies in this area, despite the World Health Organization declaring ACE prevention and support as a global public health priority.Design/methodology/approachPublished studies were identified from electronic database searches. Key journals and reference lists were also hand searched.FindingsTwo studies met the inclusion criteria and the prevalence and frequency of ACEs experienced by participants of these studies analysed. Overall, due to the small number of studies meeting the inclusion criteria, it is difficult to establish any meaningful conclusions.Originality/valueThis appears to be the first systematic review to try and identify a research base looking at the prevalence of ACEs within a PwID population. Findings suggest that this is a highly neglected area of research, and the authors hope to have identified that further evidence is required to draw clearer conclusions about the impact of ACEs on PwID.
目的对智力障碍患者不良童年经历(ace)的相关研究进行系统回顾。系统地回顾这些文献是很重要的,因为迄今为止,尽管世界卫生组织宣布ACE的预防和支持是全球公共卫生的优先事项,但该领域的研究数量知之甚少。设计/方法/方法已发表的研究从电子数据库检索中确定。关键期刊和参考书目也手工检索。两项研究符合纳入标准,并分析了这些研究参与者经历的ace的患病率和频率。总的来说,由于符合纳入标准的研究数量较少,很难得出有意义的结论。原创性/价值这似乎是第一个系统的综述,试图确定一个研究基础,研究在PwID人群中ace的患病率。研究结果表明,这是一个被高度忽视的研究领域,作者希望已经确定,需要进一步的证据来得出关于ace对PwID影响的更明确的结论。
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引用次数: 1
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