Reported Barriers to the Implementation of Person‐Centred Planning for People with Intellectual Disabilities in the UK

Background Research in the US and UK has demonstrated the effectiveness of person‐centred planning (PCP) for people with intellectual disabilities. However, it is important to acknowledge problems that arise when implementing PCP. This paper considers barriers to PCP reported during a longitudinal study of the impact of PCP. Methods Person‐centred planning was introduced over a 2‐year period for 93 people of whom 65 had a plan developed. Information was collected regarding barriers to PCP every 3 months from key informants using self‐completion questionnaires. Results Barriers to PCP were widespread particularly in relation to: availability of trained facilitators; availability of services; lack of time and reluctance of people other than paid support staff to engage in the PCP process. Conclusions Services need to be aware of potential barriers to PCP so that strategies can be developed to overcome them, the first of which should be the ongoing training and support of facilitators.     

Pain and Palliative Care for People Living with HIV/AIDS in Asia

Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. Access to adequate pain relief and palliative care is impeded by the barriers which face PLHA in Asia. These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.     

An Approach to Life Skills Group Work With Youth in Transition to Independent Living: Theoretical,Practice, and Operational Considerations

Group work is fundamental to working with youth learning about independent living and in making the tough and challenging transition to independence. The authors, seasoned and experienced group workers and researchers with youth leaving the child welfare system, will present a conceptual framework and set of practices for helping youth gain those life skills essential to effective transition and independence. The article addresses key concepts such as life skills, the nature of transition, and independence, its requirements and its support. The article also examines theoretical perspectives that support the acquisition of life skills including social learning and self-efficacy and modes of learning (e.g., visual, dialogic, problem solving, experiential, and didactic).     

慢性精神分裂症患者社区独立技能训练的效果

目的探讨社区独立技能训练对慢性精神分裂症患者社会功能的影响。方法将2008年1—6月某院临床康复出院的120例精神分裂症患者按随机数字表法分为观察组和对照组,每组各60例。对照组患者进行常规康复训练,其间有8例患者放弃训练,实际完成52例;观察组患者进行社区独立技能训练,其间有4例患者放弃训练,实际完成56例。于入组时、和训练8周末、26周末、1年后,分别采用精神分裂症阳性症状量表（scale for the assessment of positive symptoms,SAPS）、阴性症状量表（scale for the assessment of negative symptoms,SANS）、社会功能缺陷量表（social dysfunction scale,SDSS）对两组患者进行调查,并于入组时、训练1年后采用护士观察量表（nurses＇ observation scale for inpatient evaluation,NOSIE）对两组患者进行康复状态的评估。结果训练8周末、训练26周末、训练1年后,观察组患者SAPS、SANS、SDSS评分均优于对照组,两组间差异有统计学意义（P〈0．05或P〈0．01）。训练1年后,观察组患者NOSIE评分优于入组时,差异有统计学意义（均P〈0．01）。结论社区独立技能训练更能有效地改善慢性精神分裂症患者的社会功能,明显提高慢性精神分裂症患者的生活质量。     

Barriers to Caregiver Compliance with Eating and Drinking Recommendations for Adults with Intellectual Disabilities and Dysphagia

Background There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists’ (SLTs) dysphagia management strategies more difficult. Method Semi‐structured open‐ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia. Results Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers. Conclusions Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies.     

People with Intellectual Disabilities Living in Generic Residential Services for Older People in the UK

Background As part of a UK programme of work focusing on older people with intellectual disabilities, the circumstance of those who reside in generic services for older people were investigated. Materials and methods Questionnaires were sent to 2570 residential and nursing homes in 53 local authorities across the UK. Results Five hundred and thirty returned questionnaires identified 215 people with intellectual disabilities currently living in 150 homes. They were significantly younger than the other residents, and were placed in these homes more often because of organizational change or the ageing/death of a family carer, rather than any changes in their own needs. Several potential indicators of a low quality of life were identified, including limited opportunities to get out, to access day services, to have contact with family or friends and to receive input from professionals outside the home. Conclusions Attention needs to be given both to people with intellectual disabilities already residing in older people's services and to the prevention of further inappropriate placements.     

Knowledge of Advocacy Options within Services for People with Learning Disabilities

Background The aim of this study was to evaluate the extent to which care managers in learning disability services understand the role of the Independent Mental Capacity Advocate (IMCA) service, and the difference between the newly created statutory IMCA and existing general advocacy (GA) services. Method There were 22 participants from three community teams within learning disabilities services, all but one of whom had attended training on the Mental Capacity Act (2005) . Participants completed a questionnaire based on a set of nine scenarios where they were asked to identify the appropriate professional to contact in relation to the situation described, and to explain what their role would be. Results Respondents’ understanding of these issues was generally poor. There was a substantially less than 50% correct response rate for identification of scenarios that called for an IMCA referral, and respondents’ ability to discriminate between the roles of GA and IMCA was limited. Only around half of the respondents correctly identified that the function of advocacy is to represent the client’s views, and a significant minority incorrectly attributed decision‐making functions to the IMCA. Only a single participant identified the statutory requirement to involve an IMCA in relation to a change of long‐term accommodation (where the person lacks capacity and has no other non‐professional support), and none of the participants identified this as a statutory requirement in relation to serious medical treatment. Conclusion A better understanding of the statutory functions of the IMCA service may require a different approach to Mental Capacity Act training.     

Resident Involvement in Activity in Small Community Homes for People with Learning Disabilities

Background Determining the relative importance of variables including client characteristics, setting features, staffing and care practices on the lives of people with learning disabilities in residential care continues to be a relevant topic for research. Methods Measurements were made of the adaptive and problem behaviour of 343 adults with intellectual disabilities living in 76 residential homes and of various aspects of staffing, care practices (extent of active support) and resident engagement in meaningful activity. Ordinal and logistic regression was used to identify variables best predicting engagement and care practices. Results Only adaptive behaviour and care practices predicted resident engagement in meaningful activity; only age and adaptive behaviour predicted care practices. Conclusions Given the limited scope for changing resident adaptive behaviour, attention should be given to improve active support in residential homes in order to promote greater engagement in meaningful activity by people with learning disabilities.     

An Adapted Acoustic Orientation System for Promoting Independent Indoor Travel and Activity in Persons with Profound Multiple Disabilities

Two experiments assessed the effectiveness of an adapted acoustic orientation system in promoting independent indoor travel and activity in two adults with profound multiple disabilities. The system consisted of a portable control device and acoustic sources. The portable control device activated each programmed destination (and turned on the acoustic sources showing the way to it) automatically, after a preset time had elapsed from the subject reaching the previous destination. The acoustic sources emitted verbal messages as orientation cues. Results indicated that the subject participating in Experiment 1 was highly successful in reaching the various destinations and carrying out the activities available. The subject participating in Experiment 2 also showed a definite improvement in travel and activity. General implications of the findings were discussed.     

Iowa's High School High Tech Goes to College Program: Preparing Students with Mild Disabilities for Careers in Technology

This paper describes an innovative approach to preparing high school students with mild disabilities for challenging careers in high tech industries, called High School High Tech (HSHT). Iowa's HSHT Goes to College program has three central elements, each of which is discussed in this paper: High School Preparation—assisting students in identifying a suitable high tech career goal; Higher Education Preparation and Supports—assisting students in selecting college/training programs that match their career goal, and in successfully completing their postsecondary programs; Workforce Entry Assistance—linking students with employers and launching their high tech careers. The paper concludes with a presentation of outcomes to date and recommendations for program enhancements. The information presented here is intended to assist education and rehabilitation professionals interested in establishing similar efforts across the nation.     

A Framework for Evaluating Inclusive School Programs for Primary Students with Language and Learning Disabilities

In this paper, a framework for evaluating inclusive school environments for students with language and learning disabilities is described. The framework for this evaluation is based on a sociocultural perspective with an emphasis on evaluating program adaptability, opportunities to communicate orally, and access to higher order cognitive tasks and content. The framework is applied in a case study of an inclusion program in an urban elementary school.     

Towards Improving Medical Care for People with Intellectual Disability Living in the Community: Possibilities of Integrated Care

Background Ongoing deinstitutionalization has resulted in several problems in medical care delivery to people with intellectual disability, such as an increased workload for general practitioners (GPs) and a lack of active co‐ordination and co‐operation between healthcare professionals. A major consequence is the incidence of untreated yet treatable medical conditions. An integrated care approach may provide a means for better co‐ordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for people with intellectual disability. Method A literature search was conducted to trace relevant literature on integrated care for people with intellectual disability published between 1995 and 2003. Results Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in medical care for people with intellectual disability and for reducing GP workload, there are few published studies which have evaluated its implementation with people with intellectual disability. Conclusions Even though the potential advantages of integrated care are well known, the applicability of this approach for people with intellectual disability has still to be demonstrated.     

血压测量教学中学生不易掌握环节的调查分析

目的对学生在学习血压测量过程中不易掌握环节进行调查分析,从而为教学提供基础资料。方法按照规定学时在血压测量示教、练习后,教师通过目测、询问、考试等方法找出学生操作与教材不符的环节并进行分析。结果学生操作不符合教材规范环节依次为:充气(97.0%)、放气(72.2%)、听诊器胸件位置(56.0%)、袖带松紧度(54.3%)、搏动音听诊(49.7%)。不同学制之间差异无统计学意义。结论血压测量操作教学中,应强调听诊器胸件放于肱动脉搏动点上;用3种方法可替代教材对于充气的要求;开始学习放气宁慢勿快;初学者最好裸露整个上臂练习;舒张压强调以搏动消失为准。