Vocational and social learning of people with severe disabilities in sheltered employment

In addition to prevocational centres for young people with disabilities about to enter the labour market and vocational training centres for older persons, the Federal Republic of Germany provides a network of sheltered workshops for those who are unable or unlikely to work under competitive conditions. This paper describes the programme for persons in the latter category, based on applications of learning theory, provided at the sheltered workshop in Detmold, Westphalia. It also reports various steps which have been taken to evaluate and refine the two-fold approach to training developed at this centre, based on job analysis and detailed appraisal of workers' social and psychological characteristics, and to apply that approach to persons with a wider range of disabilities.     

The Valued People Project: users' views on learning disability nursing

A well-educated and trained workforce is undoubtedly crucial to the development of quality care for people with learning disabilities. Notwithstanding this, and unsure as to the need to continue to commission educational programmes for one part of this workforce-pre-registration learning disability nursing-South Central Strategic Health Authority commissioned the Valued People Project to undertake a detailed strategic review of educational commissioning, along with a review of the specialist learning disability health workforce more generally. This project has recently been completed, and provides a unique evidence-based expert evaluation of the future strategic direction of education commissioning and leadership for workforce issues in specialist learning disability services, as well as the wider NHS workforce. This is the first in a series of articles that reports on one aspect of the project: the focus group work undertaken with parents and relatives of people with learning disabilities, and people with learning disabilities themselves, as to the need and type of health workforce needed to support them in the future. The article concludes by identifying the key messages of importance from parents and people with learning disabilities concerning the future specialist and wider NHS workforce.     

Learning disabilities: a survey of community nurses for people with prevalence of challenging behaviour and contact demands

Background. There is scant knowledge on the contacts community nurses for people with learning disabilities have with clients who display challenging behaviours, or the numbers of such people on these nurses‘ caseloads. This study was undertaken in a UK region with a population of 1.68 million people. In this region it is estimated that there are 8500 people with learning disabilities who are in contact with services, this includes around 500 people remaining in hospitals awaiting resettlement. Aims and objectives. The research aims were to identify the overall caseload sizes of the nurses, the prevalence of people with learning disabilities who have challenging behaviours on the nurses’ caseloads and what contact demands these people required. An additional aim was to discover courses or training that helped the nurses to fulfill their roles. Design and methods. A postal survey was undertaken of the total population of community nurses for people with learning disabilities in the region. The method of data collection was a self‐completion questionnaire. Results. The study found that people with challenging behaviours accounted for over a quarter of the combined caseloads, and these clients required the most frequent visits from the nurses. There was a wide range in the number of clients on the caseloads of each nurse but overall these were higher than in other parts of the UK. Conclusions. It is concluded that community nurses for people with learning disabilities have large caseloads and people with learning disabilities who have challenging behaviours, who account for over one‐quarter of the clients they visit, require much more frequent contact visits than other clients. The combination of high numbers of clients (or low numbers of these nurses) may impact on how such nurses are able to perform their role and functions. Relevance to clinical practice. An increase in the numbers of community nurses for people with learning disabilities and skill development in caring for people with challenging behaviours is recommended. If this is not performed the clinical effectiveness of this group of nurses with respect to their work with people who challenge services may be unduly hampered.     

Out-of-area placements in Scotland and people with learning disabilities: a preliminary population study

People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population.     

Involving people with learning disabilities in nurse education: towards an inclusive approach

There is limited evidence that explores how to effectively include people with learning disabilities in nurse education in the U.K. The majority of reported work relates to mental health nursing and social work training (Morgan and Jones, 2009). This paper specifically reports on the processes and activities undertaken by the authors with people with learning disabilities in the development of a new BSc learning disability nursing programme, a specific branch of nursing in the U.K. In doing so, findings and discussion from two separate projects involving students and people with learning disabilities will be integrated into the paper. EPICURE (Engagement, Processing, Interpretation, Critique, Usefulness, Relevance and Ethics (Stige et al. 2009) is adopted as a qualitative framework throughout the paper to evaluate the reported work that took place between September 2006 and October 2010. Suggestions are therefore made regarding the benefits and challenges of striving towards an inclusive approach to user involvement in nurse education, with particular reference to learning disability. The work presented in the paper demonstrates how through careful involvement of this population, deeper learning opportunities for all nursing students can be created.     

Improving care for people with learning disabilities

In November 1998, a project group began a review of acute hospital service provision in Sheffield for people with learning disabilities and their carers. The aim was to produce recommendations for future development. Throughout the project, patients with learning disabilities and their carers were consulted along with professionals and focus groups representing people with learning disabilities. The project group identified the need for new audit tools and integrated care pathways, changes to documentation and working practices, as well as the need to develop training. The group presented its findings to the executive of the newly formed Sheffield Teaching Hospitals NHS Trust, which gave full support for the group's recommendations to be implemented throughout the trust.     

Learning disabilities and mental ill health: care plans

Comprehensive multidisciplinary assessment and treatment are particularly important for clients who present with learning disabilities and mental health problems (O'Hara and Sperlinger, 1997). This should not be restricted to professionals who work in services for people with learning disabilities and should include a wider network of professionals from statutory services and the independent sector. This arrangement can be complex as different agencies and even different departments of the same agency may differ fundamentally in their philosophy, vision and understanding of their own and other's roles and responsibilities. It is vital that these differences are recognised and dealt with so that they do not become a barrier to accessing best practice. Only in this way can the person benefit fully and have their needs met.     

Meeting the needs of people with learning disabilities in acute care

This article describes the work of the Birmingham Acute Hospital Liaison Project, which seeks to support people with learning disabilities in acute care. Following the community care reforms, more and more people with learning disabilities are accessing mainstream primary and secondary healthcare services in community settings staffed by generic rather than specialist learning disability staff. Unfortunately, research suggests that some people with learning disabilities receive poor quality care and that available services are not always responsive to their needs. As a result, the Acute Hospital Liaison Project has a dual role: supporting people with learning disabilities as they enter hospital; and working with ward staff to equip them with the skills and confidence they need to work more effectively with people with learning disabilities.     

Changing Selves: a Grounded Theory Account of Belonging to a Self‐advocacy Group for People with Intellectual Disabilities1

Purpose To explore the experience of belonging to a self‐advocacy group for people with intellectual disabilities, and how membership of such a group impacts on individual members. Methods Eight people with intellectual disabilities, who belonged to a self‐advocacy group for at least 6 months, were interviewed about their experiences of membership. A grounded theory approach was used to generate and analyse the interview data. Results A model of the impact of belonging to a self‐advocacy group for people with intellectual disabilities on individual members' self‐concept is developed. The model proposes that participants' self‐concept changes as a result of group membership and that this process of change involves six key categories: joining the group; learning about and doing self‐advocacy; becoming aware of group aims and identity; experiencing a positive social environment; identifying positive change in self‐concept and seeing the future of self and group as interlinked. Conclusion Membership of a self‐advocacy group for people with intellectual disabilities changes the self‐concept of participants. The processes surrounding these changes have important implications for self‐advocacy groups both, in recruitment and in supporting group members.     

An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust

Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI-trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.     

Roles of General Practitioners in the Provision of Health Care Services for People with Intellectual Disabilities: A National Census in Taiwan

Aims The aims of the present study were to explore the perceptions of general practitioners (GPs) in the provision of health care services for people with intellectual disabilities and to analyse GPs’ priorities in the delivery of health care services to this group of people in Taiwan. Methods The study employed a cross‐sectional design and was conducted by a census method, the aim being to collect information from all GPs in Taiwan. A questionnaire was mailed out, between 10 April 2006 and 16 June 2006, and the responses provided by 331 GPs (response rate = 16) were included in the analysis. Results The results showed that most of the respondents did not have sufficient experience to deal with patients with intellectual disabilities and lacked adequate knowledge about intellectual disabilities. Indeed, respondents expressed the need for on‐the‐job training in the field of intellectual disabilities and generally agreed that their role in providing health care services for people with intellectual disabilities was important. However, they were generally not satisfied with the achievements of their role on health care issues. The study highlighted that many issues need to be prioritized for people with intellectual disabilities in relation to policy planning at different health care stages (primary, secondary and tertiary health care). The results also revealed that those senior GPs with considerable experience in treating people with intellectual disabilities were more likely satisfied with their role in providing health care for this group of people. Conclusions It is concluded that Taiwanese health and welfare authorities need to focus more carefully on issues concerning deficiencies in the training of GPs, and to employ appropriate strategies to address health care issues raised in the present study so as to improve the quality of care for people with intellectual disabilities.     

Basic life support and children with profound and multiple learning disabilities

Nurses and other carers of people with learning disabilities must be able to manage choking events and perform basic life support effectively. UK guidelines for assessment of airway obstruction and for resuscitation do not take account of the specific needs of people with profound multiple learning disability. For example, they fail to account for inhibited gag and coughing reflexes, limited body movements or chest deformity. There are no national guidelines to assist in clinical decisions and training for nurses and carers. Basic life support training for students of learning disability nursing at Birmingham City University is supplemented to address these issues. The authors ask whether such training should be provided for all nurses including those caring for children and young people. They also invite comment and discussion on questions related to chest compression and training in basic life support for a person in a seated position.     

Value of employment to people with learning disabilities

A key objective of the Government White Paper 'Valuing People: A New Strategy for Learning Disability for the 21st Century' is to encourage and assist people with learning disabilities to gain employment. This is because very few people with learning disabilities are in paid work and employment is promoted as a means of improving self-esteem, skills and social integration and acceptability. The aim of this article is to highlight some benefits of, and the risks and concerns around, people with learning disabilities undertaking paid work. Learning disability nurses need to be aware of these issues if they are to advise and support clients effectively. If people with learning disabilities are not able or unwilling to enter the world of work then alternative approaches are needed. Leisure has the potential to offer similar benefits as work to people with learning disabilities.     

Health facilitation in primary care seen from practice and education

'Valuing People: A New Strategy for Learning Disability for the 21st Century' (Department of Health, 2001a,b) aimed to introduce 'health facilitation' to improve the identification of health needs and access to appropriate care for people with learning disabilities. One London Borough took a leading role in implementing this new function, in the form of dedicated, full-time health facilitators. The authors examined the implementation and its impact, employing an innovative collaboration between professionals from practice, education and research. The clinical nurse involved was observed during her first year of health facilitation. The authors evaluated her impact on professionals, people with learning disabilities and the wider system of health. In some areas (for example, information technology) the health facilitator could make little progress in one year. However, she connected with a widening circle of local people and services, for example, in introducing health action plans for adults with a learning disability. Across the Borough some professionals became more aware of specific health issues in their local population.     

The role of community nurses for people with learning disabilities: working with people who challenge

The locus of care for people with learning disabilities has transferred from institutional to community-based services. Increasingly people who have learning disabilities and additional challenging behaviours live in community settings. Spearheading the care for these people are community nurses for people with learning disabilities. This study aimed to explicate the role of these nurses in their day-to-day work with people who challenge. Using grounded theory methodology, 22 nurses were selected by theoretical sampling and interviewed. An analytical story and theoretical framework that emerged from the grounded data is presented. It is suggested that this framework has utility for practice.     

Using video and conversational analysis to train staff working with people with learning disabilities

Through analysis of video data of interaction between staff and clients with learning disabilities and limited vocal skills, it was possible to demonstrate that clients used gaze and body orientation to display a readiness that was often not responded to by staff Yet staff could recognize that readiness from the videos Video analysis was therefore developed as a medium for education and training where staff were helped to become more aware of strategies for non-vocal communication, which could help them achieve their policies of supporting clients more successfully The study also allowed development of methodology in the field of services for people with learning disabilities     

Measuring the effects of seating on people with profound and multiple disabilities--a preliminary study

This paper describes a preliminary study to investigate a range of approaches that might be used for measuring the effects of special seating on people with profound and multiple disabilities and their carers. A number of tools are proposed for measuring the effects on quality of life, function and carer satisfaction. The results of applying these tools to measure the effects of intervention with customized molded seating on nine people with multiple disabilities are described. The results suggest that these tools are sensitive to this intervention, showing a general beneficial effect with good carer satisfaction. The study points the way towards application of these tools to people with a wider range of disabilities and to different interventions.     

An exploratory investigation into the usability and usefulness of training people with learning disabilities in a virtual environment

PURPOSE: Two studies sought to answer the following questions. Are people with learning disabilities capable of using a virtual environment? Are they motivated to learn using this training method? Do they show any benefit from using a virtual environment? Does any benefit transfer to improved real world performance? Method: In the first study, 30 students with learning disabilities were sequentially allocated to an active or a passive experimental group. Active participants explored a virtual bungalow searching for a toy car. Passive participants watched the exploration undertaken by the preceding active participant and searched for the toy car. All participants then performed spatial and object recognition tests of their knowledge of the virtual environment. In the second study, the errors of 45 participants on a real steadiness tester task were noted before they were randomly allocated to three groups-a real training group, a virtual training group and a no training group. After training, the participants performed a second test trial on the real steadiness tester. RESULTS: The students were capable of using a virtual environment and were motivated to use this training method. Active exploration of a virtual environment was found to enhance their memory of the spatial layout of the bungalow but not their memory of the virtual objects. In the second study, virtual training was found to transfer to real task performance. CONCLUSIONS: These two laboratory-based studies provide answers to four important questions concerning virtual training of people with learning disabilities. Hopefully, the findings will encourage this training aid to be used more widely.     

Attitudes of nurses in a general hospital towards people with learning disabilities: influences of contact, and graduate-non-graduate status, a comparative study

A review of the literature suggests people with learning disabilities are viewed negatively by others in society Such negative views have also been found among many health care professionals, including nurses This study measured the attitudes of a randomly selected sample of nurses in a general hospital (n=31) towards people with learning disabilities The study involved a triangulation approach utilizing a Likert scale attitude measurement questionnaire Two comparisons between subjects in the study were undertaken—a comparison of the attitudes of graduate nurses and those who were non-graduates, a comparison between nurses who had most contact, and those who had least contact with people who have learning disabilities From the sample of 31 nurses, 10 subjects were selected for more in-depth interviews which were tape recorded, transcribed and, using the process of 'content analysis', quantified
Findings suggest the attitudes held by the total sample towards people with learning disabilities were more negative than would be expected from those in a caring profession The graduate nurses were found to be more positive in their perceived attitudes towards people with learning disabilities than non-graduate nurses Nurses in the sample who had high contact were found to have more positive attitudes than nurses who had lower amounts of contact with people who had learning disabilities