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Abstract: Aims: A discussion of the treatment of people with an intellectual disability across healthcare and the modernisation of learning disability nursing. Background: Health inequalities are at the forefront of the collective mind of healthcare professionals and politicians, this paper explores why people with an intellectual disability have more health issues, die earlier and sometimes receive poor care, leading to unnecessary suffering and importantly, how this may change. Learning disability nursing has long been viewed as different and less valued, probably due to dual stigmatisation, or lack of understanding of specialist knowledge and skills required. This essential field of nursing is becoming a rare resource in our battle against health inequalities, yet internationally it is becoming recognised as crucial. Design:Discussion Paper. Data Sources:Literature and policy (1971 – 2012). Implications for Nursing:All nurses need to recognise their role in meeting the health care needs of people with an intellectual disability. Health care managers and commissioners should value the unique contribution of learning disability nurse in addressing health inequalities. Conclusion:Learning disabled people, their carers and professionals view the role of the learning disability nurse as central for effectively identifying and meeting health needs, reducing inequalities and barriers, supporting decisions around capacity, consent, best interests and advising and educating professionals. Recommendations for commissioning, nursing and services are made. Summary Statement: Why is this discussion paper needed? People with an intellectual disability have shorter life-spans and receive poor healthcare because of the barriers to good health developed in societies constructed by and for people without a disability. Internationally, the need for learning disability nurses, with their specific knowledge and skills, is being recognised in the battle against early and unnecessary deaths because of discrimination and health inequalities. Learning disability nurses and ‘Strengthening the Commitment’ lead on improving healthcare for learning disabled people and this paper raises the profile of this important health issue. What are the key findings? This discussion paper explores how most of the poor health experienced by people with an intellectual disability is about discriminating healthcare provision and crucially, not because the person has a disability. People with an intellectual disability have greater health needs than others and despite this, nonspecific health professionals often have scant understanding of their disability and health needs. Learning disability nursing as a vital resource has in recent years seen posts reducing in the NHS, with actual and commissioned numbers of registered learning disability nurses dropping. How should the findings be used to influence policy/practice/education/research? People with an intellectual disability and nonspecific staff often feel they are inadequately educated and lack appropriate skills for quality healthcare provision for learning disabled people; this has to change. Sir Johnathon Michael (2008) recommendation 1 advises that all health professionals be competent in supporting learning disabled people in a non-discriminatory way - universities and employers urgently need to adhere to this recommendation. Professionals, learning disabled people and carers state learning disability nurses are vital to acquiring human rights - increased international commissioning for learning disability nurses to enable quality healthcare, education and advice to professionals is pressing. Keywords: Nursing Practice, Learning Disability, Health Inequalities, Policy, Professional Issues.Download Full Article |
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Abstract: Increased prevalence of Autism Spectrum Disorder (ASD) has generated higher special needs enrollment in schools requiring teachers and therapists to acquire, incorporate and implement specialized strategies needed to address unique educational and behavioral challenges facing children diagnosed with ASD. Budget cuts have generated a shortage of qualified professionals with expertise in autism interventions. Currently, staff training is minimal, ineffective or lacking on how to do acquire these skills. More effective staff training may provide an avenue for addressing this shortage. This study investigates the impact that an Interprofessional Staff Training Procedure (STP), consisting of Video Self‐Monitoring (VSM), Performance Feedback (PF) and Reflection (R) with and without Mentoring has on sustained and generalized teacher performance on two Dependent Variables – application of the Learn Unit (LU) and Rate of Effective Instruction (ROI). An exploratory study was conducted with 10 female teachers instructing 3‐5 year old autistic children in two private schools utilizing principles of Applied Behavior Analysis. Teacher performance on LU and ROI was evaluated after: Phase 1 – 2‐hour workshop; Phase 2 – training period using STP with and without Mentoring and Phase 3 – follow‐up period when STP and Mentoring are removed. While the STP appeared to enhance teacher performance and sustainability of procedural integrity, the greatest and most consistent improvement in performance was observed among teachers who received STP plus Mentoring as opposed to STP alone. Findings revealed that adding Mentoring to an existing STP appears to enhance teacher performance and Procedural Integrity with sustainable outcome. Keywords: Training, mentoring, Autism Spectrum Disorders, teacher training, video self‐monitoring.Download Full Article |
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Abstract: Educational legislation has made reading a priority for students with significant intellectual disabilities (ID) and associated speech, language, sensory, or physical impairments. Historically, reading instruction for students with significant ID has focused on sight word instruction, with limited exposure to other essential reading skills. This article focuses on the evidence-based instructional methods that effectively and efficiently foster the reading development of students with significant ID. The authors reviewed the literature from the past 20 years on reading interventions for students with significant ID. In spite of access and opportunity barriers that have inhibited the reading development of students with significant ID, a synthesis of the empirical research on reading instruction suggests that students with significant ID and associated disabilities can learn phonemic awareness, phonics, vocabulary, fluency, and comprehension skills with direct instruction. Implications for providing reading instruction that effectively promotes reading development are discussed and areas for future research are identified. Keywords: Intellectual disabilities, sight word instruction, reading instruction, speech and language impairment, physical impairments.Download Full Article |
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Abstract: Objective: To investigate the (1) incidence of anxiety and (2) association of anxiety with disease duration, depression, and age in an outpatient Multiple Sclerosis (MS) Center. Background: The incidence of anxiety varies in the literature but is estimated to affect 44.5% of people with MS. Anxiety can be a predictor of poor Quality of Life, especially relevant in progressive illnesses, such as MS. Though research has shown that patients newly diagnosed experience higher anxiety levels, the relationship between anxiety and disease duration is unclear. Since anxiety can be comorbid with depression in MS populations, it is relevant to establish its association in this setting. Finally, though anxiety usually increases in older age, research for this relationship in MS populations is inconclusive. Design/Methods: The commonly used Hospital Anxiety and Depression Scale, was distributed once to patients with MS over a 3 month period to assess anxiety and depression scores. MS disease duration and age were confirmed by neurologists. Results: Out of 160 patients with MS who completed the HADS, 19% reported abnormal anxiety, 14% reported borderline cases of anxiety, and 67% did not report anxiety. After following up on significant correlations, depression and younger age were related to higher anxiety levels, (R2=.35, F(4,144)=19.26, p<0.001). The standardized partial regression coefficients indicated 2 statistically significant predictors, depression (β=.55, p=<.001) and age (β=-.25, p=<.001). Discussion: 33% of patients reported symptoms of anxiety, emphasizing the need to focus on treating anxiety, specifically, early in their disease course. Clinicians may also want to recognize that elevated depression scores predicted anxiety. Lastly, in our cohort, the younger population reported higher anxiety, demonstrating that progressive illnesses may affect anxiety levels in younger populations more. Since approximately one third of patients with MS expressed anxiety symptoms, it is important to incorporate this into treatment plans. Keywords: Multiple Sclerosis (MS), anxiety, disease duration, age, disability.Download Full Article |
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Abstract: This article describes our inter-professional mental health service for adults with intellectual disability and/or autism spectrum disorder. The service consists of an inpatient unit and outpatient program that are closely aligned and operate within a mental health and addictions teaching hospital. We provide information about recent changes to our model of care and the structures and activities that are used to support inter-professional team development and team functioning. Roles and functions of different mental health professionals on the team are outlined and case examples of adults with intellectual disability and complex mental health needs are provided to illustrate how the inter-professional team members work together. Download Full Article |
