Showing papers in "British Journal of Learning Disabilities in 1997"

Follow the Yellow Brick Road! People with Learning Difficulties as Co‐researchers

Abstract: This article is written by three people with learning difficulties. It is about our experience of doing research. We are all members of Hackney People First and in 1994 we got involved in a project researching self-advocacy and families. The article describes why we decided to get involved, our feelings about doing research and what we did. It explains the help we had to take part. Researchers have been talking about disabled people doing research for quite some time, but involving people with learning difficulties as researchers is only just beginning. This article is extremely important, as one of the very few times that people with learning difficulties have written about carrying out research.

The Importance of Communication Partnerships: A Study to Investigate the Communicative Exchanges Between Staff and Adults with Learning Disabilities

Abstract: A small-scale study was conducted to investigate the extent to which the verbal communication skills used by adults with learning disabilities were complemented by those used by their keyworkers during communicative exchanges. The setting was a community-based day centre. The number of information carrying words (ICWs) used by keyworkers with their clients was measured in two contexts: (A) looking at selected pictures; (B) free conversational exchange. These were compared with the verbal comprehension level of each client, also measured in ICWs, as assessed by the administration of the Derbyshire Language Scheme: Rapid Screening Test of Comprehension (Knowles & Masidlover, 1982). The results revealed that major differences existed between the communication skills used by keyworkers, and the comprehension levels of the participants with learning disabilities under both conditions. The greater mismatch was evident in the second condition of ‘free conversational exchange’. Some limitations of the current study are discussed together with the implications for future investigations and intervention.

Burnout and Workload in Teachers of Children with Severe Learning Difficulties

Abstract: This paper addresses the possibility that teachers of children with severe learning difficulties (SLD) may be especially vulnerable to heightened stress levels. A postal questionnaire posing investigative questions relating to workload and sources and quality of stress was sent to eight SLD schools in inner city, urban and rural areas in the south-east of England. Fifty-seven SLD teachers responded. Results indicated that SLD teachers were subject to high workload and long hours of work. High scores were obtained for the variable Emotional Exhaustion as measured by the education version of the Maslach Burnout Inventory. Qualitative data identified workload and challenging behaviour as the most frequently cited sources of intense stress. Results are discussed with reference to the need to develop effective job-related coping strategies for SLD teachers.

An Anger Management Group for People with a Learning Disability

Abstract: A course on anger management of eight weeks duration for six people with learning disabilities (in the mild-moderate range), and their keyworkers, is described. The programme drew on a range of techniques to assist in the exploration and control of difficult emotions, including relaxation, role-play, problem-solving and sharing in a group. With reference to the information we received from the participants (clients and staff) about their experience of being in the group, we discuss what appeared to have been helpful to group members in learning how to express angry feelings in appropriate ways, and to keyworkers in supporting clients in the management of aggressive behaviour.

Life Story Work for People with Learning Disabilities

Abstract: The transition from long-stay hospitals to community residential homes is a difficult period for many people with learning disabilities. Whilst staff ensure a ‘clinical transition’ by forwarding details of the client's history, there is little information from the clients themselves to ensure an ‘emotional transition’. This paper examines ways in which Life Story Work can ameliorate transition stress for clients. The main issues for clients during this time are those of adjustment to the new environment as well as being given the opportunity to deal with the loss and bereavement of their previous lifestyle. It is suggested that we need to look at the clients' needs at this time from a psychological, as well as a practical viewpoint. Life Story Work is a person-centred approach which enables both staff and clients to focus on particular aspects of their lives. In addition, it allows an opportunity for relevant counselling at a time when staff support and understanding are vital.

The OK Health Check: A Health Assessment Checklist for People with Learning Disabilities

Abstract: This study was instigated in response to the growing awareness that the health care needs of people with learning disabilities are not being adequately met in the evolving community services. This paper describes how a checklist assessment of health needs for people with learning disabilities was developed using a ‘Delphi’ group approach. The paper describes how the health assessment checklist was tested for validity and inter-rater reliability with qualified and unqualified carers in different settings. The findings demonstrate that it is an effective means of identifying health needs for this client group, and is an appropriate tool for use by staff of all grades.

Pilot Study on the Development of the Learning Disability Healthcare Resource Groups

Abstract: This pilot study describes a grouping method leading to the development of prototype learning disabilities Healthcare Resource Groups. Even in a primitive form, they provide a useful degree of predictability of costs and a reasonable degree of clinical homogeneity which, if confirmed by further research, would suggest that HRGs can potentially constitute alternative currencies for the commissioning of learning disability services.

Identification of Hearing Impairment in People with a Learning Disability: From Questioning to Testing

Abstract: Nurses were questioned about the level of hearing impairment in the population (353) living in a hospital for people with learning disability. Systematic hearing assessments were then carried out on 324 individuals yielding a fourfold increase in identification. Methodological improvements over previous studies include specialised audiology facilities and equipment and staff experience in testing this special group. If hearing impairment is recognised and dealt with the potential for improvements in quality of life is considerable.

Parent and Teacher Ratings of Challenging Behaviour in Young Children with Developmental Disabilities

Abstract: Parent and teacher ratings on the Aberrant Behaviour Checklist were compared to determine its reliability for assessing challenging behaviour in young children with developmental disabilities. Twenty-four boys and eight girls aged 20 to 72 months (mean age = 51 months) were assessed independently by a parent and teacher using the Aberrant Behaviour Checklist. There were no significant differences between parent and teacher ratings on any of the five subscales. Spearman's rank correlation coefficients between parent and teacher ratings for each of the five subscales ranged from 0.50 to 0.83 (mean = 0.62). All correlations were significant (p < 0.01). Confirmatory factor analyses generated item loadings consistent with the original factor structure of the ABC and similar component loadings for parents and teachers. These results suggest the Aberrant Behaviour Checklist can provide a reliable assessment of challenging behaviour when used by parents and teachers of young children with developmental disabilities.

Teaching Psychological Strategies for Managing Auditory Hallucinations

Abstract: In recent years cognitive-behavioural techniques have begun to be applied to psychotic symptoms with positive results. There is little in the literature to suggest that such techniques have been used to help people with learning disabilities who experience psychosis. The case report provided here details the teaching of cognitive-behavioural strategies for managing auditory hallucinations and their effective use by a woman with mild learning disabilities. A number of benefits of the intervention are noted including decreases in subjective distress and use of PRN medication, as well as improved mood and reported increases in the use of positive coping strategies and self-esteem.

Auditory Integration Training (AIT): Sound Therapy? Case Studies of Three Boys with Autism who Received AIT

Abstract: Auditory Integration Training (AIT) is an experimental ‘alternative’ therapy aimed at individuals with hypersensitive hearing. Developed by Otorhinolaryngologist Dr. Guy Berard, AIT involves listening to electronically-processed music through headphones for 20 half-hour sessions. Berard (1993) believes that many cognitive and behavioural problems, including autism, dyslexia and depression, result partially from distortions in hearing, and thus, that clinical symptoms can be alleviated by use of AIT. For example, Berard (1993) considers autistic behaviours to be largely an avoidance reaction to noises heard too acutely. The progress of three boys with autism receiving AIT was closely monitored. Few if any beneficial effects on behaviour were observed. Sound hypersensitivity remained unchanged. The paper also questions the validity of the AIT technique used, and highlights a need for an AIT ‘watchdog’ in the UK.

How Do We Stop ‘Doing’ and Start Listening: Responding to the Emotional Needs of People with Learning Disabilities

Abstract: In the context of a growing recognition of the importance of looking at the emotional needs of people with learning disabilities this paper describes the Interact Project which aims to provide a safe framework within which to explore the quality of the client-carer relationship. By asking clients to attend workshops with a chosen carer, and by guiding the content of the mutual time given in the workshops we tried to help develop and foster a positive and mutually valuing relationship for the client and carer. There was a deliberate shift away from any concept of a technique or therapy to a focus on the quality of the relationships offered. By offering follow-up sessions we ensured that the workshops did not become ends in themselves but part of an on-going process which needs to be available on a regular basis as situations/relationships and emotions evolve over time.

Towards Rational Psychotropic Prescribing for People with Learning Disability

Abstract: The use of psychotropic medication to treat emotional and behavioural disorders among people with learning disability has been a cause of concern for some time. It has also been the subject of numerous surveys and reviews in a number of countries. The types and uses of psychotropic drugs, and some of the research evidence regarding the prescribing of these compounds to people with learning disability, are reviewed. Good practice is based on maximising the benefits and minimising the risks of prescribing. Criticisms of ‘inappropriate’ prescribing have often been based on assumptions that may not apply in clinical practice, especially when other treatment options have been exhausted. However, few clinicians would dispute the need for better evidence about the efficacy of drugs in the management of behaviours that challenge services. Advances in neurochemistry and psychopharmacology have opened up the possibility of more rational approaches to the treatment of maladaptive behaviours associated with learning disability, based on a knowledge of underlying biological abnormalities and the actions of drugs on specific receptors or neuroregulatory systems. Clinical trials with sound methodology are beginning to appear, but there are many unanswered questions.

At What Cost? Using Cost Information for Purchasing and Providing Community Care for People with Learning Disabilities

Abstract: An appreciation of costs and cost effectiveness has been central to policy initiatives, reports by the Audit Commission and the 1990 community care reforms. This paper argues the case for a more informed use of cost information in services for people with learning disabilities, using examples from research into the costs and outcomes of care in the conununity. Commissioners and providers of services should address a number of methodological considerations when using cost information to purchase services or review their competitiveness or cost-effectiveness. Principles for using information are offered, including comprehensiveness, taking account of variations, making comparisons and linking costs with outcomes. The wider implications for commissioners and providers are then discussed in the context of policy issues and management concerns.

Smoking Education for People with Learning Disabilities

Abstract: A Health Education Programme for adults with learning difficulties is described. Health Education for this group has often been neglected with limited resources available, especially in relation to tobacco use. The programme described aims to redress this issue by providing a package, which effectively presents information, in a manner which is sensitive to the needs and abilities of this particular group, on the health and social issues of smoking. Two case examples are presented to illustrate how the package is effective in both group and individual settings.

Involving People with Learning Disabilities in Community Care Planning

Abstract: It is now time for people with learning disabilities to become fully involved in community care planning at all levels. This paper highlights some possible reasons (and excuses!) why people have not been accepted as full and equal members of groups serving the planning and commissioning processes. It examines the issues and difficulties around enabling people to become full members and suggests strategies, interventions and good practice guidelines for overcoming those difficulties. Finally, it argues that people with learning disabilities should be key players in the planning of services that directly affect them.

The Introduction of Role‐play to a Group of Women with Learning Disabilities: Graded Stages in Developing Role‐play Skills and Some Practical Hints for Facilitating Role‐play

Abstract: This paper describes the experiences of introducing role-play in the context of a women's group aimed at developing assertiveness around appropriate and inappropriate touch. The aim of the group was to provide the women with skills they would be able to generalise to everyday situations. We aim to highlight an approach for overcoming the difficulties we have experienced in previous group work and give a practical guide for people attempting similar projects.