There is a general lack of self-report data from service users with an intellectual disability (ID) about their views of psychological interventions. This research explored the views and experiences of female inpatients, with a diagnosis of a personality disorder and an ID, about dialectical behaviour therapy (DBT). Semi-structured interviews were used with 10 women, recruited from two independent mental health hospitals. The interviews were analysed using interpretative phenomenological analysis. Participants showed varying levels of understanding of DBT. Findings highlight the need for a standardized approach with a suitably adapted structure and curriculum to meet the needs of inpatients with an ID. Factors such as the therapeutic relationship were identified as playing a role in participants' motivation, engagement and participation in DBT.
People with ID and SSP appear to be more debilitated by the co-occurring disorder than those with the same disorder but without ID. Increases in observable psychopathology and "negative" schizophrenic symptoms, and decreased functional abilities were observed in the group with ID when compared to the GAMH group. The clinical implications of these findings are discussed.
is based at the University of East Anglia, Norwich, UK. Cathy Thomas and Verity Chester are based at Partnerships in Care Learning Disabilities Service, Diss, UK. Abstract Purpose -The aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure sen/ice for people with intellectual disabilities. Design/methodology/approach -Patients (37men, 14 women. Mean age = 33.24 years, SD= 11.29, age range: 18-71 years) residing in a secure intellectual disabilities service completed the EssenCES as part of routine clinical practice.Findings -Reliability analysis revealed acceptable reliability for all three subscales (a = 0.76-0.88). In order to consider one aspect of the construct validity of this measure, a predicted group difference regarding the impact of security level on ratings of social climate was investigated. Analysis revealed that social climate ratings were more positive on low secure wards than medium secure wards as measured by the combined EssenCES subscales F(3, 31)= 4.71, p = 0.008; A = 0.69; t)^=0.31, and the Experienced Safety subscale, F(1, 33) = 7.41, p = 0.01.
Research ilmitations/implications -Future research should consider the link between social climate and treatment outcome within forensic secure intellectual disability services.Originaiity/vaiue -Results provide preliminary evidence to suggest that the EssenCES subscales (patient report) are reliable in this previously unconsidered population. However the validity of the measure is still unclear and requires further investigation.
Mindfulness is the practice of focusing attention effectively/purposefully, in a non‐judgemental manner, on current circumstances (Kabat‐Zinn, 2009; Crane, 2009). It has been increasingly used as a tool for managing a range of difficulties associated with personal suffering, including stress and chronic pain, as well as some aspects of mental disorder. In this study the practice of mindfulness was introduced to a medium secure ward for female patients with learning disabilities in the form of twice‐weekly, 30‐minute group sessions. Proxy measures of institutional aggression namely the number of observations (Obs), physical interventions (PI), and seclusions (Sec) were recorded at baseline (during the month prior to the introduction of the mindfulness sessions and at two months and six months following the introduction of the sessions). Friedman's Analysis of Variance and post‐hoc analyses using Wilcoxon's Signed Ranks showed a significant reduction at six months. The potential influence of basic mindfulness practice sessions in reducing aggression is discussed.
This article describes the design and implementation of the management of aggression care plans (MOACAP) in a secure service for people with learning disability and severe challenging behaviour. The MOACAP is a five‐part document, which has sections for descriptions of challenging behaviour, escalation patterns of the behaviour, non‐physical interventions, physical interventions and post‐incident briefing.Preliminary evaluations suggest that use of MOACAP leads to a reduction in aggressive incidents in the service. The approach should also be relevant to other forensic, mental health and challenging behaviour services and brain injury units. The MOACAP may also be relevant to services that will be affected by the National Institute for Clinical Excellence (NICE) and the National Institute for Mental Health in England (NIMHE) guidelines on the short‐term management of disturbed (violent) behaviour.
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