Purpose The purpose of this paper is to investigate the oral health of inpatients within inpatient intellectual disability forensic settings. Individuals with intellectual disabilities may encounter substantial oral health barriers such as cognitive, psychological, physical and sensory challenges, exacerbated by limited access to information, tools and services. There are likely to be additional barriers within forensic settings, yet no research has investigated the oral health of inpatients within inpatient forensic settings. Design/methodology/approach An audit of oral health was conducted in a medium-secure intellectual disability and forensic service. Over four time points, the Mouthcare Matters Toolkit was used to assess the condition of the tongue, lips, teeth, cheeks, palate and floor of mouth. Eighteen patients underwent baseline assessment and were offered individual and group interventions between audit cycles. Findings The oral health screening process was feasible to deliver clinically, and acceptable to patients. Oral and dental health fluctuated over the course of the audit, likely associated with uncontrolled clinical and treatment variables. Improved dental health was observed following ward-based education sessions. Originality/value Targeted oral screening and associated educational interventions may improve the oral health of inpatients with intellectual disabilities. Recommendations for future practice include routine oral health screening, staff training, accessible educational resources and bespoke consultations.
Purpose People with intellectual disabilities (ID) are overrepresented in the criminal justice system (CJS) both as victims and perpetrators. The purpose of this paper is to provide a thematic synthesis of qualitative data on criminal justice professionals’ perceptions, attitudes, awareness and understanding of people with ID. Design/methodology/approach A systematic search of four major electronic databases and one grey literature database revealed six qualitative studies and three mixed-methods studies to synthesise. Findings Results reflect the experiences of 530 professionals internationally. All studies were quality appraised. Four analytical themes emerged: (i) professionals perceived people with ID as vulnerable and who required adaptations; (ii) professionals recognised change is required considering the additional needs of this group; (iii) uncertainty was expressed at how best to support individuals and in particular (iv) when considering issues around responsibility. Research limitations/implications Further training is required alongside research into barriers for criminal justice professionals to effectively implement learnings from training. Originality/value Unlike similar previous reviews in this area that have been more specific with their question or sample, this study sought to explore research involving all professionals working across the CJS, including police, lawyers, judges, magistrates and probation officers.
Purpose This report aims to explore the diagnostic and clinical challenges associated with the co-occurrence of intellectual disability (ID), autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in a patient with 16p11.2 duplication and significant psychosocial adversity. The case highlights the phenotypic heterogeneity of 16p11.2 duplication, the complexity of differential diagnosis in neurodevelopmental disorders and the interplay between genetic vulnerability and environmental factors in symptom presentation and treatment planning. Design/methodology/approach The case report details the patient’s history, presenting concerns, clinical findings and diagnostic assessments, including genetic testing (karyotype, array comparative genomic hybridization, quantitative polymerase chain reaction and multiplex ligation-dependent probe amplification) and psychopathological assessments. It outlines the proposed management plan, including methylphenidate sensitivity testing, a multidisciplinary approach and cautious psychopharmacology. Findings The patient exhibited delayed ambulation and language development, hyperactivity, poor sense of danger and impaired adaptive skills. He also showed anxiety, emotional and behavioral dyscontrol and school difficulties. Genetic testing confirmed a 16p11.2 duplication. Diagnoses included duplication of the short arm of chromosome 16, moderate ID, ASD and ADHD. Originality/value This report contributes to understanding the complex neurodevelopmental phenotype of 16p11.2 duplication, particularly by reporting for the first time the co-occurrence of ID, ASD and ADHD. It emphasizes challenges in differential diagnosis and the importance of considering genetic and environmental factors in clinical presentation.
Purpose The purpose of this paper is to better understand how inpatients with Intellectual Disabilities (ID) make sense of the therapeutic climate in their secure units, particularly in terms of therapeutic hold, patient cohesion and safety. Design/methodology/approach This study uses Thematic Analysis to analyse the qualitative comments collected using the Intellectual and Developmental Disabilities adaptation of the Essen Climate Evaluation Schema (EssenCES-IDD) in Medium and Low Secure services. Three years of data collected as part of routine clinical care were retrospectively analysed from detained patients in ID secure services. Findings Under the three superordinate themes of Therapeutic Hold, Patient Cohesion and Experienced Safety, relational consistency emerged as a unifying mechanism underpinning positive experiences of care. When staff were experienced as familiar, emotionally available and reliable, participants reported greater therapeutic engagement, improved peer relationships and enhanced feelings of safety. Originality/value This study contributes to a limited evidence base exploring ward climate from the perspective of patients with ID in secure settings. By analysing the qualitative data generated by the EssenCES-IDD, it provides novel insight into how safety is subjectively experienced within these environments.
PurposeThe purpose of this study was to explore health-care access, experiences and barriers among people with learning disabilities from ethnic minority backgrounds and their informal carers within an NHS mental health trust in the East of England. The evaluation aimed to understand experiences of health-care access, and to generate practical, service-user- and carer-informed priorities for improving equity, coordination and reasonable adjustments across the local pathways. Design/methodology/approachMulti-method service evaluation. .An easy-read questionnaire was mailed to 64 eligible service users, where 13 responded (descriptive analysis). A focus group with six carers was conducted online and transcripts were analysed using reflexive thematic analysis. The design sought feedback on service use, satisfaction and reasonable adjustments, alongside carer experiences of access, information, coordination and support. Findings“Not knowing where to find help” was the most frequent barrier, alongside language barriers, stigma and insufficient reasonable adjustments. Carers reported high weekly caregiving hours and limited respite; coordination and signposting were inconsistent, with fewer than half of survey respondents (46.15%) reporting yearly specialist input. While 69.2% of people with learning disabilities had an annual GP health check and many felt involved in their care, information gaps undermined satisfaction. Desired adjustments included earlier/later appointments and easy-read materials. Carers advocated for stronger multidisciplinary working. Research limitations/implicationsAs this evaluation did not set out to isolate the role of ethnicity, findings reflect general experiences of health-care access rather than providing an in-depth account of how ethnicity specifically shapes these experiences. Originality/valueThis evaluation contributes empirical evidence to the limited research on health-care access for people with learning disabilities from ethnic minority backgrounds and their carers, bringing together both service user and carer perspectives. It highlights actionable levers, such as clearer signposting, proactive communication, staff training in learning disability and better multidisciplinary coordination – to reduce avoidable burden on families and carers and improve equitable access, experiences and outcomes for people with learning disabilities.
PurposeThis service evaluation investigated frontline staff attitudes towards artificial intelligence (AI) implementation in NHS learning disabilities services to address critical knowledge gaps in workforce perspectives. Despite growing NHS AI adoption, systematic understanding of staff concerns remains limited, particularly regarding vulnerable populations who face heightened risks around consent capacity, communication barriers and potential exploitation. This study aims to capture staff perceptions of AI benefits, concerns and implementation needs to inform evidence-based, ethically-grounded Trust-level digital strategy that prioritises patient safety while supporting workforce readiness for technological change.Design/methodology/approachThis mixed-methods service evaluation used an online questionnaire (n = 68) and semistructured focus group to explore staff attitudes in NHS specialist learning disabilities services. Participants included clinical professionals and nonclinical operational staff recruited through team meetings and electronic communications during July 2025-August 2025. The quantitative survey assessed AI familiarity using five-point scales, examining comfort levels, concerns regarding vulnerable patients, perceived benefits and training needs. A 30-minute focus group conducted via MS Teams explored clinical experiences, safeguarding concerns and implementation barriers. Descriptive statistics analysed quantitative responses while thematic analysis examined qualitative data. The study received Trust Practice Audit Implementation Group approval with voluntary participation and informed consent protocols.FindingsMost staff (57%) demonstrated basic AI understanding, with 16% already using AI tools. Attitudes were predominantly cautious: 40% expressed neutrality and 35% voiced concerns about implementation with learning disabilities patients. Administrative efficiency emerged as the primary recognised benefit (62%), with limited support for clinical applications. Training priorities emphasised both AI fundamentals (47%) and ethical reassurance regarding bias and safety (47%). Qualitative analysis revealed four themes: heightened vulnerability concerns around patients' capacity to distinguish AI from human interactions, significant safeguarding and exploitation risks, pragmatic engagement and training needs and governance.Originality/valueThis service evaluation addresses a critical gap by examining frontline workforce perspectives on AI implementation in an intellectual disabilities' services, a population often marginalised in digital health transformation. It reveals unique vulnerabilities absent from general health-care AI literature, particularly around reality testing, consent capacity and exploitation risks through AI interactions. Unlike broader NHS AI surveys focusing on technical feasibility or public trust, this research captures specialist staff concerns about safeguarding implications and therapeutic relationship preservation. Findings provide evidence-based guidance for developing population-specific governance frameworks rather than applying standard protocols unsuitable for vulnerable groups. The equal emphasis on technical training and ethical reassurance offers practical insights for staged implementation strategies that balance innovation with patient safety.
PurposeThe purpose of this paper is to analyze, describe and reflect upon the clinical complexity of the case, the diagnostic methodology, the need for an interdisciplinary approach, and the response to the clinical interventions. Design/methodology/approachAn exploration of the patient’s different areas of functioning was carried out. A functional analysis of the behavior problems, observations in the natural environment, formulation of an individualized interdisciplinary therapeutic plan, and administration of pre–post intervention measurement instruments are described. To manage challenging behaviors, parent-mediated intervention and positive behavioral support principles were delivered, along with withdrawal of screens in the patient’s environment, sensory diet and structuring occupation time, and incorporation of an augmentative and alternative communication system in the family context. Pharmacological assessment and adjustment were also performed. FindingsThe use of screens is an important modulator of behavioral problems. At the pharmacological level, adjuvant treatment for attention deficit hyperactivity disorder was prescribed with a good response in attention symptoms. Behavioral problems decreased in frequency and severity. Better management of emotional and conduct challenges was achieved. Originality/valueThe diagnosis of a behavioral addiction is discussed. The literature does not contain information on behavioral addictions in patients with an autism spectrum disorder profile and moderate/severe intellectual disability, nor do specific diagnostic manuals contemplate their description. The intervention based on positive behavioral support produced improvement in the described clinical profile. The importance of and need for a multidisciplinary approach and a multimodal intervention are highlighted.
PurposeIn equine-assisted therapy (EAT), service users, clinicians, horse behaviourists and horses work together. This project aimed to explore the impact of providing EAT sessions at a Medium Secure Forensic Intellectual Disability Hospital.Design/methodology/approachThe project was co-designed with a service user and considered the impact of EAT through therapy process, and impact on life in the hospital, while monitoring incident data. Sixteen service users participated.FindingsService users experienced EAT as a space where they could learn, feel calm, make relationships, create positive connections and feel empowered. Perceptions of life in the hospital changed: service users said EAT bought fun, motivation, a sense of freedom and they began to think about their futures.Originality/value EAT is a psychosocial intervention in which service users, mental health clinicians, horse behaviourists and horses work together towards treatment goals. The expansion of EAT in many different populations has meant that as the practice develops, there is little evidence to support the success claimed by EAT. EAT was set up in a Medium Secure Forensic Intellectual Disability hospital. The hospital team were keen to develop novel approaches to support quicker progress through and discharges from hospital, in line with the Transforming Care Agenda (2015). This purpose of this study was to provide some evidence about its effectiveness.
PurposeThis study aims to explore the prevalence of baseline assessment services for people who have Down's syndrome in the UK. It aimed to collate information on the types of assessment offered and information about additional interventions offered after the completion of the baseline assessment.Design/methodology/approachA short survey form was developed and distributed via the British Psychological Society Faculty for People with Intellectual Disabilities.FindingsResponses were received representing 73 services across all four nations of the UK. About 47 (64%) of services currently offer baseline assessments to people who have Down's syndrome, mostly at age 30. Also, 34 (72%) of these services offer both direct cognitive assessment and informant assessment. Direct cognitive assessments were primarily conducted by members of the psychology team, and informant assessments by psychologists and other members of the Community Learning Disability Team (CLDT). Services that only offered informant assessments tended to be nurse-led and involve other members of the CLDT. In total, 23 (49%) services offered a variety of post baseline interventions. Comments reflected issues with resources; commissioning; transformation; expertise; terminology.Practical implicationsBaseline assessments for people who have Down's syndrome are an important part of service provision, and there needs to be further work to ensure that people are not subject to a post-code lottery on whether they can receive this service. The recommendations from the BPS/RCPsych guidance (BPS, 2025) should be implemented in full.Originality/valueThis is the first survey of services across the UK to establish information about baseline assessments for people who have Down's syndrome.
PurposeThis paper aims to explore the use of adapted CBT for addressing needle phobia in an individual with a learning disability, autism, and histories of trauma related to medical interventions. Anxiety of needles can result in avoidance of preventive treatments such as vaccinations, resulting in poorer health outcomes for people with diagnoses of a learning disability and autism spectrum disorder (autism). Cognitive behavioural therapy (CBT) is recommended for needle phobia. However, there is limited research documenting effective treatments for needle phobia for people with a learning disability and autism. Design/methodology/approachThis case study presents adapted CBT for needle phobia, with a 35-year-old man with diagnoses of a mild learning disability, autism and anxiety. FindingsAlthough therapy helped the individual to become more confident about having injections, he did not have a COVID-19 vaccination during the time he was attending therapy. He also reported consistently high fear and pain appraisal on ratings of subjective units of distress, despite graded exposure therapy. Originality/valueThis paper highlights the long-lasting impact of needle phobia and trauma related to negative experiences of vaccinations. It also presents evidence for the importance of person-centred, collaborative approaches and involvement of loved ones during therapy to improve outcomes. Recommendations include training and awareness for staff carrying out injections and development of intervention programmes to reduce distress for people with a learning disability and autism. Limitations, ethical considerations, power and implications for clinical practice are also discussed.
PurposeThis paper aims to explain the role of Intensive Support Teams (ISTs) and illustrate how they can operate to emotionally and practically support people with learning disabilities, their families, providers and professionals during critical times.Design/methodology/approachThrough introducing theory and showing how it can be applied in practice, the study argues that positive behaviour support (PBS) and systemic approaches, together with ideas from Trauma Informed Care (TIC), can help enhance the work of ISTs.FindingsCombining PBS, systemic approaches and TIC, which are person-centred and recognise the invaluable contribution of the system around the person with learning disabilities, can help develop effective interventions at times of crisis, prevent placement breakdowns, reduce hospital admissions and improve the quality of life of people with learning disabilities and their networks.Practical implicationsOther ISTs can explore the idea of using the models illustrated in the paper in their practice and dialogue between services can continue to develop to drive forward clinical innovation.Originality/valueThis study shows how an integrative approach can enable working in a person-centred way, drawing on the strengths and resources of the person with learning disabilities and those in their system to co-create ideas and solutions which take into account the impact of traumatic experiences on the person's life.
This study aims to explore an intervention that addresses the physical health inequalities and premature mortality experienced by people with intellectual disabilities and comorbid mental health difficulties. In the UK, physical health care has traditionally been coordinated and delivered through primary health-care settings. There is a case that physical health inequalities for those with intellectual disabilities and mental health difficulties can be reduced further if primary care interventions are supplemented by Enhanced Physical Health Clinics (EPHCs) co-located in mental health outpatient settings. This paper describes the structure and setting up of an EPHC for people with intellectual disabilities and mental disorders and an evaluation of its first two years. The EPHC database, which contains patient demographics and process data for the clinic regarding tests and interventions completed, was used for this study. This includes sociodemographic, psychiatric and physical health diagnoses, prescribed medication, physical health assessments and interventions. During its first two years, the clinic saw 463 patients. The mean age was 44 years, and 62% were male. There was considerable developmental and psychiatric comorbidity, with high rates of autism and major mental illness. The most common physical health diagnoses were epilepsy, hypothyroidism, diabetes, hypertension and asthma. A range of previously unidentified unmet health-care needs that warrant further assessment and treatment was identified. The EPHC was effective in promoting physical health monitoring and screening in a population that experiences significant health barriers. Recommendations regarding clinical practice and future research are provided.
Pharmacological management of aggressive challenging behaviour (ACB) in people with intellectual disabilities ordinarily prioritises the use of antipsychotics, which have significant adverse effects. Antidepressant prescribing for this indication is increasing, with relatively favourable side effect profiles, but without evidential support of efficacy. Trazodone is used in the evidence-based management of aggression in other populations and typically lacks the side effects of commonly prescribed antidepressants. This study aims to review the evidence of trazodone for managing ACB in people with intellectual disabilities. A rapid review methodology was used to report findings following PRISMA guidance. The search strategy was carried out in Embase, MEDLINE and PsycInfo for articles reporting primary data on trazodone to manage ACB in people with intellectual disabilities. It was run twice in November 2023 and April 2024. Additional articles were identified from references of articles retrieved by the search strategy. Inclusion and exclusion criteria were designed to screen articles. A total of 174 papers were identified, and four met full inclusion criteria. Three were case studies, and one was a single arm, open label trial. Trazodone was generally effective and well-tolerated in the management of aggressive and challenging behaviour. Limitations included small sample sizes, lack of controls and blinding, lack of subgroup analysis, varied and subjective outcome reporting, dual diagnosis and treatment resistance, little consideration of underlying causes of aggression and wide dose ranges. This rapid review presents preliminary evidence of an effective, tolerable and safe alternative to usual pharmacotherapies in the management of ACB.
PurposeThe purpose of the study was to address the lack of Polish diagnostic or screening instruments for dementia in adults with intellectual disabilities by developing and assessing a Polish version of the Dementia Screening Questionnaire for People with Intellectual Disabilities (DSQIID-P).Design/methodology/approachThree independent linguists translated and adapted the original DSQIID into a Polish version, which three independent assessors then reviewed. Once finalised, a preliminary psychometric evaluation was conducted. Institutions supporting adults with intellectual disabilities were approached for the recruitment of participants. The questionnaire was completed by caregivers of 107 adults with intellectual disabilities aged 40 and over. A subset of 69 caregivers also completed the Barthel index.FindingsThe mean total DSQIID-P score was 13.77 (SD = 9.28). Older participants showed a statistically significant higher DSQIID-P score. Individuals with physical illnesses scored statistically significantly higher than those without. The Cronbach's alpha of 0.89 indicates satisfactory internal consistency. A statistically significant negative correlation between DSQIID-P and the Barthel index scores supported criterion validity. The early assessment of DSQIID-P looks promising for use in Polish-speaking populations.Research limitations/implicationsThis was a preliminary assessment of the newly developed DSQIID-P with a relatively small sample size. Full psychometric validation is still needed through further research.Originality/valueTo the best of the authors' knowledge, this is the first study to develop and evaluate a Polish version of a dementia screening tool specifically designed for adults with intellectual disabilities, filling a critical gap in Polish clinical practice and research.
PurposeThe COVID-19 pandemic created a rapid move to digital delivery of services within the NHS. Reduced face-to-face contact for the general population meant accessing services through video or telephone calls; this was not possible for some service users with intellectual disabilities. Technology, originally designed for use with older adults to reduce isolation, was trialled by the learning disability (LD) service in an NHS Trust. The pilot was exploratory, giving staff and service users the opportunity to experiment and find potential uses for equipment initially designed for a different client group. This evaluation aims to review how staff utilised the equipment, its benefits and drawbacks.Design/methodology/approachSemi-structured interviews were carried out with staff and service users to explore the possibilities of remote service delivery with this patient group. Interview data was coded, themed and analysed.FindingsDevices were well received once technical issues were resolved. The trial was successful in reducing isolation and delivering some services in a new way at a time of mandatory social isolation. The move to digital service delivery has not stopped post-pandemic and has enhanced choices available for clinicians. This may improve service access for vulnerable communities with limited access to mainstream IT.Originality/valueThis study highlights how technology can be used to support access to services amongst vulnerable groups. Further research into patient experience of using devices should be considered to develop evidence of their usefulness in delivering services and reducing isolation across services.
PurposeThis study aims to understand the impact on number of admissions to inpatient services for people with intellectual disability, following the implementation of the Dynamic Support Database-Clinical Support Tool (DSD-CST) and formation of intensive support functions (ISFs). Type of mental health admission was reviewed, and number of admissions avoided ascertained.Design/methodology/approachA cohort retrospective study was conducted, using secondary data from three community learning disability teams in Northwest England. Routine secondary data from 2013 to 2023 was used.FindingsThe DSD-CST and ISF model was successful in reducing admissions. Following implementation of the model in 2018, there was a decrease in the number of admissions for all ward types and the length of admission decreased. The DSD-CST data showed the number of people identified as being at risk of admission increased between 2019 and 2023; however, the number of admissions decreased.Originality/valueAs far as authors are aware, this is the only paper offering an evaluation of the combination of ISFs and risk of admission stratification, and the impact this has on admissions to inpatient services for people with an intellectual disability. It evidences a successful model to support the NHS agenda of supporting people in the community where possible.
PurposeChildren with disabilities face various challenges in their social lives, communal participation, transportation, accessibility, health and education in developing countries, including Pakistan. Disabled children are the most vulnerable group in Pakistani society due to minimal essential assistance for education and health facilities. This study aims to draw the data on ethnographic enquiry and lived experiences of leading facilitators of disabled children, i.e. parents, teachers and health practitioners, in the twin cities of Rawalpindi and Islamabad, Pakistan.Design/methodology/approachThe data is collected through a semi-structured interview technique, and ethnographic enquiry is used to analyse the data. Inductive thematic analysis was used to assess the empirical material. The lived experiences of disabled children's parents, teachers and health-care practitioners are a starting point for a broader recommendation plan for government and policymakers.FindingsThis study finds that disability among children has a social stigma and experiences attitudinal and physical barriers, mobility issues, poverty, less welfare assistance from the government, lack of trained teachers and staff in special education schools, financial constraints and no involvement of practitioners in policymaking.Originality/valueThis study proposes a model for disabled children's welfare in Pakistan.
PurposeMany people with intellectual disabilities experience complex trauma, but there is little guidance to inform intervention. This case study reports the use of Imagery rescripting (ImRs) to support an adult with an intellectual disability to recover from complex trauma. Although mental imagery may have clinical utility in intellectual disabilities, there are no reports of using ImRs in this population. This paper aims to describe the potential of ImRs for supporting trauma recovery in intellectual disability.Design/methodology/approachImRs was used as part of a multicomponent approach to complex trauma in a person with mild intellectual disability. The therapeutic approach included compassion-focused interventions during stabilisation, followed by ImRs of the traumatic memory.FindingsComplex trauma symptoms reduced during stabilisation and were eliminated following ImRs. Self-compassion improved over the course of therapy.Originality/valueTo the best of the authors' knowledge, this is the first case study reporting ImRs for people with intellectual disabilities. ImRs may have clinical utility in intellectual disability populations, however further research is required.
Purpose - This study is a part of a larger project aimed at reviewing clinical, care and managerial practices for people with intellectual disability or autism spectrum disorders (ID/ASD) and challenging behavior resulting in violence or aggression. The purpose of this study is to conduct a state-of-the-art review of interventions aimed at preventing and managing aggression in individuals with ID/ASD in formal care settings. Design/methodology/approach - A systematic literature search was conducted on January 24th, 2024, focusing on three main concepts: "intellectual disabilities/autism spectrum disorders," "aggressive behaviour" and "specialized services." Four reference databases were searched. Two independent reviewers selected studies and conducted data extraction. References were categorized by major themes, with data extraction and narrative synthesis performed for each theme. Findings - This paper found that the number of publications on this theme has gradually diminished over the past 30 years. The number of publications on psychosocial interventions increased, while those pertaining to pharmacological approaches decreased. In the former, studies on staff training have increasingly supplanted interventions directly targeting individuals with ID/ASD. Small, uncontrolled studies reported some efficacy for aggression management interventions, while controlled trials generally found no significant effects. Several authors emphasized the primary role of environmental factors in controlling aggression among individuals with ID/ASD. Research limitations/implications - The selection of literature in a unique pool without creating a separate search equation for each subsection of the study. It may cause the omission of important publications in the field. It does not allow for a complete picture of evaluated interventions for the prevention and management of violent behaviors in individuals with IA/ASD. However, it allows us to trace the evolution of discussions on the topic. In addition, a formal evaluation of the methodological quality of the included studies was not conducted. Practical implications - This review may inform researchers and practitioners about the current state of matters in clinical intervention for aggressive behavior in adults with ID/ASD. Originality/value - To the best of the authors' knowledge, this is the first review taking a historical perspective in analyzing the development of approaches for dealing with aggressive behavior in adults with ID/ASD in formal settings. This perspective enables considering past unproductive paths and inspires the development of new approaches.
