Primary care health checks, screenings and GP consultations are often the gateway for people with intellectual disabilities to access their physical and mental healthcare. For a population who experience greater levels of health difficulties alongside significant health inequality, improving care quality and access is of major importance. This meta-ethnographic, qualitative review aims to explore people with intellectual disabilities experiences of health checks, screenings and GP visits, while assessing the quality of the current literature and synthesising findings to consider clinical and research recommendations based on third order constructs. A systematic search identified 20 studies that met inclusion criteria. Quality assessment of each paper was conducted. Meta-ethnography methods were used to analyse and synthesis findings. One overarching concept was identified: Include Me, along with seven core concepts; Empowerment and Disempowerment, Communication and Interpersonal Factors, Access and Adaptations and Biased Narratives and Shifting Perspectives. Implications for practice and future direction are discussed.

Easy to read summary■Even though more psychologists are being trained, it can still be hard for Intellectual Disability (ID) services to employ psychologists.■This article talks about the psychology training process and how this might not encourage people to work in ID.■We give some ideas of things that might help during training, so that Trainees can learn more about working in ID services.■We hope this might make them more likely to consider working in ID services.■This is important because if there are not enough psychologists in ID services, people with intellectual disabilities may struggle to find the psychological help they need.

Introduction People with learning disabilities (PWLD) have been disproportionately impacted by the Covid-19 pandemic, with reports of significant impacts on psychological wellbeing. Services that support PWLD in the UK have had to make significant adaptations, however there is limited research into the perceptions and impact of these changes. This exploratory study aims to investigate the experiences of psychologists working in UK learning disability services throughout the pandemic, to explore service delivery, impact on the psychological wellbeing of PWLD, and the implications from this going forward. Methods Twelve psychologists were interviewed, and thematic analysis was used to explore patterns and themes. Results Three superordinate themes were identified. 'Delivering Psychological Services' contained five subordinate themes: 'Context,' 'Accessibility and Acceptability,' 'Professional Identity,' 'Living the Pandemic' and 'Team Connection.' 'Wellbeing of PWLD' contained three subordinate themes: 'Same Storm Different Boat,' 'Continued Inequality' and 'Resilience and Re-Evaluation.' 'Learning and Future Practice' contained three subordinate themes: 'Inclusion,' 'Choice and Connection' and 'Workforce Wellbeing.' Conclusion Findings conclude that although a time of immense challenge and loss, the pandemic has triggered significant re-thinking and learning within services. With inequality still evident for PWLD, an emphasis on future services carefully considering potential disadvantage by over-digitization of services is key. There is hope that future psychological services can be offered with more choice and flexibility. Staff wellbeing, compassionate leadership and reestablishing team connections is essential in the new landscape of services. Recommendation, practical implications, and future research directions are discussed.

BACKGROUND:People with intellectual disabilities are reported to have low self-esteem and to experience high rates of adverse interpersonal experiences (AIEs). This study aimed to investigate whether shame and self-compassion mediate the relationship between AIEs and self-esteem for people with intellectual disabilities and whether perceived social support moderates this relationship.METHOD:This study employed a cross-sectional design, involving between-group comparisons. Forty-seven people with intellectual disabilities and 50 people without intellectual disabilities completed self-report questionnaires measuring shame, self-compassion, self-esteem, early AIEs and social support.RESULTS:Shame and self-compassion were found to mediate the relationship between AIEs and self-esteem for people with intellectual disabilities. There was no evidence for a moderating effect of social support and no difference between groups in shame or self-compassion.CONCLUSIONS:The findings suggest shame and self-compassion are important concepts for people with intellectual disabilities. Clinical and research implications are discussed.

The effectiveness of a range of psychological models adapted for use with people with intellectual disabilities has been well documented. A number of studies have used qualitative methods to examine people with intellectual disabilities' experiences of these adapted interventions. Such research is important for identifying service users' views on the helpful and challenging aspects of psychological interventions to ensure that they meet the needs of people with intellectual disabilities. To consolidate this research, a systematic review using a meta-ethnographic approach was undertaken. A systematic search identified 16 relevant studies. These studies were reviewed, critically appraised and key themes were extracted. Five key concepts were identified: adapting to therapy, the therapeutic environment, group dynamics, the therapeutic relationship and the impact of therapy on life. The need for further consideration of power differentials within the therapeutic relationship and further adaptations to ensure accessibility of therapy for people with intellectual disabilities is discussed.

Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.

Long hospital stays in early life can lead to bonding problems between parent and child, and emotional distress. For this reason, the parents of babies diagnosed with kidney failure were asked how renal wards could improve their way of working to minimise stress and fear for the parents and make them feel supported. In this article, Carly Smith discusses the study findings

BACKGROUND:People with intellectual disability (ID) are more likely to be overweight or obese. Research has shown that body dissatisfaction is a key factor in influencing unhealthy eating behaviour. More evidence is needed relating to how people with ID perceive their bodies in order to provide effectively targeted weight management programmes.AIMS:This study aimed to investigate whether people with ID have concepts for underweight, overweight and healthyweight, and whether they can apply these concepts to themselves. It also aimed to explore body perception bias through comparison of perceived self to independent figure ratings, and body dissatisfaction through perceived-ideal body discrepancy measurement and a series of open-ended questions.METHOD:Mixed methodology was used to explore body perception and body dissatisfaction in 40 young adults with ID compared to 48 individuals without ID. The Stunkard Figure Rating Scale assessed how participants would like to look, and their concepts of weight categories.RESULTS:Young adults with ID tend to hold positive beliefs about their bodies. Females with ID were likely to underestimate their body size. Individuals with ID understood what is meant by 'overweight', 'healthy-weight' and 'underweight' although these concepts were different to those without ID. Individuals with ID were unable to accurately apply these body size categories to themselves.CONCLUSION:These findings suggest that individuals with ID will first need support to understand how concepts of body size apply to themselves in order to facilitate weight management.

Background: Pulmonary arterial hypertension (PAH) is a chronic condition, which is diagnosed and monitored using cardiac catheterisation (CATH). This procedure can be anxiety-provoking; however, most patients undergo CATH without any formal psychological support. Aims: This study aimed to better understand the psychological impact of the CATH, positive coping and self-management skills, from patients' and professionals' perspectives. Method: Ten patients and ten staff members at a hospital in the South West of England were interviewed. Results: Thematic analysis resulted in complimentary patient and professional themes. These included: the importance of recognising individual differences, the patient–staff relationship, and the practical and emotional journey of the CATH. Findings suggest that factors which enhance a patient's understanding and sense of control were associated with positive coping. Conclusion: Recommendations with important implications for increasing patient control and choice, and promoting positive coping for patients, were made to the service.

Introduction: Solution-focused brief therapy (SFBT) has a growing evidence base and several authors have recognized the advantages of applying this approach with people with intellectual disabilities (ID). The purpose of this review is to summarize and critique the literature that has used solution-focused (SF) approaches in ID, and consider future directions. Methods: A literature review was carried out, identifying 12 studies; six with individuals, and six with staff and families. Results: There is preliminary evidence for the effectiveness of SFBT for individuals with mild ID and Solution-Focused Coaching or Consultation (SFC) for staff working with individuals with moderate and severe ID. However, the current evidence base consists primarily of case studies. Recommended adaptations include shortened scales and more concrete approaches to eliciting exception-seeking. Conclusions: Solution-focused techniques should be modified to accommodate the cognitive abilities of people with ID and carers should be involved in sessions where possible. There is a need for further controlled studies, with valid and reliable outcome measures, larger samples, and longitudinal data.

Background: This study describes how a specific narrative therapy approach called 'the tree of life' was adapted to run a group for women with learning disabilities. The group consisted of four participants and ran for five consecutive weeks.Materials and Methods: Participants each constructed a tree to represent their lives and presented their tree to the group who responded with positive feedback and affirming statements. This led to discussion about overcoming the storms of life and a celebration of the journey the group had been through together.Key Results: Although no change was found on quantitative measures of well-being and self-esteem, participants reported benefitting from the peer support and social connectedness that the group offered, particularly in relation to themes of loss and change in their lives.Conclusions: 'The tree of life' approach has potential value as an intervention for people with learning disabilities. The benefits and challenges of this approach within the context of working with people with learning disabilities are discussed.