scholarly journals A survey of the use of seclusion and physical restraint at school and at home for children under the care of the NHS Lanarkshire CAMHS – learning disability team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S222-S222
Author(s):  
Sukhmeet Singh ◽  
Judith McKie
Keyword(s):  
Learning Disability ◽  
Physical Restraint ◽  
Challenging Behaviour ◽  
National Guidelines ◽  
Safe Place ◽  
Rights Of The Child ◽  
Retrospective Audit ◽  
The Individual ◽  
Small Team ◽  
At Home

AimsTo attempt to quantify the use of seclusion and restraint for young people managed by the NHS Lanarkshire CAMHS Learning Disability team.BackgroundThere has been increasing interest in the use of seclusion and restraint in children with learning disabilities, reflected by various news reports in the UK and USA. A survey of parents conducted by the Challenging Behaviour Foundation (2019) found that 35% of disabled children (n = 204) had been regularly physically restrained and a further 21% had been regularly secluded. The use of restrictive practice in children is contradictory to the UN Convention on the Rights of the Child as well as the conclusion of a recent report conducted by the Scottish Children's Commissioner titled “No Safe Place” which called on schools to stop using restraint and seclusion until national guidelines and standards were in place. No data were submitted to the Children's Commissioner from Lanarkshire. Anecdotally there was an impression in the team that restrictive practices were widely used at school and home.MethodThe NHS Lanarkshire CAMHS-LD team is a small team caring for children aged 5–18 years with moderate to severe/profound learning disability with mental disorder and/or severe challenging behaviour. The methodology for this retrospective audit relied on reviewing patient case notes and speaking with involved clinicians. We discussed each individual patient on their respective caseload as to whether the child had been restrained or secluded at home or at school.ResultAll 108 children from the caseload were included in the audit of whom 52.8% had been either restrained or secluded. 24.1% of children were both restrained and secluded at school, while 15.8% were restrained and secluded at home. These patients were complex. 86.1% had Autistic Spectrum Disorder and 55.6% had another comorbidity, such as ADHD.ConclusionThe figures are broadly similar to those in the Challenging Behaviour Foundation report. The team knew all of the individual patients very well and review them across a variety of settings such as school and home with instances of seclusion and restraint being directly witnessed by clinicians. Nevertheless, there is the issue of recall bias. These findings will be shared with NHS Lanarkshire management for further discussion and dissemination. .

scholarly journals Abstract : stomp in HPFT

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S220-S220
Author(s):  
Anu Sharma ◽  
Kamalika Mukherji ◽  
Chetan Shah
Keyword(s):  
Data Collection ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Clinical Sample ◽  
Challenging Behaviour ◽  
Psychological Therapies ◽  
Nice Guidance ◽  
The Individual ◽  
Community Team ◽  
The Impact

AimsAnalyse the pattern of psychotropic drug use and deprescribing (in the context of STOMP) in people with Intellectual disability and Challenging behaviour in Hertfordshire community team(s) during 2016-17. STOMP stands for Stopping Over Medication in People with Learning Disability, Autism or both.BackgroundPublic Health England in 2015 estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability, autism or both were taking prescribed psychotropics without appropriate clinical indications . HPFT signed up to the STOMP pledge in 2017 to actively review psychotropic prescribing in line with NICE guidance alongside patients, carers and professional partnerships. This audit provides the outcomes of applying the STOMP Pledge to clinical practice.MethodData collection for the current audit occurred over Q1-5 in 2016–2017. All patients with Intellectual Disabilities on psychotropic medication were reviewed in psychiatric clinics. Awareness was raised about STOMP in teams. A semi-structured tool was developed based on the Self assessment framework published by the ID faculty RCPsych and prospective data were collected after each outpatient visit.Result347 patients were prescribed psychotropic medication and reviewed quarterly between 2016-2017. 96 patients were prescribed antipsychotics for challenging behaviour. Other prescribed medications included mood stabilisers, anticonvulsants, anti-depressants and benzodiazepines. Common antipsychotics used: Risperidone (63), Aripiprazole (14), Quetiapine (9), Olanzapine (4); Chlorpromazine (2). Four patients were maintained on two antipsychotics in varying combinations. The data collection tool noted that alternatives to medication were tried in 32 cases. Deprescribing occurred in 41 casesConclusionThis study represents an attempt to capture the impact of the STOMP principles in a clinical sample. Various alternatives to medications were pursued in the sample such as positive behaviour support, sensory integration, psychological therapies, social support. Younger adults (under 30 years) represented the largest proportion of cases where medication was increased. Adults over 30 years represented the largest proportion of cases where a STOMP reduction occurred. This may reflect the individual factors at play. Younger people with ID and /or Autism are more likely to experience changes in support and structure at transition, whilst older adults may have more physical comorbidities that may influence this decision.zcvv

Acquiring variable commands at home and abroad: Examining optatives and imperatives in L1 and L2 Spanish

2020 ◽  
Vol 13 (1) ◽  
pp. 79-113
Author(s):  
Farrah Neumann ◽  
Matthew Kanwit
Keyword(s):  
Second Language ◽  
Second Language Acquisition ◽  
Study Abroad ◽  
Language Teaching ◽  
Applied Linguistics ◽  
Future Research ◽  
Control Group ◽  
Before And After ◽  
The Individual ◽  
At Home

AbstractSince many linguistic structures are variable (i. e. conveyed by multiple forms), building a second-language grammar critically involves developing sociolinguistic competence (Canale and Swain. 1980. Theoretical bases of communicative approaches to second language teaching and testing. Applied Linguistics 1(1). 1–47), including knowledge of contexts in which to use one form over another (Bayley and Langman. 2004. Variation in the group and the individual: Evidence from second language acquisition. International Review of Applied Linguistics in Language Teaching 42(4). 303–318). Consequently, researchers interested in such competence have increasingly analyzed the study-abroad context to gauge learners’ ability to approximate local norms following a stay abroad, due to the quality and quantity of input to which learners may gain access (Lafford. 2006. The effects of study abroad vs. classroom contexts on Spanish SLA: Old assumptions, new insights and future research directions. In Carol Klee & Timothy Face (eds.), Selected proceedings of the 7th conference on the acquisition of Spanish and Portuguese as first and second languages, 1–25. Somerville, MA: Cascadilla Proceedings Project). Nevertheless, the present study is the first to examine native or learner variation between imperative (e. g. ven ‘come’) and optative Spanish commands (e. g. que vengas ‘come’). We first performed a corpus analysis to determine the linguistic factors to manipulate in a contextualized task, which elicited commands from learners before and after four weeks abroad in Alcalá de Henares, Spain. Their overall rates of selection and predictive factors were compared to local native speakers (NSs) and a control group of at-home learners.Results revealed that the abroad learners more closely approached NS rates of selection following the stay abroad. Nonetheless, for both learner groups conditioning by independent variables only partially approximated the NS system, which was more complex than previously suggested.

scholarly journals Physical Restraint of Older Adults at Home: Preliminary Analysis of a Prospective Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 683-683
Author(s):  
Asa Inagaki ◽  
Ayumi Igarashi ◽  
Maiko Noguchi-Watanabe ◽  
Mariko Sakka ◽  
Chie Fukui ◽  
...  
Keyword(s):  
Older Adults ◽  
Online Survey ◽  
Physical Restraint ◽  
Community Dwelling ◽  
Physical Restraints ◽  
Care Nurse ◽  
Factors Associated ◽  
Home Care Nurse ◽  
Community Dwelling Older Adults ◽  
At Home

Abstract Our study aimed to explore the prevalence and factors of physical restraints among frail to dependent older adults living at home. We conducted an online survey to ask about the physical/mental conditions, demographics, service utilization, and physical restraints of community-dwelling older adults. Either home care nurse or care managers who were responsible for the older adult answered the survey that were conducted at baseline and one month later. We obtained data from 1,278 individuals. Physical restraint was reported for 53 (4.1%) participants. Multiple logistic regression revealed the factors associated with physical restraints at home: having been restrained at baseline, having pneumonia or heart failure, receiving home bathing, or using rental assistive devices were associated with physical restraints at one month. The findings could be used to promote discussion about which services prevent physical restraints and what we should do to support clients and their family to stay at home safely.

scholarly journals Commentary on “Who’s Challenging Who?: a co-produced approach for training staff in learning disability services about challenging behaviour”

2019 ◽  
Vol 24 (4) ◽  
pp. 200-203
Author(s):  
Mark Andrew Haydon-Laurelut ◽  
Karl Nunkoosing
Keyword(s):  
Learning Disability ◽  
Design Methodology ◽  
Psychological Research ◽  
Disability Services ◽  
Challenging Behaviour ◽  
Social Psychological ◽  
Content Type ◽  
Systemic Practice ◽  
Social Psychological Research

Purpose The purpose of this paper is to provide a commentary on the article by Flynn et al. Design/methodology/approach In this commentary, the authors will develop some further thoughts about the importance of empathy, its relational nature and place in practice. The authors use some examples from systemic practice to illustrate. Findings Social psychological research underlines the importance of empathy in practice. Systemic practice and other collaborative approaches that ask about the experiences and abilities of people with a learning disability and their networks can support new possibilities as network members are listened to, included and respected. Originality/value The relational nature of empathy and its connection with practice is explored in this paper.

scholarly journals Managing children and adolescents on parenteral nutrition: challenges for the nutritional support team

2006 ◽  
Vol 65 (3) ◽  
pp. 217-221 ◽  
Author(s):  
Tracey Johnson ◽  
Elaine Sexton
Keyword(s):  
Parenteral Nutrition ◽  
Children And Adolescents ◽  
Nutritional Support ◽  
Intestinal Failure ◽  
Home Care Services ◽  
Cholestatic Liver Disease ◽  
Care Services ◽  
Child Assessments ◽  
The Individual ◽  
At Home

Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.

scholarly journals Creative Potential is Differentially Expressed in School, at Home, and the Natural Environment

2021 ◽  
Author(s):  
Mark Runco ◽  
Ahmed M. Abdulla Alabbasi ◽  
Selcuk Acar ◽  
ALaa Eldin A. Ayoub
Keyword(s):  
Natural Environment ◽  
Statistical Test ◽  
Differentially Expressed ◽  
Creative Activity ◽  
Creative Potential ◽  
Method Variance ◽  
Creative Products ◽  
The Individual ◽  
Home And School ◽  
At Home

Creative potential is one of the very most important topics for research. It is difficult to study because, unlike creative products, potential is by definition latent. There are several methods. One involves comparing creative activity expressed in various settings. Previous research has, for example, compared creativity expressed in school with that expressed by the same individuals when they are outside of school. There tends to be more creative activity outside of school, suggesting that the individual has creative potential, but it is only allowed to be expressed in certain settings. The present investigation extended this line of research by comparing creative activity in school, at home, and that occurring outside of school and home. Results indicated that the activity scores from the three settings shared less than 52% of their variance. The measures used were highly reliable, so the conclusion was that, as in previous research, various settings do indeed differentially allow the expression of creative potential. Comparisons of means also supported this finding. Interestingly, creative activity at home was significantly more common than creative activity at school and when outside of the home and school. A statistical test of method variance indicated that it was not a notable contribution nor confound. Limitations are discussed at the end of the manuscript.

scholarly journals Restoration of elective spine surgery during the first wave of COVID-19

2021 ◽  
Vol 2 (12) ◽  
pp. 1096-1101
Author(s):  
Riaz Mohammed ◽  
Pranav Shah ◽  
Alexander Durst ◽  
Naveen J. Mathai ◽  
Alexandru Budu ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Recovery Phase ◽  
Primary Outcome Measure ◽  
Study Cohort ◽  
National Guidelines ◽  
The Mean ◽  
The Individual ◽  
The Uk

Aims With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective spinal surgery during the pandemic. Methods A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. Results In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. Conclusion This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096–1101.

Teaching Literature in Schools for Democratic Citizenship

2021 ◽  
Author(s):  
Ruth Heilbronn
Keyword(s):  
Human Rights ◽  
United Nations ◽  
Democratic Citizenship ◽  
Creative Arts ◽  
Human Right ◽  
Teaching Literature ◽  
The United Nations ◽  
The Individual ◽  
United Nations Charter ◽  
At Home

Education is a human right and benefits both the individual and the whole society. Education that encourages debate and discussion and acknowledges complexity and ambiguity is essential for people to develop a respect for others and for democracy—that is, to participate as citizens. This concept is encapsulated in the United Nations Charter of Human Rights. The humanities and the creative arts are important curriculum areas that can encompass diversity and complexity and support the development of a necessary critical disposition. Study in these areas helps to create people who are at home in a culture in which openness to others and criticality in receiving ideas are paramount. Literature plays a key role in attaining these curriculum aims.

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