Understanding Inclusive Practices for Students With Autism Spectrum Disorder Through the Individualized Education Plan Process

Students with autism spectrum disorder (ASD) often display atypical behaviors which general education teachers may not know how to handle. As a result, students with ASD may not get the opportunity to be educated alongside typical peers in the least restrictive environment. Segregated settings often become the most recommended setting for students with ASD. The way to change this practice is if the child's parent is willing to speak up and request an inclusive, less restrictive setting. Working together with the school site, as an equal partner, parents can collaboratively prepare the student for an inclusive setting. Inclusive environments can be overwhelming to a student with ASD, if they come from a smaller classroom environment. Preparing the student and teacher for the transition can help to eliminate potential barriers in the inclusion process. Barriers can be identified through the individualized education plan (IEP), and solutions can be devised within that process.

Theory and Implementation of Inclusion

The inclusion of students with special needs in general education settings has become an essential component of education. Including all students in the least restrictive environment to the maximum extent possible is the law and an innate human right. However, research reveals that some teachers do not have positive attitudes toward including students with disabilities. The purpose of this chapter is to discuss findings from a study that uncovered factors behind teachers' attitudes toward inclusion. The general findings and themes are discussed. The chapter concludes with a list of resources teachers can access without payment to help them better understand students with disabilities and ways in which the teacher can more easily develop an inclusive, inviting environment for all.

Between the Great Leap Forward and the Cultural Revolution

Yuan-tsung returned to Beijing in November 1960, but she could not forget what she had seen in the Red Flag Commune, and so she planned to circumvent another, probably worse catastrophe. She discussed options with Jack. Both agreed to leave China for Hong Kong, where Jack’s brother Percy ran the Marco Polo Club, a sort of bridge between Western businessmen and China. Jack would work as a freelance journalist. They consulted their friend Comrade Xia. Xia arranged for Jack to meet the foreign minister, Chen Yi, who liked to wear a French Beret. Chen Yi thought it was a good idea that Jack continue his work in a less restrictive environment. But Yuan-tsung and Jack disagreed on when to depart. She preferred 1965 and he, 1966. She was afraid that anything might happen in that one year.

Occupational disruptions during lockdown, by generation: A European descriptive cross-sectional survey

Introduction The periods of lockdown during 2020 led to changes in daily occupations. As participation relies on dynamic interactions between the person, his/her occupations and his/her environment, we wondered whether people from different generations shared the same perception of occupational disruptions during the lockdown. Methods We performed an online survey based on the Canadian Occupational Performance Measure (COPM) of adults in 27 European Union countries, the United Kingdom and Switzerland. Three groups were compared: young adults (YAs, aged 18–39), middle-aged adults (MAs, aged 40–59) and older adults (OAs, aged 60 and over). Results 2865 participants (YAs: 47%; MAs: 33%; OAs: 20%) reported a total of 6549 disrupted occupations. The most frequently disrupted domain was leisure (83%), followed by productivity (16%) and self-care (2%); there were no significant intergroup differences ( p = 0.18). In a multivariate analysis, socializing disruptions were more likely to be associated with younger age (adjusted odds ratio (OR) [95% confidence interval (CI)] = 0.62 [0.50–0.76] for YAs versus MAs and 0.46 [0.30–0.71] for YAs versus OAs. Conclusion With the exception of socializing, the main disrupted occupations were similar from one generation to another. Our findings might enable the more accurate assessment of the risk of occupational disruption in a restrictive environment.

Determinants of women’s preferred and actual abortion provision locations in Nigeria

Background Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can influence women’s decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted. Methods This analysis uses data from a 2019–2020 follow-up survey of 1144 women in six Nigerian states who reported an abortion experience in a 2018 cross-sectional survey. We describe women’s preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or locations. We also examine factors that influence women’s decisions about where to terminate their pregnancy and identify factors hindering women’s ability to operationalize their preferences. We then examine the characteristics of women who were not able to use their preferred provider/location. Results Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%), chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). “Privacy/confidentiality” was the most common main reason driving women’s abortion provider/location choice (20.7%), followed by “convenience” (16.9%) and “recommended” by someone (12.3%), most often a friend (60.8%), although top reasons differed by type of provider/location. Cost and distance were the two most common reasons that women did not use their preferred provider/location (46.1% and 21.9%, respectively). There were no statistically significant differences in the sociodemographic characteristics between women who were able to use their preferred provider/location and those who were not able to implement their preferred choice, with the exception of state of residence. Conclusions These findings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to many women’s choice of abortion location, while cost and distance prevent many from seeking their preferred care provider/location. Results also highlight the diversity of women’s abortion care preferences in a legally restrictive environment.

Seclusion Management in an Acute In-Patient Unit

<p>Trends in modern day mental health facilities have been towards the least restrictive environment with emphasis on patients’ rights, but these rights have to be balanced against the safety of both the patients themselves and anyone else in the immediate environment. One way of restricting a person’s movement is through the use of seclusion, a means of isolating a person in a locked room with minimal stimulus and from where that person cannot freely exit. This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. I also included some personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses’ way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person’s level of acuity and to their ability to engage in this approach in a real and tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. It is used when a person is so unwell that they cannot be managed in any other identified way. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.</p>

Seclusion Management in an Acute In-Patient Unit

<p>Trends in modern day mental health facilities have been towards the least restrictive environment with emphasis on patients’ rights, but these rights have to be balanced against the safety of both the patients themselves and anyone else in the immediate environment. One way of restricting a person’s movement is through the use of seclusion, a means of isolating a person in a locked room with minimal stimulus and from where that person cannot freely exit. This study was developed to explore the use of seclusion in an acute in-patient unit for people with mental illnesses. Investigation into this issue was considered important due to an identified large increase in seclusion use over the previous two years. The study used a qualitative research methodology with a descriptive and interpretive approach. Data collection included a retrospective file audit of patients who had been secluded over the past seven years, and one-to-one staff interviews. I also included some personal reflections of seclusion events. The principle reason for using seclusion was violence and aggression in the context of mental illness. It was also used for people who were at risk of, or who had previously absconded from the unit. A recovery approach and the use of the strengths model was fundamental to nurses’ way of working with patients in the unit. Nurses believed that the strengths process should be adapted to the person’s level of acuity and to their ability to engage in this approach in a real and tangible way. Seclusion continues to be a clinical management option in the unit that is the subject of this study. It is used when a person is so unwell that they cannot be managed in any other identified way. However, in many circumstances there are other options that could be explored so that the utmost consideration is given to the dignity, privacy and safety of that person.</p>

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

Introduction On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. Method In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. Results The prevalence of aggressive behaviour on psychiatric wards varied (8–76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. Conclusion Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.

Organisation and timeline of measures in French psychiatric establishments during the first wave of the COVID-19 epidemic: EvOlu’Psy study

Background The onset of COVID-19 required rapid organisational changes in the mental health domain. Most mental health-care departments appear to have set up infection control measures and also organised planning, coordination and measures that enabled them to provide psychiatric care in a restrictive environment. Our objective was to assess the organisation by psychiatric facilities in France of their response to COVID-19, during the first wave. Methods In June 2020, a cross-sectional study was performed by an audit with 48 items which was proposed to 331 hospitals in metropolitan France with a capacity for full-time, that is, inpatient psychiatric hospitalisation of adults. Results Of the 331 establishments contacted, 94 (28.4%) agreed to respond to the survey questionnaire. Full-time inpatient hospitalisation was completely or partially maintained by 94.7% (n = 89) of facilities. Specific measures concerning respect for patients’ rights were reported by 58% (n = 55) of establishments. Overall, 74.5% (n = 70) had set up a dedicated channel of care for patients at risk of severe COVID-19, and 52.1% (n = 49) a system for routine screening at admission for these risk factors. Nearly half the establishments (48.9%, n = 46) reported they had set up specific training programmes for patients about barrier measures and social distancing. Conclusions French psychiatric establishments on the whole were able to provide a necessary reorganisation of their management of patients and their families, regardless of facility status. Patients’ rights nonetheless seem to have not received the attention they merited during the early pandemic period. Somatic management of patients with mental illness must absolutely be improved.

Is pregnancy status being assessed within women's secure services?

AimsTo establish rates of pregnancy testing on admission of women within a blended secure service.BackgroundWomen with psychiatric illness are known to be at increased risk of pregnancy, often due to engagement in risky sexual behaviours such as having a higher numbers of sexual partners and engaging in sexual activity whilst under the influence of drugs or alcohol. Awareness of pregnancy at the point of admission to psychiatric hospital would inform ongoing care plans to manage the pregnancy in the safest, least restrictive environment and inform future prescribing decisions, to minimise the risk of teratogenicity associated with some psychotropic medications. Ardenleigh in Birmingham is a blended female secure unit. No pregnancy screening guidelines for this population currently exist. This audit sought to establish current rates of pregnancy testing at the point of admission with a view to developing future guidelines.MethodA retrospective case note audit of electronic records of all patients admitted to Ardenleigh blended women's service as of 1st September 2019 (n = 26). The expected standard for pregnancy testing within one month of admission was set as 100%.ResultKey results include: The majority of patients (67%) were aged under 35 years (range 20–56). The most common ethnicities were Caucasian (42%) and African-Caribbean (38%). Almost half (46%) had a primary diagnosis of paranoid schizophrenia.Two women were known to be pregnant at the point of admission. Only 54% of women with an unknown pregnancy status were screened for pregnancy within one month of admission.Rates of screening were particularly poor in women aged under 25 years (43%) and between 36 and 45 (0%).Women not screened for pregnancy were typically admitted from other hospital settings, including AWA services (27%) or other medium secure units (55%). 2 women admitted from prison were not tested (29%)Of those tested, the majority were checked using urine hCG (92%).None of the women tested were found to be pregnant.ConclusionOverall pregnancy testing on admission to the unit was poor, with only 54% of service users screened. Less than 100% compliance could result in serious consequences for both the woman and unborn baby if a pregnancy is not discovered. Updating the admission checklist for Ardenleigh to include pregnancy testing may prove beneficial. It is recommended that a re-audit is completed 6 months following checklist introduction.