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AbstractArguably, the most important outcome measure for services to people with intellectual disabilities is quality of life. Quality of life has been defined in numerous ways and may consist of many aspects, including physical, material, and emotional well‐being, as well as interpersonal relationships, personal development, self‐determination, social inclusion, and civic rights. However, the most important aspect is social inclusion. People with intellectual disabilities who show challenging behavior, however, often make other people uncomfortable so that social inclusion is more difficult, and evidence suggests that both children and adults with intellectual disabilities and challenging behavior (and their families) have poorer quality of life and more restrictions in their lives than others with intellectual disabilities. Examination of the psychosocial aspects of quality of life indicates that modern services are still not good at providing people with challenging behavior with opportunities for making relationships, employment, and social inclusion. We need to improve our ability to target these areas of quality of life, particularly social inclusion for people with challenging behavior.

Background  Recently, symbols have been used to increase understanding of written information for people with intellectual disabilities, yet the effectiveness of this remains largely untested. This study was undertaken around the time of an election and it aimed to test whether a symbol‐based manifesto increased the understanding of this material for people with intellectual disabilities.Method  Two versions of a simplified manifesto were produced: one text‐based and the other symbol‐based (with text). Participants were randomly assigned to two groups: one received the text‐based information, and the other the symbol‐based information (with text). Participants were asked a series of questions about the material, both immediately (time 1) and a short time afterwards (time 2), to assess understanding (the material was in front of them throughout).Results  Both versions produced relatively low levels of understanding. The group with symbols (and text) showed no better understanding than the group with text only. However, those with better language comprehension scores and those with better reading skills tended to show a higher understanding of the manifesto, in both groups. In the symbols group, those who said they had seen symbols before also showed significantly better understanding of the material at time 2.Conclusions  This study suggests that the addition of symbols to simple texts does not necessarily improve people's understanding of it. It is proposed that a closer examination of people's understanding of symbols should be made and ways of improving this understanding investigated.

ABSTRACTThis paper, the second in a three‐part series, describes the assessment and treatment programmes of two service users to illustrate the MIETS approach, and gives details of the skill profiles which were used to plan their future placements. Data on the behavioural characteristics of MIETS users at pre‐admission and discharge are also presented, together with a discussion of the difficulty of using such measures to evaluate service effectiveness.

AbstractBackgroundThe abuse of adults with intellectual and developmental disabilities in care services seems to be relatively common, although there are anecdotal suggestions that abuse may be predictable and preventable.MethodEvidence related to how abuse is detected and prevented within services was reviewed. Database and ancestry searches were conducted, and the methodological quality of studies assessed using the mixed methods appraisal tool.ResultsA total of 48 articles were reviewed. The characteristics of victims, perpetrators and organisations were summarised. Several recommendations for how abuse can be detected and prevented were made, including better staff training, supervision and monitoring of services. The quality of studies limits the reliability and validity of research findings.ConclusionRisk and protective factors related to the abuse of adults with intellectual and other developmental disabilities remain largely consistent. Further research is required to support the implementation of recommendations aimed to detect and prevent abuse.

AbstractBackgroundIn the UK, little is known about the experience of ex‐prisoners with intellectual disabilities.MethodA qualitative study was therefore conducted to investigate what life is like for ten men with intellectual disabilities who left prison at least 9 months previously. Semi‐structured interviews were employed to explore the men's views of post‐prison life, including opportunities/challenges and support received from services.ResultsThrough interpretative phenomenological analysis, four over‐arching themes were constructed: the nature of support and services, the difficulty of staying out of trouble, the importance of family and the need to act the "tough guy". The participants reported being extremely under‐supported. They were often hostile about staff who they felt were too focused on their previous crime.ConclusionsIn general, men were very under‐supported and the upheavals of post‐prison lives appeared to be "normalized" by them. Better understanding of their lives within their social context would benefit their community re‐entry.

BackgroundPositive Behavioural Support (PBS) has been shown to be effective in minimizing challenging behaviour and improving the lives of people with intellectual disabilities. Training in PBS is an important factor in achieving good coverage in the use of PBS. The aim of this study was to evaluate the impact of training managers of social care services in PBS.MethodA year‐long training programme in PBS was delivered to 50 managers of community‐based services for people with challenging behaviour. Data were collected pre‐ and post‐training, and at six month follow‐up. A non‐randomized control group design was used.ResultsData demonstrated significant reduction in challenging behaviour. However, there was no change in quality of life for service users.ConclusionTraining in PBS can reduce challenging behaviour in people with intellectual disabilities; demonstrating any impact of PBS training on quality of life remains a challenge.

Purpose
The purpose of this paper is to focus on the development of Keep Safe, a manualised group intervention for adolescents with intellectual disabilities (ID) who display harmful sexual behaviour (HSB) as the initial phase of a feasibility study. National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. Aims included taking account of adolescents' and families' needs, motivations and practical commitments, integrating best- practice and being accessible and appropriate across different types of services.


Design/methodology/approach
Keep Safe development progressed from the practitioner/researcher collaborative young sex offender treatment services collaborative-ID through a project team, Keep Safe development group, comprising a range of practitioners with a variety of clinical expertise across services and an Advisory Group of people with ID. An expert-consensus methodology based on the Delphi method was used. The iterative process for the manual draws on the slim practice-based evidence from UK, New Zealand, North America and Australia.


Findings
Keep Safe comprises six modules distributed through 36 term-time young people's sessions, alongside 16 concurrent parental/ carer sessions (some joint). The main focus of Keep Safe is to enhance well-being and reduce harm. Four initial sites volunteered as feasibility leads, and two more were added as recruitment was more difficult than foreseen.


Originality/value
National reports have highlighted the need for the development of specialist programmes, as adolescents with ID make up a significant proportion of young people referred to specialist HSB services and there is a lack of evidence or practice-based interventions for them. This study is innovative and valuable given the recognition that research and practice is significantly lacking in this area.

BackgroundThere have been a number of studies of treatment for men with intellectual disabilities and sexually abusive behaviour but few follow‐up studies. Our aim was to follow up men with intellectual disabilities who had attended group cognitive behavioural treatment (CBT) for sexually abusive behaviour.MethodThirty‐four men (from seven treatment sites) were followed up. All had attended SOTSEC‐ID groups. The mean length of follow‐up, since the end of the treatment group, was 44 months (SD 28.7, range 15–106 months).ResultsThe statistically significant improvements in sexual knowledge, empathy and cognitive distortions that occurred during treatment were maintained at follow‐up. In all, 11 of the 34 (32%) men showed further sexually abusive behaviour, but only two of these men received convictions. Analyses of the variables associated with further sexually abusive behaviour indicated that a diagnosis of autism was associated with a higher likelihood of further sexually abusive behaviour.ConclusionsThis study provides some evidence of the longer‐term effectiveness of group CBT for men with intellectual disabilities and sexually abusive behaviour.