Sexual support and education for adults with mild intellectual disabilities: a Delphi study on multiple perspectives.

BACKGROUND: Providing appropriate sexual support and education for adults with mild intellectual disabilities (IDs) is a source of considerable debate, resulting in diverse, non-funded and potentially adverse practices. This study aims to identify a consensus among experts regarding what conditions are conducive to successful sexual support and education for adults with mild IDs. METHODS: A Delphi study was conducted with 13 experts, including experts-by-experience, relatives, support staff, psychologists and sexologists. Qualitative data on the conditions for sexual support and education were gathered in the first round and thematically analysed. In the following three quantitative rounds, consensus was achieved using Likert-type response scales and participants' feedback. RESULTS: Round 1 resulted in 82 conditions on six themes: 'the necessary attitude', 'requirements', 'approach to delivering sexual support and education', 'appropriate providers', 'settings and timing' and 'effective collaboration with the network'. In the following three quantitative rounds, the experts reached consensus on 68 conditions distributed across the six themes. CONCLUSIONS: The six themes highlight conducive conditions for successful sexual support and education for adults with mild IDs, emphasising the significance of a safe and supportive environment, comprehensive educational programmes, and the promotion of autonomy and protection. The consensus-based findings have distinct implications for practice and future research.

Understanding the Process of Drug Addiction Recovery Through First-Hand Experiences: A Qualitative Study in the Netherlands Using Lifeline Interviews.

Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.

A shifting paradigm? A scoping review of the factors influencing recovery and rehabilitation in recent forensic research.

Forensic research and practice have historically focused on risk assessment and prevention. This risk-oriented paradigm is shifting towards a more recovery-oriented perspective. The aim of this scoping review is to provide an overview of research on the factors influencing rehabilitation and recovery and discuss the recovery paradigm in a forensic setting. We performed a systematic search of the literature from the past 10 years, in Pubmed, Cinahl and PsycInfo, on recovery and rehabilitation. All types of study designs were included. Data was analysed and charted using an Excel template with various data items of interest. Clinical, personal, social, functional and forensic factors were found to be of influence on recovery and rehabilitation. A number of these overlapped with factors of influence on recidivism and desistance, others did not. Most studies on recovery and rehabilitation focused on a clinical forensic setting. This study provides an overview of the current body of knowledge on the factors influencing recovery and rehabilitation in forensic clients, and encourages researchers and practitioners in their focus on the recovery paradigm in forensic care. The body of evidence on rehabilitation and recovery is not yet as profound as that on recidivism and desistance. More knowledge on recovery trajectories for offenders in prison or ambulatory care, for example, is required.

The foundations of the working alliance in assertive community treatment teams.

BACKGROUND: In this study, we aimed to identify and define the fundamental components of the working alliance in multidisciplinary (Flexible) Assertive Community Treatment teams with shared caseloads, in order to support their daily practice and further research. METHODS: After reviewing the literature, concept mapping with professionals and clients was used to define the working alliance in (F) ACT teams. The resulting concept maps formed the basis for the working alliance assessment instrument, which was pilot tested with professionals and clients through cognitive interviews with a think-aloud procedure. RESULTS: The study led to the development of a twenty five-item assessment instrument to evaluate working alliances in multidisciplinary teams (WAM) that was comprised of three subscales: bond, task/goal and team. Two different versions were developed for clients and professionals. CONCLUSIONS: The WAM instrument was developed to determine the quality of the working alliance in (F) ACT teams. Future research will focus on testing its psychometric properties and predictive value.

Predictors of quality of life of people receiving intensive community-based care.

PURPOSE: Intensive community-based care (ICBC) is a home-treatment approach aiming to support people 'living in the community' with severe psychiatric and addiction problems. Although subjective quality of life (SQOL) is an increasingly important outcome measure in health care, little is known on ICBC clients' SQOL. METHODS: Clients of three ICBC teams (N = 523) participated in the study. Upon intake, clients filled out a SQOL measure and indicated whether they had a good friend, partner, and children, as well as their experiences with crime. Professional caregivers filled in a measure on problem severity. RESULTS: Regression was used to examine to what extent the included variables contributed to explaining variance in ICBC clients' SQOL. Determinants in the model significantly predicted client SQOL and explained 37 % of the variance. 'Symptomatology' (depressive symptoms) and 'social problems' (living conditions) negatively influenced the SQOL, while having a partner, a good friend, and an overall lower problem severity positively influenced SQOL. CONCLUSIONS: SQOL among ICBC clients is related to psychopathology, in contrast to previous knowledge. It is dependent upon symptom specificity, living conditions, and social circumstances and therefore presumably on program characteristics. This study provides insight into well-being among ICBC clients and is therefore relevant to involved healthcare professionals.