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J Appl Res Intellect Disabil ; 33(4): 702-710, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31496038


BACKGROUND: Structured assessments have been shown to assist professionals to evaluate the risk of aggression in secure services for general offender populations and more recently among adults with intellectual disabilities. There is a need to develop intellectual disability sensitive measures for predicting risk of aggression in community samples, especially tools with a focus on dynamic variables. METHODS: The study prospectively followed 28 participants for up to 2 months to test whether the Current Risk of Violence (CuRV) and Short Dynamic Risk Scale (SDRS) were able to predict verbal and physical aggression in a community sample of adults with intellectual disability. RESULTS: CuRV and SDRS ratings significantly predicted verbal and physical aggression over a 2-month period. CONCLUSIONS: The current study supports the use of the CuRV with adults with intellectual disability living in community settings. The CuRV and SDRS are worthy of future development and evaluation in independent investigations.

Clin Psychol Rev ; 58: 76-85, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29066047


BACKGROUND: Risk assessments assist professionals in the identification and management of risk of aggression. The present study aimed to systematically review evidence on the efficacy of assessments for managing the risk of physical aggression in adults with intellectual disabilities (ID). METHODS: A literature search was conducted using the databases PsycINFO, EMBASE, MEDLINE, Web of Science, and Google Scholar. Electronic and hand searches identified 14 studies that met the inclusion criteria. Standardised mean difference effect sizes Area Under Curve (AUC) were calculated for studies. Random effects subgroup analysis was used to compare different types of risk measures (Actuarial, Structured Professional Judgment and dynamic), and prospective vs. catch-up longitudinal study designs. RESULTS: Overall, evidence of predictive validity was found for risk measures with ID populations: (AUC)=0.724, 95% CI [0.681, 0.768]. There was no variation in the performance of different types of risk measures, or different study design. CONCLUSIONS: Risk assessment measures predict the likelihood of aggression in ID population and are comparable to those in mainstream populations. Further meta-analysis is necessary when risk measures are more established in this population.

Agressão/fisiologia , Deficiência Intelectual/fisiopatologia , Prognóstico , Medição de Risco/métodos , Adulto , Humanos
Clin Psychol Psychother ; 21(2): 178-92, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23233237


UNLABELLED: Clinical supervision is a multi-functional intervention within numerous psychotherapeutic professions, including clinical psychology. It often relies on supervisees' verbal disclosures of pertinent information. There is limited research on supervisee self-disclosure in the UK, and none using clinical psychology populations. This study aimed to address the limitations in the evidence base. It used a constructivist grounded theory methodology to investigate qualified UK clinical psychologists' use of self-disclosure in supervision in order to develop a theoretical understanding of their self-disclosure processes. Ten clinical psychologists from various time points across the career span were recruited to the study. Four core conceptual categories were identified in the analysis as being integral to participants' decision-making processes: 'Setting the Scene', 'Supervisory Relationship', 'Using Self-disclosure' and 'Reviewing Outcome of Self-disclosure'. These four categories are comprised of a number of subcategories. The study's findings are compared with the current literature base, and it is argued that there are tensions with the scientist-practitioner model as it could be interpreted to encourage an expert stance, which may limit the self-disclosure of qualified supervisees. The implications of this perspective are discussed. KEY PRACTITIONER MESSAGE: Supervision is a key process in supporting qualified clinical psychologists and the use of disclosure appears to be important in facilitating useful supervision. It appears that clinical psychologists go through a number of complex processes in deciding whether to self disclose.

Pessoal de Saúde/psicologia , Relações Interprofissionais , Psicologia Clínica , Autorrevelação , Feminino , Humanos , Masculino , Reino Unido
J Appl Res Intellect Disabil ; 26(1): 14-25, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23255375


BACKGROUND: Creative use of legislation can produce positive change in the lives of people with intellectual disabilities. This may be 'bottom-up' or 'top-down' or at multiple levels and with multiple stakeholders. METHOD: Using a human rights-based approach (HRBA), four initiatives to improve services for people with intellectual disabilities in the UK are described. RESULTS: The first example explains the process of co-producing a DVD and board game to enable people with intellectual disabilities to understand their human rights. The second example considers the impact of organizational culture in the process of embedding a pilot evaluation of practical, human rights-based risk assessment and management tools. A third pilot project examines how the guiding principles of Mental Health Act (MHA) (2007) for England and Wales can be operationalized using an HRBA. Finally, improving equitable access to health care through a 'top-down' process of change involving the Green Light Toolkit is reported. CONCLUSION: The authors consider how to approach the process and where to focus in the system, to realize meaningful change.

Política de Saúde , Direitos Humanos/legislação & jurisprudência , Deficiência Intelectual , Serviços de Saúde Mental/organização & administração , Participação do Paciente , Medicina Estatal/organização & administração , Adulto , Atitude do Pessoal de Saúde , Internação Compulsória de Doente Mental/legislação & jurisprudência , Internação Compulsória de Doente Mental/normas , Inglaterra , Jogos Experimentais , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/normas , Cultura Organizacional , Inovação Organizacional , Educação de Pacientes como Assunto/métodos , Projetos Piloto , Gestão de Riscos/organização & administração , Medicina Estatal/legislação & jurisprudência , Medicina Estatal/normas , País de Gales
Clin Psychol Rev ; 30(3): 326-37, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20096978


Attachment theory has been proposed as a suitable framework within which to understand and explore the therapeutic alliance. This review systematically explores research that has examined the relationship between clients' self reported attachment patterns and the therapeutic alliance. Methodological characteristics and study findings are reviewed and discussed with the aim of concluding whether assessing clients' attachment patterns would be beneficial to therapy. In spite of inconsistencies with regards to the measurement and conceptualisation of attachment and the alliance, the evidence suggests that clients who rate themselves as having a more secure attachment pattern are likely to rate the alliance as stronger. The implications of this for therapeutic practice are discussed.

Apego ao Objeto , Relações Médico-Paciente , Psicoterapia , Adulto , Ansiedade/psicologia , Humanos
J Intellect Disabil ; 9(2): 145-54, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15937052


This study explored the effects of relocation from institutional to specialized community-based residential provision for six men with mild to moderate intellectual disabilities and challenging behaviour and for a comparison group of six men with mild to moderate intellectual disabilities and challenging behaviour who were already living in specialized community-based residential provision. Relocation was associated with: (1) a significant increase in participants' domestic activity skills; (2) a decrease in the observed occurrence of some problem behaviours; (3) an increase in quality of life; and (4) an increase in engagement and staff contact. The community group, however, also showed some improvements over time, most notably in their levels of engagement in meaningful activity and staff contact. The implications of these results for service provision and suggestions for future research are discussed.

Serviços Comunitários de Saúde Mental , Deficiência Intelectual/complicações , Transtornos Mentais/complicações , Tratamento Domiciliar , Apoio Social , Adulto , Feminino , Humanos , Atividades de Lazer , Masculino , Pessoa de Meia-Idade , Qualidade de Vida