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1.
Dementia (London) ; : 1471301220973067, 2020 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33372553

RESUMO

BACKGROUND AND AIMS: Sensitivity to the rights of people with dementia is a key principle cited in the World Health Organisation's global action plan on dementia. Some critics question whether rights-based approaches embody loose and ill-defined ideas incapable of bringing about meaningful change. Exercising the right to autonomy is considered a core problem for people living with dementia. The tradition of individual sovereignty dominates ideas about autonomy, although the person as an individual is not a cross-culturally universal concept. This study explored the viewpoints of people with dementia and family carers regarding the meaning of autonomy with a view to informing rights-based practice. METHODS: Twenty participants, people living with dementia and family carers, each conducted a Q-sort of statements regarding the meaning of autonomy. A by-person factor analysis was used to identify patterns in how the range of statements about autonomy were ranked. RESULTS: Three factors emerged: retaining independence and self-expression, accepting dependence but being included and opportunity for connection. There was some agreement across these different views regarding the importance of being given time to think before making decisions and being kept active. CONCLUSIONS: This study highlights the need for a person-centred approach to supporting people with dementia to claim their rights and the importance of adopting a stance of curiosity and critical thinking in rights-based training and professional practice. The findings suggest a variety of meaningful stories of autonomy and the possibility of further developing existing rights-based frameworks for dementia care.

2.
Psychol Psychother ; 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32543107

RESUMO

OBJECTIVES: This paper sought to conduct a meta-analysis of the effectiveness and durability of cognitive analytic therapy (CAT) and assess the acceptability of CAT in terms of dropout rates. DESIGN: Systematic review and meta-analysis. METHODS: PROSPERO registration: CRD42018086009. Searches identified CAT treatment outcome studies eligible to be narratively synthesized. Pre-post/post-follow-up effect sizes (ESs) were extracted and synthesized in a random-effects meta-analysis. Variations in effect sizes were explored using moderator analyses. Dropout rates were extracted. Secondary analyses synthesized between-group ES from trials of CAT. RESULTS: Twenty-five studies providing pre-post CAT treatment outcomes were aggregated across three outcome comparisons of functioning, depression, and interpersonal problems. CAT produced large pre-post improvements in global functioning (ES = 0.86; 95% CI 0.71-1.01, N = 628), moderate-to-large improvements in interpersonal problems (ES = 0.74, 95% CI 0.51-0.97, N = 460), and large reductions in depression symptoms (ES = 1.05, 95% CI 0.80-1.29, N = 586). All these effects were maintained or improved upon at follow-up. Limited moderators of CAT treatment effect were identified. CAT demonstrated small-moderate, significant post-treatment benefits compared to comparators in nine clinical trials (ES = 0.36-0.53; N = 352). The average dropout rate for CAT was 16% (range 0-33%). CONCLUSIONS: Patients with a range of presenting problems appear to experience durable improvements in their difficulties after undergoing CAT. Recommendations are provided to guide the further progression of the CAT outcome evidence base. PRACTITIONER POINTS: Large pre-post reductions in global functioning and depression outcomes and moderate-large reductions in interpersonal problems are evident after CAT. The effects of CAT appear durable, and interpersonal functioning significantly improves over follow-up time. CAT produces small-moderate benefits compared to trial comparators. CAT appears to be an engaging psychotherapy that maintains patients in treatment.

3.
J Appl Res Intellect Disabil ; 33(1): 3-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27538684

RESUMO

BACKGROUND: Previous research aiming to understand the lives of lesbian, gay bisexual and trans (LGBT) people labelled with intellectual disabilities is limited. There are few recent studies and available findings are often contradictory and inconsistent. METHOD: This study aimed to explore how LGBT people labelled with intellectual disabilities experienced their sexual identities. Five LGBT people labelled with intellectual disabilities were interviewed, and data were analysed using interpretative phenomenological analysis methodology. RESULTS: Four superordinate themes represented the following: common experiences of bullying/abuse, understanding sexualities, other's responses to intellectual disabilities and sexualities, and navigating acceptance. CONCLUSIONS: Strategies for coping with abuse maintained participant's engagement in local communities. Sexuality was often problematized by others despite being generally accepted by participants. Coming out was a continual process of decision-making to facilitate safety and acceptance. To feel fully supported, participants desired holistic service provision sensitive to their sexuality and intellectual disability needs. Clinical and research implications are suggested.


Assuntos
Deficiência Intelectual/psicologia , Minorias Sexuais e de Gênero/psicologia , Sexualidade/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
4.
J Appl Res Intellect Disabil ; 33(1): 39-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28585359

RESUMO

BACKGROUND: Research into how people with intellectual disabilities (ID) pursue intimate relationships in care settings presents some contradictory findings; despite increasingly liberal staff views, service users experience significant restrictions. This study attempts to explore this gap within a secure hospital, examining service user's representations of staff discourses about sexuality and intimate relationships. METHOD: Semi-structured interviews with eight service users with intellectual disability were analysed using critical discourse analysis. RESULTS: Analysis enabled construction of 11 themes falling into three categories. Dominant discourses appeared to maintain the integrity of the institution, enable staff to occupy a position of power and demonstrate service users' responses to perceived control. CONCLUSIONS: Discourses around sex appear to serve the interests of staff and the hospital, while being restrictive and often incomprehensible to service users. Implications for service development, and future research directions, are considered in the context of "Transforming Care."


Assuntos
Deficiência Intelectual , Relações Profissional-Paciente , Comportamento Sexual , Parceiros Sexuais , Adulto , Criminosos , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
5.
J Appl Res Intellect Disabil ; 28(3): 223-37, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25196210

RESUMO

BACKGROUND: A serious board game called 'FREDA Challenge' was co-produced with people with intellectual disabilities (PWID) as a tool for human rights (HR) education and increase positive attitudes towards HR in healthcare settings. The current study evaluated 'FREDA Challenge' with PWID and their carers. METHOD: Eighteen PWID and 13 carers participated in a repeated measures design whereby changes in attitudes and knowledge of HR were measured. RESULTS: Analysis revealed statistically significant differences (P = 0.02) between PWID and carers in their knowledge of HR. The same was not evident for attitudes towards HR. The positive attitudes and knowledge in the PWID group significantly increased after playing the game (P ≤ 0.02), but not for the carers/professionals group. CONCLUSIONS: Findings suggest that playing the board game can positively change the attitudes and knowledge of PWID towards HR. The board game seems to elicit positive interpersonal dynamics between PWID and carers/professionals.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Direitos Humanos , Deficiência Intelectual/reabilitação , Adulto , Idoso , Atitude do Pessoal de Saúde , Cuidadores , Feminino , Humanos , Deficiência Intelectual/psicologia , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Jogos e Brinquedos , Inquéritos e Questionários , Adulto Jovem
6.
J Appl Res Intellect Disabil ; 26(1): 14-25, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23255375

RESUMO

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.


Assuntos
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
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