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This paper analyses the meanings of "integration" and "inclusion" in the context of disability services to determine the extent to which the latter signals a change in perspective rather than simply a change in terminology. It is argued that integration implies that disabled people need to be integrated into "mainstream" society and that it is they rather than society which is required to change. The policy response which results from this approach may thus be a technical one which focuses on physical integration alone. In contrast, inclusion takes as its starting‐point the fact that a just state of affairs is one in which disabled people are included in society and hence the required policy response is a broad one which includes comprehensive civil rights legislation, an analysis of the effects of present and future policy on disabled people and the participation of disabled people in the democratic decision‐making process. However, as disabled people are currently excluded from many aspects of society, the potential for an inclusive approach to be dismissed as being too idealistic is noted, and a number of possible barriers to its realization are discussed. It is concluded that whilst such barriers exist they should not, in themselves, provide a reason for inaction as an understanding of the implications of inclusion for policy and practice can provide a useful starting‐point from which to bring about change.

People with intellectual disabilities experience many health disparities including difficulties with access to healthcare, and a lack of appropriate and timely healthcare. Nurses are well placed to address such disparities. In the UK, this is a key focus of the role of specialist community learning (intellectual) disabilities nurses (CLDNs), as explained in our background section. Research relating to this aspect of their role is limited. This qualitative research study explored the role of the CLDN to support access to secondary healthcare. This article reviews our study methods, which included semi-structured interviews (n = 14) conducted with CLDNs using critical incident technique. These were subsequently transcribed and critical incidents (n = 74) analysed using thematic analysis. We describe in our findings four emerging themes: Proactive/Preparatory Work; Therapeutic Relationships; Coordination; and Influencing Healthcare Outcomes. Within each theme and several subthemes there is evidence of CLDNs identifying and removing or reducing barriers to effective and timely healthcare. The discussion section asserts that CLDNs use a range of strategies to support access to healthcare and with a focus on barriers, they promote health within a social model of disability. We conclude that, whilst specialist CLDNs do not exist in many other countries, the strategies they employ could be utilised by non-specialist nurses working both within the UK and elsewhere to enhance access and reduce health disparities for people with intellectual disabilities.

AbstractBackgroundPeople with intellectual disabilities are at increased risk of abuse which may not always be responded to appropriately. This study therefore sought to explore how nurses and social workers make decisions when safeguarding adults with intellectual disabilities.MethodA situational analysis grounded theory study. Semi‐structured interviews were undertaken with social workers (n = 16) and community nurses (n = 9) working in Community Learning (Intellectual) Disability Teams in Wales. Data were transcribed and analysed thematically and cartographically in keeping with situational analysis.ResultsFour key themes emerged: The official line; Expectation and perception; Non‐vulnerable adult process options; Confidence and competence. Sites of silence were also identified: not making a decision, not asking further questions, preserving family relationships and the individual with intellectual disabilities.ConclusionDecision making in relation to safeguarding adults with intellectual disabilities is a complex process, influenced by many factors and in which discretion is exercised by professionals.

AbstractBackgroundLittle is known about how health issues identified at the annual health check (AHC) are followed up and addressed, how participants self‐manage their health in between AHCs, and what support they receive. This research aimed to explore this.MethodsPeople with intellectual disabilities (n = 12), and/or their supporters residing in Wales, were interviewed following their AHC and again at 6 and 11 months. A recurrent cross‐sectional thematic analysis was undertaken.ResultsFive main themes emerged from interview one: going for a health check, issues identified, and actions taken, supporting the self‐management of health, the personal context, and addressing health inequities. Four main themes emerged from follow‐up interviews: follow‐up, supporting the self‐management of health, the need for reasonably adjusted health services, and going for another health check.ConclusionA broader system of support around the AHC is required if people are to achieve or maintain the best possible health.

AbstractBackgroundServices have a duty to uphold the personal and sexual relationship (P&SR) rights of adults with intellectual disability. However, little is known about how social care workers' (SCWs) perceptions of public views of intellectual disability and sexuality might affect their attitudes, believes and behaviours towards supporting P&SR needs. This exploratory study addresses this gap in knowledge.Materials And MethodsQualitative interviews using critical incident technique were conducted with 18 SCWs. Data were transcribed and thematically analysed.ResultsFour dominant themes were identified; socio‐cultural, practice‐policy gaps, fear and safety needs. These highlights how perceptions of public attitudes impact on SCWs' attitudes towards supporting development of P&SR both directly and through perceptions of organisational policies. This leads to prioritisation of safety needs over support for P&SR.ConclusionsPublic expectations strongly influenced SCWs' interpretation of organisational policy, emphasising a need for practice‐based support to manage public expectations and reduce fear.

BackgroundDespite awareness of the age related health needs of people with intellectual disabilities little is known regarding how residential social care staff are prepared to meet such needs.MethodsData were gathered via semi‐structured interviews from 14 managers of supported living settings. Transcripts were thematically analysed.FindingsStaff may work in supported living settings with no prior experience of care work, and previous knowledge/experience of supporting people in relation to their health is not required. Whilst health related training is provided there is a lack of specific training regarding healthy ageing, and training seems to be reactive to changing needs of tenants meaning that proactive monitoring for changes in health status may not occur.ConclusionsWhilst some training is provided for residential social care staff in relation to health and ageing a more proactive approach is required which should include a focus on healthy ageing.

Abstract Recent years have seen the development of policy guidance documents in both Wales and England relating to the protection of vulnerable adults from abuse. This policy guidance does, however, require translation into policies at the local level and that these policies are then implemented in day‐to‐day practice. This article reports some of the findings of a two‐year study that examined the development and implementation of such policies in services for people with learning disabilities within Wales. Data were gathered by means of a survey of service providers from across Wales and also via focus groups held with direct care staff and those with a responsibility for investigating alleged abuse. Positive developments include a commitment to multi‐disciplinary working, increased clarity and consistency, and greater awareness. Less positive aspects include the potential for policy 'overload' and a feeling that, while there is awareness of the existence of vulnerable adults policies, knowledge of their content may be more limited. Recommendations are made for the development of policy, practice and research.

The abuse of people with learning disabilities is a significant problem. The response of the police to abuse that is actually a criminal offence is paramount. This paper reports on a qualitative study into the attitudes and opinions of police officers involved in abuse investigations. The aims were to understand more about the perceptions that police have about their role, the contribution made by the police to the area and to identify good practice where it occurs. Semistructured interviews and focus groups were conducted with police officers regarding their experiences of involvement in vulnerable adult protection and views on the role of the police. Findings are presented according to key themes: structure for abuse work, joint investigator training, understanding the needs of people with learning disabilities, the legislative context for abuse work and sharing good practice and striving for a consistent response. Demand is growing for the police to respond to the abuse of people with learning disabilities in a way that is both appropriate and maximises the likelihood of victims receiving justice.

The importance and challenges in providing a good practice evidence base for adult protection are outlined. The literature search, review and mapping exercise that formed part of the Abuse of Adults with Learning Disabilities: Policy, Practice and Educational Implications in Wales research study is detailed. The article presents examples from this evidence mapping exercise and considers the importance of adult protection research to the future development of policy and practice.

AbstractA growing body of knowledge highlights the negative impact of the COVID‐19 pandemic on the health and well‐being of many people with intellectual and developmental disabilities (IDDs) and their caregivers. The underlying reasons are not only due to biomedical factors but also ethical issues. They stem from longstanding and pervasive structural injustices and negative social attitudes that continue to devalue people with IDD and that underlie certain clinical decisions and frameworks for public‐health policies during this pandemic. Unless these fundamental ethical shortcomings are addressed, pandemic responses will continue to undermine the human rights and well‐being of people with IDD. This paper proposes an ethics framing for policy and practices regarding clinical care and public health based on Martha Nussbaum's approach to Capability Theory. Such a framework can reorient healthcare professionals and healthcare systems to support the capabilities of people with IDD to protect, recover, and promote health and well‐being. It could be applied during this pandemic and in planning for future pandemics. The paper presents some practical recommendations that follow from applying this framework.

AbstractAbuse of adults with intellectual disabilities can and does occur in many places, and as a result, many countries have instituted policies and enacted laws to address this problem. However, research concerning the impact of such policies on abuse remains largely limited to quantitative studies from the perspective of governmental or other authorities and is generally focused on one area or country. Absent are the views and experiences of people with intellectual disabilities with respect to real or perceived abuse. Given the dearth of research involving primary consumers, there is limited knowledge as to the success or failure of such policies and laws. Though carrying out such research can pose methodological and ethical challenges, not undertaking it can also have ethical and social consequences. An international research agenda that includes participatory research that both facilitates the active involvement of and investment in people with intellectual disabilities and views action as an essential outcome is thus proposed. The authors propose such an agenda and posit that along with the collection and analysis of substantially more robust quantitative data, this should facilitate comparison within and between countries.

AbstractThe sustainability of service provision continues to be a challenge in the field of intellectual disability due to changes in delivery as part of intermittent or ongoing lockdown requirements during the COVID‐19 global pandemic. There are many facets to this that may have temporary or permanent impacts not only on the sector, but ultimately for service access and outcomes for people with intellectual disability themselves. This narrative literature review identifies both opportunities for, and impacts on, service providers across jurisdictions. These are explored in terms of the effects that suspension, adaptation, continuity or the cessation of service delivery have had, and those that are projected. Such impacts include, but are not limited to, changes in service access and delivery, employment roles and responsibilities, financial sustainability and the need to diversify the services and supports provided and how they are delivered. The relevance of these impacts for family carers and people with intellectual disability is also discussed. Nonetheless, there have also been opportunities which inform the shape of service delivery and pandemic planning into the future.