Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background  Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method  Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results  The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions  The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Stress and burnout amongst professional carers of people with intellectual disability : another health inequity

Purpose of review This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. Recent findings Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. Summary The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.

The 1989 Comprehensive Plan of Action (CPA) and refugee policy in Southeast Asia : twenty years forward what has changed?

In 2012, the only South East Asian countries that have ratified the 1951 Convention relating to the Status of Refugees and the 1967 Protocol Relating to the Status of Refugees (hereafter referred to as the 1951 Convention and 1967 Protocol) is Philippines (signed 1954), Cambodia (signed 1995) and Timor Leste (signed 2001). Countries such as Indonesia, Malaysia and Thailand have annual asylum seeking populations from Myanmar, South Asia and Middle East, that are estimated to be at 15 000-20 000 per country (UNHCR 2012). The lack of a permanent and formal asylum processing process in these countries means that that asylum-seeking populations in the region are reliant on the local offices of the United Nations High Commission for Refugees based in the region to process their claims. These offices rely upon the good will of these governments to have a presence near detection camps and in capital cities to process claims of those who manage to reach the UNHCR representative office. The only burden sharing mechanism within the region primarily exists under the Bali Process on People Smuggling, Trafficking in Persons and Related Transnational Crime (the Bali Process), introduced in 2002. The Bali Process refers to an informal cooperative agreement amongst the states from the Asia-Pacific region, with Australia and Indonesia as the co-chairs, which discusses its namesake: primarily anti-people smuggling activities and migration protocols. There is no provision within this process to discuss the development of national asylum seeking legislation, processes for domestic processing of asylum claims or burden sharing in contrast to other regions such as Africa and South America (i.e. 2009 African Union Convention for the Protection and Assistance of the Internally Displaced, 1969 African Union Convention Governing the Specific Aspects of Refugee Problems in Africa and 1984 Cartagena Declaration on Refugees [Americas]) (PEF 2010: 19).

The knowledge of doing: Exploring the knowledge of support to older people with an intellectual disability

This ethnography presents a contextualised understanding of frontline knowledge used in the support to people ageing with an intellectual disability who live in accommodation and support services in south-east Queensland. The study identified that disability support workers accessed a range of knowledges which they synthesised into a dynamic and responsive locale knowledge, and subsequently translated into everyday acts of support within contexts of multi-faceted complexity. Findings from the study have numerous implications for the knowledge development activities of formal service and educational systems within Australia's newly implemented National Disability Insurance Scheme.

Social work with marginalised people who have a mild or borderline intellectual disability : practicing gentleness and encouraging hope

People with mild or borderline intellectual disabilities are a group of people who usually do not meet the eligibility criteria for specialist disability services, yet are high users of many generalist services, such as mental health, child protection, and criminal justice systems. They may traverse many services, often entering, exiting, and returning to the same service providers with few positive results. This article explores the practice approach of the Meryton Association, a medium-sized nongovernment agency located in Brisbane, Australia. The Meryton Association provides social work support to people with mild to borderline intellectual disabilities, actively assisting this group to build relationships, resources, knowledge, and autonomy in their everyday lives. Using qualitative in-depth interviews with Meryton Association staff and secondary analysis of Meryton Association policy and practice documents, the challenges and opportunities of using this practice approach have been documented. The article proposes that specialist services are needed that use a developmental approach, stress the importance of relationship, and the need to practice gentleness and hope in social worker-client interaction.

Experiences of leaving prison for people with intellectual disability

Purpose – The support given to prisoners when they leave prison has a bearing on their success in starting a new life and on community safety. This paper aims to examine the community re-entry experiences of ten people with an intellectual disability in Queensland, Australia. Design/methodology/approach – The findings in this paper are part of a wider study on the life stories of ex-prisoners with an intellectual disability. Seven male and three female participants with intellectual disability were interviewed using a semi-structured life story method. Interviews were respectful of the communication styles of participants and involved multiple interview sessions, ranging from two to nine interviews per person. Data were analysed using narrative and thematic analysis with the assistance of NVivo 8 software. Findings – Participants found the process of leaving prison an emotional event, often clouded with both confusion about when release was to occur, and uncertainly as to what they could expect on the outside. The need for concrete information and coordinated hands-on assistance in negotiating supports in the community have significant implications for correctional and community services. Originality/value – This study captures the perspectives of people with intellectual disability on community re-entry. These perspectives are often overlooked in policy and practice developments in the field of corrections. Yet without understanding this group, the field is unable to address their particular needs.

Crafting and retelling everyday lives : disabled people's contribution to bioethical concerns

This commentary draws out themes from the narrative symposium on “living with the label “disability”” from the perspective of auto/biography and critical disability studies in the humanities. It notes the disconnect between the experiences discussed in the stories and the preoccupations of bioethicists. Referencing Rosemarie Garland-Thompson’s recent work, it suggests that life stories by people usually described as “disabled” offer narrative, epistemic and ethical resources for bioethics. The commentary suggests that the symposium offers valuable conceptual tools and critiques of taken-for-granted terms like “dependency”. It notes that these narrators do not un–problematically embrace the term “disability”, but emphasize the need to redefine, strategically deploy or reject this term. Some accounts are explicitly critical of medical practitioners while others redefine health and wellbeing, emphasizing the need for reciprocity and respect for the knowledge of people with disability, including knowledge from their experience of “the variant body” (Leach Scully, 2008).

Literacy, poverty and schooling : what matters in young people's education?

This paper draws upon several decades of literacy research in schools in high poverty environments to explore what matters in young people’s education. In dialogue with themes from Kevin Marjoribanks’ work, such as student aspirations, family environments, and teacher expectations, key insights are summarised. Referring to longitudinal case studies and a current ethnographic project, the interplay between literacy, poverty and schooling, and, young people’s aspirations and education outcomes is explored. While the work of educators in high poverty communities continues to be highly demanding, there are some schools and teachers making a durable positive difference to learner dispositions and literate repertoires. Teacher expectations and discursive practices are crucial in this process.

Little boxes : changing perceptions and including young people in socially sustainable participatory planning

In recent years, a great deal has been written about the benefits and ethics of including young people in participative decision-making. This has been accompanied by a burgeoning interest in including their views in participatory planning exercises that has not always been realised in practice. Drawing on a detailed analysis of the perceptions of adults and young people involved in a participatory planning exercise on Australia‟s Gold Coast, we believe that there are two major hurdles to the „full‟ engagement of young people that are in some respects two sides of the same coin: the sometimes paternalistic perceptions and often dismissive attitude that many adults have towards the participation of young people; and the perceptions that young people may have of themselves and their subordinate place in an adult-dominated planning environment. Together, such views act to place limitations on the participation of young people because they set up unrealistic expectations for both adult and younger participants in terms of how and why young people participate, and what this participation should „look and feel‟ like. In this paper, through the metaphor of boxes, we propose a number of issues that should be addressed when involving young people in participatory planning processes to ensure the most from their participation for all involved.

‘It's all scientific to me’ : focus group insights into why young people do not apply safe-sex knowledge

Despite rising levels of safe-sex knowledge in Australia, sexually transmitted infection notifications continue to increase. A culture-centred approach suggests it is useful in attempting to reach a target population first to understand their perspective on the issues. Twenty focus groups were conducted with 89 young people between the ages of 14 and 16 years. Key findings suggest that scientific information does not articulate closely with everyday practice, that young people get the message that sex is bad and they should not be preparing for it and that it is not appropriate to talk about sex. Understanding how young people think about these issues is particularly important because the focus groups also found that young people disengage from sources of information that do not match their own experiences.

Young people and citizenship-delayed, diminished and empty?

This paper is presented in workshop format in order to meet the style and themes of the conference, and seeks to explore as fully as possible with participants issues, concerns and proposals around the discourse of young people and citizenship. This paper takes the position that the relationship between young people and citizenship is complex and in places contradictory, and while Ruth Lister (1998), argues for an 'inclusionary potential', a central concern is that the citizenship that young people get is as Hartley Dean (1997), suggests, at best 'ambiguous', and at its worst, 'diminished'. Under not so new Labour, the term has according to Gail Lewis (1998) re-emerged as a 'category of political articulation', imbued with the pronouncements of Charles Murray (1995) on the underclass, and Amitai Etzioni (1996), on the virtues of Communitarianism and the central assertion that in relation to young people and certain communities, 'rights have exceeded responsibilities'. This body of opinion has proved to be seductive to a government dedicated to joined up solutions in the battle against social exclusion and to the reconfiguration of the welfare state to place the onus for welfare and social provision on to individuals and communities. Those who work with young people and young people themselves may wish to be proactive in asserting the kind of citizenship they require, rights-based, expansive and supportive, rather than accept an imposed version devoid of rights but full to the brim of authoritarian measures, vindictive proposals and narrow horizons. This paper will engender debate and reflection and offer a context of the erosion of young people's rights over the last 20 years, Hartley Dean (1996), and will consider the work of T.H. Marshall (1950) in dividing citizenship into three elements: the civil element, the political element, and the social element. The paper will explore in workshop tradition, strategies and proposals for action relevant to practitioners and academics, such as the reduction in the voting age to 16.

Engaging children and young people in creating resilient and healthy urban spaces

Urban public space in Australia and internationally, can be critically examined from a number of multidisciplinary standpoints, including human geography, urban design, planning, sociology, and public health. Viewing urban public space from a range of perspectives encourages different vantage points to emerge and questions around health, wellbeing and public space are increasingly topical and important in the broadest of terms, with public space being a key arena for physical activity, mental health, commercial, cultural and community life and the possibility of social inclusion. However, in the name of urban regeneration, programs of securitisation, ‘gentrification’ ‘creative’ and ‘smart’ city initiatives refashion public space as sites of selective inclusion and exclusion (Watson 2005; Gabrys 2014). In this context of monitoring and control procedures, in particular, children and young people’s use of space in parks, neighbourhoods, shopping malls and streets, is often viewed as a threat to social order, requiring various forms of remedial action, such as being ‘designed out’ of public space (Johnson 2014). Rarely are children and young people actively and respectfully brought into planning and governance processes and consequently many urban public spaces are essentially adult places, where control and ongoing surveillance are the key concerns (Freeman 2011, Dee 2013). There is also a political economy of public space discernable in cities like Brisbane, where ‘flagship’ infrastructure such as road tunnels take pride of place, while more humbly appointed pedestrian footpaths are often narrow, in a poor state of repair and a potential barrier to good health (Atkinson and Easthope 2009). The recent development of bikeways in Brisbane is a case in point, presenting both challenges and opportunities in being a valuable new form of public space heavily used by ‘commuter cyclists’ by day, but poorly lit and conceived, for a range of users at other times (Wyeth 2014). This paper concentrates on questions of social citizenship rights and discourses of health and wellbeing and suggests that cities, places and spaces and those who seek to use them, can be resilient in maintaining and extending democratic freedoms, calling surveillance, planning and governance systems to account (Smith 2014). The active inclusion of children and young people better informs the implementation of public policy around the design, build and governance of public space and also understandings of urban citizenship, leading to healthier, more inclusive, public space for all (Jacobs 1965).

Young people, participation and public space

Young people are major users of public space, White (1990,1998) Loader (1996). * Young people are constructed as ‘problem’ and ‘non citizens’, Brown (1998). * Young people report feeling unconsulted, not part of community life, Measor & Squires (2000), Article 12 (2000), Tyler et al (1998). * Young people and citizenship/participation is a major issue. * Public Space issues affect others also such as the homeless, aged, women, Indigenous people and people of middle eastern appearance.

Young people and the struggle for public space in Australia

Public Space is important to the overall health and wellbeing of children and young people in allowing them to explore their local and wider community, meet up with friends, get some exercise and feel included in the society in which they live. A problem exists in the capacity of modern, urban public space to genuinely accommodate children and young people’s need to experience excitement and fun in what has been termed “unprogrammed space” (Lynch 1977:71), or simply to ‘hang out’ in unstructured social space, with control by civic authorities a key concern. For many children and young people, their experiences of attempting to use public space are sometimes marred by the denial of everyday rights and courtesies, in youth ‘unfriendly’ spaces and this is often the case in shopping centres in Australia as expolored in this paper.