Biomedical subjects

D Felce

Publications and source records attributed to D Felce.

At least 37 records · Page 2Linked to original sources

PubMed1994

Assessing the impact of the All-Wales Mental Handicap Strategy: a survey of four districts.

The All-Wales Mental Handicap Strategy (AWS) pledged government leadership and additional resources for the task of developing community based residential, domiciliary, respite, daycare and professional services for people with mental handicaps and their families throughout Wales. Ultimately, the authors of the AWS sought to affect for the better the extent to which people with mental handicaps experience typical community life. A large random sample of people with mental handicaps in four diverse districts was used to track changes in services received, professional input, involvement in individual planning, the number of community activities pursued, and the size and range of individuals' social networks across the middle 4 years of the AWS. The balance between private housing and service residence remained unchanged although, with the ageing of the cohort, there was a decrease in the proportion living with parents and an increase in those living independently or in another family situation. There was an increase in the availability of residential services in the form of ordinary housing and an associated contraction in large congregate care facilities. However, not all moves were towards more ordinary living. Some people moved from large statutory sector specialist facilities to other atypical forms of residence, as did some people from family homes. Family support services in the form of family aides and short-term care increased significantly, but indicators still suggest that an expansion of these services is merited. Day services diversified slightly, but without affecting the major role of the traditional centre. There was a decrease in the numbers receiving a fulltime service. Only a third of the sample received regular individual plan reviews of the services they received and the developmental goals set in their name. In general, individuals were involved in a greater number of community activities that brought them into contact with other citizens. However, such an increase has not led to significant changes in the size or composition of people's friendship networks. Overall, the changes in service provision and family and user experience have been in line with the direction set by the AWS. However, the degree of change still required before the new pattern of services envisaged by the AWS is substantially in existence, or the experience of people with mental handicaps conforms with the guiding principles which underpin it, is considerably greater than that achieved after 7 of its initial 10 years.

Adolescent↗

PubMed1993

Staff turnover in ordinary housing services for people with severe or profound mental handicaps.

The characteristics and turnover of direct-care staff in two housing services for adults with moderate, severe or profound mental handicaps are described. Both staff groups were predominantly female with a good representation of staff aged under 30, and between 30 and 50 years. Most had prior experience in a caring capacity before taking up their current posts, but only a quarter to a third had a relevant vocational qualification. Turnover was similar in the two services, but varied considerably between settings in each. Average annual turnover ranged from 8 to 39% in one and from 5 to 48% in the other. However, most houses still had a core of long-serving staff providing continuity over time. The implications of the level of staff turnover found for management and staff training are discussed, as are the reasons for leaving given by former staff of one of the services, together with their views on job satisfaction, conditions of work, and the adequacy of management and training.

Adult↗

PubMed1993

Effects of a community-based service on adaptive and maladaptive behaviours: a longitudinal study.

Changes in skill acquisition and problem behaviour, contingent upon the introduction of a new community-based service, were compared for subjects in three different residential settings: supported accommodation; hospital; and private family homes. Results over a 5-year period indicate links between service contact and increases in skill level, together with an increase in problem behaviour for subjects who moved from hospital to supported accommodation. The interpretation of client income in the context of service process is discussed.

Adult↗

PubMed1992

The behavioral and social ecology of community houses.

A small community home model for severely and profoundly mentally retarded adults is defined in terms of its program orientation, program structure, and program procedures. The model is compared to institutional settings and larger community units by collection of two data sets. The small homes were found to produce beneficial client functioning and high levels of staff/client interaction appropriately related to clients' degree of mental retardation. How staff distributed their attention to clients differed between the three types of settings. A conclusion is offered that the quality of residential care is dependent on the interaction of variables rather than on the presence of any single overridingly powerful factor.

Activities of Daily Living↗

PubMed1992

Activities and engagement in day services for people with a mental handicap.

Policy on the role and function of day services for adults with mental handicaps has changed considerably during the last 2 decades. What such settings offer their users has also changed as services have attempted to evolve in line with policy. However, the impact of these changes has gone largely unevaluated. This paper describes a study of two day centres to categorize the activity programmes of these services, and to assess service user and staff behaviour prior to a larger scale study of such services in Wales. The two centres were found to differ significantly in their programmes but not in the extent to which activities were organized in the community. Service user participation in activities varied with activity type, group composition and activity location. Whether activities were organized for the full duration of the timetabled sessions was critical to the interpretation of the extent of service user engagement. Staff showed a commendable orientation to clients and their activities in both services. Differences in the activity programmes of the two centres are discussed in terms of a continuing lack of clarity over the purposes of such day services in general. The relevance of some activities to objectives is questioned. Concern is also expressed about the resulting level of engagement achieved in planned activity.

Activities of Daily Living↗

PubMed1991

The relationship of staff:client ratios, interactions, and residential placement.

The behavior of staff and persons with severe handicaps was surveyed in nine settings, including four traditional institutions, three large community-based units, and two groups of small homes. Data were collected that established the relationship among staff:client interactions, client responding, and the size of staff:client groups. The latter showed that the institutions were characterized by larger client and staff groups than the large community units. Large client and staff groups were virtually absent in the small homes. Two general conclusions could be drawn about the relationship between staff:client ratios and client behavior: (a) when one or two staff were together, improvements in the level of the staff interactions and client adaptive functioning occurred as the client group decreased in size and the staff size remained constant; (b) improvement in staff performance and client behavior arising from the addition of staff to a client group of a given size was marginal or nonexistent. The results were discussed in terms of their implications for the design of residential environments.

Activities of Daily Living↗

PubMed1991

The evaluation of NIMROD, a community-based service for people with mental handicap: revenue costs.

The cost implications of moving from a system of services for people with mental handicaps centred on large institutions to a network of community-based services are not precisely known. The provision of the NIMROD service in a part of Cardiff, with its aim not only to meet the residential needs of adults comprehensively by providing a number of houses in the community but also to develop a support service to people living in their family home, gave an opportunity to investigate and report the revenue costs of a number of service elements with respect to a defined total population. The residential costs of intensively staffed houses in 1986-87, varying in size from two to six places, were found to range between pounds 16,473 and pounds 23,319 per person per year. With the addition of community support costs, such as the provision of day services, the total costs of care per resident averaged pounds 21,708; range, pounds 18,883-pounds 26,009. These compared to the total costs in a minimally staffed house of pounds 9,678 per resident. The costs of community support services for people living in their family homes averaged pounds 5,614 inclusive of DSS benefits, of which pounds 1,743 was accounted for by the NIMROD domiciliary support service, office base and administrative overheads. The residential costs reported were compared to other cost data in the literature. The study supports previous conclusions that there is little evidence of diseconomy attached to small scale per se but that the way staffing levels and therefore staff costs are determined is critical. No evidence was found in this study to link greater cost to better quality.

Capital Expenditures↗

PubMed1988

Basing the treatment of stereotypic and self-injurious behaviors on hypotheses of their causes.

Stereotypic and self-injurious behaviors are common forms of maladaptive responding demonstrated by severely handicapped persons. Various review papers suggest that no single treatment procedure is universally effective. Although there may be many reasons for this finding, one could be that people engage in these behaviors for various reasons, and that procedures that are incompatible with the cause of the behavior are unlikely to be effective. These studies also suggest many hypotheses for the development and maintenance of these behaviors, three of which are the self-stimulation, positive reinforcement, and negative reinforcement hypotheses. The purpose of this paper was to determine whether one of these hypotheses could be matched to the cause of the behavior and used as an effective treatment procedure. We therefore compared one hypothesis with one other for 3 subjects in a three-phase study. During baseline, data were taken in two classrooms for each subject, and a judgement was made about the hypothesis most likely to be related to the cause of the behavior. During the second phase, a treatment based on that hypothesis was used in one classroom, and a treatment based on another hypothesis was used in the second classroom. During the third phase, the treatment that was most effective in the second phase was used in both classrooms. Results showed that a successful treatment program can be developed on an hypothesis of why the behavior occurred during baseline. Results are discussed in terms of supporting the argument that treatment programs should be based on a functional analysis of the behavior in its environmental context.

Behavior Therapy↗

PubMed1987

Observational studies of staff working with mentally retarded persons: a review.

Experimental or quasi-experimental studies of the behavior of staff working with retarded persons were reviewed and provided the following generalizations: (a) staff often have very low rates of interactions with clients, (b) a disproportionate number of interactions occur with a relatively small number of clients, (c) structured settings promote more interactions, (d) small teaching groups promote interactions, (e) staff involvement in relevant decisions promotes interactions, (f) larger, more global, and ecological assessments of both staff and clients provide important information on the effects of staff management and training, (g) lowering the reading difficulty of training materials increases staff comprehension, (h) lectures tend to improve academic skills while practicum training improves teaching skills, (i) some trained skills generalize while others do not, apparently unsystematically, (j) a system in which supervisors rather than researchers external to the facility do the training is feasible, (k) various low cost systems of public or private feedback can increase staff participation in their duties, (l) implementation of strict administrative policies can reduce tardiness and absenteeism, and (m) staff may be very reactive to announced observation by inspection agencies.

Environment↗

PubMed1987

To what behaviors do attending adults respond? A replication.

In a replication of a study by Warren and Mondy (1971), we observed the responses of staff in four institutional setting, three large community units, and five small community houses to the behavior of a total of 90 severely and profoundly mentally retarded adults. In the institutions and large community units, staff members showed problems in their responding similar to those reported by Warren and Mondy, in particular a lack of responding to appropriate behavior. Staff in the small community houses showed a greater level of encouragement of appropriate behavior and a discrimination in attending to appropriate as opposed to other behavior of 3:1. Whether this finding was due to the difference in size of the residential settings, their organization, or staff characteristics and training was discussed.

Adult↗

PubMed1986

An eco-behavioral analysis of small community-based houses and traditional large hospitals for severely and profoundly mentally handicapped adults.

Recently, much interest has centered on the transfer of mentally handicapped people from institutions to other settings. Most studies in this area have focused indirectly on the behavior of the mentally retarded client, usually measured intermittently by global assessments such as the American Association On Mental Deficiency's Adaptive Behavior Scale. In contrast, the present study combined these indirect measures with direct continuous observation of each subject. In doing so, it examined the effects of such a transfer to small community-based homes on the behavioral functioning of severely and profoundly mentally handicapped adults. In addition, staff activity, in terms both of providing opportunities for engagement in activity and of consequating client behavior, was also measured. Two comparisons were made, those being between a group of clients in a small home and a comparable group in institutions and between the latter group when in the institutions and after having moved to a small home. Results show increased client functioning in the small homes, particularly in domestic activity and interaction with staff, and a markedly higher level of staff provision of opportunity to engage in activities. The results are discussed in terms of size, design, staff-client ratio, and staff training in small community-based residential services. The need for more research on the determination of staff performances is highlighted.

Activities of Daily Living↗

PubMed1986

Change in adaptive behaviour of severely and profoundly mentally handicapped adults in different residential settings.

A demographic sample of 28 severely and profoundly mentally handicapped adults with a mental age of four years and below were assessed on Part 1 of the Adaptive Behavior Scale (ABS) at three points 18 months apart. The Griffiths Mental Development Scales and Reynell Developmental Language Scales were also conducted at the first and last assessment points. The subjects were resident in either a small community-based home, the parental home or other residential institutions. The small-home group showed the greatest adaptive behaviour change particularly in the areas of independent functioning, domestic skills and self-direction and on the scale total. Although reservations are expressed on the accuracy of assessment, the ABS data and the comparative result received some validation from the mental age and language assessments. Gains were independent of subject characteristics. The study adds to the literature showing adaptive behaviour gains arising from transfer from institutional to more normal residential environments. However, in attributing the results found to the general characteristics of the residential settings, the explicit programming emphasis of the small-home service should not be overlooked.

Adolescent↗

PubMed1985