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Publication Specialist Psychiatric Bed Utilisation by People With Intellectual Disabilities and Autistic People: A Time-Series Analysis Using the English Assuring Transformation Dataset(Wiley, 2025-06-12) Nisar, Atiyya; Thompson, Paul, A; Boer, Harm; Al-Delfi, Haider; Langdon, Peter; University of Birmingham; Coventry and Warwickshire Partnership NHS Trust; REACH OUT West Midlands Provider Collaborative for Adult Secure Care, Birmingham; Birmingham Community Healthcare NHS Foundation Trust; Herefordshire and Worcestershire Health and Care NHS Trust; Learning Disabilities; Medical and Dental; Boer, HarmBackground: Using nationally available anonymised and aggregated English data, we examined specialist and nonspecialist psychiatric bed utilisation by people with intellectual disabilities and/or autism. Methods: Using data about specialist psychiatric bed utilisation from the Assuring Transformation Dataset, from March 2015 to January 2024, we applied linear regression (with moving average or autoregressive errors) to explore the relationships between a set of outcome variables (e.g., number of inpatients and length of stay) and a set of sociodemographic, clinical and service-related predictor variables (e.g., age, ethnicity, admission source, legal status, admission source, discharge destination, Care (Education) and Treatment Reviews) over time. Comparisons were made with data from the Mental Health Services Data Set about nonspecialist psychiatric bed utilisation. Results: Over time, there was an average reduction of 8.07 inpatients per month. This reduction was due to a reduction in the number with a length of stay longer than 2 years, and fewer inpatients with intellectual disabilities without autism over time, rather than fewer autistic inpatients without intellectual disabilities; instead, the number of autistic inpatients increased by 6.02 per month. However, overall, there were fewer inpatients in specialist psychiatric beds than in nonspecialist beds by an average of 877 patients, and the number in specialist beds reduced faster than the number in nonspecialist beds over time. We found that more hospital spells were associated with more inpatients older than 18, more detentions under Part III of the Mental Health Act, more inpatients not known to the local authority, and an increased number of White inpatients. More admissions were associated with fewer discharges, while those with a hospital stay longer than 2 years were less likely to have had a postadmission Care (Education) and Treatment Reviews and were more likely to use advocacy. Conclusions: The number of inpatients with intellectual disabilities in specialist psychiatric beds continues to decline over time, while the number of autistic inpatients without intellectual disabilities is increasing. Future research should utilise participant-level data to explore patient long-term trajectories.Publication Investigating the component structure of the Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD)(Sage Publications, 2025-03) Painter, Jon; Purandare, Kiran; McCabe, Joanne; Roy, Ashok; Shankar, Rohit; Sheffield Hallam University; Central and Northwest London NHS Foundation Trust; University Hospital Coventry and Warwickshire; Coventry and Warwickshire Partnership Trust; Cornwall Partnership NHS Foundation Trust; University of Plymouth Peninsula School of Medicine; Learning Disabilities; Medical and Dental; Roy, AshokBackground: Outcome measurement is increasingly recognised as a vital element of high-quality service provision, but practice remains variable in the field of intellectual disabilities. The Health of the National Outcome Scales for people with Learning Disabilities (HoNOS-LD) is a widely used Clinician Reported Outcome Measure in the UK and beyond. Over its 20-year lifespan, its psychometric properties have been frequently investigated. Multiple dimensionality reduction analyses have been published, each proposing a different latent structure. Aim: To analyse a set of HoNOS-LD ratings to test its internal consistency, to identify the optimal number of latent variables, and to propose the items that group together in each domain. Methods: A Principal Component Analysis of 169 HoNOS-LD ratings was performed to produce an initial model. The component loadings for each HoNOS-LD item were then examined, allowing the model to be adjusted to ensure the optimal balance of statistical robustness and clinical face-validity. Results: HoNOS-LD's internal consistency (18 items) was 'acceptable' (Cronbach's alpha = 0.797). On excluding three items that had no bivariate correlations with the other 15 items internal consistency rose to 'good' (Cronbach's alpha = 0.828). The final, four-component solution, using the 15 items possessed good internal reliability. Conclusion: HONOS-LD statistical properties compared favourably to the other published latent structures and adheres to the tool's rating guidance. The four-component solution offers an acceptable balance of statistical robustness and clinical face validity. It provides advantages over other models in terms of internal consistency and/or viability for use at a national level in the UK.Publication The impact of NHS change processes on art therapists working in LD services(Taylor & Francis, 2019-09-16) Ashby, Elizabeth; Coventry and Warwickshire Partnership NHS Trust; Learning Disabilities: Community Services; Allied Health Professional; Ashby, ElizabethThe impact of working as art therapists in the NHS during protracted change processes, with people with learning disabilities (LD), was investigated in a qualitative heuristic doctoral study (Ashby, Citation2018), which considered concerns about emotional exhaustion and reduced efficacy, symptoms of burnout (Maslach, Citation1982), as a result of occupational stress. The researcher’s own data was examined, and 15 art therapists employed by NHS Trusts across England were interviewed. This article explores how the research was conducted, its findings related to LD services in the NHS and wider employment issues, and addresses how the findings are relevant to all art therapists. Most burnout studies are quantitative and consider workplace sources of occupational stress, but this qualitative research importantly revealed how crucial personal sources of support and stress were in terms of aiding or reducing clinicians’ capacities to cope. There was evidence of job satisfaction, resilience, and personal growth developed over years of practice, and high levels of stress resulted in symptoms of burnout in some participants, but recovery was shown to be possible.Publication QI 1259 Improving Awareness Documentation and Care of Bowel Movements in Learning Disability and Autism (Inpatients, Respite and Community)(Coventry and Warwickshire Partnership NHS Trust, 2024) Stickels, Claire; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Learning Disabilities; Additional Professional Scientific and Technical Field; Stickels, ClaireAim: To identify constipation at an early stage or any changes to bowel habits that could indicate a physical health condition. To empower patients and staff alike to have healthy and open conversations regarding their bowel movement and urine output health and when to act upon it. Historically, conversation and awareness of healthy bowel movements (BM) has been a taboo topic amongst both staff and patients in Learning Disabilities. Patients in particular can find the topic uncomfortable to talk about which can lead to gaps in healthcare; making it harder for staff and patients to understand their physical healthcare needs. Constipation is also a contributor to death with those of a learning disability (LeDeR reports), with a high use of laxatives for LD&A patients. Initially, a project was proposed to look at physical healthcare as a whole, however it was quickly understood that the topic was extremely broad and a few different projects were initiated, including this one. Tools Used: Stakeholder Analysis - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-stakeholder-analysis.pdf; Process Mapping - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-mapping-the-process.pdf Project Impact: • A Physical Health Group and Patient Forum has been started in LD&A to foster open conversations. • Patients have been taught to self-report with a user-friendly chart. • Vinyl stickers are now in all toilets to help patients identify good vs bad bowel movements. • Standardised chart to help staff monitor bowel movements in a standard way. • Staff and patients feel more empowered to talk about bowel movements. Staff Feedback; “We have a patient on the ward who is very independent and doesn’t talk about bowel movements. We used the self-reporting chart and they thought it was great! They wrote down their BM and were happy to show us the chart. They said they don’t like to talk about it, which is why they’d never told us before.”Publication QI 114 Providing Immediate Staff Support Following a Difficult Incident(Coventry and Warwickshire Partnership NHS Trust, 2024) Perkins, Hannah; David, Claire; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Learning Disabilities; Medical and Dental; Perkins, Hannah; David, ClaireAim: Reduce the percentage of staff who felt not supported at all following a difficult incident from 21% to 10% by October 2023. Within the specialist assessment and treatment learning disability inpatient services at Brooklands, staff are subject to and witness to high levels of physical violence towards others, towards the environment and self-injurious behaviour. The team wanted to ensure that staff were receiving the right support at the right time following a difficult incident by developing a robust process for providing immediate support. The team looked at incident data and gathered staff feedback. The team then developed a set of guidance for staff to support them in providing this support and in recognising when and how to signpost colleagues to further support where needed. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; Project Charter - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-define-your-project-charter.pdf. Project Impact: The new guidance promotes consistency and provides a structure to the process which was not previously in place. The percentage of staff who felt not supported at all following a difficult incident reduced from 21% to 15%. Staff feel 26% more confident to provide support following an incident. Improvements are being made to staff well-being through feeling supported and valued. The percentage of staff who felt a bit supported or very supported following an incident increased by 5%. Awareness of additional support (TRiM) has increased by 31%. The improvements link with Trust policy and align with the Trust drive to be trauma-informed. The improvements contribute to a culture of openness.Publication Response to ABAI Task Force on the Use of Contingent Electric Skin Shock(Springer Science+Business Media, 2023-06) Zarcone, Jennifer R; Brown, Ivan; Langdon, Peter; Mullane, Michael; Scheithauer, Mindy; May Institute; Brock University; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Cambridge Health Alliance; Harvard Medical School; Children's Hospital of Atlanta; Emory University; Learning Disabilities; Additional Professional Scientific and Technical Field; Langdon, Peter EIn this article, the authors provide their response to the Association for Behavior Analysis International (2022) position statement on the use of contingent electric skin shock (CESS). In this response, we address concerns raised by the task force regarding limitations of the Zarcone et al. (2020) review article in which both methodological and ethical concerns were raised about the quality of research in the use of CESS with people with disabilities in the treatment of challenging behavior. We note that with the exception of the Judge Rotenberg Center in Massachusetts, no state or country currently supports the use of CESS as it is not recognized as the standard of care in any other program, school, or facility.Publication Review and update of the Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD)(SAGE Publications, 2023-05-17) Painter, Jon; Adams, Nicola; Ingham, Barry; James, Michael; Majid, Madiha; Roy, Ashok; Shankar, Rohit; Smith, Mark; Sheffield Hallam University; Mental Health, Addiction and Intellectual Disability Services; Capital and Coast District Health Board, New Zealand; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust; Newcastle University, Newcastle upon Tyne; Royal College of Psychiatrists; Coventry and Warwickshire Partnership Trust; University of Plymouth Peninsula School of Medicine; Learning Disabilities; Medical and Dental; Majid, Madiha; Roy, AshokBackground: The Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD) is an 18-item measure which provides a structured and standardized approach to rating various clinical and psychosocial outcomes and has been in use nationally since 2002. Aims: To revise and improve the HoNOS-LD’s utility in contemporary intellectual disability (ID) services whilst retaining its original objectives and five-point severity ratings. Method: ID clinicians were invited to complete an online survey, rating each item on the existing measure for being fit for purpose, identifying issues and suggesting improvements based on their experience of using the HoNOS-LD in practice. Scales were then assessed and revised sequentially; survey responses were used to inform discussion and revisions to the HoNOS-LD by the Advisory Board. Results: A total of 75 individuals replied. Respondents had used HoNOS-LD for an average of 8.0 years (S.D. 5.28 years) and 88% found the scale to be useful in their practice. On average, respondents used HoNOS-LD ratings to inform care 42.4% of the time (S.D. 33.5%). For each scale there was a significant negative correlation between the percentage of positive/very positive respondent ratings and the number of changes proposed. Common changes included simplifying terms, reducing ambiguity and replacing anachronistic language. Conclusion: The changes outlined in this paper are based on the advisory group’s expert consensus. These changes are intended to improve reliability and validity but now need empirical testing as well as review by service users.