The experience of the COVID-19 pandemic in a UK learning disability service: lost in a sea of ever changing variables - a perspective

Epidemic preparedness and innovations in digital healthcare: enhancing post-pandemic speech-language pathology services for child and adolescent mental health in Qatar

BACKGROUND

This paper discusses the critical importance of epidemic preparedness and innovations in digital health care by examining the transformative impact on speech-language pathology (SLP) services in a specialist outpatient child and adolescent service (CAMHS).

METHOD

This retrospective review analyzes referral data from three periods: pre-pandemic (15 March 2019-14 March 2020), pandemic (15 March 2020-14 March 2021), and post-pandemic (15 March 2021-14 March 2022). Statistical analyses assess trends in referrals and diagnoses during these periods. Feedback was also obtained from Parents of children who received virtual consultations during the pandemic.

RESULTS

The results reveal an increase in the demand for SLP services during and after the pandemic, with a surge in referrals (increased from 9.7 to 12.9% when compared pre-pandemic to post-pandemic periods; Chi-Square value 3.33, P = 0.068) for children with social communication challenges and autism spectrum disorder. Phone and video consultations were effectively adopted. Feedback from families shows a positive response (69%-98% of participants responded as strongly agreed and agreed on various items listed in feedback form specifically designed in line with the service objectives) to telehealth interventions, with many parents finding virtual consultations effective and helpful.

CONCLUSIONS

The study emphasizes the importance of telehealth SLP services in meeting the increasing demand for mental health interventions among children and adolescents. It suggests integrating telehealth into clinical practice beyond the pandemic and highlights the need for long-term evaluation and addressing potential barriers to access.

Impact of the Care and Coercion Act on recorded involuntary care in intellectual disability care: a time-series analysis

BACKGROUND

On 1 January 2020, the Care and Coercion Act came into effect in the Netherlands, subjecting involuntary care to more strict regulations and monitoring. This study tested changes in recordings of involuntary care during the transitional year of 2020 and after full implementation in 2021, which coincided with the first severe test of the new regulations, when COVID-19 lockdown measures were taken on 16 March 2020.

METHODS

Data consisted of weekly counts of involuntary care from 1 January 2017 to 31 December 2021, taken from the care data of more than 3000 clients with intellectual disabilities and challenging behaviour of 's Heeren Loo, a large long-term care organisation in the Netherlands. An interrupted time series design was used to compare the period under the former law with the period under the new law and to the period during and after implementation, taking into account the impact of the COVID-19 lockdown measures on recordings of involuntary care.

RESULTS

Under the new act in Week 1 of 2020, a statistically significant drop occurred in involuntary care counts, after which these counts gradually decreased. The start of 2021, the year in which the act was fully implemented, showed an initial increase in counts of involuntary care, followed by a decrease (all Ps < .001). The introduction of the COVID-19 lockdown measures did not statistically affect the weekly counts of involuntary care.

CONCLUSIONS

The decrease in registered involuntary care after the Care and Coercion Act came into effect is a first indication of the efficacy of this new law that requires careful multidisciplinary consultations around the right of clients to respect their self-determination. Follow-up research should examine whether the impact of the new law aligns with clients' experiences of self-determination.

Care and rehabilitation institutions for people with intellectual disabilities during the COVID-19 pandemic: Polish experiences

People with intellectual disabilities benefit from many forms of institutional support, which include residential, rehabilitation, and educational services. Changes caused by the pandemic, especially the introduction of new rules relating to various aspects of life, raised several challenges and problems in the functioning of these institutions and for the people with disabilities during the COVID-19 pandemic. The research concerned facilities providing services for people with intellectual disabilities in Poland during the pandemic. The research goal was to determine what changes took place in the rehabilitation and care institutions during the pandemic in terms of their organization and the functioning of their clients and personnel. An online questionnaire was used. The respondents were institution employees. Data showed a number of preventive, educational, and supportive activities carried out by the institutions. Adverse changes in the psychosocial functioning of people with intellectual disabilities and other problems during the pandemic were reported.

The experiences and attitudes of family caregivers of adults with intellectual and developmental disabilities at different timepoints in the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has resulted in increased pressures for family caregivers of adults with intellectual and developmental disabilities (IDD). However, little is known about how their attitudes and perceptions have changed over the course of the pandemic.

OBJECTIVE

To compare the COVID-19 experiences and attitudes of two groups of family caregivers, reported at different timepoints in the pandemic: prior to vaccine availability and after.

METHODS

As part of a larger research study, family caregivers of adults with IDD from across Canada completed surveys on their COVID-19 experiences. Survey questions included responses about access to supports, stressors, self-efficacy, mental wellbeing, and pandemic impacts on their family member with IDD. Respondents were assigned to either of two groups based on the time of questionnaire completion: late 2020/early 2021 for Group 1 and mid 2022 for Group 2. Descriptive statistics and analysis between groups were reported.

RESULTS

Despite being surveyed at different timepoints in the pandemic, both groups indicated concerns regarding lack of professional support and resources, lack of programming, and experiences of loneliness for their family members. However, Group 2 reported greater self-efficacy dealing with COVID-19 related challenges and greater overall mental wellbeing, compared to Group 1. Group 2 caregivers, after which vaccines were widely available in Canada, were largely vaccinated (96.4%).

CONCLUSIONS

Despite the COVID-19 pandemic persisting for over two years, family caregivers of adults with IDD reported facing the same challenges as families who reported on their experiences a year prior. Notwithstanding, family caregivers surveyed later in the pandemic described a greater sense of self-efficacy and mental wellbeing.

A Bibliometric Study on the Social Validity of Telepractice in Autism Spectrum Disorder

The field of telepractice is generating increasing interest in recent years. In recent years, early childhood services have used resources such as support for interventions in families with children with autism spectrum disorder. Due to this situation, the social validity of such resources has emerged in this sector, receiving individual attention from academics and practitioners. However, a further deepening of such analyses is needed. Therefore, the main objective of this work is to analyze papers published in the Web of Science on social validity and telepractice in autism spectrum disorders. Bibliometric analysis allows us to discover the current state of a research field, to identify the main authors, articles, and topics, and to propose future lines of research to develop it further. Articles published between 2000 and 2021 were analyzed quantitatively, and by co-occurrence of words and authors. Subsequently, through bibliographic linking, the articles were grouped into different clusters. Five central themes were found, with social skills and the effectiveness of intervention programs being the most developed areas of research. Furthermore, studies focusing on evidence-based practices are necessary for the development of this research field. Thus, the analysis of social validity in the field of telepractice in children with autism spectrum disorders is a developing field within the early childhood sector.

Self-advocates with Down syndrome research the lived experiences of COVID-19 lockdowns in Aotearoa New Zealand

BACKGROUND

Individuals with Down syndrome are particularly vulnerable to COVID-19 because they are recognised as significantly immunocompromised. Yet their voices regarding their lived experiences of pandemic lockdowns have not been sought or heard.

AIM

This study aims to describe the lived experiences of people with Down syndrome during the pandemic lockdowns in Aotearoa New Zealand to add evidence in order to inform systemic advocacy.

METHOD

A mixed-methods approach positioned within an inclusive research paradigm was used, in which a group of self-advocates with Down syndrome co-designed a structured interview schedule and conducted 40 face-to-face interviews. Key themes were identified by using content analysis.

RESULTS

Despite the difficulties associated with lockdowns and participants not receiving their usual supports and having to make significant adjustments, they remained positive, adapted well, and demonstrated a high level of resilience and adaptability.

CONCLUSIONS

The findings add to the limited research on the lived experiences of people with Down syndrome during pandemic lockdowns. This research has given them a voice to contribute to policy, government initiatives, and service providers; particularly on issues around support during lockdown and staying connected with others.

International clinician perspectives on pandemic-associated stress in supporting people with intellectual and developmental disabilities

BACKGROUND

People living with intellectual and developmental disabilities (IDD) have suffered disproportionately in health outcomes and general well-being during the COVID-19 pandemic. There is emerging evidence of increased psychological distress. Increased strain has also fallen on clinicians managing the psychological needs of people with IDD, in the context of learning new technologies, staff shortages, reduced services and paused training opportunities.

AIMS

To examine clinicians' experiences of patient care, clinical management and the impact of care delivery.

METHOD

A mixed fixed-response and free-text survey comprising 28 questions covering four areas (responder demographics, clinical practice, changes to local services and clinician experiences) was developed, using the STROBE guidance. It was disseminated through an exponential snowballing technique to clinicians in seven high-income countries. Quantitative data were analysed and presented with Microsoft Excel. Qualitative data were coded and thematically analysed, and presented with in-text quotations.

RESULTS

There were 139 respondents, mostly senior physicians (71%). Two-thirds reported over 10 years working in the field. Quantitative findings include increased clinician stress (77%), referrals (53%), patient distress presentations (>70%), patient isolation (73%) and carer burden (89%), and reduced patient participation in daily activities (86%). A third reported increased psychotropic prescribing. Qualitative analysis outlined changes to clinical practice, particularly the emergence and impact of telehealth.

CONCLUSIONS

In the countries surveyed, the pandemic has not only had a significant impact on people with IDD, but also their carers and clinicians. A proactive, holistic international response is needed in preparedness for future public health emergencies.

COVID-19 IDD: Findings from a global survey exploring family members’ and paid staff’s perceptions of the impact of COVID-19 on individuals with intellectual and developmental disabilities (IDD) and their caregivers

Background: A growing body of evidence attests to the disproportionate impact of COVID-19 on persons with intellectual and developmental disabilities (IDD) during the pandemic. This study asked caregivers about their perceptions of how COVID-19 impacted them and the people they support.

Method: An online survey was conducted in 12 countries during August-September 2020 and sought information on demographics, support practices, information and training, experiences of COVID-19, social distancing, and wellbeing, as measured by the DASS12. This study reports on 3,754 family members, direct support professionals, and managers who participated in the survey.

Results: Caregivers observed increases in depression/anxiety, stereotyped behaviours, aggression towards others and weight gain in the person(s) they supported. They also reported difficulties supporting the person(s) to access healthcare.  Families reported reducing or ceasing employment and absorbed additional costs when supporting their family member. Direct support professionals experienced changes in staff shifts, staff absences, increased workload and hiring of casual staff. Caregivers’ wellbeing revealed high levels of stress, depression, and less so anxiety. The strongest predictor of wellbeing among families was observation of changes in mood in the person(s) they supported, while for direct support professionals, the strongest predictors of wellbeing were reorganisation of staff shifts and increases in new direct support staff. 

Discussion: Findings support the contention of this population experiencing a disproportionate burden during the COVID-19 pandemic, reflecting historical inequities in access to healthcare and other human rights violations which are now protected under the United Nations Convention on the Rights of Persons with Disabilities.

The mental health and well-being of adults with intellectual disability during the COVID-19 pandemic: A narrative review

Prior to the start of the pandemic, adults with intellectual disability (ID) were more likely to experience mental health difficulties and face barriers obtaining mental health care. COVID-related public health restrictions, combined with heightened challenges to obtain timely mental health care, have served to worsen this situation internationally, with a combination of new onset conditions and worsening mental health for those already struggling. In this narrative review, we summarize literature on the mental health of adults with ID during the COVID-19 pandemic to describe what is known based on clinician perceptions, existing administrative health data, family and staff perceptions, and self-report. In addition to noting similarities and differences in findings based on the source of information, we also explored how experiences differed depending on where and when the research was conducted. Based primarily on research conducted during the first six months of the pandemic, there is a consistent finding across sources of increased anxiety, stress, and isolation. This review also explored the delivery of virtual mental health care and the impact of pandemic-based mental health interventions. There have been very few research studies evaluating clinical care during this time but clinicians have managed to provide supports virtually, which has been evaluated positively by some individuals. This narrative review concludes by identifying gaps in the literature and suggests key directions for future mental health research, policy, and practice efforts. Any mental health efforts now and during pandemic recovery need to have an understanding of how the mental health needs and services for adults with ID have evolved over the course of the pandemic. Further research is needed on the impact of both clinical interventions and other nonclinical efforts on the mental health of people with ID.

COVID ‐19: Evolving challenges and opportunities for residential and vocational intellectual disability service providers

The 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.

A thematic analysis into the experiences of people with a mild intellectual disability during the COVID-19 lockdown period

Background. The COVID-19 pandemic is expected to have a substantial impact on people with an intellectual disability. The goal of the current study was to explore the experiences and needs of people with a mild intellectual disability during the COVID-19 lockdown period in the Netherlands. Method. A descriptive qualitative methodology was conducted, using semi-structured individual interviews with six people with a mild intellectual disability. Data were analysed thematically. Results. Three overarching themes were found: (i) Missing social contact and having people close; (ii) Being housebound has changed my daily life; and (iii) Hard to understand the preventive measures. Conclusions. Important insights into the experiences and needs of people with a mild intellectual disability during the COVID-19 lockdown period were gained. These insights are valuable with respect to a potential second COVID-19 wave or a future infection-outbreak.

Occupational therapy interventions for adults with learning disabilities: evaluating referrals received pre and during the height of the COVID-19 pandemic

Abstract Introduction The COVID-19 pandemic has significantly impacted on service provision for adults who have a learning disability, resulting in reduced occupational activities, routine, and social contact. Objective To analyse referrals received for Occupational Therapy intervention for adults who have a learning disability pre-COVID-19 (2019) and during COVID-19 (2020). Method This is a descriptive study conducted as a service evaluation with an NHS Trust Clinical Effectiveness Team in a city in the North of England. The data source was obtained from referral documentation. Quantitative and qualitative data were extracted from a data Performa and analysed using descriptive statistics (mean, median, mode, and standard deviation) performed by the Software Microsoft Excel. Results The total number of cases used in this evaluation was 274. There was an increase in referrals during the COVID-19 pandemic, the greatest increase was for Occupational Therapy intervention focusing on engagement in meaningful occupation. Over both years the predominant referrals were for equipment reviews. Conclusion Data collected captures a broad range of information regarding Occupational Therapy service provision pre and during the COVID-19 pandemic and puts this in the context of future considerations regarding the Occupational Therapy services for adults who have a learning disability.

The reported effects of the COVID-19 pandemic on people with intellectual disability and their carers: a scoping review

BACKGROUND

People with an intellectual disability are a vulnerable group during COVID-19 due to multi-morbidity, frailty, underlying conditions/health problems, social circumstances and limitations in understanding. This place them at greater risk of more severe outcomes from COVID-19.

OBJECTIVE

To chart the evidence of the effects of the COVID-19 pandemic on people with intellectual disability and their carers reported in the research.

METHODS

A scoping review method was used to review literature published across eight databases in 2020 and included manual searches of reference lists of included articles.

RESULTS

Sixteen studies were selected for inclusion. The findings highlight that professionals, people with intellectual disability and their carers were keen to comply with pandemic related public health guidance. However, implementing infection prevention and control measures in certain contexts for people with intellectual disability was challenging. Thereby a rights-based, person-centred approach to care is essential and professionals need to extend their understanding and practice of collaborative working to include people with intellectual disability and their family/carers. The findings highlight that compliance with public health guidance and infection control measures can be difficult for people with intellectual disability to implement.

CONCLUSIONS

There is limited good quality robust research on COVID-19 and people with intellectual disability and/or their carers experiences.

Effect of interactive video-based instruction on learning performance in relation to social skills of children with intellectual disability

Interactive video-based instruction (IVBI) session was organized in day-care rehabilitation settings to provide training in acquiring new skills related to social skills development for targeted moderate intellectual disability (MID) population. The main objective is to inter-relate the effect of individual and collaborative interactive video-based instruction on social skills development for experimental group children with those in the comparison group. A quasi-experimental design was conducted on (n = 99, comprising 56 males and 43 females) students with MID from selected three rehabilitation centres of Guwahati, Assam, India. The mean and standard deviation of individual interactive video-based instruction (IIVBI) and collaborative interactive video-based instruction (CIVBI) was better than the conventional group. The ANCOVA result shows a significant effect of IIVBI and CIVBI in the improvement of social skills over conventional approach on students after controlling the effect of the pre-test. The interactive session in both the experimental group allowed the students to create their own space for learning social skills via different activities using IVBI. The researchers concludes that regular practice of various activities through video sessions can help children with intellectual disability to overcome minor obstacles by themselves without any additional service.

Remote Support for Adults with Intellectual Disability During COVID-19: From a Caregiver's Perspective

The reality of people with ID changed during the pandemic COVID‐19. Most institutions supporting people with ID switched to remote work. This required some major adaptation to these individuals' new realities, their immediate families, and facility staff. Supporting and monitoring the quality of life of individuals with disabilities and their family members during a crisis is an essential topic of current research. This research project aimed to explore the experiences of parents of adults with ID in relation to remote support provided by public support agencies. In a qualitative study, the authors used semistructured individual interviews with caregivers of people with ID. Data analysis distinguished the following categories: parents as therapists, organization difficulties, material problems, lack of social contacts, positive solutions, and difficult behavior. The results show the difficulties of parents in balancing professional, domestic, and supporting tasks. The study was the first in Poland to report on the qualitative assessment of remote support for people with ID during COVID‐19. Further, more extensive research is needed to search for solutions that respect the rights of people with disabilities to professional support.

Perceptions of people with intellectual and developmental disabilities about COVID-19 in Spain: a cross-sectional study

BACKGROUND

As the world battles COVID-19, there is a need to study the perceptions of people with intellectual and developmental disabilities (IDD) about the effects of the pandemic and associated lockdown on their lives. This work explores the perceptions of Spaniards with IDD during the lockdown with respect to four topics: access to information, emotional experiences, effects on living conditions and access to support.

METHODS

The topics were explored using a subset of 16 closed-ended questions from an online survey. In total, 582 participants with IDD completed the survey. The frequencies and percentages of responses to the questions were calculated, and chi-square tests performed to explore the relationship between participants' sociodemographic characteristics and responses. Given that people differed in the way in which they completed the survey, the relationship between participants' responses and completion method was also analysed.

RESULTS

Participants reported that the pandemic and subsequent lockdown have had a deleterious effect on their emotional well-being (around 60.0% of participants) and occupations (48.0% of students and 72.7% of workers). Although access to information and support was reportedly good overall, being under the age of 21 years and studying were associated with perceptions reflecting poorer access to information (V = .20 and V = .13, respectively) and well-being support (V = .15 and V = .13, respectively). Being supported by a third party to complete the survey was consistently related to perceptions of worse outcomes.

CONCLUSIONS

The study yielded data on the perceptions of people with IDD regarding the effects that COVID-19 and the subsequent lockdown have had on their lives. Suggestions on how to overcome the difficulties reported and future lines of research are discussed.

Supports for people with intellectual and developmental disabilities during the COVID-19 pandemic from their own perspective

BACKGROUND

Individuals with intellectual and developmental disabilities (IDD) represent a particularly vulnerable group to the threats posed by COVID-19. However, they have not yet been given a voice on how their living conditions have been affected by COVID-19.

AIMS

This study aims to report the impact on people with IDD of COVID-19 and the response measures applied in Spain during the lockdown.

METHOD

Data on 582 individuals with IDD were collected through a survey. Seven open questions were included to capture the perspectives of people with IDD on COVID-19 and its consequences. Content analysis was performed to identify themes and categories across participant responses. Chi-square tests were used to analyze the relationship between reporting a specific category and participants' characteristics.

RESULTS

Supports have been conditioned by the living context. People living in specific settings had fewer natural supports, while those living with their family relied heavily on it. Participants also lacked supports considered necessary. It is worth stressing that persons with IDD have also provided support to others.

CONCLUSIONS

Although people with IDD have generally received the assistance they need during the lockdown, it must be ensured that appropriate supports are provided regardless of the context in which they live.

Effect of the COVID-19 pandemic on the mental health of carers of people with intellectual disabilities

INTRODUCTION

The measures implemented to manage the COVID-19 pandemic have been shown to impair mental health. This problem is likely to be exacerbated for carers.

METHOD

Informal carers (mainly parents) of children and adults with intellectual disabilities, and a comparison group of parents of children without disabilities, completed an online questionnaire. Almost all the data were collected while strict lockdown conditions were in place.

RESULTS

Relative to carers of children without intellectual disability, carers of both children and adults with intellectual disability had significantly greater levels of a wish fulfilment coping style, defeat/entrapment, anxiety, and depression. Differences were 2-3 times greater than reported in earlier pre-pandemic studies. Positive correlations were found between objective stress scores and all mental health outcomes. Despite their greater mental health needs, carers of those with intellectual disability received less social support from a variety of sources.

CONCLUSIONS

The greater mental health needs of carers in the context of lesser social support raises serious concerns. We consider the policy implications of these findings.