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Honors capstone udel for money 509 capstone drive lynchburg va reporting reason avp 8722 I'm I'm Angela Casio there's an I'm professor of psychiatry of intellectual disability or learning disability at UCL the division of psychiatry so I have a role in terms of teaching and carrying out research and also I'm a consultant psychiatrist so I work in the NHS and I work in the Camden learning disability service as a consultant psychiatrist oh I see and manage and treat patients with intellectual disability across the spectrum of intellectual disability and they may have a mental health problem some of them obviously will have challenging behavior I advocate on their behalf I may and carry out research within the service I take part in service developments and so on so that's my kind of general role obviously we also train young doctors who specialize or want to specialize in the psychiatry of intellectual disability in the future and so consultant and clinician I'm an educator and I'm also a researcher and my basic interest in research is about health services and how we improve those services and how we evaluate interventions specific specifically for people with intellectual disabilities so my service is for adults but we do see sometimes younger people kind of aged 16 and over and because of course there is a kind of transition issue there so and you know we may work together with colleagues from common special needs child and adolescent mental health services and or we may assess individuals who are in inpatient services out of area and so on actually how PBS can be something different than just an initiative it seems to me PBS actually it's not a new initiative it's been there for a long time is an intervention is almost a continuation of applied behavior analysis or an advancement or kind of an another format I guess and which has now a kind of different set of principles embedded in terms of actually looking at people's environments and how the environment actually can trigger or maintain challenge and behavior so trying to get away from the very sort of specific behavioral element of applied behavior analysis there are lots of arguments and debates about that and I don't want to get into this particular discussion however in terms of actually distinguishing PBS from other initiatives it's actually and I would say the same for applied behavior analysis although I think that be autism a field has made more of a success in in that before applied behavior analysis but for PBS I think that we should try and prove that it works or which elements of it work best to help individuals to reduce challenging behavior if we don't do that and I'm coming at this from a very specific sort of lens which is the research perspective I think it's going to be another initiative but if we wish to avoid that then we need to really prove that it's the best thing that we can do for patients if it's another intervention if it's evidence-based then it goes away from the real of initiatives and it becomes something that we have to implement we have to give this intervention to people because that's how we're going to make a difference in their lives and there is no point say a service for example if we prove that this is the sort of best thing that we can do or is better than doing nothing because this is the other thing I mean and services in the UK in particular are probably at a more advanced stage than services elsewhere in the world because we've got a special is that intellectual disability so and it may well be that whatever practices I mean that could be a potential outcome for us in particular for the study that whatever happens in normal practice in routine care is probably as good as but what we have to understand is that we need to find the evidence and it may not be everything about PBS but could be specific components a function and analysis or something about the rain forces and so on but if we do and if we prove that point I think it will not be an initiative it will be you know more sustained sort of effort it's something that we've got to to do so um now the issue about the institutionalization it's an interesting one because it has happened for many years although there are still over 2000 people in hospital and so on although I guess the circumstances are different and saying the sixties and the fifties and so on and but there has been a lot of information about how people should be resettled in their local communities they've been endless reports they've been endless papers scientific papers on for example specialist teams they used to call them in actually I think some colleagues still call them peripatetic teams I would potentially call them specialists behavioral teams and so on so we know about what we need to do but for some reason we do not do those things so and I don't know whether it's an issue of implementation I'm not quite sure whether it's the fact that the people with intellectual disabilities are under the social care agenda and for whatever reason that prevents the mental health aspects or psychological or emotional aspects including the challenging behavior and so on to be recognized as particular element have to be taken out of their context I mean I work in an integrated team so maybe that's the first thing maybe that all services were integrated potentially we could have a better way of pulling budgets or managing someone who needs to be resettled in managing the process rather of someone's resettlement but we always sort of seem to have a difficulty and given that we have not actually as yet a compared different service model so for example where a team is out there on their own as a tertiary service for instance or whether they're embedded or and some other combination if we don't have this comparative results if we just have descriptions that's not going to help us but we have an idea of what might work but without again showing how it works in comparison to something else then I think we will still continue to do struggle and of course there will be always other priorities people with learning disabilities are about 1% of the population if we think about mental illness such as psychosis that's one percent of the population and there's so much input for people with psychosis although I'm sure they will say that there isn't enough but what about our population if it's 1% who also have and you know they've got other difficulties and so on then why is it that we're not doing something a bit more specific a bit more concentrated why is it that we are still not able to put whatever evidence we have into practice or carry out the kind of work that's required in order to be able at least to answer some of those questions but the lessons have been there and it's incredible to see that the first month of the report was in 1993 the first peripatetic teams were bucking the ages and we're still struggling with and those terms out of 154 areas in England in particular which have community intellectual disability teams it's only probably about half of them or less and fewer who have specialist teams in some kind of format or another why is it and again you know goes back to the question of the government initiative so maybe if there was a director of Vienna that would help things to move along a little bit write for me enterprise risk management defined John Jay College of Criminal Justice.

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