Purpose It is known that people with learning disabilities are more likely to experience trauma, compared to the mainstream population. Services that are “trauma informed” are more able to recognise the lasting impact of adversity and to resist the possibility of being re-traumatising. Within mainstream adult mental health services, the Roots tool framework has been developed as a way of monitoring progress towards this goal. The purpose of this paper is to describe a project that was carried out to assess how relevant and feasible it was to use the Roots tool within a learning disability service. Design/methodology/approach A descriptive design was used. The participants were multi-disciplinary professionals who volunteered to take part in the service evaluation. Three domains of the Roots tool were completed (language, social and whole system approach). The findings of this study were presented to a service user group to gain their feedback and facilitators also shared their experiences of using the tool. Findings The findings were that the Roots tool was relevant to the learning disability service. The three domains yielded several areas where practical changes could be made. However, using the tool was time consuming, and the service user version was too complex for individuals with learning disabilities. Originality/value To the best of the authors’ knowledge, this is the first known application of the Roots tool framework to learning disability services. It is important to measure how trauma informed services are so that progress can occur. There may be a case for developing bespoke tools, specifically for learning disability services, with particular focus on how to include service users directly.

Purpose The purpose of this article is to provide a definition of Positive Behaviour Support (PBS), developed by a group of practitioners of PBS, in the United Kingdom (UK). Design/methodology/approach The definition was developed through a series of online meetings with a group of practitioners, and through reference to the existing research. Findings A definition is presented in the form of 9 defining characteristics. These include a specific underpinning philosophy (functional contextualism), a focus on promoting quality of life, rights, relationships, the use of Applied Behaviour Analysis, functional assessment to inform function-based strategies, the provision of multielement support, collaborative working and implementation support. Originality/value There are numerous pre-existing definitions of PBS. However, this article seeks to present a definition specifically from the perspective of practitioners in the United Kingdom.

Purpose This study aims to explore how menopause is recognised, recorded and treated in women with intellectual disability receiving care from community learning disability services. It sought to identify gaps in diagnosis, treatment provision and access to routine health checks, as well as regional disparities across a NHS Trust in the Northwest of England. Design/methodology/approach A retrospective cohort study was conducted using routinely collected clinical data from 555 women aged 40–60 with intellectual disability, obtained from electronic health records across multiple community learning disability teams. Descriptive and comparative analyses were performed to examine menopause diagnosis rates, treatment patterns and annual health check (AHC) participation. Findings Only 4% of women had a recorded diagnosis of menopause or perimenopause. However, a greater proportion received menopause-related interventions, indicating a potential gap in formal recognition. The use of Hormone Replacement Therapy varied significantly across regions, with less than half of eligible women having had an AHC. Practical implications Findings support the need for accessible screening tools, workforce education and equitable service commissioning. Originality/value To the best of the authors’ knowledge, this is one of the first studies to audit menopause care for women with intellectual disability at scale using data from electronic patient records. The findings highlight systemic under-recognition, inconsistent documentation and inequities in access to care, calling for improved screening, professional training and inclusive policy responses.

Purpose Staff supporting individuals who engage in “challenging behaviour” have been identified as at risk of burnout. Despite direct support staff playing a fundamental role in the delivery of preventative approaches such as positive behaviour support, relatively little is known about factors which reduce the likelihood of stress and burnout in this population. The purpose of this study was to investigate several factors which may play a preventative role with respect to stress and burnout. Design/methodology/approach This study investigated the relationships between perceived organisational support (POS) and trait mindfulness, with emotional exhaustion. Eighty-four staff members completed the survey of perceived organisation support, the mindful attention awareness scale and the emotional exhaustion scale from the Maslach Burnout Inventory. Findings A multiple regression identified that POS, trait mindfulness and working with adults, negatively predicted emotional exhaustion. The strongest predictor of emotional exhaustion was POS. These findings provide evidence that POS and mindfulness could play a preventative role in the development of burnout. As POS was the strongest predictor, it is recommended that organisations in this field do not underestimate the importance of their staff feeling valued. Originality/value To the best of the author’s knowledge, this is the first study conducted in intellectual and developmental disability services within the UK, investigating the relationship between either POS or trait mindfulness with emotional exhaustion.

Purpose This paper aims to explore the self-efficacy of trainee teachers from one higher education institution in England, as well as their knowledge of autism, experience of educating autistic students and their training needs. Design/methodology/approach This study used a cross-sectional design by means of a mixed methods approach. A sample of 31 trainee teachers from one higher education institution in England responded to a survey, which included a measure of teacher self-efficacy (The Autism Self-Efficacy Scale for Teachers) and autism knowledge (Autism Spectrum Knowledge Scale General Population). Eleven trainee teachers engaged in a follow up interview. Findings Trainee teachers’ knowledge of autism was comparable to that of the general population. Self-efficacy to teach autistic students varied considerably among trainee teachers. A thematic analysis of findings identified three main themes; (1) gaps between theory, inclusive intent and practice, (2) systemic barriers to true inclusion and (3) institutional cultures. Originality/value Findings from this preliminary exploration into the knowledge, experiences and self-efficacy of trainee teachers working with autistic students in England suggested that specialist knowledge of autism, teacher self-efficacy and opportunities for training were lacking. A more consistent approach to delivering evidence-based training is, in-part, what is needed to promote the inclusive education of autistic students.

Purpose Developing effective community-based services for children with intellectual disabilities and behaviours that challenge in England is a national priority. Service design and delivery guidelines state services should be co-produced with the children and families/carers accessing them. There are no identified data about how well services are delivering this recommendation. This research paper aimed to describe self-reported co-production activities within such services, and to consider how well these align with co-production definitions. Design/methodology/approach During a mapping exercise of community-based services for children with intellectual disabilities and behaviours that challenge in England, staff at 60 services completed an interview including questions concerning co-production. Types of self-reported co-production within services were described. The authors then examined how well these aligned with definitions of co-production. Findings Six types of self-reported “co-production” activities were identified via content analysis – (i) service planning, (ii) recruitment processes and decisions, (iii) individual case work, (iv) resources used within the service, (v) running training, workshops and groups and (vi) the service’s physical environment. Very few activities met co-production definitions, typically being classified as participation or co-creation. Practical implications All involved in the planning and delivery of services need to better consider how to implement additional activities that meet higher-level co-production definitions. Originality/value To the best of the authors’ knowledge, this is the first known assessment of how well community-based services for children with intellectual disabilities and behaviours that challenge are enacting guidance that service design and delivery should be co-produced.

Purpose Recognising and interpreting emotions are fundamental to social interaction, and autistic and non-autistic individuals may differ in how emotions are expressed, recognised and interpreted. When individuals prioritise developing shared understanding in this area, applied behaviour analysis (ABA) practitioners can partner with them to support those objectives, representing a notable shift from the field’s initial lack of attention to internal states. The purpose of this review is to examine research on emotion recognition over the past 40 years, summarising contributions and identifying directions for future work. Design/methodology/approach A comprehensive search was conducted across 13 behaviour-analytic and autism research journals (see Table 1) from 1982 to 2022. Search terms included “feeling”, “emotion”, “facial”, “expression” and “private event”. Articles explicitly listing tacting or assessing emotions in the title or objective were included. The search produced 721 articles, of which 63 met inclusion criteria, published across four journals: JADD, RIASD, JIDR and BAP. Interrater reliability was assessed using Cohen’s kappa for a subset of double-coded items. Findings Most studies focused on assessing emotions rather than teaching, with children comprising 83% of participants. Few studies used stimuli that were diverse (covering multiple populations) or validated (verified via interrater agreement). Originality/value To the best of the authors’ knowledge, this review is among the first comprehensive analyses of emotion recognition research in behaviour-analytic and autism research journals. It highlights underexplored areas, including limitations in interventions, participant populations and validated, diverse stimuli, which are valuable for developing socially meaningful interventions in ABA practice.

Purpose Ageing with intellectual disability is an increasingly recognised area of need. The purpose of this paper is to report on the perspectives of people with intellectual disability, families and practitioners regarding the challenges and priorities for ageing well and identify implications for future practice and research. Design/methodology/approach A co-produced stakeholder event was held in the Northwest of England with people with lived experience, family carers, practitioners and service providers. Engagement activities included small group discussions, a wishing well activity, flipchart exercises and creative artefacts. Data were captured through facilitator notes, written contributions and questionnaires, then anonymised, digitised and thematically analysed. Findings Four main themes were identified: mental health and service access; social inclusion and community support; respite and carer well-being; and dementia. Stakeholders highlighted gaps in tools to recognise early signs of dementia, track changes and provide evidence to clinicians, leading to delays in diagnosis and support. Participants also described the impact of anxiety on daily life, fragmented and costly community services and the strain families face because of outdated or crisis-driven respite provision. Research limitations/implications The findings of this study reflect perspectives from one region of England and cannot be generalised to all populations, though the themes align with wider literature and suggest broader relevance. Practical implications Priorities include co-produced dementia monitoring tools, embedding person-centred mental health planning, addressing geographical disparities and expanding proactive respite provision. Originality/value To the best of authors’ knowledge, this is one of the first co-produced UK studies to explore ageing with intellectual disability through direct stakeholder engagement. This study foregrounds lived experience voices and identifies dementia, mental health and carer well-being as critical areas for future policy and practice.

Purpose This paper aims to enhance communication and person-centred care in a low secure forensic learning disability service and describes a quality improvement project on developing and implementing a co-produced Combined Personal Passport (CPP). The CPP sought to replace fragmented documentation with a single, accessible, service user-led resource. Design/methodology/approach The project followed a Plan-Do-Study-Act cycle. People with learning disabilities and autistic people detained under the Mental Health Act co-produced the CPP, integrating communication, sensory and personal profiles into one document. Feedback was collected before and after implementation using structured forms and thematic analysis of comments from service users, multidisciplinary team members and Care and Treatment Review panels. Findings Qualitative data suggested that the CPP enhanced therapeutic relationships, increased professional understanding of individual needs and empowered service users to take more active roles in their care. Quantitative feedback showed improved clarity, usability and uptake by professionals. While some challenges were reported around digital access and consistency, the overall response was strongly positive. Research limitations/implications This quality improvement project had several limitations. The sample was small and drawn from a single service, which limits generalisability. The evaluation relied mainly on descriptive and qualitative feedback rather than outcome measures; the authors did not assess changes in staff behaviour or longer-term impact on care. Despite efforts to ensure accessibility, not all service users were able to contribute equally due to differences in literacy, communication and engagement. In addition, the project did not include follow-up to evaluate sustained use or impact over time. Future work should involve larger, multisite cohorts, longitudinal follow-up and structured outcomes (e.g. implementation fidelity, staff practice change, incident data and experience measures). Practical implications A notable finding was that people responded not only to the content of the passport but also being involved in shaping it. For some, this was the first time they had influenced how professionals talked about them. Co-production appeared to foster agency and wider therapeutic engagement. The team also observed a shift in staff mindset, from receiving information to collaborating around it, suggesting cultural benefits when personalised communication tools are embedded in routine practice. Originality/value This project highlights how co-produced tools can meaningfully improve communication and engagement in secure services. The CPP model is practical, low-cost and has the potential for broader application across services supporting people with learning disabilities and autism.

Purpose People with intellectual disabilities (ID) have shown similar body dissatisfaction levels to those without ID. However, little research has investigated the factors that contribute to their beliefs about their bodies (physical self-concept). This study aimed to investigate the unique experiences and behaviours contributing to positive physical self-concept of women with ID, as this has been associated with positive wellbeing outcomes. Design/methodology/approach A qualitative phenomenological design using thematic analysis was undertaken on women with ID (n = 12) to identify experiences impacting on their physical self-concept. Findings Several mechanisms (behaviours and experiences) and associated psychological benefits (positive psychological experiences) were identified as contributing to their physical self-concept. Several identified themes converged with the Self-Efficacy Theory, suggesting that a sense of competence is particularly important in perceiving one’s body positively. Originality/value These findings provide initial evidence for practical ways to support women with ID to enhance their physical self-concept through enhancing engagement with identified mechanisms, and importantly, their associated psychological benefits.