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WHO | Sexual health, human rights and the law

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This report demonstrates the relationship between sexual health, human rights and the law. Drawing from a review of public health evidence and extensive research into human rights law at international, regional and national levels, the report shows how states in different parts of the world can and do support sexual health through legal and other mechanisms that are consistent with human rights standards and their own human rights obligations.

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Driscoll's Model of reflection book link

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Driscoll's Model of reflection book link

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This title is directed primarily towards health care professionals outside of the United States. With contributors from the UK and Australia, the second edition builds on the success of the original, which was praised for engaging readers and being a pragmatic and practice-orientated addition to the literature on clinical supervision.

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Welsh Specific Public Health links to sexual health

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Welsh Specific Public Health links to sexual health

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Sexual Health | Public Health Network Cymru

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Providing people with the tools and knowledge to maintain healthy sexual development and safe sexual relationships.

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Here are the most up to date recordings of disease reports from lab testing is available

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This site offers professional training,resources, signposting and supports the Wales 2010 'Statement of Key Rights and Values'

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World Menopause Day: Easy Read Wales launches new easy read guides about menopause

New easy read resources to support people with a learning disability to get their vaccines are now available

We want Wales to be the best country in the world for people with a learning disability to live, learn and work

Keep up-to-date with the latest news, opinion, and events from the learning disability sector in Wales.

See all News

Our training courses and events are a great way to increase your knowledge, develop new skills and broaden your experience and understanding of learning disabilities.

Keep up-to-date with the latest news, opinion, and events from the learning disability sector in Wales.

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If you'd like to stay in the loop with all our project news and events, sign up to our newsletter.
Privacy Statement

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We want Wales to be the best country in the world for people with a learning disability to live, learn and work

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Link to the latest reports on sexual health in Wales and related strategies

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One role of Public Health Wales is to contribute to protecting the population of Wales from infection. This includes prevention and control strategies for STIs and BBVs through surveillance of symptomatic infection, independent advice, epidemiological investigation and research.

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Campaign dedicated to reducing harm and listening to the service user voice

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New research focus on the role of communications in healthcare improvement 1000 Lives Improvement and Swansea University's Centre for Improvement and Innovation in Health and Social Care, hosted by the College of Human and Health Sciences, have announced an exciting new partnership to develop a research base for the use of communications as a central part of quality improvement.

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UN Convention on the rights of persons with disabilities

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UN Convention on the rights of persons with disabilities

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Link to full report

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6 May 2022 Status:

Ratifications/Accessions: 185

Signatories*: 164

Ratifications/Accessions: 100

Signatories*: 94

(* Signatories include countries or regional integration organizations that have signed the Convention and its Optional Protocol)

For more Information on the Status of the Convention, please visit: https://bit.ly/UNCRPD-Status

The Convention on the Rights of Persons with Disabilities and its Optional Protocol ( A/RES/61/106) was adopted on 13 December 2006 at the United Nations Headquarters in New York, and was opened for signature on 30 March 2007. There were 82 signatories to the Convention, 44 signatories to the Optional Protocol, and 1 ratification of the Convention. This is the highest number of signatories in history to a UN Convention on its opening day. It is the first comprehensive human rights treaty of the 21st century and is the first human rights convention to be open for signature by regional integration organizations. The Convention entered into force on 3 May 2008.

The Convention follows decades of work by the United Nations to change attitudes and approaches to persons with disabilities. It takes to a new height the movement from viewing persons with disabilities as "objects" of charity, medical treatment and social protection towards viewing persons with disabilities as "subjects" with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society.

The Convention is intended as a human rights instrument with an explicit, social development dimension. It adopts a broad categorization of persons with disabilities and reaffirms that all persons with all types of disabilities must enjoy all human rights and fundamental freedoms. It clarifies and qualifies how all categories of rights apply to persons with disabilities and identifies areas where adaptations have to be made for persons with disabilities to effectively exercise their rights and areas where their rights have been violated, and where protection of rights must be reinforced.

The Convention was negotiated during eight sessions of an Ad Hoc Committee of the General Assembly from 2002 to 2006, making it the fastest negotiated human rights treaty.

Full text of the Convention on the Rights of Persons with Disabilities:

Other translations *

Sign Language*

Easy read versions*

Other related publications

CRPD Training Guide - PDF (OHCHR, 2014)

* These non-official versions of the Convention are provided by other sources and are for informational purposes only; they do not constitute endorsement of, or an approval by, the United Nations of any of the text or products, services, or opinions of the organization or individual. The United Nations bears no responsibility for the accuracy, legality or content of their statements and opinions.

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Convention on the Rights of Persons with Disabilities (CRPD) | United Nations Enable

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6 May 2022 Status: Ratifications/Accessions: 185 Signatories*: 164 Ratifications/Accessions: 100 Signatories*: 94 (* Signatories include countries or regional integration organizations that have signed the Convention and its Optional Protocol) For more Information on the Status of the Convention, please visit: https://bit.ly/UNCRPD-Status The Convention on the Rights of Persons with Disabilities and its Optional Protocol ( A/RES/61/106) was adopted on 13 December 2006 at the United Nations Headquarters in New York, and was opened for signature on 30 March 2007.

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Covering professional responsibilities for students and nurses alike

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Professional standards of practice and behaviour for nurses, midwives and nursing associates. All standards apply within your professional scope of practice.

Contents:

About us

The Nursing and Midwifery Council exists to protect the public. We do this by making sure that only those who meet our requirements are allowed to practise as a nurse or midwife in the UK, or a nursing associate in England. We take action if concerns are raised about whether a nurse, midwife or nursing associate is fit to practise.

It is against the law to claim to be, or to practise as, a nurse or midwife in the UK, or as a nursing associate in England, if you are not on the relevant part of our register.

It is also a criminal offence for anyone who, with intent to deceive, causes or permits someone else to falsely represent them as being on the register, or makes a false representation about them being on the NMC register.

Publication date: 29 January 2015
Effective from: 31 March 2015
Updated to reflect the regulation of nursing associates: 10 October 2018

A note on this version of the Code

All regulators review their Codes from time to time to make sure they continue to reflect public expectations. This new version of the Code is substantially similar to the 2015 version, but it has been updated to reflect our new responsibilities for the regulation of nursing associates. In joining the register, nursing associates will uphold the Code.

The current versions of our Code, standards and guidance can always be found on our website. Those on our register should make sure they are using the most up to date version of the Code.

For more information about the Code, please visit: www.nmc.org.uk/code.

Introduction

The Code contains the professional standards that registered nurses, midwives and nursing associates ¹ must uphold. Nurses, midwives and nursing associates must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing ² and midwifery practice in other roles, such as leadership, education, or research. The values and principles set out in the Code can be applied in a range of different practice settings, but they are not negotiable or discretionary.

Our role is to set the standards in the Code, but these are not just our standards. They are the standards that patients and members of the public tell us they expect from health professionals. They are the standards shown every day by those on our register.

When joining our register, and then renewing their registration, nurses, midwives and nursing associates commit to upholding these standards. This commitment to professional standards is fundamental to being part of a profession. We can take action if those on our register fail to uphold the Code. In serious cases, this can include removing them from the register.

The Code sets out common standards of conduct and behaviour for those on our register. This provides a clear, consistent and positive message to patients, service users and colleagues about what they can expect of those who provide nursing or midwifery care.

The professions we regulate have different knowledge and skills, set out in three distinct standards of proficiency. They can work in diverse contexts and have different levels of autonomy and responsibility. However, all of the professions we regulate exercise professional judgement and are accountable for their work.

Nurses, midwives and nursing associates uphold the Code within the limits of their competence. This means, for example, that while a nurse and nursing associate will play different roles in an aspect of care, they will both uphold the standards in the Code within the contribution they make to overall care. The professional commitment to work within one's competence is a key underpinning principle of the Code (see section 13) which, given the significance of its impact on public protection, should be upheld at all times.

In addition, nurses, midwives and nursing associates are expected to work within the limits of their competence, which may extend beyond the standards they demonstrated in order to join the register.

The Code should be useful for everyone who cares about good nursing and midwifery.

Patients and service users, and those who care for them, can use it to provide feedback to nurses, midwives and nursing associates about the care they receive.

Those on our register can use it to promote safe and effective practice in their place of work.

Employer organisations should support their staff in upholding the standards in their professional Code as part of providing the quality and safety expected by service users and regulators.

Educators can use the Code to help students understand what it means to be a registered professional and how keeping to the Code helps to achieve that.

For the many committed and expert practitioners on our register, this Code should be seen as a way of reinforcing professionalism. Through revalidation, nurses, midwives and nursing associates provide evidence of their continued ability to practise safely and effectively. The Code is central to the revalidation process as a focus for professional reflection. This gives the Code significance in the professional life of those on our register, and raises its status and importance for employers.

The Code contains a series of statements that taken together signify what good practice by nurses, midwives and nursing associates looks like. It puts the interests of patients and service users first, is safe and effective, and promotes trust through professionalism.
1 Anyone practising as a registered nurse or midwife in the UK, or a nursing associate in England, has to be registered with us. The nursing associate role is being used only in England.
² We have used the phrase 'nursing' in this document to apply to the work of nurses and nursing associates. Nursing associates are a distinct profession with their own part of our register, but they are part of the nursing team.

Prioritise people

You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

1 Treat people as individuals and uphold their dignity

To achieve this, you must:

1.1 treat people with kindness, respect and compassion

1.2 make sure you deliver the fundamentals of care effectively

1.3 avoid making assumptions and recognise diversity and individual choice

1.4 make sure that any treatment, assistance or care for which you are responsible is delivered without undue delay

1.5 respect and uphold people's human rights
The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.
2 Listen to people and respond to their preferences and concerns

To achieve this, you must:

2.1 work in partnership with people to make sure you deliver care effectively

2.2 recognise and respect the contribution that people can make to their own health and wellbeing

2.3 encourage and empower people to share decisions about their treatment and care

2.4 respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care

2.5 respect, support and document a person's right to accept or refuse care and treatment

2.6 recognise when people are anxious or in distress and respond compassionately and politely

3 Make sure that people's physical, social and psychological needs are assessed and responded to

To achieve this, you must:

3.1 pay special attention to promoting wellbeing, preventing ill health and meeting the changing health and care needs of people during all life stages

3.2 recognise and respond compassionately to the needs of those who are in the last few days and hours of life

3.3 act in partnership with those receiving care, helping them to access relevant health and social care, information and support when they need it

3.4 act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care

4 Act in the best interests of people at all times

To achieve this, you must:

4.1 balance the need to act in the best interests of people at all times with the requirement to respect a person's right to accept or refuse treatment

4.2 make sure that you get properly informed consent and document it before carrying out any action

4.3 keep to all relevant laws about mental capacity that apply in the country in which you are practising, and make sure that the rights and best interests of those who lack capacity are still at the centre of the decision-making process

4.4 tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person's care (see the note below)
You can only make a 'conscientious objection' in limited circumstances. For more information, please visit our website at www.nmc.org.uk/standards/code/conscientious-objection-by-nurses-and-midwives/
5 Respect people's right to privacy and confidentiality

As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately.

To achieve this, you must:

5.1 respect a person's right to privacy in all aspects of their care

5.2 make sure that people are informed about how and why information is used and shared by those who will be providing care

5.3 respect that a person's right to privacy and confidentiality continues after they have died

5.4 share necessary information with other health and care professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality

5.5 share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment sensitively and in a way they can understand

Practise effectively

You assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You reflect and act on any feedback you receive to improve your practice.

6 Always practise in line with the best available evidence

To achieve this, you must:

6.1 make sure that any information or advice given is evidence-based, including information relating to using any health and care products or services

6.2 maintain the knowledge and skills you need for safe and effective practice

7 Communicate clearly

To achieve this, you must:

7.1 use terms that people in your care, colleagues and the public can understand

7.2 take reasonable steps to meet people's language and communication needs, providing, wherever possible, assistance to those who need help to communicate their own or other people's needs

7.3 use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people's personal and health needs

7.4 check people's understanding from time to time to keep misunderstanding or mistakes to a minimum

7.5 be able to communicate clearly and effectively in English

8 Work cooperatively

To achieve this, you must:

8.1 respect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate

8.2 maintain effective communication with colleagues

8.3 keep colleagues informed when you are sharing the care of individuals with other health and care professionals and staff

8.4 work with colleagues to evaluate the quality of your work and that of the team

8.5 work with colleagues to preserve the safety of those receiving care

8.6 share information to identify and reduce risk

8.7 be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety

9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues

To achieve this, you must:

9.1 provide honest, accurate and constructive feedback to colleagues

9.2 gather and reflect on feedback from a variety of sources, using it to improve your practice and performance

9.3 deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times

9.4 support students' and colleagues' learning to help them develop their professional competence and confidence

10 Keep clear and accurate records relevant to your practice

This applies to the records that are relevant to your scope of practice. It includes but is not limited to patient records.

To achieve this, you must:

10.1 complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need

10.3 complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements

10.4 attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation

10.5 take all steps to make sure that all records are kept securely

10.6 collect, treat and store all data and research findings appropriately

11 Be accountable for your decisions to delegate tasks and duties to other people

To achieve this, you must:

11.1 only delegate tasks and duties that are within the other person's scope of competence, making sure that they fully understand your instructions

11.2 make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care

11.3 confirm that the outcome of any task you have delegated to someone else meets the required standard

12 Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse, midwife or nursing associate in the United Kingdom

To achieve this, you must:

12.1 make sure that you have an appropriate indemnity arrangement in place relevant to your scope of practice

For more information, please visit: www.nmc.org.uk/indemnity

Preserve safety

You make sure that patient and public safety is not affected. You work within the limits of your competence, exercising your professional 'duty of candour' and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You take necessary action to deal with any concerns where appropriate.

13 Recognise and work within the limits of your competence

To achieve this, you must, as appropriate:

13.1 accurately identify, observe and assess signs of normal or worsening physical and mental health in the person receiving care

13.2 make a timely referral to another practitioner when any action, care or treatment is required

13.3 ask for help from a suitably qualified and experienced professional to carry out any action or procedure that is beyond the limits of your competence

13.4 take account of your own personal safety as well as the safety of people in your care

13.5 complete the necessary training before carrying out a new role

14 Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place

To achieve this, you must:

14.1 act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm

14.2 explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers

14.3 document all these events formally and take further action (escalate) if appropriate so they can be dealt with quickly
The professional duty of candour is about openness and honesty when things go wrong. "Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress." Joint statement from the Chief Executives of statutory regulators of healthcare professionals.
15 Always offer help if an emergency arises in your practice setting or anywhere else

To achieve this, you must:

15.1 only act in an emergency within the limits of your knowledge and competence

15.2 arrange, wherever possible, for emergency care to be accessed and provided promptly

15.3 take account of your own safety, the safety of others and the availability of other options for providing care

16 Act without delay if you believe that there is a risk to patient safety or public protection

To achieve this, you must:

16.1 raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other health and care setting and use the channels available to you in line with our guidance and your local working practices

16.2 raise your concerns immediately if you are being asked to practise beyond your role, experience and training

16.3 tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of concern if you can

16.4 acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so

16.5 not obstruct, intimidate, victimise or in any way hinder a colleague, member of staff, person you care for or member of the public who wants to raise a concern

16.6 protect anyone you have management responsibility for from any harm, detriment, victimisation or unwarranted treatment after a concern is raised

For more information, please visit our website at www.nmc.org.uk/raisingconcerns.

17 Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection

To achieve this, you must:

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse

17.2 share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information

17.3 have knowledge of and keep to the relevant laws and policies about protecting and caring for vulnerable people

18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations

To achieve this, you must:

18.1 prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person's health and are satisfied that the medicines or treatment serve that person's health needs

18.2 keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs

18.3 make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines

18.4 take all steps to keep medicines stored securely

18.5 wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship

Prescribing is not within the scope of practice of everyone on our register. Nursing associates don't prescribe, but they may supply, dispense and administer medicines. Nurses and midwives who have successfully completed a further qualification in prescribing and recorded it on our register are the only people on our register that can prescribe.

For more information, please visit: www.nmc.org.uk/standards

19 Be aware of, and reduce as far as possible, any potential for harm associated with your practice

To achieve this, you must:

19.1 take measures to reduce as far as possible, the likelihood of mistakes, near misses, harm and the effect of harm if it takes place

19.2 take account of current evidence, knowledge and developments in reducing mistakes and the effect of them and the impact of human factors and system failures (see the note below)

19.3 keep to and promote recommended practice in relation to controlling and preventing infection

19.4 take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care and the public
Human factors refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety - Health and Safety Executive. You can find more information at www.hse.gov.uk
Promote professionalism and trust
20 Uphold the reputation of your profession at all times
You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other health and care professionals and the public.

To achieve this, you must:

20.1 keep to and uphold the standards and values set out in the Code

20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment

20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people

20.4 keep to the laws of the country in which you are practising

20.5 treat people in a way that does not take advantage of their vulnerability or cause them upset or distress

20.6 stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers

20.7 make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way

20.8 act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to

20.9 maintain the level of health you need to carry out your professional role

20.10 use all forms of spoken, written and digital communication (including social media and networking sites) responsibly, respecting the right to privacy of others at all times

For more guidance on using social media and networking sites, please visit: www.nmc.org.uk/standards

21 Uphold your position as a registered nurse, midwife or nursing associate

To achieve this, you must:

21.1 refuse all but the most trivial gifts, favours or hospitality as accepting them could be interpreted as an attempt to gain preferential treatment

21.2 never ask for or accept loans from anyone in your care or anyone close to them

21.3 act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with, including people in your care

21.4 make sure that any advertisements, publications or published material you produce or have produced for your professional services are accurate, responsible, ethical, do not mislead or exploit vulnerabilities and accurately reflect your relevant skills, experience and qualifications

21.5 never use your status as a registered professional to promote causes that are not related to health

21.6 cooperate with the media only when it is appropriate to do so, and then always protecting the confidentiality and dignity of people receiving treatment or care

22 Fulfil all registration requirements

To achieve this, you must:

22.1 meet any reasonable requests so we can oversee the registration process

22.2 keep to our prescribed hours of practice and carry out continuing professional development activities

22.3 keep your knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop your competence and improve your performance

For more information, please visit: www.nmc.org.uk/standards

23 Cooperate with all investigations and audits

This includes investigations or audits either against you or relating to others, whether individuals or organisations. It also includes cooperating with requests to act as a witness in any hearing that forms part of an investigation, even after you have left the register.

To achieve this, you must:

23.1 cooperate with any audits of training records, registration records or other relevant audits that we may want to carry out to make sure you are still fit to practise

23.2 tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty of, a criminal offence (other than a protected caution or conviction)

23.3 tell any employers you work for if you have had your practice restricted or had any other conditions imposed on you by us or any other relevant body.

23.4 tell us and your employers at the first reasonable opportunity if you are or have been disciplined by any regulatory or licensing organisation, including those who operate outside of the professional health and care environment
When telling your employers, this includes telling (i) any person, body or organisation you are employed by, or intend to be employed by, as a nurse, midwife or nursing associate; and (ii) any person, body or organisation with whom you have an arrangement to provide services as a nurse, midwife or nursing associate. For more information, please visit our website at www.nmc.org.uk
23.5 give your NMC Pin when any reasonable request for it is made

24 Respond to any complaints made against you professionally

To achieve this, you must:

24.1 never allow someone's complaint to affect the care that is provided to them

24.2 use all complaints as a form of feedback and an opportunity for reflection and learning to improve practice

25 Provide leadership to make sure people's wellbeing is protected and to improve their experiences of the health and care system

To achieve this, you must:

25.1 identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first
Throughout their career, all our registrants will have opportunities to demonstrate leadership qualities, regardless of whether or not they occupy formal leadership positions.
25.2 support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken

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Read the NMC Code, code of conduct for nurses and midwives, online

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British Institute of Learning Disabilities resource page

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This section has resources from a range of organisations in these subject areas:

If you can recommend any information about people with learning disbilities that would be useful to others, please let us know at enquiries@bild.org.uk

You may be interested in the links to easy read resources in the Easy Read section of this web site.

Pilot programme helps new mums

New mothers with learning difficulties have benefited from a pilot programme that helped them learn to care for and interact with their babies, an evaluation by University of Bristol experts has found.

As well as meaning the mothers who took part were better-equipped to look after their children and reported changes including increased confidence, better life choices and more positive engagement with services, the additional support they received through the programme also provided potential cost savings for local authorities on child safeguarding, care proceedings and provision.

Download the parent pioneers pilot programme evaluation

Download 'Inclusive support for parents with a learning disability' by Mencap

Find out more about working together with parents network from The University of Bristol

Guidance on legislation for childcare

Barrister Steve Broach has written a guide for parents of children with disabilities based on the childcare laws which currently exist in England. The guide outlines the rights of children, the childcare that they are entitled to, and the reasonable adjustments which have to be provided by local councils to allow them to attend childcare services.

Helping pave the way to an ordinary life for children with extraordinary needs...

New problem-solving toolkit for parents

This toolkit aims to support people with disabilities and carers, as well as their families and advisers, who are encountering difficulties with the statutory agencies in relation to the provision of health, social care and education support services.

This toolkit aims to unpick these problems and to develop effective strategies for resolving them. The toolkit was compiled by Professor Luke Clements, Cerebra Professor of Law and Social Justice so offers an in-depth look at family's rights but presents it in a clear "jargon busted" format.

KIDS launches recources for the SEN reforms

Guide to Supported Parenting

The Scottish Commission for Learning Disability has produced a practical and strategic guide to developing a supported parenting approach for parents with learning disabilities. The Guide:

Outlines important issues inherent in developing a supported parenting approach

Highlights key factors of a supported parenting approach

Outlines good practice in supported parenting

New Cerebra guide on transition

Cerebra, the charity for children with neurological conditions, has published a new guide for parents and carers on 'Transition to Adulthood' which aims to help parents of young people with disabilities and/or special educational needs manage their child's transition into adulthood so that the social care, education and health needs of their child are met and sustained throughout this process and into the young person's adult life.

Find out more on the Cerebra website.

Rare Chromosome disorders - Practical Guides for Families

Unique have been collecting information to help families affected by rare chromosome disorders with practical daily living and have produced a series of information guides on a variety of topics from communication to grants and funding. Unique does its best to keep abreast of changing information and to review its published guides as needed.

Find out more on their website.
Working Together with Parents Network
The network supports professionals working with parents with learning difficulties and learning disabilities and their children through: A UK-wide Network for professionals sharing positive practice; Working at policy level, they have a national taskforce; a parents' network co-ordinated by CHANGE.

The network is supported by a wide range of organisations including the Norah Fry Research Centre, CHANGE, Family Action, the Scottish Consortium for Learning Disabilities and Learning Disability Wales.

Find out more on the Network's website.

There are country specific websites for Scotland and Wales.
Good practice guidance on working with parents with a learning disability
Good practice guidance, published by the Department of Health in 2007, including a summary of relevant legislation and policy, on how adult and children's services should work together to improve support to parents with a learning disability and their children.

Download the report from their website.

Voiceability Parents Booklet

Written for, and by, parents who have learning disabilities, this booklet tells you what happens if Children's Services feel your child is at risk of harm.

The booklet explains in easy to understand words and pictures:

Who normally makes decisions about child protection

What happens when Children's Services get involved

The Child Protection Process

What happens at different meetings

Emergency Protection Orders

What happens in court

Different legal orders

Adoption and Fostering processes

Download the booklet from the Voiceability website.

Social Care Institute of Excellence research briefing 14: Helping parents in their role as parents

The topic of this briefing is parents with intellectual or learning disabilities and the support they may need to help them as parents. It summarises the policy, guidance and research literature on how parents with learning disabilities may be supported in their efforts to provide the best possible type of parenting for their children.

Find out more on the SCIE website

Disability, Pregnancy & Parenthood International

Disability, Pregnancy & Parenthood International is a UK national information charity on disability and parenthood and the publisher of the international journal on disabled parenting, 'Disability, Pregnancy & Parenthoood international'.

In November 2011 they published 'Supporting parents with learning disabilities and difficulties: a starting point', which brings together details of the resources available to professionals working to support parents with a learning disability. It also provides a brief introduction to the main issues faced by parents with learning disabilities.

Find out more on their website.

"Growing up with Down's syndrome", a series of films which demonstrate activities for babies and toddlers

Movimento Down, Brazil, have produced 12 films which show activities for babies and toddlers guided by physiotherapist Alexandra Wakahara. The short films describe activities and supports for children from birth to 3 months, 6 to 9 months, 9 to 12 months and for children older than 12 months.

Movimento Down have supported the video's translation into English so that even more people can watch the films. More >

Parenting Toolkit - helping Partnership Boards meet the needs of people with learning difficulties

A Toolkit to help Partnership Boards look at the support and services that are offered to parents with learning difficulties, helping them to check how good they are. You can read the toolkit on screen or download it as a PDF.

Find out more on the London Network of Parents with Learning Difficulties website

Starting Primary School: For parents who have learning disabilities

'Starting Primary School' is a new DVD produced by SCLD for parents with learning disabilities who have pre-school age children. It gives them first hand practical advice to help them navigate their children's transition to primary school.

Watch the video online

School funding changes and children with SEN in mainstream schools: a briefing for parents
This briefing from the Council for Disabled Children provides information about the school funding changes and explains what you should do if a school or local authority proposes to change the special educational provision for your child.

Disabled children In the Picture

Scope's "In the Picture" campaign is about encouraging publishers, illustrators and writers to embrace diversity - so that disabled children, are included alongside other in illustrations and story lines in books for young readers. The "In the Picture" website has lots of resources for children and professionals including stories, images, fact sheets and a reading list of picture books that feature disabled characters.

Find out more about the campaign

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In Control
In Control is a national charity. Their mission is to create a fairer society where everyone needing additional support has the right, responsibility and freedom to control that support.

They have a lot of information and resources about individual budgets and self-directed support.

They have pages of fact sheets here and audio versions here.

Think local, act personal
Think local, act personal is a group of over 30 national partners that are committed to real change in adult social care. Their goal is for people to have better lives through more choice and control over the support they use: often referred to as "personalisation". They represent a wide range of organisations - from people who use services and carers, to the providers of services and representatives from central and local government.

Find out more on their website.

One of their publications, Best Practice in Direct Payment Support: A guide for commissioners, describes how to commission really good direct payments support by showcasing examples of innovative practice.

Download from the Think local, act personal website.
SCIE Report 20: Personalisation - a rough guide
This publication aims to tell the story so far about the personalisation of adult social care services. It is intended to set out our current understanding of personalisation and its implementation, exploring what personalisation is, where the idea came from and placing the transformation of adult social care in the wider public service reform agenda.

Find out more on the SCIE website.
A Positive approach to risk and personlisation - a framework
Commissioned by the West Midlands Joint Improvement Partnership, this provides a framework for Councils in shifting the balance away from risk aversion towards supported positive risk taking. The aim is to share risk between the individual using services (regardless of funding source), their family, carers, professional care staff, third parties and the Council.

Download the report.

Carers and personalisation study by the SPRU

The Social Policy Research Unit examined how current English adult social care practice balances the interests of service users and family carers, in assessment, planning, on-going management and reviews of personal budgets, particularly when budget-holders have cognitive or communication impairments. The study examined senior local authority perspectives, everyday practice by frontline staff and experiences of service users and carers.

According to the study, carers' involvement in assessments, support planning and reviews for personal budgets (PBs) lacks clarity and consistency. In most councils surveyed, service user assessment guidance reminded practitioners to ask about carers' 'willingness' and 'ability' to provide support. However, there was little guidance on carers' roles in support planning or on-going PB management.

Download the report summary from the SPRU website

Service users, not social workers, should lead support planning

A report from the Groundswell Partnership says good support planning means people need to have plans which they can evolve at their own pace, and to be meaningful, the process of planning needs to help people explore how to achieve the things that are important to them and to stay safe at the same time. Unfortunately, such planning is often considered time intensive, expensive and unrealistic in the current financial climate. The report puts forward a planning process, called Empower and Enable, which is a people led approach to support planning.

Download the report here
Positive Behaviour Support in Residential Care webinar
BILD ran a webinar for Action for Children on 'Positive Behaviour Support in Residential Care: Making good decisions within the legal framework' by Action for Children and the Centre for the Advance of Positive Behaviour Support (CAPBS). This is now available to watch here >

The webinar was commissioned by the Children's Homes Quality Standards Partnership and delivered by Phil Howell, BILD Accreditation Scheme Manager and Sarah Leitch, Development Manager for the CAPBS.

"The simple existence of a Behaviour Support Plan is not enough"

In the Positive Behavioural Support Competencies Framework for the UK, there is a central role for a document called a Behaviour Support Plan (or BSP), says Professor Richard Hastings in his blog.

This document is the culmination of the process of detailed assessment, including work with people whose behaviour is being described as challenging and their carers.

The PBS competencies framework is very clear about all of the work that needs to go on around the BSP to ensure that PBS is going to be done properly. Thus, BSPs are important but they are not the whole of PBS.

Positive Approaches: Reducing Restrictive Practices in Social Care

This learning resource aims to provide an understanding of how to work using positive and proactive approaches and reduce the use of restrictive practices in social care.

It is relevant to all of those who provide social care and support to adults and children and young people.

Excellent accessible and useful resources from the Massachusetts Department of Mental Health available here >

The safety tools are frequently used in CAPBS' PBS programmes to help people develop more collaborative Behaviour Support Plans with children and young people.

Anyone who has a copy of John Clements' book, 'Assessing Behaviors regarded as problematic for people with developmental disabilities', Clements, JC and Martin, JKP (you can get it on Amazon) or who was lucky enough to attend any of his training, will know how empathic his approach to assessment and working with people that provide direct support was.

John has now sadly retired but has given permission for his assessment document to be shared - he is happy for people to change or update it if they find it useful.
Download the resource

Tizard

Tizard have created an Easy Read booklet to explain what Positive Behaviour support is and why it should be included in service specifications. The booklet includes information on Behaviour that challenges services and the reasons why people exhibit challenging behaviour, as well as what a support plan is and how it can be implemented into an organisation.
Department for Education advice
Advice from the Department for Education published April 2012, aimed at governing bodies, head teachers and school staff in all schools:

Use of reasonable force: provides clarification on the use of force to help school staff feel more confident about using this power when they feel it is necessary and to make clear the responsibilities of head teachers and governing bodies in respect of this power.

Screening, searching and confiscation: explains the use of the power to search pupils without consent. It also explains the powers schools have to seize and then confiscate items found during a search. It includes statutory guidance which schools must have regard to.

Challenging Behaviour Foundation

Services for children and young people with learning disabilities who display challenging behaviour - Well matched and skilled staf is aimed at commissioners of children's services and was written by Dr Sarah Bernard, in collaboration with the Challenging Behaviour National Strategy Group.

An accompanying resource for commissioners of adult's services Services for adults with learning disabilities who display challenging behaviour - Well matched and skilled staff was written by Dr Peter Baker, in collaboration with the Challenging Behaviour National Strategy Group.

Positive Behavioural Support: a learning resource

The learning resource is based on a pilot training programme developed for NHS Education for Scotland (NES) by Edinburgh Napier University, The Learning Disability Managed Care Network and The Forensic Network School of Forensic Mental Health. The resource aims to equip participants with knowledge in positive behaviour support (PBS) and to help participants begin to identify how they could use PBS in their practice, to support positive behavioural change to improve the lives of people with a learning disability.

Positive Behaviour Support and Active Support

'Positive Behaviour Support and Active Support: Essential elements for achieving real change in services for people whose behaviour is described as challenging' is a report produced by The Avenues Group, United Response and the Tizard Centre. Its purpose is to demonstrate the extent to which Active Support underpins the effective implementation of Positive Behaviour Support and the role it can play in supporting people with challenging behaviour.

Positive Behavioural Support Competence Framework

The UK PBS Competence Framework provides a detailed framework of the things that you need to know and the things that you need to do when delivering best practice PBS to persons with intellectual disabilities and behaviours that challenge.
Physical Restraint Direction Paper -
Supporting people to achieve dignity without restraints
A policy direction document for the Australian State of Victoria outlining a move away from use of physical restraints.

"Prohibition on the use of physical restraint on people with a disability who are receiving a disability service provided by a disability service provider."

Download the document.

See also the BILD Positive Behaviour Resources page on this website.
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New bereavement and loss learning resource pack

PAMIS' Bereavement and Loss Learning Resource Pack consists of two separate units and a DVD. The first Unit focusses on supporting bereaved people with profound and multiple learning disabilities (PMLD). The second unit is about supporting bereaved parents and carers who have cared for a person(s) with profound and multiple learning disabilities.

Find out more and download the Bereavement and Loss learning resource pack.

Involve Me aims to increase the involvement of people with profound and multiple learning disabilities (PMLD) in decision making and consultation. The resource is the result of a three year project, supported by the Renton Foundation and run by Mencap in partnership with the British Institute of Learning Disabilities (BILD).

Find out more and download the Practical Guide to Involving People on the Mencap website

Understanding the lives and needs of people with profound and multiple learning disabilities in Lambeth

Family carers in Lambeth said that people with PMLD were not getting the support and services they needed to have a good life. They took this concern to Lambeth learning disability partnership board. The board agreed that a piece of collaborative work, focusing on the needs of people with PMLD in the area, would be a valuable step in improving the lives of people with PMLD and their families in Lambeth.
Download a copy of the report from the PMLD Network website
Working with People who have a Learning Disability and Complex needs - the essentials

This learning resource has been developed by Edinburgh Napier University, The University of Stirling and The Learning Disability Managed Care Network. The resource aims to offer workers supporting people with a learning disability and complex needs opportunities to develop their knowledge, skills and values in ways that maximise the involvement of service users and families and increase health and wellbeing. To promote the provision of support that maximises quality of life, choice, opportunity and capability.

Download the resource

Bag Books - multi-sensory stories

Bag Books is the only organisation in the world publishing multi-sensory books specifically for people with learning disabilities. Each year they reach around 19,000 children and adults throughout the UK with Profound and Multiple Learning Disabilities, Severe Learning Disabilities or severely affected by Autistic Spectrum Disorder.

Their main activities are:

the design and production of a range of multi-sensory books

providing specialist multi-sensory storytellers

training others (parents, carers, librarians and teachers) in multi-sensory storytelling technique

Find out more about Bag Books Raising our Sights guides

Mencap and the PMLD Network have produced a series of how-to guides and films to help local areas meet the needs of people with profound and multiple learning disabilities (PMLD), funded by the Department of Health.

Download the guides from the Mencap website

PAMIS - A Better Life

A publication to celebrate the 20th birthday of PAMIS. This booklet showcases the services, projects, campaigning work and research that PAMIS has carried out over the last two decades and continues to do so. The booklet highlights, through the many colourful images and accompanying text, how people with complex needs are valued as both individuals and the contribution they make to the community.

The publication is available to download from the PAMIS website

"If you listen you will hear us"

"If you listen you will hear us" is an innovative film which explores effective communication measures for people with profound and multiple learning difficulties. It is important to have consistent staff and treat each person as unique, a staff member from the film says, as well as using a wide range of approaches and activities to explore how the individual communicates best. Measures to improve communication shown in the film include using a communication passport and sensory story telling, which helps to detect how people are feeling. The film was commissioned by Leicestershire learning disability partnership boards.

Watch the film here

Fire Safety

A 'Fire 999' DVD in which all the cast have a learning disability, developed by Devon & Somerset Fire & Rescue Service is proving a useful resource in delivering consistent and accurate fire safety training. The DVD is divided into four short sections to encourage interactive Q&A sessions throughout. It explains what to do in a fire and more importantly how to prevent a fire occurring in the first place, as well as what to expect from a home safety visit from the Fire Service.

For further information on the DVD please email Dave Evans on devans@dsfire.gov.uk.

Speak Up Self Advocacy group have created a range of easy read resources to help protect people against the hazards of fire. The aptly named 'No smoke without fire' resources include a 'socket overload calculator' which demonstrates how easy it is to overload power sockets and a downloadable booklet which explains how fires are started, what to do in the case of a fire and how to spot fire hazards.

Find out more information

The Childnet STAR Toolkit is a free online resource that offers practical advice and teaching activities to help secondary schools explore internet safety with young people with autism spectrum disorders. The Toolkit is free to download online and the teaching activity ideas are provided in Word so you can edit and adapt them to suit your learners.

Find out more information

Safesurfing - Internet Safety

The internet is useful in many ways, however sometimes there can be risks and dangers, such as stolen personal data and cyber bullying. People with a learning disability are especially at risk of being hurt, so to tackle this, the SafeSurfing project created its own internet safety training. This training aims to support people with a learning disability to know what personal information they should share online, how to protect their personal data, and surf the web safely. The training is broken down into the following modules:

How to use the internet safely and protect my personal data

Dangers of the internet

How to stay safe using the internet and apps

Facebook and browser safety

Summary of what we have learnt

A Local Experience of National Concern

The aim of producing this report was to contribute to the debate about how extremely vulnerable people with learning disabilities, autistic spectrum disorder and mental health needs or challenging behaviours can be better supported and safeguarded by providing information, advice and support to their families.
Download the report
My keep safe checklist

Challenging the media and staying safe online

The Foundation for People with Learning Disabilities are calling for a change to the language used about people with learning disabilities and the way they are represented in the media, in order to tackle the increase in bullying, harassment and hate crime. They have also produced two guides to provide tips and advice to help people with learning disabilities stay safe, 'Staying Safe on Social Media' and 'Staying Safe Out and About'. The Foundation has also developed a guide for broadcasters to help them improve how they represent people with learning disabilities in the media.

Find out more information

Care Council app and online training to enhance care worker knowledge
The Care Council for Wales has launched an app, Safeguarding - Test Your Knowledge, to help staff and volunteers in adult and children's care services check their safeguarding know-how. They've also launched an online training course Effective Supervision in Social Care, an e-learning training package for new and aspiring social care managers that aims to help them effectively supervise staff. Find out more

Safeguarding Adults: The role of health services

These Department of Health documents remind health services of their duties to safeguard adults. They assist NHS commissioners, health service managers and practitioners in preventing and responding to neglect and abuse, focusing on patients in the most vulnerable situations. The documents include good practice principles and examples.

Hidden in Plain Sight: Patient safety and Southern Health NHS Foundation Trust

George Julian from the Justice for LB campaign team has posted a blog post analysing the Southern Health NHS Foundation Trust's Annual Report 2014/15 section on quality.

In a review of the performance for clinical quality which stated "Serious incidents requiring investigation (SIRIs): Incidents resulting in serious harm not common. 396 out of a total of 12499 incidents", George responded by writing "Not common? Who is defining not common? What parameters are being used here? There has been no change in the number of incidents resulting in serious harm in four years - that isn't exactly great evidence of Katrina's passionate quality team being able to demonstrate any progress."

Read George's blog

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Children with learning disabilities at risk of sexual exploitation
Children with learning disabilities are more vulnerable to sexual exploitation than other children, facing additional barriers to their protection and to receiving support, new research published this week has revealed.

This issue is particularly hidden because few children with learning disabilities meet high thresholds for support from services. There is also limited awareness that young people with learning disabilities are sexually exploited.

The report, 'Unprotected, Overprotected: meeting the needs of young people with learning disabilities who experience, or are at risk of sexual exploitation', was commissioned by Comic Relief, and undertaken by Barnardo's, The Children's Society, BILD, Paradigm Research and Coventry University.

Safer Relationships Toolkit

Options for Life worked in partnership with BILD and a grant from Sandwell Early Help Innovation Fund to create a 'Safer Relationships Toolkit'.

There are seven individual sessions aimed to support adults with learning disabilities to keep themselves safe in the relationships they make. Each session contains a plan with discussion questions, scenarios and group activities. This plan can be used as a guide and adapted to each individual's needs or interests.

The sessions can be carried out in a small groups or 1-1 setting as appropriate, and can be part of a series of workshops or one off for a specific topic. Sessions available:

It's not on the radar: The hidden diversity of children and young people at risk of sexual exploitation in England

In 2015, a series of four roundtables was held with experts in the fields of Child Sexual Exploitation (CSE) and diversity to discuss how the two areas connect. The round tables focused on boys and young men, lesbian, gay, bisexual, trans and questioning young people, disability and ethnicity and faith.

Bringing together the findings of the roundtable events and additional research, the report, 'It's not on the radar', explores how perceptions of sexual exploitation can affect the identification of and response to CSE.

Framework launched to support work with harmful sexual behaviours

NSPCC, in collaboration with Research in Practice, youth justice agencies and council leaders, have developed a new online framework to support a shared understanding, consistent approaches and improved practice when dealing with children and young people displaying harmful sexual behaviour.

The framework contains a set of auditing tools and standards for local authorities to use to assess current service provision and identify where improvements are needed.

Help people with disabilities find love!

Fitzroy Love4Life aim to end loneliness and help people with disabilities find love and lifelong relationships.

'Love is stronger' a message from Fitzroy's short but striking video.

Watch the video and find out more.

Supporting people with learning disabilities to develop sexual and romantic relationships

Despite laws, policies and guidance it is clear that people with learning disabilities continue to face barriers to building and developing relationships.

In order to understand more about the reasons for this and what can be done to support people to develop relationships, the National Development Team for Inclusion have conducted a short review of the evidence and information available. In particular, the report focuses on the following two key questions:

What are the barriers or challenges to people with learning disabilities developing sexual/romantic relationships?

What works to support people with learning disabilities develop sexual/romantic relationships?

Scope's Romance Classics #EndTheAwkward

Scope have released swoonsome recreations of iconic Mills & Boon book covers - starring people with disabilities.

Find out more information.

A to Z of sex and disability

The A to Z of sex and disability is a raunchy and light-hearted look at the loves and lusts of people with disabilities in Britain today. Too often people assume that people with disabilities don't have fulfilling sex lives and relationships. Nothing could be further from the truth! It's time to End the Awkward and get it on.

Find out more information.

People with learning disabilities want to find love too

"I am married. I am in love. I also happen to have a learning disability - this shouldn't matter"

"As soon as I set eyes on Helen, I knew she was the one for me. I have a learning disability and never thought I could have a relationship with someone. I proposed to Helen after two and a half years together, and we got married in 2014.

I always dreamt about getting married, so my wish came true in the end. I tell this story as I want other people with a learning disability to realise they can have relationships as well. There are not enough role models out there, and I want to show that my disability doesn't stop me from living the life I choose.

Read the article.

Easy-read guide to contraception

An easy-read guide to methods of contraception and sexual health has been created for people who have a learning disability. The guide, with information shown mostly as pictures, has been developed by organisations in Plymouth for those working with people who have a learning disability to help initial discussions.

To find out more email info@eddystone.org.uk

Anti-Bullying Alliance guide in 'Tackling homophobic, biphobic and transphobic bullying for disabled children and young people and those with special educational needs'

Pupils who have a disability or have learning difficulties are significantly more likely to experience homophobic bullying than their mainstream classmates, according to a charity which has produced a guide for teachers on tackling the problem.

Information about sexuality, safe sex and contraception for people with learning disabilities from the Family Planning Association.

All the resources in this range of materials - including the award-winning 'All About Us' CD or DVD - can be used by teachers and other professionals working with people with learning disabilities, as well as by their parents and carers. 'All about us' and 'Talking together' ... books can be used by people with learning disabilities, either with support or on their own.

Relationships, sexual health and parenting resource for young people with autism spectrum disorder

This extensive resource, produced by Learning and Teaching Scotland aims to help those involved in delivering sexual health and relationships education to those with an autism spectrum disorder by giving autism-specific advice aimed primarily, but not exclusively, at mainstream secondary school staff to encourage innovative, individualised and creative teaching and giving guidance on the different approaches that can be taken to support individuals with an autism spectrum disorder.

Find out more and download it from their website.

Useful resources on LGBT identities, gender, sexuality, sexual health and relationships

This resource includes an extensive range of information relating to LGBT identities, gender, sexuality, sexual health and relationships including:

Easy read and accessible resources

General LGBT guides, resources and services

Information and support for parents, carers and family members

Further reading and resources for professionals

Other resources

All the resources in this range of materials is provided by George Burrows from LGBT Health and Wellbeing.

Connect talk to us about relationships and safe sex

Connect is a comprehensive sexual health service, for people of all ages who have learning difficulties or Autistic Spectrum Disorder (ASD). It is held at The Wolverton Centre at Kingston Hospital which is a dedicated sexual health centre.

Connect offers testing and treatment for STIs, HIV testing, cervical smear tests, free condoms, pregnancy testing and more.

For further information download the leaflet >

Child sexual exploitation: support for 16- and 17-year-olds must improve

A report by the Children's Society, 'Old enough to know better?', found that many sex crimes against older teenagers in England and Wales in the past year went "unreported and unpunished" because victims were afraid they wouldn't be believed by the justice system, feared going to court or did not consider it worth reporting.

Social workers have been urged to improve their support for 16- and 17-year-olds affected by child sexual exploitation in a week where new figures showed huge under-reporting of sexual offences among this age group.

More information is available on the website.

Download The Children's Society report.

Guide to tackle homophobic, biphobic and transphobic and bullying for young people with disabilities and those with special educational need

Pupils who have a disability or have learning difficulties are significantly more likely to experience homophobic bullying than their mainstream classmates, according to a charity which has produced a guide for teachers on tackling the problem.

The Anti-Bullying Alliance's new guide, 'Tackling homophobic, biphobic and transphobic, bullying for disabled children and young people and those with special educational needs' recommends that:

Teachers must take reports of bullying seriously. Pupils often say that they are not believed when they report bullying

Teachers deliver sex and relationships education that mentions both homosexual sex and also sex among people with disabilities

Teachers discuss being LGBT in school, as well as being LGBT and with a disability

Download the Anti-Bullying Alliance >

Report shows people are still being let down 5 years on from Winterbourne

Five years on from the Winterbourne View scandal, a Royal College of Nursing report shows people with learning disabilities are still being let down. The report shows that since 2010 the learning disability nursing workforce in England has been cut by a third. That's a total of 1,700 posts, a third of which are senior nurses. More >

Download the RCN report >

Download the Easy Read version of the RCN report >

The size and structure of the adult social care sector and workforce in England, 2011

Produced by Skills for Care, this report aims to provide a comprehensive overview of the size and structure of the adult social care sector and workforce in England as at 2010.

It shows, among much else, that the number of jobs in adult social care in England in 2010 was estimated at 1.77 million and is projected to grow by between 24% and 82% between 2010 and 2025.

Download the report.

Skills for Care adult social care Management Induction Standards

The Skills for Care adult social care Manager Induction Standards (MIS) are aimed at those new to management as well as those new in post who have previously managed other care services. They are also intended for aspiring or potential managers to help support their development, although evidence of having met some of the standards will require actual management experience.

The standards can to be used in a wide range of settings, including people who manage their own services and micro-employers, as well as small, medium and large organisations across the public, private and voluntary sectors.

Although these MIS are not mandatory in the same way as the Common Induction Standards, they are definitely a measure of good practice and Skills for Care recommend that new managers should normally have demonstrated all the knowledge requirements of the recommended core standards within six months of taking up a management role.

Find out more and download the Standards from the Skills for Care website.

Health and Safety Executive www.hse.gov.uk

The Transition Information Network
The Transition Information Network (TIN) is an alliance of organisations and individuals who come together with one common aim; to improve disabled young people's experience of transition to adulthood. TIN provides information about transition through its website, magazine, e-bulletin and seminars. It is free to become a member of TIN.

Find out more on their website.

Young people in transition: guide
Preparing for adulthood
The Preparing for Adulthood programme is delivered by a partnership between the National Development Team for inclusion, the Council for Disabled Children and Helen Sanderson Associates.

The partnership brings together a wide range of expertise and experience of working with young people and families at a local and national level and across government, to support young people into adulthood with paid employment, good health, independent living, community inclusion.

Find out more on their website.

2015 report on the needs of young persons with intellectual disabilities transitioning to adulthood

The ''Young Adults with Intellectual Disability' (YAID) project issued by Bitlis and Inclusion Europe, aims to fill the gap created by the lack of services provided during the transition to adulthood by identifying the main problems faced by young adults with intellectual disabilities and their families. The report, 'A compass to develop services for families with disability', highlights the desire for independence for young people with learning disabilities and support services for their families.

Download the report issued by YAID

Ofstead: Progression post-16 for learners with learning difficulties and/or disabilities

This survey, published in August 2011, evaluates the arrangements for transition from school and the provision in post-16 settings for learners with learning difficulties and/or disabilities up to the age of 25. Through visits to 32 providers and the completion of 111 detailed case studies, inspectors assessed the effectiveness of provision in enabling learners to develop greater independence, and progress to further learning or open or supported employment.

Download from the Ofstead website.
Read an Ofstead overview of this study

Getting a Life

The Getting a Life programme ran from April 2008 to the end of March 2011, as part of the Valuing People Now employment work.

It was set up to show what needs to happen so that young people with a severe learning disability achieve paid employment and full lives when they leave education.

The central programme team has now disbanded, but the people who have been involved in the local projects are continuing their work to improve employment opportunities for young people with learning disabilities in each area.

Find out more on the Getting a Life website.

Pathways to getting a life

This document brought together what was learned about transition
from Valuing People and Valuing People Now during the past 10 years, and in particular from Getting a Life. It sets out clearly the key things that need to happen to support young people to move into adulthood, with the information, experiences, confidence and skills they need to fulfil their aspirations, enjoy equal opportunities and have good lives.

Download Pathways to getting a life.

Info packs on the SEND Pathfinder Programme

The Pathfinder Support Team have published the second set of information packs on the SEND Pathfinder Programme. The packs include evidence of good practice from across Pathfinders including case studies and helpful resources.

Each pack pulls together resources from across the pathfinder programme to cover the six principal themes pathfinders have been working on: Preparing for adulthood; 0 - 25 coordinated assessment and EHC plans; Personal budgets; Local offer; Joint commissioning; and Participation and engagement with children, young people, parents and carers.

Download the packs from their website

SEN and disability best practice and information

Preparing for Adulthood produce a monthly e-bulletin that contains updates from the PfA programme, information about the wider SEND programme, and updates from work in pathfinders and other local areas. Each issue also focuses on one of the four PfA outcomes: Paid Employment, Independent Living, Good Health and Community Inclusion.

Read the Preparing for Adulthood monthly e-bulletin

Whizz-Kidz launches free smartphone app

Designed with disabled children, young people and their families in mind, this allows users to view mobility equipment available from Whizz-Kidz, discover additional Whizz-Kidz's services, such as wheelchair skills training, and find out how they can get involved in fundraising and volunteering.

Find out more about the app on the Whizz-Kidz website

Mencap Best Practice Guide - Young People and Social Action

This guide is for anyone who works with young people or who provides services for them, as well as young people and their friends, families and carers. This guide demonstrates the difference young people with a learning disability can make to their own lives and to the communities they live in. It provides tips, case studies and resources to help you understand what you can do to support them. The guide will help those who work with young people to see similar positive change in the groups they support, their communities and organisations.

Download Mencap's Best Practice Guide from their website

Children's Views on Restraint (2012)

In 2004 Ofsted asked children for their views about physical restraint and published their last report about this. Children have raised concerns about restraint in consultations they have held about other things since then, and they decided they should carry out a follow-up consultation to check what children now think about restraint. So they consulted children again this year to find out their views and concerns about restraint. This report gives their views in 2012.

Download the report from the Ofsted website
Emotional Wellbeing

YoungMinds is the UK's leading charity committed to improving the emotional wellbeing and mental health of children and young people. The site provides helpful information for young people, parents and professionals. Young people who think they may have mental health problems or want to know more about the topic will find useful sections on, for example, rights, being heard and getting support, as well as information on common mental health issues.

Find out more on the YoungMinds website

Disabled children In the Picture

Scope's "In the Picture" campaign is about encouraging publishers, illustrators and writers to
embrace diversity - so that disabled children, are included alongside other in illustrations and story lines in books for young readers. The "In the Picture" website has lots of resources for children and professionals including stories, images, fact sheets and a reading list of picture books that feature disabled characters.

Find out more about the campaign on Scope's website

New Resources: A Pathway for Children

The Challenging Behaviour Foundation has been working with the National Development Team for inclusion to develop three new resources setting out a vision of future local pathways for children with learning disabilities and/or autism whose behaviours may challenge.

Find out more information.

A practical guide to learning and development for personal assistants

Skills for Care have produced a guide to learning and development for personal assistants. There is an interactive guide answering questions about learning new skills, informs on a range of issues in employing a personal assistant. It also includes learning topics that may be useful to your own development, as an employer. Download the guide

Visit the Skill for Care's website

See Skill for Care's Frequently Asked Questions on funding to pay for learning and development.

HEE responds to review on developing the future care workforce but not enough dealing with learning disability nursing

Health Education England (HEE) has published its response to Shape of Caring review 'Raising the Bar', which explored how nurse and care assistant and training could be improved given their expanding and changing roles. Download the response >

VODG launch 'Thought Leadership' report about rising to the social care workforce challenge

The social care sector will need to fill around 400,000 jobs by 2035. In the light of this reality, how can providers create a competitive edge in local labour markets and transform the sector into a career of choice?

Following a summit held with over 100 chief executives and senior directors in the sector alongside Skills for Care and Charityworks, VODG have launched a new report rising to these challenges.

Find out more information.

Remploy online support chat

Remploy offer an online chat service to use for inquiries about employment and what to expect during the recruitment process. They also offer an online job search as well as interview tips and what to do to impress an employer.

Why I love my nursing job: a personal look at the profession

Seven nurses working in different sectors share their thoughts on what makes a career as a nurse so special. One of the nurses is Linda Phillips, a community learning disability nurse in Llanelli, Wales.

"I have always had an interest in working with people with a learning disability - even at school I used to volunteer at a youth club helping children with learning disabilities. Today I manage a caseload of people with learning disabilities who have additional health needs. I had a lady who was deaf because of wax in her ears; she was terrified of hospitals. With desensitisation, she was able to go into hospital and have an op - it made a huge difference to her."

Opening job opportunities to people with a learning disability

The Director of the NHS Learning Disability Employment Programme, Lela Kogbara, has introduced a new series of blogs which aims to share perspectives on employing people with a learning disability in the NHS.

"Over the next few months we'll be posting blogs on a wide range of topics from employers, carers, and people with a learning disability who are employed in the NHS, with the aim of sharing best practice and helping others find solutions to employing people within their organisations. We look forward to sharing their stories with you", said Lela.

New guide launched to help adults with learning disabilities find employment

Families sometimes do not know how to go about helping their family member with learning disabilities into paid work. This guide, produced by the Foundation for People with Learning Disabilities and the National Valuing Families Forum, offers valuable information to help families think about what they can do to support their family member.

Download the Getting a job guide here.

If you can recommend any information about people with learning disabilities that would be useful to others, please let us know at enquiries@bild.org.uk

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This section has resources from a range of organisations in these subject areas: If you can recommend any information about people with learning disbilities that would be useful to others, please let us know at enquiries@bild.org.uk You may be interested in the links to easy read resources in the Easy Read section of this web site.

# data[].attributes.body
A resource for seeing the most up to date lab analysis for Wales

# data[].attributes.body
A Wales and Europe wide UN Supported project

# data[].attributes.attachment_link.title
Our Rights to Have a Relationship - Learning Disability Wales

# data[].attributes.body
Organisation by learning disabled people, for learning disabled people increasing their access to equality in all forms

# data[].attributes.attachment_link.title
CHANGE - Learning Disability Rights Charity - Easy Read

# data[].attributes.attachment_link.description
CHANGE is a learning disability rights charity and accessible information expert. We consult on projects, offer training and accept Easy Read commissions.

# data[].attributes.attachment_link.title
End the Awkward | Disability charity Scope UK

# data[].attributes.attachment_link.description
Not enough people know or interact with disabled people. Because of that they panic, or worse, just avoid situations for fear of doing the wrong thing.

# data[].attributes.body
Created by Change to be easy access

# data[].attributes.body
UK based charity that supports and educates public about disability matters

# data[].attributes.attachment_link.readable_text
We use cookies on the Scope website to show us how many people our content is reaching.

It means we can:

See what content is most useful to people

Target more help where it's needed

Show relevant advertisements for our own services, no-one else's

It also means we can work more closely with partners in government, local councils and other public bodies, targeting support where it's needed most and offering a better range of services.

It's your choice whether to allow them or not, but you're helping us do more if you opt in. Thank you.

# data[].attributes.attachment_link.description
We're Scope, the disability equality charity in England and Wales

# data[].attributes.body
People with Learning Diffs discussing relationships

# data[].attributes.attachment_link.title
I can - have relationships (challenging assumptions about learning disabilities)

# data[].attributes.attachment_link.description
This myth busting film challenges the belief that people with a learning disability can't do many of the things that others take for granted. It aims to dispel those myths and shows how they can can live life to the full.

# data[].attributes.headline
Empathy Versus Sympathy in the provision of good health care (link to be used for access)

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Empathy Versus Sympathy in the provision of good health care (link to be used for access)

# data[].attributes.body
https://s3.amazonaws.com/academia.edu.documents/46433299/Empathy_and_Phronesis.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1513063896&Signature=vH39o0ZfuJw1nK6Ar%2Fw3Hl1eCJs%3D&response-content-disposition=inline%3B%20filename%3DEmpathy_as_a_necessary_condition_of_phro.pdf

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Systematic review of how screening could be a barrier to young people with learning difficulties

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Systematic review of how screening could be a barrier to young people with learning difficulties

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Marianne J. Webb 1 Email author ,

Sylvia D. Kauer 1,

Elizabeth M. Ozer 2, 3,

Dagmar M. Haller 1, 4, 5 and

Lena A. Sanci 1

BMC Family Practice BMC series - open, inclusive and trusted 2016 17:104

https://doi.org/10.1186/s12875-016-0504-1

Received: 22 January 2016

Accepted: 28 July 2016

Published: 4 August 2016

Abstract

Background

Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale.

Results

From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use.

Conclusions

There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence.

Keywords

Adolescent Screening Primary care Health compromising behaviour Mental health Prevention

Background

Health compromising behaviours and mental health in adolescence

Adolescence is an important developmental period for physical, cognitive, social and emotional growth. It is also a time when health and lifestyle habits and behaviours that influence adult health are initiated [ 1]. The terms adolescent, youth, teenager and young people are defined by different age ranges but also tend to be used interchangeably. A comprehensive overview of adolescent development presents a contemporary argument in favour of grouping these terms because the age range of 10 to 24 years captures the physical and psychosocial changes that typically occur in transition from childhood to adult maturity [ 1]. Hence, unless otherwise stated, the term young people is used in this article to refer to those aged 10 to 24.

In young people aged 10 to 24 substance use, poor diet, lack of exercise and mental disorders are the causes of significant disability [ 2]. Seventy-five per cent of mental illnesses begin before the age of 25 years with one in four young people experiencing mental health disorders, most commonly anxiety, affective disorders and substance use disorders [ 3]. These health compromising behaviours and mental health disorders are likely to co-occur and have the potential to adversely affect physical and mental health, and development [ 4].

Opportunities for detecting health compromising behaviours and mental health disorders in primary care

Barriers to screening for and intervening with health compromising behaviours and mental health disorders in primary care

The identification of emotional distress by primary care practitioners is highly correlated with young people recognising and expressing that they have a problem [ 18]. Apart from efforts to increase mental health literacy amongst young people, a screening framework that facilitates discussion of health and lifestyle is likely to increase disclosure and enhance engagement [ 19]. While screening for health compromising behaviours and mental health disorders do not strictly mirror screening for a disease process with a known pre-disease phase (for example dysplastic cells predating carcinoma in situ), peak health bodies recommend screening young people for health compromising behaviours and mental health disorders in primary practice [ 20- 22]. Screening facilitates early intervention or preventive counselling efforts as young people do not often volunteer these issues as concerns to their health care providers [ 7].

Available tools for screening for health compromising behaviours and mental health disorders and useful interventions

Screening typically does not occur in isolation and, as recommended by national guidelines, should be followed up with appropriate interventions such as motivational interviewing [ 32], referrals to specialty care [ 33] or the provision of health education materials [ 34]. There is evidence to suggest that interventions for specific detected health issues in young people can improve depression symptoms [ 35], decrease weight in the obese [ 36] and reduce sexually transmitted infections [ 37]. Given these advantages, screening followed up by appropriate intervention in the primary care setting can be conceptualised as a health promotion strategy.

Evidence for benefits of screening and intervening for multiple and commonly co-occurring health compromising behaviours and mental health disorders

Despite the potential benefits of screening for and intervening with multiple and commonly co-occurring health compromising behaviours and mental health disorders, there have been few studies that investigate the actual health impacts of interventions across multiple behavioural or risk areas. One systematic review of clinical trials by Moyer et al. [ 38] found that there was limited evidence to support screening and preventive interventions in young people and called for more studies in the area. A more recently published systematic review by Hale et al. [ 39] found that interventions for multiple risk behaviours were effective and comparable to those interventions targeting single risk factors. However, this review excluded terms for primary care and did not include young adults aged 20 to 25, who have a higher prevalence of significant health risks compared to younger adolescents [ 40]. Given that preventive care of young people continues to be recommended as best practice to primary care practitioners [ 21, 22], and central to well-care visits, it is timely to update the evidence in this setting.

This systematic review aims to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people.

Methods

A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [ 41] and registered on the PROSPERO website ( http://www.crd.york.ac.uk/prospero/ , registration number CRD42013005828). A search was conducted on 18 November, 2015 on Medline, PsycINFO, Scopus and the Cochrane Library databases using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour (details described in Additional file 1: Appendix 1). The reference lists of all relevant studies and reviews were also manually searched.

Individual health outcome measures were not specified in the inclusion criteria. An exhaustive search of the databases had previously been undertaken that listed individual health compromising behaviours and mental health disorders in the search terms. However this was found to be impractical as most papers returned were for individual health conditions rather than for multiple domains. Instead broader terms were tested (e.g. 'mental disorders' rather than 'depression', 'anxiety' 'schizophrenia' etc.) and papers more relevant to the objectives were found. In addition, the original intention, as stated in our Prospero Registration Form, was to exclude young people with pre-existing health conditions. However, a preliminary look at the literature returned such a small number of results that it was felt it would be reasonable to remove this exclusion criterion and in doing so acknowledge the differences in these participants in the results and discussion, including the potential limitations in generalizability.

To be eligible for inclusion studies had to: include a measure of health outcome; include at least 75 % of participants aged 25 years and under; use a screening tool or approach that assessed more than one health domain, which may have included at least one measure of behaviour modification, such as drink driving, and; be conducted within a primary care setting. As suggested by Linde et al. [ 42], this review included uncontrolled trials and qualitative studies to obtain an overview of the topic and inform future research. Studies were excluded if they did not evaluate health outcomes.

The first author (MW) examined all titles and abstracts extracted for relevance and read the full text of any potentially eligible articles. Articles that met the exclusion criteria were removed. The second author (SK) confirmed that all selected articles were eligible for inclusion. MW extracted data from the studies using the form described in Table 1, which was confirmed by SK. Risk of bias within each study was assessed using the Quality Rating Scale (QRS) [ 43]. The QRS is a 23-item instrument for the assessment of the quality of clinical trials, covering both internal validity (control of bias) and external validity (generalisability). A key advantage of the QRS over other rating scales is that it is suitable for the appraisal of non-randomized trials. Each item of the QRS is rated 0 to 2 with a total instrument range of 0 to 46; higher scores indicating better quality. The first two authors used the QRS independently. One of the potential limitations of the QRS is that it may have only moderate inter-rater agreement [ 43], hence inter-rater reliability was assessed by Cohen's absolute weighted kappa statistic in Stata Version 12.0. Weighted kappa allows for different levels of agreement in ordered data, and the absolute function allows for all numbers including those unassigned by either rater.

N  = 142, 16-24 years, primary care clinic for HIV positive young people, 5 sites, 45 % female, HIV positive with at least 2 of 3 HIV risk behaviours, RCT

4 × 60 minute motivational interviewing (MI) sessions focused on 2 most problematic behaviours by mental health clinicians

Improvement:

35.5

* no condom use for participants categorised as at increased sexual risk (adjusted B = .364, p < .01) and those categorised as not at risk (adjusted B = .325, p  < .01)

* low sexual risk (63 % vs. 32 %, p < .01) and likelihood to be in delayed high sexual risk group (16 % v 50 %, p  < .01)

Outcomes measured:

* no condom use behaviour

* risk of no condom use behaviour

Face-to-face (trained interviewer), clinic waiting room, eligibility screen

N  = 28, 14-18 years, general primary care, 1 site, 100 % female, African American with at least 1 substance use risk, pilot RCT.

Improvement:

22

* substance use before sex (F(1) = 4.870, p  = .038, η2 = 0.18)

* social stress (F(1) = −0.187, p  = .047, η2 = 0.16),

* trouble due to alcohol use (F(1) = 4.301, p  = .049, η2 = 0.15)

* offers to use marijuana (F(1) = 4.222, p  = .047, η2 = 0.14)

No change:

* substance use

* social network quality

* readiness to start counselling

Domains screened:

* substance use (incl. drink driving)

* mental health

Digital (PDA) self-administrated, waiting room, intervention screen

11-20 years, general primary care, two cross-sectional sample recruited pre and post intervention within 5 sites and completed baseline and 6 month follow up survey. Usual care group prior to intervention: N  = 148, 47 % female

Improvement:

23.5

* exercise scores between intervention (0.581) and control (−0.220, p  = .006)

* milk intake between intervention (0.190) and usual care (−0.313, p = .012) b

No change:

* fruit and vegetables

* sweetened beverages

* screen time

Participants recruited 1 year after intervention introduced in practices: N  = 136, 50 % female

Domains screened:

* diet

* exercise

* screen time

* substance use

14 years, paediatric clinic Longitudinal study ( N = 904) compared with several cross-sectional surveys (safety N = 579, sexual behaviour N = 1306, substance use N  = 1410)

2 × clinical encounters: 1. provider intervention following '5 A' framework for behavioural counselling; 2. health educator intervention 15-30 min informed by social cognitive theory

Improvement:

28

* helmet use (OR = 2.0, 95 %, CI = 1.1,3.7, p  ≤ .05).

No change:

* smoking

* alcohol

* drug use

* sexual behaviour

Outcomes measured:

* seat belt use

* helmet use

* tobacco use

* alcohol use

* drug use

* sexual behaviour

Computer, self-administrated, immediately before intervention in the clinical office, intervention screen

N  = 819, 11-15 years, general primary care, 6 sites, stratified by gender (53 % female), RCT with sun exposure protection as control group. Participants booked in for a well care visit

Improvement:

34

* sedentary behaviours per week for girls (% change was −12 % for intervention and 4.8 % for control group, p = .001) and boys (% change was −24 % for intervention and 2.4 % for control group, p  = .001)

* physical active days per week for boys (relative risk,1.47, 95 % CI: 1.19,1.75) compared to the control group

No change:

* calories from fat

* fruit/vegetables

* minutes of physical activity per week

Domains screened:

* diet

* exercise

N  = 901, 14-25 years, general primary care, 40 sites, 76 % female, pragmatic clustered RCT stratified by postcode advantage score and billing type

40

N = 3525 c, paediatric clinic, 12 sites, 46 % female, 5 th and 6 th grade adolescents and parents, clustered RCT with two active arms

No change:

29.5

* tobacco use

* seatbelt use

* gun storage

Negative effect:

* Increased alcohol use at 24 and 36 months; OR = 1.27, 95 % CI: 1.03, 1.55, p = .02 and OR: 1.30, 95 % CI: 1.07, 1.57, p  = .01, respectively

N  = 1516, 14-16 years, general primary care, 8 sites, 51 % female, clustered RCT

1 × 20 min consultation with nurse to discuss health concerns & develop plans for healthier lifestyles based on self-efficacy and behaviour change

26.5

Outcomes measured:

* diet

* exercise

* tobacco use

* alcohol use

N = 155 c, student health care, 1 site, 66 % female, 3 arms randomised trial

1 of 3 interventions from trained research staff: 1. multiple behaviour health contract based on Behavior-Image Model; 2. 1 × 25 min tailored consultation with fitness specialist; or 3. a combined consultation plus contract intervention

Improvement:

25.5

* drink driving behaviours in all groups (F(2136) = 4.43, p  = .01)

* exercise behaviours in all groups, (F(5140) = 6.12, p  < .001)

* nutrition habits in all groups, (F(3143) = 5.37, p  < .001)

* sleep habits in all groups (F(2144) = 5.03, p = .01), and health quality of life, (F(5140) = 3.09, p  = .01)

* Stress management F(2144) = 5.48, p = .01, and the number of health behaviour goals set in the last 30 days, F(2143) = 5.35, p  = .01, but only among adolescents receiving the consultation, or consultation plus contract

No change:

* alcohol use

* tobacco use

* marijuana use

* quality of life

* self-control

Outcomes measured:

* alcohol use

* tobacco use

* marijuana use

* drink driving

* exercise

* diet

* sleep

* quality of life

* self-control

* stress management

The studies were also compared to determine whether there were similarities in the country of research, research group, or years in which the research was conducted. All studies were included irrespective of their design, quality, and biases. No statistical analyses were conducted due to the heterogeneity of study designs permitted in the inclusion criteria. Instead, we favoured narrative description of the data including statistical analyses used where appropriate.

Results

Summary

A total of 5051 articles were identified through the literature search, of which 1103 were excluded due to duplication, 3875 were excluded based on abstracts and a further 64 excluded after the full article length was examined, leaving a total of nine studies to review. Figure 1 depicts the PRISMA flow diagram for inclusion.

Assessment of bias

The QRS for both raters ranged from 20 to 40, out of a possible maximum score of 46, and had similar means. Interrater agreement was higher (95.2 %) than the expected agreement (83.3 %) with an acceptable kappa score (Rater one: M = 29.33, SD = 6.10, Rater two: M = 29.44, SD = 6.09 k =0.71, SE = 0.202, p = 0.0002). The average QRS for each study is listed in Table 1. The pilot RCT [ 46] and the pre-post study [ 52] scored low, between 22 and 24 for each rater, while the two RCTs [ 44, 45] and one of the cluster RCTs [ 48] scored highest, between 33 and 40 by both raters.

Discussion

There was also a lack of information provided about how the electronic tools [ 44, 49, 52] were developed and designed, and whether end-users were consulted or involved in the design of the tool's content and functionality. Involving end-users in the design of technology ensures that the tool meets young people's needs and is contextually relevant [ 56]. There is increasing interest in how technology may be incorporated into primary care to enhance service delivery and health outcomes [ 57] and more research is required to understand its role in screening.

Only two studies reported on harms or negative effects that may have occurred during the study. Harms may include the additional costs and medical procedures associated with false-positive screening results, or a paradoxical increase in an unhealthy behaviour [ 38]. The study by Sanci et al. [ 48] reported no harmful events, while Stevens et al. [ 50] reported a negative outcome effect of increased alcohol use in the intervention arm focussed on alcohol and tobacco use. The Dartmouth Prevention Project reported by Stevens differed from the other studies in that included subjects were pre-adolescents in the fifth or sixth grade and their parents, and the intervention rested on encouraging communication between parents and children about health risks rather than the clinician communicating directly with an adolescent. Authors proffer that the observed results may have arisen from family discussions that may have been broader ranging than the topics in focus or that the intervention was insufficient to curb short term alcohol use; without follow-up into later adolescence when uptake of alcohol is greater, full effect on preventing use could not be evaluated. Future research needs to explicitly measure potential harms or risks in screening for and intervening with multiple health compromising behaviours and mental health disorders.

Other limitations in study designs may have minimised the ability to detect a change in health compromising behaviour or mental health outcomes. For instance, Walker et al. [ 47] had small participant numbers in each domain that was measured, as well as high rates of non-response, particularly at 12 months, which may account for the lack of effectiveness observed in this study. Other important potential limitations are the challenges inherent in measuring changes in multiple health outcomes. It is difficult to obtain sufficient statistical power to show shifts in several outcomes and measuring multiple outcomes increases the potential for positive findings by chance alone [ 38]. It is hard to overcome this latter challenge without a combined risk variable, which also has drawbacks in that detail of which risks are affected and which are not is lost. It is noteworthy that not all outcomes targeted in these interventions changed; we did not view this negatively as it is highly unlikely a young person with co-occurring health risks will modify all behaviours simultaneously. Studies require longer follow-up times to test whether interventions have cumulative effects with subsequent exposures over time [ 55].

Limitations

This review has a number of limitations. Firstly, while including uncontrolled studies allowed for a broad overview of research in this area to date, this meant that a meta-analysis was not possible. Another limitation was that as this review investigated studies that combined screening and at least one intervention it is possible that eligible articles that were not categorised with the theme of 'screening' as a key term in the databases were not picked up in the search.

Conclusions

This systematic review suggests that there is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Given that young people have expressed a desire and willingness to engage in these discussions and trust clinicians' advice, this review suggests that these discussions should be part of the routine primary care of young people. There is a need for further quality studies, able to overcome the challenges of measuring change in multiple outcomes over time, to strengthen this evidence. Study quality might be enhanced by following young people over time to capture return visits to clinicians and effects of these repeat exposures to screening and intervention on health outcomes, and by conducting a trial alongside wide scale implementation in a population with greater numbers of young people and more study power. Further work might also examine the role of this clinical intervention in multifaceted approaches across health, education and community settings to tackle complex adolescent risky behaviour. This review also highlights a need for research including young adults (18-25 years) and research of screening that includes the identification of protective factors.

Declarations

Acknowledgements

The authors also like to thank Dr Dyani Lewis for her preliminary contribution to this work.

Funding

This research is supported by the Young and Well Cooperative Research Centre, an Australian-based international research centre that unites young people with researchers, practitioners, innovators, and policy-makers from over 70 partner organizations. Additional support was provided by the Maternal & Child Health Bureau's (MCHB) Adolescent & Young Adult Health Research Network (Elizabeth M. Ozer, PI; grant #: UA6MC27378).

Availability of data and material

Not applicable.

Authors' contributions

MW conducted the systematic review and reviewed the articles, carried out the quality assessment ratings, analysed and interpreted the data, and drafted the manuscript; SK carried out the quality assessment ratings, contributed to the analysis and interpretation of the data, and critically reviewed and modified the manuscript; and, LS, DH and EO contributed to the analysis and interpretation of the data, and critically reviewed and modified the manuscript. All authors have read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Not applicable.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Additional files

Authors' Affiliations

(1)

Department of General Practice, University of Melbourne

(2)

Division of Adolescent & Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco

(3)

UCSF Office of Diversity and Outreach, University of California San Francisco

(4)

Primary Care Unit, Faculty of Medicine, University of Geneva

(5)

Adolescent and Young Adult Program, Department of Community, Primary Care and Emergency Medicine and Department of Pediatrics, Geneva University Hospitals

References

1. Department of Health (UK). Quality Criteria for Young People Friendly Health Services. 2011th ed. London: Department of Health; 2011.

2. Royal Australian College of General Practitioners. Guidelines for Preventive Activities in General Practice, Volume Spec No. 8th ed. East Melbourne: Royal Australiasian College of General Practitioners; 2012.

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# data[].attributes.subject
PDF Link to article looking at where in the UK can contraception be obtained

# data[].attributes.body
Needs to be downloaded to read