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This paper aims to describe the outcomes of the use of the Quality Outcome Measure for individuals with dementia (QOMID) within a dementia pathway for people with Down’s syndrome (DS). The QOMID is a tool for clinicians to use with 17 outcome domains, each with descriptors for early, mid and late stage dementia, rated on a four point scale from rarely achieved for the person (1) to consistently and completely achieved for the person (4).

Data from first time use of the QOMID with 49 people with DS and dementia was analysed to determine if specific outcome domains are more achievable than others, if this differs by stage of dementia and what recommendations are suggested.

Results suggest that there were significant differences in achievability across the domains but that achievability did not vary between early and mid-stages of dementia. The themes with most recommendations were: quality of paperwork and documentation; improving communication with the person with DS and dementia; and working together with health and social care professionals.

Results suggest that outcomes which fall outside of the typical learning disabilities skillset and are dementia specific are being achieved less often. Primarily, recommendations focused on practical solutions such as using visual timetables to communicate with the person and adapting their environment. Further work on integrating the QOMID and stage-related team training for care staff is underway.

To the best of the authors’ knowledge, this is the first detailed analysis of the use of the QOMID in clinical practice with people with DS and dementia.

The purpose of this paper is to consider the implications for people with Down’s syndrome and their families of identifying those people who are at risk of developing dementia from the research study “Estimating the number of people with Down’s syndrome in Scotland and the cohort at elevated risk of early onset dementia”.

The commentary is based on a review of the associated literature.

Estimating the numbers is important but has serious implications for people who have an elevated risk and their families. Preparation and ongoing support and planning are vital to ensure that quality of life is maintained as dementia is identified and progresses.

The commentary considers the research presented from a practitioner perspective.

This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England.

The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed.

Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions.

This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments.

This paper aims to describe the development and evaluation of integrated intensive support service (ISS) for adults with learning disabilities who have complex needs and are at risk of admission to an inpatient unit.

Existing services were remodelled. The service explored external service models and established an integrated ISS comprising intensive community support and intensive support beds.

Data indicates that the majority of people referred to the service avoid both admission to an inpatient unit and placement breakdown. Most people admitted to the inpatient unit are not known to community services. Length of stay has significantly reduced.

Other services can use the information to remodel how to provide intensive support and avoid admission to an inpatient unit.

It demonstrates how remodelling can drive improvements to reduce placement breakdown and risk of admission.

The purpose of this paper is to explore the importance of equal access to Improving Access to Psychological Therapies (IAPT) for people with intellectual disabilities.

The paper identifies barriers to access and shows how a reference group can work to solve the barriers and increase access.

The paper evaluates the authors’ progress to date and how the authors plan to continue to take the work forward.

The paper highlights some of the factors responsible for the authors’ success and gives information that will be helpful to other areas who are interested in facilitating equal access.

The paper demonstrates how the focus of a reference group can drive improvements across services to improve access for people with intellectual disabilities to IAPT services.

The purpose of this paper is to consider the issue of types of assessment offered by services for people with learning disabilities from the research study “A Comparison of Dementia Assessment Services for People with Intellectual Disabilities”.

The commentary is based on a review of the associated literature.

Assessment for possible dementia is a complex activity. The gold standard is to ensure that the assessment process is comprehensive including both direct assessments with the person and gathering information from key informants. The issues in not adopting this methodology are considered, as are issues in what services and assessments are called.

The commentary considers the studies presented from a practitioner perspective.

The purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker.

A 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD.

Results show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question.

The main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work.

Compared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.

Assessment of executive functioning is an important element of a comprehensive assessment of intellectual abilities. Few assessments available are accessible for individuals with intellectual disabilities (ID) and none have population-specific norms. This paper aims to describe the adaptation of the behavioural assessment of dysexecutive syndrome (BADS).

Adaptations were made to the BADS tests to create the BADS – intellectual disabilities (BADS-ID). Data from three doctoral dissertations were combined to explore the utility, reliability, validity and component structure of the BADS-ID. Properties of the BADS-ID were compared with the Cambridge Executive Functioning Assessment (CEFA).

The BADS-ID is accessible to IQ range 50–70 and has a two-component structure. It has good inter-rater reliability, but poor internal consistency. It has a good face and content validity but evidence for concurrent and discriminative validity is weak. All properties are comparable to or better than the CEFA.

Further research is needed to improve reliability and validity. The development of an accessible test battery with known reliability and validity for individuals with ID should facilitate research into executive functioning in this population. There is the potential to develop population-specific norms from the data.

An accessible test battery for individuals with ID is helpful in clinical situations.

To the best of the authors’ knowledge, this is the first study to explore the adaptation of the BADS for use with individuals with ID.

This paper is one of seven in this volume elaborating different approaches to quality improvement in education. This paper aims to delineate a methodology called Deliverology.

The paper presents the origins, theoretical foundations, core principles and a case study showing an application of Deliverology in the Kentucky Department of Education in the USA.

The core principles underlying the approach are embodied in its guiding questions: What is our system trying to do? How are we planning to do it? At any given moment, how will we know whether we are on track to succeed? and If we are not on track, what are we going to do about it?

Few theoretical treatments and demonstration cases are currently available on commonly used models of quality improvement in other fields that might have potential value in improving education systems internationally. This paper fills this gap by elucidating one promising approach. The paper also derives value, as it permits a comparison of the Deliverology approach with other quality improvement approaches treated in this volume.

The focus of interest in dementia in people with learning disabilities has been largely on epidemiology, prevalence, assessment and diagnosis. There has been less focus on care issues and interventions, with a paucity of research papers but a growing number of books and resource packs addressing these issues. Psychological and non‐pharmacological approaches are useful in services for people with learning disabilities and dementia, but must be delivered in line with a clear conceptual framework of dementia that aids staff in understanding what is happening to the person with dementia and the effect of their care and responses. This paper describes the most commonly used approaches, including developing an understanding of dementia, anxiety and stress reduction, life story work, reminiscence, reality orientation and validation techniques, helping peers to understand dementia, other therapeutic approaches, and understanding behaviour and dementia care mapping and their impact on the well‐being of people with learning disabilities and dementia and the people who support them.