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Fidelity data in clinical trials are not only necessary for appraising the internal and external validity, but also could provide useful insights how to improve the application of an intervention in everyday settings. The purpose of this paper is to understand the current literature of fidelity measurements in complex interventions for people with intellectual disabilities (ID) and behaviours that challenge.

The electronic databases MEDLINE, Embase, PsycINFO, Web of Science and CINAHL Plus were searched for studies published between 1990 to 2017 that have mentioned fidelity in randomised controlled trials of complex interventions for people with ID and behaviours that challenge based on positive behaviour support or applied behaviour analysis principles. The authors also searched the grey literature and reference lists.

Five randomised controlled trials were included in the review. The authors found variable and inconsistent fidelity measurements reported in the studies. The most frequently provided fidelity elements found in four out of five studies were adherence of implementation, dose and some aspects of quality of delivery.

Research recommendations for a standardised approach of measuring fidelity in such studies are suggested.

The first review of such type that confirms the paucity of research measuring fidelity in complex interventions in this population.

Community mental health services are of increasing importance for people with an intellectual disability (ID), as the government aims to reduce the number of people treated within inpatient services. However, due to limited evidence base, it is unclear which service models are most effective for treating people with both ID and a mental health condition. Therefore, the purpose of this paper is to carry out a survey in order to gain a better understanding of the current state of ID community services.

The survey was e-mailed to 310 consultant psychiatrists based in England and whose main specialism was in ID. In total, 65 consultants responded to the survey with 53 complete data sets.

In total, 84 per cent of consultants identified themselves as working in a generic community ID team. The majority of services were not integrated with social care (71 per cent). Regional differences were found. In contrast to the rest of England, the majority of services in London were integrated with social care. The Health of the Nation Outcome Scale for people with Learning Disabilities (HoNOS-LD) was found to be the most common outcome measure used by services. A range of interventions are widely available across services including psychological therapies and specialist memory assessments. The survey also provides evidence for increased decommissioning of specialist inpatient units and a need for more robust community services.

Findings limited by low return rate (21 per cent) and because responses could not be matched to specific services. The implications of this survey are that there is still a variable level of integration with social care and that lack of integration could affect the quality of service. While HoNOS-LD is used consistently across services, there may be a need to supplement it with other outcome measures. There is a need for larger scale and higher quality studies in this area to strengthen the evidence base and therefore demonstrate the benefits of integration and specialisation more convincingly to health professionals and commissioners.

This survey presents an overview of the current state of community services for adults with ID in England. This information can be harnessed to add to revised approaches to mental health service models for people with ID.

This case study of a woman with moderate learning disabilities, autistic traits and bipolar affective disorder illustrates the challenges of supporting people with learning disabilities in community settings during an acute episode of mental illness. She was admitted to a generic in‐patient psychiatric service, and the way in which her links with her home and community were maintained are described. The difficulty of transferring and maintaining behavioural guidelines from the in‐patient to a community setting are discussed. The delay in effecting a discharge necessitated her admission to a specialist unit for people with learning disabilities outside the local area. The possible reasons and solutions for this scenario are debated.

The purpose of this paper is to provide a synthesis of the literature on the topic of developmental framework and health comorbidities of children and adults with borderline intellectual functioning (BIF) and neurodevelopmental disorders.

A rapid review of the literature and hand searching of relevant papers from 1999 to 2015 was carried out. Totally, 21 papers were identified covering a range of perspectives from neurodevelopmental trajectories to prevalence, treatment and service use.

All papers were utilised and complemented a previous review which, however, had not covered the aspect of treatment approaches for this population. As a group they appear to have distinctly different profiles from people with mild intellectual disability and of peers with average intelligence.

The evidence summary indicates an ongoing interest by the international scientific community in the topic of BIF. This group are often lost in the health system and may not receive appropriate care given their unique clinical profile. More should be done to increase clinicians’ awareness of their health needs.

The paper adds substantially to a previous review of the topic. An international collaboration may help to increase the profile of this work and lead to further changes in the care these individuals receive across the diagnostic and treatment spectrum.

The care programme approach (CPA) is an important part of supporting people with mental health problems in the community and has been applied with variable success in services for people with learning disabilities. Investigation into service users' understanding of the CPA has been limited. We employed multiple methodologies to explore what service users with learning disabilities and additional mental health problems thought about the CPA process, and what their understanding of it was. We used the findings to work with other professionals to adapt the meetings in a way that was accessible and inclusive. We included this work in the service communication plan and produced guidance for care co‐ordinators and materials to be used at the meetings. The guidance and materials can be used by any service and will be available online.

This article examines the prevalence of mental disorders in a community and clinic population of adolescents with learning disabilities in one catchment area (in the UK). A two stage cross‐sectional survey was used. Measures included screening by parental report (Developmental Behaviour Checklist), adaptive behaviour (Vineland Survey Scale) and clinical interview (ICD 10 childhood disorders).Seventy‐five adolescents aged 12‐19 years old participated in the study. 50.7% screened positive for mental disorders, mainly in the disruptive and anti‐social domains. Almost all of those were found to have an identifiable ICD10 mental disorder. The most common diagnoses included pervasive developmental disorders, hyperkinetic disorder and emotional disorders. Male participants as well as those with autism were more likely to be reported as cases. Caseness was associated with lower adaptive level, presence of autism and family history of mental disorder.Rates of psychopathology are high in adolescents with learning disabilities. There are continuing difficulties in diagnostic ascertainment primarily due to mediation by developmental factors. Further research is necessary in order to clarify continuities of mental disorders in this population and to develop effective interventions.

Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS).

Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports.

At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found.

This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency.

The purpose of this article is to explore the current evidence base in understanding the relationship between mental health and challenging behaviour in people with intellectual disabilities.

The article discusses how challenging behaviour is associated with psychiatric disorders. Common aetiological factors between challenging behaviour and psychiatric disorders and diagnostic issues are considered. The article ends with a review of the assessment and management of challenging behaviour within the context of mental health.

Several studies have highlighted common aetiological factors that are responsible for challenging behaviour and psychiatric disorders in people with intellectual disabilities, and although there is an overlap in the symptoms, both are thought to be different phenomena. Treatment of the psychiatric disorder should ameliorate the challenging behaviour, although a functional analysis of the behaviour may still be required in order to understand the purpose of the behaviour. There is evidence for a range of different treatment approaches.

The article will assist professionals working with people with intellectual disabilities to understand the complex relationship between mental health and challenging behaviour. It also gives guidance on principles of management of people with complex mental health and behavioural needs.