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The purpose of this paper is to outline the role played by different aspects of the social, physical and organisational environments in preventing behaviour described as challenging in people with learning disabilities.

Conceptual elaboration drawing on research and practice literature.

Community placements for people with learning disabilities should develop the characteristics of capable environments. Such characteristics are associated with prevention of challenging behaviour and improved quality of life outcomes.

The notion of the capable environment may help to shift the focus from the individual who displays behaviour described as challenging to the characteristics of the social, physical and organisational supports that they receive.

Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”.

This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges.

It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again.

Standards in relation to care pathways are presented.

The purpose of this paper is to analyse ratings data from the recently developed Learning Disability Needs Assessment Tool (LDNAT) to identify factors associated with specialist intellectual disability (ID) hospital admissions.

Ratings from 1,692 individuals were analysed and the LDNAT items differing significantly between inpatients and non-inpatients were identified. Statistical analyses on total scores derived from these items were used to calculate an optimal cut-off. This LDNAT inpatient index score was also confirmed via an alternative statistical technique.

On average, 18 of the 23 LDNAT item ratings were significantly higher in people with ID assessed as inpatients compared to those rated in community settings. Using the total of these items, the resulting LDNAT inpatient index was analysed. A cut-off score of 22.5 was calculated to be the optimal balance between sensitivity (0.833) and specificity (0.750). This was confirmed by calculating the Youden index (j=0.583). At this level 68 per cent of inpatients and 81 per cent of non-inpatient cases were correctly identified.

Currently there is a national (UK) programme to radically reduce the amount of specialist inpatient care for people ID. This will necessitate early identification of individuals most at risk of admission together with investment in improved, proactive community services if admissions to a diminishing bed-base are to remain manageable.

This study confirms the associations between mental health difficulties, challenging behaviour and specialist hospital admissions for people with ID, extending existing research by translating these findings into a clinically usable risk index.

A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.

Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.

Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.

To the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

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.

The case deals with the Supreme Court's decision of August 31, 2012, ordering Sahara to refund Rs. 24,000 crores and interest to SEBI, so as to refund to the real investors. Despite unambiguous orders, Sahara did not comply fully and kept on prolonging the matter using number of pretexts, ultimately resulting in Roy's arrest. The case has been primarily written for easy understanding of facts, principles of corporate governance, and further developments, as mentioned in judgment, which runs into hundreds of pages. It depicts the legal journey of the fight between a company and the financial regulator in the country.

The present field-based case study is related to topics in marketing area, more specifically brand management, strategic marketing and business strategy.

This case is primarily meant for second-year students in a postgraduate program in business management (MBA). The case could also be discussed in an executive development program on marketing/business strategy.

The present case is based on Aava natural mineral water, the brainchild of Mr Behram Mehta, Chairman of Shelpee Enterprises. The case explores at the various marketing strategies adopted by Aava in India. The case traces the brand's foray into the Indian bottled water market as a regional players and its growth as a pan Indian brand. However, in early 2012, the majority of Aava's sales were coming through institutional sales. The brand was facing a challenge of trying to find a foothold in the retail market. The balance between becoming a mass and a premium brand was also looming large. The major question that Aava needed to answer is whether it should restrict itself to the B2B market or whether it should try to penetrate the retail market. Given the latter is more beneficial for the company, the issues of product, pricing and brand communication needed to be revisited since these are not similar for B2B and B2C brands.

The various learning outcomes of the case include: understanding the differences between B2B and B2C marketing and the need for different strategies for both, apply marketing research findings to introduce a product in a market, evaluate and execute marketing communication strategies based on human behaviour for more effectiveness, evaluate alternatives leading to the right choice of branding/marketing strategy, understand the role of 4Ps of marketing for successful business and industry analysis.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

This paper reports on the first three years of a community forensic team in Birmingham working with individuals with learning disabilities who have offended or are at risk of doing so. Using an interprofessional model, the team provided assessment, intervention and management, enabling individuals to live in the least restrictive environment. There were 113 referrals, the majority (94%) of whom were males. Only 26 had been convicted. The problems this raised for the team are discussed, along with the cost‐effectiveness, impact on admission rates and benefits of providing such a service. Two case scenarios are presented to highlight some of the issues encountered by the team. The paper supports the development of such services.

This paper reports on the development and service delivery of the Supported Living Outreach Team for people with severe psychiatric, behavioural and forensic needs in a city with a population of 1.1 million. The authors discuss the reasons why the team was formed, and the partnerships it has formed with local housing and care providers in order to enable people with very complex needs to lead ordinary lives in their local communities. The pathway of team involvement is described, starting with the initial assessment, setting up and monitoring of new schemes, through to discharge. Also described are the measures the team uses to monitor its effectiveness, the benefits the team has brought to the service, and the hurdles and barriers it has had to overcome on its journey to support people with complex needs to live safely in their local communities.

Aims to assess the development of clinical governance within NHS Trusts in the West Midlands by means of a cross‐sectional qualitative study based on in‐depth interviews and observation with all acute and non‐acute (n equals 43) Trusts in the West Midlands Region to determine the rating of Trusts’ competencies across five areas of clinical governance. There was a fourfold variation in the development of clinical governance across Trusts, measured against the identified competencies. Trusts with high competency scores showed a number of characteristics, including clear leadership at executive team level for the agenda, a collaborative style of working between clinicians and management, clinicians involved in management and a culture of openness and empowerment of front‐line staff. Concludes that attention must be paid to the organisational and cultural environment within Trusts, as well as resource issues, if high quality clinical governance is to become the norm