This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service.
Abstract
Purpose
This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service.
Design/methodology/approach
Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services.
Findings
All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used.
Originality/value
To the best of the authors’ knowledge, this is the first paper to compare dementia assessment provision between different services in England.
Details
Keywords
It is generally admitted that the professions are much over‐crowded. While the condition of affairs which exists in professions of older standing such as medicine or the law is…
Abstract
It is generally admitted that the professions are much over‐crowded. While the condition of affairs which exists in professions of older standing such as medicine or the law is fairly well known, even to the unprofessional man, and the qualifications requisite for advancement and success are generally appreciated to a certain extent, the same degree of knowledge does not obtain in the case of chemistry, about which, as a means of livelihood, the profoundest ignorance prevails—even among the better‐educated classes. The opportunities which are apparently held out to aspirants and the greatly increased facilities for chemical study have given rise to an absolutely false idea in the mind of the public at large as to the positions obtainable and the prospects offered. Chemistry is, perhaps, the most over‐crowded of all professional careers, for, although the science has gained enormously in importance and in technical application within a comparatively recent period of time, the supply of highly‐trained chemists greatly exceeds the number of positions available, while the remuneration to be obtained is, from a professional point of view, extremely low, and is quite out of proportion to the scientific qualifications possessed and to the nature of the work exacted. The causes of the over‐crowding are too many and too complex to be considered in detail here, but there may be cited as among the principal factors in this respect the greatly increased popularity of the science as a specialised study, the entrance into the profession of individuals who are in reality personally unsuited for a professional career, and the failure of the educationalists to grasp what the exact meaning and aim of the education of a community should be. While, however, the ultimate prospects of advancement and success are influenced greatly by the growing tendency of crowding out, there are, in this respect, other factors to be considered which are liable to be overlooked, namely, the actions of the members of the profession themselves, and, following from this, the degree of respect accorded and the value attached to that profession by the general public. A profession retains its status before the world, or loses it, according to the nature of the individual and concerted actions of its members, both in their relations with each other and in their intercourse with the public. The particular type of person who enters a profession might appear at first sight to be a factor of comparatively minor importance, provided that a thorough training had been undergone and good qualifications obtained. Such, however, is far from being the case. If it is to maintain an honourable position before the world and a recognised place among other intellectual callings, a profession must endeavour to attract the best type of man—the man who, apart from his scientific qualifications, possesses the true professional instinct and ideals, and the ambition to raise his calling and himself to as high a level as possible. “Qualifications” alone are not sufficient. To attract the man of higher type it is necessary to offer a reasonable prospect of adequate reward. It is open to question whether the chemical profession can, at present, offer the necessary inducement, from this point of view, to enter its ranks. It cannot be pretended that chemistry can present ultimate prospects compared to those offered by the other professions. The reward of the man of science is fixed unless his discoveries have a commercial value, and he himself possess the commercial instinct necessary to profit by them. It will be admitted that this is not the case with the specialist in medicine or with the leader at the Bar. The common objections put forward against such considerations as these are that a man devotes his life to the pursuit of a science purely out of love for that science and with little consideration for remuneration or for social status, and that questions of reward or remuneration being purely mercenary considerations should not be brought into the discussion. While such objections may appear reasonable at first sight, a little reflection will show that the matter lies somewhat deeper than this. The future of the chemical profession itself, and not only the pecuniary profit of the individual, is involved. To offer low remuneration for scientific positions is to ensure these positions being ultimately filled by men of mediocre capacities, and it must be understood that this applies as much to a junior assistantship in a technical laboratory as to a chair in a university or to a public position of trust. The prospects which there are at present in the chemical profession can be regarded only as being more likely to attract the mediocre person than the man of superior capabilities, and mediocrity cannot be considered as conducive to the advancement of a science. In these days of excessive competition it is imperative to consider many facts before choosing a particular professional career. Men of attainments superior to the ordinary will not voluntarily enter a profession in which the reward for their labours is to be in no way proportionate to their abilities, and that particular profession will necessarily suffer by their absence. It is a common fallacy to suppose that a man's intellectual capacity is measured by the number of examinations he has passed or by the number of degrees and diplomas which he may possess. Under our present Chinese system of examination it is possible for anyone, even if he be of really very modest attainments, to make a collection of degrees and diplomas. Originality in thought and the power to apply the knowledge obtained during training are not asked for. There is a type of man extremely common to‐day whose capacity for absorbing existent scientific facts (i.e., the ideas of other people) is as great as his incapacity for originating ideas of his own. To this particular type of person the obtaining of qualifications is a comparatively easy matter, especially in the case of chemistry, which is, strictly speaking, a non‐mathematical science. Whereas originality and individualism in thought makes for advancement in science, the mere repetition of the ideas of other persons can only result in stagnation. These facts are generally lost sight of by those persons who assert that the interest of his particular subject should prove an ample compensation for a low remuneration provided that that remuneration be sufficient in order to live. It is not recognised that if such a prospect of affairs becomes general those persons whose ideas are bounded by a narrow horizon (and such form the majority in any community) are attracted in preference to those whose ambitions take a wider scope, and who will naturally turn to another field of operations where their abilities will be more amply rewarded. The competition to‐day in the chemical profession has become even keener than that among the quill‐drivers; the early prospects are about the same as, or are little superior to, those of the latter calling, while ultimately there is the reward of a position at a remuneration very little better than that obtained by a head bookkeeper, and generally very much inferior to that of a small merchant or fairly successful tradesman—the supposed intellectual inferiors of the man of science. Again, with respect to public chemical appointments, there is the growing tendency to create “whole‐time” appointments at a fixed and insufficient remuneration, with no prospect of advancement or certainty of superannuation, and, in many cases, no security of tenure. In the purely technical world the position of affairs is even worse, while the prospect of making a living by practising privately as a technical and consulting chemist is limited, since the demand from the public is not large, and much of the work formerly obtained by the private practitioner is now done much more cheaply by a “tester” of some kind at a works. The consultant is certainly needed in certain cases, but these are of such comparative rarity as to have but little influence upon the general position. There is no doubt that much harm has been done by the nonsense emitted from time to time by unthinking persons and by those who describe themselves as “pure” chemists, to the effect that much of the work carried out in a technical or analytical laboratory can be performed quite as satisfactorily by the untrained person as by the skilled chemist. These opinions, which may perhaps find excuse in the ignorance of the persons holding them, are based upon the supposition that, as the work in such laboratories may tend to be of a routine nature, unskilled labour is quite as valuable as scientific training. The harm done by the promulgation of such statements is to be found in the fact that untrained persons conceive the idea that employment may be obtained in a chemical laboratory without any previous scientific education, and hence there is introduced a further tendency to lower the status of the chemical profession by the admission of unqualified persons. Whatever the condition of chemistry may be at present from an intellectual standpoint, it is manifestly unfair to give the preference to unskilled persons over those who have at least studied their subject, simply on the ground that such labour is cheaper, and it is suicidal that such a preference should be encouraged by the members of the chemical profession themselves. It is necessary to admit that much of the unsatisfactory condition of affairs in the chemical profession is due directly to the behaviour of the members themselves. They have never really appreciated the necessity of acting together for the benefit of all and for the profession as a whole; they have never recognised that, whatever the specialised branch of each may be, all are linked together by a common training and by common interests, that that which adversely affects an individual member adversely affects the whole profession, and that their actions and the value they themselves put upon their services determine the degree of respect accorded to their profession and to themselves by the outside public. The chemist who is engaged in teaching cares little if his technical colleague is underpaid, because he himself is not a technical chemist, and the latter, on the other hand, does not concern himself with the condition of affairs in the teaching branch of the profession. This policy of “sauve qui peut” is disastrous. Combination among its members is absolutely necessary if a profession is to “live.” A number of individuals having a general common training in a particular branch of knowledge, each one working for his own special interest and without regard for that of his fellows, no more constitutes a profession than a people possessed of no laws or constitution and bound by no social obligations constitutes a nation. That the necessity of efficient combination is not understood may be seen from a statement made by the President of the Institute of Chemistry at the last annual general meeting of that body. In the course of his address, the President said: “If the Institute were … . to become, as some critics have suggested it might become, a professional trade union for the regulation of fees and the suppression of competition, I feel sure that the larger proportion of its members would rightly lose all interest in its affairs.” If the Institute of Chemistry is to be regarded solely as an examining body, this particular statement of the President may be held to be excusable, if not justifiable, but if the Institute be considered as a professional body for controlling the interests of its members and acting for the advancement of the whole chemical profession, two possibilities are presented. Either a condition of affairs exists in the Institute of Chemistry which is lamentable, and which it would, perhaps, have been kinder to the Institute to have kept secret, or the statement of the President is not justified by the facts. The word “rightly” has, logically and morally, no place in the sentence in which it occurs. It would appear from a passing reference by the President to the Institute as “a great professional organisation” that the body in question does desire to be considered a professional institution. Under these circumstances, the statement above quoted amounts to this: as the Institute of Chemistry is not to concern itself with the fees paid to its members, or with the fees which those members choose to accept, it becomes open to any member (although a member of a “professional” body) to accept any fee, however low, for any work, and by a slight extension of this free and easy principle, any member may undercut any other member by performing the same work for a lower fee, and, given a sufficient scope for such “competition” without any restriction (and the only restriction possible is the veto of a firm professional authority), an impossible state of things would soon be reached. It will be noted that no account has been taken of length of service, years of experience, and professional position. A man with these extra qualifications is not to expect his own professional organisation to recognise them or to aid him in making others recognise them. Those for whom the regulation of fees has an interest are, for the most part, men in responsible public positions, or in private practice, who are endeavouring to maintain their profession and themselves in as high esteem as possible—in spite of the ignorant opposition offered to them by the public who do not appreciate their services and by their “professional” brethren who cannot understand what a professional man should be. It is these men who represent the Institute of Chemistry before the public, and without whom that Institute would be practically unknown. It is only to be expected that such men would be in the minority. The initiation of all wise things comes from individuals—generally from some one individual—and never from the mass. The general tendency of things throughout the world is to render mediocrity the ascendant power among mankind, and this applies as much to small bodies of men as to society at large. In questions of policy and future action the opinion of the majority of the mass may be discounted, for while the reasoned opinion of an individual may be biassed, it is an opinion (and, therefore, right or wrong, worth consideration); but, in the case of majorities, the opinions expressed by them do not represent the sum of individual ideas, but are simply the expressed preference of one or a few of the same type as those who constitute the majority, followed unthinkingly by the remainder—a state of things best comparable to a flock of sheep running round a tree. There is no reason for supposing that the majority in the Institute of Chemistry is any more capable of giving a wise and reasoned answer to a question of policy than are other majorities. In the present instance the reasons which can be brought forward against the assumption by a professional body of an indifference to the question of the remuneration of its members far outnumber any which may be advanced in defence of such a policy. We have drawn attention to the necessity of attracting the man of superior attainments to a profession, we have indicated what the ultimate effects of inadequate remuneration for scientific work will be, and we have urged the vital necessity of combination in calling attention to the policy of segregation which is having such disastrous results. Some of these points are referred to in the address of the president of the Institute of Chemistry, but from a different standpoint. “A large number of our Fellows are engaged in practice as analytical and consulting chemists, and questions of professional interest naturally appeal to this section of our membership, but an equally important section feel only a more remote interest in these questions, though they appreciate the wide influence of the Institute as a great professional organisation.” Again: “It must never be forgotten that an important part of the work of the Institute is the consolidation of the profession.” Nothing but unqualified approval can be accorded to this last statement. It is difficult to see, however, how the consolidation of the profession is to be effected by the Institute if one section of its members feel only a more remote interest in the questions which concern the advancement and success of the other, and if the majority of the members would view with disfavour an attempt on the part of the Institute to place the recognition of professional service upon a proper and a dignified basis. The problem of the regulation of fees is one of the most important questions with which a professional body has to deal, and it is not easy to comprehend how a body which deliberately ignores or avoids this point can, properly speaking, be called a professional organisation. There is now more than at any other time the crying need for a strong controlling authority in the chemical profession—an authority which would enforce professional conduct upon those under its control, and, passing the bounds of mere protestation, take a definite and severe line of action in all cases of infringement of its rules. Before joining a given professional organisation a man has a perfect right to inquire what benefits he is likely to gain from his membership. It is not sufficient to merely hold examinations and to grant diplomas—any examining institution can do that. In a body intended to deal with professional interests examinations are of secondary importance; the advancement of the profession and the welfare of the members demand the first consideration. If not, it becomes reasonable and perfectly justifiable for any member of the profession to refrain from allying himself with that body, and to refuse to recognise it professionally—a course of action which, although necessary in such a case, would not be beneficial to the profession; the fault, however, would lie with the controlling authority and not with the individual.
The Soweto revolt of 1976 was mounted by black students in South Africa mobilized under the banner of the Black Consciousness (BC) ideology. However, when thousands of these…
Abstract
The Soweto revolt of 1976 was mounted by black students in South Africa mobilized under the banner of the Black Consciousness (BC) ideology. However, when thousands of these youths were driven into exile by state repression, they joined the African National Congress (ANC) or its military wing. When hundreds of them returned as guerrillas after 1978, some were arrested and tried, while others were involved in spectacular shootouts with the police. The resulting press coverage began to revive ANC ideology in popular consciousness. With further publicity in 1980 from a Free Mandela campaign, and from luridly successful sabotage attacks, popular support for the ANC soared, shaping political events for the rest of the decade. The only other noteworthy tendency among blacks was the Zulu‐based Inkatha movement led by Chief Gatsha Buthelezi, whose support among young people was slight because of his hostile stance to both BC and the ANC.
THE annual election of the Library Association Council for 1946 is over. Of course, only a small part of the Council has been before the electors. The results follow an…
Abstract
THE annual election of the Library Association Council for 1946 is over. Of course, only a small part of the Council has been before the electors. The results follow an old‐established precedent, but are nevertheless curious. Why is it that country members seem not to be interested in their selection of candidates who come from the metropolitan area? There were two to be elected for London and those successful were Frank M. Gardner with 572 and Captain Richard Wright with 501 votes; there were five Country Councillors required and Miss M. F. Austin (854) and Messrs. W. A. Munford (831), F. G. B. Hutchings (817), E. Wisker (716) and E. Osborne (601) were elected. Besides the London candidates who were successful by ballot, Mr. W. B. Stevenson (447) and Mr. E. Sydney (360) will serve on the Council for shorter periods in the room of Mr. J. D. Stewart and S/Ldr. J. D. Cowley. It will therefore be seen that there is considerable disparity in the voting for the two parts of the Council. As we say, this is rather curious as it follows a long established tradition. The new members are Mr. Gardner, Mr. Stevenson, Miss Austin, Mr. Munford and Mr. Wisker; this appears to us to be a very interesting and useful team. They have already shown by definite work, mostly in the A.A.L., that they are qualified leaders amongst the younger librarians. We wish them good fortune in the carrying out of their part in the reconstruction period ahead.
Doreen Robinson and Reenee Singh
In this chapter, we describe the belief system of Izzat which is central among South Asian families. The idea of forced marriage is based upon the concept of Izzat or honor which…
Abstract
In this chapter, we describe the belief system of Izzat which is central among South Asian families. The idea of forced marriage is based upon the concept of Izzat or honor which is a cornerstone of family life in South Asian communities.
Rai (2006) suggests that South Asian community members are deeply affected by what others say about them. The closest English translations to Izzat and Sharam are honor and shame, respectively. Rai argues that Izzat and Sharam are mechanisms that safeguard patriarchal customs such as arranged marriage which are familiar to us from our own backgrounds as two Asian women. It is our belief that Izzat is the highest “context marker” (Pearce & Cronen, 1980) for forced marriages.
We will illustrate the concept of Izzat through two case vignettes and explicate theoretical ideas, based on Izzat to include Borzemyi-Nagy’s ideas about belief systems.
The research of Ryan Brown (2016) University of Oklahoma on “honour cultures” in the USA draws some parallels in gendered discourses about power of men over women. He suggests that high levels of murder rates as well as reluctance to address mental health issues are present in “honour cultures.” These ideas resonate with the strong influence of Izzat upon South Asian family and community systems which we have met in our practice. The development of our practice was in response to issues arising from our clinical work in these communities (Robinson, 2016).
We will explore the continuum of marriage to include forced, arranged and consensual marriage within the context of Izzat and compare with black African and African-Caribbean families.
We will also consider issues of cultural competence and expertness and how this interplays with strongly held belief systems such as Izzat. We will end with some clinical implications and pointers for practice.