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There is a move to make primary care models of mental health care more accessible to people with intellectual disabilities (IAPT, 2009) but little evidence of their ability of services to make the necessary reasonable adjustments or their effectiveness (Dodd et al., 2011). The purpose of this paper is to describe a pilot project to evaluate an anxiety management group co-facilitated by Least Intervention First Time (LIFT) Psychology and Community Team for People with Learning Disabilities (CTPLD) services.

Five people attended a nine-week anxiety management group, adapted from a course offered by LIFT services. The Glasgow Anxiety Scale (GAS-ID) and a skills and knowledge assessment were completed pre-group, post-group and follow-up to evaluate outcome and consider the ability of LIFT to make reasonable adjustments to deliver effective services for people with intellectual disabilities.

Participants showed no significant reduction in anxiety levels but improvements in their skills and knowledge. An evaluation of the adjustments to make the group accessible for people with intellectual disabilities identified that some were feasible if offering the group on a long-term basis, and others were not. The viability of future groups is considered.

The paper looks at the viability of making reasonable adjustments to psychoeducational groups within Improving Access to Psychological Therapies services to better meet the needs of people with intellectual disabilities, an area of limited research. It raises dilemmas and considerations for the future development of such services.

Prevalence of post-traumatic stress disorder (PTSD) among UK veterans is higher than in the general population. However, prevalence figures do not reflect the complexity of this phenomenon and ways in which it may be bound up with veterans’ experiences of adjusting to civilian life. The purpose of this study is to explore veterans’ experiences of successfully managing PTSD.

Semi-structured interviews were conducted with six veterans who had served in the UK armed forces and analysed using interpretative phenomenological analysis.

Three themes were developed: accepting the problem, taking responsibility and gaining control; talking to the right people; and strategies, antidotes and circling back around. Managing PTSD appeared to be bound up with veterans’ experience of renegotiating their identity, where positive aspects of identity lost on leaving the military were rebuilt and problematic aspects were challenged. Participants sought to speak about their difficulties with others who understood the military context. They felt that their experiences made them a valuable resource to others, and they connected this with a positive sense of identity and value.

The findings suggest the importance of wider provision of peer support and education for civilian health services on veterans’ needs.

This study adds to the understanding of what meaningful recovery from PTSD may involve for veterans, in particular its potential interconnectedness with the process of adjusting to civilian life.

This study draws on the service-dominant (S-D) logic paradigm to examine value co-creation and co-destruction. As these phenomena are driven by positive and negative “customer-to-customer” (C2C) interactions, this paper aims to examine their influence on tourist perceptions of service quality and how they shape affective responses toward tourism and hospitality services and brand loyalty.

Following a comprehensive literature review, the authors used convenience sampling to gather a large sample of tourists at Shanghai Disneyland, a recently opened and already popular international tourism attraction. Structural equation modeling was used to test for direct and moderated relationships.

The findings indicated that positive and negative C2C interactions have significant though differential impacts on customer responses. Furthermore, it was found that visitor arousal mediated the relationship between service quality and brand loyalty. Prior experience was identified as a moderator in the co-creation and co-destruction process during service encounters.

This paper is one of the first to examine the concept of co-destruction in the tourism and hospitality context. It contributes to the literature by demonstrating the merits of proactive service provision by tourism operators, taking account of both the co-creation and co-destruction of value.

The study extends the literature by taking account of both positive and negative C2C interactions when examining co-creation and co-destruction in the context of service encounters. It also contributes to knowledge by assessing the asymmetry of such interactions in the context of the customer experience.

The initial purpose of this study was to examine the educational needs and perceptions of students and clinicians in Canadian legal clinics.

The author conducted a literature review of leading educational materials in Canada and the United States focusing on required or preferred competencies for law students. The author then interviewed law students, clinicians, social workers, and community legal workers from across Ontario, Canada, all of whom were working or studying at law school-affiliated legal clinics. Interview subjects were asked a series of questions about their learning experiences in hopes of informing the creation of clinical teaching and learning materials.

The data revealed an under-reliance of the affective elements of teaching, learning, and practice in both existing literature and current teaching practices. The data also revealed deep structural divides between doctrinal and clinical teaching and learning approaches.

Without further integration between these two approaches, students and, ultimately, communities and clients will not reap the benefits possible from an integrated curriculum.

The National Health Insurance Scheme (NHIS) was introduced in 2005 to provide equitable access to healthcare. Furthermore, concessions were made for pregnant women, yet inequities in access continue to exist. The purpose of this paper is to explore whether dimensions of social exclusion explain why some groups of women are not benefitting from the scheme.

Data were collected from 4,050 representative households in five districts. Logistic regression is used to examine the factors that determine enrolment of women under the NHIS.

The study sample consists of a sub-sample of 3,173 women out of whom 58 per cent were insured. The majority (64.9 per cent) of the women were in the reproductive age (15–45 years). The results show that wealth status, age, health status, locality, perception about the quality of care at health facilities and perception of the NHIS, are the key factors that determine enrolment into the scheme.

By conceptualising social exclusion as the multi-dimensional processes driven by unequal power relationships which lead to differential inclusion and exclusion in social systems, the study provides evidence to show that certain groups of women are systemically excluded from participating in the NHIS.

With women dominating the informal sector of Ghana’s economy which is often characterised by relatively low incomes, these inequities in access need to be addressed.

Although gender equality incorporates discussions on issues affecting men and women this paper focusses on women in Ghana due to disadvantaged position in which many of them find themselves in terms of access to resources. Almost all of the identified barriers in previous studies have been worsened by gender with women generally facing greater difficulties in accessing adequate care. Few of these papers have taken account the specific health needs and gender-specific constraints of women in the NHIS. The authors aim to fill this gap by using a social exclusion lens to explore whether Ghanaian women (i.e. 15 years and above) are participating in the NHIS and examine the processes by which exclusion occurs and what explains the patterns observed.