http://hdl.handle.net/10147/22294 Thu, 20 Jun 2013 06:49:11 GMT 2013-06-20T06:49:11Z http://hdl.handle.net/10147/269292 Title: A case study analysis of Person-Centred-Planning for people with intellectual disability following their transfer from institutional care. [Ph.D. thesis] / by Donal Fitzsimsons Authors: Fitzsimons, Donal Description: Person centred planning (PCP) has an essential part to play in ensuring self determination for the lives of people with intellectual disability. It is typically taken as an indicator to the quality of services and it is regarded as especially important when considering its effectiveness in impacting on the lives of people with intellectual disability. Robertson’s et al (2005) six indices of PCP efficacy of social networks, community involvement, scheduled day services, contact with friends, contact with family and choice are regarded as a standard measure. This research examined the PCP process and its impact on the reality of the life of the person with intellectual disability. It considered the understanding of various stakeholders in the PCP process and investigated whether PCP brings added value to the lives of people with intellectual disability in community settings. Finally, it explored the relationship between the theory, policy, and outcomes of PCP for ongoing practice. Using a qualitative case study approach this study examined the lives of ten people who were selected from a list of people with intellectual disability who were removed from their families and placed in institutional settings and later transferred to community residences. Semi-structured face-to-face interviews based on Robertson’s six indices of PCP efficacy took place with the three stakeholder groups including the person with intellectual disability, their family member and their key worker (thirty interviews). For each focus individual further information was collected from relevant professionals such as day service staff, social workers, psychologists and speech and language therapists. Finally, one PCP meeting was attended for each individual (10 in total). This informed a descriptive account of each case which were based on the following structure: background and content, current status, the PCP process and comment and anlaysis which resulted in an individual case study for each of the ten people with intellectual disability of this study. Recurring themes emerged from a detailed cross case study analysis. A key theme that emerged was the legacy of institutional care and practices. The study found the structure of the PCP meeting to be over formal with a limited understanding of the aims and impact of PCP by all concerned. Different factors led to resource limitations for each of the stakeholders resulting in a reliance of special services combined with a fear of additional costs and routine activities in PCP. This study also found that there was an emphasis on duty of care that led to risk aversion in PCP goal setting with individual differences and local variations impacting on the efficacy of PCP. The PCP’s in this study were found to promote community presence but did not lead to community participation. This study also found that there are some positive impacts to having a PCP in place for people with intellectual disability. This study did not find evidence for true person centeredness in the community residences but it found that the community residence service model (which is in affect a smaller version of the institutional model) still lacks flexibility in providing people with intellectual disability lives of their own determination. In considering PCP this study found that the community based residence model acted as a barrier to Robertson’s standards of PCP efficacy as the goals of the PCP simply 5 did not include actions that would lead to community participation, enduring family involvement or any element of real choice. It did find that when people with intellectual disability moved from the institution to a community setting the PCP delivered on an increased range of hobby activities, typically in the context of special service settings and special service networks. This study found the need to introduce a fresh look at improving the PCP by in service training on the philosophical basis of PCP, guidance for families, accessible formats for the people with intellectual disability to take on ownership of their PCP’s, deeper consultation with families as well as introducing standard measures and ongoing monitoring of PCP. This is important as we know from the National Intellectual Disability Database (NIDD, 2010) that 26,484 people with intellectual disability are in receipt of services. In addition there are over 4000 Irish citizens with intellectual disability who continue to languish in large institutions who need to transfer to a community setting (HSE, 2011) while a further 4,088 individuals reside in community residences. As well as concluding that the PCP’s examined in this study were flawed it is also evident that there is a need to challenge the premise of the congregate care model of service provision as inherent in this is segregation and lack of valued social roles. Optimal individual service design (OISD) is one such way of challenging the outdated 20th Century service model which is perpetuated by a reliance on grouping people based on their disability in both day and residential services. In an effort to be truly person centred this study sets out to challenge services and policy makers on the the individual and citizenship rights of each person with intellectual disability and questions whether PCP has the power to act as a conduit in the structuring of person centred support which ultimately can only be done for one person at a time. Thu, 01 Nov 2012 00:00:00 GMT http://hdl.handle.net/10147/269292 2012-11-01T00:00:00Z http://hdl.handle.net/10147/268294 Title: Caring for people with intellectual disability: the need for residential care: thesis submitted for membership for the Faculty of Public Health Medicine of the Royal College of Physicians of Ireland. Authors: Egan, Ann T. Description: The care of people with intellectual disability has evolved, at an increasing pace, down through the centuries. Attitudes have changed from that of shame and the hiding away of people with intellectual disability from the general community, to one of open discussion of their needs. Nowadays their participation in the local community is being encouraged to the maximum. However, there are still many areas of service delivery which fall short of that considered necessary for the optimum care of those with intellectual disability. This study was undertaken against a background of increasing awareness of the importance of the integration of individuals with .intellectual disability into the general community. It is desirable that health services should be matched to the local health needs. These services should be developed in a structured and orderly manner as resources become available and be based on objectively compiled data. The findings of the study should be of value to those with responsibility for planning residential and community services for those with intellectual disability both in the South Eastern Health Board region and nationally. Sun, 01 Oct 1995 00:00:00 GMT http://hdl.handle.net/10147/268294 1995-10-01T00:00:00Z http://hdl.handle.net/10147/268312 Title: Audit of a Paediatric Accident and Emergency Department: thesis submitted for membership of the Faculty of Public Health Medicine in Ireland. Authors: Boland, Mairin C. Description: This study consists of an audit of the Accident and Emergency department of a large Dublin paediatric hospital, Our Lady's Hospital for Sick Children, Crumlin. Audit is the process of reviewing the delivery of health care to identify deficiencies so that they may be remedied. It is a valuable tool which can be used to measure and modify the quality of care. This audit focuses on three aspects of quality, namely acceptability, accessibility and equity. It also encompasses a fourth dimension of appropriateness of use of this service; this is vital to the total quality management process, as inappropriate attenders may decrease the quality of care for appropriate attenders. A total of 645 patients attending the Accident and Emergency department (Accident and Emergency department) were sampled to represent the patterns of attendance by season (summer and winter), day of week and time of day. Sun, 01 Feb 1998 00:00:00 GMT http://hdl.handle.net/10147/268312 1998-02-01T00:00:00Z http://hdl.handle.net/10147/246454 Title: The effectiveness of seat-belt legislation in the Republic of Ireland [thesis]/by Dr. Mary Murphy Authors: Murphy, Mary Dr. Description: Motor vehicle accidents cause death and disability. The seat belt is designed to keep a vehicle occupant within the vehicle during a crash and reduce the severity of impact by the occupant against ,the vehicle interior immediately after a crash. The seat belt, thus acts to , reduce the injury producing forces brought to bear on the wearer In a crash situation. Seat belt legislation is a health promotion measure aimed at encouraging people to use seat belts and by so doing reducing their risk of death and serious injury in a crash. Legislation regarding use of seat belts is now in operation in 27 jurisdictions • 'Seat belt legislation was introduced In thd Republic of Ireland In February 1979. , S~atbelt legislation has everywhere been effective In increasing seat belt use. The best wearing rate was achieved in Victoria, where 97% of car drivers use seat belts. The most recent survey In Ireland indicates that 60% of front seat car occupants use seat belts. 'Studies on seat belt effectiveness in reducing the risk of fatalities and injuries have been done in other countries. Results of studies suggest that if everybody wore seat belts then deaths and injuries resulting from crashes would be. reduced by 40%. All studies show that the more serious injuries are reduced more than the less serious injuries. Seat belt use is especially effective in reducing head, facial and spinal injuries. Some authors have noled an association between seat belt use and injury production. Injury produced by wearing seat belts, however, may represent a saving from worse injury or death. There is little data available in Ireland on seat belt effectiveness. A protective effect of seat belt use is suggested by accident data. At a population level, however, there has been no decrease in accident casualty figures since the introduction of seat belt legislation. A hospital based study of injury severity and risk of death in relation to seat belt use is proposed in this research. The study population is that of front seat motor vehicle occupants who are involved 1n crashes and who attend the Accident and Emergency Unit of hospital. The study sample will be persons belonging to the study population who present in the Accident and Emergency Units of four Dublin hospitals over a one year period. The proposed study hopes to provide a scientific basis for evaluating the effectiveness of seat belt legislation 1n the Republic of Ireland . Sat, 01 Mar 1986 00:00:00 GMT http://hdl.handle.net/10147/246454 1986-03-01T00:00:00Z