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Biomedical subjects

I C H Clare

Publications and source records attributed to I C H Clare.

7 recordsLinked to original sources
PubMed2006

Understanding of basic financial concepts among adults with mild learning disabilities.

OBJECTIVE: In the context of recent legal and social policy developments, which encourage clinicians to support vulnerable adults in making their own financial decisions, we explored understanding of basic financial concepts among adults with mild learning disabilities. METHOD: Using the literature about typically developing children, five measures entailing identification and ordering tasks were devised and were used to examine understanding of quantity, numbers and money among 30 men and women using specialist clinical services (mean FSIQ = 61.80; SD=10.59). RESULTS: The concept of quantity was easier to understand than those of numbers and money, and task difficulties increased with the magnitudes involved. The different types of conceptual understanding were closely related. CONCLUSIONS: These measures may be useful for analysing difficulties in, and informing interventions to maximize, independent financial decision making.

Adolescent↗
PubMed2005

Capacity to make financial decisions among people with mild intellectual disabilities.

BACKGROUND: Although there has been growing recognition of the importance of enabling people with intellectual disabilities (ID) to be more directly involved in managing their own financial affairs, so far, little is known about this aspect of their decision- making. METHOD: Using vignettes and semi-structured interviews, the financial decision-making abilities of men and women with mild ID (n=30; mean FSIQ =61.80; SD=10.59) were compared with those of their counterparts in the 'general population' (n=16; mean FSIQ=101.56; SD=7.62) and 'very able' individuals (n=14; mean FSIQ=123.93; SD=7.60). RESULTS: Whilst the financial decision-making abilities of participants with ID were generally weaker than those of other participants, the differences were not discrete, and many individuals were judged to be able to make at least some personal financial decisions. For all three groups, understanding information relevant to the decision, and reasoning with it, were the hardest parts of the process. CONCLUSIONS: The findings support a functional approach to the assessment of financial decision-making for both legal and clinical purposes, but raise concerns about mental incapacity legislation and assessment.

Adolescent↗
PubMed2005

The relationships among three factors affecting the financial decision-making abilities of adults with mild intellectual disabilities.

BACKGROUND: Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals' decision-making abilities are sufficient, and many factors may affect the development of such abilities. METHOD: As part of a wider project on financial decision-making, we analysed previous data from a group of 30 adults with mild IDs, identifying correlations among four variables: (i) financial decision-making abilities; (ii) intellectual ability; (iii) understanding of some basic concepts relevant to finance; and (iv) decision-making opportunities in everyday life. RESULTS: The analysis indicated a direct relationship between ID and basic financial understanding. Strong relationships of a potentially reciprocal nature were identified between basic financial understanding and everyday decision-making opportunities, and between such opportunities and financial decision-making abilities. CONCLUSIONS: The findings suggest that the role of intellectual ability in determining financial decision-making abilities is only indirect, and that access to both basic skills education and everyday decision-making opportunities is crucial for maximizing capacity. The implications of this are discussed.

Adolescent↗
PubMed2005

Self-harm, capacity, and refusal of treatment: implications for emergency medical practice. A prospective observational study.

OBJECTIVES: In the context of increasing attention to the rights of adults to make treatment decisions for themselves, this study investigated, among patients who have engaged in self-harm (i) the extent of valid decision making; (ii) the impact of mental disorders; and (iii) the effect of systematically providing relevant clinical information. DESIGN: A prospective observational study. SETTING: The emergency department of a large teaching hospital in southeast England. PARTICIPANTS: Seventy one adult men and women who had presented for treatment following self-harm. MAIN OUTCOME MEASURES: Semi-structured interviews were used to make clinical judgements about participants' capacity to consent before, and following, the presentation of simple written information about the proposed treatment(s). Demographic data, and data about mental disorder and alcohol misuse, were also collected. RESULTS: Based on accepted legal criteria, only 28/71 (39.4%) of the patients were judged to have capacity to consent to the proposed intervention(s) initially. However, the number of patients judged to have capacity improved significantly (p<0.001) after the presentation of written information, to 45/71 (63.4%). Those judged incapable were significantly more likely (p<0.01) to refuse treatment. Continuing incapacity was significantly associated only with cognitive impairment (p<0.001) and/or severe psychiatric disturbance (p<0.01). CONCLUSIONS: Consistent with current views, capacity is not static, even among patients who have engaged in self-harm, but can be improved through a simple intervention. The findings are consistent with recent guidance about supporting this vulnerable group of patients, many of whom are ambivalent about treatment.

Adult↗
PubMed2003

The Human Genome Project: considerations for people with intellectual disabilities.

The paper discusses the impact which recent advances in gene technology may have for people with intellectual disabilities. It highlights a conflict between the apparent benefits of advances in genetics for the population in general and the negative effects on persons with intellectual disabilities in particular. This conflict is illustrated in the paper through the use of examples, including the implications of a person's lack of capacity to consent to investigations and treatment; the issue of individual responsibility for antisocial behaviour when this is considered to have a genetic component; and the issue of life and death decisions about treatment in the face of a progressive, genetically determined, disorder. The authors adopt a human rights perspective to discuss these examples because it provides a richness to articulate and justify moral concerns in this area which is lacking in much of the current debate as this is dominated by the primacy of autonomy.

Human Genome Project↗
PubMed2002

Prevalence of criminal offending by men and women with intellectual disability and the characteristics of offenders: implications for research and service development.

The investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of 'ID' and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below-average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over-represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as 'challenging behaviour' becomes 'offending' is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how 'difficult' behaviour becomes identified as 'antisocial/criminal behaviour'. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re-expansion of institutional models of care, rather than the development of multi-agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.

Comorbidity↗