Background Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population. Methods Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel. Results Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas. Conclusion The findings of limited training and self-perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services.

Purpose: Individuals with intellectual disabilities (ID) and individuals with mental illness are consistently found to be among the most socially excluded populations and continue to face substantial health, housing, and employment disparities due to stigma. Although this has spurred extensive research efforts and theoretical advancements in the study of stigma toward mental illness, the stigma of ID has received only limited attention. In this article we explore the application of mental illness stigma research for ID. Design: We carefully reviewed the existing research on mental illness stigma as a foundation for a parallel summary of the empirical literature on attitudes and stigma related to ID. Results: Based on our review, there has not been a systematic approach to the study of stigma toward ID. However, multilevel conceptual models of stigma have received much attention in the mental illness literature. These models have been used to inform targeted interventions and have application to the study of the stigma process for individuals with ID. Nonetheless, there are indeed key differences between-as well as substantial variability within-the ID and mental illness populations that must be considered. Conclusions: Stigma is an issue of social justice impacting the lives of individuals with ID, yet there remains virtually no systematic framework applied to the understanding of the stigma process for this group. Future research can draw on the stigma models developed in the mental illness literature to guide more rigorous research efforts and ultimately the development of effective, multilevel stigma-change strategies for ID.

Studies have shown that stigmatization is linked to lower quality of life; however, only scant research has examined the association between family caregivers' internalization of stigma (affiliate stigma) and their subjective quality of life (subjective well-being, SWB). Furthermore, studies have rarely examined this association via comparison between caregivers of individuals with different developmental disabilities in addition to examining the influence of psychosocial protective factors. These were the aims of the current study. Family caregivers ( N= 176) of individuals with autism spectrum disorders (ASD), intellectual disabilities (ID), and physical disabilities (PD) completed a self-report structured questionnaire including scales measuring SWB, affiliate stigma, burden, positive meaning in caregiving, social support and self-esteem. Results showed that SWB of family caregivers was below the average normative level and especially low for caregivers of individuals with ASD. The strongest predictors of SWB were caregivers' self-esteem, social support, positive meaning in caregiving, and affiliate stigma. Furthermore, an interaction was found between affiliate stigma and diagnosis, showing that among caregivers of individuals with ASD, greater levels of stigma were associated with lower ratings of SWB, whereas such an association was not found among caregivers of individuals with ID or PD. Findings from this study point to the importance of supporting caregivers across the life-span in order to decrease stigma, improve social support and self-esteem and improve SWB. Further, findings point to the need to respond differentially to the various developmental disabilities.

Background: Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology. Methods: Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden. Results: The strongest predictors of burden were care-recipients lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of carerecipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients behavioral and emotional states were also positively related to caregiver burden. Conclusions: The findings stress the importance of maintaining older persons out-of-home mobility during cognitive decline.

Background: Problems with out-of-home mobility are among the more common behavioral disturbances in dementia. Today people with dementia can be aided by easily accessible assistive technologies, such as tracking devices using Global Positioning Systems (GPS). Attitudes toward these technologies are still inconclusive and their use with people with dementia raises ethical concerns. The lack of ethical consensus on the use of GPS for people with dementia underlines the need for clearer policies and practical guidelines. Methods: Here we summarize qualitative and quantitative findings from a larger research project on the ethical aspects of using GPS for tracking people with dementia. Results: The findings are formulated in a list of recommendations for policy-makers as well as for professional and family caregivers. Among other points, the recommendations indicate that the preferences and best interests of the people with dementia should be central to the difficult decisions required in dementia care. Further, no-one should be coerced into using tracking technology and, where possible, people with dementia must be involved in the decision-making and their consent sought. Conclusions: The decision whether, when and how to use GPS for tracking people with dementia should be made at the time of diagnosis jointly by the person with dementia, his/her family and professional caregivers. This decision should be made in formal structured meetings facilitated by a professional team.

To achieve the basic human right of autonomy, individuals, including those with intellectual disabilities (ID), must be able to practice decision-making, that is, to make their own decisions and communicate these decisions to others. In support of autonomous decision-making, Article 12 of the United Nations Convention on the Rights of People with Disabilities (CRPD) stresses the right of individuals with disabilities to legal capacity on an equal basis with others.1Supported decision-making approaches may aid individuals with ID in achieving this right. The question remains whether the enactment of the CRPD indeed is translated into opportunities for autonomous and supported decision-making among individuals with ID. In order to examine this question, a systematic review of bibliographic databases since 2008, when the CRPD came into force, was conducted in order to map the current state of decision-making among individuals with ID, and to identify areas in need of improvement. Twenty-seven manuscripts were reviewed, most focusing on decision-making within the fields of residential settings, health care, and sexuality-related decisions. This review showed that difficulties in decision-making in the area of ID remain during the early years after the CRPD entered into effect. These difficulties are related to the individuals with ID themselves, to their caregivers, and to the service system. No working models on supported decision-making for this population were found. The discussion highlights the importance of developing decision-making skills among people with ID, allowing them opportunities for decision-making, training professionals in supported decision-making, and fostering the philosophy of person-centered planning.

Providing holistic care to individuals with the dual diagnosis (DD) of intellectual disability and mental illness is a challenging task that requires the work of various health care specialists. The aim of the current study was to examine the intentions of students from various fields to work with individuals with DD. A questionnaire was completed by 512 social work, occupational therapy, speech and language therapy, special education, and nursing students in Israel to measure students' attitudes toward working with individuals with DD, as well as their perceptions of subjective norms, controllability, and self-efficacy. Structural equation modeling showed that the students' intentions to work with individuals with DD were predicted by their attitudes and perceptions of subjective norms. Controllability was found to negatively affect their behavioral intentions. Furthermore, social work and nursing students were found to have the lowest behavioral intentions. Given the lack of education in the field of DD and the prevailing stigmatic attitudes toward this population, university programs should focus on increasing knowledge, promoting positive contact, and reducing the fear attached to working with people with DD. 2012 National Association of Social Workers2012

Background Dual diagnosis (DD) refers to the coexistence of intellectual disability and psychiatric disorder. In order to provide individuals with DD with adequate care, it is essential for mental health workers to have adequate knowledge and positive attitudes. These may be achieved through proper training. Aims To summarise the available literature examining the knowledge, attitudes and training of psychiatrists and other professional caregivers in regard to serving people with DD. Methods A search strategy was developed to find manuscripts published in English since 1995. Results Twenty-seven studies on knowledge, attitudes and training in the field of DD were identified and reviewed in this paper. Conclusion The findings of this review stress the need to improve the knowledge, competence and attitudes of practitioners within the DD field via training and practice opportunities. In light of this review, recommendations for improving training opportunities and for conducting future research are made.

Needs of individuals with serious mental illness (SMI) must be understood in order to promote recovery. This study examined the needs of 206 individuals with SMI and compared their perceptions with those of their professional caregivers. Needs were reported in the areas of accommodations, psychotic symptoms, daytime activity, intimate relationships, and psychological distress. Caregivers reported more met needs, while individuals themselves reported more unmet needs. Results suggest that in order to promote recovery, services for persons with SMI should be developed in accordance with patients' most prominent needs, specifically in the social and personal areas of intimate and sexual relationships.

The theoretical construct of stigma has received much attention in psychiatric disability research, leading to the development of widely used measures. Such measures have had real world impact in that they allow for the assessment of stigma change efforts. The study of stigma has not received the same level of attention for persons with intellectual disabilities. In this manuscript we evaluate existing measures of intellectual disability stigma through a systematic review of the literature. Twenty-four scales were reviewed and evaluated. Findings indicate a paucity of stigma measures based on theoretical conceptualizations pointing to a need for further development of measures to pursue the study of public, self, and family stigma as related to intellectual disability.

Hope, as a basic resource in human life, may affect individuals' perceptions of subjective well-being (SWB). Further, understanding individuals' needs is essential to improving their SWB. It is unclear how the impact of hope on SWB may be mediated by needs. The current study aimed to examine a mediation model for the relation between hope and SWB among individuals with serious mental illness (SMI). Face-to-face structured interviews were conducted with 172 individuals with SMI. Instruments included the Personal Wellbeing Index, the Hope Scale, and the Camberwell Assessment of Needs. Hope and needs were predictive of 40% of the variability in SWB, with hope being a stronger predictor. Having no needs was positively predictive of SWB, while total number of needs was negatively predictive of SWB. Path analyses revealed a strong direct effect of hope on SWB and a weaker, though still strong, indirect effect mediated through needs. The results underscore the importance of hope in improving SWB and, consequently, enhancing the recovery process of individuals with SMI. Therefore, mental health services should focus on hope-building.

על שילובם של אנשים עם צרכים מיוחדים בתחומי חיים שונים.

A range of professionals needs to work collaboratively in providing services for the growing numbers of people diagnosed with autism. Given the challenges of recruiting health professionals to work with people with disabilities in general, it is important to understand the factors that affect students' choices about working with people with autism, in particular. The aim of the present study was to assess attitudes of students in various health and social professions toward working with people with autism. An elicitation study based on the theory of planned behavior was conducted among 42 female students from the departments of social work, education, nursing, occupational therapy, and communication disorders/speech and language therapy. Working with people with autism was perceived as difficult, challenging, and frustrating, yet rewarding, important, and an opportunity to develop personally and professionally. Furthermore, the importance of awareness to stigmatic beliefs was raised. Familiarity, knowledge, and training were perceived as important. The results call for increasing university curriculum in the area of autism, increasing the contact of students with this population and focusing on training in interprofessional collaboration.

Providing adequate care to individuals with intellectual disability (ID) requires the willingness of students in various health and social professions to care for this population upon completion of their studies. The aim of the current study was to examine the factors associated with the intentions of students from various fields to work with individuals with ID, using the framework of the Theory of Planned Behavior. A structured self-administered questionnaire was completed by 512 social work, occupational therapy, speech and language therapy, special education, and nursing students. The questionnaire measured students' attitudes toward individuals with ID and toward working with this population, as well as their perceptions of subjective norms, controllability, self-efficacy, prior acquaintance with individuals with ID, and subjective knowledge about ID. Structural equation modeling showed that the students' intentions to work with individuals with ID were predicted by their attitudes and perceptions of subjective norms. Field of study and subjective knowledge were also found to be predictive of behavioral intention. The TPB proved to be a useful framework for examining students' intentions to work with persons with ID. Given the lack of education in the field of ID, as well as the prevailing stigmatic attitudes toward this population, university departments should develop programs aimed at increasing knowledge, promoting positive contact, and reducing the fear attached to working with persons with intellectual disability.

Global Positioning Systems (GPS) have recently been employed to helpmonitor persons with dementia. While the advantages of such technologies are clear, making use of them raises a number of ethical dilemmas. Considering the fact that social workers may be called upon to assist families in making decisions regarding the use of GPS, their attitudes on this issue are important. Fifty-five social workers and 61 social work students completed a questionnaire including: Attitudes toward tracking, knowledge of Alzheimer's Disease (AD) symptoms, familiarity with persons who have AD, and ratings of who should be involved in the decisionmaking process regarding GPS use. Findings showed that the highest-scored attitude factor was respecting elders' autonomy, while the lowest-scored factor opposed GPS use. The elderly and their spouses were rated as important decision-makers regarding the use of GPS. Knowledge of AD and respecting autonomy were negatively correlated. Students gave a higher rating to respecting elders' autonomy than the social workers. Social workers gave a higher rating to the importance of a multidisciplinary team. Implications for social work education are discussed including recommendations for person-centered AD care on the one hand, and the need to balance the interests of the individual and the family on the other.

Objectives: In recent years advanced technologies, such as Global Positioning Systems (GPS), allow for tracking of human spatial activity and provide the ability to intervene to manage that activity. The purpose of this study is to examine the issue of who should decide about the use of electronic tracking using GPS for people with dementia. Methods: Based on quantitative data collected from 296 participants comprising cognitively intact elderly, family caregivers of people with dementia, social workers, other professionals, and social work students, study participants were asked to rate nine different potential decision-makers to make this decision. Results: The results show that figures inside the family, particularly the spouse or the most involved family caregiver, were perceived more important in the decision-making process than figures outside the family, whereas the person with dementia was ranked third in the order of the figures. Since the decision to use GPS for tracking raises the ethical dilemma of personal safety versus autonomy and privacy of people with dementia, the findings seem to indicate that the reluctance of professional caregivers to assist family caregivers to make this decision is experienced as frustrating. Conclusions: The findings imply that in order to reach a balance between the wishes and interests of both people with dementia and their family caregivers, there is a need for more active involvement of the professional caregivers to facilitate the family decision-making process.

Objective: Attachment theory was employed as the theoretical framework for the purpose of examining attitudes toward people with disabilities. Method: A total of 404 Jewish Israeli students without disabilities completed the Multidimensional Attitudes Scale Toward Persons With Disabilities (MAS) and the Experiences in Close Relationships Scale (ECR). Results: Reading a scenario about an encounter with a person with a disability gave rise to more negative emotions than reading a similar scenario about an encounter with a person without a disability, regardless of participants' attachment orientations. However, attachment orientations moderated participants' positive cognitions and distancing behaviors. Conclusions: Findings suggest a dynamic process of self-regulation when reacting to a written scenario about people with disabilities. This process consists of an initial spontaneous negative emotional response accompanied by compensatory positive cognitions and behavioral tendencies.

Recently developed tracking technologies may be useful in managing mobility problems among elders with cognitive impairment. For clinical and research purposes it is critical to assess research participants' cooperation with the tracking protocol. The aim of the current study was to assess the ability of older adults with various levels of cognitive impairment to participate in GPS-based studies. Fifty-three participants aged 63+ and their study partners were interviewed. Participants were tracked for four weeks, 24 hours a day, using a location kit combining Global Positioning System with Radio Frequency Identification technology. Participants’ cooperation was associated with positive affect (r = 0.35, p < .01), life satisfaction and study partner’s older age (r =0.37, p<.01). Advanced tracking technologies offer a feasible method of measuring outdoor mobility behavior of older adults. This preliminary study sets the stage for further data collection via innovative technologies and design interventions to manage mobility problems.

In this study we examined the ethical aspects of the use of the Global Positioning Systems (GPS) to track people with dementia. The findings are based on qualitative data gathered from focus groups of family and professional caregivers. The most important theme was the need to balance patients need for safety with the need to preserve their autonomy and privacy. The main potential benefit of the use of GPS was related to the peace of mind of the caregivers themselves. The findings also suggest that caregivers views change according to the locus of responsibility of the caregivers for the safety of people with dementia. The caregivers give preference to patients safety more than autonomy when they are responsible for the patients. When the patients are under the responsibility of other caregivers, they give preference to patients autonomy more than their safety. Overall, the variety and the depth of the views of different stakeholders toward the use of electronic tracking for people with dementia presented in this article provide a meaningful contribution to the ethical debate on this topic.