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.

This study aims to investigate the effect of observer's gender and target's gender on attitudes toward people who use wheelchairs due to a physical disability. Four hundred four Jewish Israeli students without disabilities completed the Multidimensional Attitudes Scale Toward Persons With Disabilities (MAS). Initially, confirmatory factor analysis was used to revalidate the MAS. Five factors of attitudes were confirmed: distancing behaviors, positive cognitions, negative emotions, interpersonal stress, and calm. Findings showed that an encounter with a person using a wheelchair raised more positive cognitions and less distancing behaviors, but also evoked more negative emotions, than an encounter with a person without a disability. In the case of an encounter with a person without a disability, men contributed to greater interpersonal stress among women, whereas women contributed to greater interpersonal stress among men. The multidimensional approach revealed that the effect of gender was mostly salient with regard to interpersonal stress.

Background: The issue of using advanced tracking technologies such as Global Positioning Systems (GPS) is part of a wider debate on the acceptability of assistive technology to older people with dementia. The use of GPS can enhance the personal safety of older people by alerting caregivers to potential dangers or adverse events that might threaten the individual's health and safety, but at the same time it raises ethical concerns. This study examines the attitudes of cognitively intact older people toward the use of tracking devices for people with dementia. Methods: The analysis is based on quantitative data from a convenience sample (n = 42) and qualitative data gathered from two focus groups of cognitively intact older people in Israel. Results: Whereas cognitively intact older people clearly differentiate between themselves and people with dementia, they support the use of tracking devices when dementia is either formally diagnosed or its signs are evident. They value the safety of people with dementia above preserving their autonomy. Although they perceive the decision to use tracking devices as an intra-family issue, they expect guidance from professional caregivers of people with dementia. The acceptability of tracking devices is dependent on their appropriate weight, size and ease of use. Conclusions: Cognitively intact older people favor the idea of tracking people with dementia. To facilitate family decision-making on the use of tracking devices, structured meetings guided by professionals and including persons with dementia and their family caregivers are suggested.

הקשר שבין סכיזופרניה למיצב (סטטוס) חברתי-כלכלי נחקר רבות, אולם ממצאים לא עקיבים הקשו על הבנתו. מטרת המחקר הנוכחי היתה לבחון את הקשר בין מיצב חברתי-כלכלי ברמת הפרט והקהילה ואת הסיכוי לאשפוז על רקע של אבחנת סכיזופרניה. במחקר נעשה ניתוח רב-שכבתי על נתונים שהתקבלו מסקר בריאות האישה ההרה ותינוקה (JPS – Jerusalem Perinatal Study), הכוללים מידע חברתי-כלכלי על אודות כלל היילודים במערב ירושלים בשנים 1976-1964. סקר זה אוחד עם מאגר הרישום הפסיכיאטרי הארצי של משרד הבריאות. ההשפעה של משתני המיצב החברתי-כלכלי ברמת הפרט (מאפיינים של הורי היילוד) וברמת הקהילה (מאפיינים של אזור המגורים) על הסיכוי לאשפוז עקב סכיזופרניה בבגרות נבחנה במבחן דו-משתני וכן בתסוגה (רגרסיה) רב-שכבתית. מן הממצאים עולה כי מיצב חברתי-כלכלי נמוך בעת הלידה הן ברמת הפרט הן ברמת הקהילה קשור לסיכון גבוה יחסית לאשפוז על רקע של אבחנת סכיזופרניה בבגרות. גורמי הסיכון לאשפוז עקב אבחנת סכיזופרניה בבגרות הם מאפייני המיצב החברתי-כלכלי האלה בזמן הלידה: השכלת אב נמוכה יחסית, יוקרת מקצוע נמוכה יחסית של האב ואזור מגורים ברמה חברתית-כלכלית נמוכה. (מתוך המאמר)

This study examined the attitudes of family and professional care-givers towards the use of advanced electronic tracking such as GPS (Global Positioning Systems) and RFID (Radio Frequency Identification) for elderly people with dementia. The study revealed four principal findings. First, care-givers' views ranged from feeling obligated to use the tracking device for the sake of patients' safety through support of the use of the device for the sake of the care-givers' peace of mind and restricted support, to objection to the use of the device and respect for a person's autonomy. Second, family care-givers showed higher support for the use of GPS and RFID both for their own peace of mind and for the safety of the elder in their care. Professionals attached higher value to respect for a person's autonomy and restricted support for using GPS and RFID. Third, both family and professional care-givers agreed that the decision on tracking dementia patients should be an intra-family issue. Fourth, family care-givers attached more importance to the tracking device's characteristics and design, thus emphasizing that the tracking device must be considered by them as 'user-friendly'. The implications of the results for social work are also discussed.

Background: The Family Quality of Life Survey (FQOLS-2006) was developed as the result of increased interest in family quality of life (FQOL) among families with a member who has an intellectual disability (ID). The instrument includes nine life domains and six dimensions reflecting the main areas and characteristics of FQOL. The aim of the current study was to provide a descriptive analysis of the domains and dimensions of the survey and to explore their relationship to one another and to global satisfaction. Method: A convenience sample of 35 participants with a family member who had ID completed the FQOLS-2006 in a large urban centre in Canada. The data were analysed using descriptive analyses. Results: The findings showed that although participants differentiated between different domains and dimensions, as reflected in their variability, stability was also found. For example, support from others was rated lowest across most dimensions, while family relationships and health of the family were generally rated higher. Conclusions: The findings strengthen the importance of examining both the overall perception of FQOL as well as the perceptions in individual life domains. Moreover, they highlight the need to examine each life domain according to its various dimensions. In sum, the results call for further examination of the FQOLS-2006 as a useful tool for assessing FQOL and for implementing services based on it.

The effect of out-of-home residential placement on families has been previously studied. However, no study has examined this issue through the lens of "family quality of life" (FQoL). The aim of this study was to produce a picture of FQoL among families with a member with an intellectual disability (ID) who has multiple diagnoses (i.e., an additional condition such as a behavioral or emotional disturbance). FQoL before and after residential placement was examined. Sixteen family carers with family members with an ID participated in an in-depth interview focusing on five areas of FQoL: stress, coping, emotional impact, family relationships, and overall FQoL. The authors found that most families reported positive emotional changes after the placement occurred, except for lingering guilt and worry. In addition, after placement, families experienced more freedom, enhanced FQoL, and an improvement in familial relationships. Coping mechanisms, including problem-focused and emotion-focused coping, as well as external support resources, were utilized before and after placement. These findings suggest that an out-of-home residential placement of a family member with an ID both positively and negatively impacts the entire family. The authors propose a number of support recommendations that might serve to enhance the QoL of the individual with a disability, specific family members, and the family as a whole.

Background. One of the more common behavioral manifestations of dementia-related disorders is severe problems with out-of-home mobility. Various efforts have been attempted to attain a better understanding of mobility behavior, but most studies are based on institutionalized patients and the assessment usually relies on reports of caregivers and institutional staff, using observational approaches, activity monitoring, or behavioral checklists. The current manuscript describes the research protocol of a project that measures mobility in Alzheimer's disease and related cognitive disorders in an innovative way, by taking advantage of advanced tracking technologies. Methods/design. Participants are 360 demented persons, mildly cognitively impaired persons, and unimpaired controls aged ≥ 65 in Israel and Germany. Data regarding space-time activities will be collected via a GPS tracking kit for a period of 4 weeks in 3 waves (one year apart) with the same participants (using a repeated measures design). Participants will be interviewed by use of a battery of instruments prior to and following GPS data collection. Further, a family member will complete a questionnaire both before and after data tracking. Statistical analyses will strive to explain differences in mobility based on a wide range of socio-structural, clinical, affect-related and environmental variables. We will also assess the impact of the use of advanced tracking technology on the quality of life of dementia patients and care givers, as well as its potential as a diagnostic tool. Systematic assessment of ethical issues involved in the use of tracking technology will be an integral component of the project. Discussion. This project will be able to make a substantial contribution to basic as well as applied and clinical aspects in the area of mobility and cognitive impairment research. The innovative technologies applied in this study will allow for assessing a range of dimensions of out-of-home mobility, and provide better quality data.

המאמר מציג ובודק שתי תיאוריות המנסות להסביר את הקשר שבין מעמד חברתי-כלכלי וסכיזופרניה. האחת, תיאוריית ההידרדרות והסלקציה החברתית, גורסת כי אנשים הלוקים בסכיזופרניה מידרדרים למעמדות חברתיים-כלכליים נמוכים יותר לאחר התפרצות המחלה. לעומתה, תיאוריית הסיבתיות החברתית מייחסת את הקשר שבין מעמד חברתי-כלכלי וסכיזופרניה למצוקות שחווים אנשים ממעמדות חברתיים-כלכליים נמוכים. המאמר דן בממצאי מחקרים שבדקו את הקשר שבין מעמד חברתי-כלכלי לבין סכיזופרניה, ובוחן את תמיכתם בתיאוריות הנדונות. כמו כן בוחן המאמר את הקשר שבין מוצא אתני לבין סכיזופרניה, היות שלהשתייכות לקבוצת מיעוט אתנית יש אפיונים דומים כמו להשתייכות למעמד חברתי-כלכלי נמוך. לבסוף דן המאמר בהשלכות יישומיות מבחינת מדיניות, פרקטיקה ומחקר עתידי בתחום (תקציר מתוך המאמר).