ASID CONFERENCE 2014 1 Rydges-EVENT ASID2014 2 ASID CONFERENCE 2014 Contents Overview – ASID Conference 2014 - Welcome Aboard 4 - ASID 2014 Organising Committee 6 - President’s Message - Maps - Thank You to our Sponsors 5 7 8 - General Conference Information 14 - Keynote Presentations 16 - Social Program Day 1 – Wednesday 5th November 2014 - Program - Abstracts Day 2 – Thursday 6th November 2014 - Program - Abstracts Day 3 – Friday 7th November 2014 - Program - Abstracts 15 22 23 38 40 54 56 Poster Presentations67 ASID CONFERENCE 2014 3 The ASID WA conference organising committee acknowledges the Wadjuk people as the traditional custodians of the land and pay respect to their elders past and present. Welcome Aboard . . . On behalf of the West Australian ASID conference organising committee I am pleased to welcome you to the 49th Annual ASID conference. This year the WA organising committee challenges you, our keynote speakers, delegates and speakers to consider both what you hear over the next three days and the presentations you will share, and ask yourself ‘how will this contribute to a better life for someone with an intellectual disability?’ At the conclusion of the first and second day’s proceedings we invite you to join some of our keynote speakers who will provide their thoughts and insights into how much of what we have heard that day will have a positive impact on the lives of people with an intellectual disability. Be prepared to ask questions and share your comments at the discussion. The conference program includes an impressive range of international and local keynotes; papers; symposiums and workshops as well as posters and roundtables which will allow for interaction and discussion. ASID aims to provide a fully inclusive program and integrated within the scientific program there will be presentations by delegates from many different backgrounds, including people who receive services, people who provide services, people from government, academics, family members and carers. I am sure that you will find the next three days stimulating; challenging; informative and perhaps a little exhausting! We live in exciting times and the rollout of the National Disability Insurance Scheme is the most significant event for Australians with 4 ASID CONFERENCE 2014 disability in living memory. This momentous and ambitious scheme has been labelled the largest piece of social policy to be implemented in Australia for the last 30 years and so it is fitting that the focus for the 49th Annual Australasian Society for Intellectual Disability is about every one of us getting on board and preparing for the future. As we all know, conferences are more than just the formal program so there is a rich and varied social program for you to enjoy, including our opening cocktail reception; a variety of performances to open and close the conference; a stylish conference dinner at the iconic Red Herring restaurant; and a wine and cheese evening/art exhibition to finish. Many years ago one of our ASID fellows said that ASID conferences were quite unique because of the eclectic nature of the conference programs as well as the opportunities that the conference presented to catch up with like-minded colleagues from Australia and New Zealand as well as the globe. The conference is a time to meet old friends and develop new ones, to learn and grow from the experience and to share your knowledge and insights along the way. It’s been a long journey for the organising committee and we are all excited that you are finally here with us to enjoy the results of our endeavours. Welcome aboard! Sue Peden Conference Conveyor President’s Message . . . I am delighted to welcome you to the 2014 ASID Board Conference in the wonderful port city of Fremantle; and if you are visiting Western Australia, a very warm welcome. I am delighted to welcome you to the 2014 ASID Board Conference in the wonderful port city of Fremantle; and if you are visiting Western Australia, a very warm welcome. Fremantle is a very special place and it is no surprise that the Conference has returned again to this historic yet modern port city. I hope that you have the time to discover some of the many attractions Fremantle has to offer. conference program provides everyone with the opportunity to explore current research and practice with presentations from people with intellectual disabilities and their families, service providers and academics .I would like to welcome our international and local keynote speakers. We are fortunate to have speakers who will challenge us with a diverse range of perspectives. ASID Conferences are wonderful and unique experiences - hearing presentations, networking, and renewing and making friendships. If you have previously been to an ASID conference you will know what I mean. If this is your first ASID conference, take the time to make the most of what it has to offer you will not be disappointed! Over the next three days you will hear about current research and practice, and discover ideas you can take away and implement in your own context. I also hope we all leave the Conference challenged with as many ideas about what we need to be doing, developing and researching to ensure that people with intellectual disabilities are All Aboard. This Conference theme “All Aboard” has been chosen to reflect the significant changes happening in the disability sector with the implementation of individualised approaches for people with intellectual disability across Australia and New Zealand. It is an important theme because it makes us ask the questions - what needs to change?; what work needs to be done?; and what are the challenges we need to address to ensure people with disabilities are “on board”? The I would like to thank to Conference Organising Committee for their commitment and hard work over the past two years to bring you this conference. ASID is fortunate to have such an outstanding group of members so willing to voluntarily commit their time. Enjoy the ASID Conference experience! Angus Buchannan ASID President ASID CONFERENCE 2014 5 ASID 2014 Organising Committee The Members of the organising committee and sub-committees: Susan Peden (Convenor) Angus Buchanan (Chair person; Scientific program sub-committee) Gordon Trewern (Co-chair person; Social program sub-committee) Mauricio Sanabria (Co-chair person; Social program sub-committee) Chris Yates (State President) Jo Bristow (Conference Registrar) Tom Bell (Conference Treasurer) Ron Regan Jenny Fairthorne Craig Robinson Jill Mackenzie Rebecca Dewar Ben Cox Andrea Dearden Ruth Lee Morag Budiselik Linda Chiu Heath Flanagan Michele Thomas Lauren Falconer Jacki Hollick Ellen Walker Pamela Toster Frances Buchanan Helen Leonard Sincere thanks to everyone who has offered so much help, with their time, creativity and commitment to getting us here. Special thanks to our ‘executive group’ Chris, Ron, Angus, Gordon, Mauricio, and Mimi, our events coordinator. 6 ASID CONFERENCE 2014 City of Fremantle Venue: The Esplanade Hotel Fremantle - by Rydges 46-54 Marine Terrace, Fremantle WA 6160 Dinner location: The Red Herring 26 Riverside Rd, East Fremantle WA 6158 ASID CONFERENCE 2014 7 Thankyou to our sponsors The organising committee would like to express our sincere thanks and appreciation to the following organisations for their generous support of this conference. Please support them now and in the future. OR CR UI S E IP SH S ON P S The State Government’s Disability Services Commission is responsible for advancing opportunities, community participation and quality of life for people with disability. The Commission provides direct services and support; funds non-government agencies to provide services to people with disability, their families and carers; and partners and collaborates with stakeholders to improve participation, inclusion and access for people with disability across the community. 8 ASID CONFERENCE 2014 COMMUNITY PARTNER We are very fortunate to be the only Australian State where the money raised from lottery products is distributed back to the community to support not-for-profit organisations that help build a better Western Australia. The reason Lotterywest is able to make grants, big and small, is through the sale of Lotto tickets and scratchies. The 49th Annual Australasian Society for Intellectual Disability Conference recognises and celebrates the participation in community life of individuals with intellectual disabilities. Lotterywest is proud to have given grant support to enable 50 delegates to attend the conference to be inspired and informed by a program that includes both current research and personal journeys. John Atkins Chairman, Lotterywest ASID CONFERENCE 2014 9 CRUISE SHIP SPONSOR The School of Occupational Therapy and Social Work at Curtin University is committed to excellence in teaching and research with a strong research focus on disability and social inclusion. Researchers within the School are engaged in a wide range of research to support the inclusion and citizenship of people with disabilities. Areas of research include autism, employment, community living, self-direction and management, disability inclusive development, mental health, community mobility, end of life and family violence. The School is committed to supporting higher degrees by research and opportunities are available for suitable post graduate students to participate in a vibrant and progressive research environment. Further information on the School and research programs is available on our website. Here is the link to our Research webpage http://healthsciences.curtin.edu.au/teaching/otsw_research.cfm. 10 ASID CONFERENCE 2014 FERRY SPONSOR FISHING BOAT SPONSORS ASID CONFERENCE 2014 11 FISHING BOAT SPONSORS 12 ASID CONFERENCE 2014 FISHING BOAT SPONSORS DINGHY SPONSORS ASID CONFERENCE 2014 13 General Conference Information Registration Desk – The Registration desk is located in the Southern Cross Lobby. There will be ASID conference committee members at the registration desk to help you at any time during the conference. Lanyards - Lanyards should be worn at all times for entry into conference sessions, the trade exhibition and social events. Breakout Sessions - Parallel sessions are located on the ground and first floor. They are a first in first served basis. Please arrive at the room in plenty of time prior to the start of the session; this will ensure you do not miss out on your preferred selection. Seats cannot be guaranteed or reserved. Catering – All morning teas, lunches and afternoon teas will be held in the Sirius room on the ground level. Please refer to the venue floor plan for directions. If you feel like heading out into Fremantle a quick walk to the ‘cappuccino strip’ on South Terrace will supply you with an array of options to suit any taste. Please refer to Fremantle Map for more information. Mobile Phones – Please be considerate to other conference delegates and speakers by switching your mobile phone off during sessions Accessibility – The Esplanade Hotel is an accessible venue, please enquire at the registration desk about guidance on accessibility within the venue. Volunteers will be available to assists if you require. 14 ASID CONFERENCE 2014 Evacuation – In the event of an emergency please follow the instructions of the venue supervisors. Taxis – The Esplanade Hotel concierge will be able to assist with the booking of Taxi and Shuttle Services. Conference Events The following program timetable outlines the event, session times and locations. To find our more about each session, please refer to the Speaker Abstracts. The Abstract information is listed in numerical order, matched to the timetable. Conference Theme All Aboard is celebrating the commitments of the whole of Australia to a new way of supporting people with a disability to have a good life. Poster Sessions Posters will be on display throughout the conference in the Indian Ocean Foyer, Poster sessions will be held in the Indian Ocean Foyer at lunchtime on Wednesday 5th November. ASID Awards Wednesday 5th November 5:00pm -5:20pm There will be a brief presentation of ASID Awards in the Orion & Pleiades Room. Social Program Summary Wednesday 5th November Opening: Fremantle Major, Dr Brad Pettitt, will welcome attendees. Ingrid Cumming, CEO Kart Koort Wiern Aboriginal and Torres Strait Islander Corporation, will do Welcome to Country along with Greg Barr, Artist with a Disability, who will play the didgeridoo. The Variety Youth Choir performance will be part of the opening ceremony. Conference Cocktail Party: The Conference Cocktail Party will take place at the Esplanade Hotel in the foyer of level 2. This is a fabulous opportunity to catch up with old friends & colleagues and to meet some new ones. As part of the welcome cocktail party we are also excited to announce the launch of a new book by Naomi Townsen. Odette Murphy, pianist with a disability, will also entertain attendees with her amazing talent. One ticket to the welcome cocktail party is included in your conference registration. Thursday 6th November Conference Dinner: 6:45pm (for a 7pm sharp start) on Thursday, 6th November. We have a coach available to transfer people from the Esplanade Hotel to the dinner venue, if you would like a seat on the coach please be ready outside the Esplanade Hotel main foyer by 6:30pm. There will be a coach shuttle back at the end of the evening as well. Join us for a fantastic evening at the spectacular location of the Red Herring – The Red Herring combines the uniqueness of the peaceful Swan River waterside location with a menu that is an exciting reflection of Australian contemporary cuisine. The night will be filled with fine food, music and another great opportunity to meet new people and discuss the conference program. The Red Herring Restaurant is located on Riverside Road, East Fremantle. Friday 7th November Closing Ceremony: The conference will close with a highlight performance with a classical Indian dance from Shanti Anita Fielding, this will be followed by a closing speech from president of ASID Angus Buchannan and a formal handover of the “baton” to the ASID 2015 Conference Conveyor, which will be held in Victoria. As We Are Art Exhibition: One of WA’s premier events that showcases the work of Western Australian artists who have an intellectual disability. As part of the Conference program ASID has arranged for a special opening of the exhibition on Friday 7th November, from 5 to 7 pm. This is a great way to start a Friday evening; so come in and enjoy what Perth City has to offer at the same time enjoying some wine and cheese whilst looking at the artworks presented in the As We Are exhibition. The As We Are Art Award is a state-wide annual art award and exhibition open to all Western Australian artists who have an intellectual disability (aged 18+). This year’s exhibition is being held at the prestigious Central Park Building Foyer (152-158 St George’s Terrace, Perth). ASID CONFERENCE 2014 15 Keynote Presentations Keynote 1 Marita Walker Introduction to the National Disability Insurance Scheme Implementation of the National Disability Insurance Scheme began in four trial sites in July 2013. The Scheme is underpinned by the three pillars of • An Insurance approach • Choice and control • Effective interface with community and mainstream supports It is a radical change of approach for people with disability and the most significant social and welfare reform since the introduction of Medicare. Much has been learned already in the first year of operation that has been incorporated into the three trial sites, including the Perth Hills in WA, which commenced on the 1st July 2014. In WA there is also a second approach which is being delivered by the Disability Services Commission in two further trial sites. In the Perth Hills people will phase in over the 8 quarters of the trial. Participants who meet the access criteria will meet a Planning and Support Coordinator to consider their goals and aspirations as the foundation for their plan. The plan pays close attention to the informal, community and mainstream supports that are important to achieve social and economic participation. If required funded supports are provided within a framework of “reasonable and necessary.” People with intellectual disability or autism make up 60% of those currently accessing the scheme. It is a challenge to ensure that their voices are heard in individual planning conversations, learning what works and doesn’t, future scheme design and agency governance. There is still a lot to learn! Keynote 2 Dr Ron Chalmers Director General, Disability Services Commission The NDIS in Western Australia – early outcomes of the My Way trial 16 ASID CONFERENCE 2014 Abstract: In August 2013 the West Australian Government signed an agreement with the Commonwealth to implement two separate trials of the National Disability Insurance Scheme in Western Australia over a two year time frame. The National Disability Insurance Agency is implementing a trial in the Perth Hills and the Western Australian Disability Services Commission is implementing an NDIS trial in the Lower South West region and in the Cockburn-Kwinana areas. The NDIS My Way approach builds on the positive features of the existing disability service system that has been developed over the past 25 years. It is based on the internationally recognised Local Area Coordination model and has a strong focus on working in partnership with people with a disability; engaging strongly with community and mainstream resources and is supported by a mature nongovernment disability sector. This keynote address will focus on the early outcomes of the My Way model emerging from the Lower South West trial site. Keynote 3 David Corner During my presentation, I will talk about the work of Inclusion International and how I am involved as a Council member for the Asia-Pacific region. A lot of our recent work and campaigns focus on the United Nations Convention of the Rights of Persons with Disabilities (CRPD). Recently, we have released a Global report on Article 12 of the CRPD which is about the right to decide. I will talk about that as well as some of the other work we have done in relation to the CRPD. Keynote 4 Prof Patricia Minnes Moving Towards Social Inclusion and Participation of Individuals with Intellectual Disabilities: The Journey Continues. What does it mean to be included? What does it mean to participate? Since the deinstitutionalization movement began over 4 decades ago, there has been a great deal of discussion about inclusion of people with intellectual K disabilities from different perspectives. Inclusive education and community living have gained general support through government policies and legislation but it is still not clear to what extent individuals are actually included and participating in meaningful ways. There is general agreement that inclusion is a complex concept that needs to be viewed from a multidimensional perspective, however, there a lack of consensus on the definition of inclusion and participation and on the factors that contribute to successful inclusion and participation. This talk will ask participants to consider what these concepts mean in their lives as we explore different perspectives on concepts of inclusion and participation. Selected research findings will be presented regarding what we know about the inclusion and participation of individuals with intellectual disabilities followed by a discussion of directions for future research and practice. Keynote 5 samples drawn from nationally representative population studies). Emerging results adopting longitudinal methods in population-representative samples suggest that both parental psychological health (especially high levels of stress or mental health problems) and dimensions of parent-child relationships may increase the risk for behavioural and emotional problems in young children with IDD. Implications for early intervention will be discussed. Keynote 6 Prof Mike Kerr The management of epilepsy in people with an intellectual disability – it is rocket science Epilepsy is the most common severe neurological co-morbidity in people with an intellectual disability. Its impact is often profound and pervasive across the lifespan for both the individual and the family. This impact ranges from reduced lifespan and increased hospitalization through to an impact on psychopathology and social integration. Prof Richard Hastings This presentation will argue for the reasonable adjustments needed to meet these impacts. In particular that an approach of simply raising care levels to those experienced by individuals without intellectual disability is insufficient. Parenting training in families of children with intellectual and developmental disabilities (IDD) has an impressive evidence base. Several parenting interventions such as Triple P and the Incredible Years models have randomised controlled trials supporting their effectiveness with parents of children with IDD. To what extent are these parenting interventions focused on the right variables for change? Are parenting behaviours the only variables we need to worry about for children with IDD? In this presentation, I will explore these questions by discussing evidence especially from the early life of children with IDD. In the early years, a range of family and social context variables may be important in determining behavioural and emotional outcomes for children with IDD. Socioeconomic position is clearly associated with behavioural and emotional inequalities in young children with IDD. However, rarely have longitudinal models been used to explore other early pathways for the development of behavioural and emotional problems in IDD. Even rarer is the use of research samples and designs that may be less affected by sample biases (i.e., Assessing an individual and their epilepsy needs the application of multiple competencies. These include a detailed knowledge of: epilepsy risk including death, individual variation including genetic causation, treatment effects especially impact on behavior, and understanding treatment availability and choice. The family as a context for the behavioural and emotional health of young children with intellectual and developmental disabilities The reasonable adjustments mean that all services and individuals who work with people with intellectual disability must apply the highest scientific evidence. I will describe how this may be done and how it can be prioritized for the most significant needs. The conclusion is that a range of professionals will need to keep up with the rocket science to ensure the inequality in health experienced by this population is not extended. ASID CONFERENCE 2014 17 K Keynote Presentations Keynote 7 Keynote 8 Prof Glynis Murphy Dr Torbjorn Falkmer Community–based Treatment Options for People with ID who Break the Law Innovations in Autism research – Launching into the adult space At times, people with intellectual disabilities break the law, like anyone else. In most developed countries, deinstitutionalisation, with all its many benefits, has also brought the debatable benefit that people with ID are subject to the criminal law, just like anyone in the general population. Yet it is known that people with ID are very vulnerable to false confessions, since they often do not understand their rights at the police station or in court and are subject to acquiescence and suggestibility when under pressure in both settings. Many countries therefore have built in protections for people with ID in the Criminal Justice System and these include the issue of mens rea, the need to be fit to plead (or have capacity to stand trial), and the possibility of other means of diversion out of the CJS and/or mandated treatment in the community. Historically, fitness to plead legislation has been unsatisfactory in the UK as well as in the USA and the reasons for this will be reviewed. Nowadays very few fitness to plead findings are made for people with ID in the UK and this will be discussed. Many professionals, families and service users consider it preferable to be treated in the community and there are now a range of such treatment options available in the UK, including anger management training, treatment for those who set fires, and treatment for sexual offenders. These treatments and their outcomes will be reviewed and the linked risk assessments will be considered. Given these developments in treatment, the question will be posed: Is prison or long term detention in anyone’s best interest? It will be argued that it is costly for Governments as well prolonging discriminatory treatment for people with ID. Research in Autism Spectrum Disorders (ASD) is not dissimilar to rocket science. Almost all of ASD research is done on the ground at the base, i.e., in early childhood or even before, and at the very core of the body structure. Advances in technology allows genes, blood, saliva, brain cells, brain tissues, and brain interconnectivity to be the foci, all in order to understand the enigma of ASD, or as some TVviewers would name it; the Big Bang Theory. The problem is that while research is focusing on solving this conundrum, 1% of school leavers transition to adulthood and face all its challenges on top of their diagnosis of ASD. In launching from their families, support is lost and the vast unknown lies ahead. Sadly, the 1% figure also applies to the share of ASD related research that targets adults on the spectrum. So while progress is made on the ground, little is known in the adult space. But there’s hope; this keynote address will take you on a journey with adults with ASD, trying to find their place in society. It will guide you through research ranging all the way from brainwaves, eye movements, and emotion recognition to employers’ workplace adjustments, driving, family functioning, and the costs of ASD. This journey will even take you to a virtual space where a diagnosis of ASD is the only valid entry passport: the Autism Software Inspection Academy. 18 ASID CONFERENCE 2014 The School of Occupational Therapy and Social Work is a proud sponsor of the 49th Annual ASID Conference 2014. Make tomorrow better. CRICOS Provider code 00301J (WA) 02637B (NSW). Curtin University is a trademark of Curtin University of Technology. 1458HS Annual Australasian Society for Intellectual Disability Conference Making it real ... together Save the Date!! 11-13 November 2015 Crown Promenade Southbank, Melbourne A platform for delegates to come together and explore what is means to convert recent advances in disability legislation and policy into real and meaningful changes for people with intellectual disability. The conference will bring together a range of stakeholders: people with intellectual disability and their families and support persons, coordinators, disability support workers, researchers from universities, health professionals and policy makers, to share and prompt new ideas around the idea of collaboration and inclusion. Making it real ... together. www.asid.asn.au 20 ASID CONFERENCE 2014 DAY Wednesday 5th November 2014 ASID CONFERENCE 2014 21 1.15 pm 12.15 pm 11.45 am 11.15 am 10.45 am Rooms 10.15 am 9.30 am 8.45 am 7.00 am ASID CONFERENCE 2014 ` LUNCH - Room – Sirius N Hagiliassis, E Wilson, R Campain, J McGillivray, M Caldwell & J Graffam Measuring social inclusion of people with intellectual disability In Australia: initial evidence about a new tool 7. The NDIS: Doing it My Way in WA Room – Orion & Pleiades Dr Ron Chalmers Director General, Disability Services Commission Keynote 2: Poster Session - Southern Cross Lobby / Prince Regent L Mitchell, R Baker, N Ollington, A O’Brien, M Jessop & J Briers Positive Behaviour Support and Quality of Life in a residential support setting 4. J Cleghorn The ethnographic method: a case study for research among people with severe intellectual disabilities. 6. 3. M Cubbage & M Edwards The Positive Behaviour Framework: a descriptive journey of implementation. G Ottmann, K McVilly & J Anderson Safeguarding Children and Adults with Disabilities: A Framework for Disability Service Providers 5. P Fitzpatrick Building the capacity to deliver best practice in positive behaviour support to people with a disability . 2. Chair: Jacki Hollick 1 Chair: Claire Quilliam Positive behaviour Symposium C. Bigby The National Disability Insurance Scheme Inclusion King Sound /Admiralty Gulf Rottnest MORNING TEA - Room – Sirius Room – Orion & Pleiades (Sponsored Exclusively by Curtin School of Occupational Therapy and Social Work) Marita Walker National Disability Insurance Agency Keynote 1: OPENING CEREMONY REGISTRATION Orion & Pleiades Wednesday 5 November 2014 22 T Pikora, J Bourke, K Bathgate, K-R Foley, N Lennox & H Leonard Health conditions and their impact among adolescents and young adults with Down syndrome 10. J Garriock, G Lim & J Ng An independent review of polypharmacy risks for people with intellectual disabilities 9. A Thomson, S Thoresen & E Cocks The WA Study of Health and Intellectual Disability: an overview 8. Chair: Laura Hogan Health Carnac 1 4.00 pm 3.30pm 3.00 pm 2.30 pm 2.00 pm Rooms A roundtable discussion of successful strategies that promote inclusion of people with intellectual disability P Minnes Social Participation: the way forward 26. 23 5.30 pm Cocktail Function - Room – Orion & Pleiades CLOSE Roundtable - Room – Orion & Pleiades E Walker All Aboard MS Microboard: how microboards are used to address the challenges faced by young adults with complex disabilities, and their families 25. 5.20 pm N Crates & M Spicer Trauma Informed Support for people with disability, compatibility with Positive Behaviour Support and opportunities to enhance existing practice. 24. R Munn Children’s Therapeutic Accommodation in action: a case study from South Australia. 23. Presentation of ASID Awards - Room – Orion & Pleiades L Hamilton Beyond the file note: making group homes genuine homes 22. C Quilliam, C Bigby & J Douglas Preliminary findings from the frontline perspective of paperwork in group homes for people with intellectual disability 21. Chair: Michael Keates Roundtable Chair: Ian Pearce Symposium Therapeutic approaches AFTERNOON TEA - Room – Sirius J Burton, H Redfern, H Seiffert & B Lonne Long stays in hospital for people with disabilities: Is this the right care at the right place? 28. N James Family carers’ experience of their relative’s need for admission to an Assessment and Treatment Unit 27. Chair: Errol Cocks Health S Gellar Autism Spectrum Disorders in middle to late adulthood 20. 18. J Merrells, A Buchanan & R Waters How young adults with an intellectual disability spend their time, make friends and feel included: experiences of social inclusion J Bourke, H Leonard & J Marsh How common is intellectual disability? 19. Chair: Ben Crothers Health Carnac C Furner, C Oswald & A Ackland Being active and not just visible - Young adults with severe, multiple disability embrace true inclusion through their community-based day program 17. Chair: Hilary Johnson Inclusion Garden Accommodation K Boxall, S Dowson & P Beresford Selling Choice and Control: Some critical reflections on the UK Personalisation Agenda and the Australian National Disability Insurance Scheme (NDIS) E Cocks & S Thoresen Measuring quality of individual supported living (ISL) for adults with developmental disability 16. 14. 12. M Arco, T Robinson & A Perlinski Shared Management My Moorditj Mob¹s Experience F Redgrove Concepts of Adulthood for Young People with Intellectual Disability – A source of conflict amongst stakeholders 15. E Ervine Services Our Way – The Aboriginal way 13. L Jay In a landscape of ‘choice and control’ whose voice makes the choice? 11. Chair: Justin O’Meara Smith Chair: Chris Yates Chair: Angus Buchanan Rottnest Adulthood King Sound /Admiralty Gulf AccommodationIndigenous Orion & Pleiades 5.00 pm 4.30 pm ASID CONFERENCE 2014 Abstracts 1. 2. The NDIS and People with Intellectual Disability: Challenges and Opportunities. Building the capacity of human services to deliver best practice in positive behaviour support to people with a disability C Bigby People with intellectual disability will comprise 6070% of those eligible for individualised packages of support in Tier 3 of the National Disability Insurance Scheme (NDIS). The scheme is a ‘work in progress’ with trial sites in each State and Territory with the exception of Queensland. Experiences in the trail sites are providing opportunities for conversations between the NDIA, the agency responsible for its administration, people who use the scheme and other stakeholders, that will help shape the scheme’s design. As board member John Walsh said at the NSW NCID conference ‘we want to hear from you guys’. This symposium is an opportunity to hear from a panel of speakers with varying types of engagement in the NDIS and its trail sites, to both gain a snap shot of what’s happening and debate some of the key issues for people with intellectual disability that are emerging. Key points for discussion will be • To what extent are the voices and perspectives of people with intellectual disability embedded in the fabric of the new scheme? • What impact is the additional funding on the quality of support services and improved outcomes for people already receipt of services? • How are people with intellectual disability being supported to make decisions both about their plans and the services they purchase- are effective mechanism in place to mediate any differing views about their wants and who should support them to make decisions? • Is the market providing what people with intellectual disability in the pilot sites need or wantwhat are the gaps? • Are some people in the pilot sites benefiting more than others – how can equity for be ensured? • What is the place of advocacy as the new scheme rolls out? • What energy is being directed to building mainstream capacity of housing, health, education and criminal justice services? Why is this critical to success of the scheme? 24 ASID CONFERENCE 2014 P Fitzpatrick Background: Research evidence suggests that positive behaviour support is best practice for people with a disability who present with behaviours of concern. This research paper asks what the best approach is to building the capacity of disability support workers from different organisations with diverse educational backgrounds to deliver this best practice. This study compares different forms of training, one of which used an organisational change strategy that focused on providing the positive behaviour skills to people using course material that focused on: the development of a good quality behaviour support plan; how to assess the quality of a behaviour support plan and as well as how to implement similar training within their own organisation. Method: The study compares the quality of groups of 30 Behaviour Support Plans (BSPs) using the Behaviour Support Plan Quality Evaluation II tool (included reference). Group 1: BSPs written by people who did not attend any training; Group 2: BSPs written by people who attended a half day BSP Toolkit Training; Group 3: BSPS by attendees of a four day PBS training: Group 4: BSPs by those who attended both. A between groups, pre and post-test design will be used to examine group differences in the quality of behaviour support plans as assessed by the BSP-QE II. Results: Data analysis is currently being undertaken. Final results will be available at the time of presentation. Implications: The results of this research will help inform service providers of the optimum means to both train staff in PBS and BSP writing as well as promote successful implementation of these approaches within their organisations. 3. M Cubbage & M Edwards The Positive Behaviour Framework: A Descriptive Journey of Implementation. Wednesday 5 November 2014 Background: In 2007 the Sector Health Check on Disability Services concluded that “challenging behaviour is a human rights and quality of life issue for individuals, primary carers and families” and identified that there is “limited capacity of the sector as a whole, with only a few providers having the knowledge and skills to manage challenging behaviours. This paper tells the story of how the Disability Services Commission (the Commission) addressed this issue. Method: The Commission subsequently established the Positive Behaviour Framework (the Framework) and has worked with people with families and the disability sector to commission a series of pilot studies. These studies have built evidence of effective implementation strategies of Positive Behaviour Support as an evidence-based and contemporary approach to supporting the needs of people with disability who sometimes experience challenging behaviour. The University of Western Australian is partnering with the Commission to analyse how the implementation of the Framework can best proceed across the state. Results: Results will integrate management and organisational change theory into the existing knowledge of Positive Behaviour Support and review the preliminary outcomes of a new approach to organisational research (Qualitative Comparative Analysis). Implications: This research has the potential to inform the design and delivery of services to a population of people who face systemic disadvantage. 1 marked by anxiety, conflict, and aggression, a partnership was developed between STAR Tasmania Inc. and the Disability Assessment and Advisory Team (South West) to address readiness and training. Method: Staff training and support encompassed a set of values including leadership, staff readiness, and ownership. STAR values were implemented alongside five common approaches for Active Support and PBS: (a) Communication with Style, (b) Support Communication – Initiating and Engaging, (c) Social Role Modelling, (d) Activity Planning, and (e) Supporting Skill Development. Manageable protocols were developed with staff input that described observable staff action. Results : Feedback from stakeholders indicated that residents were happier, had improved relationships with staff, family and friends, and were able to use a wider range of skills to participate more fully in residential responsibilities and leisure activities. Staff reported an increased understanding of requirements as well as confidence surrounding their ability to provide consistent quality service. Implications: Coordinated and innovative use of established best practice, including change management and training can change staff attitude and behaviour and lead to improved outcomes for residents and positive work-related outcomes for staff in residential care settings. 5. G Ottmann, K McVilly & J Anderson 4. Presenting the findings of a national Delphi study focusing on the safeguarding of children and adults with disabilities within a service provider setting: Towards a holistic safeguarding framework Positive Behaviour Support and Quality of Life in a Residential Support Setting Background: Research conducted in the 1990s revealed the tragic irony that exposure to the disability support system, and particularly to its institutional forms, is a major risk factor related to the abuse of children and adults with a disability. While a range of measures have been introduced since to reduce this risk, re-occurring events of abuse and neglect in the patchwork of small residential group homes, day centres, education and training centres, and domiciliary services that constitute the Australian disability support sector demonstrate that processes geared to safeguard children and adults with a disability are far from effective. This L Mitchell, R Baker, N Ollington, A O’Brien, M Jessop & J Briers Background: Research has shown that in residential support settings Positive Behaviour Support (PBS) training increases the likelihood of positive relationships between staff and residents and decreases the likelihood of challenging behaviours; and Active Support (AS) increases engagement. However practice knowledge indicates that efforts in implementing either approach may falter due to organisational and staff readiness. To improve the support culture in a residential setting in Tasmania ASID CONFERENCE 2014 25 Abstracts paper reports on a project that sought to explore the most important barriers and facilitators to the safeguarding of children and adults with disabilities from abuse and neglect within a service provider context. The project forms the basis of a national, multi-disciplinary, cross-sector collaboration involving researchers, government, peak bodies, and service provider representatives aimed at the development of a holistic safeguarding framework for disability services providers. Method: A modified on-line Delphi study was conducted generating 257 responses from Australian disability services providers. Round 1 comprised demographic, knowledge and attitudes, and questions highlighting barriers and facilitators to safeguarding measures. Concept mapping and thematic analysis was employed to analyse the data. Round 2 asked participants to rate responses to two of the open ended questions (what are the most important facilitators/barriers to safeguarding children and adults with disabilities). Results: The study generated over 200 consensus statements outlining the key components of a comprehensive safeguarding framework associated with six different domains. Implications: The study generates a much needed evidence base on which a safeguarding framework for disability service providers can be constructed. The study reveals important limitations of the corner stones of current safeguarding approaches (police checks and reporting) and clearly outlines the need for a more holistic approach. 6. J Cleghorn The ethnographic method: a case study for research among people with severe intellectual disabilities Background: There is a plethora of social research among people with intellectual disabilities, but somewhat of a dearth of qualitative social research conducted with people with more severe disabilities. This is hardly surprising given the difficulties of time, budget, access, and communication. Method: I spent the 2013 school year at a Perth special education needs school working with eighteen senior students, and the staff, with the hope of gaining an understanding of the students’ sense of ‘self.’ using the ethnographic methods of participant- 26 ASID CONFERENCE 2014 observation (students), guided conversations (staff), and interviews (parents), I got to know the students and their socio-cultural environment. There is nothing new about these methods, but participantobservation, in the true ethnographic sense, is not commonly used to conduct research among people with severe intellectual disabilities. Results: Using a case study of a young woman, Diana, I illustrate the utility of this method for gaining an understanding of her sense of self, and her social world. From the first time Diana and I met I was made aware that she could be a danger to me, and indeed I spent many months being afraid of her, and what she might do to me. But, over time we each accepted the presence of one another in the school, and became firm friends. Implications: There are constraints on participantobservation, but if these can be overcome there are great benefits to getting to know your research participants yourself, as well as through the knowledge and experience of their parents, guardians, teachers, and carers. 7. N Hagiliassis, E Wilson, R Campain, J McGillivray, M Caldwell & J Graffam Measuring Social Inclusion of People with Intellectual Disability In Australia: Initial Evidence About a New Tool Background: Social inclusion as a concept has figured prominently in policy and planning for disability services and is an expected outcome of the National Disability Insurance Scheme. There is however a need for valid instruments that accurately capture the judgement of people with intellectual disability on the outcomes resulting from services, supports and government policies. The paper provides initial evidence for the validity and reliability characteristics of the Social Inclusion Measure (SIM), a new tool for measuring social inclusion, designed to be accessible to people with a range of abilities. Method: The SIM is an on-line administration tool designed to be accessed (with or without support) by people with a range of abilities including people with intellectual disability and communication impairment. This group is typically excluded from direct surveying, with default reliance on proxy Wednesday 5 November 2014 reporting. To the extent possible, the SIM enables the subjective experience of the person to be captured and prioritized. Results: The SIM was completed by 671 people with disabilities. Participants were recruited through the ‘1 in 4 Poll’, an Australia-wide poll which gathers first hand experiences of people with a disability on issues of importance to them. When the 22 items of the SIM were analysed, they emerged along four recognisable dimensions: Social Participation, Social Relationships, Services Access and Economic/ Material Access. Internal consistency of items was high while the SIM correlated highly with the Personal Wellbeing Index (Cummins 1997). Implications: Initial evidence suggests the SIM is a valid and reliable tool for monitoring social inclusion status, a critical area of social and population level change targeted for people with disability in Australia. 8. A Thomson, S Thoresen & E Cocks The WA Study of Health and Intellectual Disability: an overview Background: International and national research and reports indicate poorer health for adults with intellectual disability (ID) than the general population. The WA Study of Health and Intellectual Disability (WASHID) identified factors affecting the health of adults with ID and is a baseline of this cohort’s health status. Method: Structured interviews were carried out in the first half of 2013. The majority were face-toface interviews. A total of 328 participants of 413 volunteers (79%) were surveyed. The structured interview included socio-demographics, health status, health behaviours, and health systems. Results: Nearly 90% reported one or more long-term health conditions, despite most participants’ health (77%) being described as good/very good. Epilepsy and some mental illnesses were more common than in the general population. Cancers, high blood pressure and high cholesterol were reported less frequently. 70% were on medication/s. About half of the participants were overweight/obese (58%) and 47% spent seven or more hours/day sitting down. 15% had seven serves of fruit and vegetables/ day. Few adults smoked (5.8%), or drank alcohol more than twice/week (3.3%). 1 In the previous year, use of hospital services was high (30%), and 22% had seen a mental health professional. Most people said their GP and staff were respectful and explained things clearly. Cervical and bowel cancer tests were rare. Implications: Adults with ID in WA have poor health. The study did not identify any ID-specific preventive measures or interventions used to help people with ID to live a good life. 9. J Garriock, G Lim & J Ng ‘Multiplicity risk’ - An independent review of polypharmacy risks for people with intellectual disabilities Background: The risks of polypharmacy (the use of multiple medications) in the treatment of people with intellectual disabilities are well documented, both nationally and internationally. These risks are compounded by this group now living longer and developing age-related conditions, such as Type 2 diabetes. This paper presents the work Spectrum Care is undertaking to address the issue of polypharmacy for people accessing its residential services. Method: Medication charts for all people accessing these services have been assessed to determine the extent of polypharmacy and to identify people most at risk (ie highest number of medications per day, plus age and the extent/nature of disability). A medication review by an independent panel (pharmacist, pharmacologist, clinical nurse specialist and clinical advisor) will commence with the 10 people identified as most at risk. Results: The recommended medication changes will be effected by the review group, in consultation with the appropriate prescribers (general practitioners, clinical psychologists, psychiatrists etc). Reviews will continue with the next group of 10 high-risk people until all people accessing this service have had their medications reviewed. Implications: Post-medication reviews will be completed with the initial group of 10 people (and their support staff) six months later to assess reductions in falls and adverse drug reactions, along with improvements in cognition, mobility and quality of life. ASID CONFERENCE 2014 27 Abstracts 10. T Pikora, J Bourke, K Bathgate, K-R Foley, N Lennox & H Leonard Health conditions and their impact among adolescents and young adults with Down syndrome Background: Young adults with Down syndrome are at increased risk for a variety of medical conditions which may impact upon their lives. Methods: Using questionnaire data collected in 2011 from parents of young adults with Down syndrome we investigated the medical conditions experienced by their children in the previous 12 months. Univariate, linear and logistic regression analyses were performed. Results: We found that in addition to the conditions commonly experienced by children with Down syndrome, including eye and vision problems (affecting 73%), ear and hearing problems (affecting 45%), cardiac (affecting 25%) and respiratory problems (affecting 36%), conditions also found to be prevalent within our young adult cohort included musculoskeletal conditions (affecting 61%), body weight (affecting 57%), skin (affecting 56%) and mental health (affecting 32%) conditions and among young women menstrual conditions (affecting 58%). Few parents reported that these conditions had no impact, with common impacts related to restrictions in opportunities to participate in employment and community leisure activities for the young people, as well as safety concerns. Implications: There is the need to monitor, screen and provide appropriate strategies such as through the promotion of healthy lifestyles to prevent the development of comorbidities in young people with Down syndrome and, where present, to reduce their impact. 11. L Jay In a landscape of ‘choice and control’ whose voice makes the choice? People whose lives are characterised by challenges associated with intellectual, developmental and/ or communication disabilities are among the most marginalised citizens in many developed countries. 28 ASID CONFERENCE 2014 The rights and opportunities for many such individuals to make or participate in decisions that directly affect their own welfare and life experiences are frequently undermined or extinguished - even by well-intentioned people. The arrival of the NDIS in Australia has been accompanied by the broad adoption of the phrase ‘choice and control’ as a key descriptor. It reflects the growing expectations of many service recipients and their family members within this cohort. As the established support systems that service this group adapt, it is imperative that we ask the question: “whose voice is being heard in the exercise of choice?” In considering this question the concept of governance can usefully be applied at the level of individuals’ lives. This paper demonstrates that this concept can reposition such individuals as more engaged co-designers of the services and supports they need. However, the application of governance at the level of individual lives requires service agencies, family members and friends to re-evaluate the nature of their relationships and engagement with people living with intellectual disability. The paper also identifies some potential public policy implications. 12. K Boxall, S Dowson & P Beresford Selling Choice and Control: Some critical reflections on the UK Personalisation Agenda and the Australian National Disability Insurance Scheme Background: In order to compete in increasingly globalised markets, governments may have little choice but to reduce state spending and adopt marketised policies; those ‘selling’ individual choice and control offer convenient and timely support for the development of such policies in disability care. Method: UK policy analysis, with some comparisons to Australia. Results: In the UK, from 2003, personalisation was promoted using marketing techniques which broadcast ‘feel good’ stories of individual choice and control, whilst at the same time diverting attention from potential problems associated with the wholesale implementation of personalisation ideals. Individual personal budgets similarly traded on notions of social inclusion by focussing attention on barrier removal in individual people’s lives, thus diverting attention from structural barriers faced Wednesday 5 November 2014 by people with intellectual disabilities in British society. As a marketing exercise, the personalisation approach has been outstandingly effective; however many people with intellectual disabilities have seen little positive change. Implications: The UK experience may provide some important pointers when implementing the Australian National Disability Insurance Scheme. 13. E Ervine Services Our Way - The Aboriginal Way Despite a high prevalence of disability, Aboriginal Australians access disability services in Australia less than non-Aboriginal Australians with a disability, this group regularly encounter barriers to accessing appropriate services. Services Our Way commenced in New England in 2011. Services Our Way is an Aboriginal program designed to give Indigenous people with a disability and their carers/ families individualised funding options to help support them with their disability, re-engage them with their local community networks and resources, increase their capacity to engage with external support networks and utilise existing family networks, promote independence and self-sufficiency in their decision making and future planning. In this presentation Elizabeth Ervine Manager Services Our Way and Deborah Missingham Senior Manager Access ADHC will discuss progress being made in the delivery of disability services for Indigenous people with an intellectual disability. Services Our Way has worked in conjunction with service providers and ADHC to supplement cultural support for Aboriginal clients to ensure that they are linked in with local service providers, whether they be Indigenous or non-Indigenous. Services Our Way has a focus on capacity building and acknowledges that the program is at a point where facilitating access to the disability system is a baseline step, but effectively preparing people for the National Disability Insurance Scheme is the critical goal. As a result of Services our Way in New England there has been a major increase in numbers of Aboriginal people with a disability accessing services. Since the start of Services Our Way there has been an in increasing awareness and uptake of services. 1 14. M Arco, T Robinson, & A Perlinski Shared Management My Moorditj Mob¹s Experience Background: Shared Management is a “Do It Yourself” (DIY) approach that combines self-direction with an agency administrative service to enable individuals and families to employ, set up, and tailor support around their particular lifestyle. Method: A 33-year-old Noongar man with complex needs, and his family, living in the Lower South West of Western Australia, chose a My Place Shared Management service after no other agency in the local area was prepared to offer a service. Using the shared management approach they successfully arranged meaningful and culturally appropriate support to achieve a person centred, healthy and engaged lifestyle. Results: Although liberating, DIY has not been easy. Being responsible for selecting, preparing and skilling assistants to be work ready, along with scheduling activities and overseeing everyday living plans, presented a myriad of challenges. Maintaining ties with supporters from various government and non-government agencies proved an important strategy to assist with problem solving and resolving issues. Overall results show improved wellbeing and reduced involvement with the justice system. Implications: On the one hand the “DIY” approach allows greater control and flexibility of support along with the ability to maximise available funds all with minimal agency involvement. On the other hand, “DIY” can require a significant amount of time and energy by individuals and their families to set things up and to keep them running, especially for those with more complex needs. The up side though is generally positive with people generally enjoying a more improved lifestyle away from institutional living. 15. F Redgrove Concepts of Adulthood for Young People with Intellectual Disability – A source of conflict amongst stakeholders Background: Transition from schooling to adult ASID CONFERENCE 2014 29 Abstracts services is well recognised as stressful for families of young people with intellectual disability (ID), and that this stress may be attributable to tension between stakeholders This PhD study considers the possibility that families of young people with ID and professionals and policy makers employ conflicting processes of decision making to guide their actions during this transitional phase. Method: Focus groups and semi-structured interviews were used to collect data for concept analysis to determine the defining attributes of adulthood as considered by families and support staff. Concepts and attributes identified were mapped to represent the relationship, and determine similarities and dissimilarities between conceptualisations of adulthood by stakeholders. Results: The study found common factors to conceptualisations of adulthood between family members and staff, such as physical maturity, no longer being a child, being over 18, and being able to contribute to, rather than being a burden on the community. However, significant differences were found that can be aligned to five main themes: • Adults are independent being • Adults are rational beings • Adult life offers meaning • Adults are accepted members of society • Adulthood may be considered as actual or “virtual” (created by those in a position to control) Implications: The paper recognises the need to consider an adequate definition of adulthood to allow families and support staff to communicate and make decisions using the same conceptualisation of the term. 16. E Cocks & S Thoresen Measuring quality of individual supported living (ISL) for adults with developmental disability Background: Supporting adults with disabilities to live good lives in their own homes has emerged relatively recently and is strongly encouraged by contemporary policy in the disability sector, although individual supported living (ISL) has received very 30 ASID CONFERENCE 2014 little consideration in the formal research literature. This approach will receive a substantial boost with the advent of the National Disability Insurance Scheme and the enhanced demand for ISL that will occur. However congregating people with disabilities with few life choices into group homes, for example, remains the common option. We need a more rigorous, critical understanding of the meaning and quality of supporting one person at a time in homes of their own choice. Method: Over five years, using qualitative research methods, we worked with people with disabilities, families, advocates, and service providers experienced with ISL. We developed a framework describing what ISL means. Then we operationalised that framework into a method for evaluating and reviewing the quality of arrangements. Results: Preconceptions about who can or cannot live in an ISL arrangement were challenged. People with very high support needs thrived in ISL. There were many different manifestations of ISL. There were many long-term arrangements and relationships that surpassed the uncertainties of formal congregate options. The key aspects of the framework and instrument coincided with the universally acknowledged concept of “one’s own home”, which takes many forms but consistently emphasises specific qualities. Implications: We plan to use the instrument to provide training and to examine the relationship between ISL quality and outcomes including inclusion, participation, friendships, and costs. 17. C Furner, C Oswald & A Ackland Being active and not just visible - Young adults with severe, multiple disability embrace true inclusion through their community-based day program Breakaway’s Post School Lifestyle Program was borne out of an idea from one of our families, who had a vision for a quality and real day program for their daughter. They had been disillusioned with past experiences and wanted a program that embraced true inclusion, active attendance and participation whilst also having safeguards in place so full participation happened – no matter what! From this vision, and in consultation with families and Wednesday 5 November 2014 individuals, we developed what we consider to be a truly inclusive day program for eight young adults with multiple disabilities. Our program focuses on the person first: ensuring they are involved in planning for their lifestyle and allows for support to be provided should health needs of the person change and they cannot access their chosen activities. Each of the guests have goals: ones they have identified as being important to them and ones that they have the power to change. Over the years, the guests have grown in confidence and are personally known by many, embracing a true sense of belonging. The choices, flexibility and endless possibilities for the people we support are present daily and the program is fluid to allow for changes to occur without disruption. The implications for our program is that through mutual respect and ability driven expectations we’re learning and growing from our combined experiences. Planning for the future is imperative due to the changes within our sector, however our vision and reason for being will always be central to our planning and delivery. 18. J Merrells, A Buchanan & R Waters How young adults with an intellectual disability spend their time, make friends and feel included: experiences of social inclusion Background: There is limited research regarding social inclusion from the perspective of young adults with intellectual disability. Social inclusion is a core domain of quality of life and crucial to positive outcomes in life. Method: Ten participants aged 18 to 24 years with a diagnosis of intellectual disability were selected through purposive sampling and interviewed about how they spend their time, make friends and feel included. A phenomenological approach was used to explore this. NVivo 10 software was used to assist in organising the data for the thematic analysis for this research project. Results: The majority of young adults with intellectual disability do not have contact with many people of similar age without disability who are not paid staff or family. They spend the majority of their time involved in work, formal programs and at home or with 1 family. Few have regular contact with friends. Work, neighbours, programs and educational venues help young adults with intellectual disability meet other people and feel ‘part of something’; however entry into these can be difficult. Implications: Service providers of social inclusion initiatives as well as health professionals, teachers and carers will benefit from insight into the lives of West Australian young adults with intellectual disabilities and their experiences of social inclusion from their perspective. 19. J Bourke, H Leonard & J Marsh How common is intellectual disability? Background: The ability to provide accurate and valid estimates of the prevalence of intellectual disability has been challenging because of inconsistencies in definition and case ascertainment. In Western Australia, the IDEA (Intellectual Disability Exploring Answers) database has been established since 2003 as a population-based register on individuals with an intellectual disability, sourced from notifications from both the Disability Services Commission (DSC) and the Department of Education. The database provides a resource for studies linking to other population datasets. Method: Individuals born from 1983-2010 with an intellectual disability (ID) and identified by either DSC or Education have been linked to birth data held at the Data Linkage Branch of the Department of Health, WA. Prevalence of intellectual disability was calculated using total population live-births as the denominator. Where available, cause of intellectual disability was classified as biomedical, autism or unknown. Results: Overall prevalence of intellectual disability in WA was estimated to be 17.4/1000 live-births, of which 16.0/1000 had mild or moderate ID. The prevalence of autism spectrum disorder was 3.7/1000 live-births with two-thirds of these having an intellectual disability. The most common biomedical cause was Down syndrome however in approximately 60% of all cases no known cause was identified. Implications: The provision of accurate estimates of numbers of individuals with an intellectual disability is essential for adequate service planning for this important group. The ability to link to other datasets ASID CONFERENCE 2014 31 Abstracts such as hospitalisations, justice and child protection enables investigation of the particular needs within this population. 20. S Gellar Autism Spectrum Disorders in middle to late adulthood Background: ASD has been studied widely in children and young adults. However, little research has been conducted into adults over the age of 40. ASD is now recognized as a lifetime disorder, yet research into the adult phenotype is severely lacking. Does the adult phenotype differ? And if so, how? Our study is part of an international effort to define the adult phenotype of ASD, and for the first time provide an estimate of cost for adult ASD in Australia. Method: The data for this study has been collected from interviews with family, care providers and adults over the age of 40 with ASD. Cost of care has been established from records housed with the Disability Services Commission of WA, and other government and NGO organizations. Results: Preliminary results suggest adults diagnosed with ASD as children continue to meet criteria for autism spectrum disorder well into adulthood. The symptom profile is however susceptible to change as deficits experienced in childhood may no longer be an issue in adulthood. Preliminary data collected on prevalence suggests the known adult prevalence is significantly smaller than would be expected from national and international data. Furthermore, cost estimates are higher for adults than for children. Implications: These findings show adults with ASD face different challenges from children. The prevalence data suggests there are many adults in WA who are undiagnosed and may not be receiving adequate support. In addition, our data indicate adulthood is the most costly age group, despite being under-recognised and under-researched. Background: Paperwork forms a large part of daily service provision in group homes for people with intellectual disability. Government departments and disability service organisations perceive paperwork as an important service technology in the delivery of quality support to residents. However, the frontline staff perspective of paperwork is not well understood. This study aims to explore group home paperwork from a frontline staff perspective, providing an alternative perspective to a heavily used service technology. Methods: This qualitative project is underpinned with a constructivist Grounded Theory Methodology, and uses qualitative data collection and analysis research methods. Data involves participant interviews and observations, and researcher journal reflections. In order to generate theory firmly grounded in the data, the data collection and analysis process is conducted iteratively. Results: Preliminary findings identify factors that influence both the negative and positive perspectives of paperwork, and these will form the basis of discussion in the paper. Implications: There is a crucial need to understand paperwork from the perspective of frontline staff, as this stakeholder group is the major audience and user of group home paperwork. This perspective provides insight into the impacts of paperwork processes on the quality of support provided to residents. 22. L Hamilton Beyond the file note: making group homes genuine homes Background: Are group homes workplaces or genuine homes? Are they organisational assets or places of belonging and connection? There is a paucity of research that examines group homes from the perspectives of people with intellectual disability. 21. C Quilliam, C Bigby & J Douglas Method: Ethnographic research was undertaken over 18 months at Lake House, a group home for six people with intellectual disability. A frontline perspective of paperwork in group homes for people with intellectual disability: Preliminary findings Results: Surveillance is part of life at Lake House; housemates are constantly subject to the administrative gaze. File notes are used as sanctions 32 ASID CONFERENCE 2014 Wednesday 5 November 2014 of the administration and housemates experience file notes punitively. A refusal to hang out the washing can lead to a label of “being difficult” recorded on file; not obeying a staff member’s request to change your windcheater can lead to a negative note in the communication book. A request to buy a softdrink can be refused because it is not a “healthy choice” and having a sexual relationship with another housemate can lead to threats of eviction. Implications: Administrative regimes designed to protect staff and residents such as quality standards, health and safety, file notes and operational procedures can create environments of enclosure (Deleuze, 1992) where home is prescribed via machinations of the regime. The development of genuine partnerships with people with intellectual disability is urgently required to reconsider the group home model. The perspectives of people living in group homes counter the dominant discourses of service provision and supports people with intellectual disability to create the lives that they choose, including creating genuine homes. 23. R Munn Children’s Therapeutic Accommodation in action: a case study from South Australia. Background: Children under Guardianship of the Minister often have experienced trauma within their short lives, and those who also struggle with the additional needs associated with Intellectual and other disabilities are even more susceptible to traumatic experiences due to the additional obstacles they face on a daily basis. Method: Cara are supporting four children under the age of 14 years with a diagnosis of Intellectual Disability within a therapeutic accommodation setting. The last 12 months has seen many obstacles overcome for each child resulting in significant quality of life advances. This paper will describe how trauma informed practices, combined with understandings of attachment and play theory alongside the implementation of Active Support practices have shaped the provision of accommodation support to children who have been unable to be placed in the traditional foster care model. 1 Results: The team of Community Support Workers provide a program of support for the children that has enabled them to become active members of their community. This has reduced incidences of behaviours of concern to a point where children now can see futures beyond long term care. Implications: This paper will demonstrate how a trauma informed and best practices approach to children and learning can provide an accommodation experience for children with Intellectual Disability and trauma that supports their personal growth and reduces staff turnover and burnout. 24. N Crates & M Spicer Trauma Informed Support for people with disability, compatibility with Positive Behaviour Support and opportunities to enhance existing practice. Background: Being a person with an intellectual disability does not automatically mean that a person will present with challenging behaviour. Prevalence rates of mental health disorders in people with disabilities are significantly higher than the general population. Indeed, many people with intellectual disability who present with challenging behaviour also have a history of trauma and disrupted attachment. Despite the expanding knowledge base in relation to the treatment of trauma and disrupted attachment, there is little discussion of its application to supporting people with disability with such history. Method: The authors conducted a literature review of approaches to treating trauma and disrupted attachment. They then undertook a mapping process comparing these approaches to current best practice responses for challenging behaviour based on non-linear, multi-element positive behaviour support (PBS). Results: Many of the treatment approaches for trauma and disrupted attachment (regarding understanding problem behaviour, staff practices and intervention techniques) are synonymous or compatible with the best practices in PBS. Implications: The authors propose that PBS using the multi-element model is a trauma and attachment informed approach. Further, being an inclusive model, trauma informed techniques can be ASID CONFERENCE 2014 33 Abstracts embedded within the multi-element support model (MEM) to deliver trauma and attachment informed practices for people with intellectual disability. The MEM provides a framework for applying the broad range of trauma informed treatment practices within a holistic treatment planning framework, providing a cohesive method for integrated support and treatment where typical ‘language’ based therapy may not be effective. The MEM also provides a framework for supervising, supporting and engaging support staff as the mediators providing this intervention. 25. E Walker All Aboard MS Microboard: how microboards are used to address the challenges faced by young adults with complex disabilities, and their families Background: Microboards offer valuable assistance to people who choose to self-direct their services. A microboard • is a legally recognised organisation set up for the benefit of one person; • has 5-8 members who have an unpaid, close relationship to the person; • develops and maintains a citizen based network; and, • supports a person to retain as much control as possible. Microboards have the potential to address issues associated with staffing, care into the future, and having a good life. Although well established in Canada, microboards are new to Australia. This paper provides an update of research into how microboards work. Method: I am using a qualitative methodology involving interviews and interpretation to deepen my understanding of six microboards from across British Columbia and Western Australia. Results: • Microboards helped people with complex disabilities to develop friendships, live in their own home, and be part of their community. 34 ASID CONFERENCE 2014 • Microboards provide emotional and practical support to parents. • Incorporation bestows legal authority, and contributes to sustainability. • Members identified the strengths and challenges associated with microboards. Implications: Microboards, as a model of support, have the potential to ensure quality, sustainable care in all aspects of a person’s life. Information provided will be useful to anyone considering how to resolve concerns associated with a person with complex disabilities living a good life. 26. P Minnes Social Participation: the way forward Inclusive education and community living have gained general support through government policies and legislation but it is still not clear to what extent individuals are actually included and participating in meaningful ways. The research literature to date often focuses on the many barriers to inclusion and participation and the true meaning of these concepts needs further discussion. The purpose of this Round Table discussion is to share experiences of successful inclusion of people with intellectual disabilities in Australia and overseas. Rather than focusing on barriers and challenges, this discussion will focus on strategies that have worked to promote successful inclusion and participation. 27. N James Family carers’ experience of their relative’s need for admission to an Assessment and Treatment Unit Background: There is a lack of research that explores the experiences of acute in-patient admissions from the perspective of carers of people with an intellectual disability and professionals. The aims of this study were: • To explore family carers’ perceptions of how their views and opinions were received by professionals during their relative’s stay in an assessment and treatment unit. Wednesday 5 November 2014 • To obtain the views of professionals in relation to what they consider to be the barriers and facilitators to addressing some of the experiences discussed by carers. This study provides an original contribution to the understanding of this area of carer experience, from the perspectives of carers and professionals, and adds to the wider literature that focuses on exploring the family carer experience. Method: The experiences of three mothers and three fathers were explored via the use of semi-structured interviews. Interpretative phenomenological analysis (IPA) was used to analyse the data. Nine professionals participated in four semi-structured interviews and one focus group with the data analysed using descriptive thematic analysis. Results: Themes from carers exemplify this experience has influenced their sense of self, identity, value and importance during the admission. Professionals identified resources, time, funding, information provision and attitude as important factors to support. Key to relationships were effective communication, collaboration, involvement and the need to be consistently open and honest. 1 of age with a disability and semi-structured interviews with hospital social workers and multidisciplinary team members. Results: Key characteristics of those long-stay patients with intellectual disability or cognitive impairment are reported. Fifteen patients had an existing intellectual disability. Others with existing or newly acquired disabilities included patients with acquired brain injury and other conditions impacting on cognition. Staff experiences of working with these patients and ideas for practice improvement are analysed. Implications: Better understanding of reasons for discharge delays and the kinds of difficulties faced by these patients can assist with the development of in-hospital services. Staff views about how to better meet the needs of these patients are discussed including how to improve practice with families and carers. Furthermore, this study points to the necessity of developing appropriate options for people with disabilities when health conditions, while not acute, require a level of medical intervention generally not available elsewhere. Implications: The results from this study will raise awareness and help to inform practice by providing a deeper level of understanding of the experience of admission to an acute in-patient unit. 28. J Burton, H Redfern, H Seiffert & B Lonne Long stays in hospital for people with disabilities: Is this the right care at the right place? Background: Being a hospital in-patient can be a daunting experience especially if discharge is delayed for an extended period. This paper reports a practice improvement project at a Queensland hospital. It describes key characteristics of longstay patients with intellectual disability or cognitive impairment and examines staff views including how to address the situation for people who remain in hospital after needs for acute care are met. Method: Research methods were an audit of clinical data of 80 long-staying adult patients under 65 years ASID CONFERENCE 2014 35 Notes ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ 36 ASID CONFERENCE 2014 DAY Thursday 6th November 2014 ASID CONFERENCE 2014 37 Thursday 6 November 2014 38 1.30 pm 12.30 pm 11.45 am 11.00 am Rooms 10.30 am 9.45 am K Arrow, L Hamilton, R Hitchcock, K Whelan & A Kokonis Beyond Yes or No: applying a continuum of consent to sexual activity 29. Patricia Minnes Keynote 4: Working with Inclusion International Room – Orion & Pleiades Rottnest LUNCH - Room – Sirius R Dewar How I have got two jobs I like. 32. B Cox The Information, Communication & Technology Project - Activ Foundation 31. N Davies & A Byrne Country Towns: an opportunity for growth, inclusion and real community involvement 34. 33. M Long & O King My Life My Way Richard Hastings Room – Orion & Pleiades 2 P Shannon A Life Without Limits 36. S Jenkinson, I Mansfield & D Hoffman Getting prepared for the health journey ahead. Are life preservers on board? 35. Chair: Jennifer Mofflin Carnac The family as a context for the behavioural and emotional health of young children with intellectual and developmental disabilities Keynote 5: Lived experiences Chair: Morrie O’Connor Garden ASID Members’ Meeting - Room Orion & Pleiades P O’Brien & M Knox On becoming an inclusive researcher 30. Chair: Jill McKenzie Workshop King Sound /Admiralty Gulf MORNING TEA - Room – Sirius Moving Towards Social Inclusion and Participation of Individuals with Intellectual Disabilities: The Journey Continues. Room – Orion & Pleiades Workshop Orion & Pleiades Keynote 3: 8.45 am David Corner REGISTRATION 8.00 am ASID CONFERENCE 2014 CLOSE Conference Dinner - Venue – Red Herring, East Fremantle 7.00 pm J Butler, C Hinchcliffe & N Crates The Road to Success - evaluation of self-advocacy program developed by Speak Out Tasmania 53. M O’Connor and D Thomas People’s Organisations 52. 5.15 pm A discussion of inclusive experiences for and by people with intellectual disability S Jenkinson, I Mansfield & D Hoffman Who is “All aboard” on the good ship ‘Inclusion’? 51. Roundtable - Room – Orion & Pleiades H Johnson, C Bigby, D West, R O’Halloran & E Bould Communication accessibility issues of V/Line train travel for people with disabilities 50. T De Bortoli & M Arthur-Kelly Building capacity to maximise communication with children with multiple and severe disabilities: A research agenda 49. Chair: Ron Regan Advocacy A Buchanan, S Peterson, A Barns & J Bristow Self-directed early intervention funding: the parents’ lived experience 44. R Chalmers The Audit of Disability Research in Australia: what does it tell us? 43. Chair: Denise Whardall Perspectives Garden 4.45 pm K Boxall, R Boycott-Garnett, C Carter & P Bragman Sex education for people with intellectual disabilities in Europe 48. 4.15 pm K-R Foley, S Girdler, J Downs, P Jacoby, J Bourke, N Lennox, S Einfeld, G Llewellyn, T Parmenter & H Leonard Family quality of life and day occupations of young people with Down syndrome 47. Chair: Jennifer Mofflin Chair: Chris Yates Roundtable Communication AFTERNOON TEA - Room – Sirius S Fisher, C Fyffe, C Bigby& N Rose Research to Practice: Practice to Research: what it takes 42. N Ollington, D Wiggins & A Flack Evidence-based practices in inclusive settings: Building towards collaborative partnerships 41. Young people 3.45pm 3.15 pm K Povee The social construction of ‘Intellectual Disability’: perspectives of staff 40. 38. 2.45 pm H Johnson, C Bigby, T Iacono, J Douglas & S Katthagen Developing positive relationships for adults with severe and profound intellectual disabilities A Urbanowicz, H Leonard, S Girdler, N Ciccone & J Downs Parental perspectives on research into the communication abilities of those with intellectual disability: An example from Rett syndrome. N Wilson & P Frawley Supporting the socio-sexual needs of young men and women with intellectual disability 39. 37. Chair: Justin O’Meara Smith Chair: Laura Hogan Chair: Allyson Thomson Rottnest CommunicationResearch King Sound /Admiralty Gulf Relationships Orion & Pleiades 2.15 pm Rooms ASID CONFERENCE 2014 39 S Conn, K Lante, C Kohlenberg, A Chung & C Arundell Engagement in physical activity by people with intellectual disability living in supported accommodation 55. J Garriock ‘Outcomes of consequence’ – an implementation review of the Comprehensive Health Assessment Programme for people with intellectual disabilities 54. Chair: Ian Pearce Health K Bathgate, H Leonard, J Bourke, K Wong, I Chown & R Steele Defining and overcoming barriers to successful breastfeeding of infants with Down syndrome 46. K van Dooren, B Kraal, V Popovic & N Lennox Improving eRecord systems for people with intellectual disability 45. Chair: Nicole Beresford Health Carnac Abstracts 29. K Arrow, L Hamilton, R Hitchcock, K Whelan & A Kokonis – Workshop Beyond Yes or No: applying a continuum of consent to sexual activity There is a lack of literature and resources guiding professionals and carers in the practicality of discussing consent to sexual activity and current practice tends to limit this discussion to the choice between yes and no. The consent continuum is a new structured approach adapted by the Disability Services Team at Family Planning which distinguishes free choice from pressured, coerced, or forced sexual activity. The framework addresses motivations, feelings and safety in concrete ways and simultaneously promotes positive sexual experiences and improves protection from coercion, exploitation and abuse. This workshop will give professionals and carers a way to talk to people with intellectual disability (ID) about consent to sexual activity. Instead of just seeing the choice about sexual activity as being a yes or no decision, the workshop helps professionals and carers to think about the times that people might say yes to sexual activity because they are scared or worried about saying no. The workshop will cover the feelings people may have before and after these decisions. It will also cover how people with ID can be supported and safe with their choices about sex. It is important that professionals and carers have resources that help people with ID stay safe and have positive sexual experiences. The workshop will go for two hours. There will be activities and discussions so that the professionals and carers can feel confident to talk about consent to sexual activity in a way that helps people with ID. 30. P O’Brien & M Knox - Workshop On becoming an inclusive researcher This workshop aims to provide participants with an opportunity to learn about and discuss the theoretical and practical aspects of inclusive research. It will comprise three sections, each approximately 30 minutes long. The first section traces the evolution of an inclusive approach to research, exemplified in both Australian and international literature. Participants will be 40 ASID CONFERENCE 2014 introduced to a range of perspectives on the conceptualisation of inclusive research, as well as arguments for its added value. In the second section, participants will hear from members of the Centre for Disability Studies Inclusive Research Network on a segment of a study, funded by NSW Consumer Development Fund, they conducted on the perceptions of people with intellectual disability on the potential impacts of the NDIS for them. The third section of the workshop adopts a world café format, whereby, drawing on their own research experiences, members of the network will lead three groups. Respective groups will cover: first, how to establish and deliver training workshops for people wishing to work as co-researchers, and ways in which to decide on research questions people with disabilities consider meaningful to their lives; secondly, how to decide on data collection tools and practising their delivery; thirdly, how to analyse data and then disseminate findings. As participants move from one group to the next, they will be invited to complete their own action plan on how they might transfer the knowledge gained in the three discussion groups to their own research interests. 31. B Cox The Information, Communication & Technology Project - Activ Foundation My Name is Ben Cox and I am a person with an intellectual disability. I have worked with the Activ Foundation for last seven years. I have undertaken administration duties to the central services building undertaking both Records and IT. My Career started when I left school at Lemming Senior High School joined the Activ Foundation in 2006. My Goals was to go from a workshop floor as a general hand to an administration at Wembley Central Services. I was the first person with a disability to work at Wembley Central Services. Last year I did a talk about the leaders for tomorrow project which has now come to an end. This year I am more focussing about my work life on one particular subject called the Information Technology Devices which will be brought out to all our accommodation houses. Thursday 6 November 2014 My role in this project is to teach the clients how to use their own devices and give some guidelines on safe use. 33. This Project is run by Activ Foundation ICT and funded by the Independent Living Centre. My Life My Way 32. R Dewar My employment journey to getting two jobs I like. It is hard for young people when they leave school to get a job they like but it is harder if you have a disability. I want to share my experience of how at the age of 20 I have two awesome jobs one in hospitality and the other is public speaking to help other people with disabilities get a job they like. The key messages I want to tell people about how to get a job are: • Everyone has talents and gifts which can be used to turn into finding a job. • Self-belief is important • Belief of people around you is important • It is important that you tell people what they are good at as they don’t always see it themselves. • It is important that you have people outside your families and friends to talk to and provide support • It is important to continue to look at ways of continually improving skills to find a better job • It is important if you have a disability to sometimes share with your work mates that your disability may cause you to behave differently sometimes from what they may expect. Presentation overview: At age ten I was diagnosed with Asperger’s syndrome. On top of Asperger I also have Low Muscle Tone a learning disability and slow deployment. When I was 14 I got my mother got me my first job at Gloucester Park which my Mother helped me get. This year I gained employment at Crown Perth which was my goal. I want to share my journey on how I achieved my goal. A couple years ago someone told me I would be good at public speaking so I thought I would give it a go. I have had a number of gigs and I am working on improving my skills at presenting. One day I want to travel with my public speaking. It is awesome that I now have two jobs as I enjoy working. Working is important to me and it is pleasure. 2 M Long & O King When I knew I wanted to move out of home, I knew I didn’t belong in a group home, but I also didn’t want to live alone. I wanted to live like the people I see on TV, in a fun and dynamic environment with housemates and freedom. I know there are some things that I need help with, but they are only small things. Then I found Kardinya. The Kardinya House model and team demonstrates beautifully how person centred practices can create a culture which enables people living with an intellectual disability to direct their own lives. If you imagine a life which is built on making your own decisions about what you want to do and when you want to do it. If you could share these choices with your friends and families and if you could do this in a way that is encouraged and facilitated by the people that support you - then you begin to understand what living at Kardinya House means. Now add to this staff and volunteers that are committed to person centred practices and actively supporting you in accessing a community that embraces you, then you start to understand life at Kardinya for us - 6 young adults. Kardinya House is a pilot, which uses a concept that whilst not unique, has determinedly used the philosophies of person-centred practices to create a culture of inclusion and choice and its success demonstrates that changing the mindset and practices can create cultural change. 34. N Davies & A Byrne Country Towns: an opportunity for growth, inclusion and real community involvement Background: Traditionally, when looking to move out of home, many service users who live in regional areas feel they have no choice but to move to the city. Often this isn’t the best choice and can cause issues of loss for the family and the community in which the person has lived. It is also often argued that regional towns don’t provide adequate services or fail to connect with people living with intellectual disabilities. This is my story of how this isn’t always true and how my community has included me in all aspects of my life ASID CONFERENCE 2014 41 Abstracts and provided me the opportunities I may not have had if I lived elsewhere. Method: Through my links in the community that have been created throughout my life, myself and the other people accommodated by my service provider have been able to be active contributors within community. Through living where I do, myself and the people I live with have been given opportunities that may not have been readily given had we lived elsewhere. An example of this is a local business allowing us to do a regular walking of the dogs they look after and have for sale. Results: Where I live is approximately two hours’ drive from South Australia’s capital city and the next closest disability service provider is based an hour away. In the beginning people were told they would have to leave to gain accommodation, but thanks to community lobbying housing was set up within my town. This was the beginning of our community showing support to us and it continues to build in many ways that I want to tell you about. Implications: Our story is a positive one for rural communities and can hopefully show others what can be achieved through strong community links. 35. S Jenkinson, I Mansfield & D Hoffman Getting prepared for the health journey ahead. Are life preservers on board? Background: People with intellectual disability are living longer with better care and support. This also means they are experiencing the effects of age related disability just like the rest of the population. However for people with disability this also means a change in support is required. Introduction: Ian and David are good friends who are looking out for each other. They have both lived with a high degree of independence. Over the last 2 years they are experiencing health issues related to aging and this is having an impact on their lives and the support required. There have been changes required at home and at work. There have been changes required in what they can expect of themselves as their health has changed. Research presented at previous ASID (Rafat Hussain, Helen Edwards, Stuart Wark, 2010) and IASSID (Evenhuis, H., Henderson, C.M., Beange, H., Lennox, N., & Chicoine, B. (2000)) conferences have identified that age related health issues for people with intellectual disabilities include 42 ASID CONFERENCE 2014 access to services, extra support, and access to health promotion. The barriers and potential barriers identified by Ian, David and Samantha show that in Australia there are issues of access to age related supports and services, extra support from disability specific support and still many questions about how the NDIS, HACC services and disability service providers will work for people with disability who are ageing. Implications: There needs to be a better understanding of what changes in support happen as people with intellectual disabilities age and encounter the normal range of health issues to do with ageing. Service systems must be better prepared at all levels to support people as and when required. 36. P Shannon A Life Without Limits When those around you say you cannot, it is up to the determination inside you to tell them you can. Rather than focus on one’s inability, the focus instead should be on one’s ability. We are at an important time in which society is beginning to recognise this fact, a perspective that is especially relevant to people living with disabilities. My name is Phillip Shannon and I was born with a disability. I wish to share my own personal story about the challenges and struggles I have faced. Life is good for me right now. But a time ago, things were not so favourable. My story will speak to anyone who has ever been homeless – a cold, dangerous, and difficult place to be. It will relate to those who have faced health problems as I recall a terrible night in which I was taken to hospital by ambulance. But most significantly, my story will be recognised in the challenges many of us face through intellectual disability and mental health. Despite these struggles that so many others share, I have pushed through and tried to do the best with my life. I have overcome adversity with a long list of achievements. What keeps me going is my goals, passion and focus on my abilities. As such, my mission is to promote, inspire and empower people with disabilities to live a great life without limits and achieve their goals. I am standing for the rights of people with disabilities in society. I aim to inspire others to accept people who are different and to recognise that we have a lot in common. We are all trying to do our best with our lives. Thursday 6 November 2014 37. N Wilson & P Frawley Supporting the socio-sexual needs of young men and women with intellectual disability Background: People with intellectual disability (ID) have long been seen as either asexual or hypersexual which affects the type and amount of support they are offered in this area. Young adults with ID transitioning to adulthood typically miss out on the same sociosexual education as their non-disabled peers. We need to better understand how to support young adults with ID during this transition to help them avoid the unwanted sexual experiences and difficulties negotiating safe and fulfilling relationships. This research explored the kind of supports young adults with ID want during this transition and the types of support that work well and don’t work so well. Methods: We conducted 4 separate focus group interviews with young men (n=14) and young women (n=11) with ID. We also conducted 3 separate focus group interviews with disability transition staff (n=17). Data were analysed using the constant comparison method of grounded theory. Results: Young people with ID want to develop relationships, but gendered messages about sexual safety lead to a fear-based and risk-aversive lifestyle that, through socio-sexual regulation, deny opportunities to rehearse and hone knowledge about sex. Conclusions: Future in-depth research needs to explore the perceptions, expectations and concerns of parents and other unpaid caregivers. We need to develop and test socio-sexual interventions that will not only offer increased socio-sexual knowledge, but also the social context in which to rehearse and hone this knowledge. Demand for places in similar accommodation will increase, adding to the existing burden on service providers. There was substantial use of medical services, and the need for more extensive hospital care is also predicted to grow with the onset of age-associated disorders. 38. H Johnson, C Bigby, T Iacono, J Douglas & S Katthagen Developing positive relationships for adults with severe and profound intellectual disabilities 2 Background: The aim of this study was to increase the capacity of direct support staff to understand and facilitate social relationships with people with intellectual disability and little or no speech with both themselves and with others in the community. The intervention was based on a theoretical model of processes in positive relationships developed in an earlier study Method: Nineteen staff members and five adults with intellectual disability participated. A Multiple Baseline Design, across three day services, was implemented. Observational data (104 hours) of interactions between staff and focal participants were obtained using momentary time sampling and field notes. Staff participants also completed two questionnaires and participated in interviews. The intervention comprised four staff workshops on four processes, recognising the individual, sharing the moment, connecting and sharing the message. Results: Pre and post comparisons of the data showed individual variability resulting in different intervention effects across services. Changes varied in relation to staff member, activity and communication skills of the service user. The positive changes in social interactions demonstrated increased engagement with increases in the processes connecting and sharing the message. These observations were verified through interview report. Implications: The results point to complexities involved in data collection on social interactions in day services and indicate the benefits of facilitating social engagement through short term training in group based program settings. 39. A Urbanowicz, H Leonard, S Girdler, N Ciccone & J Downs Parental perspectives on research into the communication abilities of those with intellectual disability: An example from Rett syndrome Background: It is generally accepted that the perspectives of parents are integral in the assessment of communication abilities of individuals with a severe physical and intellectual disability. Although numerous studies have investigated parental perspectives on communication abilities of children with disabilities such as Down ASID CONFERENCE 2014 43 Abstracts syndrome or cerebral palsy, the perspective of parents with a daughter with Rett syndrome, a rare neurodevelopmental disability associated with numerous physical limitations and impairments in language, have not been described in detail. This study described from the perspective of parents, how females with Rett syndrome communicate in everyday life and the barriers and facilitators to successful communication. Method: Sixteen semi-structured interviews were conducted with parents whose daughters were aged from two to 29 years, had varying functional abilities and were registered with the Australian Rett Syndrome Database. Interviews were recorded and transcribed verbatim. Transcripts were analysed using directed content analysis. Results: All parents reported their daughters were able to express discomfort and pleasure and make requests and choices using a variety of modalities including vocalisations, body movements and eye gaze. Parents also reported their daughters understood most of what they said and the level of functional abilities, such as mobility, and environmental factors, such as characteristics of the communication partner, influenced the success of communication. Implications: Health and teaching professionals need to consider the parental perspective when assessing communication abilities and developing communication interventions for girls and women with Rett syndrome. 40. K Povee The social construction of ‘Intellectual Disability’: perspectives of staff Background: In this study I explored the social construction of ‘intellectual disability’ from the perspective of the staff who work with people with intellectual disabilities. Method: An Advocacy Agency participated in the study and unstructured interviews were conducted with five staff members. Interview transcripts were analysed using causal layered analysis, a multilevel analysis that enables the factors that perpetuate social issues to be identified through the interaction of several levels of understanding. 44 ASID CONFERENCE 2014 Results: The exclusive grouping of people with intellectual disabilities and the diagnosis of intellectual disability were issues raised by most of the staff. The impact of the visibility of the intellectual disability (or stigma) was explored, as was the discourse surrounding ‘difference’. Staff identified that the Members of the agency with intellectual disabilities often ‘pushed the boundaries’ of societal expectations just by ‘apparently feigning’ ‘normality’. Another theme discussed the limited opportunities afforded to Members and revealed that this was legitimised by the assumption that people with intellectual disabilities are happy and have a “bloody good life”. Imposed identities were identified; ‘the deviant’, ‘the eternal child’ and ‘the intellectually disabled’, a consuming master status. The opposition and discomfort surrounding the exclusive grouping of people with intellectual disabilities was examined, revealing an interesting paradox; we (society) want you to be independent and autonomous but as defined by us. Implications: Constraints are placed on the lives of people with intellectual disabilities which are unwarranted given their actual impairment. The findings of this study can inform the practices of disability service providers. 41. N Ollington, D Wiggins & A Flack Evidence-based practices in inclusive settings: Building towards collaborative partnerships Background: The adoption and implementation of evidence-based practices in inclusive settings requires an understanding of the translation of research into practice, as well as an understanding of the way in which practitioners can inform and guide research. Using a translational science framework to address issues and barriers to evidence-based practice including translation, and implementation, the current work aims to bridge the gap between those who conduct research or generate knowledge, and those who use evidence-based information in practice. Method: A basic training (workshop) approach was implemented in Southern Tasmania. Pre and postworkshop surveys were administered. Results: A model was developed for the promotion of skill development and collaborative research Thursday 6 November 2014 2 partnerships between researchers/academics and on the ground/support workers. The model identifies the skills necessary to discover and appreciate relevant research findings, to realise opportunities for the communication of research ideas, and to incorporate new findings into practice; that is, the awareness to adapt guidelines and strategies for a ‘good fit’ with the environmental context. be able to demonstrate how they provide support which achieves specific outcomes, rather than just makes claims based on their own perspectives. The NDIS will expect information about organisational performance. This paper will give an outline of a program logic and accompanying system of collecting data about program outcomes which moves from monitoring compliance to outcomes. Implications: The education and training model shows promise towards the enhancement of the application of evidence-based practices in inclusive settings. 43. R Chalmers 42. S Fisher, C Fyffe, C Bigby& N Rose Research to Practice: Practice to Research: what it takes Background: As part of a service redevelopment initiative by the Tasmanian state government, Veranto won the tender for the Seniors Lifestyle Options program and took over responsibility for it in March 2011. The program elements were initially described as: person centred thinking; a flexible model of support; use of person centred active support and positive behaviour support; an action learning framework for continuous improvement. The program aimed to create daily support for older people where by the activities, pace and pattern of their day were flexible and determined as much as possible by the individual needs and preferences of each individual. The Audit of Disability Research in Australia: what does it tell us? The current national interest in the reform of the disability services system has brought a renewed focus on research that focuses on matters related to people with disability. Questions are being raised about the level, intensity and appropriateness of research in Australia to support reform and innovation in the field of disability. In June 2012 a working group linked to the Council of Australian Governments (COAG) funded an audit of disability research in Australia. The audit was undertaken over a twelve month period by the Centre for Disability Research and Policy at the University of Sydney with team members from People with Disability Australia, National Disability Services and the University of Melbourne. Professor Gwynnyth Llewellyn was the lead researcher. Method: A program logic (or program design statement) that captured the organic method of individual and program planning adopted by the program, was written by Veranto staff, with the support of two external consultants, through a series of workshops, review of documents and observations of day to day practice. Based on this a system was developed and trialled to collect regular client level data that provided evidence to support beliefs that the program was offering flexible individualised support for older people that reflected their preferences and improved their lives. The main aim of the audit was to produce a report that provides a comprehensive picture of the current state of disability research in Australia. Results: Initial data about program outcomes will be presented using individual case studies, and a detailed description of the program logic and data collection system will illustrate the distinct components of these. 44. Implications: Increasingly service providers need to The report, which has just been released, is an important resource for the disability research community and offers valuable recommendations to guide and stimulate research initiatives. This presentation will consider the implications of the audit findings and recommendations for the future of disability related research in Australia. A Buchanan, S Peterson, A Barns & J Bristow Self-directed early intervention funding: the parents’ lived experience ASID CONFERENCE 2014 45 Abstracts Background: Consumers of services are increasingly being provided with opportunities to self-direct and manage their funding with the aim of achieving more personalised and effective outcomes. Self-direction and managing of funding for early childhood (ECI) intervention services by parents of children with intellectual disability is being trialled as an alternative approach for families who would have only previously been offered block funded government services. The research was exploring - what is the lived experience of parents, caring for children (aged 0 - 6 years) living with disabilities, who are using self-directed and shared management ECI funded services to meet their child’s intervention needs. Method: Forty families who chose to self-direct and manage their funding were invited to participate in this mix methods study. Families were interviewed regarding their lived experiences and completed two measure measures considering empowerment and resilience. Participants agreed to be interviewed three times at six month intervals. Results: Initial results of the study have identified there major themes – the importance of the families general lived experience at the time of commencing self-management, understandings and expectations of self-management, and previous service experiences. Details results will be provided. Implications: The results of this study will have particular significance as funding models for people with disabilities and their families are rapidly moving to approached of self- direction and self-management. Understanding parents’ lived experience of self-direction and management will assist in future service design and delivery. 45. K van Dooren, B Kraal, V Popovic & N Lennox Improving eRecord systems for people with intellectual disability Background: The introduction of eHealth records represents the potential to improve health-related outcomes for many Australians by improving accessibility of health information. Although little is known about how Australian consumers will actually use eHealth records, international research suggests that using patient-controlled health 46 ASID CONFERENCE 2014 records is especially problematic for disadvantaged populations. Methods: Using a local eRecord system as a case study, we aimed to describe the barriers and facilitators to uptake of eRecords in a manner that improves the lives of individuals with intellectual disability. Over six months, we conducted qualitative interviews with organisations, eRecord developers and, critically, those individuals and their carers for whom the system was developed. Results: Based on a thematic analysis and triangulation of qualitative data, we developed a model of system use that allows us to identify barriers and facilitators to eRecord system use by people with intellectual disability. Implications: Our findings provide important insights both for the eRecord system under scrutiny and for the national PCEHR system currently being rolled out by the Australian Government. 46. K Bathgate, H Leonard, J Bourke, K Wong, I Chown & R Steele Defining and overcoming barriers to successful breastfeeding of infants with Down syndrome Background: Breast milk is recognised as the optimal food for infants. Breast milk and breastfeeding can give additional benefits to infants with Down syndrome by protecting against increased risk of infection and stimulating muscle control. Despite the benefits, little is known about the Australian mother’s experience of breastfeeding an infant with Down syndrome. The aim of this research is to describe the rates of breastfeeding in mothers of infants with Down syndrome, barriers experienced and how they were overcome. Method: In 2011, 197 parents of a son or daughter with Down syndrome aged between 15 to 31 years living in Western Australia completed a questionnaire that included questions on how their son or daughter was fed as an infant, how long any breastfeeding continued, problems experienced with breastfeeding and support received or desired. Results: In total, 81% of mothers initiated breastfeeding with 62% of infants exclusively breastfed in the first week. All mothers who did not initiate breastfeeding and 57% of mothers who did initiate Thursday 6 November 2014 breastfeeding experienced problems, with the main barriers being poor sucking, medical complications and infant lethargy. Health professionals, including medical staff, nurses, midwives and lactation consultants were the most frequently cited support. Implications: Most mothers of infants with Down syndrome successfully initiated breastfeeding however the rate of exclusive breastfeeding was lower than in the general population. Parents and health professionals need to be aware of the benefits and barriers to breastfeeding to support new mothers of infants with Down syndrome. 47. K-R Foley, S Girdler, J Downs, P Jacoby, J Bourke, N Lennox, S Einfeld, G Llewellyn, T Parmenter & H Leonard Family quality of life and day occupations of young people with Down syndrome Background: Family quality of life is an important outcome that needs to be considered when support is being provided to families with a young person with an intellectual disability. The transition from school to adulthood is a crucial time and the lack of post-school options has been shown to have negative implications for the whole family in terms of satisfaction and family adjustment. Method: In 2009 questionnaires were completed by 203 families (88.6% of those contacted) with a young person with Down syndrome aged 15 to 32 years participating in the Down syndrome “Needs Opinions Wishes” study at the Telethon Kids Institute. Data collected included the young person’s day occupations as well as family characteristics such as income, family and community supports and quality of life. Results: About a quarter of the 150 young people who had left school were working in open employment and 40% in sheltered employment, while 10% were participating in training options and a quarter in day recreation programs. Families of young people participating in sheltered employment tended to report poorer family quality of life than those of young people attending open employment, after adjusting for personal characteristics, behaviour and income. Implications: Participation of young people with intellectual disability in open employment may positively influence family quality of life. However we 2 can only speculate about the mechanisms through which this occurs. 48 K Boxall, R Boycott-Garnett, C Carter & P Bragman Sex education for people with intellectual disabilities in Europe Background: The Sex Education and Disability (SEAD) Project has been working with adults with intellectual disabilities, their parents and staff to try and understand people’s questions and concerns about sex education in six different European countries. Method: Project partners from Germany, Hungary, Finland, Lithuania, the Netherlands and the UK have been doing research in their own country, finding out about how sex education is taught to adults with intellectual disabilities and asking if people would like things to be different. They have done this by researching government papers and interviewing people with intellectual disabilities, their parents and staff. Results: Our project is only half-way through. So far, we have tried to answer these questions: How can we talk to each other about sex education? How can we collect data (information) across six European countries? How can we make an accessible summary of what we found out? We found it was difficult and embarrassing for people to talk about sex and sex education but there are ways of making it less embarrassing (for example, using puppets or life-size dolls). Implications: More and more adults with intellectual disabilities are living in community settings (within and beyond Europe) and forming relationships. It’s important to talk to people about sex education and to try and find ways of doing this that are less embarrassing. The SEAD Project is funded by the European Commission Grundtvig programme. 49. T De Bortoli & M Arthur-Kelly Building capacity in families and communities to ASID CONFERENCE 2014 47 Abstracts maximise communication with children who have multiple and severe disabilities: A research agenda Background. Communication is crucial to the participation of children with multiple and severe disabilities (MSD) in everyday life. Research has identified the central role of families in supporting the communication opportunities of these children, yet little is known about their experiences of communicating, their support needs, or the barriers they face. With the introduction of the National Disability Insurance Scheme (NDIS), families will gain greater say over the support they receive, and services such as speech pathology will no longer be delivered in segregated settings but in children’s natural environments. Method. This paper presents an argument for a research focus, employing qualitative and participatory action research on: (i) the range of facilitators and barriers to the communication of children with MSD from the perspectives of the children themselves and significant people in their lives; parents, siblings, peers/friends, neighbours/ other community members and educators, and (ii) the development and implementation of approaches to empowering families and communities to build their capacity to maximise the communication opportunities and participation of their children with MSD. Results and Implications. The findings of such research will contribute to designing and implementing appropriate inclusion-based, familycentred supports for maximising the communication opportunities and participation of children with MSD. It will contribute to new knowledge and skills needed by families and communities to navigate the changing environment created by the introduction of the NDIS. 50. H Johnson, C Bigby, D West, R O’Halloran & E Bould Communication accessibility issues of V/Line train travel for people with disabilities Background: Transport accessibility has focussed on physical access and neglected many issue relevant to people with intellectual disability. This study systematically investigated the communication barriers and facilitators of services to customers of a mainline rail company (V/Line) in Victoria, Australia. 48 ASID CONFERENCE 2014 Method: Twenty five interviews and five focus groups were conducted with 12 customers with communication difficulties and 13 staff, and an online survey completed by 111 front line staff. Data were analysed thematically and with descriptive statistics. Results: The focus group and interview data revealed generally positive attitudes by staff towards the customers with a disability. The survey data from front line staff reflected these findings showing a degree of comfort in their interactions with this group. Both groups identified the need for a greater variety of interactive communication tools, strategies for customers needing assistance and education programs. Customers recommended infrastructure changes including improved signage, and multiple ways to receive or access information. Implications: Considerable potential exists to utilise the generally positive staff attitudes towards people with communication, strengthen customer service and reduce barriers to communication through the greater use of communication tools by staff, more targeted training in communication and adaptation of signage, and written printed or on line communication. 51. S Jenkinson, I Mansfield & D Hoffman Roundtable Who is “All aboard” on the good ship ‘Inclusion’? Background: Inclusion for a person with intellectual disability is about feelings of friendship and having a choice to be with all sorts of people that you feel included by, whether that is other people with disability, friends, family, community groups etc. It is much more than where you do things. Flexible support and inclusion should include peer support. Peer support is often about bringing together people with the same type of disability, yet there is a lot that people can learn from other people who have experienced the same barriers and attitudes. Purpose: People with disability will talk about what they think “All Aboard” means. People will give examples of when they have felt included. People will give examples of times they have shared information and experiences with other people with disabilities. Everyone will have a chance to say how they meet friends, how they have felt included, and when they have felt supported. The group will find out what can Thursday 6 November 2014 be good about people with disability talking to each other and learning from each other. A round table allows the presenters/hosts to give their experience and then ask others to share theirs. There will be a series of questions the presenters will put to the round table to explore inclusion and peer support from both a theoretical and practical perspective. The hosts will speak first answering the question “Who is All Aboard? And What does the theme All Aboard mean to them? Others at the table can then contribute with their answers and answer further questions such as Where do you find friends? Who have you gotten the most useful information from? How can talking to other people with disabilities encourage inclusion in mainstream activities? Why is it important to be included? Implications: Exploring this topic is important for recognising the expertise of peoples lived experience. A potential impact may be for there to be more opportunities for peer support as valid learning experiences, and that peer support is connected to experience not just disability type. 52. M O’Connor People’s Organisations: People with Intellectual Disabilities developing their own housing/employment and related resource groups Background: People’s Organisations, also known as mutual support groups or co-operatives are a rarity in the disability field although a mainstay of developmental practice. This paper contends that People’s Organisations have a significant role to play in improving the social and economic conditions of people with Intellectual Disabilities and that the NDIS should offer opportunities for people with Intellectual Disabilities to create People’s Organisations. Method: Case study of three People’s Organisations, mutual support groups established by people with Intellectual Disabilities. A housing company, a workers’ co-operative and a musical group operating under sponsorship. Results: Drawing on the work of Concetta Benn/Tony Kelly and Ingrid Burkett the three case study groups have utilised a ‘Capacity Building Framework’ that has led to success in social and economic inclusion. 2 of a Capacity Building Framework are a vehicle for social and economic inclusion. The NDIS should offer new opportunities for People’s Organisations of people with Intellectual Disabilities 53. J Butler, C Hinchcliffe & N Crates The Road to Success - evaluation of self-advocacy program developed by Speak Out Tasmania Background: Capacity to be self-determining is critical for individuals to negotiate a plan that truly supports their goals and aspirations under an NDIS. Wehmeyer et al (1997) demonstrated high capacity for self-determination in adolescence had a correlation with an individual’s employment and social outcomes. This paper will report on the effectiveness of the Road to Success. Method: The Road to Success is a self-advocacy training program designed for people with intellectual disability. Following a review of self-advocacy training and materials within Australia and overseas the program was developed utilising some aspects of this and new information and activities developed by Speak Out self-advocates. The Road to Success is co-facilitated by self-advocates and uses the analogy that self-advocacy is a journey with the destination being empowerment and control over one’s own life. Prior to commencing the program the 5 participants, people with intellectual disability, completed subtests of the ARC Self Determination Scale (Wehmeyer et al 1995). At the completion of the program they repeated the scale in order to evaluate effectiveness. Results: The results evaluate the effectiveness of this group based program in terms of capacity for selfdetermination as assessed on a quantitative tool. Participants also reported qualitative outcomes; these will be discussed by one of the participants Implications: Given the opportunity individuals can improve their ability to be self-determining. The focus of the NDIS is on providing support to individuals that enables them to achieve their goals and aspirations therefore evidence based programs that increase capacity for self-determination are essential. Implications: People’s Organisations operating out ASID CONFERENCE 2014 49 Abstracts Thursday 6 November 2014 54. J Garriock ‘Outcomes of consequence’ – an implementation review of the Comprehensive Health Assessment Programme for people with intellectual disabilities Background: The main findings of the Ministry of Health’s ‘Health Indicators report for people with Intellectual Disability (2011)’ were that these people were worse off in terms of their health and life expectancy, had higher rates of health problems and used health services more than the general population. Method: In 2009, Spectrum Care implemented a Comprehensive Health Assessment Programme (CHAP) for people accessing residential services. This paper evaluates the implementation to establish whether the initial aim has been met and to identify disparities which may hinder further improvement of this group’s health outcomes. Results: The CHAP implementation was successful, as evidenced by the 20 percent average increase in the identification of health conditions, health screening and specialist referrals. However, there were still evident gaps in the appropriate health and syndrome-specific screening for people over 40, and the referrals for breast and prostate screening were still below expected levels. Implications: The general practitioners’ (GP) acceptance of the CHAP improved with each annual assessment. However, a need for a specialist clinical resource was identified as providing a higher level of health advocacy and clinical support for people and staff when interfacing with the GP. This and other information gleaned from the implementation review, including costs, required funding and the initial impact of a dedicated clinical nurse specialist, will be presented. 50 ASID CONFERENCE 2014 2 55. S Conn, K Lante, C Kohlenberg, A Chung & C Arundell Engagement in physical activity by people with intellectual disability living in supported accommodation Background: There is evidence to show that people with intellectual disability (PWID) have low levels of engagement is physical activity. There is no documented evidence of the levels of engagement in physical activity by PWID residing in New South Wales, government supported accommodation. The risks associated with low levels of physical activity increase over time and include risks of falling, loss of mobility and the development of preventable conditions including diabetes and obesity. This pilot study looked at current factors that impact on the engagement in physical activity. Method: Focus groups were conducted with people who reside in supported accommodation in regional and metropolitan Sydney and with the people who support them. Qualitative analysis was used to examine the participants’ attitudes and beliefs towards and the importance of engaging in physical activity. Results: Preliminary results suggest that the engagement in physical activity of PWID in this study can be dependent on staff attitudes, risk management and knowledge of resources and strategies. Motivation (of staff and residents), purposeful activities and flexibility in staffing and accountability were key issues raised. Implications: A multi model approach to improve engagement in physical activity needs to occur. This should include increasing awareness around physical activity, the development of resources and the sharing of ideas and knowledge around strategies. Importantly the promotion of physical activity within the resident’s lifestyle plan is seen as a way forward to promote sustainable activity. Notes ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ASID CONFERENCE 2014 51 Annual Australasian Society for Intellectual Disability Conference Making it real ... together Save the Date!! 11-13 November 2015 Crown Promenade Southbank, Melbourne A platform for delegates to come together and explore what is means to convert recent advances in disability legislation and policy into real and meaningful changes for people with intellectual disability. The conference will bring together a range of stakeholders: people with intellectual disability and their families and support persons, coordinators, disability support workers, researchers from universities, health professionals and policy makers, to share and prompt new ideas around the idea of collaboration and inclusion. Making it real ... together. www.asid.asn.au 52 ASID CONFERENCE 2014 DAY Friday 7th November 2014 ASID CONFERENCE 2014 53 Friday 7 November 2014 54 ` Innovations in Autism research – Launching into the adult space Room – Orion & Pleiades Torbjorn Falkmer Keynote 8: D Fagan Justice for Autism: a targeted training approach for the criminal justice sector 60. M Mansour Declared Places: declaring and meeting the needs of the accused with intellectual or cognitive disability 59. S Boulter Legal advocacy for people with an intellectual disability 58. 1.45 pm 57c. Emotional functioning in youth with developmental disabilities and significant emotional or mental health difficulties. 57b. Use of intranasal/oral Midazolam for primary health intervention when faced with challenging behaviours. 57a. Reducing the gap with the GAP Program at the Centre for Disability Health, South Australia. Inclusive healthcare in South Australia: Engaging with complexity J Curran, M Kyrkou, K Rye, J Entwistle, C Maher, M Usman, S Cama & C Mushan 57. LUNCH - Room – Sirius 56. M Cuskelly, K Moni & C Leggatt-Cook Constructing futures: Aspirations and expectations of young adults, their parents and service providers. 56a. Enhancing future trajectories for young adults with intellectual disabilities: Family aspirations and implications for service provision. 56b. Perspectives of support staff on the likely futures of adults with intellectual disability. 56c. Building research capacity and culture: Strategies and challenges within a large nonGovernment organisation. 12.45 pm 12.15 pm 11.45 am 11.15 am 3 C Bigby, E Bould & J Beadle-Brown Quality of life for people with intellectual disability in group homes: What makes a difference? 63. C Bigby, M Knox, J Beadle-Brown & E Bould Identifying good group homes for people with severe intellectual disability using a Quality of Life framework 62. S Thoresen, E Cocks & R Parsons Employment and related economic outcomes for apprenticeship and traineeship graduates with disability: findings from a three year longitudinal study 61. Chair: Ron Regan Chair: Morag Budiselik Carnac JusticeAdulthoodd Rottnest SymposiumSymposium King Sound /Admiralty Gulf MORNING TEA - Room – Sirius 10.45 am Rooms Melbourne Promotion - Room – Orion & Pleiades Orion & Pleiades Glynis Murphy Community-based treatment options for people with intellectual disability who break the law Room – Orion & Pleiades Keynote 7: The management of epilepsy in people with an intellectual disability – it is rocket science Room – Orion & Pleiades 10.30 am 9.45 am Keynote 6: 9.00 am Mike Kerr REGISTRATION 8.00 am ASID CONFERENCE 2014 5.00pm 3.30 pm 3.00 pm 2.30 pm Rooms ART EXHIBITION Venue – Central Park Building, Perth “As We Are” CLOSING CEREMONY`` Room – Orion & Pleiades J Fairthorne, G Hammond, N De Klerk & H Leonard Exploring the risk factors for disability using linked health data 69. J Man, M Kangas, J Trollor & N Sweller Current clinical attitudes and practices of psychologists working with adults with dual disabilities: a National survey. 68. Chair: Morag Budiselik Health Rottnest A Jobling Enhancing post-school literacy education programs for young adults with intellectual disabilities. 71. D Casey Who will make decisions for your child when they turn 18? 70. Chair: Stian Thoresen Adulthood Garden C Fyffe, L Raskin & D Leighton Steps towards friendships – implementing a leisure buddy program 73. S Waller & J Verjans As We Are: a West Australian community initiative bringing joy and wellbeing to the lives of artists who have an intellectual disability 72. Chair: Morrie O’Connor Leisure Carnac www.asid.asn.au 11-13 November 2015 - Crown Promenade Southbank, Melbourne Annual Australasian Society for Intellectual Disability Conference E Walker, F Crawford & H Leonard Seeking belonging: how parents of daughters with Rett syndrome facilitate friendship and community involvement. 67. 65. R Hussain, T Parmenter, M Knox, M Parmenter, S Wark & M Cannon-Vanry Ageing-in-Place: perceptions of people with intellectual disability and those without lifelong disability in rural and metropolitan NSW J Goodwin, P Strutt, T Dudding-Byth & L Campbell Psychological growth inparents of children with genetic neurodevelopmental conditions: preliminary results. C Bigby Perspectives on ‘Supported Living’ from people with intellectual disability 66. Chair: Nicole Beresford Chair: Sharon Brandford 64. Parenting King Sound /Admiralty Gulf Community involvement Orion & Pleiades Making it real ... together ASID CONFERENCE 2014 55 Abstracts 56. M Cuskelly, K Moni & C Leggatt-Cook _ Symposium Constructing futures: Aspirations and expectations of young adults, their parents and service providers. Background: There is dissatisfaction with the nature of opportunities available to young adults with intellectual disability once they leave school. Introduction: Some organisations that provide services to adults with intellectual disability have recognised they are failing to meet the aspirations of young adults and their families. The project reported in the symposium aimed at providing a deeper understanding of the hopes for the future held by young adults with intellectual disability and their parents. Contribution to the symposium The symposium comprises three papers: the first presentation details the results from a series of interviews about aspirations for the future conducted with young adults with intellectual disability, their parent(s) and a person who provided support to the young adults and/or the family; the second presentation provides information about the expectations of staff who work with this group about the likely futures for adults with intellectual disability; the third presentation presents some of the challenges facing organizations who provide services to adults with intellectual disability and focuses particularly on how research data may be used to change services so that they are more responsive to the needs to the group they serve. Conclusions: Collecting data from both service users and service providers should provide information both about what services are required and about some of the barriers and facilitators to the provision of those services that exist within the service provider organisation. The consideration of these elements together should result in more effective and more responsive service provision. 56a. Enhancing future trajectories for young adults with intellectual disabilities: Family aspirations and implications for service provision. Background: The importance of work in the lives of adults with intellectual disability is well recognized, with increasing efforts to assist these individuals to 56 ASID CONFERENCE 2014 transition from school into paid employment. However, these efforts have not changed the circumstances of many adults. Thus, there is a need to build effective approaches to constructing future trajectories that better meet the aspirations of young adults and their families. The aims of this project were to develop an understanding of these aspirations as a first step to enhancing service provision. Methods: Case studies were developed of 20 families in urban and regional Queensland, recruited using a range of approaches. Each family had a young adult aged between 16-30. The data reported here are drawn from semi-structured, individual interviews with the young adult, his/her parent(s) and a significant support person. Transcripts were analysed inductively using thematic coding. Results: Families had varied aspirations for the future of the young adults although the expectations of the young adults, parents, and their supporters were not always aligned. However, independence, friendships and employment were consistently mentioned. Several key issues emerged including: barriers to independence, the influence of location and local community networks, the role of siblings, and inconsistencies in service provision. Implications: The implications are that meeting these aspirations requires a deeper understanding of families’ needs and a broader, more situated approach to service provision to address the issues raised. 56b. Perspectives of support staff on the likely futures of adults with intellectual disability. Background: Support staff play an important role in the lives of the individuals with whom they work. Their behaviours and the opportunities they offer are likely to be influenced by their beliefs about what is possible for these individuals; however, little is known about this aspect of the beliefs of those who support adults with intellectual disability. Methods: 179 staff responded to a web-based survey which included a questionnaire on attitudes towards those with intellectual disability, and some open ended questions about the future of one of two individuals with intellectual disability, briefly described in a vignette. Initially, participants were asked a general question about the future of one individual, and this was followed by more specific questions, including a question about their perceptions of their role at this future time. Results: Attitudes were generally positive; however, Friday 7 November 2014 expectations regarding the future were not very hopeful. Thirty-five percent believed there would be no change in the lives of the individuals depicted in the vignettes; employment did not receive any consideration from the majority of respondents. The National Disability Scheme was mentioned by a very small percentage of respondents. When asked specifically about their roles, there were a range of responses, some of which reflected a narrow view of possible roles, some of which suggested a much wider view that included contributing to social change. Implications: Staff expectations may need to be challenged if adults with intellectual disability are to be provided with opportunities and challenges required for a more included life 56c. Building research capacity and culture: Strategies and challenges within a large non-Government organisation. Background: The importance of using research to underpin policy and practice is well established, yet the disability sector is characterised as lacking a sufficient evidence base for services that can meet consumer expectations and support quality of life outcomes. In response, many NGOs seek to contribute to or conduct disability research, but significant challenges can arise around the researchpractice nexus. This presentation describes one NGO’s effort to support disability research and the successes and challenges experienced. Methods: The approach taken comprised examination of policy and reflection upon practice, and of the nexus between these aspects of organizational culture. 3 people to live a life of their choosing, research evidence can be an essential tool for driving organisational change. However, the multiple demands experienced within a dynamic and constantly shifting policy environment means that the ability of NGOs to successfully use research for this purpose requires significant investment. 57. J Curran, M Kyrkou, K Rye, J Entwistle, C Maher, M Usman, S Cama & C Mushan - Symposium Inclusive healthcare in South Australia: Engaging with complexity Introduction: The Centre for Disability Health (CDH) is a health service which is funded and managed by Disability Services. The CDH provides a range of services designed to improve the health and wellbeing of people with intellectual or developmental disability who have health conditions that are not currently managed adequately (or at all) by the mainstream health services in South Australia. Contributions: This symposium will include three papers. Each paper which illustrate how in practice the CDH addresses issues of accessibility in the broadest sense, by describing three services offered by the CDH Conclusions: The CDH clinical services are designed to support mainstream health services to include people with an intellectual or developmental disability of all ages by offering more accessible health consultations, and by providing more expertise in relation to disability and developmental aspects of the health condition with the long term goal of engaging the person with disability in mainstream health care over time. Results: Despite a moderately successful growth in research activity, it has become apparent that Endeavour Foundation’s internal response to research evidence is comparatively underdeveloped. Within an organisational context that is unaccustomed to using research, further strategies are required to build a culture that values research and enables space for reflection and change. To support this, research needs to be practical and outcomes-focused and findings require careful and innovative dissemination. 57a. Implications: As service providers seek to support Method: Initially the client (aged 8-20 years) and Reducing the gap with the GAP Program at the Centre for Disability Health, South Australia. Background: The Centre for Disability Health (CDH) was initially developed to support deinstitutionalised adults with intellectual disability, but as Service Coordinators in Disability SA became aware of the benefits to clients, families/carers of attending CDH, younger clients were being referred in, especially those with challenging behaviours. ASID CONFERENCE 2014 57 Abstracts family/carer were seen by a general practitioner to exclude medical causes for the challenging behaviour, especially pain or medication side effects, but they then had to wait a few weeks for their psychiatric appointment. To minimise the waiting time, joint appointments were arranged so the client could be seen by the GP and psychiatrist simultaneously. As many of the clients had autism spectrum disorder with anxiety, and had not coped well in formal clinical settings, the consulting rooms were redesigned to reduce anxiety. Results: Clients first seen by the GP had one or more planned options including further assessment or management of a health issue, referral to a psychologist using a Mental Health Care Plan, referral to allied health services under the Chronic Diseases Management Plan, and referral to a psychiatrist for assessment and management, or medication review. Some also required the use of the midazolam clinic to achieve blood taking. Implications: Parents/ carers of clients unable to be successfully managed in generic health settings were supported through CDH for successful outcomes. Some were later able to successfully re-engage with their generic service providers. Case studies will be used to illustrate the GAP Program services. 57b. Use of intranasal/oral Midazolam for primary health intervention when faced with challenging behaviours. Background: Intranasal Midazolam was first trialled for seizure management in South Australia. First as seizure management in the school setting and then utilised within Strathmont Institution. Trials undertaken prior to prescribing were deemed successful as pre-procedure sedation. With deinstitutionalisation and growth of the Centre for Disability Health clinic, trialling and use of Midazolam has evolved into a structured and successful program in offering, otherwise difficult health care access. Method: The Centre for Disability Health can offer an appointment to a client registered with Disability Services, for assessment in prescribing Midazolam. Consent for a trial is gained at this time. If suitable, a trial is arranged to assess suitability and dose for ongoing prescribing. Trial approach and administration method is planned with those that know the client best. Trial outcomes are variable in regard to levels of sedation met. The clinic setting 58 ASID CONFERENCE 2014 and staff approach are equally as important as the medication. Results: Disability Services clients from the ages of 8 to 65+ have benefited from Midazolam administration for venepuncture, dental appointments and scans undertaken within a radiology department. Registered Nurses can administer and support an appointment with a Disability Services client. Benefits include the short acting sedation offered by Midazolam and the amnesiac properties that ensure a return visit to the clinic. Implications: Greater access to medical interventions with less fear and challenging behaviour evident. 57c. Emotional functioning in youth with developmental disabilities and significant emotional or mental health difficulties. Background: Intellectual disability is a major risk factor for developing psychopathology and mental illness. Dual disability (mental illness and developmental disability co-occurring) is a challenging area in which to work for mental health professionals. This paper describes an assessment of the functional emotional capacities of a person with an intellectual disability in the context of mental health assessment. Appreciation of client’s functional emotional capacities enables targeted functional and developmentally informed interventions. Method: The Schema for the Appraisal of Emotional Development (SAED) is described, including a case study which illustrates the use of the SAED to guide a mental health intervention. Results: The case study indicates that emotional development is a relevant aspect of assessment of dual disability, and that a better understanding of the specific profile of emotional development can provide new ways to approach interventions Implications: In the intellectual and developmental disability fields, emotional development has been a relatively neglected area when assessing a person’s developmental competencies. However an understanding a person’s emotional developmental profile has helped people with intellectual disability with emotional and behavioural difficulties, their families, clinicians, therapists, support workers and educators to generate developmentally appropriate interventions. Friday 7 November 2014 58. S Boulter Legal advocacy for people with an intellectual disability Background: Every participant in our Boards, Tribunals and Courts must understand and be required to address, the particular needs facing people with an intellectual disability who appear before them. People with an intellectual disability can also experience mental illness, which exacerbates the need for this understanding. People experiencing the signs and symptoms of this comorbidity often find themselves caught up in the criminal justice or civil detention systems, where breaches of their human rights may occur. Methods: In Western Australia, we have a particularly iniquitous “mentally impaired accused person” legislative regime, which can lead to great and unnecessary hardship. Furthermore, advocacy through specialist legal advice and representation is fraught with the lawyer’s professional dilemma of the requirement to be instructed by someone with capacity to instruct a lawyer, as required by the Legal Profession Conduct Rules 2010 (WA), but helping a client who is in need of specialist legal advice and representation, whose legal standing is undoubted but whose legal agency is doubtful, if not absent. Results: This paper will explore legislation that causes unfair and unreasonable hardship to people living with an intellectual disability and experiencing the signs and symptoms of a serious mental illness, in WA in particular. The paper will explore the responses to disability by us, as a community, through our parliamentary representatives’ legislative program, and the particular impediments that this produces for people with an intellectual disability. Implications: The paper will close with some proposals for and implementation of national law reform. 59. M Mansour Declared Places: declaring and meeting the needs of the accused with intellectual or cognitive disability Background: People with intellectual or cognitive disability who are found unfit to plead to criminal 3 charges are often detained in mainstream prisons. This is an ongoing social justice issue. Method: Custodial services never established the “declared place(s)” for the accused, as permitted by the Criminal Law Mentally Impaired Act 1996. The Disability Services Commission (Commission) is the government agency experienced in meeting the needs of people with disability in Western Australia. The Declared Places (Mentally Impaired Accused) Bill 2014 (Bill) is a milestone. The Bill gives the Commission the legislative framework and authority to operate a declared place, control behaviour of the accused, maintain his or her welfare and secure environment and provide the accused with individualised services. Results: The Commission, via the Bill and an “all aboard” approach, is establishing the declared place (disability justice centre(s)). The development of declared place(s) is a current project, and this place is (or these places are) yet to operate. Implications: This paper will examine the implications of the Bill, and how, for example, by giving the accused a secure environment and the skills and training to be future responsible citizens, community safety will be ensured and protected, the needs of the accused will be met and the vulnerabilities of the accused in the justice system will be significantly decreased. Therefore, this paper will emphasise how principles and operative effect of the Bill will contribute to an “all aboard, inclusive society”. 60. D Fagan Justice for Autism: a targeted training approach for the criminal justice sector Background: Current data both from the UK and USA informs us that there are many people in the criminal justice system with a range of complex cognitive impairments including Autism Spectrum Disorder (ASD) who are presenting behaviours of concern across the sector. Evidence suggests that the criminal justice sector would benefit from targeted Autism-specific support to assist them in dealing with the unique interactions they have with this group. We propose that training should be provided to those within the criminal justice sector to assist them to work more effectively with the specific criminogenic needs of people who identify with ASD. These ASID CONFERENCE 2014 59 Abstracts include dynamic risk factors such as: • Lack of effective communication skills • Complex comorbidities such as mental health, ADHD or alcohol & drug issues • Misperceptions of societal social norms • Sensory overload in public spaces • Rigidity around routines & expectations Method: The Justice for Autism initiative proposes to firstly address the limited understanding and training that is available to people within the criminal justice sector about the complex characteristics associated with people on the Autism spectrum. We believe effective training would provide the essential knowledge that can be put into immediate practice when dealing with an offender or a victim on the spectrum, or in supporting family carers with behaviours of concern which present. The training would include: • Overview of Autism and its characteristics – debunking myths • Indicators that an individual may have traits of Autism – what do we see? • Complex comorbidities – mental health / ADHD / AOD • Appropriate referral pathways and available resources for this group • Successful international practice models within justice settings • Behaviours of concern – possible triggers • Minimising sensory impact and de-escalation strategies • Appropriate communication strategies and aides Results: The results will evidence: • Performance indicators for staff awareness within the justice system around Autism-specific concerns. • Qualitative and quantitative data collection to inform practice improvement. Implications: It is anticipated that improved outcomes will be experienced by those working in the justice sector and those with ASD needing to negotiate the criminal justice system. It is also anticipated that more effective communication can be realised for victims or carers linked to offenders with ASD. It is also expected that the data collected will provide a body of knowledge to inform future practices and policies which seek to address the complex behaviours that are associated with ASD and the criminal justice sector. 60 ASID CONFERENCE 2014 61. S Thoresen, E Cocks & R Parsons Employment and related economic outcomes for apprenticeship and traineeship graduates with disability: findings from a three year longitudinal study Background: Australian and international research consistently document poor employment and related economic outcomes for people with disabilities. Contributing factors may include low vocational expectations, discrimination and inaccurate perceptions of work capacities in the workplace, inadequate employment supports, as well as challenges related to social security eligibility criteria and benefits. Apprenticeships and traineeships are useful vocational pathways for people with disabilities as they include work-based training which has been identified as leading to positive vocational outcomes. Method: Three annual mail surveys (2011-2013) of an initial cohort of 489 graduates with (403) and without (86) disabilities mapped social and economic outcomes. Intellectual or learning disability was the most prominent disability classification, comprising 40% of first wave respondents in the disability group. A total of 350 (72%) participants completed all three surveys. Results: The study documented good employment and related economic outcomes for graduates with and without disabilities. Data analysis from the first wave suggested that employment outcomes (employed, hours of work, and wages) were statistically significantly better for graduates without disabilities. However, for graduates in full-time employment, there were no statistically significant differences in hours of work or wages between graduates with and without disabilities. Second wave analysis of economic and related outcomes suggested a narrowing of employment and related outcomes as there were fewer variables with statistically significant differences between graduates with and without disabilities. Analysis of third wave outcomes is currently underway. Implications: The study suggests that completing apprenticeships and traineeships provides good employment and related economic outcomes. There are indicates that over time, outcomes for graduates with and without disabilities narrows (fewer variables with statistically significant differences). Friday 7 November 2014 62. C Bigby, M Knox, J Beadle-Brown & E Bould Identifying good group homes for people with severe intellectual disability using a Quality of Life framework Background: Despite change towards more individualized support, group homes are likely to remain for people with severe intellectual disabilities. As such, the search continues for ways to determine and maintain the quality of these settings. Method: This paper draws on in-depth qualitative analysis of participant observations conducted over 9 – 12 months in seven group homes for 21 people with severe and profound intellectual disability. Four of the homes had been nominated as ‘the best of their kind’ by provider organisations or the community visitor program. The paper explores the conceptualization of good outcomes and support for this group of residents in terms of their quality of life and staff practices. Results: A set of qualitative indicators of good outcomes and practice in respect of people with severe and profound intellectual disability was developed from the data based on quality of life domains. Homes were rated against the indictors on the basis of consistent performance over time and for all residents in each home. Finding; The ratings indicated differences in resident outcomes and staff practices between the seven homes and showed that the four homes nominated by others as the beset of their kind were not uniformly good. None of the homes performed strongly on the domains of personal development and interpersonal relationships. Implications: External judgements without some form of systematic approach about quality of group homes are not necessarily reliable. The set of indicators have been adapted as a guide to community visitors of what to look for in good group homes and support a greater during their visits on practice. The indicators could also be used by auditors, community visitors, funders, advocates or family members to guide observation and judgements about group homes. 63. C Bigby, E Bould & J Beadle-Brown Quality of life for people with intellectual disability in group homes: What makes a difference? 3 Background: Outcomes are variable in small group homes and dependent on the practices of staff. Person centred active has been shown to lead to better outcomes. Active support has been adopted by disability support organisations in Australia but has proved difficult to implement consistently over time. This study investigated the outcomes for residents of small group homes and staff practice of active support and whether these change over time, as well as the organisational structures and processes associated with high levels of active support. Method: Early findings from a longitudinal study of 9 organisations in 3 Australian states are presented. Date are reported on outcomes for 189 people with intellectual disability living in 58 group homes. An audit of resident characteristics, structured observations, surveys, and interviews with staff were used to collect data about staff practices, the level of active support, organisational structures and process, such as practice leadership, and resident outcomes such as the engagement. Results: Levels of active support was generally low but with an upward trajectory in the organisations for which this was the third year of participation. Higher levels of engagement were associated with higher levels of active support which in turn were associated with good practice leadership. Implications: These findings point to the importance of front line practice leadership to support staff practice, and the effect of a concerted organisational focus on staff practices. They also demonstrate the importance of observation as a method of monitoring practice within organisations and measuring outcomes. 64. C Bigby Perspectives on ‘Supported Living’ from people with intellectual disability Background: Dissatisfaction with the inflexibility of group home models has led to the growth of ‘supported living’ which separates housing from support. This paper reports findings from the first phase of a study to develop knowledge about the configuration of support arrangements and social contexts that optimise the success of supported living arrangements and good quality of life for people with intellectual disability. ASID CONFERENCE 2014 61 Abstracts Method: Six focus groups were conducted with 41 people with intellectual disability who lived in various types of supported living arrangements. Participants discussed their views about living independently, their support arrangements, what worked well and not so well for them. The conversations were recorded and transcribe verbatim and analysed thematically. Results: All participants preferred living independently; its primary advantage was the ‘freedom to do your own thing’. All had informal social connections and used local community facilities. Tenancy and support arrangement varied, and support was split between different providers, but everyone felt help was available when needed. Contrary to previous studies a participants had regular structured engagement in purposeful activities. Their level of income and control over finances, safety, and poor access to technology created problems for some participants. Implications: These data provide insights into the perceived advantages of community living, the potential for it to work well and some of the challenges of providing an underpinning network of support. 65. R Hussain, T Parmenter, M Knox, M Parmenter, S Wark & M Cannon-Vanry Ageing-in-Place: perceptions of people with intellectual disability and those without lifelong disability in rural and metropolitan NSW Background: There is a substantial increase in the number of people with intellectual disabilities (PwID) who are ageing. However, there is very limited information on commonalities and differences in the ageing experience of PwID and those without a lifelong disability. Method: Semi-structured in-depth qualitative interviews were conducted with PwID who are ageing as well as those ageing without a lifelong disability and their designated carers in rural and metropolitan NSW. The sample (n=40) included people who were living in their local community (family or group homes) and also those who had moved into a residential aged care facility. Thematic analysis was undertaken to determine major themes embedded in the qualitative data. Results: Some of the key themes across both groups 62 ASID CONFERENCE 2014 include the importance of choice and involvement in decision-making about accommodation arrangements, a strong desire for maintaining social connections, continuing to be actively involved in contributing to society (having a role, purpose and meaning). Some of the challenges across both groups included managing continuity of social networks, difficulties in accessing services and for rural residents, limited availability of accommodation options and health services. Implications: The presentation will focus on strategies for improving inter-sectorial collaboration across disability and aged care services especially in resource limited rural environments. The implications of the study findings with regard to national reforms in disability and aged care sector will also be discussed. 66. J Goodwin, P Strutt, T Dudding-Byth & L Campbell Psychological growth in parents of children with genetic neurodevelopmental conditions: preliminary results. Background: When a child has a developmental disability the entire family unit is affected. However, parents can improve and even thrive as a result of their child, often constructing meaningful stories surrounding their journey, or discovering new happiness. This is psychological growth. There is limited research determining the factors that promote growth or resilience in families with a child affected by developmental disorder. Method: We aim to examine psychological growth (and the factors affecting it) in parents of children affected by neurodevelopmental conditions including 22q11.2 deletion syndrome, Down syndrome, and multiple congenital anomalies which have not yet been diagnosed. The current sample comprises 189 parents and caregivers. Results: Initial analyses indicate that parents generally perceive positive change as a result of their child, with high scores across participants on psychological growth. Those who were more accepting of their child’s diagnosis showed greater growth than those who were less accepting. However, the child’s condition type, parental education level, and country of residence did not affect growth in this sample. Friday 7 November 2014 Implications: An explanation of the results in light of the preliminary nature of this study will be provided. Strong and supportive family functioning is particularly important to examine in families of children with neurogenetic conditions, as they are at increased risk for adverse developmental outcomes. A supportive family environment can act as a protective factor when faced with significant challenges and increase resilience. 67. E Walker, F Crawford & H Leonard Seeking belonging: how parents of daughters with Rett syndrome facilitate friendship and community involvement. Background: Having friends is beneficial to our health and wellbeing. People who have profound intellectual and multiple disabilities are reported to have few friends, and to face significant challenges to being involved in their community. The aim of this study was to deepen understanding of how young women with Rett syndrome and their families address these challenges. Methods: The qualitative study was informed by the theory of social construction of reality. Face to face interviews were conducted with the families of six young women registered with the population-based Australian Rett Syndrome Database. Transcripts of the interviews were explored for narratives associated with friendship and social participation. Results: Parents said they would like their daughters to have friends and a sense of belonging in their community. They described their daughters as lacking capacity to take part in activities that might allow friendships to develop. They were concerned that complex communication needs posed a major risk to the safety of their daughters in the community. Parents reported and valued friendly interactions between their daughters and people in the community. Implications: Parents of young adults with severe intellectual disability should be supported to explore what it would take for their young people to have friends. Parents need help to support their young person to have opportunities to meet people in their community, interact with them, and to keep them safe in risky social situations. 3 68. J Man, M Kangas, J Trollor & N Sweller Current clinical attitudes and practices of psychologists working with adults with dual disabilities: a National survey. Background: The contribution of psychologists in mental health provision of people with intellectual disabilities (PWID) has been largely neglected. The aim of the study was to investigate current clinical assessment practices of psychologists in Australia who provide services to adults with intellectual disability and co-morbid mental health concerns. Method: Psychologists who work with adults with intellectual disabilities completed an online survey on clinical attitudes and practices. A total of 109 participants consisting of provisional, generalist and clinical psychologists from a variety of work settings were recruited nationally. Results: Almost half (49%, n=109) of psychologists surveyed considered themselves as specialists in mental health and intellectual disability. Amongst 61 psychologists who conduct mental health assessments 24% considered mental disorder diagnosis to be the role of generalist psychologists; 8.2% considered this the role of clinical psychologists while 39% considered this the role of psychiatrists. Psychologists reported collaborating with other professionals for mental health assessment for PWID, with psychiatrists reported as the mostly likely profession for collaboration. Applying special considerations and modifying mainstream clinical practice to suit clients with an intellectual disability was reported to be common practice. The majority (86%, n=105) of participants reported needing further training in mental health and intellectual disability. Implications: The findings from this national survey suggest that psychologists often engage in interdisciplinary collaboration and apply modifications to mainstream practice when working with PWID. Although half perceive themselves as specialists in mental health and intellectual disability, further training is required to improve mental health assessment and diagnosis in PWID. ASID CONFERENCE 2014 63 Abstracts 69. J Fairthorne, G Hammond, N De Klerk & H Leonard Exploring the risk factors for disability using linked health data Background: Retrospective, linked population-based health data enables the exploration of pre-existing characteristics and exposures of people who later parent a child with a disability. In this way, risk factors for the event might be identified and future research implicated. Method: We illustrate this technique using our study of pre-existing psychiatric disorders in the mothers of children with intellectual disability (ID) and autism spectrum disorder (autism). We aimed to assess the relationship between women’s outpatient psychiatric contacts and subsequent offspring with ID, autism or both. We linked three Western Australian populationbased registers. The relationship between maternal psychiatric contacts before the birth and the odds of ID and/or autism in a subsequent child were investigated using multinomial logistic regression. Results: Women with pre-existing psychiatric contacts were more than twice as likely to have a child with ID or autism. Hence, our use of linked data enabled us to conclude that the rate of pre-existing psychiatric disorders is higher in mothers who have subsequent children with ID or autism. Implications: Research exploring the effect on pregnancy outcomes of medications prescribed to women with psychiatric disorders and the common genetics of psychiatric disorders, ID and autism is implicated. 70. D Casey Who will make decisions for your child when they turn 18? For parents of a child or young adult with a decisionmaking disability, planning for the future raises many questions. Making decisions about their child’s future care and support often leads parents to consider how decisions will be made for their child if they are no longer able to make them on behalf of their child. In planning for their child, parents may also start to consider their own future and who will support and make decisions for them if they ever lose capacity – 64 ASID CONFERENCE 2014 due to illness or an accident. Alternatively it may be that in focussing on their child, the parents never give consideration to planning for their own future. Many people think their spouse or children may take on this role, but what happens when those people also lack capacity and there is no one available to make decisions? The Guardianship and Administration Act 1990 provides options in both situations. It provides a process for the State Administrative Tribunal to appoint a substitute decision-maker, when a person has lost capacity. The Act also gives adults with full decision-making capacity, the ability to decide who will make decisions for them if they ever lose capacity, which they can do by making an enduring power of guardianship and/or enduring power of attorney. This paper will identify: (1)what ‘guardianship’ and ‘administration’ are, and how people can have a substitute decision maker appointed; (2)the main agencies involved in guardianship and administration and details on where to get further information; (3) the different options when planning for the future, to enable parents to consider whether applications for guardianship and administration orders might be necessary, or if there are informal processes which will work in the best interests of their child after they turn 18; (4)considerations for parents in thinking about their own future decision-making. 71. A Jobling Enhancing post-school literacy education programs for young adults with intellectual disabilities. Background: Post-school literacy education programs that are specifically designed for young adults with intellectual disabilities are under researched. Such research has mainly comprised single case studies, clinical interventions, or program analyses. The impact of these studies is limited by the focus on literacy instruction as intensive or short-term interventions disconnected from community contexts, and a lack of information about meaningful learning outcomes. In the context of the NDIS, there are increasing calls to enhance educational opportunities available to young adults. However, we need more evidence about how learning can be sustained in these programs that moves beyond access and intervention to consider meaningful learning outcomes. Friday 7 November 2014 This presentation reports the learning outcomes gained by participants in a longitudinal research project investigating one such post-school literacy program. Methods: Since 1998, data related to receptive language, vocabulary, and reading comprehension were collected from 165 participants on enrolment (Time 1) and graduation (Time 2) using the Peabody Picture Vocabulary Test - Form IIIA (PPVT), the Burt Word Reading Test - New Zealand Revision, and the Neale Analysis of Reading Ability – 3rd ed,. Results: The quantitative analysis of the data revealed significant differences in receptive language, vocabulary, and reading comprehension across the two data collection points. Implications: Young adults participating in one specifically tailored post-school educational program to develop literacy, continued to improve their receptive language, vocabulary, and reading comprehension. The implications of this are that post-school educational programs need explicit measureable learning goals that can provide evidence of students’ learning. 72. S Waller & J Verjans As We Are: a West Australian community initiative bringing joy and wellbeing to the lives of artists who have an intellectual disability Inspired by the creative expression of artists who have an intellectual disability and a belief in equal opportunities, As We Are was initiated in 2002 as a one-off Art Award and Exhibition and has grown to become a prestigious and significant event on the WA arts calendar. Managed by the Nulsen Association and supported by Mosaic Community Care, As We Are, in response to overwhelming support, has continued and expanded to include a number of initiatives aimed at recognising and valuing the creative expression of WA artists who have an intellectual disability and their contribution to the Western Australian arts and broader community; projects including a Disability and the Arts Network, annual Disability and the Arts Forum, a quarterly newsletter, children art workshops, and most recently an art competition to design the logo of the 2014 ASID Conference! A number of outcomes have resulted from As We Are and its many initiatives. In respect to artists who 3 have an intellectual disability, key outcomes include: artists’ earning an income from their art practice; developing/strengthening the artists’ professional art practice including skills development; developing/ strengthening the artistic knowledge and skills of the supporters of the artists; increased recognition and value of artists who have an intellectual disability by the WA arts and broader community; and a more inclusive Western Australian arts community. Anecdotal evidence supports these claims as well as As We Are’s contribution to the joy and wellbeing of participating artists as well as those who are part of the experience. Coordinator Susie Waller will be joined by Artist John Verjans who will share his experience of being part of As We Are and how his involvement has impacted upon his arts practice and life more broadly. 73. C Fyffe, L Raskin & D Leighton Steps towards friendships – implementing a leisure buddy program Background: Many people with intellectual disability are isolated and lonely. This paper describes the program design and outcomes from one approach to matching a community volunteer with a person with intellectual disability to spend time together on a regular basis in various community settings. Method: Interviews were conducted with the program coordinator; program documents, case studies and program statements were reviewed; and program data reports were analysed. Results: There were nineteen instances of successful matches between a community volunteer and a person with a disability, called the leisure buddy. Issues identified in running the program were the importance of, ongoing recruitment efforts to attract potential community volunteers and leisure buddies; the community volunteer and leisure buddy living nearby; and the importance of the program coordinator’s role in successful matching and follow up in the first 3-6 months after matching. Acknowledgements: This work was funded as part of an evaluation for Inclusion Melbourne, Victoria. Case studies have been de-identified and with details combined in order to summarise but not identify particular people’s situations ASID CONFERENCE 2014 65 Notes ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ........................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................................ 66 ASID CONFERENCE 2014 Poster Presentations ASID CONFERENCE 2014 67 Poster Presentations P1. A Urbanowicz, J Downs, N Ciccone, S Girdler & H Leonard Contextual factors influence the success of communication between girls and women with Rett syndrome and their communication partners. Background Rett syndrome is a neurodevelopmental disorder associated with mutations in the X-linked methyl-CpG-binding protein 2 gene. The syndrome is a leading cause of intellectual disability in females and those affected experience numerous, and often severe, physical and language impairments that negatively impact on their ability to communicate. Parent report information suggests contextual factors relating to the communication partner and the environment may influence the success of communicative interactions however few studies have empirically investigated these factors. We conducted a study using video recorded data to investigate the influence of the communication partner and environment has on the communicative success of girls and women with Rett syndrome. Method Data for this study was obtained from the Australian Rett Syndrome Database, a populationbased database collecting information on girls and women with Rett syndrome born since 1976 using a variety of methods. Using videos provided by families, of girls and women with Rett syndrome engaged in everyday activities, we described the communicative interaction between the girl or woman and their communication partner. We coded communicative forms and functions, and measured communication partner factors such as the length of time spent waiting for a response and environmental factors including the context of the activity. Results and implications The results of this study will present the influence of the communication partner and other environmental factors on the success of communicative interactions. The implications of modifying these factors to enhance communicative interactions, between girls and women with Rett syndrome and others, will also be presented. P2. K-M Gilson, E Davis, E Waters & L Corr Enhancing the mental health of parents of children with a severe disability 68 ASID CONFERENCE 2014 Background: Higher rates of chronic stress, poor physical health, depression and anxiety are commonly reported for mothers of children with a disability. These findings are reported both within Australia and at the international level. Poor mental health can strongly affect parents’ capacity to provide quality care to their child and respond to their child’s developmental needs. There are very few practical resources available to parents that encourage them to look after their mental health and provide advice on self-care. This study aimed to work in partnership with parents and health professionals to develop and test the acceptability of a practical resource that enhances awareness about parents’ mental health. Method: An exploratory qualitative approach using semi-structured telephone interviews was taken. Twenty parents who cared for a child or young person (aged 2-18 years) with a severe disability participated in an initial interview. Thematic analysis was used to code emergent themes and identify key areas of content for the resource. Results: All parents voiced the need for a resource that is specifically targeted towards their wellbeing. Parents recommended that the following was included: 1) Strategies for looking after yourself 2) Ways to improve social support 3) Opportunities for action/self-reflection 4) Activities and strategies to promote wellbeing 5) Awareness of what can affect a person’s wellbeing 6) Barriers to wellbeing 7) Complexity of respite and 8) Importance of counselling. The acceptability testing showed that carers were satisfied with the resource and this has been in wide demand by parents and disability services. Implications: The findings highlighted the need for more mental health research in parents of children with a disability and the value of producing costeffective resources that can be accessed by parents within health and disability services. P3. J Downs, K Wong, M Ravikumara & H Leonard Feeding methods, growth and gastrostomy in girls and women with Rett syndrome Background: Rett syndrome is a severe neurodevelopmental disorder caused by a mutation on the MECP2 gene. We investigated feeding difficulties and outcomes following gastrostomy in Rett syndrome. P Method: The Australian Rett Syndrome Database contains data on 411 females with Rett syndrome born since 1976, 103 (25.1%) with a gastrostomy. We analysed feeding and gastrostomy satisfaction data from 2011 family questionnaire data, supplemented with weight data from family and clinical records. For those feeding orally, we analysed relationships between feeding difficulties, age and genotype. For those with a gastrostomy, we analysed weight gain and family satisfaction. Results: If feeding orally (n=167/223), girls younger than 7 years had longer than average meal-times (OR 2.69, 95% CI 0.91,7.98) and families were more concerned about food intake (OR 4.40, 95% CI 0.96,20.07) compared with their adult peers. Those with a large deletion were often perceived as eating poorly with close to 8 fold (OR 7.76, 95% CI 1.64,36.86) increased odds of coughing during meals compared to those with the p.Arg133Cys mutation. Sixty-six girls and women had a gastrostomy and in those who were fed enterally (n=50/223), large deletion, p.Arg106Trp and p.Arg270* mutation were commonly observed. Weight-for-age z-score increased by 0.77 (95% CI 0.27,1.27) over 2 years after surgery. Families were satisfied with gastrostomy procedures feeling less anxious in subsequent caring for their child. Implications: Parents of girls who were younger or with a large deletion mutation more frequently reported feeding difficulties. Gastrostomy can successfully ease the management of feeding difficulties and poor weight gain. P4. A Thomson, E Glasson, P Roberts & A Bittles ‘…a weapon against the stress…’: coping with the role of family carer Background: Many parents of people with Angelman syndrome (AS) and Prader-Willi syndrome (PWS) in Western Australia will act as carers for their offspring for considerable periods of time. We investigated the stresses associated with the caring role, and the adoption by parents of specific coping methods. Method: Parental carers of people with AS and PWS participated in the Family Stress and Coping Interview, a semi-structured interview which provides a stress level score, and allows discussion of stressors and coping methods associated with 24 life situations. Results: Family carers (13/18) reported particularly high stress associated with two life situations: the initial diagnosis of AS or PWS in their offspring; and finding time for themselves. Parents identified numerous factors as stressors, including lack of quality information about the disorder, time constraints, and physical and emotional tiredness. Most parents adopted a variety of coping strategies, including improving their knowledge of the condition, accepting the situation, and putting effort into dealing with problems. Implications: There was no association between any specific coping strategy and reduced stress. However, parents felt that accurate and timely information during the diagnostic period would be beneficial. Parents with ample family and community support were more likely to find sufficient personal time than carers with few such supports in place. Government agencies, service providers, family members, and peer support organisations should be aware of the need for practical and emotional support to assist parental carers of people with AS and PWS, and indeed any intellectual disability, across the lifespan. P5. H Johnson, B Solarsh & D West Communication Access: A pathway to community inclusion Background: Communication problems of people with intellectual and developmental disability limit their ability to be social included. In Victoria, Australia, over 50 businesses and services across government, non-government, retail and leisure sectors have registered to break down these barriers and become communication accessible. We describe the journey towards accessibility and the critical features of the process. Method: The Communication Access Checklist is administered by trained communication access assessors who have communication difficulties. This checklist assesses attitudes and skills of staff when interacting with people with communication difficulties, and how aspects of the environment assist communication. A communication access assessment involves a preparation phase, when businesses and services are guided to improve their communication access; a face to face communication access assessment and a phone assessment. If the ASID CONFERENCE 2014 69 Poster Presentations business /service meet the minimum standards, they are awarded the communication access symbol. Results: Currently all of the organisations eventually achieved communication access. Some organisations were slow to adapt signage. Successful organisation reported how the staff had developed greater awareness about communication difficulties and learnt how to communicate more effectively after receiving training. Implications: An essential part of becoming communication accessible relies on the training component delivered by people with communication difficulties. P6. J Fairthorne, C Fisher, J Bourke & H Leonard Mothers of children with intellectual disability and comorbid autism spectrum disorder and the impact of the disability on their health and relationships: a qualitative study Background: Mothers of children with intellectual disability and mothers of children with autism spectrum disorder (autism) have a lower quality of life than other mothers. Since the 1980s, the prevalence of autism has increased and many institutions caring for people with developmental disabilities have been closed. Hence, more mothers are now caring for their children with intellectual disability and autism. We aimed to identify factors affecting the quality of life of mothers of children with both intellectual disability and autism. This has not been done before and is important since factors impacting on this group of mothers are likely to be different from those affecting the first two groups. Method: The first author interviewed 16 mothers of 11-24 year olds with both intellectual disability and autism and transcribed audio recordings of the interviews. The first two authors then analysed the resulting texts using a hermeneutical phenomenological approach. Results: Mothers perceived strong negative impacts on their quality of life through the effects of their child’s disability on their health and relationships. A majority of mothers suggested interventions to improve the quality of life of other mothers caring for children with intellectual disability and autism. 70 ASID CONFERENCE 2014 Implications: These data might be used to inform services and interventions aimed to improve the quality of life of affected families and thereby reduce the economic burden to the community. P7. G Andrews A systematic review of the ‘lived experiences’ of persons with intellectual disabilities who have lived their life in residential state care facilities. Background: This presentation showcases the ‘lived experiences’ of persons with an intellectual disability who have lived in residential state care in the western world from 1950’s - 2012. Until recently, the first person ‘lived experience’ accounts of this cohort have been neglected, in favour of accounts of persons with physical or sensory impairments who live in the wider community. Method: This study redresses the balance, through a systematic review of available literature on the lived experiences of this cohort. A literature review of key international (English publications) and Australasian published peer reviewed first person accounts of the lived experience of being intellectually disabled and living in state care is undertaken. Case studies illustrate key findings, particularly the works of Traustadottir & Johnson (2000), Mitchell and Traustadottir (2006), Johnson and Traustadottir (2005), Manning (2009), and Mirfin-Veitch (2005). A personal unpublished case study from the researcher’s lived experience as a carer of an intellectually disabled family member from this cohort will serve as the anchor to illustrate findings. Results: This study confirms the comparative lack of first person and reconstructed accounts for this cohort, and the reality of being intellectually disabled and living in state care. It is argued that collation of first person accounts is key to understanding the impact of institutionalisation, deinstitutionalisation and the human costs and associated experiences of individuals and families who have family members living in state care. Implications: The process of living in state care has left an indelible impact on the clients and families involved. It is argued that the development of firsthand accounts is crucial to understanding the lessons from the impact of government administrative P decisions and policies. Recording of first person accounts is also key to honouring the importance of the individual’s experience and the irreversible impact that living in state care has had on their lives and that of their families. P8. N Crates & J Prodan From Conference to Practice- A Community Inclusion Project Inspired by Angela Novak Amado’s Presentation at ASID 2013 Background: “With the closure of institutions in the 1970’s and 1980’s a movement began to transition people back into the community. As the deinstitutionalisation started, many noted that although people with disabilities were now in the community, they were not of the community. That is although individuals with disabilities may have been physically living in the community they had little sense of belonging to community life” Angela Novak Amado 2013. Optia’s clients agree, they rated being involved in their community and creating friendships as of the highest importance to them in a feedback survey held in 2013. Method: By using Angela Novak Amado’s manual Friends, Connecting People with Disabilities and Community Members and worksheets a pilot project has been conducted within Optia involving 5 five clients and their support workers. Angela’s manual is a compilation of more than 20 years of learning from support staff and from people who receive services and from community members that have befriended people. Worksheets were used to help identify individual desires and aspirations and to define strategies to support people to connect with their community. Results: The perspectives of staff and clients will be presented in images and words, in terms of their experiences participating in the program and the personal outcomes that have resulted from the project. Implications: Community inclusion and the development of real friendships and relationships is a key aspiration identified by clients of Optia and more broadly for people with disability. This poster will demonstrate the challenges and possibilities that come from translating a conference presentation into practice. P9. K Boxall Different ways of knowing - the knowledges of people with intellectual disabilities and academic researchers Background: In November 2009, I was lucky enough fly from the UK to the ASSID Conference in Hobart, Tasmania. It was a fantastic conference with many presentations which interested me greatly but it was almost as if there were two separate ‘streams’: one for people with intellectual disabilities and their supporters; the other for academic researchers. Both were however inspirational and my aim in this presentation is to raise the question, ‘What is the relative status of the knowledges presented in each of the two ‘streams’? Method: To do this, I draw on the work of Feminist philosophers Sandra Harding and Miranda Fricker who discuss knowledge from the perspectives of non-dominant groups and the epistemic (knowledgerelated) injustice which can occur when people are wronged in their capacity as knowers of valid knowledges. Results: Academic knowledge is important but there are also other ways of knowing; these ways of knowing are important too. Implications: It is important to take seriously the knowledges and perspectives of people with intellectual disabilities at conferences, and elsewhere. P10. T. Stott & J Tan Strengths for Life Profile; Enabling Families to Set Meaningful, Functional and Participation Based Goals Background: In order to ensure the key concepts of our practice were central to all our dealings with families we developed a visual tool which ensures client-centred, trans-disciplinary, and strengths based practice. This visual tool enables clients and families to self-direct goal setting by supporting a ASID CONFERENCE 2014 71 P Poster Presentations rich conversation allowing them to articulate what is important and meaningful. The profiling tool uses a visually accessible format that focuses on everyday routines and activities. Pictures support the application of skills and abilities across contexts including home, education and the community. The profile also facilitates conversations regarding how foundational skills can build to develop more complex abilities. This enables clients and families to establish functional and specific SMART goals. The tool harnesses clients’ strengths and interests into their goals, supporting and motivating them to work on their challenges. Method: The Strengths for Life Profile was used across Therapy Focus as an adjunct to our current initial consultation meetings and review of service meetings held with clients and their families. Qualitative results indicated a positive trend in the families’ satisfaction with the goal-setting process with many families and therapists reporting more positive engagement in all concerned. Workshop training was targeted to ensure uniformity of use of the tool. Follow-up questionnaires were used to gather feedback from therapists and families involved. Results: The ability to set trans-disciplinary goals was enhanced while holistic goal setting considering all environments was made much simpler and more achievable. Implications: • Empowering clients and their families • Promoting trans-disciplinary practice • -SMART, meaningful and participation based goals are established 72 ASID CONFERENCE 2014 P11. S Urrutia, F Coluccio, and the team at Infinity Technologies ‘Advocacy Voice’ – A new avenue for Advocacy Background: In the changing world of Disability, it is recognised by Uniting Care NSW.ACT that the services we currently provide, especially advocacy, will need to evolve over the next four years. The policy shift from the NDIS will empower people with a disability and their families to take control of their lives, with an emphasis on choice and control. Choice and control have never before been as important therefore it is an identified need that people with disability and their families will require greater support, tools and education around these issues. Advocacy has often been achieved through a service provider but under NDIS, this much needed service model is at risk of disappearing. Method: UnitingCare NSW.ACT decided to develop an innovative platform, an App and a website, which will provide support many people in advocacy. The App will allow end users, people with a disability, to self-advocate, and give members of our community a platform to launch a cause (advocate) for further social change and support. This App will be accessible to all registered users and will provide an opportunity for individuals to have a stronger and louder voice and to raise issues and concerns that they care about. Implications: Advocacy has never been as important as it is in the evolving disability environment. UnitingCare NSW.ACT is working to close this gap by encouraging Australians with and without a disability into the digital space, where like-minded individuals can create a community, and join forces to fight for justice and social causes they care about. Annual Australasian Society for Intellectual Disability Conference Making it real ... together Save the Date!! 11-13 November 2015 Crown Promenade Southbank, Melbourne A platform for delegates to come together and explore what is means to convert recent advances in disability legislation and policy into real and meaningful changes for people with intellectual disability. The conference will bring together a range of stakeholders: people with intellectual disability and their families and support persons, coordinators, disability support workers, researchers from universities, health professionals and policy makers, to share and prompt new ideas around the idea of collaboration and inclusion. Making it real ... together. www.asid.asn.au ASID CONFERENCE 2014 73 www.asid.com.au 74 ASID CONFERENCE 2014
© Copyright 2024