Following the exposure of abuse of people with Intellectual Disabilities (ID) at Winterbourne View, the Government launched the Transforming Care programme, to support people to transition out of hospital into their own home. A literature review revealed limited research into people with IDs experiences of transitioning. The study aimed to explore how transitions through Transforming Care were experienced. Eleven people with ID were interviewed about their experiences, with ten nominating a Key Support Person to be interviewed alongside them on a second occasion. Interviews were analysed using a Social Constructionist Grounded Theory methodology. The model demonstrated that participants experienced transitioning as a highly complex process of managing change. In hospital, how participants were seen by significant others and how they saw themselves resulted in a 'restricted story'. In moving to the community, participants and those around them were able to shift ideas about who they were, allowing for a 'widening out' of their story. Participants discussed seeking a sense of safety in new relationships, managing loss, and going through uncertainty as part of the process of transitioning. The findings of this study demonstrate that transitioning is not a single event, but an ongoing process over time. Clinical implications include ensuring that people with ID feel prepared about their move and the importance of staff understanding peoples' behaviours within a wider context.

Aims: The UK policy documents ‘Valuing people’ (DOH, 2001) and ‘Valuing people now’ (DOH, 2009) presaged a new direction in learning disability services: towards a human-rights model of care with the underlying principles of rights, choice, inclusion, freedom and independence. However, despite such legislative changes, a recent review (DOH, 2008a) candidly described that people with learning disabilities have greater need for healthcare than other people, yet have worse access to the care that they actually need and poorer health outcomes. Whilst some research has explored this from the perspective of people with learning disability (Jones & Donati, 2009; Jones & Parry, 2008) there is significantly less from the perspective of support workers. This research seeks to examine the emotional and psychological experience of support workers in learning disability services. Although research has explored the experience of support workers from the perspectives of ‘stress’ and ‘burnout’, there is a dearth of research in areas such as emotions, sense-making, their constructing of systems, relationships and their underlying motivations. Method: Semi-structured interviews were carried out with seven support workers from three learning disability care homes. Verbatim transcripts of interviews were then analysed using Interpretative Phenomenological Analysis (IPA). Results: The analysis produced two superordinate themes, both with two main themes. The superordinate theme ‘Emotional Motivation’ had the main themes ‘Personal Fulfilment and motivation’ and ‘The Emotional Struggle’. The superordinate theme ‘Demands and Coping’ had the main themes ‘Safety and Conflict within Coping’ and ‘Persecution and Protective Positions’. Implications: This research suggests that the support worker role may evoke strong feelings of pleasure but also powerlessness, blame, deficit, injustice, responsibility and anger. Support workers seem to manage these emotions in various ways: such as compensating by striving to be the ‘ideal’ carer, protecting themselves by avoiding and not elaborating on difficulties, and also projecting their difficulties onto others. Problematically, this may reinforce a work culture in which no individual actually takes responsibility for the ongoing difficulties, conflict and struggles. Thus, political and legislative changes may be negated or ineffective unless addressed within the context of this dynamic; namely, the value, emotional and meaning systems within services, i.e. the nature of the relationship between the support worker and resident. Indeed, paid staff are often the only meaningful relationship that people with learning disability have in their lives. Such findings are discussed in light of existing theory, research and practice.

The first paper is a literature review which examines how women with a learning disability experience breast and cervical cancer screening, as well as how these procedures can be made more acceptable and accessible to them. Fifteen papers are reviewed and critically appraised. Learning disabled women tend to feel anxious at the prospect of these screening tests although for some, it is said to facilitate a feeling of connectedness to a ‘sisterhood’. The presentation of a DVD may be more worthwhile than lengthy classroom interventions in increasing preparedness for screening in this population. Simple adjustments, such as having accessible information, have been shown to make the process of screening more acceptable. Researchers are encouraged to use creative outcome measures which are not knowledge based when conducting research with individuals who have learning disabilities. The second paper is an empirical study which explores what women with a learning disability think makes a good mother. Eight women with a learning disability were recruited and interviewed on a one-to-one basis. Interpretative Phenomenological Analysis is used to analyse the resulting data into themes. The women spoke about the variety of skills needed to make a good mother, including an ability to show love and provide sensitive discipline. Many themes mirror principles of Attachment Theory, including an appreciation of reciprocity within a mother-child relationship. Some of the women interviewed feel mothers with a learning disability are stigmatised and are frustrated by this. An unexpected theme around bereavement frequently arose and is also included.

A partir des situations mises en œuvre en éducation physique et sportive (EPS), quels facteurs influencent l’intégration sociale des adolescents présentant une déficience intellectuelle (DI) ? Nos travaux s’appuient sur une expérience d’intégration au collège avec pour objectif d’explorer en profondeur la communication entre deux sous-groupes d’adolescents DI issus d’un Institut médico-éducatif (IME) et trois classes de sixième au cours de séances d’éducation physique et sportive. Pour ce faire, compte tenu des représentations des collégiens analysées à partir d’une enquête par questionnaire et autour d’une étude comportementale au long terme, nous mettons en comparaison un questionnaire sociométrique avec un outil original praxéologique (privilégiant l’ambivalence et l’instabilité). Nous constatons que, malgré des représentations d’ensemble plutôt positives, les résultats de l’intégration sont variés. Certains adolescents DI sont appréciés par les sixièmes tandis que d’autres sont ignorés voire rejetés. Les raisons proviennent à nos yeux, d’une part, de la structure même des sous-groupes d’adolescents DI et de leurs compétences propres. D’autre part, la logique interne de certaines situations motrices semble exclure en grande partie les élèves de l’IME. De ce fait, une meilleure connaissance de ces personnes et des relations qu’elles développent entre elles devraient améliorer leur intégration. De plus, une maîtrise par l’enseignant des effets des situations sociopraxiques mises en œuvre, lors des séances communes aux deux populations, sera probablement bénéfique. / From the situations operated in physical education (PE), what factors determines the social intégration of the teenagers presenting an intellectual deficiency (ID)? Our works lean on an experiment of integration to the middle school with for objective to explore in depth the communication between two subgroups of teenager ID coming from a Medical educational institute and three first classes of the secondary school during physical educational sessions. To do it, considering the representations of the schoolchildren analyzed from a survey by questionnaire and around a behavioral study in the long term, we compare a sociometric questionnaire with an original motor tool (favoring the ambivalence and the instability). The results show that in spite of representations of group rather positive, we notice the effect of a multivariated integration. Certain teenagers DI are appreciated by the sixth of the secondary school whereas of other one are ignored or rejected. The reason result for us on one hand from the structure of the subgroups of teenagers DI and from their appropriate skills. On the other hand the internal logic of certain motor situations, seems to exclude largely the pupils of the medical educational institute. Therefore, a knowledge of these persons and the relations which they develop between them should improve their integration. Furthermore, a control by the teacher about the effects of the sociomotor situations implemented, during the sessions to both populations, will probably be beneficial.

Cette thèse aborde l'histoire des enfants et adultes handicapés mentaux en France et en Allemagne entre 1890 et le milieu des années 1930. Ce travail prend pour objet les personnes atteintes de déficience mentale, qualifiées à l'époque de « débiles mentaux », « imbéciles », « idiots » ou du terme plus générique d' « arriérés ». Cette étude apporte un éclairage nouveau sur plusieurs thèmes, en adoptant une perspective transnationale pour éclairer la circulation et les résistances dans les pratiques médicales et pédagogiques destinées aux arriérés. Cherchant à mettre en valeur la part de construction qui est en jeu dans l'élaboration de ces catégories nosographiques, les critères aboutissant à créer la « faiblesse d'esprit » (Schwachsinnigkeit) sont étudiés à travers de points de vue variés (famille, instituteurs, psychologues et aliénistes). On montre ainsi comment la catégorie est forgée par ceux qui les observent au quotidien. A l'échelle des institutions étudiées, l'évolution des pratiques asilaires démontre une volonté progressive de rationaliser le tri entre ceux qu'on pense « éducables » et les « incurables » par l'emploi d'outils tels que les tests psychométriques. La thèse démontre aussi comment les arriérés sont envisagés peu à peu comme une charge, voire un danger à l'échelle nationale. Après la Grande Guerre, le coût de leur prise en charge est vu comme un fardeau dans les deux pays, justifiant une rationalisation des soins qui leur sont accordés. Ils sont surtout considérés comme porteurs de tares transmissibles héréditairement, soit des individus qu'il s'agit de sélectionner voire d'éliminer en tant que danger sanitaire. La thèse explore ces deux aspects observés en France comme en Allemagne, et leur part dans la légitimation de la stérilisation forcée des arriérés comme « Malades héréditaires » mises en place par la loi adoptée dès les premiers mois de l'avènement du IIIe Reich, ainsi que les réactions du milieu psychiatrique français. / The topic of this PhD dissertation is the history of mentally deficient children and adults in both France and Germany between 1890 and 1934. This work focuses on people who suffered from mental retardation although at that time they would have been referred to as "feeble-minded," "idiots" or "imbeciles." This study provides a new focus on different subjects. The various circulations of medical models are considered in a dynamic perspective. lt also provides an original vision of the construction of the category of feeblemidness, influenced by agents like doctors [psychiatrists], families or teachers, questioning what was done in practical terms. Mentally deficient people were shaped by the gaze of the people they interacted with. They are also examined in a social and economic context to which these individuals respond. The evolution of the characterization of feeble-mindedness and the use of intelligence tests highlight various attempts to classify those individuals in a more rational way. From a more specific psychiatrie point of view, this thesis shows how the emphasis on their classification as "unproductive persans" as well as the description of feeble-mindedness as a hereditary and "racial" disease transformed them into a social issue in the context of the rise of social Darwinism and eugenics, which led fo their sterilization in Germany from 1934 on.