The dilemma for staff in 'playing a game' with a person with profound intellectual disabilities: empowerment, inclusion and competence in interactional practice.

Games between staff and people with intellectual disabilities serve to promote social engagement and inclusion. However, when the person has limited and idiosyncratic communicative abilities, it may be hard to gauge what his/her own view of the matter is. We examine video-taped records of two episodes in which a staff member of a group home prompted a resident with profound intellectual disabilities to play a verbal and a non-verbal 'game'. We examine how the staff member in these two cases designs her actions to solve the dilemma she faces between, on the one hand, abandoning an activity when the resident does not provide clear indications that she/he wants to continue or, on the other hand, persisting with it until the resident begins to enjoy it or, at least, participate more fully. The solution lies in a pervasive institutional practice: treat resistance or ambiguity as temporary reluctance. We discuss these interactions as examples of how principles of empowerment, inclusion and independence play out in the details of everyday interaction

Saying no to the staff: an analysis of refusals in a care home for people with severe communication difficulties.

People with severe communication difficulties may attempt to exercise control over their lives by verbally or non-verbally refusing an activity proposed by supporters. We detail examples in which such refusals are treated by care home staff as a temporary reluctance, warranting further attempts to persuade the individual to co-operate. We identify the following conversational (and bodily) practices by which staff achieve their institutional ends: appreciating a resident's behaviour as something other than refusal; formulating the invitation again in a no-blame format; minimising the task required; escalating the invitation to a request and an order; moving the person bodily; and positively glossing the proceedings. Dealing with refusals illustrates the dilemma faced by institutional personnel in health and care settings in accepting choices which might disrupt the efficient management of the service

Social Inclusion and the `Get Heard' Process Implications for the Horizontal and Vertical Integration of Governance and Policy in the UK

Since 1997, there has arguably been a 'rediscovery' of those most at risk of poverty and social exclusion by New Labour. Within this context, it is important to consider the European, national and sub-national policy frameworks within which interventions are being developed. The European Union's 'Open Method of Co-ordination' is of relevance given its emphasis on making a decisive impact on poverty and social exclusion by 2010 through stimulating domestic policy processes in the form of National Action Plans on Inclusion (NAPSI). It also attempts to provide a coordinating framework for member states to exchange policy ideas and practices. As part of the development of the 2006-8 UK NAPSI, a Social Policy Task Force worked jointly with the Department of Work and Pensions to take forward the 'Get Heard' process — a mechanism to ensure that the views of those at the 'grassroots' could be fed into the process of developing the plan. This article presents key findings from one case study area (Merseyside). There is a subsequent consideration of the degree to which either informal or more formalized arrangements are conducive to securing enhanced horizontal and vertical integration in governance frameworks, policy making and service delivery for those most marginalized

Young, gifted, and caring: a project narrative of young carers, their mental health, and getting them involved in education, research and practice

Young carers are a global phenomenon. The UK estimates it has in excess of 175 000 young carers, the onset of their caring role often occurring between 8 and 10 years of age. Of these, 17 000 are caring for a parent who has severe mental illness, a significant factor for children entering the health and social care system, as up to 60% experience mental health difficulties themselves. This paper reports on the outcome of a participatory project aimed at better understanding the needs of young people. A World Café event was hosted, bringing together those involved in promoting the mental health of young people in a partnership consortium. The event was led by young service users and carers. Important issues raised by the young carers were being excluded from being included; stuck in the here and now, ignoring the future; a hole in the net; and ensuring the hidden is on the agenda. The World Café gave the university the privilege of insight into what local young carers need to improve their mental health, and more importantly, how we can utilize our skills to help them achieve their goals