OpenUCT :: Browsing by Author "Kleintjes, Sharon"

Browsing by Author "Kleintjes, Sharon"

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Open Access
A Review of Psychotropic drug prescription for patients with Intellectual disability at Alexandra Hospital (a specialist Intellectual Disability psychiatric hospital) outpatient clinic
(2021) Akpabio, Idorenyin Ubon; Kleintjes, Sharon; Smith, Peter
Background: People with intellectual disability are more likely than the general population to be prescribed psychotropic agents. The most common indications include treatment of a psychiatric disorder and management of behaviours that challenge. Aim: The study aimed to assess the prescribing patterns of psychotropic medication to outpatients with intellectual disability at a psychiatric hospital. Setting: Alexandra hospital outpatient clinic, Cape Town. Methods: This was a retrospective folder and prescription chart review. Folders of all new patients (103) seen between January 2018 and August 2019 were examined at two points, the initial appointment and again at six months. The information was examined against the World Psychiatric Association (WPA) and the National Institute for Health and Care Excellence (NICE) guidelines for prescribing in people with intellectual disability. Results: psychotropic medication was prescribed to 88% of patients. Antipsychotics accounted for more than 56% of the medication prescribed and was used mainly to manage behaviours that challenge. Clinicians at Alexandra hospital followed prescribing guidelines to some extent; however, more still needs to be done to ensure best practice and care. Conclusion: This review revealed a few shortcomings in meeting prescribing guidelines by clinicians at Alexandra hospital. Measures to address these shortcomings could be the inclusion of medication review schedules and standardised forms for clerking and monitoring of side effects in patient files, the use of behavioural strategies as the primary management of behaviours that challenge, and the performance of regular clinical practice audits.
Open Access
An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia
(BioMed Central Ltd, 2011) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, Alan
BACKGROUND: Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. METHODS: The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. RESULTS: All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. CONCLUSIONS: Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
Open Access
Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics
(BioMed Central Ltd, 2013) Kleintjes, Sharon; Lund, Crick; Swartz, Leslie
BACKGROUND: This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa.METHOD:Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. RESULTS: Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. CONCLUSION: A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
Open Access
Conceptualisation of mental illness among Christian clergy in Harare, Zimbabwe
(2016) Murambidzi, Ignicious; Kleintjes, Sharon
Background: More than 13% of the global burden of disease is estimated to be due to neuropsychiatric disorders, with over 70% of this burden in low- and middle-income countries. Characterised by severe shortages of human and material resources, formal mental health services alone are inadequate to meet the burden of mental disorders in low- and middle-income countries. New community models and innovative ways of increasing community participation and systematic delegation of specific tasks to other community level professionals have been recommended. Available evidence documents historic clergy involvement in health and wellbeing issues, but they have rarely been viewed as a partner in community mental health care. Aim: This study examines the clergy's conception, recognition of and responses to people with mental illnesses. The purpose of the study is to inform the potential roles and contributions of the clergy to community mental health either as the only contact or as a step in to formal mental health care. Method: Twenty eight in-depth interviews were conducted with clergy from ten church denominations in Harare, Zimbabwe. A framework analysis approach was used for thematic analysis. Nvivo 10 qualitative data software was used to organise the data. Results: Mental illness was conceived as a multifactor phenomenon attributed to both natural (biological and psychosocial) and supernatural (malevolent and benevolent spiritual) causes. Spiritual factors were a dominant theme in both the clergy's views on the causes of, and in their management of mental illness. The clergy were regularly consulted on a variety of emotional and psychological problems. Assistance was readily provided for these problems by all denominations, despite professed capacity gaps in the recognition and management of mental illness, and lack of appropriate training in basic mental health issues. Basic mental health training was recommended by the clergy to enhance clergy capacity for mental health awareness raising, recognition of mental disorders, brief problem focused counseling, and for improving collaborative management for initial and continued informal and formal health care and support. Implications of clergy conceptions, current responses and the perceived role of the church in community mental health are discussed.
Open Access
D/deaf and hard-of-hearing young adults with intellectual disability?s experience of and their caregivers' and audiologists? perceptions of aural rehabilitation practices and tools utilized at schools for the D/deaf in Western Cape Province, South Africa
(2023) Mashologu, Sandiswa; Kleintjes, Sharon
Background: Hearing loss is one of the leading causes of disability worldwide. Aural rehabilitation may aid in reducing participation barriers and facilitating improved personal and environmental strategies to mitigate the disabling effects of hearing loss. It has been documented in research that there is limited literature available on aural rehabilitation practices and tools available for D/deaf and hard-ofhearing children and adolescents with an intellectual disability. Available literature on this topic showed that studies were mostly conducted in high-income countries, with no research studies conducted in South Africa. Aim: This study aimed to explore aural rehabilitation practices and tools utilized with D/deaf and hard-of-hearing children and adolescents with a coexisting intellectual disability in public schools for D/deaf in the Western Cape, South Africa. Methods: An exploratory qualitative research design was chosen for this study to gather information and explore participants' experiences and perceptions of aural rehabilitation practices and tools utilized by them or on them. Semi-structured interviews were conducted with three audiologists to gather information on their perceptions and experiences of aural rehabilitation practices and tools utilized with D/deaf and hardof-hearing children with an intellectual disability. Semi-structured interviews were also done with four Deaf young adults with a coexisting intellectual disability, as well as two caregivers and two parents of these young adults, to gather information on their experiences and perceptions of aural rehabilitation practices and tools that were utilized on them. Results: The scoping review findings indicate that management plans should be individualized and tailored to the child's specific needs, and practices and counselling should be family centred, particularly as inclusion of family members can provide practice in and improve communication at home with their child. Review findings also support consideration of cochlear implants as a treatment option for rehabilitation for deaf and hard-ofhearing children and adolescents with intellectual disability. From the data collected during the interviews there were four themes highlighted: (1) counselling (2) tools, which included three subthemes of hearing aids, cochlear implants as well as scales, checklists, and questionnaires (3) practices and (4) accessibility of audiology services. Discussion: Aural rehabilitation practices and tools that are utilized on D/deaf and hard-of-hearing children and adolescents without an additional disability are also utilized on D/deaf and hard-of-hearing children and adolescents with an intellectual disability in South Africa, even though their speech and language outcomes are generally poorer. The severity of intellectual disability is a major factor influencing this population's speech, language, and auditory outcomes. The findings of this study indicate that aural rehabilitation practices and tools should be selected based on the needs of the child or adolescent, and a family-centred approach to aural rehabilitation should be encouraged. Further, there is a significant need for additional research focusing on aural rehabilitation practices and tools utilized on this population in other settings within the South African context. Conclusion: To conclude it is a clear that there is aural rehabilitation practices and tools that are applicable for this population although one must consider that this population presents with unique needs thus they require more support than D/deaf and hard-ofhearing children and adolescents without an additional disability. Furthermore, there is gap in research relating aural rehabilitation practices and tools for this population
Open Access
Development of a conceptual framework to inform self-advocacy for social and health-related policy priorities of adults with intellectual disability
(2023) Tyabashe-Phume, Babalwa; Kleintjes, Sharon; Capri Charlotte
Background: People with intellectual disability are generally not consulted in the development of public policies which impact on their lives. This study focuses on the development of a conceptual framework to support self-advocacy by people with intellectual disability for the inclusion of their priorities in social and health-related policy in South Africa. The study was informed by empowerment theory, with the integration of the concept of Ubuntu. Method: The study design was qualitative and was underpinned by the hermeneutic phenomenological approach. This approach allowed the researcher to understand lived experiences of the research participants in order to gain deeper insights regarding core elements of a conceptual framework for self-advocacy through interpreting their views on how they understand those experiences. Data were collected through a scoping review, semi structured interviews and focus groups. Twenty-five participants were sampled for this study; 10 participants were policy makers and service managers, five were self-advocates with intellectual disability, five supporters of people with intellectual disability and five parents/carers of people with intellectual disability. Sampling in this study was purposeful, policy makers, service providers, supporters and parents were purposefully sampled to participate in the study. Snowballing was used to identify participants with intellectual disability involved in advocacy groups in local Non-Profit Organisations. Data were analysed thematically, using ATLAS.ti. software. The framework approached guided the data analysis process. All data sources were triangulated to develop the conceptual framework for self-advocacy by people with intellectual disability. The development approaches used for three similar frameworks were considered in deriving a process to develop this study's conceptual framework. The first framework that focused on strengthening the participation of people with psychosocial disability and their caregiver's involvement in the National Institute for Mental Health England. The second framework was a self-advocacy framework by Test and colleagues, and the third was Cook's multi-cultural and social justice counselling competencies framework. Results: Data triangulation identified three core elements for self-advocacy, a) personal development, the main contention of this element being that in order for people with intellectual disability to self-advocate, self-development is essential to their participation in self-advocacy in policy processes; b) creating a supportive environment through the empowerment of people with intellectual disability – in order for people with intellectual disability to fully participate in self-advocacy they require empowerment through two main sub-elements: self-advocacy skills development and supported self-advocacy; and c) improved policy participation opportunities, this element focusing on the importance of concerted effort to ensure that there are policy participation opportunities which will permit inclusive participation of people with intellectual disability. Conclusion: A wholistic approach is needed to increase policy makers understanding of how best to empower people with intellectual disability to provide input to public policy decisions which can improve their quality of life
Open Access
“Life’s About Choices”: Exploring the everyday occupational choices of young adults with intellectual disability in a community context in South Africa
(2019) Goldberg, Cole; Kleintjes, Sharon; Adnams, Colleen
Background: It is well documented in the literature in the intellectual disability field that choice people with intellectual disabilities is limited. The human need to experience and inform everyday life choices, and the limited opportunities to do so, results in a contemporary health and human rights issue. Research Question: This study aims to explore what informs the everyday occupational choices made by young adults with intellectual and developmental disabilities in a community based setting in South Africa. Method: Qualitative interviews and a focus group were held with six young adults, who were recruited through a local non-profit training organisation. Results: Respondents identified (1) being different, (2) having limited choices, (3) accepting and staying small or (4) challenging and growing up, were the four core themes that arose from the interviews. Conclusion: It became evident that everyday occupational choices are co-constructed in context, where factors that were identified are consistent with those from the international literature which show that people with intellectual disabilities are widely stigmatised and prohibited from choice making, for several reasons, both intrapersonal and contextual. Implications: This study highlights the influence and importance of raising awareness and consciousness in society so that counter-hegemonic practices can promote occupational and social justice and change attitudes to ensure that people with disabilities have the choice to engage in balanced, meaningful occupations.
Open Access
The relationship between patient, carer and staff perceptions of need in an assertive community treatment team in South Africa
(2015) Cossie, Qhama Zamani; Kleintjes, Sharon
Background The assessment of a patient's individual needs offers many benefits and it is essential for planning and implementing services and interventions. Need is a subjective concept and may be defined from several perspectives. Patient, carer and staff interests may differ, influencing their perspectives in defining needs. Traditionally, the staff perspective on needs has taken priority but the steady growth of the 'user movement' and 'recovery philosophy' has led to this being challenged. This study aimed to establish patient, carer and staff perceptions of patient need, the extent to which these perceptions were homo- or heterogeneous, and what factors were associated with local perceived needs. Methods The study was informed by a systematic review of the literature focused on the individual needs of people with severe mental illness assessed from multiple perspectives. Patients, carers and staff on the Valkenberg Hospital assertive community treatment (ACT) service were assessed using the Camberwell Assessment of Need Short Appraisal Schedule to evaluate needs. Patient global functioning and current levels of psychopathological symptoms were assessed using the Global Assessment of Functioning scale and the Positive and Negative Syndrome Scale respectively. Kappa statistics were computed to assess agreement in the participants' perspectives.
Open Access
Social and health-related policy priorities of adults with intellectual disability in South Africa
(2023) Zihlazi, Siphesihle; Kleintjes, Sharon
Background: People with intellectual disability are rarely consulted on what should be prioritised in public policy to improve their quality of life. It is also well documented in the literature that people with intellectual disability experience barriers when accessing social and health services. The aim of the study is to gain an understanding of policy priorities from the perspective of people with intellectual disabilities. Method: The study is qualitative in nature, with data collected through a scoping review from 1994 to 2021 on policy priorities for people with intellectual disability, and semi-structured interviews on the views of South African adults with intellectual disability on their policy priorities. The study participants comprised a sample of six participants with intellectual disability, aged 18 years and older, who were recruited through a non-profit organisation that offers a range of services for people with psychosocial and/or intellectual disability and their families; ranging from counselling and support, special education and care centres for children and adults, as well as training and employment opportunities for those who are able to work. Results: Policy priorities identified in this study include the need for support in education and skills training, adequate healthcare access, work opportunities, inclusive housing, and supportive relationships. Conclusion: It is evident from the findings of this study that people with intellectual disability are still largely excluded from policy participation. Public policy makers and implementers should consider reasonable accommodations to enhance involvement of people with intellectual disability in discussions and decisions about policy and practice which impact on their lives. Research documenting the voices of people with intellectual disability can also assist to inform policy development and needs to include adaptations to data collection methods to optimise participants opportunities to share their views on what they need. Study implications: This study highlights the importance of reasonable accommodations for people with intellectual disability to inform policy developments, and the need to eliminate barriers encountered by people with intellectual disability when accessing social, health and other public services. Keywords: Intellectual disability, self-advocacy, lived-experiences, health policy, social policy
Open Access
Strategies for people with intellectual disability to engage in social policy-related self-advocacy in South Africa
(2023) Goldberg, Nicole; Kleintjes, Sharon
Aim: This study investigated strategies for people with intellectual disability to self-advocate for inclusion of their priorities in social policy processes in South Africa. Method: Self-advocacy strategies were identified through a scoping literature review, a review of self-advocacy toolkits and semistructured interviews with people with intellectual disability and other stakeholders working at nongovernmental and disabled people's organisations. The data were triangulated to identify common strategies which can best support self-advocacy for people with intellectual disability. In addition, these findings informed the development of a local self-advocacy toolkit which was reviewed by a group of young adults with intellectual disability. The toolkit provides an evidence-based compilation of strategies for self advocacy that can be used by self -advocates with intellectual disability and their supporters in the local context. Results: Data triangulation identified three core strategies for selfadvocacy, specifically, (1) strategies for in-person self-representation in public spaces, (2) written communication strategies, and (3) engagement through social and other forms of media. These were incorporated into the self-advocacy toolkit. The experiential review of the toolkit yielded positive feedback from participants. As part of the experiential review, participants related to the idea of social media advocacy by choosing to produce a video as their self-advocacy activity, aimed at sharing their perspectives on the way they experience society and social policy. Discussion: Inclusion of people with intellectual disability in civic and political life is crucial and will only be achieved if self-advocates are accepted into the policy-making arena. Strategies are available for people with intellectual disability to challenge the status quo of society in which prejudice and stigma continue to impact on their inclusion in social discourse. By using these self-advocacy strategies, people with intellectual disability can have a say in policy decisions which impact on their lives. Conclusion: Self-advocacy to enhance policy participation can promote the inclusion of the voices of people with intellectual disability to influence public social policy decisions. Adopting strategies which enable the inclusion of the voices of people with intellectual disability in civic activities holds potential for diversifying perspectives brought to public participation in policy development and implementation, which is currently primarily the domain of citizens without disability.
Open Access
Strategies for people with intellectual disability to engage in social policy-related self-advocacy in South Africa
(2023) Goldberg, Nicole; Kleintjes, Sharon
Aim: This study investigated strategies for people with intellectual disability to self-advocate for inclusion of their priorities in social policy processes in South Africa. Method: Self-advocacy strategies were identified through a scoping literature review, a review of self-advocacy toolkits and semistructured interviews with people with intellectual disability and other stakeholders working at nongovernmental and disabled people's organisations. The data were triangulated to identify common strategies which can best support self-advocacy for people with intellectual disability. In addition, these findings informed the development of a local self-advocacy toolkit which was reviewed by a group of young adults with intellectual disability. The toolkit provides an evidence-based compilation of strategies for self advocacy that can be used by self -advocates with intellectual disability and their supporters in the local context. Results: Data triangulation identified three core strategies for selfadvocacy, specifically, (1) strategies for in-person self-representation in public spaces, (2) written communication strategies, and (3) engagement through social and other forms of media. These were incorporated into the self-advocacy toolkit. The experiential review of the toolkit yielded positive feedback from participants. As part of the experiential review, participants related to the idea of social media advocacy by choosing to produce a video as their self-advocacy activity, aimed at sharing their perspectives on the way they experience society and social policy. Discussion: Inclusion of people with intellectual disability in civic and political life is crucial and will only be achieved if self-advocates are accepted into the policy-making arena. Strategies are available for people with intellectual disability to challenge the status quo of society in which prejudice and stigma continue to impact on their inclusion in social discourse. By using these self-advocacy strategies, people with intellectual disability can have a say in policy decisions which impact on their lives. Conclusion: Self-advocacy to enhance policy participation can promote the inclusion of the voices of people with intellectual disability to influence public social policy decisions. Adopting strategies which enable the inclusion of the voices of people with intellectual disability in civic activities holds potential for diversifying perspectives brought to public participation in policy development and implementation, which is currently primarily the domain of citizens without disability.

Browsing by Author "Kleintjes, Sharon"

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