Mace (2016): Multi-component behavioural intervention reduces harmful sexual behaviour in a 17-year-old male with autism spectrum disorder: a case study, Journal of Sexual Aggression,

Awareness of potential needs at the end of life can assist clinicians to understand the choices of their patients and develop effective end-of-life care plans that improve the outcomes for patients and families.

SUMMARYHealth services continue to be seen as significant settings for health improvement, and developments continue to be made in the nature of such work, means of optimal delivery and outcomes. This paper builds on previous work by reporting on activity in a series of sites within 'NHS Health Scotland's (NHS HS)' Health Promoting Health Service (HPHS) initiative. The objectives of the review were to: describe the achievements of HPHS sites, assess the degree of influence and embedding of the HPHS approach, review the support functions provided by 'NHS HS' and identify the challenges to implementation and sustainability. The review identified a variety of activity associated with HPHS, ranging from a topic focused/behaviour change approach to efforts to re-orientate organizational features. The role that NHS HS played in developing settings capacity was largely endorsed, and there was, despite the existence of some barriers, evidence that HPHS was being successfully embedded within health service organizational policies and procedures. In particular, the role of a national level strategic guidance document to NHS CEOs ['Chief Executive Letter (14)'] is noted as having been significant in creating a conducive context for HPHS. In this context, the paper concludes by reflecting more broadly on the current status of settingsbased health improvement and suggests that on the basis of this review there should be optimism in pursuing a relatively expansive vision of health improvement in this particular setting and potentially others.

Accessible summary  Children and young people with learning disabilities who present sexually harmful behaviour are often not allowed into the community.  This study describes the work carried out with a boy with sexually harmful behaviour attending a residential special school.  The staff helped teach the boy how to behave in social situations and about sex, consent and relationships.  Afterwards, the boy was able to participate in supervised community activities. SummaryChildren and young people with learning disabilities who present sexually harmful behaviour are marginalised and do not always participate in community activities. This case study describes a multi‐component intervention that successfully reduced the sexually harmful behaviour of a 16‐year‐old boy with a mild learning disability. The intervention was comprised of cognitive behaviour therapy, Social Stories™ and a behavioural programme that reinforced appropriate behaviour with social praise and access to preferred items and a range of community activities. Following the intervention, he was able to participate in a wide range of supervised community activities.

Accessible Summary A 16‐year‐old boy diagnosed with a mild learning disability, atypical autism, attention‐deficit hyperactivity disorder, bipolar disorder, conduct disorder and epilepsy was admitted to a residential special school for treatment of severe aggression. Prior to admission, he had been prescribed various psychotropic medications, including sodium valproate, to treat his aggressive behaviour, bipolar disorder and epilepsy. His behaviour improved when his medication was stopped. Summary People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or epilepsy were observed over the course of this 135‐week case study. No aggression was observed during the last 20 weeks of the study. Aggressive behaviour as a possible side effect of sodium valproate should be considered in people with learning disabilities.