scholarly journals Service provision in Scotland for people with an intellectual disability who have, or are at risk of developing, dementia

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 736-749 ◽  
Author(s):  
Karen McKenzie ◽  
Dale Metcalfe ◽  
Amanda Michie ◽  
George Murray
Keyword(s):  
At Risk ◽  
Intellectual Disability ◽  
Learning Disability ◽  
Service Provision ◽  
Disability Services ◽  
Health Board ◽  
Common Elements ◽  
Online Questionnaire ◽  
Community Learning ◽  
Direct Assessment

This research aimed to identify current national provision by health services in Scotland in relation to proactive screening and reactive assessment for people with an intellectual disability in Scotland who have, or are at risk of developing, dementia. Staff from 12 intellectual disability services, representing the 11 health board areas in Scotland, completed an online questionnaire which asked about proactive screening and reactive assessment for people with intellectual disability who had, or were at risk of developing, dementia as well as suggested areas for improvement. All of the areas provided services for people with intellectual disability who have, or are at risk of developing, dementia, but differed as to whether this was reactive, proactive or both. Nine services offered intervention following diagnosis. The most common elements used across both proactive screening and reactive assessment were conducting a health check, using a general dementia questionnaire designed for people with an intellectual disability and direct assessment with the person. Clinical psychology and community learning disability nurses were the professions most likely to be involved routinely in both proactive screening and reactive assessments. The psychometric properties of the most commonly used assessments of cognitive and behavioural functioning were mixed. The areas of improvement suggested by practitioners mainly related to ways of improving existing pathways. This research represents the first step in providing an overview of service provision in Scotland. There was some inconsistency in relation to the general and specific components which were involved in proactive screening and reactive assessment. Implications for service provision are discussed.

scholarly journals Transfer and transition referrals of patients with intellectual disability from children's services to adult community learning disability teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S103-S103
Author(s):  
Jalil-Ahmad Sharif
Keyword(s):  
Intellectual Disability ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Limited Information ◽  
Children's Services ◽  
Term Care ◽  
Community Learning ◽  
Children’S Services ◽  
Support Plan ◽  
Transition Support

AimsThe audit aimed to assess if patients under the care of children's services in Wessex were transferred at the appropriate age and whether transition referrals to Community Learning Disability teams (CTLD) occurred timely. It also aimed to look at how many patients underwent transitions in a three month period, and if their transition support plan (TSP) was completed. A transition support plan should include chronological information on psychopharmacology, psychotherapy, and social support measures. Patients should be referred between the ages of 17–19 but require a justification after 18 years of age.MethodThe BI team was contacted to provide all IDs for patients referred within a three month period between the ages of 17–19. The BI team provided 42 patients with their ID. Patients discharged from services within a short time span were excluded for the following reason: inappropriate referral (9pts), discharged after 1st assessment (6pts), internal discussion (6pts), only referred to Autism team (4pts), moved out of area (1pts). From the initial 42 patients, 16 patients were analysed using the collection tool.Result4/16 had a TSP, and only two had a complete TSP and transitioned in another trust and were inter-team referrals.CAMHS services referred 1/16 patients.Psychotropic medication was prescribed to 12/16 prior to or on time of referral, but only two patients had a complete psychotropic medication history.8/16 patients' referral was commenced prior to their 18th birthday, and no information was provided for delay in transfer.Health records did mention psychotherapy, but apart from 2/16 TSP records, no additional information was available on the modality.ConclusionPatients with Intellectual Disability face challenges when transferring from children to adult services. Insufficient referral information may have a detrimental impact on patients wellbeing and long-term care.Access to a patient's chronological journey through the different children's services allows Adult CTLD health professionals to provide effective care. Historical psycho-social and pharmacological interventions provide a reference point for future interventions.Concerns included: limited information on most TSP regarding psycho-social and psychotropic treatments, lack of access to CAMHS/CHYPS paperwork and ineffective inter-trust communication for transition patients.This project highlighted the average number of transition cases in 3 months. It led to changes to the transition pathway, as awareness was raised in trust and CCG meetings to improve patient outcome. CTLD created the new role of transition facilitators to support children's services. They sit in meetings before patients transition referrals.

scholarly journals Identifying Needs-Based Groupings Among People Accessing Intellectual Disability Services

2018 ◽  
Vol 123 (5) ◽  
pp. 426-442 ◽  
Author(s):  
Jon Painter ◽  
Barry Ingham ◽  
Liam Trevithick ◽  
Richard P. Hastings ◽  
Ashok Roy
Keyword(s):  
Intellectual Disability ◽  
Service Provision ◽  
Mental Health Problems ◽  
Assessment Tool ◽  
Challenging Behaviors ◽  
Autism Spectrum ◽  
Face Validity ◽  
Disability Services ◽  
Assessment Data ◽  
The United Kingdom

Abstract There is increasing emphasis on needs-led service provision for people with intellectual disability (ID). This study outlines the statistical cluster analysis of clinical data from 1,692 individuals accessing secondary care ID services in the United Kingdom (U.K.) Using objective needs assessment data from a newly developed ID assessment tool, six clusters were identified. These had clinical face validity and were validated using six concurrently (but independently) rated tools. In keeping with previous studies, the clusters varied in terms of overall level of need as well as specific clinical features (autism spectrum disorder, mental health problems, challenging behaviors and physical health conditions). More work is now needed to further develop these clusters and explore their utility for planning, commissioning and optimizing needs-led services.

scholarly journals Psychiatric assertive outreach and learning disability services

2003 ◽  
Vol 9 (5) ◽  
pp. 368-373 ◽  
Author(s):  
Angela Hassiotis ◽  
Peter Tyrer ◽  
Patricia Oliver
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Learning Disabilities ◽  
Learning Disability ◽  
Service Provision ◽  
Disability Services ◽  
Established Method ◽  
Assertive Outreach ◽  
Limited Application

Assertive outreach is a well-established method of managing patients with severe mental illness in the community. However, there is limited application and evidence of its efficacy in services for people with learning disabilities who also have mental illness. This paper elucidates current service provision for this group of patients and illustrates the pathways to mental health care available to them.

The experience of COVID-19 “lockdown” for people with a learning disability: results from surveys in Jersey and Guernsey

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sinead Peacock-Brennan ◽  
Kitty Stewart ◽  
Rosalind Jayne Angier ◽  
Julian Morris ◽  
Rachel Rud ◽  
...  
Keyword(s):  
Learning Disability ◽  
Service Provision ◽  
Design Methodology ◽  
Service Evaluation ◽  
Disability Services ◽  
Content Type

Purpose The purpose of this paper is to outline a service evaluation that gathered feedback from people with a learning disability on their experience of lockdown in Jersey and Guernsey. This feedback was intended to guide planning for service provision during any future lockdown and for life as we exit lockdown. Design/methodology/approach An accessible survey was sent to everyone accessing learning disability services across the two islands and Mencap in Jersey. Data was analysed quantitatively and qualitatively to identify patterns in the data and key themes. Findings Most respondents felt safe, calm and happy and valued support from services. Key themes emerging from the data included the importance of relationships, messages of safety, keeping busy and communication. Originality/value This survey has been undertaken at a time where there is a paucity of research and consultation with individuals with a learning disability self-reporting on their experiences of lockdown, during the COVID-19 pandemic.

scholarly journals The Mental Health Clustering Tool for people with severe intellectual disability

2012 ◽  
Vol 36 (12) ◽  
pp. 454-458 ◽  
Author(s):  
Vishwa Radhakrishnan ◽  
Kevin Smith ◽  
Jean O'Hara
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Community Mental Health ◽  
Learning Disability ◽  
Rating Scales ◽  
Disability Services ◽  
Clinical Implications ◽  
Current Form ◽  
Severe Intellectual Disability ◽  
Integrated Mental Health

Aims and methodWe assessed 92% (117/127) of the patients in our community mental health learning disability team using the Mental Health Clustering Tool (MHCT) to establish whether their needs could be captured sufficiently well to enable assignment to a care cluster for payment by results in mental health. We explored the characteristics of those assigned to Cluster 0 to identify how they differed from those who could be assigned to Clusters 1-21.ResultsAs expected, nearly half of the case-load (48%) could not be assigned to any cluster except Cluster 0, the variance cluster, which is used when the needs of patients cannot be captured by the current 21 care clusters but a service is, or will be, provided.Clinical implicationsThe MHCT in its current form does not adequately capture the needs of people with more severe intellectual disability. An integrated mental health and learning disability clustering tool is in development. This is expected to include new rating scales and new clusters, however until the development is completed and validated it will not be possible to implement payment by results in mental health in learning disability services.

scholarly journals A new service model in East Lothian community learning disability team: evaluation of service with and without specialist positive behaviour support team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S309-S309
Author(s):  
Saima Asif ◽  
Andrew McKechanie
Keyword(s):  
Intellectual Disability ◽  
Learning Disability ◽  
Individual Case ◽  
Challenging Behaviour ◽  
Service Model ◽  
Community Learning ◽  
Complex Behaviour ◽  
Health And Social Care ◽  
Support Team ◽  
Positive Behaviour Support

AimsTo evaluate the provision of services to patients with challenging behaviour in East Lothian Community Learning Disability population with and without specialist behaviour support team.BackgroundBehaviour that proves to be a challenge to manage (Challenging behaviour) is not uncommon in adults with intellectual disability and has a reported prevalence of 10–15%.1,2Positive behaviour support (PBS) is recommended as evidence-based intervention for adults with intellectual disability who have challenging behaviour. East Lothian community learning disability team (CLDT) underwent a change in service model for people with challenging behaviour. This change followed a Health and Social care partnership agreement that behaviour support and management could be provided by multidisciplinary CLDT rather than region-wide specialist team.MethodData collection was split into two cycles. First cycle looked retrospectively at six months prior to exit of Specialist Positive Behaviour Support Team (SPBST). Second cycle looked prospectively at 6 months after exit of SPBST.In first cycle, data were collected doing retrospective review of cases known and referred to SPBST. This included calculating time spent on each individual case by SPBST and by CLDT. SPBST provided information in the form of hours spent on each individual case for patients identified by them. For CLDT, electronic medical records system (TRAK) was used by looking at appointment entries on TRAK. For second cycle, newly developed Complex Behaviour pathway was used to identify the patients. Data were collected by using TRAK system as in the first cycle for CLDT.Data collected in both cycles was compared at the end of second cycle.ResultIn first cycle, 5 patients were managed jointly by SPBST and CLDT in 96.4 hours over six months and average clinical time spent on each patient was 19 hours. SPBST spent a total of 59 hours and CLDT spent 40 clinical hours. In second cycle, 12 patients were managed by CLDT alone in 130 hours over six months and average clinical time spent on each patient was nearly 11 hours.ConclusionResults of this evaluation suggest that SPBST had been providing significant contribution to East Lothian CLDT not only with their expertise but also with clinical time. More than 50 % of total clinical time spent on the patients with challenging behaviour in first cycle, was provided by SPBST. This is also evidenced in second cycle where there is an increase in clinical time of some professions when SPBST was withdrawn.

scholarly journals Genetic testing of adults with intellectual disability

2012 ◽  
Vol 36 (11) ◽  
pp. 409-413 ◽  
Author(s):  
Jana de Villiers ◽  
Mary Porteous
Keyword(s):  
Intellectual Disability ◽  
Genetic Testing ◽  
Learning Disability ◽  
Genetic Diagnosis ◽  
Disability Services ◽  
Clinical Implications ◽  
Clinical Genetics ◽  
Genetic Abnormality ◽  
Structured Interviews ◽  
Health Boards

MethodPatients known to learning disability services in two health boards in southeast Scotland were cross-matched with the patients tested at the Western General Hospital in Edinburgh. Those with a positive genetic diagnosis were identified. Semi-structured interviews were conducted with senior learning disability psychiatrists and clinical genetics consultants.ResultsOf the 3323 patients with intellectual disability across both health boards, 41% have had genetic tests and 6% have an identified genetic abnormality as the cause for their intellectual disability. Of the 1349 patients who have been tested, a genetic abnormality was found in 14%. Psychiatrists named several benefits to genetic testing, but they also highlighted a number of non-medical reasons for not testing adults with intellectual disability.Clinical implicationsIdentifying genetic aetiology in intellectual disability has a number of benefits. Our study would indicate that genetic diagnoses are being missed due to a lack of genetic testing in this patient group. Adult learning disability services need to consider increasing genetic testing.

scholarly journals Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039647
Author(s):  
Mairead Moloney ◽  
Therese Hennessy ◽  
Owen Doody
Keyword(s):  
Intellectual Disability ◽  
Acute Care ◽  
Scoping Review ◽  
Service Provision ◽  
Care Setting ◽  
Acute Care Setting ◽  
Inclusion Criteria ◽  
Health Service Provision ◽  
Acute Care Settings ◽  
Fair Access

ObjectivesPeople with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.DesignScoping review.SettingAcute care settings.MethodsFive databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.ResultsOf the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.ConclusionsThe scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.

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