Nicholas Lennox

Health targets for people with an intellectual disability

This article describes the development and identification of a set of health targets for adults with an intellectual disability. The authors developed the targets through a process of collaboration, consultation and literature review. The targets were included if reliable studies had shown the conditions to be highly prevalent, easily detected, and amenable to treatments that are readily available. It is envisaged that these targets will be further refined and eventually endorsed by IASSID for presentation to the World Health Organisation in the year 2000.

Meeting in the middle: improving communication in primary health care consultations with people with an intellectual disability

The increased presence and participation in Australian society of people with an intellectual disability provides challenges for the provision of primary health care. General practitioners (GPs) identify themselves as ill equipped to provide for this heterogeneous population. A major obstacle to the provision of appropriate health care is seen as inadequate communication between the GP and the person with an intellectual disability, who may or may not be accompanied by a carer or advocate. This qualitative study in which five GPs, three people with intellectual disability, seven carers and two advocates (parent and friend) were interviewed was conducted in Brisbane, Australia. The aim was to better understand the factors that have an impact upon the success of communication in a medical consultation. Findings suggested that GPs were concerned with the aspects of communication difficulties which influenced their ability to adequately diagnose, manage and inform patients. Implications for practice management were also identified. People with intellectual disability reported frustration when they felt that they could not communicate adequately with the GP and annoyance when they were not included in the communication exchange. Carers were strong advocates for the person with intellectual disability, but indicated insufficient skill and knowledge to provide the level of assistance required in the consultation. The outcome was a model of cooperation that outlined the responsibilities of all players in the medical encounter, prior to, during and after the event.

General practice registrars’ care of people with intellectual disabilities

The aim of the study was to elucidate the barriers experienced by general practice registrars in their provision of health care to people with intellectual disabilities. A questionnaire was sent to 289 general practice registrars employed in practices across Australia. The responses indicated that 90% of registrars find it harder to provide good quality care for their patients with intellectual disabilities compared to their non-disabled patients. More specifically, a number of important barriers were identified, including difficulties in assessment and communication factors, limitations in consultation time, inadequate training and education in the field of intellectual disability, problems maintaining continuity of care, and uncertainties relating to resources available for people with intellectual disabilities. Identification of these barriers allowed a number of possible solutions to be explored, such as improved training of registrars and the development of a handbook about intellectual disabilities.

The Psychiatric Care of People with Intellectual Disabilities: The Perceptions of Consultant Psychiatrists in Victoria

Objective: This study was undertaken to establish the perceptions of psychiatrists regarding the care of people with intellectual disabilities. Method: A 28-item self-administered questionnaire was developed, piloted and sent on two occasions to 467 psychiatrists who receive the newsletter of the Victorian branch of the Royal Australian and New Zealand College of Psychiatrists. The questionnaire incorporated a Likert scale to document the opinions of the respondents. Results: A response rate of 51.1 % was achieved. The respondents indicated that, in their opinion, people with intellectual disabilities receive a poor standard of care in the inpatient and community setting. To improve this situation, the following strategies were recommended: the development of improved liaison between services; improved training for all personnel who provide services to people with intellectual disabilities; the development of greater resources; and support for professionals working in the area. The study also indicates that there is a core group of very interested psychiatrists who are currently practising and that people with intellectual disabilities are accessing private psychiatric services. In addition, the results suggest that diagnostic overshadowing is not a major barrier to psychiatric assessment, and that disorders which were presumed to be commonly overlooked by doctors (such as depression) are in fact frequently being diagnosed. Conclusions: Despite some positive findings, the majority of psychiatrists who responded held major concerns about the situation of people with intellectual disabilities. To improve the care provided to these people, it is recommended that these concerns are addressed by the psychiatric profession and responsible government departments in conjunction with university departments of psychiatry.

Health care for people with an intellectual disability: General Practitioners’ attitudes, and provision of care

The aim of this study was to investigate general practitioners’ (GPs) beliefs about the importance of addressing nine health care issues for people with intellectual disabilities, and their roles in providing this care. GPs’ current level and intended future level of addressing these health care issues were also determined. Questionnaires were mailed to 912 GPs Australia wide, with a 58% response rate. The vast majority of respondents agreed that the nine issues are important health care issues for people with an intellectual disability. Most respondents also agreed that it is the GPs’ role to facilitate or ensure these health issues are addressed. Although having broad attitudes about their roles, GPs indicated significant deficiencies in their current level of health care provision for many of the health issues. However, they also indicated their intentions to increase the frequency of addressing these health issues in the future as a result of issues raised in previous questions on the questionnaire. This response to simply increasing GPs’awareness of their practice behaviour has a variety of important implications for training and ongoing education.

The Psychiatric Care of People with Intellectual Disabilities: The Perceptions of Trainee Psychiatrists and Psychiatric Medical Officers

Objective: The main aim of this study was to document the perceptions of trainee psychiatrists and psychiatric medical officers regarding the psychiatric care of people with intellectual disabilities. Method: A 28-item self-administered questionnaire was developed by the investigators and pretested on eight psychiatrists and psychiatric trainees. A revised version of the questionnaire was then sent to 128 psychiatric trainees and 27 medical officers working in the public psychiatric services in Victoria. 116 questionnaires were returned, and the responses analysed. Results: The results indicate a high degree of interest in the psychiatry of intellectual disability, however this was tempered by a feeling that the respondents and their senior colleagues are inadequately trained. The respondents expressed major concerns regarding the care of people with dual disabilities in the hospital and community setting, and significant support for the development of specialised units and subspecialisation within psychiatry. The major concerns which were identified would in part explain why 30% of the respondents felt that they would prefer not to treat people with an intellectual disability and a psychiatric disorder. Conclusion: We can only support the assertion made by the Burdekin Report [12] that “there is an urgent need for academic research, increased clinical expertise and substantial increased resources in the much neglected area of dual disability.”

Effects of health screening for adults with intellectual disability: a pooled analysis.

Health screening has been shown to have beneficial effects on health outcomes in adults with intellectual disability. However, the nature of the population, which makes it difficult to recruit, has meant past studies have been relatively small and effect estimates unstable. This study conducted a pooled analysis of two randomised trials and one cohort study, containing a total of 795 participants. Use of a simple, low-cost screening tool produced substantial increases in health-promotion and disease-prevention activity, when compared with usual care.

Ask : a health advocacy program for adolescents with an intellectual disability: a cluster randomised controlled trial

BackgroundAdolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services.Methods/DesignA cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families’ organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP.DiscussionAdolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention.Trial Registration NumberClinicalTrials.gov Identifier: NCT00519311

Medication use among Australian adults with intellectual disability in primary healthcare settings: A cross-sectional study

Abstract Background There is concern about widespread medication use by people with intellectual disability (ID), especially psychotropic and anticonvulsant agents. However, there is sparse information on prescribing patterns in Australia. Method This cross-sectional study was conducted between 2000 and 2002 among adults with ID who live in the community in Brisbane, Australia. Medication data were extracted from a health screening tool. Demographic and medical data were collected from telephone interviews and medical records. Results Of 117 participants, 35% were prescribed psychotropic medications, most commonly antipsychotics, and 26% anticonvulsants. Complementary medications (vitamins, minerals, amino acids, fish oil, and herbal products) were used by 29% of participants. After adjusting for potentially confounding variables, psychotropic medication use was significantly associated with having a psychiatric illness (adjusted odds ratio = 4.6, 95% CI [1.0, 20.6]) and challenging behaviours (4.4, [1.1, 17.3]). Conclusions People with ID use a broad range of medications. Psychotropic medications continue to be the most predominant agents prescribed for this population. Psychotropic medication use is positively associated with having a psychiatric illness and challenging behaviours.

Psychiatric care of adults with intellectual disabilities: changing perceptions over a decade.

Objective: In light of developments in training and service provision, the aim of the present study was to compare two state-wide surveys, undertaken in 1994 and in 2004, of psychiatrists about their perceptions of their training and psychiatric treatment of adults with intellectual disabilities who also have mental health needs. Methods: A 50-item self-administered questionnaire was developed for the 2004 survey, based on the 1994 study. This was sent to all 624 Fellows of the Royal Australian and New Zealand College of Psychiatry registered in Victoria at the time. A series of questions was asked based on workload, training, the role of psychiatry in intellectual disabilities, opinions on assessment and management, improving services, and the demographics of participant psychiatrists. Results of the 2004 survey are compared with the 1994 study. Results: There has been some change in psychiatrists’ opinions about acute admission wards, believing strongly that they do not meet the needs of the adults with severe intellectual disabilities, leaving them vulnerable to exploitation. There has been some improvement in their ability to adequately manage adults with intellectual disabilities who have mental health needs and/or problem behaviours. Conclusions: Mainstream mental health services fail to meet the needs of adults with intellectual disabilities. Improved specialist clinical services and more clinical training opportunities are required.