Philip Burge

Prevalence of Mental Disorders and Associated Service Variables Among Ontario Children Who Are Permanent Wards

Objective: To identify the prevalence rate of mental disorders among Ontario children who are permanent wards and also the key practice and descriptive variables associated with their diagnostic status. Method: I reviewed case files from a stratified random sample of 429 Ontario children who were permanent wards with no access to biological parents on December 31, 2003. Data abstracted from files included information on descriptive variables (such as age, sex, and type of permanent ward), all disorders (that is, mental and other current medical diagnoses and disabilities), family history, maltreatment experiences, service history (such as age at admission to care and current residential placement type), and permanency plans. Results: The prevalence of mental disorders was 31.7%. A significantly higher proportion of children with mental disorders experienced maltreatment. Children with mental disorders were almost 3 times more likely than those without mental disorders to be placed by Childrens Aid Societies in privately operated resources, such as group homes, and almost 10 times less likely to be living in a probationary adoption home. Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables—age on becoming a permanent ward and age at the time of the study—were predictive of childrens adoption plans. Conclusions: The findings support the need for improved monitoring of the aggregate mental health needs of children who are permanent wards. Numerous implications for service delivery and future research are discussed.

Length of stay for psychiatric inpatient services: A comparison of admissions of people with and without developmental disabilities

This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n=294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n=287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalyses in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder.

Acute psychiatric inpatient care for people with a dual diagnosis: patient profiles and lengths of stay.

Objective: This study describes characteristics of psychiatry inpatients with developmental disabilities (DD) and their admissions to psychiatry wards in 2 acute care hospitals. It also compares differences in lengths of stay between admissions of this group with a comparison sample of inpatient admissions without DD. Method: A retrospective chart review was conducted on all individuals with DD who were psychiatric inpatients at 2 Kingston, Ontario, general hospitals, within a 4-year period (1994 to 1998). A comparison sample of admissions of patients without DD was chosen. Frequency tables were used to describe the inpatients with DD and to describe the 2 samples of admissions. Nonparametric statistics were used to compare the median length of stay between the 2 samples. Associations between length of stay and other covariates were explored within the sample of patient admissions with DD. Results: The 62 individuals with DD had 101 admissions over the study period. Suicidal ideation was the most common admission reason (46%), and mood disorder was the most common discharge diagnosis (29%). The median length of stay for patients with DD was 8 days, which did not differ meaningfully from the comparison sample. Variables that were significantly associated with length of stay among individuals with DD included sex, referral source, and diagnosis. Conclusion: When individuals with DD are psychiatric inpatients, their length of stay is affected by some factors that have been identified in previous studies not specific to DD (for example, referral source and diagnosis). Our finding that male patients with DD have longer lengths of stay than do female patients in the same sample has not been reported in previous research.

Senior residents in psychiatry: Views on training in developmental disabilities

Objectives: To determine the proportion of senior residents who believed their education in the field of developmental disabilities was adequate and to collect suggestions for improvements. Method: We distributed a self-administered questionnaire to senior residents prior to an annual voluntary preparatory exam. Their views on training in developmental disabilities and ideas about improving curricula were solicited in detail, and their feedback results were analyzed. Results: Of the 89 senior residents who attended the exam, 60 (67.4%) completed the survey. This represents 29% of the national complement. Most (85%) of the one-half who reported receiving undergraduate training in developmental disabilities felt the quantity was inadequate. Almost 90% of those who did not receive training felt they should have. Of respondents, 85% received residency training in dual diagnosis, but most (59%) felt more curriculum time was needed. Conclusions: Senior residents also desire curricular enhancements that experts in developmental disabilities have long recommended.

Making Choices: Adoption Seekers’ Preferences and Available Children with Special Needs

Most children available from public adoption agencies are children with special needs, such as disabilities. This pilot study on the child profile preferences of 5830 adults registered with province-wide adoption agency found that those who were most open to considering children with special needs had been formally seeking to adopt for some time and had completed government-required SAFE assessments and training. Most preferred younger children, and half would consider sibling groups. Between 43% to 60% indicated willingness to consider adopting children with degrees of learning disabilities, emotional behavioral disorders, and physical disabilities, although the willing proportion decreased as the level of each disabilitys specified impact progressed from “mild” to “moderate” to “severe.” Most preferred, among 20 categories of available childrens possible exposures and health diagnoses, were past abuse exposures versus diagnosed disabilities or enduring conditions. Possible explanations for these findings and their implications are explored and ideas for further research proposed.