Clinical needs and outcomes of adults with intellectual disabilities accessing an inpatient assessment and treatment service and the implication for development of community services

Abstract

The role and future of assessment and treatment units for people with intellectual disabilities is once again the focus of debate and government policy. Reviewing the admissions to inpatient services can provide useful information about the characteristics, needs and clinical outcomes of clients. Data were collected retrospectively for all 36 referrals accepted to an inpatient assessment and treatment unit for people with intellectual disability, between January 2013 and April 2014. Clinical and demographic characteristics of service users were identified through descriptive analysis. Male service users, mild intellectual disability and diagnosis of autistic spectrum disorder were frequent, and a high proportion of admissions had complex and multiple needs. The Health of the Nation Outcome Scale–Intellectual Disabilities was used as a clinical outcome measure. We conclude with recommendations for service development following closure of our inpatient service.

Keywords

intellectual disabilities clinical outcome measures service development complex needs assessment and treatment

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References

Bakken

Martinsen

(2013) Adults with intellectual disabilities and mental illness in psychiatric in-patient units: empirical studies of patient characteristics and psychiatric diagnoses from 1996 to 2011. International Journal of Developmental Disabilities 59(3): 179–190.

BBC One Panorama (2011) Undercover care: The abuse exposed. Available at: http://www.bbc.co.uk/programmes/b011pwt6 (accessed 14 April 2015).

Birmingham City Council (2014) Ethnic groups: Population and census. Available at: http://www.birmingham.gov.uk/cs/Satellite?c=Page&childpagename=Planning-and-Regeneration%2FPageLayout&cid=1223096353923&pagename=BCC%2FCommon%2FWrapper%2FWrapper (accessed 3 June 2014).

Chaplin

(2011) Mental health services for people with intellectual disabilities. Current Opinion in Psychiatry 24(5): 372–376.

Cooper

Smiley

Morrison

. (2007) Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. British Journal of Psychiatry 190: 27–35.

Department of Health (2012a) Department of Health Review: Winterbourne View Hospital Interim Report. London: Department of Health.

Department of Health (2012b) Transforming Care: A National Response to Winterbourne View Hospital: Department of Health Review Final Report. London: Department of Health.

Douglass

Hurtado

(2013) Establishing and evaluating an assertive outreach team. Intellectual Disability Practice 16(9): 30–34.

Emerson

Kiernan

Alborz

. (2001) The prevalence of challenging behaviors: a total population study. Research in Developmental Disabilities 22(1): 77–93.

10.

Hall

Parkes

Samuels

. (2006) Working across boundaries: clinical outcomes for an integrated mental health service for people with intellectual disabilities. Journal of Intellectual Disability Research 50(8): 598–607.

11.

Hassiotis

Tyrer

Oliver

(2003) Psychiatric assertive outreach and learning disability services. Advances in Psychiatric Treatment 9: 368–373.

12.

Hemmings

O’Hara

McCarthy

. (2009a) Comparison of adults with intellectual disabilities and mental health problems admitted to specialist and generic in-patient units. British Journal of Intellectual Disabilities 37(2): 123–128.

13.

Hemmings

Underwood

Bouras

(2009b) Services in the community for adults with psychosis and intellectual disabilities: a Delphi consultation of professionals’ views. Journal of Intellectual Disability Research 53(7): 677–684.

14.

Heslop

Blair

Fleming

. (2013) Confidential Inquiry into Premature Deaths of People with Intellectual Disabilities (CIPOID). Bristol: Norah Fry Research Centre.

15.

Hillier

Wright

Strydom

. (2010) Use of the HoNOS-ID in identifying domains of change. The Psychiatrist 34: 322–326.

16.

Mackenzie-Davies

Mansell

(2007) Assessment and treatment units for people with intellectual disabilities and challenging behaviour in England: an exploratory survey. Journal of Intellectual Disability Research 51(10): 802–811.

17.

Martin

Costello

Leese

. (2005) An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical and service issues. Journal of Intellectual Disability Research 49(7): 516–524.

18.

Maxwell

(1984) Quality assessment in health. British Medical Journal 288: 1470–1472.

19.

McKenzie Paterson (2010) Evaluating an assertive outreach team for supporting clients who present behaviour that challenges. British Journal of Intellectual Disabilities 38: 319–327.

20.

Morgan

Leonard

Bourke

. (2008) Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study. British Journal of Psychiatry 193: 364–372.

21.

Morris

(2008) Challenging behaviour: a unified approach. Advances in Mental Health and Intellectual Disabilities 2(2): 55–57.

22.

National Institute for Health and Care Excellence (NICE) (2014) Mental health problems in people with learning disabilities. Available at: http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0684 (accessed 14 April 2015).

23.

National Intellectual Disability Professional Senate (2015) Delivering effective specialist community learning disabilities health team support to people with learning disabilities and their families or carers. Available at: https://www.bps.org.uk/system/files/user-files/DCP%20The%20Faculty%20for%20People%20with%20Intellectual%20Disabilities/public/national_ld_professional_senate_guidelines_for_cldt_specialist_health_services_specifications_and_practice_exec_summary_3_mar_2015.docx (accessed 14 April 2015).

24.

NHS England (2015) Making the friends and family test inclusive. Available at: http://www.england.nhs.uk/ourwork/pe/fft/fft-inclusive/ (accessed 22 May 2015).

25.

Oliver

Fiachaud

Tyrer

. (2005) Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study. Journal of Intellectual Disability Research 49(7): 507–515.

26.

Outhwaite

(2003) The importance of leadership in the development of an integrated team. Journal of Nursing Management 11(6): 371–376.

27.

Parkes

Hassiotis

(2007) Incorporating the views of service users in the development of an integrated psychiatric service for people with learning disabilities. British Journal of Intellectual Disabilities 35: 23–29.

28.

Pearce

(2011) Health of the nation outcome scales in an in-patient unit. Intellectual Disability Practice 14(3): 33–38.

29.

Porter

Sangha

. (2002) Reaching out. Intellectual Disability Practice 5(6): 18–21.

30.

Powell

McKenzie

Murray

. (2003) The challenge of achieving enduring change. Intellectual Disability Practice 6(6): 8–11.

31.

Roy

Matthews

Clifford

. (2002) Health of the nation outcome scales for people with learning disabilities. British Journal of Psychiatry 180: 61–66.

32.

Royal College of Psychiatrists (2013) People with Intellectual Disability and Mental Health, Behavioural or Forensic Problems: The Role of In-patient Services. London: Royal College of Psychiatrists’ Faculty of Psychiatry of Intellectual Disability Faculty.

33.

Royal College of Psychiatrists (2014) What is HoNOS? Available at: http://www.rcpsych.ac.uk/traininpsychiatry/conferencestraining/courses/honos/whatishonos.aspx (accessed 14 April 2015).

34.

Skelly

D’Antonio

(2008) Factor structure of the HoNOS-ID: further evidence of its validity and use as a generic outcome measure. Clinical Psychology and People with Intellectual Disabilities 6(3): 3–7.

35.

Skirrow

Perry

(2009) The Maslow Assessment of Needs Scales. Liverpool: Mersey Care NHS Trusts.