Health care transition planning for adolescents and emerging adults with intellectual disabilities and developmental disabilities: Distinctions and challenges

Purpose

The purpose of this article is to provide the reader with insight and enhanced understanding of the health care transition planning process for adolescents and emerging adults with intellectual disabilities and developmental disabilities. There are distinctly different programmatic considerations that need to be addressed in advancing their transfer of care to adult providers and promoting their transition to adulthood. These differences are due in part to the federal and state legislative initiatives that were established in the education, rehabilitation, employment, and developmental disabilities service systems. In contrast, no comparable federal and state mandates exist in the system of health care. The legislative mandates in education, rehabilitation, and employment are presented and discussed as well as the federal legislation on rights and protections for individuals with intellectual disabilities and developmental disabilities. Consequently, health care transition (HCT) planning involves application of a framework of care that is characteristically different than the planning efforts undertaken for adolescents and emerging adults (AEA) with special health care needs (SHCN)/disabilities and for typically developing AEA. The best practice HCT recommendations are discussed in the context of this intellectual disabilities and developmental disabilities framework of care.

Conclusions

Health care transition planning for adolescents and emerging adults with intellectual disabilities and developmental disabilities involves additional and distinctly clinical and programmatic models of care.

Practice Implications

Health care transition planning guidance for adolescents and emerging adults with intellectual disabilities and developmental disabilities are provided based upon best practice recommendations.     

'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.     

Care pathway initiative for people with intellectual disabilities: impact evaluation

AIM: To improve the integrated care of individuals with learning disabilities. BACKGROUND: We report on the evaluation of a care pathway initiative in learning disability services. METHOD: Three separate care pathways were developed and implemented as part of a pilot project. Improvements in parameters were independently verified. RESULTS: Service providers and people with learning disabilities welcomed the introduction of care pathways into their services. CONCLUSIONS: We conclude that the introduction of care pathways leads to increased communication within services, greater satisfaction and improved outcomes. These gains were achieved without an increase in resources.     

Meeting the needs of families and carers on acute psychiatric wards: a nurse-led service

ACCESSIBLE SUMMARY: ? Families and carers of inpatients often have little contact with ward staff. ? A nurse-led service was set up to address this issue. ? Families were highly satisfied with the service they received. ABSTRACT: The needs of families and carers are often not met by the busy staff on inpatient units. A nurse-led family and carers service was set up on three adult acute psychiatric wards. A four-session protocol was developed for structuring sessions with families and carers. Methods of engaging reluctant carers were developed. Satisfaction rates are high. Families and carers value the emotional support, improved communication, help and advice. About one quarter are referred on for further input after discharge. A nurse-run service for the families and carers can make a significant difference to those who use it, providing support, creating a working alliance and improving the two-way exchange of information.     

Violence in the care of adult persons with intellectual disabilities

Background. Violence, for example physical, psychological, financial and sexual abuse and neglect, exists and is an under‐reported problem in caring situations involving adult persons with intellectual disabilities and their caregivers, where both parties can be seen as victims and perpetrators. Aims and objectives. To investigate violent situations involving Swedish adult persons with intellectual disabilities and their caregivers in group‐dwellings. Design. A total population‐based survey. Methods. A questionnaire, including violence towards adults with intellectual disabilities and violence towards staff members during 1 year, was sent to all staff members (n = 164) from 17 care settings for adults with intellectual disabilities with a response rate of 74%. Results. Thirty‐five per cent of 122 respondents admitted they had been implicated in or witnessed a violent incident towards an adult person with intellectual disabilities and 14% of the staff members admitted they themselves had been the perpetrators. Sixty‐one per cent of the staff members described various situations when they were exposed to violence from an adult person with intellectual disabilities. Physical violence was most frequently reported. Most of the aggression occurred in helping situations when persons with intellectual disabilities did not co‐operate or when both actors reacted with violence. The violent situations led the staff members to feel powerless and inadequate. In order to cope they discussed with each other or with the manager. Conclusions. Violence seems to be accepted as a natural part of the daily care for adult persons with intellectual disabilities. Most of the violence is physical and psychological and occurs in close helping situations. Relevance to clinical practice. Supportive interventions, i.e. supervision for the staff members and training of communication skills individually or in group for the adults with intellectual disabilities.     

Medical care services for people with intellectual disabilities living in the general community: a cross-sectional survey of inpatient care utilization in Taiwan, 2001

Background. The medical care needs and problems of persons with intellectual disabilities (ID) living in the general community have received limited attention in previous studies. The aim of this article is to describe aspects of medical care utilization among people with ID living in the general community, with particular emphasis on examining the type and determinants of inpatient care utilization in Taiwan.

Methods. A cross-sectional survey of people with intellectual disabilities was employed. A total of 997 respondents who provided fully completed data concerning inpatient care utilization were recruited into the analysis.

Results. A total of 12.4% of individuals with intellectual disabilities had used inpatient care in the 7 months prior to the survey. The average number of inpatient care visits in that time was 1.43, with an average hospital stay of 16.91 days. Surgery, fever, gastrointestinal disorders, psychiatric disorders, and accident were the main causes of inpatient care utilization. A stepwise logistic model showed that the factors of holding a Major Illness Card, regular medicine-taking and self-perceived health status were statistically significant to inpatient care utilization of people with intellectual disabilities.

Conclusions. Medical care providers and policy makers need to be aware that many people with intellectual disabilities have increased medical care needs that may require modification of standard medical care practices and service models in society.     

Medical care services for people with intellectual disabilities living in the general community: A cross-sectional survey of inpatient care utilization in Taiwan, 2001

Background. The medical care needs and problems of persons with intellectual disabilities (ID) living in the general community have received limited attention in previous studies. The aim of this article is to describe aspects of medical care utilization among people with ID living in the general community, with particular emphasis on examining the type and determinants of inpatient care utilization in Taiwan.

Methods. A cross-sectional survey of people with intellectual disabilities was employed. A total of 997 respondents who provided fully completed data concerning inpatient care utilization were recruited into the analysis.

Results. A total of 12.4% of individuals with intellectual disabilities had used inpatient care in the 7 months prior to the survey. The average number of inpatient care visits in that time was 1.43, with an average hospital stay of 16.91 days. Surgery, fever, gastrointestinal disorders, psychiatric disorders, and accident were the main causes of inpatient care utilization. A stepwise logistic model showed that the factors of holding a Major Illness Card, regular medicine-taking and self-perceived health status were statistically significant to inpatient care utilization of people with intellectual disabilities.

Conclusions. Medical care providers and policy makers need to be aware that many people with intellectual disabilities have increased medical care needs that may require modification of standard medical care practices and service models in society.     

Coerced medication in psychiatric inpatient care: literature review

Title. Coerced medication in psychiatric inpatient care: literature review. Aim. This paper is a report of a narrative review of the coercive use of medication in inpatient psychiatric care to identify a demographic and clinical profile of patients who are forcibly medicated, and to examine patient and staff views of this practice. Background. Lack of compliance with medication is associated with quicker relapse and increased risk to self and others in mental disorder. It is this increased risk which provides the ethical and legal grounds for detaining and treating psychiatric patients without their consent. Legislation for involuntary psychiatric treatment exists in all European Union member states and in other western countries. Data sources. Online bibliographic databases from 1980 to 2008 were searched, including British Nursing Index, CINAHL, PsycINFO, EMBASE and MEDLINE. Search terms relating to coercion, force, chemical restraint, rapid tranquilization, inpatients and psychiatry were used. Review methods. Titles and abstracts were reviewed. All peer reviewed papers concerning coercion in the administration of medication in inpatient psychiatric care were included and a narrative review was conducted. Results. Fourteen papers from seven countries were included. Patients who have experience coerced medication tend to be aged in their 30s, with a diagnosis of schizophrenia, bipolar or other psychotic disorders, and are often involuntarily admitted. Assault or threat of assault is the main reason for giving forced medication. Conclusion. There is a dearth of literature in the area of coercion in administration of medication and much more research is needed examining all aspects of this contentious practice.     

Psychiatric nursing and compulsory psychiatric care

Community psychiatric nurses (CPNs) have long been involved in the operations of the English Mental Health Acts. Research has shown that compulsory detention is not used uniformly or consistently. Rates of involuntary hospitalization are reported to vary widely across Europe, but there is some consensus on patient profiles. The ethnicity, social status and gender of the patient, the involvement of the police, the availability of care, problems caused to relatives, and the country and particular legislative system where these judgements take place, all influence who is compulsorily detained. This article reviews recent evidence from Europe and argues that involuntary psychiatric care can no longer be seen as entirely dependent on the symptoms and behaviour of the patient and that CPNs should be aware of and reflect upon these factors before invoking the detention process.