Outcomes in different residential settings for people with intellectual disability: a systematic review

Mortality patterns in a Danish nationwide cohort of persons with intellectual disabilities

Mortality disparities among persons with intellectual disability are important to guide health-care practices. The objective was to evaluate mortality patterns of persons with intellectual disability in a nationwide study from 1976 to 2020. This study establishes a Danish nationwide cohort of persons with intellectual disability and age- and sex-matched reference cohort through linkage between several registers. We established a cohort of 79,114 persons with intellectual disability. Standardized mortality ratios were increased for persons with intellectual disability, most pronounced among younger persons and among females. Life expectancies were markedly lower; among persons with intellectual disability 63.6 years among females and 59.8 years among males in 2016-2020 compared to 82.4 and 78.7 years among females and males in the reference cohort. Life expectancies decreased with severity of intellectual disability. This study reports the establishment of a nationwide Danish cohort of persons with intellectual disability.

The Association of Organizational, Environmental, and Staffing Characteristics of Residential Care Facilities and the Risk Rating of Statutory Notifications: A Cross-Sectional Study in Ireland

OBJECTIVES

Safety incidents (SIs) are an indicator of quality in health and social care services. Safety incident research has largely focused on acute health care settings. We aimed to examine the association of organizational, environmental, and staffing characteristics of residential care facilities (RCFs) and severity of regulatory SI notifications.

METHODS

This was a retrospective analysis of SI notifications to the regulator for social care in Ireland received in 2018 and 2019. The mean risk rating of SI notifications for each RCF was used as the outcome. Regression analysis was conducted for the association of RCF characteristics (beds, staff to bed ratio, staff full-time equivalent (FTE), nurse to bed ratio, nurse FTE, number of RCF operated by the service provider, non-statutory or statutory provider) and the outcome, separately for nursing homes and residential disability services.

RESULTS

A total of 53,268 SI notifications were received. One thousand nine hundred RCFs were operational during the period: 594 (31.3%) for RCF-Nursing home and 1304 (68.7%) for RCF-Disability. For nursing homes, in the most adjusted model, the number of RCF operated by a provider ( β coefficient [95% confidence interval] = 0.508 [0.223-0.793]) was positively associated with mean risk rating of SI. For disability services, the following characteristics were positively associated in the most adjusted model: beds (0.081; 0.060-0.101), staff to bed ratio (0.068; 0.017-0.120), nurse to bed ratio (0.356; 0.044-0.667), staff FTE (0.029; 0.015-0.042), and number of RCF operated by a provider (0.067; 0.050-0.084).

CONCLUSIONS

Various modifiable organizational, environmental, and staffing characteristics and severity of SI notifications were associated in this study, most of which were related to RCF-Disability. Policymakers and providers of social care services should be cognizant of the relationship of these characteristics and severity of SI, when designing and planning residential care.

Israeli social workers' recommendations on residential settings for individuals with intellectual disabilities

BACKGROUND

People with intellectual disabilities have the right to live in the community. As social workers have an important role in decisions regarding residential settings, this study examined their recommendations regarding residential living arrangements of individuals with intellectual disabilities.

METHOD

Using a factorial survey approach 174 social workers were presented with true-to-life vignettes and asked to provide their recommendations regarding housing in community apartments, hostels (large group homes) and meonot (large institutions).

RESULTS

Higher likelihood of recommending housing in a community apartment was associated with mild intellectual disability, lack of daily support needs, no sexual abuse history, and stated preference for a community apartment. Social workers' experience in working in a specific residential setting was associated with recommending it.

CONCLUSIONS

Ongoing training on rights-based ethics and the importance of community inclusion should be provided to social workers. Further, community alternatives should be made available to all individuals with disabilities.

No ordinary adult life: Living conditions from the perspective of adults with intellectual disabilities

This study focuses on the subjective experience of the living conditions of adults with intellectual disabilities as related to the Uppsala Quality of Life model (UQoL2). Eleven semi-structured interviews were conducted to study issues raised by people with intellectual disabilities. Study participants had their own home, either in an ordinary dwelling or group home. The findings show that the dependence on support in daily life infringes on the sense of adult social status and control of life. Staff and family had a mandate to define Quality of Life, which countered the possibilities of a life based on the preferences of those with intellectual disabilities. Knowledge about factors that affect living conditions, one of the social determinants of health, has implications for public health in general and the development of society's efforts for people who are in lifelong dependence on support and service from others.

The Impact of Living Situation on Healthcare Encounters for Individuals With Intellectual Disability

Introduction The living situation of individuals with intellectual disabilities (ID) has evolved throughout the years and ranges from living at home with family caregivers to group homes to independent living arrangements. Living situations can affect access to care and thus healthcare utilization seen by healthcare encounters for individuals with ID. Methods The researchers conducted a chart review of 112 patients to assess demographics, living situations, and healthcare encounters between 2019 and 2021. Living situation categories included independent, biological family, group home, home with other support, and others. Statistical analyses were conducted using R version 4.2.1 (The R Foundation for Statistical Computing, Vienna, Austria). Univariable analyses consisted of the Shapiro-Wilk test of normality, Kruskal-Wallis rank sum test, and pairwise Wilcoxon rank sum test with multiple comparisons correction using the Bonferroni method. Statistical testing for multivariable analysis included the Kruskal-Wallis rank sum test, Spearman's rank correlation, and the negative binomial model. Results Results showed a statistically significant difference in median total encounter value between independently living individuals with ID compared to all other living situations, Χ2 = 4.230, df = 1, p-value = 0.040. Additionally, there is a significant association between medication count and total encounter count, rho = 0.341, S = 154322, p-value < 0.001. Conclusion The study showed that individuals with ID who live independently have fewer healthcare encounters compared to all other living situations. This may be due to various factors such as increased autonomy and free choice, increased barriers to healthcare, or better overall health requiring less medical attention in independently living individuals with ID.

Training programme for community service providers who support adults with intellectual disabilities: A systematic quantitative literature review of single-case research

BACKGROUND

Research on training direct support professionals to address challenging behaviour exhibited by adults with intellectual disabilities is essential in generating effective training approaches for this sector. This systematic review's objective was to evaluate the effects of training types and whether specific training delivery components influenced outcomes.

METHODS

Following PRISMA (2020) guidelines, 16 single-case design studies were included that directly evaluated behaviour change of service providers training for adults with intellectual disabilities in community settings. Study quality was assessed using Horner et al. (Exceptional Children, 2005, 71(2), 165-180) criteria. The database searched included Academic Search Complete, CINAHL, Embase, ERIC, Psych Info, and Web of Science.

RESULTS

Descriptive analysis of effect size outcomes suggested that all training types were associated with improved outcomes. Further, in situ training was associated with improved service provider performance. Interestingly, feedback was associated with poorer service provider performance.

CONCLUSIONS

We provide possible explanations for this surprising outcome and propose future research.

Current services and outcomes of formerly institutionalised and never-institutionalised US adults with intellectual and developmental disabilities: A propensity score matching analysis

BACKGROUND

Deinstitutionalization research shows better services and outcomes relative to institutional life but has not compared formerly institutionalised and never-institutionalised service users.

METHODS

We used propensity score matching (PSM) to match formerly institutionalised and never-institutionalised participants on six personal characteristics. Data came from the 2018 to 2019 National Core Indicators In-Person Survey. We excluded current institution residents, and states with 25% + of missing data on former institutionalisation.

RESULTS

Overall, 15.5% of participants in the 29-state full sample had lived in an institution for 1 year or more. Findings from the PSM sample showed that former-institution residents were more likely to use congregate living arrangements and less likely to live with family. They experienced more loneliness, less support-related choice, and had a consistent pattern of disability service-focused social connections.

CONCLUSIONS

Many former institution residents remain disadvantaged relative to matched peers. There is a need to identify factors to enhance services and outcomes following deinstitutionalization.

A community living experience: Views of people with intellectual disability with extensive support needs, families, and professionals

BACKGROUND

Despite the benefits of community living for people with intellectual disabilities (ID) and extensive support needs, they remain highly institutionalized.

AIMS

To qualitatively analyze the perceptions of people with ID, including those with extensive support needs, professionals, and family members six months after the implementation of 11 community homes for 47 people in different regions of Spain METHODS: Thematic analysis of 77 individual interviews conducted with 13 people with ID, 30 professionals and 34 family members was performed using Nvivo12.

RESULTS

Seven themes were found: (1) "the room as I like it", (2) "sometimes I don't obey", (3) "here I do a bit of everything", (4) "lots of people love me here", (5) "all thanks to them, who have helped me" (6) "I miss my mom", and (7) "I'm happy here".

IMPLICATIONS

Transitioning into the community has shown a clear positive change in emotional well-being, opportunities to participate in activities or exercise control over one's life. Nevertheless, certain restrictions were still present in people's lives, which significantly limit their right to independent living. While many of these restrictions may disappear, professional practices typical of a medical model can be recreated in services located in the community.

Adult Independence Living Measurement Scale: Psychometric validation of a scale to estimate personal skills for independent living in people with intellectual and developmental disabilities

BACKGROUND

The United Nations has declared that people with disabilities should be enabled to live as independently as possible, since independence is correlated with a better quality of life. Consequently, services need to have common and validated measurement tools for the evaluation of the different levels of personal support needs in order to promote independent living skills. We aimed to create and validate the Adult Independence Living Measurement Scale (AILMS) to estimate personal skills considered tantamount for independent living in adult persons with intellectual and developmental disabilities.

METHODS

AILMS is a short informant-rated assessment tool consisting of 19 items (goals) regarding the most important skills related to independent living. AILMS total score is directly proportional to the degree of independence, with scores ranging from 19 to 76. Our validation is a multicentre study attended by 243 subjects, 110 female and 123 males, with a median age of 37 years and with an interquartile range (IQR) of 18 (25th percentile [Q1] 29 years to 75th percentile [Q3] 47 years). All subjects had a diagnosis of intellectual disability associated with various neurodevelopmental disorders or syndromic conditions.

RESULTS

The AILMS shows a wide range of scores with a minimum score of 21 and a maximum of 72. We found no floor or ceiling effects for the total score on the AILMS. Cronbach's α coefficient (= 0.95), based on the 19 AILMS items, indicated high internal consistency. The tool demonstrates a very good agreement even when comparing the results submitted by two different interviewers. It also shows an excellent temporal stability of 1 week, with intraclass correlation coefficients both of 0.97. AILMS total scores do not differ by sex or age, while statistically significant differences are observed between people with different levels of severity of ID. Convergent validity of AILMS was analysed by correlating its total scores with the Italian validated versions of the Support Intensity Scale (SIS-I) and the Alzheimer's Functional Assessment Tool (AFAST-I) scores. Strong inverse Spearman correlations coefficients (r_s ) were found both for the Support Need Index of the SIS-I (r_s  = -0.66; P < 0.001) and AFAST-I (r_s  = -0.73; P < 0.001). Scores of support needs in exceptional health disorders of the SIS-I appear unrelated to AILMS total scores (r_s  = -0.01; P = 0.05), confirming the divergent validity of the new scale. Exploratory factor analysis reveals three underlying factors within the AILMS, with factor 1 explaining 51.2% of the total variance (Cronbach's α = 0.92) composed of predominantly nine advanced daily activities.

CONCLUSIONS

The AILMS has good psychometric properties and user friendliness and may therefore be a valuable addition to the current informant-rated tools for screening and assessment of independent living skills of individuals with intellectual and developmental disabilities.

Mortality in residential care facilities for people with disability: a descriptive cross-sectional analysis of statutory notifications in Ireland

OBJECTIVES

To determine incidence of death in residential care facilities for people with disability in Ireland, primary cause of death, associations of facility characteristics and deaths, and to compare characteristics of deaths reported as expected and unexpected.

DESIGN

Descriptive cross-sectional study.

SETTING

All residential care facilities for people with disability operational in Ireland in 2019 and 2020 (n=1356).

PARTICIPANTS

n=9483 beds.

MAIN OUTCOME MEASURES

All expected and unexpected deaths notified to the social services regulator. Cause of death as reported by the facility.

RESULTS

395 death notifications were received in 2019 (n=189) and 2020 (n=206). 45% (n=178) were for unexpected deaths. Incidence of death per 1000 beds per year was 20.83 for all, 11.44 for expected and 9.39 for unexpected deaths. Respiratory disease was the most common cause of death, accounting for 38% (n=151) of all deaths. In adjusted negative binomial regression analysis, congregated settings versus non-congregated (incidence rate ratio (95% CI): 2.59 (1.80 to 3.73)) and higher bed numbers (highest vs lowest quartile) (4.02 (2.19 to 7.40)) were positively associated with mortality. There was also a positive n-shaped association with category of nursing staff-to-resident ratio when compared with zero nurses. Emergency services were contacted for 6% of expected deaths. Of the deaths reported as unexpected, 29% were receiving palliative care and 10.8% had a terminal illness.

CONCLUSION

Although incidence of death was low, residents of congregated and larger settings had higher incidence of death than residents of other settings. This should be a consideration for practice and policy. Given the high contribution of respiratory diseases to deaths and the potential avoidability of these, there is a need for improved respiratory health management in this population. Nearly half of all deaths were reported as unexpected; however, overlap in the characteristics of expected and unexpected deaths highlights the need for clearer definitions.

Expectations of Personal Life Development and Decision-Making in People with Moderate Intellectual Disabilities

People with intellectual disabilities have a need for personal and social development that is often unknown or poorly understood. The main motivation is the fact that students belong to a group usually excluded from the ordinary educational process. That process is replaced with measures that focus on caring for students rather than promoting their development. The objective of this research is to understand the expectations for personal development and decision-making of students with intellectual disabilities. To achieve the stated objective, a qualitative research based on two complementary approaches, grounded theory and case study, has been employed. The sample (n = 28) was drawn from a specific study program for the training and development of people with intellectual disabilities at the University of Murcia, called "We are all Campus". We aim to identify the different perceptions of their reality and potential for personal development, to understand their decision-making and what motivates them. Likewise, we investigate the self-perceptions of students with intellectual disabilities have and their understanding of their future life expectations. The main conclusions show that the training program represents an opportunity for students' progression and personal development. Thus far, the expectations of the students have remained the same, focusing on their work and social inclusion.

The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement

BACKGROUND

People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted.

OBJECTIVE

The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions.

METHODS

A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021.

RESULTS

Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored.

CONCLUSIONS

Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.

Barriers and enablers to the implementation of healthy lifestyle interventions for people with disability living in supported accommodation: A systematic review using the consolidated framework for implementation research

BACKGROUND

People with disability living in supported accommodation often experience significant health disparities, despite the availability of additional support. Healthy lifestyle interventions have been identified as one key health promotion strategy. Implementation science offers an opportunity to explore the factors that influence the efficacy and sustainability of these interventions, yet its application in this context has been underutilized.

OBJECTIVE

This systematic review synthesized the barriers and enablers to the implementation of healthy lifestyle interventions delivered to people with disability living in supported accommodation settings.

METHODS

A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search for relevant literature published between January 2011 and November 2021 was conducted across six databases. The findings of included studies were coded and analyzed according to the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) via deductive content analysis.

RESULTS

Five studies were included, and their findings were mapped to 21 out of 38 constructs under the CFIR. Interventions from each study delivered health promotion education and training to staff and/or people with disability. The most prominent determinants that influenced implementation success included an intervention's relevance and its flexibility to adapt to the needs of people with disability, alongside organizational resourcing, and stakeholder endorsement in supporting implementation.

CONCLUSIONS

The CFIR provided a systematic approach to explore the implementation of healthy lifestyle interventions. However, further research that is grounded in and guided by implementation science theories is warranted. Despite the scarcity of literature, several compelling, yet preliminary recommendations were drawn from the findings.

Strategies for enhancing social skills of individuals with intellectual disability: A systematic review

Individuals with intellectual disability who suffer from comorbid mental health problems are likely to experience difficulties in socialising. Deficits in social skills are also associated with challenging behaviours and self-injury. This paper presents global evidence from a systematic review of literature on such issues as ‘interventions’; ‘social skills development’, and ‘individuals with intellectual disability’. A thorough search of various bibliographic databases identified 1 124 academic papers. Ten papers met the inclusion criteria for in-depth analysis concerning the use of interventions to develop social skills among individuals with intellectual disability. The study revealed that the social skills of individuals with intellectual disability had been fostered using different strategies, such as classroom-based intervention, emotional intelligence training, use of a peer network intervention, computer games of emotion regulation, and puppet play therapy. Furthermore, the findings suggest that various aspects like communication, bridging the gap in social skills deficits, emotional recognition and regulation, and adaptive behaviour were fostered using the identified intervention strategy. This review revealed that social skills interventions appeared modestly effective but may not be generalisable to school settings or self-reported social behaviour for individuals with intellectual disability. It is also necessary to increase the sample size in future studies to draw generalisable conclusions.

Identity-Focused Practice in Augmentative and Alternative Communication Services: A Framework to Support the Intersecting Identities of Individuals With Severe Disabilities

PURPOSE

The purpose of this clinical focus article is to consider a framework of identity in provision of services to individuals with severe disabilities who use augmentative and alternative communication (AAC).

METHOD

Components of the framework for identity include personal, social, and cultural areas. These aspects are identified in extant literature on AAC services and discussed through the lens of the Communication Bill of Rights (National Joint Committee for the Communication Needs of Persons with Severe Disabilities in 1992). Identity-focused practice is discussed as being relevant to self-determination and quality of life among individuals with severe disabilities.

RESULTS

A case study illustrates identity-focused practice in delivery of services to an adolescent who uses AAC, considering personal, social, and cultural identities.

CONCLUSIONS

This clinical focus article proposes a theoretical framework and provides a practice example for addressing the intersecting identities of individuals with severe disabilities. Furthermore, this clinical focus article argues that identity is a basic human right and area in which additional efforts are needed in the application of AAC solutions.

The potential for person-centred planning to support the community participation of adults with an intellectual disability

Person-centred planning (PCP) puts individuals with an intellectual disability at the centre of service and support planning, identifying how individuals wish to live their lives and what is needed to make that possible. PCP has been identified as having the potential to facilitate improved social inclusion and community participation. A mixed-methods approach combined quantitative analyses with qualitative case studies of individuals with severe-profound intellectual disability to assess the impact of PCP on community participation for adults with an intellectual disability at a disability service in Dublin. We conclude that PCP may provide a good basis to plan community participation and, with the right supports in place, may provide opportunities for people with complex needs to improve their community participation. Supports including familiar staff and family are critical to the success of PCP for people with complex needs, and their absence may undermine the best intentions of PCP for this population.

Community participation and staying home if you want: US adults with intellectual and developmental disabilities

BACKGROUND

Requiring adults with intellectual and developmental disabilities to go on community outings with co-residents and staff is contrary to community-living policy's focus on person centredness and choice of activities/companions.

METHOD

We analysed 2018-19 National Core Indicators data from 36 US states concerning 7968 adults living in staffed, non-family, multi-client settings. The focus outcome was being able to stay home if you want when others in your home go out.

RESULTS

The 42.0% of participants who could stay home were more likely to go out with friends, family or alone, and less likely to go out with staff. Those who could stay home participated in a similar variety of community activities and went out more often to shop or for errands.

CONCLUSIONS

Individuals who could stay home likely had more choice about where, when and with whom they went out. Strategies for greater person-centredness are proposed.

From Deinstitutionalization to Community-Based Urban Development: Investigating Accessibility of Urban Systems in Calabria through Network Analytics

Community-based urban development is an inclusive approach for local service provision and management centered on the proactive partnerships between urban communities and local governments. Rooted in the deinstitutionalization of public services, the European Union and national policy effort is pushing towards the organization of community-based alternatives in response to the evolving needs of local communities. As the pandemic has shown, service accessibility has proven to be a key concern element that needs to be addressed to increase communities’ and cities’ resilience. In this direction, the paper aims to propose data-driven alternative approaches to assess urban systems’ accessibility and connectivity as an element of leveraging the resilience-oriented planning process and facilitating community-based development. The methodological approach focuses on the case of the Calabria region, where community-based alternatives for the provision of public services found difficulties to be operationalized through an integrated planning approach. The case study is explored by experimenting on the spatial connections of two purposefully selected clusters to assess the accessibility and connectivity of urban systems within the region through network analysis visualization tools: health and social-related services and transportation and logistics. The analytical approach outlines the accessibility level of urban systems in the region examined, proving its relevance in detecting social, economic, and environmental dynamics. This approach shows how using non-traditional data-driven perspectives can detect development dynamics—which affect local community’s needs—and their limitations in the organization of community-based development alternatives.

Perceptions of people with mild intellectual disability and their family members about family-based social capital in the Netherlands

Families play an important role in the lives of people with intellectual disability as they do for everyone. However, little research has addressed the views of people with intellectual disability about their families by using self-report. Individual family members may hold different views about their family relationships. Therefore, we used a social capital theoretical perspective to examine (a) how perceptions of people with mild intellectual disability (MID) about their family support networks compare to those of their family members and (b) what factors are associated with any diverging perceptions. Randomly selected participants with MID (n = 111) and their family members (n = 111) were interviewed individually at their homes using the Family Network Method-Intellectual Disability (FNM-ID). The FNM-ID examines how people define their family groups and how they perceive existing supportive relationships within this group. The findings showed that participants with MID perceived that they had somewhat denser family networks (i.e., bonding social capital) than family members perceived them to have and were more likely to report bridging social capital. They reported more relationships that involved them providing support to family members. This difference in estimation was greater when the participant with MID displayed higher levels of externalizing behaviour problems. They also perceived more reciprocity in their relationships with family. No differences were found in the estimated numbers of significant family members and relationships in which support was received. It is concluded that people with MID and their family members have different perceptions on several aspects of the family support network. Family professionals and services should seek the views of people with intellectual disability and their family members when carrying out assessments or organizing supports.

Association of Intellectual Disability With All-Cause and Cause-Specific Mortality in Sweden

IMPORTANCE

Knowledge of the health challenges and mortality in people with intellectual disability (ID) should guide health policies and practices in contemporary society.

OBJECTIVE

To examine premature mortality in individuals with ID.

DESIGN, SETTING, AND PARTICIPANTS

This population-based longitudinal cohort study obtained data from several national health care, education, and population registers in Sweden. Two registers were used to identify individuals with ID: the National Patient Register and the Halmstad University Register on Pupils With Intellectual Disability. Two cohorts were created: cohort 1 comprised young adults (born between 1980 and 1991) with mild ID, and cohort 2 comprised individuals (born between 1932 and 2013) with mild ID or moderate to profound ID; each cohort had matched reference cohorts. Data analyses were conducted between June 1, 2020, and March 31, 2021.

EXPOSURES

Mild or moderate to profound ID.

MAIN OUTCOMES AND MEASURES

The primary outcome was overall (all-cause) mortality, and the secondary outcomes were cause-specific mortality and potentially avoidable mortality.

RESULTS

Cohort 1 included 13 541 young adults with mild ID (mean [SD] age at death, 24.53 [3.66] years; 7826 men [57.8%]), and its matched reference cohort consisted of 135 410 individuals. Cohort 2 included 24 059 individuals with mild ID (mean [SD] age at death, 52.01 [16.88] years; 13 649 male individuals [56.7%]) and 26 602 individuals with moderate to profound ID (mean [SD] age at death, 42.16 [21.68] years; 15 338 male individuals [57.7%]); its matched reference cohorts consisted of 240 590 individuals with mild ID and 266 020 with moderate to profound ID. Young adults with mild ID had increased overall mortality risk compared with the matched reference cohort (odds ratio [OR], 2.86; 95% CI, 2.33-3.50), specifically excess mortality in neoplasms (OR, 3.58; 95% CI, 2.02-6.35), diseases of the nervous system (OR, 40.00; 95% CI, 18.43-86.80) and circulatory system (OR, 9.24; 95% CI, 4.76-17.95). Among deaths that were amenable to health care (OR, 7.75; 95% CI, 4.85-12.39), 55% were attributed to epilepsy. In cohort 2, increased risk of overall mortality was observed among both individuals with mild ID (OR, 6.21; 95% CI, 5.79-6.66) and moderate to profound ID (OR, 13.15; 95% CI, 12.52-13.81) compared with the matched reference cohorts. Those with moderate to profound ID had a higher risk in several cause-of-death categories compared with those with mild ID or the matched reference cohort. Adjustment for epilepsy and congenital malformations attenuated the associations. The relative risk of premature death was higher in women (OR, 6.23; 95% CI, 4.42-8.79) than in men (OR, 1.99; 95% CI, 1.53-2.60), but the absolute risk of mortality was similar (0.9% for women vs 0.9% for men).

CONCLUSIONS AND RELEVANCE

This study found excess premature mortality and high risk of deaths with causes that were potentially amenable to health care intervention among people with ID. This finding suggests that this patient population faces persistent health challenges and inequality in health care encounters.

How using assistive technology for cognitive impairments improves the participation and self-determination of young adults with intellectual developmental disabilities

In Norway, where all citizens are entitled to live in their own homes in their local communities, people with intellectual disabilities receive community-based home care services that aim to promote their ability to live on their own. In our study, we investigated how using an assistive device for cognitive impairment - namely, a memo planner (MP) - in community-based home care services affected the everyday lives of people with intellectual developmental disabilities (IDD). Our sample consisted of seven young adults with IDD and their support staff. Data were collected during field observations and group interviews and analysed via systematic text condensation. The findings illuminate how using an MP can structure the daily lives of young adults with IDD and afford them opportunities to participate in everyday activities. In this article, we discuss how using an MP shapes interactions between people with IDD and their support staff.

Community Capacity to Provide Mental/Behavioral Health Services for People With IDD Transitioning From State-Operated Developmental Centers

The study's aim was to explore the capacity of community-based providers of residential supports and services to support people with intellectual and developmental disabilities who transitioned out of state-operated institutions into community-based settings. Receiving agency survey results from 65 agencies and individual-level variables of 2,499 people who had transitioned from an institution to a community-based setting indicated that people who returned to an institution post-transition tended to be younger, have a higher IQ score, were more likely to have a psychiatric diagnosis, tended to have shorter previous lengths of stay at an institution, transitioned to larger settings, and received services from an agency receiving behavioral health technical assistance as compared to those who remained in their transition settings.

Community Living, Intellectual Disability and Extensive Support Needs: A Rights-Based Approach to Assessment and Intervention

People with intellectual disability (ID) and extensive support needs experience poorer quality of life than their peers whose disability is not as severe. Many of them live in residential settings that limit community participation and prevent them from exercising control over their lives. This work analyzes the extent to which professional practices are aimed at promoting the right to community living for people with ID and extensive support needs, as well as the rights that are particularly linked to it, such as the right to habilitation and rehabilitation and the right to privacy. A specific questionnaire was designed and administered to 729 adults with intellectual disability (M = 37.05; DT = 12.79) living in different settings (family home, residential facilities and group homes). Measurement and structural models were estimated using exploratory structural equation modeling. Results obtained reveal that people with extensive support needs receive less support in terms of guaranteeing their right to independent living and privacy, especially when they live in disability-related services. This study highlights the need to implement and monitor, using valid and reliable indicators, mesosystem strategies that guarantee the right to live and participate in the community, especially for individuals with ID and extensive support needs.

Participation in daily life for adults with profound intellectual (and multiple) disabilities: How high do they climb on Shier's ladder of participation?

Participation is the goal of Swedish disability policy, but it is difficult to achieve for adults with profound intellectual (and multiple) disabilities (PI(M)D). Since these adults are dependent on others in every aspect of their lives, others control their ability to participate in everyday life decisions. This study used observations, analyzed with Shier's ladder of participation, to elucidate and describe participation in daily life for adults with PI(M)D living in a group home. The results showed that the adults often reached the first three levels of Shier's ladder, one adult reached the fourth level once, and no one reached the fifth level. Participation on a higher level, therefore, seems hard to reach for adults. Staff members' attitudes toward the adults' capability can also be a barrier to participation. Applying Shier's ladder of participation can provide valuable information that might lead to increased participation in daily life for adults with PI(M)D.

Staying connected during COVID-19: Family engagement with adults with developmental disabilities in supported accommodation

BACKGROUND

Enduring family engagement and informal support is crucial to the health and well-being of adults with developmental disabilities (DD) residing in supported accommodation. The COVID-19 pandemic and restrictive measures enforced in residential settings have resulted in changes in daily routine and modified the ways families can interact with and provide support to residents. Yet, the impact of these changes has not been empirically explored.

AIM

Explore how family caregivers have interacted with and supported their relatives with DD residing in supported accommodation during the pandemic.

METHODS

Changes in frequencies of communication modes and types of informal support were measured through a cross-sectional and anonymous online survey which completed by 108 family caregivers of adults with DD.

RESULTS

Most family caregivers adopted remote communication technologies; however, these were not perceived to be effective in filling the gap created by reduced face-to-face contact. While families were able to provide emotional support and advocacy using digital technologies, they were limited in their ability to provide significant social support.

CONCLUSIONS

Findings may help key stakeholders develop and implement novel strategies and policies to accommodate the changing circumstances and to ensure continuity of family engagement and informal support in the context of COVID-19.

The Importance of Self-Determination to the Quality of Life of People with Intellectual Disability: A Perspective

There is both an intuitive and theoretical link between self-determination and quality of life for people with intellectual and developmental disabilities. Theoretically, definitions of self-determination have framed the construct with regard to its contribution to a person’s overall quality of life, while theoretical frameworks of quality of life have included self-determination among the core dimensions contributing to enhanced quality of life. These theoretical linkages have been supported by research on the quality of life and self-determination of people with intellectual and developmental disabilities and the relationships between these constructs. This article provides an overview of theoretical frameworks of self-determination, their relationship with theoretical frameworks of quality of life, and research pertaining to these constructs with people with intellectual and developmental disabilities. It is concluded that self-determination and quality of life are important constructs in designing supports that enable people with intellectual and developmental disabilities and that an important means to enhance the quality of life of people with intellectual and developmental disabilities is to promote and enable people to be self-determined.

Promoting Physical Activity in Group Home Settings: Staff Perspectives through a SWOT Analysis

PURPOSE

The aim of the study was to investigate perceptions of staff about the promotion of physical activity (PA) in selected group residences of Hong Kong (HK), some of which had experienced a multi-component PA program.

METHOD

Focus group interviews with nineteen staff members from four group homes (two of which received the program) were conducted.

FINDINGS

A SWOT analysis provided important insights into residential staff views about key influences on the quality of PA programs for residents with intellectual disabilities (ID). Positive (strengths and opportunities) and negative (weaknesses and threats) influences were identified. They were associated with characteristics of residents, staff, and group residence. Increasing age and low motivation are impediments to PA engagement of adults with ID. Staff competence and prior unsuccessful experience in promoting PA are also implicated.

CONCLUSION

The PA program quality is mediated by the quality of staff interpersonal interactions with their clients and their commitment in encouraging such adults with ID to join and persistent in PA as well as staff seeking external resources and support as well as using initiative to adapt PA promotion activities in their specific group residential context.

Individualized Apartment Accommodation for People With Intellectual Disability: Protocol for a Qualitative Study Examining the Well-Being and Support Outcomes Linking Housing and Health

Background

Understanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting.

Objective

The aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided.

Methods

Qualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings.

Results

As of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020.

Conclusions

This paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18248

The outcomes of individualized housing for people with disability and complex needs: a scoping review

PURPOSE

Worldwide, disability systems are moving away from congregated living towards individualized models of housing. Individualized housing aims to provide choice regarding living arrangements and the option to live in houses in the community, just like people without disability. The purpose of this scoping review was to determine what is currently known about outcomes associated with individualized housing for adults with disability and complex needs.

METHODS

Five databases were systematically searched to find studies that reported on outcomes associated with individualized housing for adults (aged 18-65 years) with disability and complex needs.

RESULTS

Individualized housing was positively associated with human rights (i.e., self-determination, choice and autonomy) outcomes. Individualized housing also demonstrated favourable outcomes in regards to domestic tasks, social relationships, challenging behaviour and mood. However, outcomes regarding adaptive behaviour, self-care, scheduled activities and safety showed no difference, or less favourable results, when compared to group homes.

CONCLUSIONS

The literature indicates that individualized housing has favourable outcomes for people with disability, particularly for human rights. Quality formal and informal supports were identified as important for positive outcomes in individualized housing. Future research should use clear and consistent terminology and longitudinal research methods to investigate individualized housing outcomes for people with disability.Implications for rehabilitationIndividualized housing models can foster self-determination, choice and autonomy for adults with disability and complex needs.Having alignment between paid and informal support is important for positive outcomes of individualized housing arrangements.A more substantial evidence base regarding individualized housing outcomes, in particular long-term outcomes, and outcomes for people with an acquired disability, is required.

Development of Deaf Adults with Intellectual Disability in a Therapeutic Living Community

People with intellectual disabilities who are deaf face obstacles participating in social environments that do not take into account their need for accessible visual communication. In the present case series, we describe the development of the adaptive skills profiles of eight participants in a fully inclusive therapeutic living community, designed specifically for people with developmental disabilities who are deaf and focused on supporting communication, social relationships, conflict resolution, and work satisfaction. Adaptive skills ratings collected at enrollment and twelve years later suggest increases in social awareness and community living, whereas personal care and homemaking showed relatively little change.

Dimensions of group home culture as predictors of quality of life outcomes

Background

Research has shown that there is variability in quality of life (QOL) outcomes for people with intellectual disabilities who live in group homes. The aim was to examine dimensions of group home culture as predictors of QOL outcomes.

Method

The Group Home Culture Scale (GHCS) was used to measure staff perceptions of culture in 23 group homes. QOL data were available from 98 people with intellectual disabilities. Multilevel modelling was used to examine the associations between the GHCS subscales and four QOL‐dependent variables.

Results

Of the GHCS subscales, Effective Team Leadership and Alignment of Staff with Organizational Values significantly predicted residents’ engagement in activities. Supporting Well‐Being significantly predicted residents’ community involvement. None of the GHCS subscales significantly predicted domestic participation and choice making.

Conclusions

The findings suggest that strategies to improve Effective Team Leadership and Supporting Well‐Being dimensions of culture may contribute to enhancing certain QOL outcomes.

Psychiatric symptoms, challenging behaviour and utilization of psychiatric services among adults with intellectual disabilities in Turkey

BACKGROUND

The aim of this study was to investigate the prevalence of and the factors associated with psychiatric symptoms (PS) and challenging behaviour (CB) in adults with intellectual disabilities, and the utilization of psychiatric services in Turkey.

METHOD

Psychiatric Assessment Schedule for Adults with Developmental Disorders Checklist-Revised was used for PS and a structured form for other variables in 771 participants.

RESULTS

Of the participants, 50.1% had PS and 36.4% presented with CB. Multivariate analysis revealed that a higher level of needs, better verbal ability, residential living, incontinence and CB, and lifetime suicidal ideation/attempt were independently associated with PS. For CB, it emerged as male carer, PS, lifetime suicidal attempt/ideation, lower level of verbal ability and autism spectrum disorder. Barriers were experienced by 64.7% of participants within the previous year.

CONCLUSIONS

Psychiatric symptoms and CB seem to be problems for a significant proportion of adults with intellectual disabilities in Turkey, and there are certain barriers to psychiatric services.

Development and psychometric evaluation of the Group Home Culture Scale

BACKGROUND

Organizational culture in group homes for people with intellectual disabilities has been identified as influencing staff behaviour and residents' quality of life (QOL). Despite this influence, culture has been under-researched, with no published and validated instrument to measure its dimensions in group homes. The aim was to develop such a measure.

METHOD

The Group Home Culture Scale (GHCS) was developed using a theory-driven approach. Items were generated from the research literature, which were reviewed by experts and tested in cognitive interviews. Data from 343 front-line staff were used for exploratory factor analysis.

RESULTS

The content and face validity of the GHCS were found to be acceptable. Exploratory factor analysis indicated that the GHCS measured seven dimensions of group home culture. Cronbach's alpha for the dimensions ranged from 0.81 to 0.92.

CONCLUSIONS

The GHCS has potential use in research to determine whether dimensions of group home culture predict the quality of staff support and residents' QOL.

Observed Dietary Intake in Adults with Intellectual Disability Living in Group Homes

Background: There is limited information on the dietary intakes of people with intellectual disability (ID) living in group homes. Objective: To describe and evaluate dietary intake in people with ID. Method: Dietary intake was assessed in a convenience sample of people with ID living in group homes. Dietary assessment used three-day weighed food records and digital food photography. Intakes were compared to the Nutrient Reference Values (NRVs) and dietary recommendations. Results: A sample of 33 adults, (men (M): n = 14; women (W): n = 19), mean age 51 ± 14 years, was recruited from seven group homes. Mean daily energy intake was low (M: 7.4 MJ; W: 7.0 MJ; p = 0.46), similar to levels recommended for bed rest. Many participants had intakes below the estimated average requirements (EARs) for the nutrients, magnesium (M: 86%; W: 63%), calcium (M: 43%; W: 78%), iodine (M: 43%; W: 47%) and zinc (M: 43%). Less than half of the recommended daily servings were consumed for vegetables (men and women) and dairy foods (women). Conclusion: Nutrient intake and diet quality of the participants in the group homes studied was poor. Education and policy to support healthier diets is required to improve dietary intake of people with intellectual disability, living in group homes.

A case-study of policy change in residential service provision for adult persons with intellectual disability in Ireland

In Europe, many people with intellectual disabilities continue to live in congregated settings. In 2012, Ireland formally introduced a resettlement policy with people moving to live in more personalised arrangements. This longitudinal country case-study aimed to monitor the implementation of this policy and the intra-country variations that arose using the records maintained in the National Intellectual Disability Database. Details of over 4,000 people living in congregated settings were examined in 2007 and again in 2012 and 2017. In addition, people who moved from such settings from 2007 onwards were tracked and the number of new admissions to them was estimated over the 10-year period. Overall there was nearly a 30% drop in the numbers of people in congregated settings but the reductions varied markedly across the country and by 2017 the disparity was greater than in 2007. Also by 2017 persons aged over 55 years were eight times more likely to be accommodated in congregated settings. The case-study illustrates the value of a longitudinal dataset for monitoring policy implementation across a diversity of provider organisations and administrative areas.

How service-users with intellectual disabilities understand challenging behaviour and approaches to managing it

BACKGROUND

This study explored understandings that service-users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well-being.

METHODS

Eight participants (three female, five male) partook in individual semi-structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis.

RESULTS

Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long-term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day-to-day life was perceived to reduce challenging behaviour in the long term.

CONCLUSIONS

Implications for practice are discussed.

[Autism spectrum disorders in adults with intellectual disabilities : Frequencies and characteristics]

OBJECTIVE

Collation of frequencies and clinical characteristics of autism spectrum disorders (ASD) in persons with intellectual disability (ID).

METHODS

Cross-sectional analysis of a clinical psychiatric sample of 710 adults with ID and mental disorders.

RESULTS

The frequency of ASD in an adult sample with ID was 19%. The occurrence of ASD was associated with a higher severity of ID, male gender (in mild to moderate ID), anticonvulsive therapy and reduced employment rates in workshops.

CONCLUSION

The ASD are a frequent clinical diagnosis in adults with ID.

Effect of deinstitutionalisation on quality of life for adults with intellectual disabilities: a systematic review

OBJECTIVE

To review systematically the evidence on how deinstitutionalisation affects quality of life (QoL) for adults with intellectual disabilities.

DESIGN

Systematic review.

POPULATION

Adults (aged 18 years and over) with intellectual disabilities.

INTERVENTIONS

A move from residential to community setting.

PRIMARY AND SECONDARY OUTCOME MEASURES

Studies were eligible if evaluating effect on QoL or life quality, as defined by study authors.

SEARCH

We searched MEDLINE, PsycINFO, CENTRAL, CINAHL, EconLit, Embase and Scopus to September 2017 and supplemented this with grey literature searches. We assessed study quality using the Critical Appraisal Skills Programme suite of tools, excluding those judged to be of poor methodological quality.

RESULTS

Thirteen studies were included; eight quantitative studies, two qualitative, two mixed methods studies and one case study. There was substantial agreement across quantitative and qualitative studies that a move to community living was associated with improved QoL. QoL for people with any level of intellectual disabilities who move from any type of institutional setting to any type of community setting was increased at up to 1 year postmove (standardised mean difference [SMD] 2.03; 95% CI [1.21 to 2.85], five studies, 246 participants) and beyond 1 year postmove (SMD 2.34. 95% CI [0.49 to 4.20], three studies, 160 participants), with total QoL change scores higher at 24 months comparative to 12 months, regardless of QoL measure used.

CONCLUSION

Our systematic review demonstrated a consistent pattern that moving to the community was associated with improved QoL compared with the institution. It is recommended that gaps in the evidence base, for example, with regard to growing populations of older people with intellectual disability and complex needs are addressed.

PROSPERO REGISTRATION NUMBER

CRD42018077406.

The antecedents of loneliness in older people with an intellectual disability

INTRODUCTION

The cognitive discrepancy approach to loneliness is often used to describe loneliness in ageing populations, but to date, it has never been used to explore loneliness in older people with an intellectual disability. An analysis is needed utilising a refined list of causes of loneliness in this population.

METHOD

Using data from a nationally representative dataset of people aged over 40 with an intellectual disability (N = 708), this analysis runs repeated regressions of variables grouped into conceptual blocks, organised from sociodemographic to network quality.

RESULTS

Variables selected predicted 23% of the loneliness variance. Functional limitations, education, working in the community, transport difficulties, pain, stress caused by service change, emotional health problems and confiding were all significant predictors of loneliness.

CONCLUSION

That for those with fewer functional limitations only transport difficulties precipitated loneliness, suggests living a more independent life protects from loneliness, in this group. Those with functional limitations and who lead a more service dependent life appear more exposed to loneliness precipitating variables.

Place and community inclusion: Locational patterns of supportive housing for people with intellectual disability and people with psychiatric disorders

PURPOSE

This study examines the locational patterns of publicly-funded supportive housing for people with intellectual disability (people with ID) and people with psychiatric disorders (people with PD).

METHODS

Administrative data provided housing locations of 4599 people with ID and people with PD in one urban county and one suburban county in the United States. Census tract data captured neighborhood characteristics. Descriptive statistics and spatial analysis were used to analyze the distribution of supportive housing sites.

RESULTS

People with ID were more dispersed across a larger number of census tracts with smaller number of residents per tract than people with PD. While spatial dispersion in favor of people with ID was consistent across both counties, difference in dispersion was more pronounced in the urban county. People with PD were concentrated in neighborhoods with more socio-economic disadvantage, more residential instability, and a higher level of race/ethnic diversity than people with ID.

CONCLUSION

This study suggests that spatial-analytic method can serve as a useful tool for assessing the extent to which integrated housing is achieved for people with ID and people with PD. Interpretation of findings should be given due consideration of the policy context and neighborhood characteristics of the study communities.

The exercise of human rights and citizenship by older adults with an intellectual disability in Ireland

BACKGROUND

The UN Convention on the Rights of Persons with Disabilities (CRPD) provides the benchmark for assessing human rights and citizenship for people with disabilities. This emphasises autonomy, choice, independence, equality and participation for individuals as its fundamental guiding principles.

METHODS

This paper explores the exercise of human rights and citizenship for older adults with intellectual disabilities (ID) in Ireland, including choice-making, advocacy and political participation. Cross-sectional data (n = 701) is drawn from wave 2 of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing. Rates of participation are reported, along with bivariate associations across a range of demographic, personal and social variables, while factors associated with level of choice-making and voting are explored.

RESULTS

We found very low rates of choice-making, advocacy and political participation amongst this population. Two factors of choice were explored: key life choice and everyday choice. Some commonalities were identified between the two factors, yet key differences were also noted. Type of residence was the strongest predictor of key life choice yet not significant in everyday choice, while the reverse was true for functioning in activities of daily living. Other factors were also significant in determining choice, including level of ID, contact with family, functional limitation, literacy, age, having friends and respondent type.

CONCLUSIONS

Low rates of participation reported here impinge on the rights of older adults with ID under the principles of the UN CRPD. Choice-making emerged as a multi-factorial phenomenon, with different factors important depending on the type of choice involved. This encourages a nuanced and personalised response from policy and support services to overcome individual challenges to participation as equal citizens. The significance of respondent type also highlights the difficulty of including self-report, supported and proxy participants in ID research.

Staff members and managers' views of the conditions for the participation of adults with profound intellectual and multiple disabilities

BACKGROUND

Participation is a central aspect of quality of life, and it is indicative of high-quality outcomes for people with intellectual disabilities. However, participation is difficult to achieve for adults with profound intellectual and multiple disabilities.

AIM

To describe staff members' perceptions of what participation means for adults with profound intellectual and multiple disabilities.

METHOD

Using a phenomenographic approach, 27 interviews were analysed resulting in variations in the conditions for participation.

RESULTS

The interviews revealed conditions for participation at individual, staff and organisational levels.

CONCLUSION

Participation appears to be an un-reflected phenomenon, and several conditions must be met to achieve it. The conditions are experienced being fundamental for adults within the target group to achieve any kind of participation. The staff members and managers' perceptions of participation as conditional can make it more difficult for adults within the target group to achieve the Swedish disability policy goal of participation.

Irish persons with intellectual disability moving from family care to residential accommodation in a period of austerity

BACKGROUND

Ireland has a growing population of adult persons living with family carers, thereby increasing the demand for residential places. Simultaneously, government policy aimed to reprovision residents living in congregated settings but at a time when funding was curtailed due to the economic crisis. This study examines the movements of people into and among three types of residential options between 2009 and 2014.

METHOD

A cohort of 20,163 persons recorded on the National Intellectual Disability Database in 2009 was identified and tracked to the 2014 database.

RESULTS

An estimated 200 persons per annum (@1.6% of those living with families) moved from family care although the number of places available nationally fell by 9%. Moreover, transfers of existing residents into vacated places tended to exceed those from families.

CONCLUSIONS

More people will have to continue living with their families and for longer if funding for new places remains curtailed.

Does assistive technology contribute to social inclusion for people with intellectual disability? A systematic review protocol

INTRODUCTION

The aim of this review is to answer the following question: Does assistive technology contribute to social inclusion for people with intellectual disability? Previous research on assistive technology has focused on socioeconomic impacts such as education, employment and access to healthcare by people with intellectual disability. There is a need to consolidate evidence on the interaction between intellectual disability, assistive technology, community living and social inclusion.

METHODS AND ANALYSIS

The review will consider studies from all settings: geographical, socioeconomic and care (institutional and community care), published in English. Studies reported in other languages with abstracts in English will be included if they can be translated using Google Translate, otherwise such studies will be included in the appendix. The review will include both qualitative and quantitative studies. The intervention in this review refers to the use of assistive technology to promote community participation or interpersonal relationships (social inclusion) for people with intellectual disability. The outcomes will be behavioural and social benefits of using assistive technology by people with intellectual disability. Enhanced interpersonal relationships and community participation by people with intellectual disability. Data analysis will be in two phases. The first phase will involve analysis of individual study designs separately. The second phase will be narrative/thematic synthesis of all study groups.

ETHICS

The review will not create any ethical or safety concerns.

DISSEMINATION

At least one peer-reviewed article in a leading journal such as the BMJ is planned. The findings will also be disseminated through a seminar session involving internal audience at Trinity College Dublin and within the Assistive Technologies for people with Intellectual Disability and Autism research programme.

PROSPERO REGISTRATION NUMBER

CRD42017065447; Pre-results.

Evaluating the Impact of a Clinician Improvement Program for Treating Patients with Intellectual and Developmental Disabilities: The Challenging Case of Mississippi

In recent years, people with intellectual and developmental disabilities (IDD) have moved from institutionalized settings to local community residences. While deinstitutionalization has yielded quality of life improvements for people with IDD, this transition presents significant health-related challenges. Community clinicians have typically not been trained to provide sound medical care to people with IDD, a subpopulation that exhibits unique medical needs and significant health disparities. This study reports the results of a comprehensive evaluation of an IDD-focused clinician improvement program implemented throughout Mississippi. DETECT (Developmental Evaluation, Training and Consultative Team) was formed to equip Mississippi’s physicians and nurses to offer competent medical care to people with IDD living in community residences. Given the state’s pronounced health disparities and its clinician shortage, Mississippi offers a stringent test of program effectiveness. Results of objective survey indicators and subjective rating barometers administered before and after clinician educational seminars reveal robust statistically significant differences in clinician knowledge and self-assessed competence related to treating people with IDD. These results withstand controls for various confounding factors. Positive post-only results were also evident in a related program designed specifically for medical students. The study concludes by specifying a number of implications, including potential avenues for the wider dissemination of this program and promising directions for future research.