Pub Date : 2020-05-18DOI: 10.1108/amhid-10-2019-0030
A. Clifford, Francesca Georgina Kemp
“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation.,Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis.,Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence.,Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources.,The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.
{"title":"A pragmatic mixed-methods review of changing “case-complexity” of referrals to an intensive support service","authors":"A. Clifford, Francesca Georgina Kemp","doi":"10.1108/amhid-10-2019-0030","DOIUrl":"https://doi.org/10.1108/amhid-10-2019-0030","url":null,"abstract":"“Case-complexity” is a widely used but under-explored concept across health and social care. A region’s Intensive Support Teams (ISTs) had been reporting an increase in “case-complexity”, but had not tested this hypothesis against data. This study aims to investigate this question through a pragmatic mixed-methods approach as part of a wider service evaluation.,Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD) scores were used (n = 1,766) to estimate average “case-complexity” of referrals over an eight-year sample period. Two focus groups for IST staff (n = 18) explored why “case-complexity” appears to be increasing. Participant perspectives were subjected to thematic analysis.,Average HoNOS-LD scores have steadily increased over the sample period, suggestive of increasing “case-complexity”. Focus groups identified three broad themes to potentially explain the increased complexity: effects of Transforming Care; people’s changing and unchanging support systems; and issues related to mild and borderline intellectual disability. Many perspectives are grounded in or supported by evidence.,Implications and limitations of findings are discussed, including areas for further consideration and research. The well-designed “short-cut” is promoted as a strategy for busy professionals in need of practice-based evidence but with limited research time and resources.,The findings and discussion will be of value to anyone involved in the design, commissioning and delivery of mental health and challenging behaviour services to people with intellectual and developmental disabilities (IDD) under Transforming Care. Study methodology is easily replicable to build broader picture about “case-complexity” among UK’s IDD population.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-10-2019-0030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48776476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-11DOI: 10.1108/amhid-12-2019-0044
L. Thoms, A. Idowu, Arjun Nehra, A. Biswas
There is high incidence of dementia in individuals with Down’s syndrome. Much of the emphasis has been on Alzheimer’s disease as being most prevalent; however, it is apparent that other dementia types are also likely, to which this patient cohort may be predisposed. Specifically, this paper aims to highlight the potential for subcortical dementias in Down’s syndrome, suggesting a role for broader cognitive screening in aging individuals.,This paper describes a case of a female with Down’s syndrome and mild intellectual disability who presented with early signs of distinctive cognitive impairment and radiological calcification of the basal ganglia.,An active 42-year-old lady, who was mostly independent of activities of daily living and in part-time employment, presented with a three-year history of progressive cognitive deficit, characteristic of subcortical decline. She had no personal or known family history of mental illness, epilepsy or dementia. Routine blood tests showed chronic renal impairment, mild hypocalcaemia and vitamin D deficiency, managed by her GP. CT scan showed only bilateral basal ganglia calcification.,There is a widespread appreciation for the link between Down’s syndrome and Alzheimer’s disease but lesser consideration of the possibility of subcortical dementias. Given the differential nature and presentation of the two dementias, this case report highlights a need for clinicians to consider both to effectively manage these patients in the longer-term. Screening is discussed as a potential means of achieving this.
{"title":"Significance of Basal ganglia calcification in Down's syndrome","authors":"L. Thoms, A. Idowu, Arjun Nehra, A. Biswas","doi":"10.1108/amhid-12-2019-0044","DOIUrl":"https://doi.org/10.1108/amhid-12-2019-0044","url":null,"abstract":"There is high incidence of dementia in individuals with Down’s syndrome. Much of the emphasis has been on Alzheimer’s disease as being most prevalent; however, it is apparent that other dementia types are also likely, to which this patient cohort may be predisposed. Specifically, this paper aims to highlight the potential for subcortical dementias in Down’s syndrome, suggesting a role for broader cognitive screening in aging individuals.,This paper describes a case of a female with Down’s syndrome and mild intellectual disability who presented with early signs of distinctive cognitive impairment and radiological calcification of the basal ganglia.,An active 42-year-old lady, who was mostly independent of activities of daily living and in part-time employment, presented with a three-year history of progressive cognitive deficit, characteristic of subcortical decline. She had no personal or known family history of mental illness, epilepsy or dementia. Routine blood tests showed chronic renal impairment, mild hypocalcaemia and vitamin D deficiency, managed by her GP. CT scan showed only bilateral basal ganglia calcification.,There is a widespread appreciation for the link between Down’s syndrome and Alzheimer’s disease but lesser consideration of the possibility of subcortical dementias. Given the differential nature and presentation of the two dementias, this case report highlights a need for clinicians to consider both to effectively manage these patients in the longer-term. Screening is discussed as a potential means of achieving this.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-12-2019-0044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42400178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-09DOI: 10.1108/amhid-07-2018-0032
S. Mattock, K. Beard, A. Baddeley
Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful.,A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis.,Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to.,Including a SU in the planning and facilitation of the focus group would have made this research more inclusive.,The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted.,Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.
{"title":"“When other people try to understand”: exploring the experiences of people with intellectual disabilities, who also have mental health problems","authors":"S. Mattock, K. Beard, A. Baddeley","doi":"10.1108/amhid-07-2018-0032","DOIUrl":"https://doi.org/10.1108/amhid-07-2018-0032","url":null,"abstract":"Recent guidelines from the National Institute of Health and Care Excellence highlight that service users (SUs) with intellectual disabilities and co-occurring mental health problems rarely get the opportunity to share their experiences of mental health services. Over the past 20 years, policy documents have stated that these individuals (SUs) must be included in decisions about their care. Research suggests that often this is not the case. Therefore, this paper aims to create a space for SUs to share their experiences of mental health services, and what they found helpful.,A focus group was held with five SUs, two psychologists and two researchers. The audio recording of the discussion was transcribed and analysed using thematic analysis.,Three main themes were identified, namely, “relationships with others”, “inclusion and communication” and “challenges”. This focus group highlighted that although some SUs felt supported, they reported having little control in their lives and wanted to be listened to.,Including a SU in the planning and facilitation of the focus group would have made this research more inclusive.,The implications of this research suggest that by listening to and involving SUs and developing more person-centred services, recovery rates may increase as the services provided would be more targeted.,Very little research has previously been conducted to explore SUs’ experiences. This paper highlights the value of being heard and the knowledge that is often lost if the authors do not take the time to listen to the people for whom a service is designed.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-07-2018-0032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42881729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-08DOI: 10.1108/amhid-11-2019-0039
Raghavendar Baburaj, H. Dunstall, C. Bright, C. Lawthom
Epilepsy is a chronic illness affecting around 50 million people worldwide. Levetiracetam is an effective novel antiepileptic drug but can cause behavioural adverse events. A total of 10-15 per cent people with intellectual disability (ID) already present with Behaviour that Challenges (BtC). Brivaracetam is postulated to have a distinct pharmacological profile compared with levetiracetam which may result in fewer behavioural adverse events.,This paper presents two cases of people with epilepsy and ID being switched from levetiracetam to brivaracetam for reported behaviour adverse events.,The cases support that people with epilepsy and ID who are experiencing behavioural adverse events from levetiracetam can safely be switched to brivaracetam, resulting in significant reductions in BtC and potentially improved seizure control. Nevertheless, these results must be interpreted with caution, as aetiology for BtC in people with ID is often multifactorial.,This is one of the first papers to date, according to the best of the authors’ knowledge, to describe improved behavioural profile in people with ID and epilepsy when switching from levetiracetam to brivaracetam.
{"title":"Case reports of improvement in behaviour following switching of patients with intellectual disability and epilepsy from levetiracetam to brivaracetam","authors":"Raghavendar Baburaj, H. Dunstall, C. Bright, C. Lawthom","doi":"10.1108/amhid-11-2019-0039","DOIUrl":"https://doi.org/10.1108/amhid-11-2019-0039","url":null,"abstract":"Epilepsy is a chronic illness affecting around 50 million people worldwide. Levetiracetam is an effective novel antiepileptic drug but can cause behavioural adverse events. A total of 10-15 per cent people with intellectual disability (ID) already present with Behaviour that Challenges (BtC). Brivaracetam is postulated to have a distinct pharmacological profile compared with levetiracetam which may result in fewer behavioural adverse events.,This paper presents two cases of people with epilepsy and ID being switched from levetiracetam to brivaracetam for reported behaviour adverse events.,The cases support that people with epilepsy and ID who are experiencing behavioural adverse events from levetiracetam can safely be switched to brivaracetam, resulting in significant reductions in BtC and potentially improved seizure control. Nevertheless, these results must be interpreted with caution, as aetiology for BtC in people with ID is often multifactorial.,This is one of the first papers to date, according to the best of the authors’ knowledge, to describe improved behavioural profile in people with ID and epilepsy when switching from levetiracetam to brivaracetam.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-11-2019-0039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43173105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-01DOI: 10.1108/amhid-11-2019-0037
J. Himmerich
Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID.,A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review.,Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID.,Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions.,This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.
{"title":"Psychodynamic psychotherapy in severe and profound intellectual disability","authors":"J. Himmerich","doi":"10.1108/amhid-11-2019-0037","DOIUrl":"https://doi.org/10.1108/amhid-11-2019-0037","url":null,"abstract":"Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID.,A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review.,Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID.,Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions.,This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-11-2019-0037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49117768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-09DOI: 10.1108/amhid-10-2019-0031
C. Patterson, Jonathan Williams, Robert Jones
There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT.,The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria.,In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies.,To the best of the authors’ knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity.
{"title":"DBT and intellectual disabilities: the relationship between treatment fidelity and therapeutic adaptation","authors":"C. Patterson, Jonathan Williams, Robert Jones","doi":"10.1108/amhid-10-2019-0031","DOIUrl":"https://doi.org/10.1108/amhid-10-2019-0031","url":null,"abstract":"There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT.,The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria.,In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies.,To the best of the authors’ knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-10-2019-0031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45036580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-12DOI: 10.1108/amhid-07-2019-0020
G. Lines, Jodie Allen, Caryl Marshall
People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID.,An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed.,Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone.,The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias.,UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group.,This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID.
{"title":"Does training adequately equip psychiatrists for intellectual disability?","authors":"G. Lines, Jodie Allen, Caryl Marshall","doi":"10.1108/amhid-07-2019-0020","DOIUrl":"https://doi.org/10.1108/amhid-07-2019-0020","url":null,"abstract":"People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID.,An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed.,Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone.,The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias.,UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group.,This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-07-2019-0020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43543950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-03DOI: 10.1108/amhid-09-2019-0027
Faye Bohen, Ceri Woodrow
The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England.,A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement.,The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings.,Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended.,The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.
动态支持数据库(dynamic support database, DSD)临床支持工具对智力障碍患者的入院风险进行分级。本研究旨在调查英格兰西北部多学科卫生保健专业人员之间的评级信度。一项小规模定量研究调查了评分者对DSD临床支持工具的可靠性。使用了30个人的60个评级工具的数据集。描述性统计和Kappa系数探讨一致性。研究发现，DSD临床支持工具在单个项目之间具有很强的评分间信度，并且个体得分之间的差异被分散，这表明所发现的差异不能归因于特定问题。在总体评分中发现了很强的评分者之间的可靠性。结果表明，DSD临床支持工具提供了入院风险分级的分层，而不依赖于谁完成了该分级。未来的研究可以调查组织之间的可靠性，即卫生和社会护理专业人员，并使用更大的数据样本，以确保普遍性。还建议在儿童和青少年服务中使用儿童DSD临床支持工具复制该研究。在整个西北地区的儿童和成人智障服务中，已经实施了DSD临床支持工具。随着英格兰越来越多的团队考虑实施，这项研究提供了保证，编码一致性很高，允许独立于评分者的入院风险分层。
{"title":"Dynamic support database clinical support tool: inter-rater reliability","authors":"Faye Bohen, Ceri Woodrow","doi":"10.1108/amhid-09-2019-0027","DOIUrl":"https://doi.org/10.1108/amhid-09-2019-0027","url":null,"abstract":"The dynamic support database (DSD) clinical support tool structures the risk of admission rating for individuals with intellectual disabilities. This study aims to investigate inter-rater reliability between multi-disciplinary health care professionals within the North West of England.,A small-scale quantitative study investigated reliability between raters on the DSD clinical support tool. A data set of 60 rating tools for 30 individuals was used. Descriptive statistics and Kappa coefficient explored agreement.,The DSD clinical support tool was found to have strong inter-rater reliability between individual items and the differences between individual scores were spread suggesting variance found could not be attributed to specific questions. Strong inter-rater reliability was found in the overall ratings.,Results suggest the DSD clinical support tool provides stratification for risk of admission ratings independent of who completes it. Future studies could investigate inter-rater reliability between organisations, i.e. health and social care professionals, and use a larger data sample to ensure generalisability. Replication of the study within child and adolescent services using the children’s DSD clinical support tool is also recommended.,The DSD clinical support tool has been implemented within the child and adult intellectual disability services across the North West. As more teams across England consider its implementation, the study provides reassurance that coding agreement is high, allowing for stratification for risk of admission independent of the rater.","PeriodicalId":44693,"journal":{"name":"Advances in Mental Health and Intellectual Disabilities","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2020-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1108/amhid-09-2019-0027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44384295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-23DOI: 10.1108/amhid-05-2019-0013
R. Turton
Purpose The purpose of this study is to identify clinically meaningful groups of Health of the Nation Scales Learning Disabilities (HONOS-LD) single-item scales that might be used as short scales that are more reliable than single-item scale scores and more focused than the sum of scale scores. The single-item scales are likely to be unreliable in many applications. The sum of scale scores is a heterogeneous measure that is not a good representative of any specific difficulties that people who have intellectual disabilities may have and the effects of interventions on any specific difficulties may be masked by fluctuations in the ratings of other scales. Design/methodology/approach A total of 2,109 pseudonymised complete HONOS-LD ratings were factor-analysed using principal factor extraction and oblimin rotation. Three-, four- and five-factor rotated patterns were examined. Findings Three factors that each have three or more strong loadings (≥|0.50|) were identified that jointly included 11 single-item scales: one representing problems with cognitive competencies, one representing depressive phenomena or other mood problems and one representing problems with social competencies. A weaker factor that represents behaviour that challenges services is indicated; it includes five single-item scales. Both the cognitive competencies and social competencies groups of items were also reported in a previous study by Skelly and D’Antonio (2008) and may be stable. The present study’s factor representing behavioural difficulty has some similarity to Skelly and D’Antonio’s “functional behaviour and attachment disturbance” group. In other respects, the present study and the previous study differ. Research limitations/implications The outcomes of these factor analyses indicate that some of the single-item scales can be combined into groups. However, the specific groups found in this study must be regarded as possibly unstable because of the likelihood of weak inter-rater reliability in HONOS-LD data and differences between this analysis and Skelly and D’Antonio’s. Further research is needed to support or modify them. Practical implications The cognitive competence and social competence groups of items may be used as subscales if they are convenient. The groups representing mood and behavioural problems should be supported by further research before being used. Originality/value This is the second published factor analysis of the HONOS-LD and includes a much larger data set than the first. It has some similarities to and differences from the first and is a further step in the process of identifying useful groupings of HONOS-LD single-item scales.
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