Journal of Policy and Practice in Intellectual Disabilities最新文献

People with intellectual disabilities face health disparities, including in high-income countries such as the United Kingdom, despite publicly funded healthcare. This paper describes the healthcare system in England (a nation of the United Kingdom) for the general population, and more specifically for people with intellectual disabilities. Key legislation that impacts the lives of people with intellectual disabilities, such as the UK Equality Act 2010 (https://www.legislation.gov.uk/ukpga/2010/15/contents), the Mental Capacity Act 2005 (https://www.legislation.gov.uk/ukpga/2005/9/contents), and the UN Convention on the Rights of Persons with Disabilities, and its implementation in the United Kingdom, is discussed. The role of deinstitutionalization and the shift to living in the community for people with intellectual disabilities is also discussed. Programmes that have been implemented to address the health disparities experienced by people with intellectual disabilities are reviewed. Finally, the recent changes to healthcare organization in the UK, the COVID-19 pandemic, and the implementation of the Valuing People white paper are discussed.

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights-based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service-led to a rights-based, service-user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State.

People with intellectual disability experience some of the greatest health disparities in Australia. Individuals are expected to access mainstream health services that are ill equipped to meet their needs. The Australian government has made recent commitments to improve the healthcare of people with intellectual disability. This article describes the Australian health system and how it responds to the needs of people with intellectual disability. It draws on examples of advances in policy, inclusion, and service development, achieved through concrete and persistent systemic advocacy, to discuss emerging evidence on the delivery of healthcare to people with intellectual disability in Australia. The article also highlights immediate priorities including increasing the uptake of health assessments, building the capacity of our health workforce, and responding to the needs of people with intellectual disability in COVID-19 outbreaks or other natural disasters. Intellectual disability healthcare is at a dynamic point in Australia with commitment and funding from government to lead to change. It is critical that momentum in health services development is maintained to enable improved health outcomes for people with intellectual disability.

In Brazil, the Unified Health System (SUS) is the national health system that offers free medical services to all citizens including all levels of treatment and prevention of diseases, subsidized by the government. Although SUS is universally offered, people with intellectual and developmental disabilities (I/DD) face challenges regarding healthcare. This article aims to present a description of the healthcare framework for people with I/DD in Brazil, as well as to characterize the Care Network for Person with Disabilities. This is a descriptive study that reports aspects of the structure and functioning of the health system in the country. In addition, we summarize core data from the National Health Survey that characterizes the health condition of people with I/DD in the country. Although Brazil has promoted legislation in favor of the health of people with I/DD and other disabilities, the obstacle is the implementation. Overall, there have been advances in SUS efficacy. However, challenges include long waiting times for diagnosis, habilitation/rehabilitation, inadequate transportation, and insufficient staff training on disability and I/DD, particularly. In this sense, it is necessary to monitor laws and inclusive actions so that the principles of the SUS are actually applied.

Over 7.5 million people (approximately 2% of the US population) with intellectual and developmental disability live in the United States with the vast majority living in the community and accessing healthcare from the general healthcare system. For over two decades, there has been a national recognition that people with IDD experience poorer health outcomes and experience barriers in access to healthcare. We describe the important legal and financial frameworks that influence access to health care for people with IDD in the US, including a summary of major federal laws and insurance programs that have shaped the landscape of health and social care in the community, evolving trends in payment models, and the risks and benefits of these models. Further, we provide a description of health care delivery models which have been developed to support healthcare for people with disabilities including coordinated care delivery models. Clinical training and support for non-clinicians to attend to the particular health care needs of the population with IDD is critical yet is not widely available. Additionally, there remain significant access and quality gaps in healthcare for people with IDD. We conclude with a call for advances in health care quality, access and efforts to advance research and data collection to promote health equity for this population.

Ensuring families of children with intellectual and/or developmental disabilities (e.g., developmental delay, intellectual disability, autism) can access early intervention and support is important. Current research indicates there are family-level socioeconomic disparities of access to early intervention and support, however, there is limited evidence on the relationship between neighbourhood-level socioeconomic deprivation and access to support. Therefore, the aim of this study was to examine the relationship between neighbourhood deprivation and families' access to and unmet need for early intervention and support. We collected cross-sectional data using a survey of 673 parental caregivers of young children with suspected or diagnosed intellectual and/or developmental disabilities in the UK. Multiple regression models were fitted for three early intervention and support outcome variables: access to early intervention; access to services across education, health, social care, and other sectors; and unmet need for services. Each regression model included a neighbourhood deprivation variable based on the index of multiple deprivation and five control variables: family-level economic deprivation, country, caregivers' educational level, developmental disability diagnosis, and informal support sources. Neighbourhood deprivation was a significant independent predictor of access to services, but neighbourhood deprivation was not a significant predictor of access to early intervention or unmet need for services. Families living in the most deprived neighbourhoods accessed fewer services than other families. Socioeconomic disparities of access to early intervention and support, at both a neighbourhood and family level, exist for families of young children with suspected or diagnosed intellectual and/or developmental disabilities in the UK. Future research should focus on policy and other interventions aimed at addressing socioeconomic disparities at the neighbourhood and family level, to ensure equitable access to early intervention and support.

Legislations for persons with disabilities emerged in the 1990s in India, providing them with rights and entitlements. Aligned with the UNCRPD, the Rights of Persons with Disabilities Act (2016) supports improved programmes and services. There are no exclusive policies for those with intellectual and developmental disabilities. Different government departments and non-government organisations provide services including centrally sponsored programmes to persons with disabilities and enable them to exercise their rights. For example, rehabilitation and provision of aids and appliances lie with the Ministry of Social Justice and Empowerment, right to education is with the Ministry of Education, and, early intervention and health services and related supports are with the Ministry of Health. In India, non-government organisations also play a vital role in health care services. In this paper, we discuss the existing health care systems including medical services in India for persons with disabilities with a specific focus on persons with intellectual and developmental disabilities. The discussion include how the system was evolved and what is in place today, the coverage, strengths, and limitations in the system. We have tried to provide a comprehensive description of existing policies, and practices of health care as well as the cultural influences with regard to health care for people with intellectual and developmental disabilities in India.

The Norwegian health care system is built on individual rights and the principles of universal access, decentralization, and free choice of provider. Norway has universal health coverage, funded primarily by general taxes and by payroll contributions shared by employers and employees. Local authorities at the municipal level organize and finance primary health care services according to local demand and within national frameworks. Habilitation services are offered both in the primary health care and as a part of the specialist health services. They offer both inpatient and outpatient services for people with intellectual/developmental disabilities (IDD). National guidelines, known as Good health and care services for people with IDD, have recently (2021) been launched after various reports over the years of serious breaches and challenges in the health and care services provided to people with IDD.

This article considers the contributions from the field of Disability Studies to the conceptualization of Quality of Life (QOL) for people labelled with Intellectual Disability (ID). We suggest four elements from the field of Disability Studies that may be incorporated into an evolving QOL paradigm. The first element concerns the meaning of disability itself. Those working in contemporary Disability Studies identify societal obstacles and points of inaccessibility as sources of disablement while also recognizing the experience of difference. We suggest this understanding of disability as an interaction between a person and the social world/environment may be included more explicitly in QOL conceptualization. A responsive and adaptable definition of disability in the QOL paradigm is recommended. The second element is the recognition of relationality. The field of contemporary disability studies challenges the value of considering a person's disability as a solitary medical experience and questions the goals of independence, instead considering the value in interdependence and community. This could be included in the QOL paradigm by further emphasizing the importance of relationships and contributions of those labelled with ID. The third element is participatory design and epistemic justice, making space for people labelled with ID to contribute to research and direct the course of their own lives and supports. This element of self-determination is important to QOL but an increase in participatory research, service, and support design in the field is recommended. The final element is intersectionality, the idea that the experience of disability must be understood in the context of other points of identity or marginalization such as race, gender, and sexuality. We recommend that the QOL paradigm should allow for these additional elements to be included in further design and research in the field.

This paper aims to give a short description of Swedish healthcare provision for persons with intellectual and developmental disabilities (IDD). Swedish persons with IDD should have access to the general healthcare system on the same terms as the general population, and thereby enjoy equal opportunities for healthcare of good quality. Reports from government agencies and interest groups, however, describe a decentralised and fragmented healthcare system that requires significant coordination; a lack of adjustments; a lack of specialised healthcare professionals; and gaps in healthcare provision. Research in recent years has reported unequal access to planned healthcare; excess mortality and premature deaths; and insufficient or inadequate support in end-of-life care. We conclude that health inequalities and healthcare challenges faced by Swedish persons with IDD might be caused by obstacles at several structural levels. Allowing persons with IDD to access timely and adequate healthcare requires the development of better opportunities for coordination of healthcare and social services, as well as training for healthcare professionals and direct support staff.