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Durbin A, Jung JKH, Chung H, Lin E, Balogh R, Lunsky Y. Prevalence of intellectual and developmental disabilities among first generation adult newcomers, and the health and health service use of this group: A retrospective cohort study. PLoS One 2019; 14:e0215804. [PMID: 31220086 PMCID: PMC6586270 DOI: 10.1371/journal.pone.0215804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 04/09/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. METHODS This population-based retrospective cohort study of adults aged 19-65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. RESULTS Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. CONCLUSION First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care.
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Affiliation(s)
- Anna Durbin
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, 1 King’s College Cir., Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James K. H. Jung
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, W., Toronto, Ontario, Canada
| | | | - Elizabeth Lin
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Balogh
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, 1 King’s College Cir., Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, W., Toronto, Ontario, Canada
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Robertson J, Raghavan R, Emerson E, Baines S, Hatton C. What do we know about the health and health care of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1310-1334. [DOI: 10.1111/jar.12630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/23/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
| | - Raghu Raghavan
- Faculty of Health and Life Sciences, Mary Seacole Research Centre De Montfort University Leicester UK
| | - Eric Emerson
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
- Centre for Disability Research and Policy University of Sydney Sydney New South Wales Australia
| | - Susannah Baines
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
| | - Chris Hatton
- Centre for Disability Research, Division of Health Research, Faculty of Health and Medicine Lancaster University Lancaster UK
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Friedman DJ, Parrish RG, Fox MH. A Review of Global Literature on Using Administrative Data to Estimate Prevalence of Intellectual and Developmental Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2018; 15:43-62. [PMID: 29681966 DOI: 10.1111/jppi.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As understanding of health deficits among people with intellectual and developmental disabilities (IDD) increases, concerns grow about how to develop comprehensive, sustainable surveillance systems to reliably monitor the health of this population over time. This study reviews literature from 12 countries in which retrospective administrative data have been used to estimate population-based prevalence of IDD, identifies promising practices in that literature, and discusses the feasibility of applying those promising practices to other countries. Administrative data sources can be used to identify the number of people with IDD (numerators) in the presence of population estimates from which people with IDD are drawn (denominators) for discrete geographic locations. Case ascertainment methods, age groupings, data years captured, and other methods vary, contributing to a wide variation in prevalence rates. Six methods are identified from five countries that appear to offer the greatest likelihood of expanded applications. Approaches in which administrative data collections are linked with other population-based data sources appear promising as a means of estimating the size and characteristics of populations living with IDD in defined geographic locations. They offer the potential for sustainability, timeliness, accuracy, and efficiency.
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Affiliation(s)
| | - R Gibson Parrish
- Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael H Fox
- Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Abstract
Despite the higher prevalence of learning disabilities among some minority ethnic communities and the greater burden of care, families from minority ethnic communities with a member who has learning disabilities are doubly disadvantaged as a result of racial discrimination and culturally inappropriate forms of care and service provision. This paper looks at the issue of discrimination, as well as the generally negative attitudes towards people with learning disabilities, and synthesises these into the concept of ‘double jeopardy’. It concludes by proposing ways of developing cultural competence in the delivery of care to this population.
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Southby K. Barriers to non-residential respite care for adults with moderate to complex needs: A UK perspective. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2017; 21:366-386. [PMID: 27440229 DOI: 10.1177/1744629516658577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Respite aims to alleviate the stress and burden of caring for someone with an intellectual disability and/or autism. Respite can take place in a number of different ways, but most commonly occurs in a residential setting. Based on survey and interview data with carers (CAs), service users and stakeholders (STs) in a northern city in England, this article explores some of the perceived or actual barriers to availing 'non-residential' respite. A number of barriers to non-residential respite are identified. Residential respite appears to be the default conceptualization of 'respite' for carers, service users and stakeholders. Persuading carers, service users and stakeholders to give up the familiarity and safety of residential respite in favour of a non-residential alternative will be challenging unless those involved are more informed. Limitations and directions for future research are suggested.
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Bhardwaj AK, Forrester-Jones RVE, Murphy GH. Social networks of adults with an intellectual disability from South Asian and White communities in the United Kingdom: A comparison. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:e253-e264. [PMID: 28503841 DOI: 10.1111/jar.12351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little research exists comparing the social networks of people with intellectual disability (ID) from South Asian and White backgrounds. This UK study reports on the barriers that South Asian people with intellectual disability face in relation to social inclusion compared to their White counterparts. MATERIALS AND METHODS A mixed-methods research design was adopted to explore the social lives of 27 men (15 White; 12 South Asian) and 20 women (10 White; 10 South Asian with intellectual disability). Descriptive and parametric tests were used to analyse the quantitative data. RESULTS The average network size of the whole group was 32 members. South Asian participants had more family members whilst White participants had more service users and staff in their networks; 96% network members from White intellectual disability group were also of White background, whilst the South Asian group had mixed ethnic network members. CONCLUSIONS Social networks of individuals with intellectual disability in this study were found to be larger overall in comparison with previous studies, whilst network structure differed between the White and South Asian population. These differences have implications relating to future service planning and appropriateness of available facilities.
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Malik KJ, Unwin G, Larkin M, Kroese BS, Rose J. The complex role of social care services in supporting the development of sustainable identities: Insights from the experiences of British South Asian women with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:74-84. [PMID: 28222961 DOI: 10.1016/j.ridd.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Carers and service users with intellectual disabilities from minority ethnic groups have typically been reported to be dissatisfied with the social care services they receive. However, service users themselves have rarely been asked directly about their experiences of social care. This paper aims to understand the meaning of social care services in the lives of South Asian women with intellectual disabilities, in the United Kingdom. METHOD AND PROCEDURE 10 British South Asian women with mild-moderate intellectual disabilities were interviewed about their experiences of social care services. The transcripts were analysed using interpretative phenomenological analysis. RESULTS The analysis produced three super-ordinate themes, which focus on how services facilitate the development of complex identities, how the participants explored their sense of being 'stuck' between cultures as they negotiated their journeys towards independence, and the triple disadvantage which they experienced as a consequence of the intersection between gender, ethnicity and disability. The participants were broadly satisfied with the role which services played in these domains, and appeared to find them valuable and helpful. CONCLUSIONS The results suggest that the participants successfully managed complex identity issues, such as acculturation processes, with the support of services. It may be helpful to give more explicit consideration to the positive role which good services can play in supporting people with intellectual disabilities in the development of their identities and goals, alongside the more traditionally 'concrete' objectives of such social care. Engagement with families in 'positive risk-taking' is likely to be an important component of success.
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Affiliation(s)
- Kulsoom Jawaid Malik
- School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Gemma Unwin
- School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Michael Larkin
- School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Biza Stenfert Kroese
- School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - John Rose
- School of Psychology, The University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
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Unwin G, Larkin M, Rose J, Kroese BS, Malcolm S. Developing resources to facilitate culturally-sensitive service planning and delivery - doing research inclusively with people with learning disabilities. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:17. [PMID: 29062518 PMCID: PMC5611676 DOI: 10.1186/s40900-016-0031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 04/06/2016] [Indexed: 06/06/2023]
Abstract
PLAIN ENGLISH SUMMARY (Please see www.Toolsfortalking.co.uk for an easy read summary of the project.) The Tools for Talking are a set of resources that were developed through collaboration between Black, Asian and minority ethnic people with learning disabilities and researchers at the University of Birmingham. The resources were designed to be used by people with learning disabilities and service providers to facilitate culturally-sensitive communication and information sharing, service planning and delivery. They comprise illustrative videos and exploratory activities relating to five topics, namely, culture, activities, support from staff, important people, choices and independence. These topics emerged as important to people with learning disabilities during the 'Access to Social Care-Learning Disabilities' (ASC-LD) study which involved interviews with 32 adults with learning disabilities from Black, Asian and minority ethnic communities. The results of the ASC-LD study were used to develop a set of draft resources which were then co-developed through collaboration with people with learning disabilities and service providers. A 'Partnership event' was convened to involve stakeholders in the development of the resources. This paper describes the refinement of these materials by people with learning disabilities from Black, Asian and minority ethnic backgrounds in cooperation with a range of other stakeholders. ABSTRACT Background Black, Asian and minority ethnic people with learning disabilities face inequities in health and social care provision. Lower levels of service uptake and satisfaction with services have been reported, however, this is largely based on the views of carers. The 'Access to Social Care: Learning Disabilities (ASC-LD)' study sought to explore the views and experiences of social support services among adults with learning disabilities from Black, Asian and minority ethnic communities. Interviews with 32 Black, Asian and minority ethnic adults with learning disabilities were conducted to explore participants' cultural identities, their understanding and experience of 'support'. The views and experiences expressed in the ASC-LD study were used in the 'Tools for Talking project' to develop a suite of resources designed to facilitate culturally-sensitive communication and information-sharing, service planning and delivery through improved mutual understanding between providers and users of services. This paper describes the Tools for Talking project which sought to co-develop the resources through a partnership event. Methods An inclusive approach was adopted to address issues that are important to people with learning disabilities, to represent their views and experiences, and to involve Black, Asian and minority ethnic people with learning disabilities in the research process. Partnerships were developed with provider organisations and service users who were invited to a 'Partnership Event'. Collaborators at the partnership event were asked to comment on and evaluate draft resources which included a series of videos and activities to explore topics that emerged as important in the ASC-LD study. Their comments were collated and the tools developed as they suggested. Results Using the results from the ASC-LD study helped to ensure that the draft resources were relevant to service users, addressing topics that were important to them. The partnership event was an effective method to collaborate with a relatively large number of stakeholders. However, the event was resource intensive and required substantial planning to ensure active and meaningful participation. Considerations, such as inviting stakeholders, developing the programme and selecting a venue are discussed. Conclusions The partnership approach has led to the development of a set of five illustrative videos and accompanying activities that address issues that emerged from the collaborative process including: culture, activities, support from staff, important people, choices and independence. These resources are freely available at: www.Toolsfortalking.co.uk. They are designed to be used by users and providers of services, but may also be useful in other settings.
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Affiliation(s)
- Gemma Unwin
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT UK
| | - Michael Larkin
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT UK
| | - John Rose
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT UK
- St. Andrews Healthcare, Academic Unit, Northampton, UK
| | - Biza Stenfert Kroese
- University of Birmingham, School of Psychology, Edgbaston, Birmingham B15 2TT UK
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Tajuddin M, Nadkarni S, Biswas A, Watson MJ, Bhaumik S. A Study of the Use of an Acute Inpatient Unit for Adults with Learning Disability and Mental Health Problems in Leicestershire, UK. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979504799103985] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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10
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Brolan CE, Taylor Gomez M, Lennox NG, Ware RS. Australians from a non-English speaking background with intellectual disability: the importance of research. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2013; 38:70-73. [PMID: 23244697 DOI: 10.3109/13668250.2012.747675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Claire E Brolan
- School of Population Health, The University of Queensland, Australia.
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McClimens A, Lewis R, Brewster J. Dr. Tulp, I presume: intellectual disability and ethnicity in Rotherham. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2013; 17:78-89. [PMID: 23262988 DOI: 10.1177/1744629512469172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article, we report on that aspect of our ongoing simulation project which focuses on the cultural needs of a 'virtual' young man living with profound and multiple intellectual disabilities, who is British Asian and receives care in a residential setting. We describe our involvement with a local agency who support families from black and minority ethnic populations and who have children with a variety of intellectual disabilities. We then go on to detail the focus group we attended and how we incorporated the data generated into a more comprehensive story for our 'virtual' young man, Ahmed.
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Bonell S, Underwood L, Radhakrishnan V, McCarthy J. Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:902-909. [PMID: 22044491 DOI: 10.1111/j.1365-2788.2011.01494.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. METHOD A two-round Delphi process was utilised. White British and Black or Black British service users from a specialist community-based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. RESULTS Twenty-four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. CONCLUSIONS People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.
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Affiliation(s)
- S Bonell
- South London and Maudsley NHS Foundation Trust, London, UK.
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Durà-Vilà G, Hodes M. Ethnic factors in mental health service utilisation among people with intellectual disability in high-income countries: systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:827-842. [PMID: 21883599 DOI: 10.1111/j.1365-2788.2011.01466.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND An emerging literature suggests that ethnic and cultural factors influence service utilisation among people with intellectual disability (ID), but this has not previously been reviewed. AIMS To investigate possible ethnic variation in uptake of mental health services in children, adolescents and adults with ID in high-income countries. METHOD A systematic review using main databases of studies that consider ethnic influences on mental health utilisation of people with ID. Methodological quality of studies was assessed. RESULTS Nine studies that reached selection criteria were identified. Six studies that compared two or more ethnic groups found a variation in levels of mental health service utilisation. The most consistent finding was that South Asian children, adolescents and adults with ID in the UK had lower use of mental health services than White British comparison groups. CONCLUSION Ethnic influences on mental health service utilisation were identified. Understanding their significance and potential negative consequences requires further investigation.
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Affiliation(s)
- G Durà-Vilà
- Research Department of Mental Health Sciences, University College London, London, UK.
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Bell BG, Clegg J. An Ecological Approach to Reducing the Social Isolation of People With an Intellectual Disability. ECOLOGICAL PSYCHOLOGY 2012. [DOI: 10.1080/10407413.2012.673983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chou YC, Lu ZYJ. Caring for a daughter with intellectual disabilities in managing menstruation: a mother's perspective. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2012; 37:1-10. [PMID: 22320310 DOI: 10.3109/13668250.2011.651615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The concerns of mothers and their experiences while providing help to their daughters with intellectual disability (ID) and considerable support needs during menstruation have rarely been addressed. This qualitative study explored mothers' experiences and perceptions of managing their daughters' menstruation. METHOD Twelve Taiwanese mothers of 13 daughters with ID (1 mother had twins) were interviewed to explore their experiences of providing help to their daughters with high support needs during menstruation. RESULTS Support networks were limited and mothers developed their own strategies for managing their daughter's menstruation. Surgical hysterectomy or use of medication to cease or postpone menstrual bleeding was never considered by the mothers. The financial cost of menstrual pads and nappies was significant. CONCLUSIONS Both an appropriate allowance for families involved in the menstrual care of women with ID and access to appropriate support are needed. More information and educational programs need to be provided to relevant professionals and carers.
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Affiliation(s)
- Yueh-Ching Chou
- Institute of Health and Welfare Policy, National Yang-Ming University, 155 Li-Nong St. Sec. 2, Peitou, Taipei, Taiwan.
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Bhaumik S, Watson J, Barrett M, Raju B, Burton T, Forte J. Transition for Teenagers With Intellectual Disability: Carers' Perspectives. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00286.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Durà-Vilà G, Hodes M. Ethnic variation in service utilisation among children with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:939-948. [PMID: 19732279 DOI: 10.1111/j.1365-2788.2009.01214.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND This study examined whether service utilisation among children with intellectual disability (ID) varied by ethnic cultural group. METHOD Survey carried out in four special schools in London. Information was provided by school teachers using case files, and 242 children aged 7 to 17 years with mild and moderate ID were identified. Ethnic categories were derived from self-reported main categories. Service utilisation categorised as use of: child and adolescent mental health services (CAMHS), social services, physical health and education services. RESULTS Child and adolescent mental health services uptake was lower for South Asians than for White British (P = 0.0487). There were statistically significant differences among ethnic groups for community-based social services uptake (being the highest for the Black groups and the lowest for South Asians, P = 0.015) and respite care uptake (being the highest for the Black and White European groups and the lowest for South Asians, P = 0.009). In regression analysis family structure predicted CAMHS service utilisation and social service community support. Ethnicity predicted use of respite care. CONCLUSIONS Significant ethnic differences in service utilisation among children with ID were found for both CAMHS and social service contact. There was particularly low service use for the South Asian group. These differences might arise because of differences in family organisation, as more South Asian children lived in two-parent families, which may have been better able to provide care than single-parent families. Other factors such as variation in parental belief systems and variation in psychopathology may be relevant. Implications are discussed.
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Affiliation(s)
- G Durà-Vilà
- Division of Neuroscience and Mental Health, Imperial College London, London, UK
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The Prevalence and Incidence of Mental Ill-Health in Adults with Autism and Intellectual Disabilities. J Autism Dev Disord 2008; 38:1676-88. [DOI: 10.1007/s10803-008-0549-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 02/06/2008] [Indexed: 10/22/2022]
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Raghavan R, Waseem F. Services for young people with learning disabilities and mental health needs from South Asian communities. ACTA ACUST UNITED AC 2007. [DOI: 10.1108/17530180200700028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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McGrother CW, Bhaumik S, Thorp CF, Hauck A, Branford D, Watson JM. Epilepsy in adults with intellectual disabilities: prevalence, associations and service implications. Seizure 2006; 15:376-86. [PMID: 16782360 DOI: 10.1016/j.seizure.2006.04.002] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/28/2006] [Accepted: 04/11/2006] [Indexed: 10/24/2022] Open
Abstract
STATEMENT OF THE PROBLEM The prevalence of epilepsy in people with an intellectual disability (ID) is apparently higher than in the general population. The outlook for individuals with both epilepsy and ID depends on the presence of any associated conditions. However, there have been few epidemiological studies of the prevalence of epilepsy and associated problems within a representative adult ID population to inform the development of policy. METHOD This was a population-based prevalence study using the Leicestershire Learning Disability Register. Prevalence was estimated from the number of individuals with reported epilepsy identified from structured home interviews with carers. Associations with epilepsy were investigated for a range of defined physical, mental and skill attributes. Logistic regression was done with and without adjustment for age, sex and level of understanding to identify specific and holistic links respectively. RESULTS The prevalence of epilepsy was 26%. Among those with epilepsy, 68% experienced seizures despite anti-epileptic medication. Epilepsy showed a significant association with low levels of understanding. Specific morbid associations included wetting (adjusted odds ratio 2.7), soiling (2.2), walking (2.5), daily living skills (1.6), poor speech (2.2), lack of empathy (1.5), mood swings (1.5), being uncooperative (1.6), seeking attention (1.7) and disturbing others at night (1.9). Holistic associations included a wider range of physical and mental problems and global skills deficits. CONCLUSIONS The high prevalence, associated morbidities and global skills deficits make epilepsy care for adults with ID important and complex. Specialist epilepsy services for this population need a multidisciplinary skills mix.
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Affiliation(s)
- Catherine W McGrother
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, United Kingdom.
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Tyrer F, McGrother CW, Thorp CF, Donaldson M, Bhaumik S, Watson JM, Hollin C. Physical aggression towards others in adults with learning disabilities: prevalence and associated factors. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:295-304. [PMID: 16507034 DOI: 10.1111/j.1365-2788.2005.00774.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many people with learning disabilities (LD) show aggressive behaviour, but the extent of the problem and its associated factors and effects are unclear. METHODS A cross-sectional analysis was carried out using interview data from 3065 adults with LD on the Leicestershire LD Register. Physical aggression towards others was defined as carers reporting frequent (more than three times per week) and/or severe episodes. Individuals with and without aggression were compared using multiple logistic regression models for potential physical and psychological factors. RESULTS Carers reported that 443 (14%) of adults were physically aggressive towards others. Men (P = 0.001), younger individuals (P < 0.001), people with more severe LD (P < 0.001) and those in institutional settings (P < 0.001) had a significantly higher prevalence of physical aggression. People with Down syndrome had a lower prevalence of physical aggression (P < 0.001). After adjustment, we found no relationship between aggression and the presence of epilepsy or autism. Among psychological factors, symptoms of frustration (P < 0.001) and mood swings (P < 0.001) were associated with higher levels of aggression. Failure to cope among carers was reported by 14% overall: 42% of people caring for adults with aggression said they were unable to cope compared with 10% of those caring for adults without aggression. CONCLUSIONS Physical aggression towards other people presents a significant challenge to carers of adults with LD. Further research is needed to identify aetiological factors with a view to finding effective interventions to reduce, and improve management of, this behaviour.
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Affiliation(s)
- F Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Krahn GL, Hammond L, Turner A. A cascade of disparities: Health and health care access for people with intellectual disabilities. ACTA ACUST UNITED AC 2006; 12:70-82. [PMID: 16435327 DOI: 10.1002/mrdd.20098] [Citation(s) in RCA: 423] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.
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Affiliation(s)
- Gloria L Krahn
- Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, OR 97207-0574, USA.
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Alborz A, McNally R, Glendinning C. Access to health care for people with learning disabilities in the UK: mapping the issues and reviewing the evidence. J Health Serv Res Policy 2005; 10:173-82. [PMID: 16053595 PMCID: PMC2020839 DOI: 10.1258/1355819054338997] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES People with learning disabilities are more prone to a wide range of additional physical and mental health problems than the general population. Our aim was to map the issues and review the evidence on access to health care for these patients. The review sought to identify theory, evidence and gaps in knowledge relating to the help-seeking behaviour of people with learning disabilities and their carers, barriers and problems they experience accessing the full range of health services, and practical and effective interventions aiming to improve access to health care. METHODS A three-strand approach was adopted, involving searches of electronic databases, a consultation exercise and a mail shot to researchers and learning disability health professionals. Evidence relevant to our model of 'access' was evaluated for scientific rigour and selected papers synthesized. RESULTS Overall, a lack of rigorous research in this area was noted and significant gaps in the evidence base were apparent. Evidence was identified on the difficulties in identifying health needs among people with learning disabilities and the potentially empowering or obstructive influence of third parties on access to health care. Barriers to access identified within health services included problems with communication, inadequate facilities, rigid procedures and lack of appropriate interpersonal skills among mainstream health care professionals in caring for these patients. A number of innovations designed to improve access were identified, including a communication aid, a prompt card to support general practitioners, health check programmes and walk-in clinics. CONCLUSION There are important gaps in the knowledge base on access to health care for this group. While these need to be addressed, developing strategies to overcome identified barriers should be a priority, along with fuller evaluation of existing innovations.
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Affiliation(s)
- Alison Alborz
- National Primary Care R&D Centre, University of Manchester, Manchester, UK.
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Oliver PC, Piachaud J, Tyrer P, Regan A, Dack M, Alexander R, Bakala A, Cooray S, Done DJ, Rao B. Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:507-15. [PMID: 15966958 DOI: 10.1111/j.1365-2788.2005.00706.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. METHOD In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. RESULTS We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. CONCLUSIONS Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.
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Affiliation(s)
- P C Oliver
- Department of Psychological Medicine, Faculty of Medicine, Imperial College London, Paterson Centre, London, UK.
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McGrother C, Thorp C, Watson J, Taub NA, Bhaumik S. Response to Emerson et al. (Journal of Intellectual Disability Research, 48, 201-202). JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2005; 49:306-308. [PMID: 15816818 DOI: 10.1111/j.1365-2788.2005.00650.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Hensel E, Krishnan M, Saunders K, Durrani N, Rose J. Impact of Policy Shifts on South Asian Carers in the United Kingdom. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2005. [DOI: 10.1111/j.1741-1130.2005.00003.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Summers SJ, Jones J. Cross-cultural working in community learning disabilities services: clinical issues, dilemmas and tensions. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:687-694. [PMID: 15357689 DOI: 10.1111/j.1365-2788.2004.00601.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND People with learning disabilities from minority ethnic communities face many layers of disadvantage. Providing services that are culturally appropriate and sensitive can be difficult. METHOD Through the use of clinical examples the issues, tensions and dilemmas raised for a community learning disabilities team in attempting to provide culturally sensitive services in an increasingly multicultural environment are discussed. Ways in which good practice can be more closely achieved are debated. CONCLUSIONS Conflicts between the principal service values of individuality, choice, promotion of mental health and normalization, whilst also respecting the beliefs and values of other religions and cultures, can raise tensions and dilemmas for learning disabilities services. The importance of sensitive and appropriate service configuration, sharing of good practice, and good staff training are emphasized.
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Affiliation(s)
- S J Summers
- Tees and North East Yorkshire NHS Trust, Learning Disabilities Service, Hartlepool, UK.
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Emerson E, Hatton C. Response to McGrother et al. (Journal of Intellectual Disability Research, 46, 299-309) 'The prevalence of intellectual disability among South Asian communities in the UK'. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:201-202. [PMID: 14723661 DOI: 10.1111/j.1365-2788.2004.00501.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Weston HJ. Public honour, private shame and HIV: issues affecting sexual health service delivery in London's South Asian communities. Health Place 2003; 9:109-17. [PMID: 12753794 DOI: 10.1016/s1353-8292(03)00002-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Within a wider discussion of health service provision for black and minority ethnic (BME) groups, this paper considers how socio-cultural factors affect the provision of HIV and sexual health services to South Asians in London. It argues that communally held concepts of honour and shame within South Asian communities create a framework of social control with significant implications for HIV/AIDS transmission. It examines the provision of culturally sensitive services to BME communities by ethnically specific and generic service providers through a case study of the Naz Project London. Finally, it proposes an agenda for future research into BME sexual health service provision.
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Affiliation(s)
- H J Weston
- Department of Geography, University of Cambridge, Downing Place, Cambridge CB2 3EN, UK.
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