Are there differences between the characteristics of people with learning disabilities and mental health problems admitted to specialist or generic in patient services?
This study looked at admissions to a specialist six bedded unit within learning disability services, and those to a generic in-patient unit, both operating in the south of London. The study looked at 154 consecutive admissions over a five and a half year period.
Most individuals used either generic units (40.3%) or a mixture of the specialist and generic units (37%). Only 22.7% were admitted exclusively to the specialist unit. There were no significant differences found between individuals admitted to specialist and generic units in respect of gender, ethnicity, level of intellectual disabilities, presence of pervasive developmental disorder and Mental Health Act status.
People admitted to specialist unit were more likely to reside with their family prior to admission whilst those admitted to generic units were more likely to come from 'other' forms of residence (hostels, prison and 'no fixed abode'). Admissions to generic wards tended to be for acute episodes of mental health problems and the largest diagnostic group for all admissions was schizophrenia spectrum disorders.
The authors suggest that the longer length of stay for individuals admitted to the specialist unit may suggest particularly complex needs that cannot be met as effectively/quickly on generic units. They call for further studies to identify factors which predict admission to specialist and generic services and to measure the outcome of different forms of inpatient care from clinical and service user perspectives.
Original article:
Comparison of adults with intellectual disabilities and mental health problems admitted to specialist and generic inpatient units, C. P. Hemmings et al, in British Journal of Learning Disabilities, 37, 2, 123-128
LDSC extended summary:
http://www.library.nhs.uk/learningdisabilities/viewResource.aspx?resid=317083&code=f03e25772b2af2d65edbc8175fcf49fc
How do people with learning disabilities view employment support programmes?
This study used Q methodology, used to help rank importance of a set of statements. Eighteen respondents with a mild intellectual disability were asked to rank-order 22 statements that represented five main aspects of supported employment. The five domains identified were:
a. social interaction,
b. job preferences,
c. competencies,
d. physical capabilities
e. support
Two views were observed: 'work as participation' and 'work as structure'. In the first, greater value was placed on participation, task variety, belonging, and feeling appreciated; in the second greater value was placed on working independently, clear working agreements, and friendly co-workers. The views indicate two distinct approaches to creating a positive relationship between supported employment and social integration.
In post Q sorting interview, 14 of 18 respondents indicated that supported employment had contributed to their self-development, and respondents who had worked in a learning disability day-care institution indicated they were happier in their supported employment environment.
The authors suggest the study indicates that supported employment contributes to self-development, with all respondents reporting greater value for supported employment than previous work experience.
Original article:
How employment support and social integration programmes are viewed by the intellectually disabled J. M. Cramm, et al, in Journal of Intellectual Disability Research 53, 6, 512 -520
LDSC extended summary:
http://www.library.nhs.uk/learningdisabilities/viewResource.aspx?resid=317087&code=a43282c1e0c01eeccd10bd82a0acf372
What are the experiences of children and young people admitted to general hospital?
In light of Government policy to ensure the healthcare needs of people with learning disabilities are met by mainstream health services, this study looked at the experiences of a small group of 13 children admitted to hospital for a period longer than 24 hours.
The authors interviewed parents, nursing staff and two children to identify the main themes associated with their experiences. The five themes emerging were - child, carer and staff anxiety – they all reported feeling anxious about the admission; preparedness for admission, with nursing staff all reporting better preparedness for planned over emergency admissions. There were some reports of lack of preparedness even for planned admissions; difficulties managing the child's behaviour, with nursing staff reporting this as the most challenging aspect of the admission; carer presence during the admission, with nursing staff suggesting it would be very difficult to meet the child’s needs without this involvement and ward environment and facilities, where many respondents reported the experience as much easier when the child had their own room.
The authors suggest the study findings underline the importance of recognising the emotional distress that can be b experienced that all concerned with a hospital admission. They suggest that there is a need to explicitly discuss and agree roles of carers and nursing staff at the start of a hospital admission to reduce later misunderstandings.
Some respondents suggested the need for specialist learning disability nurses to be made available to reduce pressures experienced by carers and staff, and the authors suggest this approach should be subject to further investigation.
Despite the small sample, the authors point out that findings are consistent with previous research, with this study focusing on children with more significant health needs.
Original article:
The experiences of children with learning disabilities, their carers and staff during a hospital admission, Freddy Jackson Brown & Jane Guvenir, in British Journal of Learning Disabilities, 37, 2, 110-115
LDSC extended summary:
http://www.library.nhs.uk/learningdisabilities/viewResource.aspx?resid=317086&code=afb3a428a7e0cdb59aaccf18e52ce8f2
