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A Comparison of Outpatients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals

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Title: A Comparison of Outpatients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals
Language: English
Authors: Lunsky, Y., Gracey, C., Bradley, E., Koegl, C., Durbin, J.
Source: Journal of Intellectual Disability Research. Feb 2011 55(2):242-247.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
Peer Reviewed: Y
Page Count: 6
Publication Date: 2011
Document Type: Journal Articles
Reports - Research
Education Level: Adult Education
Descriptors: Mental Retardation, Psychiatric Hospitals, Patients, Foreign Countries, Profiles, Clinics, Medical Services, Medical Care Evaluation, Demography, Symptoms (Individual Disorders), Health Needs, Case Records, Clinical Diagnosis, Client Characteristics
Geographic Terms: Canada
DOI: 10.1111/j.1365-2788.2010.01307.x
ISSN: 0964-2633
Abstract: Background: This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. Methods: A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes. Results: Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care. Conclusions: Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.
Abstractor: As Provided
Number of References: 31
Entry Date: 2011
Accession Number: EJ927737
Database: ERIC
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  Value: <anid>AN0057367133;eul01feb.11;2019Jun04.10:45;v2.2.500</anid> <title id="AN0057367133-1">A comparison of outpatients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals. </title> <p>Background  This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. Methods  A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes. Results  Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care. Conclusions  Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.</p> <p>Keywords: intellectual disabilities; mental health; psychiatric services; outpatients</p> <p>Studies among persons with an intellectual disability (ID) and comorbid psychiatric conditions have compared the effectiveness of specialised intensive outpatient programmes with less specialised/intensive or standard specialised outpatient programmes ([<reflink idref="bib4" id="ref1">4</reflink>]; [<reflink idref="bib7" id="ref2">7</reflink>]; [<reflink idref="bib14" id="ref3">14</reflink>]; [<reflink idref="bib15" id="ref4">15</reflink>]; [<reflink idref="bib8" id="ref5">8</reflink>]). A recent Cochrane review of these studies concluded that there is not yet enough evidence to demonstrate the advantage of one type of programme over another and that further research is required ([<reflink idref="bib1" id="ref6">1</reflink>]). The review found inconsistent results, with some studies reporting better outcomes for specialised intensive programmes ([<reflink idref="bib4" id="ref7">4</reflink>]; [<reflink idref="bib7" id="ref8">7</reflink>]) while others did not ([<reflink idref="bib14" id="ref9">14</reflink>]; [<reflink idref="bib15" id="ref10">15</reflink>]). Persons with ID are a heterogeneous group; it is therefore possible that certain subgroups benefit more from intensive programmes delivered for the general population whereas others benefit from intensive services provided by specialists in the field of ID.</p> <p>The reviewed studies assume that both types of services are accessible to persons with an ID. The reality is that some individuals may be better suited to one service vs. another and that some individuals, whether appropriate or not, tend to access one type of service over another. Prior to determining which model of care is better for whom, more research is required to better understand how patients currently accessing the two types of services differ from each other. This research can only be completed by comparing the two groups in a health system where there are both types of services.</p> <p>The Comprehensive Assessment Projects ([<reflink idref="bib11" id="ref11">11</reflink>]; [<reflink idref="bib10" id="ref12">10</reflink>]) explored the clinical profile and service needs of individuals with intellectual disabilities receiving tertiary level mental health care in Ontario, Canada (estimated population of 12.39 million). In a previous paper ([<reflink idref="bib13" id="ref13">13</reflink>]), inpatients with ID and psychiatric diagnoses in specialised programmes were compared with inpatients in general programmes. Inpatients with ID were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than inpatients in general programmes. Although more inpatients in specialised programmes were rated as requiring more intensive outpatient support (level 4), the two groups did not differ in terms of overall distribution of care. However, this study was limited in that it focussed only on inpatients.</p> <p>It is important to examine whether, similar to the 2008 study of inpatients, differences are found in outpatients directed towards specialised services compared with general services. The goals of the present study were to compare socio‐demographic and symptom profile of outpatients with ID receiving specialised and general tertiary mental health care in a large geographical region and to compare service needs and recommended levels of care for patients in the two groups.</p> <hd id="AN0057367133-2">Methods</hd> <p></p> <hd id="AN0057367133-3">Sample and data collection</hd> <p>The analytic sample for this study was drawn from a larger mental health services planning study (Comprehensive Assessment Projects) conducted in Ontario during 1998–2003 of all nine psychiatric hospitals responsible for providing tertiary outpatient mental health services to individuals aged 16 years and older in urban, semi‐urban and rural communities. Tertiary outpatient programmes are mandated to provide services to individuals with chronic or complex mental health issues and represent the middle ground between tertiary level inpatient and community‐based mental health care (for further details on sample selection, see [<reflink idref="bib12" id="ref14">12</reflink>]). The planning study employed a cross‐sectional design, assessing a stratified random sample of outpatients. The final analytic sample for this study included 246 outpatients with ID, of which 103 (41.9%) were in specialised programmes and 136 (55.3%) were in general programmes. Details regarding data collection, the Colorado Client Assessment Record ([<reflink idref="bib5" id="ref15">5</reflink>]; [<reflink idref="bib6" id="ref16">6</reflink>]) and level of care assessment are described in an earlier paper ([<reflink idref="bib13" id="ref17">13</reflink>]).</p> <p>Programmes were considered specialised if services were exclusively for individuals with ID and mental health issues. At the time of data collection, there were six specialised outpatient programmes for individuals with ID. All specialised programmes were interdisciplinary with services tailored to the needs of patients with ID and mental health needs, although the staff complement varied by programme (for details on programmes see [<reflink idref="bib10" id="ref18">10</reflink>]). General programmes, although specialised in some cases (e.g. forensic, schizophrenia), did not focus on treating individuals with ID but also did not exclude individuals with ID from their service.</p> <hd id="AN0057367133-4">Analyses</hd> <p>Differences between outpatients with ID receiving specialised and general psychiatric services on demographics, diagnoses and recommended level of care were compared using χ<sups>2</sups>‐tests. Differences on symptom severity and strengths/resources were compared using <emph>t</emph>‐tests. Analyses were performed with spss version 15 ([<reflink idref="bib16" id="ref19">16</reflink>]). Institutional ethics review board approval for conducting these secondary analyses was obtained.</p> <hd id="AN0057367133-5">Results</hd> <p></p> <hd id="AN0057367133-6">Patient characteristics and symptom profile</hd> <p>Outpatients receiving specialised services were compared with outpatients receiving general mental health services on the basis of patient characteristics and psychiatric diagnoses. Outpatients in specialised programmes were significantly younger (, SD = 11.2) than their counterparts accessing general services [, SD = 13.7; <emph>t</emph>(<reflink idref="bib1" id="ref20">1</reflink>, 236) = 4.39, <emph>P </emph>< 0.05]. Table 1 presents patient characteristics and psychiatric diagnoses. Outpatients in specialised programmes were more likely to be male and single and less likely to have a comorbid medical diagnosis as well as history of suicide attempts than their counterparts receiving general services. Regarding psychiatric diagnoses, outpatients in specialised programmes were more likely to have a mood or anxiety disorder diagnosis and were less likely to have a psychotic disorder diagnosis.</p> <p>1 Comparison of patient characteristics and psychiatric diagnoses for those in specialised and general programmes</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>Category</bold></th><th><bold>Specialised</bold></th><th><bold>General</bold></th><th><bold>χ<sup>2</sup></bold></th><th><bold><italic>P</italic>‐value</bold></th></tr><tr><th><bold>(N = 103)</bold></th><th><bold>(N = 136)</bold></th></tr><tr><th><bold>% (<italic>n</italic>)</bold></th><th><bold>% (<italic>n</italic>)</bold></th></tr></thead><tbody valign="top"><tr><td>Patient characteristics</td><td /><td /><td /><td /></tr><tr><td> Gender (male)</td><td>65.7 (67)</td><td>50.0% (68)</td><td>5.84</td><td>0.018</td></tr><tr><td> Never married</td><td>93.1% (95)</td><td>68.1% (92)</td><td>20.32</td><td>0.000</td></tr><tr><td> Psychotropic medication</td><td>97.1% (100)</td><td>93.8% (106)</td><td>1.32</td><td>0.338</td></tr><tr><td> Comorbid medical condition</td><td>27.1% (23)</td><td>51.9% (56)</td><td>12.09</td><td>0.001</td></tr><tr><td> History of legal problems</td><td>5.9% (6)</td><td>12.3% (16)</td><td>2.75</td><td>0.117</td></tr><tr><td> History of fire setting/ property</td><td>9.2% (9)</td><td>5.3% (6)</td><td>1.23</td><td>0.294</td></tr><tr><td> History of suicide attempt</td><td>1.9% (2)</td><td>23.5% (32)</td><td>22.39</td><td>0.000</td></tr><tr><td>Psychiatric diagnoses*</td><td /><td /><td /><td /></tr><tr><td> Mood disorder</td><td>31.1% (32)</td><td>16.9% (23)</td><td>6.63</td><td>0.013</td></tr><tr><td> Anxiety disorder</td><td>17.5% (18)</td><td>5.9% (8)</td><td>8.13</td><td>0.006</td></tr><tr><td> Substance abuse</td><td>1.0% (1)</td><td>5.9% (8)</td><td>3.90</td><td>0.082</td></tr><tr><td> Psychotic disorder</td><td>28.2% (29)</td><td>64.0% (87)</td><td>30.10</td><td>0.000</td></tr><tr><td> Personality disorder</td><td>6.8% (7)</td><td>14.0% (19)</td><td>3.11</td><td>0.094</td></tr><tr><td> Organic disorder</td><td>2.9% (3)</td><td>4.4% (6)</td><td>0.36</td><td>0.736</td></tr></tbody></table> </ephtml> </p> <p>1 *  Patients could receive more than one diagnosis.</p> <p>Table 2 compares mean Colorado Client Assessment Record ratings for outpatients from the two types of programmes. Outpatients in specialised programmes had higher scores on attention problems (d = 0.37) and self‐care/basic needs (d = 0.46) than their counterparts in general programmes. In regards to challenging behaviour, outpatients in specialised programmes had higher ratings on six of the seven domains; aggressiveness (d = 0.62), antisocial behaviour (d = 0.38), resistiveness (d = 0.43), security/management risk (d = 0.73), danger to self (d = 0.27) and danger to others (d = 0.38). In terms of lack of resources, outpatients receiving specialised services received lower ratings on economic (d = 0.62), social support (d = 0.50) and overall lack of resources (d = 0.29), meaning that outpatients in general services actually had fewer resources than those in specialised services.</p> <p>2 Comparison of mean problem severity and resources of outpatients in specialised and general programmes</p> <p> <ephtml> <table><thead valign="bottom"><tr><th><bold>CCAR domain</bold></th><th><bold>Specialised</bold></th><th><bold>General</bold></th><th><bold><italic>t</italic>‐score</bold></th><th><bold>df</bold>*</th><th><italic><bold>P</bold></italic></th><th><bold>Cohen's d</bold></th></tr><tr><th><bold>Mean</bold></th><th><bold>SD</bold></th><th><bold>Mean</bold></th><th><bold>SD</bold></th></tr></thead><tbody valign="top"><tr><td>Adaptive behaviour and cognition</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Attention problems</td><td>5.11</td><td>1.89</td><td>4.38</td><td>2.02</td><td>−2.82</td><td>237</td><td>0.005</td><td>0.37</td></tr><tr><td> Cognitive problems</td><td>4.54</td><td>1.73</td><td>4.32</td><td>1.96</td><td>−0.82</td><td>200</td><td>0.416</td><td>0.12</td></tr><tr><td> Role performance</td><td>5.53</td><td>2.68</td><td>5.41</td><td>3.16</td><td>−0.31</td><td>223</td><td>0.756</td><td>0.04</td></tr><tr><td> Self‐care/basic needs</td><td>5.94</td><td>2.19</td><td>4.93</td><td>2.25</td><td>−3.47</td><td>237</td><td>0.001</td><td>0.46</td></tr><tr><td>Challenging behaviour</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Aggressiveness</td><td>4.12</td><td>2.17</td><td>2.79</td><td>2.16</td><td>−4.68</td><td>235</td><td>0.000</td><td>0.62</td></tr><tr><td> Antisocial behaviour</td><td>3.12</td><td>1.98</td><td>2.40</td><td>1.88</td><td>−2.79</td><td>224</td><td>0.006</td><td>0.38</td></tr><tr><td> Legal issues</td><td>1.34</td><td>1.27</td><td>1.40</td><td>1.30</td><td>0.33</td><td>211</td><td>0.740</td><td>0.05</td></tr><tr><td> Resistiveness</td><td>4.39</td><td>1.60</td><td>3.62</td><td>1.91</td><td>−3.26</td><td>231</td><td>0.001</td><td>0.43</td></tr><tr><td> Security/management risk</td><td>4.78</td><td>1.95</td><td>3.27</td><td>2.19</td><td>−5.51</td><td>237</td><td>0.000</td><td>0.73</td></tr><tr><td> Suicide/danger to self</td><td>2.63</td><td>2.17</td><td>2.09</td><td>1.89</td><td>−1.99</td><td>224</td><td>0.048</td><td>0.27</td></tr><tr><td> Violence/danger to others</td><td>3.04</td><td>2.19</td><td>2.28</td><td>1.89</td><td>−2.80</td><td>228</td><td>0.006</td><td>0.38</td></tr><tr><td>Lack of resources</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Educational and social</td><td>7.50</td><td>1.81</td><td>7.73</td><td>1.59</td><td>0.97</td><td>202</td><td>0.333</td><td>0.14</td></tr><tr><td> Economic</td><td>4.67</td><td>1.53</td><td>5.80</td><td>2.07</td><td>4.43</td><td>203</td><td>0.000</td><td>0.62</td></tr><tr><td> Personal (social support)</td><td>4.85</td><td>2.17</td><td>5.95</td><td>2.24</td><td>3.58</td><td>204</td><td>0.000</td><td>0.5</td></tr><tr><td> Personal strengths</td><td>6.36</td><td>1.99</td><td>6.66</td><td>1.89</td><td>1.11</td><td>204</td><td>0.267</td><td>0.16</td></tr><tr><td>Global rating of problem severity</td><td>5.45</td><td>1.43</td><td>5.18</td><td>1.56</td><td>−1.39</td><td>235</td><td>0.167</td><td>0.18</td></tr><tr><td>Global rating of lack of resources</td><td>5.99</td><td>1.60</td><td>6.48</td><td>1.77</td><td>2.19</td><td>234</td><td>0.030</td><td>0.29</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 Ratings on a 1‐ to 9‐point Likert scale where 1 = high functioning/no special problem and 9 = low functioning/extreme problem of difficulty.</item> <item>3 *  Overall sample size varies because of missing information; some variables were not collected at all sites.</item> <item>4 CCAR, Colorado Client Assessment Record.</item> </ulist> <hd id="AN0057367133-7">Patient need: recommended level of care</hd> <p>As can be observed from Table 3, outpatients in the two types of programmes differed in terms of recommended level of care. The majority of outpatients in both types of programmes were rated as requiring level 3 care (43.6% vs. 47.0%), but more individuals in specialised programmes were rated as requiring level 4 care than individuals in general programmes (34.6% vs. 17.2%). Conversely, more outpatients in general programmes were rated as requiring level 2 care than those in specialised (19.8% vs. 35.1%).</p> <p>3 Recommended level of care for patients in specialised and general programmes</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th><bold>Specialised</bold></th><th><bold>General</bold></th></tr><tr><th><bold>(N = 103)</bold></th><th><bold>(N = 136)</bold></th></tr><tr><th><bold>% (<italic>n</italic>)</bold></th><th><bold>% (<italic>n</italic>)</bold></th></tr></thead><tbody valign="top"><tr><td>Level 1</td><td>5.9% (6)</td><td>11.2% (15)</td></tr><tr><td>Level 2</td><td>13.9% (14)</td><td>23.9% (32)</td></tr><tr><td>Level 3</td><td>43.6% (44)</td><td>47.0% (63)</td></tr><tr><td>Level 4</td><td>34.6% (35)</td><td>17.2% (23)</td></tr><tr><td>Level 5</td><td>2.0% (2)</td><td>0.7% (1)</td></tr></tbody></table> </ephtml> </p> <p>5 χ<sups>2</sups> = 12.71, <emph>P </emph>< 0.05 (<emph>P </emph>= 0.013).</p> <hd id="AN0057367133-8">Discussion</hd> <p>The present study was conducted to contrast the patient characteristics and clinical needs of outpatients with ID receiving specialised services to those receiving general services within the tertiary care psychiatric hospital system in Ontario. Many of these same trends were also observed in the 2008 inpatients study, with a few exceptions that are elaborated upon below. Individuals in both types of programmes have complex needs that warrant special attention.</p> <p>In the current study, psychiatric outpatients receiving general services were older, more likely to have a comorbid medical condition, with fewer resources. These findings paint a picture of a marginalised, hard to support group. They have a need for more intensive services, but general outpatients typically only receive level 2 type care. This study adds to the literature suggesting that individuals in generic programmes with ID and serious mental illness could benefit from more intensive services beyond what is provided in the standard outpatient mental health care ([<reflink idref="bib7" id="ref21">7</reflink>]; [<reflink idref="bib2" id="ref22">2</reflink>], [<reflink idref="bib3" id="ref23">3</reflink>]; Reid 1995).</p> <p>Patients in specialised programmes were younger, more likely to be diagnosed with a mood or anxiety disorder, displayed more aggression and were recommended for higher levels of care than other patients. With the exception of anxiety disorder diagnoses, these findings are similar to what was found among inpatients in specialised programmes when compared with their counterparts in general programmes ([<reflink idref="bib13" id="ref24">13</reflink>]). Higher recommended level of care for individuals in specialised programmes suggests that overall patients with greater needs are apparently being directed to the specialised services.</p> <p>As was suggested in the earlier paper ([<reflink idref="bib13" id="ref25">13</reflink>]), diagnostic differences may be due in part to differing skill sets between the two types of services. Clinicians with specialised training in ID may be more likely to recognise mood and anxiety disorders, hence the higher rate of these diagnoses and lower rate of schizophrenia diagnoses (See also [<reflink idref="bib9" id="ref26">9</reflink>]). That being said, the higher rate of schizophrenia in general services may also be reflective of a subgroup of individuals with schizophrenia who are low functioning, such as those described in the UK700 trial ([<reflink idref="bib7" id="ref27">7</reflink>]). These individuals do not tend to get referred to specialised services, but may not get as much support as they need in general schizophrenia outpatient programmes and evidence would suggest that they benefit from more intensive services ([<reflink idref="bib7" id="ref28">7</reflink>]).</p> <p>This study has several limitations, which should be taken into consideration when interpreting its findings. First, information regarding ethnicity, race and level of ID was not available and issues such as accuracy of ID and psychiatric diagnosis cannot be addressed using this database, as the data were developed for another purpose. Second, this study does not address the needs of outpatients who access services outside of tertiary level care psychiatric hospitals or who are not receiving any services. Third, findings here may be unique to Ontario, and not generalisable to other jurisdictions. Only comparable research in other places will address this issue. Finally, the level of care algorithm adopted here has demonstrated good concurrent validity, yet is still relatively new and would benefit from further testing, especially in psychiatric populations with complex conditions such as those with ID and mental health needs.</p> <hd id="AN0057367133-9">Acknowledgement</hd> <p>This research was supported by an Ontario Mental Health Foundation New Investigator Award.</p> <ref id="AN0057367133-10"> <title> References </title> <blist> <bibl id="bib1" idref="ref6" type="bt">1</bibl> <bibtext> Balogh R., Ouellette‐Kuntz H., Bourne L., Lunsky Y. & Colantonio A. (2008) Organizing health care services for persons with an intellectual disability. Cochrane Database of Systematic Reviews 4, Art. No.: CD007492, DOI: 10.1002/14651858.CD007492</bibtext> </blist> <blist> <bibl id="bib2" idref="ref22" type="bt">2</bibl> <bibtext> Chaplin R. (2004) Generic psychiatric services for adults with intellectual disability and mental illness. 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Available at: <ulink href="http://www.camh.net/Care%5fTreatment/Program%5fDescriptions/Mental%5fHealth%5fPrograms/Dual%5fDiagnosis/dual%5fdiagnosis%5fontpsyhos%5fph2dec05.pdf">http://www.camh.net/Care%5fTreatment/Program%5fDescriptions/Mental%5fHealth%5fPrograms/Dual%5fDiagnosis/dual%5fdiagnosis%5fontpsyhos%5fph2dec05.pdf</ulink></bibtext> </blist> <blist> <bibtext> Lunsky Y., Bradley E., Durbin J., Koegl C., Canrinus M. & Goering P. (2003) Dual Diagnosis in Provincial Psychiatric Hospitals: A Population Based Study. Centre for Addiction and Mental Health, Toronto. Available at: <ulink href="http://www.camh.net/Publications/Resources%5ffor%5fProfessionals/dualdiagnosis%5fprovpsychhosp%5f1styr2003.pdf">http://www.camh.net/Publications/Resources%5ffor%5fProfessionals/dualdiagnosis%5fprovpsychhosp%5f1styr2003.pdf</ulink></bibtext> </blist> <blist> <bibtext> Lunsky Y., Bradley E., Durbin J., Koegl C., Canrinus M. & Goering P. (2006) The clinical profile and service needs of hospitalized adults with mental retardation and a psychiatric diagnosis. Psychiatric Services 57, 77 – 83.</bibtext> </blist> <blist> <bibtext> Lunsky Y., Bradley E., Durbin J. & Koegl C. (2008) A comparison of patients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals. Journal of Intellectual Disability Research 52, 1003 – 12.</bibtext> </blist> <blist> <bibtext> Martin G., Costello H., Leese M., Slade M., Bouras N., Higgins S. et al. (2005) An exploratory study of assertive community treatment for people with intellectual disability and psychiatric disorders: conceptual, clinical, and service issues. Journal of Intellectual Disability Research 49, 516 – 24.</bibtext> </blist> <blist> <bibtext> Oliver P., Piachaud J., Tyrer P., Regan A., Dack M., Alexander R. et al. (2005) Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study. Journal of Intellectual Disability Research 49, 507 – 15.</bibtext> </blist> <blist> <bibtext> SPSS Inc. (2007) SPSS Base 15.0 for Windows. SPSS Inc., Chicago, IL.</bibtext> </blist> </ref> <aug> <p>By Y. Lunsky; C. Gracey; E. Bradley; C. Koegl and J. Durbin</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib14" firstref="ref3"></nolink> <nolink nlid="nl2" bibid="bib15" firstref="ref4"></nolink> <nolink nlid="nl3" bibid="bib11" firstref="ref11"></nolink> <nolink nlid="nl4" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref13"></nolink> <nolink nlid="nl6" bibid="bib12" firstref="ref14"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref19"></nolink>
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  Label: Title
  Group: Ti
  Data: A Comparison of Outpatients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals
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  Label: Language
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  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Lunsky%2C+Y%2E%22">Lunsky, Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Gracey%2C+C%2E%22">Gracey, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Bradley%2C+E%2E%22">Bradley, E.</searchLink><br /><searchLink fieldCode="AR" term="%22Koegl%2C+C%2E%22">Koegl, C.</searchLink><br /><searchLink fieldCode="AR" term="%22Durbin%2C+J%2E%22">Durbin, J.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+Disability+Research%22"><i>Journal of Intellectual Disability Research</i></searchLink>. Feb 2011 55(2):242-247.
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  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA/
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  Data: Y
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  Label: Page Count
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  Data: 6
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2011
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  Data: Journal Articles<br />Reports - Research
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  Data: <searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Mental+Retardation%22">Mental Retardation</searchLink><br /><searchLink fieldCode="DE" term="%22Psychiatric+Hospitals%22">Psychiatric Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Patients%22">Patients</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Profiles%22">Profiles</searchLink><br /><searchLink fieldCode="DE" term="%22Clinics%22">Clinics</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Services%22">Medical Services</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+Care+Evaluation%22">Medical Care Evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Demography%22">Demography</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Needs%22">Health Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Case+Records%22">Case Records</searchLink><br /><searchLink fieldCode="DE" term="%22Clinical+Diagnosis%22">Clinical Diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Client+Characteristics%22">Client Characteristics</searchLink>
– Name: Subject
  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Canada%22">Canada</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/j.1365-2788.2010.01307.x
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0964-2633
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: This study compares outpatients with intellectual disability (ID) receiving specialised services to outpatients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources, and clinical service needs. Methods: A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for a stratified random sample of 246 outpatients identified as having ID, from both specialised and general programmes. Results: Individuals with ID in specialised programmes differed from patients with ID in general programmes with regard to demographics, diagnostic profile, symptom presentation and recommended level of care. Conclusions: Further research is required to determine why individuals access some services over others and to evaluate whether specialised services are more appropriate for certain subgroups with ID than others.
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  Data: As Provided
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  Data: 31
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  Label: Entry Date
  Group: Date
  Data: 2011
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  Label: Accession Number
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  Data: EJ927737
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      Pagination:
        PageCount: 6
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      – SubjectFull: Mental Retardation
        Type: general
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      – SubjectFull: Canada
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      – TitleFull: A Comparison of Outpatients with Intellectual Disability Receiving Specialised and General Services in Ontario's Psychiatric Hospitals
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