Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba

1. Comprehensive Health Assessments for adults with Intellectual Disability in Manitoba CCDDA, 2014

2. Research Team Dr. ShahinShooshtari, Faculty of Human Ecology Dr. Beverley Temple, College of Nursing Celeste Waldman, RA, MN Student, Nursing Sneha Abraham, Trainee, Community Health Sciences

3. Background • Research from Canada and abroad shows that: • Significant health disparities exist between persons with and without ID (see Ouellette-Kuntz et al., 2005, for a comprehensive review). • Despite poorer health and higher health-care needs, persons with ID experience more difficulty accessing proper health care than the general population [e.g., Janicki et al., 2002; Krahn, et al., 2006; Bigby, 1998; Robertson et al., 2011).

4. Your Expectations • How many of you have had an annual health check/physical? • Why do you have those ? • What do you expect to accomplish by having a physical? • What kinds of screening have you had? • Cancer checks – such as stool, colonoscopy, pap tests, prostate checks, mammography? • Eye, hearing, dental?

5. Background • Different strategies have been suggested to reduce health disparities for persons with ID. For example: Comprehensive health assessments • The CHAP, an Australian-developed tool, was designed to help minimize the barriers to access primary health care for persons with ID by prompting comprehensive health reviews.

7. Background • The effectiveness of the CHAP was established through well-designed studies [RCT; 450+ participants] (Lennox et al., 2007). • increased health promotion, disease prevention, and case-finding activity in the intervention group, who received comprehensive health assessment based on the CHAP. • 30-fold increase in hearing testing; 9-fold increase in rates of immunization; 8-fold increase in women’s health screening, and increased detection of new disease (e.g., diabetes, heart disease) by 1.6 times.

8. Background • The CHAP is a two-part booklet • The caregiver will complete the first part • The GP will complete the second part • A list of conditions which are usually unrecognized or poorly managed in populations with ID (Page 15). • A chart of syndrome-specific comorbidity, which has proven useful for GPs (Page s 22-23).

9. Study Aim • To determine the feasibility of implementing the Comprehensive Health Assessment Program (CHAP) for adults with ID in the Province of Manitoba.

10. Study Method • Interviews with • General Practitioners (GPs) • Nurse Practitioners (NPs) • Frontline Support Workers • Family Members

11. Providers or Families • Question areas include: • Breathing system – e.g does the person cough? • Heart system – do they have chest pain? Ankles swell? • Muscles and joints – do they have joint/back pain? • Stomach and bowel – Lost weight, trouble swallowing? • Urinary system – Pain when passing urine? Any blood in urine? • Nervous system – are they unsteady on their feet when walking?

12. Providers or Families • Epilepsy? • Types of seizures • Drs. Seen for epilepsy • Allergies • Cause of Intellectual Disability • Human Relations – sexual activity? • Medications • Prescription • Over the counter

13. Providers or Families • Women’s health – menstrual cycles, contraception, etc • Pap smear, mammograms? • Men’s health – discharge from penis, undescended testes? • Problem Behaviours • Mental Health • Vision • Hearing

14. Providers or Families • Dental • Blood Pressure • Cigarettes • Alcohol • Thyroid, Vit D test, Bowel cancer tests • Activity and lifestyle – mobility changes, ?exercise, diet? • Immunizations • Personal Medical history – e.g. surgeries • Family History

15. Barriers and Facilitators • Ideas of barriers to completing the CHAP • Ways to facilitate use • What would you need to assist you to complete the 1st part?

16. Barriers and Benefits From GPs and NPs, some initial ideas that have arisen include: Barriers • Time • Payment Benefits • Assist practitioners to anticipate more diseases to provide better care • Potential difficulty in completing the action plan – or follow-ups.

18. Next Steps • We are organizing the ideas from all of the interviews from Nurse Practitioners, and GPs • We will be recruiting family members and direct support workers to discuss their ideas of using the CHAP • Plan to meet with government to discuss reimbursement of GPs who would be willing to do the assessments • Need to develop ways to measure success – improved health of people with ID if we have CHAP done.

19. Do you have questions? Are you ready to help improve the health of people you support?

20. References • Bigby, C. (1998). Shifting responsibilities: The patterns of formal service use by older people with intellectual disability in Victoria. Journal of Intellectual and Developmental Disability, 23(3), 97-109. • Janicki, M., McCallions, P., & Dalton, A. (2002). Dementia-related care decision-making in group homes for persons with intellectual disabilities. Journal of Gerontological Social Work, 38(1/2), 179-195. • Krahn, G., Hammond, L., & Turner, A. (2006). A cascade of disparities: health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews, • Lennox, N., Bain, C., Rey-Conde, T., Purdie, D., Bush, R., Pandeya, N. (2007). Effects of a comprehensive health assessment programme for Australian adults with intellectual disability: a cluster randomized trial. International Journal of Epidemiology, 36(1), 139-140. • Ouellette-Kuntz, H., Garcin, N., Lewis, M., Minnes, P., Martin, C., Holden, J. (2005). Addressing health disparities through promoting equity for individuals with intellectual disability. Canadian Journal of Public Health, 96 (S2), S8-S22. • Robertson, J., Roberts, H,. Emerson, E., Turner, S., Greig, R. (2011). The impact of health checks for people with intellectual disabilities: a systematic review of evidence. Journal of Intellectual Disability Research, 55(11), 1009-1019.