Table 1: Combining mainstream and specialist healthcare for adults with rare causes of intellectual disability [15,19-21].

1

Optimal availability and accessibility to mainstream health services and health professionals

 

Requires development and establishments of reasonable adjustments to mainstream to facilitate access to and participation in healthcare by adults with intellectual disability: e.g. more time for consultations, adequate support for communication, adoption of a proactive approach to healthcare, sedation service for imaging, opportunistic testing

 

No extra financial, physical, organizational or legislative barriers to use mainstream

 

Participation in mainstream processes involving auditing of quality service, mortality and morbidity reviews, and other healthcare outcomes

 

Adoption of a proactive approach to healthcare

 

Aim for continuous improvement in service delivery and health outcomes

2

Organized access to core specialist group within mainstream

 

Available for consultation by all health professionals (physicians, general practitioners, surgeons, psychiatrists, allied health professionals) with expertise in rare conditions of intellectual disability and having links with other related networks

 

Maintains a direct clinical role in care of adults with intellectual disability with their families and disability support networks

 

Provides information about rare disorders of intellectual disability in adults with appropriate levels of complexity to colleagues as well as adults with intellectual disability, their families and disability support networks. Information includes associated disabilities, medical issues, behavioral and cognitive phenotypes, treatments, and about living with intellectual disability.

 

Provides clinical advice to colleagues about how to refine their bio psychosocial approach to taking a history, performing examinations, ordering tests, making diagnoses, management plans and review for their adult patients with rare cause of intellectual disability accommodating for impact of intellectual disability on communication and living circumstances and disability supports.

 

Provide advice on testing for unknown cause of intellectual disability in adults

 

Participate in review and oversight of quality of ethical aspects of health care

 

Participate in overseeing framework in place for to ensure that adults with intellectual disability have adequate disability supports organizes to enable them to access and participate in mainstream health services

 

Responsibility for improved education and competencies among mainstream colleagues on science, clinical aspects, and values in relation to healthcare of adults with intellectual disability within mainstream health settings

3

Organized and optimal disability supports plan in place to enable access to and participation in mainstream healthcare

 

Requirement that adult patients with intellectual disability have established and robust disability supports plans in place which are activated when they need healthcare in any setting.

 

Development of standards, expectations and specific roles of disability and family supports in healthcare settings

 

Requires implicit understanding that disability supports be included, involved and accept responsibility in specialist core and mainstream healthcare with the individual adult patient with intellectual disability

4

Establishment of a health-disability interface within mainstream

 

Involves adults with intellectual disability and their families as well as disability sector professionals to collaborate with specialist core and mainstream health professionals on types of reasonable adjustments, feedback on quality service aspects, service delivery and outcomes

 

Facilitates cross fertilization of knowledge and values with respect to paradigms, policy, protocol, demarcation of duties, regulatory and legislative issues between disability and specialist and mainstream health sectors and professionals

 

Clarifies practical responsibilities of health and disability sectors and professionals to adults with intellectual disability patients/clients in GP and specialist visits, public health and inpatient settings

 

Carries information from collaboration into their own sector to increase knowledge and education about the other