A quantitative assessment of educational integration of students with Down syndrome in the Netherlands.

BACKGROUND: In the Netherlands, as in many other countries, there are indications of an inclusive school policy for children with Down syndrome. However, there is a lack of studies that evaluate to what extent this policy has actually succeeded in supporting the mainstreaming of these students. METHOD: For the period 1984-2011, the number of children with Down syndrome entering regular education and the percentage of children still in regular education after 1-7 years were estimated on basis of samples from the database of the Dutch Down Syndrome Foundation. These estimations were combined with historical demographic data on the total number of children with Down syndrome in primary school age. Validity of the model was examined by comparison of the model-based estimations of numbers and percentages in regular education with relevant available empirical data from the Dutch Ministry of Education and from Dutch special schools. RESULTS: The percentage of all children with Down syndrome in the age range 4-13 in regular primary education has risen from 1% or 2% (at the very most about 20 children) in 1986-1987, to 10% (about 140 children) in 1991-1992, to 25% (about 400) in 1996-1997, to 35% (about 650) in 2001-2002 and to 37% (about 800) since 2005-2006. The proportional increase stopped in recent years. CONCLUSION: During the 1980s and 1990s, clearly more and more children with Down syndrome were in regular education, being supported by the then existing ad hoc regulations aimed at providing extra support in regular education. In the Netherlands, in 2003, these temporary regulations were transformed into structural legislation for children with disabilities. With regard to the mainstreaming of students with Down syndrome, the 2003 legislation has consolidated the situation. However, as percentages in regular education stayed fairly constant after 2000, it has failed to boost the mainstreaming of children with Down syndrome. The results of this study are discussed in the context of national and international legislation and educational policy.

The P15 - a multinational assessment battery for collecting data on health indicators relevant to adults with intellectual disabilities.

BACKGROUND: Health disparities between adults with intellectual disabilities (ID) and the general population have been well documented but, to date, no dedicated assessment battery for measuring health disparity has been available. This paper reports on the development and testing of a multinational assessment battery for collecting data on a range of health indicators relevant to adults with ID. METHODS: An assessment battery (the P15) was developed following piloting, and administered to samples of adults with ID, in 14 EU countries. Samples were neither random, nor representative of the countries from which they were drawn. However, within the local health administration areas selected in each country, efforts were made to ensure samples were broadly representative of the typical living circumstances, ages and ability levels of the administrative population of adults with ID. The total sample comprised 1269 adults with ID, of whom 49% were female. The mean age was 41 years (range 19 to 90). RESULTS: Overall, feasibility, internal consistency and face validity of the P15 was acceptable. CONCLUSIONS: With some refinement the P15 could be useful for collecting data on health indicators known to be particularly important for adults with ID. It is useable in a range of countries and has the potential to highlight health inequity for adults with ID at a national or local level. Larger scale epidemiological studies are needed to exploit the potential of the P15 to address health inequity in this group.

Health problems in people with intellectual disability in general practice: a comparative study.

In a GP database, 318 people with intellectual disability (ID) appeared to have 2.5 times more health problems than people without ID. This short report deals with the nature of the health problems. Consequences for health care policy are discussed.

People with intellectual disability in general practice: case definition and case finding.

In a general practice database containing data on 62,000 patients, those with intellectual disability (ID) were traced. Health problems in this database were recorded according to the International Classification of Health Problems in Primary Care (ICPC) code. By using selected codes, 318 people with ID (0.65% of the study population) were found; the sample contained nearly as many false positives. Adding up the percentage of people with ID living in residential facilities, the total prevalence of people with ID was estimated as 0.82%. Documentation on the cause and level of ID was available in about half of the cases. The demographic characteristics of the people with ID were significantly different from the general population: there was a higher percentage of males and a lower percentage of people over 50 years of age among those with ID. Information about the use of home care was virtually non-existent in the general practice data. The results are compared with those of other studies. The discussion deals with reasons for complete documentation of cases with ID in general practice and the role of the general practitioner in health care supply to people with ID.

The need for assessment of sensory functioning in ageing people with mental handicap.

Within the framework of a study on the ageing process of people with mental handicap in the Netherlands, information about visual and hearing impairments in 1583 people with mental handicap living in group homes or institutions was obtained from their physicians by means of a written questionnaire. Of the people with Down's syndrome (DS) who were older than 50 years of age, 46% had a visual impairment, whereas approximately 13% of subjects with other causes of mental handicap at the same age experienced similar visual impairment. Hearing loss in this age group was reported in 28% of people with DS, but only in 8% of subjects with other causes of mental handicap. The most common eye condition was cataracts, and the most frequent cause of hearing impairment was infection. In people with severe and profound mental handicap of all ages, sensory impairments were more frequent than in persons with mild or moderate mental handicap. Glasses or hearing aids were rarely used by people with severe or profound mental handicap. Assessment of visual and hearing impairments in people with mental handicap seemed clearly indicated, especially in those aged 50 years and older, in those with DS, and in those with severe or profound mental handicap.

Care dependence and services planning.

For policy purposes as well as for the provision of individual care, it is relevant to know which individual characteristics have an impact upon the level of care dependence. For policy purposes, it is preferable to predict the level of care dependence as efficiently as possible. This study of residents of institutions and group homes for people with mental handicap showed that profoundly mentally handicapped residents are almost all totally dependent upon care: additional information about the individual characteristics of this group is superfluous. The results of logistic regression analyses for residents with severe or mild mental handicap showed that age, gender and aetiological diagnosis (Down's syndrome or other) do not have significant predictive power. For the level of care dependence, adding the score on Activities of Daily Life (ADL) to the various models improved the predictive power. It depends on the level of mental handicap and on the level of care dependence which one wants to predict which other individual characteristics have to be included in order to improve predictive power.

[Possibilities in the management of long-term patients outside the psychiatric hospital; clinical assessment by the treatment staff in The Netherlands]. / Uber Möglichkeiten in der Versorgung von Langzeitpatienten ausserhalb des psychiatrischen Krankenhauses; klinische Einschätzungen des behandelnden Personals in den Niederlanden.

How many longstay patients could be just as well served by less sheltered facilities, and what are the main reasons for staff-members to consider patients suitable for alternative care? These were the two questions of a Dutch study (1984-1985) in five mental hospitals. Both, the attending psychiatrist and one of the nurses, were asked to give an independent judgement for each of the persons of a random sample of 381 longstay patients. Some results: thirty percent of the longstay patients were judged eligible for alternative care. They were younger, less frequently diagnosed as schizophrenic, better integrated inside and outside of the mental hospital, more likely to be residents of wards with high turnover-rates, were less aggressive, and had better social skills, and shorter periods of inpatient stay. Compared with the rest of the patients no statistically significant differences were found with regard to suicidal behaviour, organic brain syndrome and formal admission status.