Establishing core mental health workforce attributes

22  |  wileyonlinelibrary.com/journal/jar J Appl Res Intellect Disabil. 2017;30(Suppl. 1):22–33.
Published for the British Institute of Learning Disabilities
© 2017 John Wiley & Sons Ltd
Accepted: 2 June 2017
DOI: 10.1111/jar.12407
ORIGINAL ARTICLE
Establishing core mental health workforce attributes for the
effective mental health care of people with an intellectual
disability and co-occurring mental ill health
Janelle Weise1 | Karen R Fisher2 | Julian N Trollor1
1
Department of Developmental Disability
Neuropsychiatry, School of Psychiatry, UNSW
Sydney, Sydney, NSW, Australia
2
Faculty of Arts and Social Sciences, Disability
Research Program Social Policy Research
Centre, UNSW Sydney, Sydney, NSW,
Australia
Correspondence
Julian N Trollor, Department of Developmental
Disability Neuropsychiatry, School of
Psychiatry, UNSW Sydney, Sydney, NSW,
Australia.
Email: [email protected]
Funding information
The work of the Chair Intellectual Disability
Mental Health is supported by core funding
from Ageing Disability and Home Care, Family
and Community Services NSW and the
Mental Health and Drug and Alcohol Office,
NSW Ministry of Health. This project was
specifically funded by Mental Health Drug and
Alcohol Office, NSW Ministry of Health.
Background: People with intellectual disability experience high rates of mental ill
health but multiple barriers to access to quality mental health care. One significant
barrier to access is a generalist mental health workforce that lacks capacity, and consensus on what constitutes core workforce competencies in this area. As such, the
first step in developing a comprehensive strategy that addresses these barriers is to
define the core mental health workforce attributes.
Methods: Thirty-six intellectual disability mental health experts from across Australia
participated in a modified online Delphi which aimed to reach consensus on the core
attributes required of the generalist mental health workforce. At the end of each
Delphi round, descriptive analyses and thematic analyses were completed.
Results: Consensus was reached among the participants for 102 attributes across 14
clinical domains. The results highlighted specific attributes in all areas of clinical practice, especially for communication (e.g., utilizes assistive communication technology),
assessment (e.g., assess contributing factors to behaviours) and intervention (e.g., uses
integrative interventions).
Conclusion: A comprehensive strategy is required to facilitate the generalist mental
health workforce to obtain these attributes.
KEYWORDS
core competencies, Delphi method, intellectual disability mental health, mental health
workforce, workforce attributes, workforce development
1 | INTRODUCTION
People with an intellectual disability are a minority group who are at
increased risk of mental health problems when compared to the general population (Hatton, E. Robertson, & Baines, 2015), experiencing
high rates of common mental disorders (Cooper, Smiley, Morrison,
Williamson, & Allan, 2007; Einfeld, Ellis, & Emerson, 2011; Einfeld
et al., 2006; Emerson & Hatton, 2007; Smiley et al., 2007). They are
also higher users of services in primary care (Weise, Pollack, Britt, &
Trollor, 2016), emergency departments (Lunsky et al., 2012), hospital
and ambulatory care settings (Howlett, Florio, Xu, & Trollor, 2015) for
psychological problems than the general population. Given the high
rates of mental disorder and service use, it is important that there are
appropriate systems in place that ensure timely access to quality mental health assessment and management. However, available research
indicates that people with an intellectual disability and co-occurring
mental ill health find the mental health services difficult to access, with
only up to a quarter of people having participated in mental health
care (Beange, McElduff, & Baker, 1995; Dekker & Koot, 2003; Einfeld
et al., 2006; McCarthy & Boyd, 2002).
The World Health Organization (WHO) has identified six essential
elements to strengthening health services and improving population
health outcomes. These include the health workforce, service delivery,
information, medical products, financing and leadership/governance
(WHO 2007). However, one of the key barriers to health access for
people with disability is the lack of capacity of the disability health
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workforce (WHO 2011). At a national level in Australia, both the
National Disability Strategy (Council of Australian Governments 2011)
and the Fourth National Mental Health Plan (Australian Government
Department of Health and Ageing 2009) acknowledge the need for
targeted workforce development that addresses the structural participation barriers. However, the current National Mental Health
Workforce Strategy (Mental Health Workforce Advisory Committee
2011), which articulates the strategic direction of the Australian
Government in relation to workforce development, does not specifically describe the actions required to meet the needs of people with
an intellectual disability and co-occurring mental ill health. This omission is discordant with findings of a subsequent National Roundtable
on the Mental Health of People with Intellectual Disability (NSW
Council for Intellectual Disability 2013) which articulated an explicit
need for the inclusion of people with an intellectual disability in all
mental health initiatives.
The need to better equip the generalist mental health workforce
in the area of intellectual disability mental health has been repeatedly acknowledged within the literature (Edwards, Lennox, & White,
2007; Lennox & Chaplin, 1995, 1996; NSW Council for Intellectual
Disability, 2013; Torr et al., 2008; Trollor, Ruffell et al., 2016; Trollor,
Salomon, & Franklin, 2016; Weise & Trollor, 2017). Recommendations
to enhance capacity of the workforce have primarily focused on the
need to increase education and training in this area. While education
and training are important factors, they are unlikely in isolation to result in measurable change (Lancaster, Silagy, & Fowler, 2000; Roche,
2001; Roche & Pidd, 2008; Skinner, Roche, O’Connor, Pollard, & Todd,
2005). Work in other disciplines and sectors such as public health nutrition and addiction have highlighted the need for a comprehensive
workforce strategy that considers action at a systems, organization,
team and individual level (Hughes, 2008; Roche, 2001). As such, the
first step in developing such a comprehensive strategy is to clearly
identify the attributes (also known as core competencies) required
of the workforce. The articulation of these attributes would provide
structure for action, aligns workforce attributes with health consumers and community needs, consolidates intellectual disability mental
health as an essential area of practice and provides measurable targets
(Barry, Allegrante, Lamarre, Auld, & Taub, 2009; Brownie, Bahnisch, &
Thomas, 2011; Hughes, 2004; Nelson & Graves, 2011).
Given the lack of explicit recognition of the mental health needs of
people with an intellectual disability at a strategic level in Australia, it is
unsurprising that the specific attributes required of the generalist mental health workforce to work with people with an intellectual disability
are not articulated in the National Practice Standards for the Mental
Health Workforce (Australian Government Department of Health
2013) and that there is minimal relevant content to the area of intellectual disability within the National Mental Health Core Capabilities
(Health Workforce Australia 2014). The paucity of guidance in this
area may have contributed to the lack of comprehensive workforce
development, and low levels of confidence, skills and knowledge reported by mental health professionals in intellectual disability mental
health (Edwards, Lennox, & White, 2007; Lennox & Chaplin, 1995,
1996; Torr et al., 2008; Weise & Trollor, 2017). While some positive
examples of intellectual disability mental health workforce attributes
can be found in professionals who belong to specialist interest groups,
such as that hosted by Royal Australian and New Zealand College of
Psychiatrists, work is required to define the core attributes of the
generalist mental health workforce to deliver accessible, quality and
effective mental health services to people with an intellectual disability and co-occurring mental ill health across their lifespan. Within an
Australian context, this is of particular importance because nearly all
mental health care is provided within the mainstream mental health
service system, with only very limited pockets of specialist intellectual
disability mental health services available.
To address this need, the authors of the present study partnered with the New South Wales Ministry of Health to initiate the
Intellectual Disability Mental Health Core Competencies Project. This
project aimed to define the core workforce attributes of the generalist mental health workforce in public mental health services in NSW,
Australia (now referred to as mental health workforce), when working
with people with an intellectual disability, their families and support
networks. To do this, a multiphased, multimethod approach was taken
to consult with key stakeholders including people with an intellectual
disability and co-occurring mental ill health, their families and support networks, and intellectual disability mental health experts. This
article reports on one phase of the project which involved conducting a Delphi with intellectual disability mental health experts to elicit
group consensus on the core mental health workforce attributes in
this area. This methodology was selected because it has been extensively used for this purpose by healthcare researchers (Butterworth
& Bishop, 1995; Hughes, 2004; Jonsdottir, Hughes, Thorsdottir,
& Yngve, 2011; Lakeman, 2010). The Delphi method has also been
shown to make best use of existing evidence and professional experience (Balasubramanian & Agarwal, 2013; Murphy et al., 1998) and
provide a structured process to reach group consensus on the topic
being researched (Hsu & Sandford, 2007).
It was hypothesized that the Delphi process would identify, from
the perspective of intellectual disability mental health experts, the key
workforce attributes required to meet the needs of people with an
intellectual disability and co-occurring mental ill health.
2 | METHODOLOGY
2.1 | Study design
This study used a modified online Delphi method to identify core
intellectual disability mental health workforce attributes. This modified Delphi method aimed to address some of the commonly reported challenges and limitations of the traditional Delphi method
including for example high dropout rates and moulding of opinions
(Balasubramanian & Agarwal, 2013). This method deviated from a
traditional Delphi in four ways: (i) it commenced with a proposed
framework of attributes, (ii) it ensured complete participant anonymity, (iii) it used less than three rounds of consultation because
consensus had been reached after two rounds, and (iv) it was delivered online. A critique of this modified technique confirmed its
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utility in defining workforce attributes (Weise, Fisher, & Trollor,
2016).
A full description of the method used is published elsewhere (Weise,
Fisher & Trollor, 2016); however, in brief, the research team initially completed a review, consulted with key experts and drew on the researchers’
clinical experience to identify potential attributes. These results were
then used to develop a Delphi survey tool which collated potential attributes into 14 domains that mirrored the existing competency frameworks used by the mental health workforce (see Table 1).
The resulting survey tool, which included a quantitative and a qualitative component, was then used to commence the Delphi consultation process. Between December 2013 and the end of January 2014,
using online survey software, participants were asked to (i) rate their
level of agreement (five point agreement Likert scale) that each of the
proposed attributes was a core element of clinical practice for mental
health professionals working with people with an intellectual disability
within mainstream services and (ii) identify and record any additional
core attributes, to comment on the existing proposed content and
make recommendations for changes to the wording.
The authors used a predetermined criterion for group consensus
and informed the participants of these to assist them in responding to the survey. The research team defined consensus as 70% or
more of participants agreeing or strongly agreeing that the attribute was core to clinical practice, and the attribute had a median
of 3.5 or higher. This definition of consensus was selected because
it has been used successfully in previous studies which aimed to
define workforce attributes (Barry, Battel-Kirk, & Dempsey, 2012;
Goligher, Ferguson, & Kenny, 2012). Following each round, the research team analysed the results and modified the content in line
with the quantitative and qualitative feedback from the participants.
The participants were provided with a summary of the results from
round one and a list of deleted items. This research was granted ethics approval from NSW Health, HREC Reference Number: 13/028
(LNR/13/POWH/83).
2.2 | Delphi panel members
A convenience sample of key clinical, academic, advocates and policy
experts in intellectual disability mental health in Australia were invited to
participate in the research via email. A snowballing technique was used
to identify additional experts whereby invited participants were encouraged to forward an invitation onto their relevant professional networks.
A total of 52 intellectual disability mental health experts from
across Australia were initially invited to participate in the Delphi. An
additional 10 individuals were identified through the snowballing
technique, bringing the total number of potential participants to 62.
Of these, responses were obtained from a total of 36 participants, 32
participants for round one and 26 participants for round two (four participants from round two did not participate in round one).
Table 2 shows the profile of participants with the majority of participants being female (64%), aged 35 years and over (97%) and had
10 or more years of experience working in the area of intellectual disability mental health (75%). Each of the key mental health professional
groups involved in the clinical care of people was present including
TABLE 1 The 14 domains of the core competency framework
No. Domain
1 Values and approaches
2 Attitudes and beliefs
3 Responsible, safe and ethical practice
4 Working with people with an intellectual disability, their
families and support networks in recovery focused ways
5 Meeting the diverse needs of people with an intellectual
disability
6 Working with Aboriginal people with an intellectual disability,
their families and communities
7 Communication
8 Continuous quality improvement
9 Partnership, collaboration and integration
10 Intake
11 Assessment, formulation and care planning
12 Intervention
13 Transfer of Care
14 Mental health promotion and primary prevention
TABLE 2 Participant profile (N = 36)a
Profile Category nb %
Gender Female 23 64
Male 13 36
Age Under 25 years 0 0
25–34 years 1 3
35–54 years 20 57
55+ years 14 40
Professional
background
Nursing 6 18
Occupational therapy 2 6
Psychiatry 11 32
Psychology 7 21
Social work 2 6
Other 6 18
Current position Academic 5 14
Advocate 1 3
Clinician 24 69
Policy 5 14
Years of experience in
IDMH
<5 years 3 8
5–9 years 6 17
10–20 years 19 53
>20 years 8 22
IDMH, intellectual disability mental health.
a
A comparison between individuals who participated in round one and
round two could not be made because of the data collection
methodology.
b
Excludes missing data.
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nursing, occupational therapy, psychiatry, psychology and social work.
Although clinicians dominated (69%), there was also substantial participation from academics and policymakers.
The study used complete participant anonymity because of the
research team’s existing relationships with many of the invited participants and because of the small pool of intellectual disability mental
health experts in Australia.
2.3 | Statistical analysis
At the completion of each round, the research team undertook both
quantitative and qualitative analyses. Quantitative descriptive analyses were used to determine the percentage agreement and the median score as a measure of central tendency. Qualitative content
and thematic analyses were completed on additional core attributes
suggested by participants, and their comments on the existing proposed content, and recommendations for changes to the wording of
the attributes. One member of the research team analysed the data
for themes and specific recommendations of wording changes to the
proposed attributes within each of the 14 domains and for themes
that crossed over the domains. A second member of the research
team then reviewed the data and confirmed if they agreed with these
themes and generated any additional themes. If there was a disagreement between the two researchers, a discussion was held until consensus was reached.
Due to the complete anonymity of participants, direct member
checking was not possible. However, as the Delphi is an iterative process, with the participants being provided with feedback, a revised
framework, and the opportunity to re-rate their level of agreement
they were able to validate the research team’s interpretation of their
responses.
Triangulation of data involved a process by which after each round
the research team used the predetermined quantitative threshold
to highlight attributes that were to be retained or removed from the
framework. The qualitative data were then reviewed for each of the
attributes to see whether it supported or conflicted with the quantitative results. When the qualitative data conflicted with the quantitative
data, the research team assessed each individual case to decide on the
best course of action. These decisions were guided using the results
and consideration of the overall aim of the Delphi. The qualitative results were also used to generate additional items and to modify the
wording of existing attributes.
3 | RESULTS
3.1 | Round one
The quantitative results showed that the level of agreement on the
proposed attributes ranged from 78.1% to 100.0% and the median
scores ranged from four to five. A majority of attributes had a median
of 5 (93.9%). Therefore, the quantitative definition of consensus was
reached for all the proposed attributes.
The four main themes from the qualitative data were as follows:
1. The need to clarify and merge attributes where possible to
reduce the large number of attributes. For example, one participant reported that “Some of the wording is not
consistent.”
2. The need to add additional items. Participants proposed additional
content, for example within the intervention domain a participant
reported the need for mental health professionals to “Work with
disability support, and behavioural support teams.”
3. The need to remove attributes that are the responsibility of
advanced clinicians and services, rather than mental health practitioners. For example, one participant reported that “Some of above
are ‘ideal’ not ‘core’, can be beyond individual clinician to enact.”
4. The attributes describe a high standard of professional conduct and
that the main challenge will be in implementing this framework
across the workforce. For example, one participant reported that
the attributes within domain four (working with people with an intellectual disability, their families and support networks in recovery
focused ways) were “Too idealistic. I can’t see these things happening in reality.”
The triangulation of data highlighted that although the quantitative
definition of consensus was reached for all of the proposed attributes,
further work was required to clarify the content within each of the domains. For example, the attribute “Demonstrates the ability to include
people with an intellectual disability, their families and support networks
within the design, implementation and dissemination of research” was
deleted because although 94% of participants agreed that it was a core
attributes, and the median was four, it was identified that such research
skills are a requirement of an advanced clinician rather than a generalist
clinician.
In total, the research team deleted 35 items, modified 25 items
and added of 10 items (see Table 3). However, the overall structure of
the framework remained the same.
3.2 | Round two
The quantitative data showed that the level of agreement on the
proposed attributes ranged from 73.1% to 96.2% and the median
scores ranged from four to five. Therefore, the quantitative definition
of consensus was reached for all the proposed attributes. Between
round one and round two, the level of agreement remained above the
TABLE 3 Summary of the development of the intellectual
disability mental health core competencies framework over the two
Delphi rounds
Round one Round two Final
Items at beginning of round 132 107 102
Items deleted 35 3
Items modified 25 19a
Items added 10 0
a
Four items were merged into two items.
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defined consensus threshold; yet, the percentage of agreement did
not always increase between the two rounds.
The qualitative data in round two echoed the findings of round one
with two of the same themes. These were that:
1. The language needs to be clarified to ensure that the attributes
describe what can be expected of the workforce and are accessible to readers. For example, one participant reported that
in relation to domain 8, part 1 – research and evaluation: “While
individual clinicians will collect info that may be used in research-it is service responsibility to disseminate in accessible
form.”
2. The attributes set a high standard and the challenge will be in the
implementation and uptake across the workforce. For example, one
participant reported “….(mental health professionals) will need extensive training to achieve many of these competencies.”
The triangulation of data again highlighted that although the quantitative definition of consensus was reached for all of the proposed attributes, further work was required to clarify the content within each of the
domains. For example, the attribute “Disseminates research findings in
an accessible format” was deleted because although 76% of participants
agreed that it was a core attributes, and the median was four, it was identified that dissemination of research findings was a service responsibility
rather than that of a generalist clinician.
The research team in total deleted 3 items and modified 19 items
(see Table 3).
The final list of core intellectual disability mental health attributes
is described in Table 4.
4 | DISCUSSION
This phase of the study generated a key set of attributes that intellectual disability mental health experts believe are required of generalist mental health professionals to meet the needs of people with
an intellectual disability and co-occurring mental ill health. The final
framework consists of 102 attributes across each of 14 key domains,
highlighting the breadth of knowledge and skills required across all
areas of clinical practice. Delphi participants predominately agreed on
the importance of items emanating from the literature and an earlier
consultation with key stakeholders, indicating relevance of existing
knowledge and expertise. However, the approach used here allowed
this previously fragmented representation to be systematically collated and presented within a cohesive framework to guide generalist
mental health workforce development. It has also highlighted the importance of attributes in the areas of communication, assessment and
intervention, discussed further here. However, these findings need to
be viewed with caution as they represent only the views of intellectual
disability mental health experts. This is explored in more detail in the
‘Limitations’ section.
Within the communication domain, the present study identified
that mental health professionals require skills to allow them to identify
the person’s preferred communication style, adapt their communication style to meet the needs of the person and use assistive communication technology. The need for these additional skills is important
because communication impairments can affect the ability of people
with intellectual disability to effectively communicate their healthcare
needs (Ziviani, Lennox, Allison, Lyons, & Mar, 2004). Further, as previous research has found communication to be a significant barrier
to providing quality health care for this population group (Cook &
Lennox, 2000), it is anticipated that gaining these attributes may help
mental health professionals to mitigate the impacts of communication
impairments on access to and participation in mental health services.
Within the assessment, formulation and care planning domain
consensus were reached for eighteen attributes. These included important aspects of assessment including the way in which mental
health professionals prepare for an assessment, the approach taken
towards assessment, and the importance of assessing the relative
contribution of mental health, physical health, environment, communication and skills to behaviours. The need for these attributes is
supported by previous research which found that the current lack of
knowledge and skills in health assessments for people with an intellectual disability has impinged on the ability of health professionals
to provide quality care to this group (Cook & Lennox, 2000; Lennox,
Millar, & Chorlton, 2004). These skills are also important because of
the atypical presentation of mental ill health in some people with an
intellectual disability (Bertelli, Rossi, Scuticchio, & Bianco, 2015; Fuller
& Sabatino, 1998), their complex healthcare needs, and the impact
of diagnostic overshadowing on access to quality mental health care
(Mason & Scior, 2004; Michael & Richardson, 2008; Reiss, Levitan, &
Szyszko, 1982). In particular, the need for mental health professionals
to employ an individualized, longitudinal and multisource approach to
the assessment process (attribute 11.3) is important because historical
literature has shown that the workforce are using symptoms (Lennox
& Chaplin, 1996) rather than a comprehensive longitudinal assessment
process, which has been shown to negatively impact on the quality of
the assessment provided to people with an intellectual disability. The
need for a comprehensive assessment has also been recently reiterated as key component to accessible mental health services for people
with an intellectual disability (Department of Developmental Disability
Neuropsychiatry, 2014).
Enhancing the mental health workforce’s capacity in the area of
intervention is crucial because research has shown that some mental health professionals perceive that interventions are ineffective in
a person with cognitive impairment (Vereenooghe & Langdon, 2013).
Further, inappropriate prescribing of psychotropic medications is a
common problem for this population and is associated with potential
adverse health impacts (Trollor, Ruffell et al., 2016; Trollor, Salomon,
2016). Awareness of the need to adapt standard psychotherapeutic
approaches to accommodate the needs of people with an intellectual
disability (Hurley, 1989), and, directly involve them in the process
(Parmenter, 1988) appears critical, as does awareness of the efficacy
of adapted interventions (Trollor, 2013). Our work assists practitioners
to develop appropriate applied skills in these areas to enhance both
biological and psychological approaches to treatment.
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TABLE 4 Intellectual disability mental health core attributes for the generalist mental health workforce
1. Values and approaches
Values
1.1 Equitable access and care
1.2 Quality therapeutic and other services
1.3 Valuing the lived experience of the person, their families and support networks
1.4 Choice and self determination
Approaches
1.5 Person centred
1.6 Proactive
1.7 Empowering the person, their families and support networks
1.8 Strengths based
1.9 Multidisciplinary and cross agency
1.10 Flexible
1.11 Inclusive
2. Attitudes and beliefs
2.1 People with an intellectual disability can experience the entire spectrum of mental disorders
2.2 People with an intellectual disability have the same rights as other to access and receive high quality mental health care. This
includes access to mainstream and, when required, specialist mental health services.
2.3 Working with people with an intellectual disability is part of the role of all mental health professionals.
2.4 A good mental health service can significantly improve the quality of life of people who have an intellectual disability.
2.5 People with an intellectual disability should be supported to participate to the fullest extent in all aspects of their mental health
care
2.6 Mental health professionals have a role to play in working with others to address behaviours of concern (also known as
challenging behaviour)
2.7 People with an intellectual disability have the right to be supported to achieve health outcomes that are equitable to those
without an intellectual disability
3. Responsible, safe and ethical practice
3.1 Complies with state legislation related to treatment of mental illness, safety, privacy and confidentiality.
• Guardianship Act 1987
• Disability Services Act (NSW) 1993
• The NSW Anti-Discrimination Act 1977
• NSW Health: Your Health Rights and Responsibilities. PD2011_022
3.2 Provides information on the rights of people with an intellectual disability, their families and support networks in an accessible
format
3.3 Follows service procedures in relation to safety, privacy and confidentiality in shared care arrangements and transfer of care.
This includes the implementation of the:
• Memorandum of Understanding between Ageing, Disability and Home Care and NSW Health in the provision of services to
people with an intellectual disability and mental illness’,
• LHD specific Disability Action Plans, and
• Disability – People with a Disability: Responding to Needs During Hospitalisation PD2008_010
3.4 Equitably provides quality services to people with mental health problems including those with an intellectual disability and
co-occurring mental ill health
4. Working with people with an intellectual disability, their families and support networks in recovery focused ways
4.1 Identifies, respects and applies the lived experience and knowledge of the person, their family and support network
4.2 Demonstrates the ability to facilitate supported decision making and give priority to the persons expressed wishes as far as
possible and safe to do so.
4.3 Acknowledges and articulates how personal beliefs and emotional reactions towards people with a disability might influence
clinical practice.
4.4 Identifies when the person does not have a support network and actively assists them to find an independent support person(s)
(Continues)
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4.5 Demonstrates the ability to support the person to use and strengthen their support networks
4.6 Supports the person, their family and support network to engage in services that are able to meet their recovery needs
4.7 Is aware of the potential issues relating to physical, sensory and motor disability and physical health problems for people with
an intellectual disability
4.8 Implements the National Mental Health Recovery Framework (2013)
5. Meeting the diverse needs of people with an intellectual disability
5.1 Implements intellectual disability mental health specific practices as described in relevant national, state and local guidelines,
policies and frameworks. This currently includes the following:
• National Disability Strategy 2010–2020
• National Disability Strategy NSW Implementation Plan 2012–2014
• LHD Disability Action Plans
• Service Framework to Improve the Health Care of People with Intellectual Disability
• Memorandum of Understanding between Ageing, Disability and Home Care and NSW Health in the provision of services to
people with an intellectual disability and mental illness
• Disability – People with a Disability: Responding to Needs During Hospitalisation
5.2 Demonstrates the ability to determine how the person relates to their own abilities and disability
5.3 Works collaboratively with mainstream/specialist mental health services, health services and other support services to meet the
needs of people with an intellectual disability
5.4 Implements strategies to enhance access for people with an intellectual disability
5.5 Articulates the extent and limits of their own understanding of intellectual disability and mental ill health in intellectual disability
and seeks advice/support to address this
6. Working with Aboriginal people with an intellectual disability, their families and communities
6.1 Acknowledges the varying views of intellectual disability within Aboriginal culture and impact that this may have on access and
participation in services
6.2 Addresses barriers to engaging Aboriginal people with an intellectual disability and co-occurring mental ill health, their family,
community and support network in mental health services
7. Communication
7.1 Demonstrates and applies the ability to determine the persons preferred communication style and strengths.
7.2 Adapts communication style to meet the needs of the person
7.3 Demonstrates and applies a reflective approach to communication
7.4 Confirms that their interpretation of the persons communication is accurate
7.5 Adapts the environment to facilitate and maximize independent and open communication
7.6 Utilizes assistive communication technology and seeks support to use technology as required
7.7 Uses appropriate, person first language, when describing a person with an intellectual disability and co-occurring mental ill
health
7.8 Identifies when support is required from a communication specialist and seeks their support through appropriate referrals
7.9 Works with people who are familiar to the person and who can assist with communication
7.10 Uses non-judgemental language when describing behaviour and other clinical presentations
8. Continuous quality improvement
Part 1: Research and evaluation
8.1 Collects quality improvement data on people with an intellectual disability who participate in service
8.2 Participates where possible in research relating to people with an intellectual disability and co-occurring mental ill health
Part 2: Service improvement
8.3 Demonstrates the ability to support people with an intellectual disability, their families and support networks to participate in
service improvement activities
Part 3: Professional practice and development
8.4 Demonstrates a willingness to learn about intellectual disability mental health and to translate what is learned into improved
practice
8.5 Seeks opportunities for professional development from within the disability and other relevant sectors
9. Partnership, collaboration and integration
TABLE 4 (Continued)
(Continues)
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9.1 Demonstrates an awareness of the different skills and approaches available in the mental health and disability sectors and how
they may impact of collaborative work
9.2 Uses communication methods, terms and language that will be understood by all agencies
9.3 Follows local protocols for collaboration and joint work between mental health services, specialist intellectual disability mental
health services and other key parties.
9.4 Works with partner organizations to deliver a seamless service to people with an intellectual disability, their families and
support networks
10. Intake
10.1 Confirms that information on intake has been understood by the person, their family and support network
10.2 Informs the person, and with their consent, their family, support network and the referrer about the outcome of the intake
assessment and any subsequent referrals that have been made in an accessible manner
10.3 Informs the person, their family and support networks of the clinical pathway through the service
10.4 For rereferrals, avoids replication of the first referral pathway and extensive re-assessments, unless this adds to the existing
assessment information.
10.5 Implements a ‘no wrong door’ approach and when required links individuals, their families and support networks with the most
appropriate services.
11. Assessment, formulation and care planning
11.1 Prepares for an assessment by:
• allocating adequate time to accommodate for possible complexities,
• organizing an appropriate environment that addresses the persons physical and sensory needs,
• establishing the persons communication needs and prepare to use their preferred method of communication in the
assessment,
• understanding the sensory and physical needs of the person,
• identifying and communicating with those who can provide an accurate history and/or further information or data related to
the presenting problem,
• reviewing detailed background health and mental health information,
• establishing who will be accompanying the person with intellectual disability, and accommodating them as appropriate in the
consultation
11.2 Works with the person, their family and support network to overcome barriers to attending and participating in the assessment
and care planning
11.3 Employs a longitudinal and a multisource approach to the assessment
11.4 Collects assessment information on relevant areas including, for example, developmental, biomedical, psychiatric, psychological,
cognitive, social, adaptive behaviour, functional abilities, environmental, cultural and educational history.
11.5 Adapts assessment techniques to reflect the possible difficulties in identifying signs of a mental disorder in someone with an
intellectual disability
11.6 Uses assessment information to establish a baseline function for each individual and the possible functional manifestations of
mental disorder.
11.7 Demonstrates the ability to understand and consider the potential risk factors and compounding conditions that may influence
the mental state of a person with an intellectual disability
11.8 Identifies signs that a person may have an intellectual disability and seek assistance as required to confirm disability through an
appropriate assessment.
11.9 Demonstrates the ability to assess the relative contribution of mental health, physical health, environment, communication and
skills to behaviours.
11.10 Collaborates with disability services, and other relevant stakeholders to provide a comprehensive assessment of behaviours of
concern
11.11 Identifies when support is required from specialist intellectual disability mental health professionals and seeks their support
11.12 Works with the person and their support network to integrate information into a single plan that governs the services and
support they receive
11.13 Demonstrates the ability to assess capacity of people with intellectual disability to understand information, make decisions and
be involved in their mental health care.
11.14 Implements multimodal assessment techniques including observational records such as sleep, weight and ABC charts to aid
assessment
TABLE 4 (Continued)
(Continues)
30  |
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WEISE et al.
In the ‘partnership, collaboration and integration’ domain, it was
surprising that few attributes were identified because the literature
indicates that partnership and collaboration are critical elements to
the delivery of quality care (Mohr, Curran, Coutts, & Dennis, 2002).
Further, the importance of this area is a significant barrier to delivery of psychiatric care (Lennox & Chaplin, 1995; Torr et al., 2008), and
findings of a study with Australian consultant psychiatrists suggest
that improved liaison between services would improve psychiatric
care (Lennox & Chaplin, 1996). From a carer perspective, relationships
between mental healthcare providers and carers have been identified
as a critical element to delivering quality care (Wurth, 1994).
Importantly, the research reached consensus on the role of mental
health professionals in providing clinical care to a person with an intellectual disability who has behaviours of concern. This is an important finding as historically there has been contention over the role of
mental health professionals in supporting people who present in this
manner. This often disputed clinical territory arises out of the belief
that behaviours of concern are not a symptom of mental ill health but
11.15 Considers disability as a dimension of diversity together with other individual and contextual dimensions
11.16 Develops care plans which appropriately consider and recommend strategies for crisis prevention, early intervention and
long-term follow up as necessary.
11.17 Identifies when a multiagency/service assessment is required and contributes to this joint assessment process
11.18 Communicates care plans to individuals taking into account their level of comprehension and communication needs.
12. Intervention
12.1 Demonstrates the ability to assess whether the person has capacity to consent to the proposed intervention
12.2 Confirms that the person, their family and support network are aware of and understand their right to be informed and give
informed consent and of their right to refuse treatment at any point
12.3 Develops treatment strategies that considers the broader psychosocial aspects of the person including other interventions that
they are receiving
12.4 Delivers treatments and interventions using a person-centred holistic approach
12.5 Identifies when peer support is appropriate and facilitates the engagement of such support
12.6 Uses integrative interventions directed towards restoring a person’s mental well-being and recovery
12.7 When required adapts interventions to reflect the persons needs
12.8 Modifies the environment to maximize the persons participation in an intervention
12.9 Provides the person, and where appropriate their family and support network with a copy of the intervention care plan in an
accessible format.
12.10 Monitors for adverse effects associated with interventions and takes action to minimize their negative impact
12.11 Demonstrates the ability to identify and work with alternative decision makers.
12.12 Works with primary care physicians and other health professionals to manage physical health issues that impact on the person
overall health and well-being
12.13 Evaluates individual intervention outcomes globally and in relation to specific intervention goals
12.14 Works collaboratively with the person, their family and support networks during the intervention phase
12.15 Takes into account the training and experience of family members and support networks when developing plans for the
management and monitoring of illness
12.16 Seeks support from more experienced clinicians and/or specialist intellectual disability mental health professionals to address
situations of increased complexity
13. Transfer of care
13.1 Develops with the person and other key partners strategies to manage the transfer of care at key transition points in the
person’s life
13.2 Articulates to the person and with their consent, to other key partners, strategies to manage the transfer of care at key
transition points in the person’s life.
13.3 Provides the person and where appropriate their family and support network with a copy of the transfer care plan in an
accessible format
13.4 Confirms that the information in the transfer care plan has been understood by the person and other key partners
13.5 Demonstrates ability to identify potential risks associated with the transfer of care
14. Mental health promotion and primary prevention
14.1 Engages with primary healthcare providers, and when required specialized intellectual disability health services to support the
completion of a health assessment and the ongoing management of physical health issues
14.2 Includes health promotion and primary prevention activities relevant to the individual in their mental healthcare plan
TABLE 4 (Continued)
|  31
Published for the British Institute of Learning Disabilities
WEISE et al.
are part of the person’s disability (Bertelli, Rossi, Scuticchio, & Bianco,
2015). Ensuring that the workforce acquires skills in this area is particularly pertinent because behaviours of concern have been reported
as a commonly presenting feature of mental illness for this population
(Lennox & Chaplin, 1995; Torr et al., 2008). Skills in this area, especially
determining whether behaviours of concern are associated with mental illness in a particular case, are also critical in addressing inappropriate prescribing of psychotropic medications for behaviours alone
(Sheehan et al., 2015).
Although there was a high level of support for proposed attributes
within each of the 14 domains, the qualitative data highlighted tensions between the high standard of care that this framework articulates, and realistic competencies given the current capacity of the
workforce. The most ideal attributes were retained as there was a high
level of agreement that the attributes were a core part clinical practice,
and because the purpose of describing core competencies was to set
an ideal standard of professional behaviour (Hager & Gonczi, 1996).
This will inform an intellectual disability mental health workforce strategy which is unconstrained by the current resource limitations in this
area. This tension has, however, highlighted the need for further work
to translate these findings into a format that is accessible to the current mental health workforce and the need to support the workforce
to incrementally achieve this high standard of care.
4.1 | Limitations
Debate exists on the utility of the Delphi, with a diversity of opinions on its strengths and weaknesses. One of the key challenges
facing researchers who use this technique is that there is a lack of
agreement in the literature as to how consensus is defined (Keeney,
Hasson, & McKenna, 2006). This study is also the first that the authors are aware of to use this combination of modifications to address these commonly reported limitations of the traditional Delphi
approach. As discussed earlier, a critique of this modified approach
confirmed its utility for defining workforce attributes (Weise et al.,
2016). However, this review also identified some additional challenges that are not described within the published literature such
as that the complete participant anonymity presented challenges to
accurately recording and tracking sample characteristics over the
Delphi rounds.
This article also only considers the perspective of intellectual
disability mental health clinical experts and does not include the perspective for people with an intellectual disability, their families and
support networks. It is critical that these key stakeholders are consulted and their views are used to shape the final list of attributes
required to meet the needs of people with an intellectual disability
and co-occurring mental ill health. In acknowledgement of this, the
Intellectual Disability Mental Health Core Competencies Project is a
multiphased, multimethod project which includes the perspectives of
each of these key stakeholders in other analyses.
Generalizing these findings to other countries may be limited
because of the different ways in which mental healthcare services
are structured and delivered and the subsequent variation in the
roles of the mental health professionals. However, it is anticipated
that many of the attributes are essential to similar workforces but
that the way that their use and the way in which they are implemented may vary internationally. For example, the ‘Working with
Aboriginal people with an intellectual disability, their families and
communities’ domain may be of relevance to other first people or
more broadly to people from culturally and linguistically diverse
backgrounds.
This research also only aimed to identify attributes that are relevant to all generalist mental health professionals, regardless of their
professional specialty. Further work may be warranted with individual
professional groups to identify any further attributes are required specific to their professional role.
4.2 | Further research and implications for
policymakers and practitioners
The findings provide a unique insight for policymakers and practitioners into the attributes that may be required of the mental health
professional working within mainstream services to meet the needs
of people with an intellectual disability and co-occurring mental ill
health. They also provide an evidence based framework that can
be used to guide the development of a comprehensive workforce
strategy in this area that aims to address the capacity issues that
currently exist. In relation to translating the findings from this study
into clinical practice, this research has suggested that policymakers
may need to consider how an under resourced sector and workforce will work towards achieving this standard of care. The attributes identified within this study may also be of relevance to mental
health professional working with other population groups, especially those who experience other forms of cognitive impairment.
5 | CONCLUSION
This research found that there are a key set of additional attributes
required of the generalist mental health professionals working in
mainstream services to meet the needs of people with an intellectual disability and co-occurring mental ill health. Further research in
this area is required to gain the perspective for people with an intellectual disability, their families, and support networks. A comprehensive workforce development strategy is also required to facilitate the
obtainment of these attributes.
ACKNOWLEDGMENT
The authors would like to thank Ms Bernadette Dagg, Dr David
Dossetor, Ms Christine Fynn, Dr Roderick McKay and Ms Tania
Skippen for their participation in the project advisory group and
their generous sharing of expertise and time. The authors would also
acknowledge all the people who participated in this research. The
first author would like to acknowledge the support received through
an Australian Government Research Training Program Scholarship.
32  |
Published for the British Institute of Learning Disabilities
WEISE et al.
CONFLICT OF INTEREST
The authors declare that they have no conflict of interest.
ORCID
Janelle Weise http://orcid.org/0000-0003-0783-5898
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We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!

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