Any clinical professional working in a team can use the DST-PH, whether in secondary or primary care.
No, the aim of the tool is not to reduce the score. Instead, it serves as a guide to identify individuals at higher vulnerability and guide the interventions in place.
No, the patient doesn't have to be yellow to be discharged. However, if they are amber or red, it is expected that significant work has been done to develop care plans, conduct risk assessments, and ensure robust care plans with reasonable adjustments to facilitate access to healthcare.
Medications are grouped based on their classification. For example, psychotropic medications, antidepressants, and antipsychotic medications are considered separate groups.
Yes, a clinical guide is available that helps people understand health conditions, their relevance to the tool, and supports clinicians in using the tool effectively. It also helps prevent double scoring, where the same thing is scored twice.
Yes, it should still be scored because the presence of the condition itself is relevant. While having a treatment plan and interventions in place is positive, scoring is still necessary.
No, all physical health conditions are scored and counted in the tool. The tool aims to highlight conditions that increase the vulnerability of avoidable mortality, but it scores all physical health conditions.
If these minor illnesses or injuries lead to complications such as infections or repeated injuries caused by someone placing themselves at higher vulnerability, then they should be scored.
Yes, dysphagia should still be scored because it can lead to other illnesses, such as chest infections.
Chest infections should be scored in the infection category of the tool.
Yes, in such cases, it should be scored twice in both the dysphagia and infections categories.
If epilepsy has been well-managed and controlled for a number of years, it is one of the few areas where scoring is not necessary.
Yes, hypertension should be scored because individuals with hypertension should be visiting their GP for medication and regular reviews to ensure effective treatment.
Yes, the tool is designed with a comment box where additional information can be included. This can be helpful in providing details about existing care plans or exploring and developing new ones.
The tool should be completed initially with the person and then re-evaluated based on changing needs. For instance, if someone is rated as Amber, the tool should be reviewed every 3-6 months, and for someone rated as Red, it should be reviewed within 1-3 months. However, for those rated as Yellow and whose health condition remains unchanged, there is less need for review. Nonetheless, a review is always beneficial if someone's needs change.
Part 2 of the tool focuses on physical health conditions. Regarding epilepsy, with advancements in treatment, we have determined that for certain individuals, epilepsy can be well controlled, with no seizures occurring for several years. In such cases, if the neurologist is considering reducing medications, we believe there is no increased vulnerability of avoidable mortality. Hence, we score them lower compared to individuals whose epilepsy is not well controlled.
Yes, that is correct. For instance, in the case of dysphagia, it is often well managed with a comprehensive care plan. However, if the care plan is not followed, there is a risk to the person's safety. Even though dysphagia may be well controlled or managed through the care plan, it is still considered a high-risk item in the DST-PH due to the frequent changes in care arrangements for people with intellectual disabilities (ID). With frequent changes in care staff and providers, there is a danger of the care plan not being followed or staff not being adequately trained. Thus, it is important to rate it as a high-risk item to ensure appropriate implementation of the care plan by health services.
It is crucial to assess how the person's challenging behaviour presents itself. For example, behaviours that some people may consider challenging may not actually impact the person's ability to access healthcare, such as visiting the GP or going to the hospital. Some individuals with challenging behaviours may actually enjoy these health appointments, considering them as activities they appreciate. Therefore, if challenging behaviour does not affect the person's access to physical healthcare, it should not be scored. The key factor here is to evaluate the impact on accessing health services.
The same principle applies to the variable concerning mental illness
Communication is indeed a crucial aspect, and difficulties in communication can impede access to health services. However, we decided to incorporate communication within two other sections of the tool. Firstly, it is included in the person's level of learning disability, and secondly, it is addressed in the question that asks about the presence of other neurodevelopmental disorders like autism or ADHD.
The tool can be used by any healthcare professional responsible for meeting the healthcare needs of individuals with intellectual disabilities (ID). It can be utilised in primary care, such as during annual health checks by general practitioners (GPs) and outpatient appointments. The tool is efficient and doesn't require much time to complete. Additionally, it can be employed in secondary care, and community learning disability teams should also utilise it. It should be utilised in both primary and secondary care by anyone responsible for meeting the healthcare needs of people with learning disabilities.
Absolutely, this tool can be used to populate hospital passports or health action plans for individuals with learning disabilities. We received feedback from service users expressing their desire for the tool to be made available in an accessible format and carried with them to healthcare appointments. The tool can be effectively used in those situations. It not only highlights the person’s health conditions but also identifies complicating factors that may hinder their access to healthcare services. This comprehensive picture provided by the tool will benefit healthcare professionals in seeking appropriate support and involving relevant teams and agencies to ensure that the person can access the necessary health services.
Yes, we incorporated input from various sources during the creation of the tool. We gathered a significant amount of information and data from LeDeR, which had substantial input from service users. Additionally, we conducted focus groups with experts as part of other academic strategies. During the tool's development, we collaborated with Wirral Mencap and received valuable feedback from people with a learning disability and their carers. They provided insights regarding the structure and wording of the tool, and the suggestion to create an accessible version also came from them. So, yes, we actively involved service users and carers in the development of the tool.
The DST-PH tool was designed with the objective of population health management in mind. We aimed to assess the overall vulnerability level of individuals with learning disabilities in terms of avoidable mortality.
It is well-known that individuals with LD are at a higher vulnerability of avoidable mortality compared to the general population. However, within the LD population, there are variations in vulnerability levels, with some individuals having a much higher vulnerability than others. Our goal was to identify this population and develop tailored strategies to meet their specific needs.
Thus, we stratified the LD population into three categories: some vulnerability, higher vulnerability, and very high vulnerability, represented by the RAY rating system. This allows us to provide targeted responses from health services based on their vulnerability levels. Individuals with some vulnerability to avoidable mortality should receive annual health checks, reasonable adjustments, and health passports. For those at higher vulnerability, we should focus on health coordination, implementing regularly reviewed healthcare plans, and ensuring the presence of an allocated health coordinator responsible for coordinating care between agencies. This approach enables us to address various issues and identify those who require more specialised input from CLDT and health facilitation to ensure their healthcare needs are met.
A risk assessment tool operates at an individual level, evaluating the risks associated with a specific person. In contrast, a vulnerability stratification tool functions at a group level, looking at various vulnerabilities and categorising the population into high, medium, and low-vulnerability groups. The purpose of vulnerability stratification is to analyse vulnerabilities collectively and identify patterns and trends within a population, enabling targeted interventions and resource allocation.
