Painter J, Trevithick L, Hastings R P, Ingham B, Roy A
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.
Durham and Darlington Mental Health Services for Older People, Tees, Esk and Wear Valley NHS Foundation Trust, Durham, UK.
J Intellect Disabil Res. 2016 Dec;60(12):1178-1188. doi: 10.1111/jir.12340. Epub 2016 Oct 11.
In meeting the needs of individuals with intellectual disabilities (ID) who access health services, a brief, holistic assessment of need is useful. This study outlines the development and testing of the Learning Disabilities Needs Assessment Tool (LDNAT), a tool intended for this purpose.
An existing mental health (MH) tool was extended by a multidisciplinary group of ID practitioners. Additional scales were drafted to capture needs across six ID treatment domains that the group identified. LDNAT ratings were analysed for the following: item redundancy, relevance, construct validity and internal consistency (n = 1692); test-retest reliability (n = 27); and concurrent validity (n = 160).
All LDNAT scales were deemed clinically relevant with little redundancy apparent. Principal component analysis indicated three components (developmental needs, challenging behaviour, MH and well-being). Internal consistency was good (Cronbach alpha 0.80). Individual item test-retest reliability was substantial-near perfect for 20 scales and slight-fair for three scales. Overall reliability was near perfect (intra-class correlation = 0.91). There were significant associations with five of six condition-specific measures, i.e. the Waisman Activities of Daily Living Scale (general ability/disability), Threshold Assessment Grid (risk), Behaviour Problems Inventory for Individuals with Intellectual Disabilities-Short Form (challenging behaviour) Social Communication Questionnaire (autism) and a bespoke physical health questionnaire. Additionally, the statistically significant correlations between these tools and the LDNAT components made sense clinically. There were no statistically significant correlations with the Psychiatric Assessment Schedules for Adults with Developmental Disabilities (a measure of MH symptoms in people with ID).
The LDNAT had clinically utility when rating the needs of people with ID prior to condition-specific assessment(s). Analyses of internal and external validity were promising. Further evaluation of its sensitivity to changes in needs is now required.
为满足使用医疗服务的智障人士的需求，进行简短、全面的需求评估很有用。本研究概述了学习障碍需求评估工具（LDNAT）的开发与测试，该工具旨在满足这一目的。
一个由智障领域多学科从业者组成的团队对现有的心理健康（MH）工具进行了扩展。起草了额外的量表，以涵盖该团队确定的六个智障治疗领域的需求。对LDNAT评分进行了以下分析：项目冗余度、相关性、结构效度和内部一致性（n = 1692）；重测信度（n = 27）；以及同时效度（n = 160）。
所有LDNAT量表均被认为具有临床相关性，几乎没有明显的冗余。主成分分析表明有三个成分（发展需求、挑战性行为、心理健康和幸福感）。内部一致性良好（Cronbach阿尔法系数为0.80）。单个项目的重测信度在20个量表中为高度接近完美，在3个量表中为轻微到中等。总体信度接近完美（组内相关系数 = 0.91）。与六项特定状况测量指标中的五项存在显著关联，即韦斯曼日常生活活动量表（一般能力/残疾）、阈值评估网格（风险）、智障人士行为问题问卷简版（挑战性行为）、社会沟通问卷（自闭症）和一份定制的身体健康问卷。此外，这些工具与LDNAT成分之间具有统计学意义的相关性在临床上是合理的。与发育障碍成人精神病评估量表（一种衡量智障人士心理健康症状的指标）没有统计学意义的相关性。
在进行特定状况评估之前对智障人士的需求进行评分时，LDNAT具有临床实用性。内部和外部效度分析前景良好。现在需要进一步评估其对需求变化的敏感性。
