Psychiatric hospitalisation among individuals with intellectual disability referred to the START crisis intervention and prevention program.
One in four adults with ID who reach crisis services have a recent psychiatric hospital stay—psychosis and lack of HCBS waiver are the clearest warning signs.
01Research in Context
What this study did
The team looked at 3 299 adults with intellectual disability who were sent to the START crisis program.
They checked how many had stayed in a psychiatric hospital during the past year.
Then they hunted for red-flag traits that made hospitalization more likely.
What they found
One out of every four adults had been hospitalized at least once in the previous year.
Younger age, psychosis, high irritability, several diagnoses, milder ID, Black race, and no HCBS waiver all raised the odds.
How this fits with other research
Lunsky et al. (2012) studied the same crisis cohort two years earlier and saw that half of these adults were already on antipsychotics.
The new numbers show the drugs did not keep them out of the hospital.
McMaughan et al. (2023) later found autistic teens and young adults are hospitalized eleven times more than peers, proving the risk carries across diagnoses and ages.
S-Johnson et al. (2009) and Cashon et al. (2013) both mapped aggression in adults with ID; their work helps explain why irritability and psychosis pop up as hospital drivers here.
Why it matters
If your client with ID lands in crisis, check for psychosis and confirm HCBS waiver status first. These two flags predict hospital entry better than almost anything else. Build a crisis plan that adds waiver services or psychiatry before the next meltdown, not after the ambulance leaves.
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02At a glance
03Original abstract
BACKGROUND: Little is known about inpatient psychiatric hospitalisation among adults with intellectual disability (ID) in the United States. Greater research is, therefore, required to inform efforts aimed at preventing this costly and restrictive form of care. METHODS: Data were from 3299 individuals with ID (mean age = 31 years; SD = 14 years) who were referred to START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a community-based crisis intervention and prevention programme. A random effects logistic regression model was used to examine the association between 11 factors and caregiver report of psychiatric hospitalisation in the past 12 months. RESULTS: Twenty eight percent of the sample had at least one psychiatric inpatient stay in the prior year. Factors associated with an increased likelihood of prior hospitalisation included: younger age, diagnosis of a psychotic disorder, a score of >30 on the irritability subscale of the Aberrant Behavior Checklist, increasing number of psychiatric diagnoses, less severe ID, Black/AA race and not having a home and community waiver. CONCLUSIONS: Among this high-risk referred group, more than 1 in 4 individuals were hospitalised in the year prior to referral. While results from the analyses will help profile those at risk for hospitalisation, the findings suggest that interventions at the policy level may play an important role in reducing psychiatric hospitalisation.
Journal of intellectual disability research : JIDR, 2016 · doi:10.1111/jir.12330