The evaluation of intellectual and developmental disabilities

Introduction: Emergency departments (EDs) must anticipate and prepare for the presentation of people with intellectual and developmental disabilities (PWIDD) to their facilities. Following the June 22, 1999 Olmstead Supreme Court decision, the national expectation is that PWIDD will live in the least restrictive and most integrated setting that can meet their needs. As more states move toward closing institutions where many people from this population formerly lived, it is the common expectation that medical and psychiatric care will be delivered though mainstream (including outpatient) services. The literature has clearly established that the prevalence of somatic illness and psychiatric illness is unequivocally greater in PWIDD, as compared to the general population. Unfortunately, the extent of specialized knowledge in community settings remains uneven and sometimes only marginally capable of meeting the needs of PWIDD, particularly in the realm of psychiatric services. Medical professionals often readily admit their lack of training, experience, and compromised comfort level in working with this group of people. Given this set of circumstances, in combination with the role of the ED as the safety net for gaps in the medical care delivery system, proactive planning that anticipates the needs of PWIDD will improve efficiency in the acute care environment and avoid long stays in the ED. The purpose of this chapter is to provide guidance to ED personnel and other acute care providers as they cope with the many challenges that accompany the care of PWIDD. A series of topics are addressed: proactive acquisition of system knowledge, impact of the clinical environments including EDs, consent issues, communication and information collection strategies, and a strategy for clinical assessment.