Smoking policies and practices in a state-supported residential system for people with mental retardation.

Smoking policies and smoking practices of residents and employees in a state-supported residential system were investigated. Smoking policies existed in almost every agency, although state- and vendor-operated programs had vastly different policies. State-operated programs prohibited employees from smoking in residences and restricted residents who smoked to designated areas. One third of vendor-operated agencies allowed residents and staff members to smoke in designated areas, whereas one quarter stipulated that residences be smoke-free. Smoking among employees was higher and among residents lower than in the general population. The feasibility of specific approaches to reduce passive smoking and attitudes and beliefs about human rights issues related to smoking are presented.

Managing the care of patients with mental retardation: a survey of physicians.

A questionnaire regarding the clinical management of patients with mental retardation living in the community was mailed to a 50% random sample of physicians practicing in Maine; the response rate was 56%. Almost 80% of respondents reported that they were currently providing care to patients with mental retardation. Survey results identified the major issues confronting physicians treating such patients and quantitatively assessed their importance from the physicians' perspective. Inadequate medical information was identified as the greatest obstacle to patient care. Physicians' ratings of the utility of specific measures designed to lessen these obstacles were presented. Generally, continuing education was viewed as less useful than practice support measures.

Meeting the needs for health services of persons with mental retardation living in the community.

Adequate health services are critical to the success of efforts to maintain persons with mental retardation in the community, yet information concerning the health status of this population is in short supply. This paper presents the results of a survey of 333 mentally retarded persons randomly selected from a population of 1,333 such individuals living in community settings. Almost two-thirds had chronic conditions requiring medical intervention. The top five conditions in terms of prevalence were neurologic, ophthalmologic, dermatologic, psychiatric-emotional, and orthopedic. The majority of conditions were being managed appropriately in the community health system. A substantial proportion can be managed by primary care physicians with limited specialty involvement. For almost 60 percent of clients with conditions requiring home treatments on an ongoing basis, however, service gaps were identified. Other problems included the reluctance of some providers to accept Medicaid, and the inability of some clients to cooperate with medical examinations.

Planning for community physician services prior to deinstitutionalization of mentally retarded persons.

This study assessed the need for physician services among a group of institutionalized mentally retarded individuals in anticipation of their transfer to community residential facilities and subsequent management of their care by community-based physicians. The clients' personal physicians in the institution identified every chronic condition which required physician services, and recommended the kind of physician and frequency of visits for the management of each condition. Key informants reviewed these estimates and determined if there were sufficient physicians in their communities to provide this care. Thirty-two per cent of the conditions but only 8 per cent of the clients could be managed by a primary care physician. The most frequently required specialties were neurology, orthopedics, and ophthalmology. While primary care services and many of the necessary specialty services were available in the community to meet the needs of these individuals, several specialties essential to the medical care of this group were not available. These included orthopedics for the multiply-handicapped, neurology including behavioral neurology, and psychiatry. Deinstitutionalization policies which rely solely upon community physician services will lead to inadequate medical care in the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed.

The regulation of family involvement in deinstitutionalization.

Conflicting legal, administrative, and professional policies surround family involvement in the deinstitutionalization process. This article addresses these discrepancies and makes recommendations for developing effective and consistent channels of policy among social workers and other helping professionals.