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An investigation of smoking polices and smoking practices of residents and employees in 106 Massachusetts state-supported residential programs found that 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. (Author/CR)

A survey of 614 Maine physicians indicated that almost 80% were currently providing care to patients with mental retardation living in the community. Major obstacles in treating such patients were revealed, their importance was assessed, and ratings of the utility of specific measures to lessen these obstacles were identified. (Author/JDD)

Abstract: 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. (Am J Public Health 1990; 80:1043-1048.), Mentally retarded persons have needs similar to those of others for preventive health care, occasional care for acute illness, and continuing care for chronic medical conditions. Mentally retarded persons may also often have chronic medical conditions, physical disabilities, and defects in sensations related to their handicap, and require specialized services. In addition, some mentally handicapped persons develop disorders associated with poor medical management. There is limited information about mentally handicapped persons living in the community and their health care needs. Living arrangements for these patients may vary from sheltered housing with on-site supervision to living with families or independently. Because of the variety of living arrangements among the mentally handicapped population, it is difficult to conduct surveys that reflect the overall population. Mentally retarded persons living in institutions may have health care needs that are distinct from those of mentally retarded persons living in the community. The health needs of 333 mentally retarded persons residing in the community were assessed by survey. Only one third of this patient population had previously lived in an institution. Two thirds of this group had chronic medical conditions requiring specialized services. The five most common chronic medical conditions involved neurologic, ophthalmologic, dermatologic, psychiatric-emotional, and orthopedic disorders. The community health system was effective in managing most of these conditions, with a large proportion being handled by primary care physicians with limited specialty involvement. Deficiencies in health services for mentally handicapped patients included inadequate health services for 60 percent of patients requiring ongoing home treatments; reluctance of some health care providers to accept Medicaid; and lack of cooperation of mentally handicapped patients with medical examinations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract: 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 ¢ of the conditions but only 8 per ¢ 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 m the community for some mentally retarded individuals. In these situations, alternative approaches to care must be developed. [ABSTRACT FROM AUTHOR]

Investigates from the physicians' perspective, the issues in the provision of medical care to individuals with mental retardation. Survey of a randomly selected sample of community physicians who practice a range of specialties; Responsibility for providing medical care to mental retardates; Obstacles to the provision of medical care; Measures to facilitate the clinical management of patients.

Historical, systemic, and clinical perspectives on family involvement in deinstitutionalization have been presented. Unlike the historical and systemic approaches, the clinical approach recognizes the needs of both families and residents. Because family and resident needs vary from case to case, they are unlikely to be met by rigid policy regarding family involvement. It is concluded that flexible clinical guidelines should be used in determining the appropriate level of family involvement on a case-by-case basis. The clear implication is that when social workers are potential implementers of policy, they should have input into policymaking. [ABSTRACT FROM AUTHOR]