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Correlates for the risk of specialist ID hospital admission for people with intellectual disabilities: development of the LDNAT inpatient index

Jon Painter (Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, UK)
Barry Ingham (Northgate Hospital, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK) (Department of Psychology, Northumbria University, Newcastle upon Tyne, UK)
Liam Trevithick (Tees Esk and Wear Valleys NHS Foundation Trust, Middlesborough, UK)
Richard P. Hastings (CEDAR (Centre for Educational Development Appraisal and Research), Warwick University, Coventry, UK) (Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, Australia)
Ashok Roy (Sollihil Community Services, Birmingham, UK) (Faculty of Intellectual Disability Psychiatry, Royal College of Psychiatrists, London, UK)

Tizard Learning Disability Review

ISSN: 1359-5474

Article publication date: 2 January 2018




The purpose of this paper is to analyse ratings data from the recently developed Learning Disability Needs Assessment Tool (LDNAT) to identify factors associated with specialist intellectual disability (ID) hospital admissions.


Ratings from 1,692 individuals were analysed and the LDNAT items differing significantly between inpatients and non-inpatients were identified. Statistical analyses on total scores derived from these items were used to calculate an optimal cut-off. This LDNAT inpatient index score was also confirmed via an alternative statistical technique.


On average, 18 of the 23 LDNAT item ratings were significantly higher in people with ID assessed as inpatients compared to those rated in community settings. Using the total of these items, the resulting LDNAT inpatient index was analysed. A cut-off score of 22.5 was calculated to be the optimal balance between sensitivity (0.833) and specificity (0.750). This was confirmed by calculating the Youden index (j=0.583). At this level 68 per cent of inpatients and 81 per cent of non-inpatient cases were correctly identified.

Practical implications

Currently there is a national (UK) programme to radically reduce the amount of specialist inpatient care for people ID. This will necessitate early identification of individuals most at risk of admission together with investment in improved, proactive community services if admissions to a diminishing bed-base are to remain manageable.


This study confirms the associations between mental health difficulties, challenging behaviour and specialist hospital admissions for people with ID, extending existing research by translating these findings into a clinically usable risk index.



Painter, J., Ingham, B., Trevithick, L., Hastings, R.P. and Roy, A. (2018), "Correlates for the risk of specialist ID hospital admission for people with intellectual disabilities: development of the LDNAT inpatient index", Tizard Learning Disability Review, Vol. 23 No. 1, pp. 42-50.



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