Assessment of an Expert Committee as a Referral Process Within Health and Social Services

In Q uébec, C anada, health and social services available to persons with intellectual disability are hierarchically organized into three levels of care: primary, secondary, and tertiary care. The referral processes through which persons gain access to services at each level vary across facilities. As a result, persons with intellectual disability may not receive the appropriate level of care and the responsibilities of facilities at each level overlap, creating an undue burden on the public healthcare system. This study sought to propose a structured assessment and referral method within the network of public services. Specifically, it evaluated the correspondence between the currently received level of care and an expert committee's determination. Furthermore, it examined client‐related variables that were associated with the level of services. An expert committee evaluated the level of specialization of services required by 30 persons with intellectual disability. The committee's determination was based on participants' files and presentations by their primary case worker. It was found that 10 out of the 30 participants were not receiving the level of care determined to be necessary by the expert committee. Challenging behaviors were most strongly associated with the committee's determination. This study underscores the primacy of clinical judgment, rather than a predetermined list of participant characteristics, in order to refer persons with intellectual disability toward services that best meet their specific needs. It also highlights the importance of taking into account challenging behaviors.