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Do We Need To Revisit Our Concepts Of Community Supports?
(NADD Bulletin
Vol. 13 #1)
The prevalence of mental illness for persons with cognitive
impairment has been well studied over the past 30 years.
Although the figures vary it is generally accepted that the incidence
of mental illness in persons with an intellectual disability is 3 to
5 times greater than the nondisabled population (American
Psychological Association, 2000). Attempts to quantify the percentage
of persons with intellectual disability and mental illness have
ranged from 20% to 71% (Borthwick-Duffy, 1994; Moss, 2000).
There have been disagreements over diagnostic validity, diagnostic
overshadowing as well as significant variance in settings. For
the purposes of this discussion we will use the most conservative
estimate. In July of 2008, the population of the United States
was a little over 302 million. Using the above figures that would
suggest there are 966,000 people with intellectual disabilities who
also show signs and symptoms of a mental health disorder. [more]
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School to Adult Transitions at Vanderbilt Program Description
(NADD Bulletin
Vol. 12 #6)
The transition from adolescence to adulthood is a difficult process
under the best of circumstances. Decisions have to be made and
responsibilities have to be taken that may dramatically alter the
course of a person's life. The difficulty is magnified when the
person experiencing the transition has multiple or severe
disabilities. The failure to properly plan for and address
transition issues sets the stage for more intense difficulties later
in life. [more]
-
The TEAM Centers Autism Spectrum Clinic Chattanooga, Tennessee
(NADD Bulletin
Vol. 12 #5)
One in six children is diagnosed with a developmental or behavioral
disorder in the United States. The Centers for Disease Control states
that over one in 166 children are currently diagnosed with
autism. Many individuals with autism also have behavioral
health needs. TEAM Autism Spectrum Disorders (ASD) Clinic in
Chattanooga, Tennessee is a multidisciplinary center designed to
serve individuals of all ages, and with any degree of severity, who
require specialized autism services. [more]
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THE IMPORTANCE OF INTEGRATED SERVICES IN A DOWNTURNED ECONOMY
(NADD Bulletin
Vol. 12 #4)
Apportioning scarce resources is an essential activity of economics.
Economics takes on a disturbingly human face when the scarce
resources are facilities and services and the recipients are
individual children and adults with co-occurring developmental and
emotional disorders. The stakes are high since the risks
include homelessness, institutionalization, or criminalization. In
this current economic recession, it is more necessary than ever to
stop the historic "ping-pong" approach that is typically
used among mental health and developmental disability agencies and
other state authorities to determine eligibility and funding. It is
no longer acceptable to dispute or ignore the necessity for
coordinated and integrated services, where each state's service
systems and authorities mutually plan and work together to address
the complex needs of these individuals. [more]
-
Planned Clinical Respite Services for Individuals with
Intellectual Disabilities/ Mental Illness and Their Families
(NADD Bulletin
Vol. 12 #3)
Throughout the United States, there is a growing trend to improve
community services and supports with the provision of emergency or
crisis respite beds outside the individual's home. This is an
important service and the need should not be underestimated. Many
individuals with intellectual disabilities and mental/behavioral
health service needs may not require psychiatric inpatient stays but
may require short term facility-based support to assist the
individual and their caregiver during a time of acute difficulty. In
addition, the expected length of stay in psychiatric inpatient
facilities may require the use of transitional clinical respite as
the next step before the return home. Furthermore, we have learned
from experience that temporary removal from the place in which
difficulties arise can help to inform caregivers about what is needed
to prevent future problems. This is especially true if collaboration
with the caregiver and an assessment of the crisis situation take
place in the context of the provision of respite. [more]
-
Transforming Missouri's System for People with Developmental Disabilities
(NADD Bulletin
Vol. 12 #1)
A challenge faced by policy planners in the field of developmental
disabilities (DD) is how to continue the progress toward full
inclusion in a time of state budget crisis and retool the system to
address emerging issues for people with a dual diagnosis of DD and
mental illness (MI). [more]
-
Adverse Impact of the Medicare Acute Psychiatric Inpatient PPS For
Patients With Co-Occurring Developmental Disabilities and Mental Illness
(NADD Bulletin
Vol. 11 #6)
Following is a brief outline developed by members of the NADD US
Public Policy Committee and submitted to the DHSS Office on
Disability on behalf of individuals with dual diagnosis: [more]
-
Preventable and treatable medical comorbidities and adverse drug
events in people with ID/MH
(NADD Bulletin
Vol. 11 #5)
Few studies report the prevalence or nature of medical problems
experienced by persons with intellectual disabilities (ID) treated
for psychiatric illness (Charlot, Abend, Ravin, Mastis, Hunt &
Deustch, manuscript in preparation). This, despite the fact that for
people with ID physical distress is often associated with changes in
mood, mental status and behavior, as a significant "setting
event" (Gardner & Whalken, 1996, Gunsett, Mulick, Fernald
& Martin, 1989; Carr, Smith, Giacin, Whelan, & Pancari,
2003). Medical causes for agitated behavior are frequently
missed (Abend & Silka, 1999, Ryan & Sunada, 1997) because
people with ID are poor reporters of their own health problems.
Also, individuals with limited expressive language often show the
same externalizing behaviors at different times, for different
reasons. These behaviors act as a "final common
pathway" for distress (Charlot, Doucette & Mezzacappa, 1993). [more]
-
Reassessing Psychoactive Medication Use for Challenging
Behaviors: When is it an Antidote, and When is it the Problem?
(NADD Bulletin
Vol. 11 #4)
For those of us who take care of people with intellectual
disabilities, it’s clear that advances in psychopharmacology
have helped tremendously over the past twenty years. Advocates
have helped us recognize that challenging behaviors may well be
evidence of a treatable thought or mood disorder, and this
recognition has freed many of our patients from disorganized thought,
compulsions, and psychic pain. No longer do caregivers dismiss
those with distressing behaviors as having a hopeless consequence of
their disability. Indeed, current estimates indicate that
approximately 40% of the ID population is diagnosed with a treatable
mental illness.[more]
-
Preventable and treatable medical comorbidities and adverse drug
events in people with ID/MH
(NADD Bulletin
Vol. 11 #3)
Few studies report the prevalence or nature of medical problems
experienced by persons with intellectual disabilities (ID) treated
for psychiatric illness. Despite this, for people with ID, physical
distress is often associated with changes in mood, mental status and
behavior, acting as a significant “setting event” (Carr
& Owen-Deschryver, 2007). Medical causes for agitated
behavior are frequently missed because people with ID are poor
reporters of their own health problems. Also, individuals with
limited expressive language often show the same externalizing
behaviors at different times, for different reasons. These behaviors
act as a “final common pathway” for distress. [more]
-
The DD/MH Partnership for Children
(NADD Bulletin
Vol. 11 #2)
In the summer of 2004, leaders of several public and private
child-serving organizations in Hamilton County (Greater Cincinnati
area) Ohio embarked on a community-wide effort to improve local
services for children and adolescents with co-occurring developmental
and mental health disorders. The group identified this
population as one of the largest currently served in facilities
outside the county at a substantial cost, both financially and
emotionally, to the community and to the families and children.[more]
-
Some families’ perspective on community placement options in Utah
(NADD Bulletin
Vol. 11 #1)
The current trend in public policy regarding the closure of state
funded institutions has some groups and individuals calling for the
closure of the Utah State Developmental Center. Those in favor
of closing this facility that serves approximately 230
individuals believe individuals would be better served in more
natural settings in the community, and that savings from the closure
would result in additional funds for more people to be served
in the community overall. Closure advocates also proclaim that needed
supports will be available throughout the state to provide a better
quality of life and ensure an adequate level of safety to all who
access those services. Those who have called for this closure
also believe that all families and self-advocates would prefer to
have this facility closed.[more]
-
After 30 years of deinstitutionalization, how are we really doing
on behalf of individuals with co-occurring disorders?
(NADD Bulletin
Vol. 10 #5)
Since 1977 there has been a movement toward dramatic reductions in
the use of large congregate settings for individuals with
intellectual disabilities, and to foster integration into ordinary
community setting whenever possible. Although there is great
variability between the states in the U.S in the way they implemented
plans for community based services, there was a consistent movement
toward less reliance on institutional settings and increased
provision of community based services with a significant decline in
resources allocated to institutional settings across the board
between 1977 and 1990.[more]
-
The DD/MH Partnership for Children
(NADD Bulletin
Vol. 10 #4)
In the summer of 2004, leaders of several public and private
child-serving organizations in Hamilton County (greater Cincinnati
area) Ohio embarked on a community-wide effort to improve local
services for children and adolescents with co-occurring developmental
and mental health disorders. The group identified this
population as one of the largest currently served in facilities
outside the county at a substantial cost, both financially and
emotionally, to the community and to the families and children. [more]
-
The College of Direct Support
(NADD Bulletin
Vol. 10 #2)
The College of Direct Support (CDS) is the product of a commitment of
the Research and Training Center on Community Living/University of
Minnesota and Elsevier/MC Strategies of Atlanta to build and sustain
a state-of-the art, competency-based, nationally valid, multi-media,
web-based training program for direct support professionals (DSPs)
who support individuals with disabilities. The initial courses of the
CDS were created as “Project of National Significance,”
funded by the Administration on Developmental Disabilities, with an
understanding that with the initial 6 courses completed, CDS would be
sustained and expanded through user fees. [more]
-
Enhanced Quality Assurance for Individuals with Developmental
Disabilities and Mental Health Issues in Washington State
(NADD Bulletin
Vol. 10 #1)
Unfortunately, it is not uncommon for individuals with multiple
service needs that occur across service systems to have difficulty in
accessing effective care. Often these individuals find gaps in the
system that are difficult to overcome. In response to the need to
improve services to individuals with developmental disabilities and
mental health needs, a cross systems approach to quality enhancement
and service implementation has been undertaken in the state of
Washington. [more]
-
CHILDREN WITH DUAL DIAGNOSES ON THE FEDERAL AGENDA
(NADD Bulletin
Vol. 9 #6)
New Resources Available
It is important for public policy initiatives to address needs
throughout the lifespan, including those of children and their
families. An ongoing federal initiative for children has broad
implications for those working with adults as well, in light of calls
to improve care for young adults and similar challenges in policy and
service delivery in both systems. [more]
-
The need for a clear understanding of an individual's right to
sexual expression
(NADD Bulletin
Vol. 9 #5)
A challenging area for service providers is how to respond to issues
of sexual expression among individuals with intellectual
disabilities. While much has been written on this topic, there is
often disagreement and legitimate concern about the extent to which
an individual's sexual expression should or could be supported given
that their disability may affect their ability to consent to sexual
activity. [more]
-
Transitional Housing to Reduce Inpatient Stays
(NADD Bulletin
Vol. 9 #4)
A challenge often faced by policy planners is how to assist
individuals with intellectual disabilities and mental health needs
who no longer require a psychiatric inpatient stay, but are not yet
ready to return home. In some states transitional housing has
improved both outcomes for individuals and collaborative efforts
between service systems. [more]
-
Provision and Reimbursement of Health Care for People with
Developmental Disabilities
(NADD Bulletin
Vol. 9 #3)
Traditional health care reimbursement is based on the model of
keeping the wheels of industry turning and was designed for generally
fit and healthy workers who for the most part have acute care needs
in order to return to the workforce. While this model is effective
for the population described, it does not work well for people with
chronic conditions especially if there are implications on education,
employment and productivity, such as present for people with
developmental disabilities. [more]
-
Social-Sexual Education Policy Considerations
(NADD Bulletin
Vol. 9 #2)
We are all sexual beings from the day we are born. Sexuality is the
exploration of ourselves - our physical bodies, our emotions, our
self-worth and image, and our interrelations with others. It is one
of the most basic human instincts, and no matter what level our
learning abilities, it is a natural part of being human to have the
desire to discover what our bodies are all about. It is our ability
to learn the responsibilities and consequences of the various aspects
of sexuality that will define for each of us to what degree of
involvement and discovery we will explore. [more]
-
Smoking Cessation as a Policy Issue in Dual Diagnosis:
(NADD Bulletin
Vol. 9 #1)
According to the CDC, tobacco use and obesity are the two primary
causes of preventable death in the U.S.; over 400,000 deaths per year
are blamed on tobacco use; and about a quarter of the adult
population smokes tobacco. Over the last decade untold numbers of
dollars have gone into smoking cessation programs. Cities, towns, and
states have implemented broad policy initiatives aimed at limiting
the exposure to second-hand smoke. What is the prevalence of tobacco
use in individuals with MR/DD? [more]
-
Health Insurance and Psychiatric Inpatient Care:
(NADD Bulletin
Vol. 8 #6)
Change has been a consistent theme in inpatient psychiatry over the
past fifteen or more years. In the late 1980's the average length of
stay for a psychiatric patient was over thirty days. Reimbursements
equaled or exceeded the cost of providing the service. The treating
psychiatrist was solely responsible for care provided to their
patient. External clinical oversight was minimal. Psychiatrists
addressed a series of symptoms and used the inpatient experience as a
time to complete a number of tasks. [more]
-
State Strategies for Supporting Individuals with Co-Existing
Conditions: Preliminary Findings
(NADD Bulletin
Vol. 8 #5)
The National Association of State Directors of Developmental
Disabilities Services (NASDDDS) is completing a multi-part study of
state strategies for supporting individuals with co-existing
developmental disabilities and mental health or behavioral
conditions. [more]
-
Consideration of cultural diversity in service provision and
planning for individuals with co-occurring developmental disabilities
and mental illness (NADD
Bulletin Vol. 8 #4)
There is much written on the challenges in supporting people with
co-occurring developmental disabilities and mental illness or
challenging behaviors. There has also been growing attention to
supporting staff, particularly direct support professionals who are
from different countries and different cultures. [more]
-
How to access information with regard to changes in Medicare and
Medicaid Policy (NADD
Bulletin Vol. 8 #3)
The U.S. Public Policy Committee is focusing its attention in the
coming months on changes in Medicare and Medicaid guidelines and
potential effects on the ability for individuals with co-occurring
intellectual disabilities and mental health needs to receive mental
health, primary medical and dental care and other essential services.
Since good advocacy begins with an informed constituency, we urge you
to check out the websites listed in this update. [more]
-
The Dark Cloud over Residential Services Options for Persons with
Intellectual Disabilities and Mental Health Issues (NADD
Bulletin Vol. 8 #2)
Nearly 28 years after the initiation of the movement from a reliance
on institutional services to community based services for person with
Intellectual Disabilities/Developmental Disabilities, a dark cloud is
gathering that could jeopardize over a quarter of a century of
progress. Without a strategy implemented to address current workforce
issues and residential program design limitations, services and
supports will continue to fail to address the needs of many
individuals with co-occurring intellectual disabilities and mental
health issues in the coming years. [more]
-
Custody Relinquishment: An Avoidable Tragedy (NADD
Bulletin Vol. 8 #1)
Every year many parents of children who have both developmental and
emotional disorders are faced with an impossible situation. They must
either deny their children the intensive services they desperately
need or relinquish custody to state authorities. This tragic choice
typically arises when a child requires very costly and specialized
care but community-based programs are inadequate. [more]
-
Limitations in Third Party Reimbursement and the effects on Mental
Health Services for Individuals with Intellectual Disability (NADD
Bulletin Vol. 7 #6)
In the United States, the majority of outpatient and inpatient mental
health treatment is funded either by public or private insurance
programs. The government does not provide a national health care
program, and approximately 45 million people do not have any health
insurance at all, resulting in a national health care crisis. [more]
-
Aging and Alzheimer's Disease among Persons with Developmental
Disabilities (NADD
Bulletin Vol. 7 #5)
Increases in life expectancy expose a growing number of persons with
developmental disabilities to age related diseases such as
Alzheimer's Disease (AD). For many this becomes at least a secondary
and for some, over time, a more significant disabling condition. [more]
-
How well does your state serve individuals with co-occurring
Mental Illness and Intellectual Disabilities? (NADD
Bulletin Vol. 7 #4)
There has been much discussion with regard to the need to improve
efforts toward effective service provision between state service
systems dedicated to providing mental health care and services to
individuals with intellectual disabilities (ID) in order to better
serve people [more]
-
Understanding Supplemental Needs Trusts (NADD
Bulletin Vol. 7 #3)
The federal Omnibus Act of 1993, also called the OBRA-93 Act, is
federal legislation that affects how people with disabilities,
including dual diagnoses, can have supplemental, also called special,
needs trusts and still qualify for Medicaid benefits. The Foster Care
Independence Act of 1999 is federal legislation affecting how people
with disabilities can have trusts and still qualify for Supplemental
Security Income (SSI). [more]
-
Mental Health Parity: Will This Be the Year? (NADD
Bulletin Vol 7. #2)
Access to comprehensive mental health services has long been a
struggle for people with dual diagnoses. Health insurers typically
provide less coverage (visit caps, higher co-payments, and higher
deductibles) for mental health and substance abuse than for general
medical care. This inequity can lead to adverse outcomes. Many people
with co-occurring developmental disability and mental disorder,
particularly children, are covered under their parents' insurance
plans and regularly face this disparity. [more]
-
Effective Interagency Collaboration for People with Co-Occurring
Mental Illness and Developmental Disabilities (NADD
Bulletin Vol 7. #1)
In a recent NASDDDS Project Technical Report (April 2003), the
estimate is that 20-35% of all persons with mental retardation have a
diagnosable psychiatric disorder. As a result, most states now
acknowledge the importance of comprehensive and coordinated systems
of care to meet the needs of individuals with co-occurring disorders.
Mental retardation professionals recognize the need for the clinical
expertise available in the mental health system to assist those
individuals whose mental illness impacts their ability to live and
work successfully with others. Unfortunately, barriers are frequently
cited regarding access of one system to the other. [more]
-
Children’s Services in the Real World (NADD
Bulletin Vol. 6, #6)
A real world scenario: Picture a handsome red-headed
thirteen-year-old boy Trevor has a variety of neurological problems
including intellectual deficits. He begins to attack his little
brother quite ferociously around the time that he learns to set large
fires. The police are called in along with the fire department. His
single mother cannot leave him with a sitter or relatives because of
these dangerous behaviors and also because he runs away On a couple
of occasions, he has also torn up the drywall in his bedroom. The
public school has succeeded in teaching him to read on a basic level,
but does not feel it has the resources necessary to work with his
outbursts. The mental health agency will not accept him because he
has intellectual deficits. The state developmental disabilities
agency says they can’t help until he turns twenty-two. [more]
Down
Syndrome: When to Worry about Mental Health and What to Do About It
Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members