|
NADD U.S. Policy Update (from the NADD Bulletin Volume X1 Number 6)
Complete listing
Adverse Impact of the Medicare Acute Psychiatric Inpatient PPS For
Patients With Co-Occurring Developmental Disabilities and Mental Illness
Diane Jacobstein, Ph.D., William O'Brien, MSW, Joan B. Beasley, Ph.D.,
Ann D. Hurley, Ph.D., Terrence McNelis, MS, Robert Fletcher, DSW,
Julia Pearce
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:
·Concerns are growing across the country about the adverse
impact of the new Medicare reimbursement formula for acute
psychiatric inpatient stays on patients with co-occurring
intellectual/developmental disabilities and psychiatric problems.
·The current Medicare rates for acute inpatient psychiatric
admissions do not account for the unique needs of people with
co-occurring intellectual/developmental disabilities and mental
illness, as they were based on cost estimates for patients without
mental illness alone.
·Individuals who have both developmental disabilities and mental
illness commonly have significant medical problems that must be
considered in order to clarify the diagnosis and provide effective
treatment. They may not be able to communicate about their
symptoms. Their care requires more time, an interdisciplinary
approach and a much wider array of subspecialties than is needed for
individuals with mental illness alone (including speech-language
pathology, neurology, occupational therapy, urology, orthopedics,
physical therapy, gastroenterology, behavior specialists) because of
the developmental disability, medical co-morbidity and complexity of both.
·There is not enough time allotted by current guidelines
(generally about 8 days), so patients are being discharged before
their needs are addressed (which is estimated to take an average of
about 13-16 days for this target group).
·Communities are seeing these patients stuck in emergency rooms,
sometimes for a week or more, although open "network" beds
are available in acute psychiatric units.
·Inadequate time to complete the process leads to readmissions
for the same problem. Recidivism under the new rates is on the
rise for this population and individuals may also remain impaired for
longer time.
·Evidence shows that recidivism is reduced by a comprehensive
approach that requires more resources up front. This population is
estimated to cost approximately 35-40% more to treat appropriately in
acute stabilization admissions. Since the most common reason for
admission is severe aggression, a far more intensive staffing pattern
is also required, in order to increase safety and reduce the need for
chemical restraint. (This would not have been observable when
Medicare reviewed the costs related to diagnosis.)
·Many general psychiatric units have been reluctant to admit
these patients because they need such specialized care. There
are concerns that reduced rates will exacerbate this reluctance and
reduce access, further increasing the disparity in services for
people with developmental disabilities relative to people without
disabilities if the current payment structure is not modified. In
addition, there are concerns that dedicated specialty units that have
proven to be very effective for those with severe co-occurring
developmental and psychiatric disorders will be at risk.
·Medicaid managed care providers in some states have paid
differential rates for this population with good results.
·The recent establishment of rates for inpatient stays is not
the problem. The concern is that the current rates and
associated service expectations do not match the needs of individuals
with mental illness and intellectual/developmental disabilities.
There are specialized inpatient programs that may serve as a way to
better inform policy makers. One example is the inpatient unit at
UMASS Medical Center that serves the entire New England region. This
program and others found in the US should be identified as pilots to
help establish more appropriate rates for the population.
References
Charlot, L and Beasley, JB (2005) Specialized Inpatient Mental Health
Care for People with Intellectual Disabilities. The Mental Health
Aspects of Developmental Disabilities 8 (3) 100-103.
Lohrer, S; Greene, E.; Browning, C; & Lesser, M.S. (2002). Dual
Diagnosis: Examination of Service use and length of Stay during
psychiatric hospitalization Journal of Developmental Disabilities 14
(2) 143-158.
Lunsky, Y; Bradley, E.; Durbin, J.; Koegl, C.; Carninus, M &
Goerinz, P. (2003) Dual Diagnosis in Provincial Psychiatric
Hospitals: A Population- Based Study. Ontario Mental Health
Foundation Publisher, Ontario, Canada
O'Brien, W. (2007) Changing Environments of Inpatient Psychiatric
Care for Individuals with Intellectual Disabilities. The Mental
Health Aspects of Developmental Disabilities 10 (6) 99-106.
Xenitidis, K; Gratsa, A; Bouras, N; Hammond, R; Ditchfield, H; Holt;
G.; Martin, J.; & Brooks, D. (2004) Psychiatric Inpatient care
for adults with intellectual disabilities: generic or specialist
units? Journal of Intellectual Disabilities Research 48 (1) 11-18.
Your feedback is important to us. Please send your comments: Joan B.
Beasley, Ph.D. at jbbeasley@rcn.com
|
Upcoming Conferences:
September
Ohio State 10th Annual MI/DD Conference , Mental Health Aspects
–Treatment & Support (September 18 & September 19, 2012)
Columbus, Ohio
October
NADD 29th Conference & Exhibit Show, (October 17 - 19, 2012)
Denver, Colorado
October 2013
NADD 30th Conference & Exhibit Show, Baltimore MD (October 23 -
October 25, 2013)
Complete Calendar |
New Educational Products:
|
|
 Intellectual
Disability and Mental Health: A Training Manual in Dual Diagnosis
Sharon McGilvery, Ph.D. and Darlene Sweetland, Ph.D.
With the release of this book, Drs. McGilvery and Sweetland share
decades of experience working with individuals diagnosed with an
intellectual disability and co-occurring psychiatric disorders. Their
well-practiced approach takes into account the extremely complex
nature of working with dual-diagnosis. The authors provide
in-depth information about the diagnostic process, hands-on treatment
considerations, and their experience training thousands of people to
work passionately with these individuals. An important
contribution is their approach to addressing complicating factors in
identifying appropriate psychiatric diagnoses, as well as the problem
of the underreporting of psychiatric symptoms and disorders. Finally,
those working in a variety of contexts with these individuals will
benefit from the innovative approaches of looking at treatment and
intervention strategies that can be immediately implemented. 264 pages
Details:
ST11-053B
|
|
 A
PRACTICAL GUIDE to Assessing Medical Issues Associated with
Behavior/ Psychiatric Problems in Persons with Intellectual
Disability – Revised in 2011
Ann R. Poindexter, M.D.
This book discusses medical/medication issues which may present as
behavioral/ psychiatric problems in individuals with intellectual
disability. Three self-directed instructional courses and
several illustrative case histories are included. 110 pages\
Details:
DA05-021BR
|
Psychotherapy for Individuals with Intellectual Disability
Edited by: Robert J. Fletcher, DSW, ACSW
This book provides the reader with insightful and useful ways to
provide psychotherapy treatment for individuals who have intellectual
disability (ID). It brings together all three modalities
(individual, couple, and group), and a variety of theoretical models
and techniques are discussed. The first section, Individual
Therapy, offers a variety of approaches and techniques including
dialectical behavioral therapy, positive psychology,
mindfulness-based practice, and relaxation training. Also included in
this section are chapters on specialty populations including victims
of abuse, people who have Autism Spectrum Disorder, and people in
mourning. The second section is a chapter on group therapy addressing
trauma issues. The third section is on family and couple therapy. The
fourth section covers chapters on research, ethics, and
training. The individual authors are respected authorities in
the field of providing psychotherapy treatment for persons with ID
and all have contributed to the professional literature.
This book is a major contribution to the effort to make psychotherapy
available to individuals who have ID and should serve to further
stimulate interest in the provision of psychotherapy treatment for
individuals who have ID co-occurring with significant mental health problems.
NADD # CT11-051B Details
|
 Comprehensive
Competence-Based Parenting Assessment for Parents with Learning
Dificulties and Their Children
Maurice Feldman, PhD, Marjorie Aunos, PhD
This book presents an innovative, empirically-supported approach to
assessing parenting capacity of parents with learning difficulties
that can lead to more humane, fair and accurate child custody
decisions. The authors are leading researchers and
practitioners in this field haing worked with hundred of these
families. Many professionals working with these families
recognize that the current parenting capacity assessment approaches
are based on outdatd and invalid assumptions and methods. This
book addresses the unique assessment needs of these families and
includes detailed background information, rationales and methods.
NADD # DA10-050B Details
|
 Working
with People with Challeging Behaviors: A Guide for Maintaining
Positive Relation
Nathan Ory
The material in this book introduces general practices
and specific solutions to behavior problems that will work with
people who display difficult and challenging behaviors regardless of
who they are. It is especially suitable for working with
individuals who have developmental or intellectual disabilities
coupled with a behavior disorder. The methods also apply to the
person with emotional or psychiatric disturbances, or another serious
mental health problem. Finally, they are helpful in providing
support to elderly individuals who display challenging behavior.
NADD # ST10-049B Details
|
Human Needs and Intellectual Disabilities: Applications for Person
Centered Planning, Dual Diagnosis, and Crisis Intervention
Steven Reiss, Ph.D.
Human Needs and Intellectual Disabilities identifies the 12 human
needs most relevant to the lives of people with intellectual
disabilities, autism and related developmental disabilities. It
includes detailed, practical suggestions for caregivers or parents
interested in the happiness, quality of life, and self-determintion
of their loved ones or consumers. The book includes detailed,
practical suggestions for reducing episodes of challenging behavior
and psychiatric symptoms in people with a dual diagnosis
(intellectual disabilities and mental illness). It shows how to
substitute the language of individuality (e.g., "friendly
person") for the language of disability (e.g., "person with
disability"). It also reduces the tendency of planners to
confuse their own value system for that of the consumer. The
book includes scholarly reviews of dual diagnosis literature on
mental illness, prevalence, and assessment.
NADD # DA10-048B Details
|
Positive Identity Development
Author: Karyn Harvey, PhD
Positive Identity Development is an exciting new approach to
treatment for individuals with intellectual disabilities. This
book provides a new theoretical perspective on treatment along with a
variety of innovative tools. It rejects reducing adults with
intellectual disabilities to a mere compilation of their behaviors
and promotes the use of a positive, therapeutic approach to each
unique individual. Psychologists, social workers and therapists
should be able to use the tools presented in this book to directly
enhance the effectiveness of the treatment they provide to adults
with intellectual disabilities. This book promotes well-being on
every level and explores a broad range of issues relevant to the life
and mental health of adults with intellectual disabilities
Mbr Price: $34.95
Non-Mbr: $39.95
NADD #CT09-047B Details |
 Down
Syndrome: When to Worry about Mental Health and What to Do About It
Robin Friedlander, M.D. & Peter Johnson, Ph.D.
NADD # FI09-044B Details |
 Working
with People who have Intellectual Disability and Behavioral
Problems: A Self-Study Guide for Interdisciplinary Team Members
Ann R. Poindexter, M.D. & Paul D. Kolstoe, Ph.D.
NADD # ST09-045B Details |
Multi-Media CDs of NADD 25th Annual Conference Presentations
Presentations recorded at NADD 25th Annual Conference are available
as multi-media CDs. These CDs contain the video and Power Point
from conference presentations and are a great tool for training
yourself and your staff. To order, or for additional
information, click here.
Community Networks of Specialized Care: Building Community
Capacity through Training and Education Lisa Holmes, Liz
Froese, MSW, Rosanne Stein, LLB, BSc, Sandi Bricker
NADD Competency-Based Dual Diagnosis Certification Program Robert
Fletcher, DSW, ACSW, FAAIDD; Donna McNelis, PhD; John McGonigle,
PhD; Kathleen Olson, PhD; Jarrett Barnhill, MD
Autism Spectrum Disorders: Separating the Data from the
Myths Ann R. Poindexter, MD
Diagnostic Systems for Use with People with ID Luis
Salvador-Carulla, MD, PhD, Robert J. Fletcher, DSW, ACSW, FAAIDD,
Sally-Ann Cooper, MD
The price for the above multimedia is: Member:
$49.95 Non-member: $59.95
To order, or for additional information, click
here.
|
|
