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NADD U.S. Policy Update (from the NADD Bulletin Volume XII Number 1)
Complete listing
Transforming Missouri's System for People with Developmental Disabilities
Robin Rust
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).
The Missouri Division of Developmental Disabilities is engaged in
systems change that will result in a service continuum better
balanced toward home and community-based services versus congregate
living arrangements, with improved quality oversight.
Eleven DD Regional Offices located throughout Missouri are the
primary entry points into the system, providing eligibility
determination, assessment and service coordination. In
recent years, caseloads have increased to levels far in excess of
standard best practice of 1:40. Feedback from
stakeholders has recommended that caseloads be reduced, and that
there be more local control and decision making. To accomplish
this, the division is partnering with county boards for developmental
disabilities to increase service coordinators
statewide. Local funds may be used to match federal
Medicaid funding through the targeted case management state Medicaid
plan option and in Missouri's three 1915(c) home and community-based
waivers for developmental disabilities. As of late 2008,
31 counties have entered into agreements with the division to provide
service coordination, which has provided additional revenue to the
state resulting in increased capacity to meet the needs of
Missourians with developmental disabilities.
Missouri is progressing toward a reduction in numbers of people
residing in state operated habilitation centers. Facility
census has declined from over 1200 in 2003 to fewer than 850 as of
late 2008. The role of the state facilities is evolving
away from long-term residential care toward a short term crisis
stabilization service, due to lack of capacity of both private and
public inpatient psychiatric hospitals.
An emerging issue is an increase in the number of individuals who
have a dual diagnosis of DD/MI. While it is estimated that 20%
or more of the individuals yet to transition from habilitation
centers have a dual diagnosis, the greater proportion of the total
population eligible for division services are reflected in the
numbers of new people, including both children and older adults,
seeking to enter the developmental disabilities system for the first
time, who are already in the community and wish to remain there.
The division is implementing a multi-faceted approach to address
these challenges, by improving the person-centered planning process,
more effective assessment of risk factors during planning, improved
protocols for crisis planning and prevention, by increasing the
capacity for mobile crisis intervention, and developing short term
crisis stabilization beds in state operated ICF DD facilities.
To increase the skills pertaining to assessment of risk, a training
program for service coordinators was developed. The training
covers risk assessment and identification, integration of risk
assessment into person-centered planning, development of strategies
to address risk, and new directions in risk assessment.
In addition, a protocol and checklist for monitoring how effectively
service coordinators assess risk was developed. The protocol
will facilitate the transition from direct provision of service
coordination by state staff to the oversight of service coordination
provided by county boards for developmental disabilities and other organizations.
The division is implementing strategies to change the culture within
the system from previous philosophies and theories on behavior,
usually called behavior management, to positive behavioral support,
or PBS, which is grounded in respect for the individual, positive
outcomes for people, and current best practice standards. PBS
is a guiding philosophy for providing services and supports for all
people who have developmental disabilities, including those with
challenging behaviors. A PBS "train the trainer"
initiative is underway, with a goal of increasing the capacity within
the private provider community for the training of direct support
professionals in PBS principals and strategies.
As service coordination capacity is increased in county DD boards, it
is anticipated that Regional Office resources can be redeployed from
service coordination to behavior resource teams, including mobile
crisis teams, to respond to the needs of people in the
community. Methods of engaging the private provider
network to build local capacity to provide crisis prevention and
intervention for people receiving residential supports and services
are being explored. To facilitate the development of a
cross-systems network of crisis planning, prevention and
intervention, the Missouri Division of Developmental Disabilities is
enlisting the expertise of Dr. Joan Beasley. A series of
training events and workshops is planned, targeted to staff in
state-operated crisis units, the DD Regional Offices, and the private
provider community.
When implementing significant systems transformation initiatives,
policy planners should consider a multi-pronged approach, including
building upon and enhancing existing partnerships, enlisting
technical assistance from experts, listening to and acting on
stakeholder input, and finding creating ways to strengthen and/or
retool capacity that already exists within the system.
For more information please contact Robin Rust, Project Director, DD
Systems Transformation at: Robin.Rust@dmh.mo.gov
The "U.S. Public Policy Update" is an ongoing column in the
NADD Bulletin. We welcome your comments and submissions for
this column. To learn more or to contribute to this column, you
may contact Joan Beasley, Editor of the U.S. Public Policy Update at joan.beasley@unh.edu.
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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:
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 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
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 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
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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
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 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
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 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
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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
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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.
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