NADD U.S. Policy Update (from the NADD Bulletin Volume VII Number 1) Complete listing Effective Interagency Collaboration for People with Co-Occurring Mental Illness and Developmental Disabilities Kathryn duPree, Deputy Commissioner, Connecticut Department of Mental Retardation 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. Connecticut has a framework for collaboration between the separate mental retardation and mental health agencies that is proving to be successful. While barriers still exist in terms of adequacy of financial resources, and a lack of clinically trained and available practitioners, significant strides have been made in access to mental health inpatient services and to follow-up community outpatient services. There are lessons learned that may be useful to future policy discussions: Recognize the limitations of formal interagency agreements. The recent survey jointly issued by the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the National Association of State Mental Health Program Directors (NASMHPD) identified key components associated with successful service delivery. While 75% of the reporting states indicated they had a formal interagency agreement for services for individuals who have co-occurring conditions, 43% reported that these agreements were less than effective. A similar level of ineffectiveness was reported about regional or local collaboration. Realize the importance of interagency relationships among key professionals. The success of formal agreements is more reliant upon ongoing communication, collaboration and the achievement of professional respect. At both the state level and the regional level, we have found improvement in the areas of clinical consultation, joint planning, inpatient services, restoration training and outpatient treatment where there are long standing professional relationships. Ensure regular communication at the state and regional levels. Opportunities for sharing databases, reviewing clinical status, interagency problem solving, and joint planning allow the formal agreements to be effectively operationalized. It also allows for joint agency ownership of the desires for a successful life of each person collaboratively served by both agencies. The unique nature of the individual and what network of supports will enhance the chances for successful community living become the focus of interagency discussion. Ensure that key administrators at the state and local level have an orientation to their sister agency. When Connecticut formalized its Memorandum of Agreement (MOA), sessions were planned for all state and regional level staff responsible for implementation. Training in the specifics of the MOA was coupled with an orientation to each agency's mission, eligibility criteria, guiding principles and statutory authority. This provided an excellent opportunity to understand the different premises, service delivery approaches and limitations of both agencies. As an example, the existence of a Waiting List for individuals with mental retardation brought greater understanding to mental health professionals of a major barrier to timely discharge from psychiatric facilities for people still living at home with their families. Our mental retardation professionals learned that what was sometimes perceived as discriminatory practices were not. In this state, public mental health resources are dedicated to those people with significant, chronic mental illness and community supports are often more acute and intermittent. The mental retardation orientation to comprehensive long-term support is a departure from the mental health service delivery approach. Our service delivery orientation led us to expect service interventions that were not necessarily available to the general population accessing mental health services. Respond effectively to the organizational needs of both agencies and respect service and budgetary constraints. Through the interagency relationship, DMR became aware of the frustration of the mental health agency in supporting necessary psychiatric admissions, because of untimely, unresponsive discharge planning of individuals while in acute mental health inpatient settings. As a result, people continued to be hospitalized in expensive settings long past their readiness for discharge. Their continued presence created a burden for the hospitals, lack of access for others in need of intervention, and prolonged unnecessary hospitalization for individuals with mental retardation. The department's response was to: Work with its provider community to cooperatively plan timely discharges for individuals returning to a funded residential setting. Create a tracking system to help bring managerial attention to the problem. Streamline eligibility determinations for individuals not previously served by DMR. Strengthen collaboration with the children's agency to better plan community alternatives for adolescents who had co-occurring mental illness and mental retardation. Develop a transitional program for adults who could not return to their family's home. These initiatives have significantly reduced the length of stay for individuals with co-occurring diagnoses in both private and public psychiatric settings. Collaborate and train. There has been great opportunity for training between agency professionals that benefit community service development. Mental retardation professionals have benefited from trainings on psychiatric interventions, clinical assessment tools and medication utilization. Mental health professionals have gained expertise from positive behavior support in-services. Interagency case conferences are used as both a training opportunity and a chance to collaborate effectively for individuals who present challenges while using generic treatment and support approaches. No particular strategy will prove successful in all cases. Connecticut still struggles to meet the needs of some of its citizens with co-occurring conditions. The availability of community services and the necessary resources in sufficient quantity to fund these supports remain a barrier to effective support for some of these individuals. However, effective collaboration and communication have furthered our efforts to expand the availability of psychiatric interventions allowing more people to live successfully in community settings. A note to our readers: The U.S. Public Policy Committee of NADD is delighted to offer the "U.S. Public Policy Update" as an ongoing column in the NADD Bulletin. The goal is the dissemination of relevant public policy information. We welcome your comments, as well as submissions for this column. To learn more about the NADD U.S. Public Policy Committee or to contribute to this column, you may contact Joan Beasley, chairperson of the U.S. Public Policy Committee, 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.

© The NADD, all rights reserved
website designed and maintained by: spinningwebz services