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NADD U.S. Policy Update (from the NADD Bulletin Volume VII Number 4)Complete listing
How well does your state serve individuals with co-occurring Mental
Illness and Intellectual Disabilities?
Joan B. Beasley, Ph.D.
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 with co-occurring issues. In evaluating and or planning
services for people with ID and mental health needs, policy planners
must use a framework which incorporates what we have learned about
effective service provision. The necessary elements for effective
services can be conceptualized as follows: access to services,
appropriateness of services and accountability of services. Although
all of these areas have been covered throughout the literature, the
need to balance and integrate the elements is often overlooked.
Without a balanced perspective, policy planning is often inadequate
in meeting the needs of individuals with intellectual disabilities
who use mental health services.
In April, 2003 the National Association of State Directors of
Developmental Disabilities Services (NASDDS) published a technical
report written by Dr. Chas Moseley, Director of Special Projects, of
the outcomes of a joint survey between NASDDS and the National
Association of State Mental Health Program Directors (NASMHPD).
Participants of this survey (conducted in 2002) were state directors
of the two organizations, with 37 states represented in all. The goal
of the survey was to identify key components associated with
successful service delivery. The survey included important measures
of service effectiveness and findings indicated a need for
improvements across effectiveness indicators.
In November, 2003 NADD disseminated the same survey via e-mail to
participants at the NADD annual conference in Chicago as well as the
NADD membership. This brief article will present the results
associated with one of a number of important survey questions: How
well does your state serve individuals with co-occurring Mental
Illness and Intellectual Disabilities?
There were a total of 229 NADD respondents; 91% from 37 U.S. states
and the District of Columbia, 8% of respondents were Canadian, while
approximately 1% of the respondents from Europe and Australia.
Unlike the original survey, most of the respondents were not state
directors. The table below provides a description of NADD respondents
with regard to their stated area of specialty (4% responded as "other").
Area of Specialty
|
Admin |
42% |
|
Clinician |
12% |
|
Education Trainer |
2% |
|
Family Member |
2% |
|
MD |
1% |
|
Nurse |
2% |
|
Psychiatrist |
6% |
|
Psychologist |
16% |
|
Researcher |
1% |
|
Social Worker |
10% |
|
Direct Care Provider |
2% |
The question "In your opinion, how well does your state serve
individuals with co-occurring MI/DD?" was broken down into
several components to measure service effectiveness:
a)Access to services in the appropriate service system(s);
b)Quality, appropriateness and effectiveness of services provided;
c)Overall effectiveness of collaboration between the state MH
authority and DD authority in planning, developing and delivering services;
d)Overall effectiveness of collaboration between local ( regional/
area/county) MH authorities and their counterpart local DD
authorities in serving people;
e)Overall effectiveness of collaboration between state MH and DD
authorities and local authorities serving the same populations;
f)Overall effectiveness of statewide training, technical assistance
and other related efforts to disseminate current, state-of-the art
information concerning treatment and support; and
g)Importance of improving services in the context of competing agency priorities.
Consistent with the original NASDDS/NASMHPD survey, the NADD e-mail
survey respondents were asked to rate the components on a scale
ranging from one, least effective to five, most effective. The
results are outlined in the table below.
|
Rating |
Access to appropriate services (a) |
Quality and appropriate services (b) |
Measures of Cross systems collaboration (c-e) |
Training and technical assistance (f) |
|
1 (least effective) |
22% |
18% |
25% |
38% |
|
2 |
32% |
37% |
35% |
26% |
|
3 |
34% |
34% |
38% |
23% |
|
4 |
12% |
11% |
10% |
12% |
|
5 (most effective) |
<1% |
<1% |
2% |
1% |
The results from the original NASDDS/NASMHPD survey conducted in 2002
indicated that state directors found problems existed with regard to
service effectiveness measures across systems for individuals with
co-occurring intellectual disabilities and mental disorders. A
significant number of state directors found services to be less than
effective in all indicators. Although outcomes were similar to those
found in the original survey, the current survey results indicate
that NADD respondents were even more discouraged by their experiences
in the system, with a significant majority of respondents rating
access, quality, cross systems collaboration, training and technical
assistance as less than effective.
Efforts on behalf of mental health and ID service systems to
collaborate in order improve services is a very positive development.
It is important for policy planners to measure the effectiveness of
the current system in order to implement meaningful change in the
future. The survey developed by the state DD and MH directors is an
important step to gain a better understanding of ways to promote
effective service provision. Clearly, all stakeholders have an
important role to play in creating positive change in the system of
care. The NADD results indicate that it may be useful to repeat the
survey again to include both state directors and service providers
who may provide ongoing information and feedback with regard to
attempts to improve service effectiveness over time.
We would like to thank the state directors for granting permission to
use their survey. For more information about the NASDDDS/NASMHPD
survey, please contact Chas Moseley, Ed.D, Director of Special
Projects at cmoseley@nasdds.org.
This article is dedicated to the memory of our friend and colleague,
Dr. John Jacobson who dedicated much of his professional life to
improving services to people with disabilities.
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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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