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NADD U.S. Policy Update (from the NADD Bulletin Volume VIII Number 4)Complete listing
Consideration of cultural diversity in service provision and planning
for individuals with co-occurring developmental disabilities and
mental illness
Jeffrey Keilson. MA
Thomas Wagner, LICSW
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. However, not enough
attention, particularly in public policy, has been paid in
understanding the complexities of people from diverse cultures who
present with co-occurring conditions. Issues of co-occurring
conditions, already challenging on their own, become even more
complex when issues of race, class, language, culture or religion are
not considered. Adding to the complexity is the multiplicity of
cultures, languages, and religions that are native to many of the
direct care providers who provide front-line support to these
individuals. The task is even more challenging when the clinical and
administrative staff are from different cultures as well. Cultural
diversity enhances everyone's experiences. However it becomes
problematic when there is lack of attention in the role diverse
backgrounds may play in the determining ways people may interact and
define goals.
It is critical to have focused strategies at the state and federal
level in supporting individuals with co-existing developmental
disabilities and mental illness or challenging behaviors. It is
becoming increasingly clear, too, that agencies providing support
must have focused strategies on workforce diversity and development.
This must include a strategy to provide support and services in ways
that are respectful and responsive to an individual's culture of
origin, class, family system, and religion.
While the system is challenged in providing supports to persons with
complex needs such as the need for collaboration, communication, and
skilled professionals, this challenge is exacerbated by lack of
attention and understanding of cultural diversity. We've begun to
recognize that there is an art in recruiting, retaining and
supporting a cross-cultural workforce. We must also begin to
recognize there is an art to providing supports that respect and are
responsive to people and their families in the context of their
culture of origin.
Person centered planning approaches are ideally suited to address
these needs. By focusing on the individual and his/her wishes, dreams
and desires, the provider is less likely to make untested assumptions
based on cultural or linguistic biases. However, for this approach to
be successful, a commitment of energy and resources is required.
State, federal, and human service agencies must be committed to
development of cultural competency for facilitators of the
person-centered planning, administrators, clinicians and direct care
professionals. Cross-cultural and cross-linguistic training must be
provided to assist families, support caregivers and agency personnel
to appreciate and understand differences in ways that give
credibility and value to experiences people bring with them.
In order to insure quality supports in providing services in this
manner, individuals and families must be offered the opportunity to
give voice to their beliefs. This requires the commitment to support
people from different cultures in gaining skills required to be
effective advocates and being mentors for others. Government and
provider agencies must gain the cultural skills to be effective
listeners.
Acknowledging this complexity is the first step toward redefining and
redesigning support systems for people with co-occurring conditions.
Support systems must be re-defined to include the natural supports
that a person brings to the table . Support systems that include
families and significant others and support systems that draw on and
individual's native culture and linguistic community. Reimbursement
systems must be designed to include accommodations for interpreters
who are linguistically and culturally competent. Funding streams must
support grassroots community agencies or family support systems that
may not meet traditional licensing requirements. Documentation
requirements must be respectful of communication methods of different
cultures. For example, in Deaf culture communication is visual and
not written. Solutions that satisfy government requirements while
respecting the different cultures can be developed. The individual's
needs and expressed desires, reflected in the person centered plan
and budget, should drive funding for culturally competent services
and supports. Support brokers working for person should be a
reimbursable service and could be funded from an individual's allocation.
In 2003, a survey of State Directors conducted by NASDDDS and NASMHPD
identified lack of qualified service providers as the major obstacle
to the delivery of services to people with co-existing conditions.
Training staff from different cultures to work with consumers of
different cultures, in addition to relying more on natural
communities, creates an opportunity to develop a uniquely qualified
support system. This flexibility is even more critical to insure
cost-effective services for people with complex needs.
In conclusion, in meeting the challenge to provide effective services
to people with coexisting disorders policy planners must consider
issues of cultural diversity in addition to clinical and habilitative
needs. This may require targeted resources for recruitment and
training. A culturally responsive service network will help to insure
successful outcomes for people who live with many challenges, and can
be developed with good public policy and effective planning and
collaboration. We diminish ourselves by not being responsive. We
enrich all of us by being successful.
Reference
Moseley, C (2004) NASDDDS Technical Report: Survey on State
Strategies for Supporting Individuals with Co-existing Conditions (p5).
Jeffrey Keilson. MA is an independent consultant and Vice-President
for Advocates, Inc. in Framingham, Massachusetts and can be reached
at jakeilson@aol.com
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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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