NADD U.S. Policy Update (from the NADD Bulletin Volume VIII Number 5) Complete listing State Strategies for Supporting Individuals with Co-Existing Conditions: Preliminary Findings The National Association of State Directors of Developmental Disabilities Services (NASDDDS) is completing a multi-part study of state strategies for supporting individuals with co-existing developmental disabilities and mental health or behavioral conditions. The project has gathered data through a nationwide survey of state officials, an invitational symposium of state developmental disabilities agency directors and national experts and currently, a qualitative study of the strategies thirteen states employ to support individuals with co-existing conditions (see box below). The national survey results and a report of the findings and recommendations of the symposium are available on the NASDDDS website, www.nasddds.org.   This paper summarizes selected preliminary findings emerging from the in-depth assessment of state practices for supporting individuals with co-existing or dual diagnoses being completed by the author. Data were gathered through interviews with state officials and analyses of state policies, procedures, laws and regulations regarding the organization and delivery of services to individuals with dual diagnoses.   Service Funding and Provision. States generally use the same mechanisms for funding services provided to individuals with co-existing conditions, but allocation strategies differ, sometimes dramatically, from one jurisdiction to another. In all of the thirteen states, long-term community services are furnished to individuals with co-existing conditions by the state developmental disabilities agency and funded through Medicaid under section 1915(c) or, in the case of one state, section 1115 waiver programs.   Although, episodic mental health treatment, counseling and psychiatric care are covered Medicaid State Plan services in twelve of thirteen states, many state developmental disabilities officials reported that cuts or restrictions in mental health funding during the past five years have decreased the capacity of community mental health centers to provide timely services. Because individuals' needs must be addressed, in many areas service costs and responsibilities have shifted to developmental disabilities programs. Respondents in five of the thirteen states describe the state mental health agency has having minimal involvement in financing mental health services for persons with developmental disabilities. In one state, mental health covers only in-patient care. In three states the costs of community mental health services for individuals with developmental disabilities are shared between the state developmental disabilities and mental health agencies. One state developmental disabilities agency addressed the problem by providing additional funding to community mental health programs to improve staffing levels.   Clinical Services. In the current study, all of the state developmental disabilities agency officials reported difficulty in securing effective and appropriate diagnostic, clinical and psychiatric services. Respondents noted that many community mental health centers lack staff with the expertise necessary to effectively treat individuals with cognitive disabilities. States offering mental health services through managed care arrangements expressed conflicting opinions regarding the benefits and weaknesses of the approach. Access to psychiatric services was said to have improved in one state as a result of contract requirements obligating managed care entities to ensure the availability of all covered mental health services. Respondents in another state, by contrast, reported that access by individuals with co-existing conditions was limited by restrictive eligibility criteria employed by the managed mental health care program. The lack of sufficient numbers of qualified mental health providers was also identified as a significant barrier to service provision resulting in an excessive use of medication and the provision of inadequate care and treatment.   Case Management/Service Coordination. State developmental disabilities agencies are responsible for service coordination, planning and monitoring in twelve of the thirteen states reviewed. In three of the twelve states, the responsibility is shared with the mental health state agency. In one state, service coordination is assigned to either the developmental disabilities or mental health program, but not both. Case management services are not generally permitted to be provided by agency(ies) delivering direct services to the same individual.   Collaboration. Collaboration between state agency officials is frequently good, but consistent cooperation between local developmental disabilities and mental health providers appears to be difficult to achieve and highly dependent on program characteristics and personalities. As noted above, mental health funding and service cuts have curtailed the ability of local mental health agencies to participate with developmental disabilities agencies as full partners in service planning, coordination and delivery.   Emergency Intervention and Crisis Support. Over half (56%) of state officials responding to the NASDDDS survey on state strategies for supporting individuals with co-existing conditions identified the lack of effective crisis response capacity as a frequent or consistent barrier to the provision of supports to individuals with co-existing conditions . Although officials in the thirteen in-depth review states expressed some concern over access to emergency support generally, they each reported that their state was able to adequately address the need.   Emergency crisis response services are provided to individuals with co-existing conditions by the developmental disabilities system in five of the thirteen states under review, by the mental health system in three of thirteen states and by both systems in five of thirteen states. Crisis response teams are regionally organized in most states and able to offer a wide range of clinical and direct support services to individuals in crisis in community settings.   Summary. This paper describes some of the preliminary findings of an in-depth assessment of the policies and practices employed by thirteen states to address the needs of individuals with co-existing conditions. The data reveal strong similarities and significant differences in states' strategies for funding, coordinating and delivering supports to eligible individuals. A complete analysis of state support strategies will be available in the fall, 2005. Charles Moseley Ed.D. National Association of State Directors of Developmental Disabilities Services www.nasddds.org.

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.

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