Unmet Needs of Adults in Community Mental Health Care With and Without Intellectual and Developmental Disabilities: A Cross-Sectional Study

Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions

OBJECTIVE

The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions.

METHODS

Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach.

RESULTS

Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition.

CONCLUSIONS

Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.

Effects of Texas State Agency Integration on Mental Health Service Use Among Individuals with Co-occurring Cognitive Disabilities and Mental Health Conditions

This study uses Texas's 2017 integration of the state disability and mental health agencies as a case study, combining interviews with Texas agency and advocacy organization leaders to examine perceptions of agency integration and augmented synthetic control analyses of 2014-2020 Medical Expenditure Panel Survey to examine impacts on mental health service use among individuals with co-occurring cognitive disabilities (including intellectual and developmental disabilities) and mental health conditions. Interviewees described the intensive process of agency integration and identified primarily positive (e.g., decreased administrative burden) impacts of integration. Quantitative analyses indicated no effects of integration on receipt of mental health-related services among people with co-occurring conditions. While leaders identified some potentially beneficial impacts of state agency integration, the limited impact of integration beyond the agency suggests that interventions at multiple levels of the service system, including those targeting providers, are needed to better meet the mental health service needs for this population.

Social Group Membership, Social Identities, and Mental Health Experiences in Urban Poor Communities in Ghana: A Critical Social Psychology Inquiry

Social groups and identities significantly influence mental health outcomes, yet their impact in resource-poor communities remains understudied. We explored the role of social group memberships and identities in shaping mental health experiences in two urban poor communities in Ghana. Data from 77 participants were analyzed thematically, revealing widespread engagement in social groups that provide access to both material and symbolic resources. However, these groups also serve as sources of tension and contribute to the stigmatization and marginalization of vulnerable members. Those affected include individuals with severe mental disorders, men experiencing depression, young men involved in substance abuse, family caregivers, migrant and tenant households, and otherwise healthy individuals with recurring psychosocial challenges. The groups exacerbate mental health challenges and restrict access to care among marginalized populations. The findings underscore the need for targeted interventions aimed at enhancing mental health support and reducing stigma in resource-poor settings.

Experiences of health care services among people with cognitive disabilities and mental health conditions

BACKGROUND

People with cognitive disabilities such as intellectual and developmental disabilities face significant barriers to accessing high-quality health care services. Barriers may be exacerbated for those with co-occurring mental health conditions.

OBJECTIVE

This study compares patient experiences of health care services between adults with and without cognitive disabilities and, among people with a cognitive disability, those with and without co-occurring mental health conditions.

METHODS

Cross-sectional analyses were conducted using 2021 Medical Expenditure Panel Survey data, a national U.S. survey, to examine differences in Consumer Assessment of Healthcare Providers and Systems measures.

RESULTS

Adults with cognitive disabilities reported lower satisfaction with health care services compared to the general population (7.62 (95% confidence interval (CI): 7.41-7.83) vs. 8.33 (95% CI: 8.29-8.38) on scale from 0 to 10). Adults with cognitive disabilities were less likely to report that providers listened carefully to them (odds ratio (OR): 0.55, 95% CI: 0.42-0.71), explained things in a way that was easy to understand (OR: 0.48, 95% CI: 0.35-0.66), showed respect for what they had to say (OR: 0.38, 95% CI: 0.29-0.51), spent enough time with them (OR: 0.52, 95% CI: 0.40-0.69), or gave advice that was easy to understand (OR: 0.40, 95% CI: 0.28-0.58) compared to the general population. Among adults with cognitive disabilities, there were no differences based on co-occurring mental health conditions.

CONCLUSIONS

Adults with cognitive disabilities report lower satisfaction with health care services driven by worse experiences with the health care system. Policies to increase provider capacity to support this population should be prioritized.

Negative Impacts of Psychiatric Medications on Oral Health: A Literature Review

Evidence reveals that people with mental illnesses have a greater risk of experiencing oral diseases such as dry mouth and dental caries and have greater oral treatment needs. This is related to multifactorial causes such as factors related to the condition itself, symptoms, side effects of polypharmacy, and a lack of accessibility to dental services. This article aims to provide a summary of the reported prevalence of the most common mental illnesses in Saudi Arabia (SA), such as schizophrenia, obsessive-compulsive disorder (OCD), bipolar disorders, and dementia. The article further aims to review the negative impacts of anti-psychotic medications on oral health and the role of dentists toward people with mental illnesses. PubMed, Scopus, and Google Scholar were searched using the following keywords: special care dentistry, schizophrenia, OCD, bipolar disorder, and dementia. The main inclusion criteria were any studies describing "dental management of patients with mental illnesses" and "dental management of patients treated with anti-psychotic medications." Thematic analysis was used to summarize the findings of the included studies into main headings. Forty-eight articles/studies discussed dentistry, people with mental illnesses, and/or the negative impacts of psychotic medication on oral health. All studies were published between 1991 and 2021. In SA, the number of people with mental illnesses is increasing. Therefore, it is crucial for the dental team to understand the negative impacts of anti-psychotic medications on oral health, such as dry mouth and the increased risk of dental caries. This necessitates the need for regular dental visits and patient education on how they can mitigate the side effects of anti-psychotic medications on oral and general health.

Fourth year intellectual disability student nurses' journey and future work intention: a qualitative study

BACKGROUND

The aim of this qualitative study is to explore the views and experiences of final year BSc intellectual disability nursing students' journey, future work plans and examine factors influencing their migration intentions following graduation.

METHODS

A qualitative component of a mixed methods study where a focus group interview was conducted with final year BSc intellectual disability nursing students (n = 10) from one University in Ireland in June 2019. A topic guide was utilised, and participant's were interviewed about their programme, future work plans and migration intentions. An inductive approach was utilised, and data were analysed using a pre-existing framework for initial coding and thematic development. Duffy's conceptual model of identity transformation provided a structure to analyse the data and map themes onto the conceptual framework.

RESULTS

The findings were mapped onto the five stages of Duffy's (2013) conceptual model of identity transformation: Pre-Entry; Reaffirming; Surmounting; Stabilising and Actualising. Findings indicate that further work is required to promote intellectual disability nursing and address professional esteem issues, support for education and professional development, such as providing career guidance opportunities prior to course completion, development of clinical skills within their education programme and support for the professional development of new graduates. Participant's identified uncertainty about career opportunities and saw scope for future professional development opportunities particularly in community-based work.

CONCLUSION

This study has identified that final year intellectual disability nursing students are uncertain about career options and opportunities for intellectual disability nurses in other country's. There is an urgent need for the intellectual disability nursing profession to articulate their practice and advocate for their role and contribution to the care of people with intellectual disability. This study identified a clear need for direction and information regarding intellectual disability nursing roles and career opportunities.

Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

OBJECTIVES

People with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.

DESIGN

Scoping review.

SETTING

Acute care settings.

METHODS

Five databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.

RESULTS

Of the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.

CONCLUSIONS

The scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.

What activities individuals with intellectual disabilities do for fun: exploration into self-care

Participation in enjoyable activities is instrumental to improving individuals' quality of life. Previous studies have indicated engagement in community-based activities and physical exercise are beneficial to individuals with intellectual disabilities (ID). The purpose of this study was to understand, from their perceptions, fun activities in which individuals with ID engaged. One hundred and sixty-nine participants with ID provided 561 responses, which described what they do for fun. A multidisciplinary research team utilized a Consensual Qualitative Research (CQR) approach to differentiate responses into a list of categories that fit into six central domains. Domains (with frequency of responses) included: Community and Relationship Building Activities (130), Sports and Other Physical Activities (123), Technology and Gaming (105), Music and Other Preforming Arts (69), Mentally-Stimulating Activities (51), and Categories Outside of a Domain (82). These findings indicate that individuals with ID have a variety of interests. Our discussion, which reviews literature on individuals with and without ID, suggests similar leisure activity engagement among both groups. This literature also suggests individuals with ID experience similar benefits to their peers without ID when engaging in leisure activities. Our results provide a framework to explore self-care routines that can improve quality of life for individuals with ID.

Unmet Need for Medical Care: The Role of Mental Health Status

Mental health status is an important factor to consider when exploring correlates of unmet need for medical care and prescription drugs. This paper explores whether self-rated mental health status is associated with unmet need and delays in obtaining medical care and prescription drugs. Descriptive statistics and multivariable logistic regression with 27,305 non-institutionalized adults aged 18 and older from the 2012 Medical Expenditure Panel Survey explore factors associated with self-reported unmet need for medical care and prescriptions, as well as access delays. Patients with lower physical and mental health status had the highest odds of experiencing unmet need for medical care and prescriptions, as well as access delays. These findings highlight the importance of increasing access to a usual source of care among individuals with lower self-rated mental health status as a strategy for addressing unmet need.

Supporting Efforts by Intellectually Disabled Adults to Exit Homelessness: Key Ingredients of a Cross-Sector Partnership

This column describes the development of a partnership between health care, housing, and intellectual disability services to support efforts by homeless adults with intellectual disabilities to exit homelessness. Applying a Housing First approach and philosophy, the partners launched a pilot intervention, which at its first phase engaged 26 homeless adults with intellectual disabilities in Toronto. This cross-sector service model was acceptable to service users, who reported positive experiences and good program engagement. Key enablers of success included the program's capacity to address complexity, stakeholders' approach to choice and compromise, and fulsome collaboration and communication at every level.

Community mobility plans for individuals with developmental disabilities: A feasibility study

Introduction

Individuals with intellectual and/or developmental disabilities have unmet transportation needs, which limits their community mobility. Access to transportation is linked to community participation and independence in adult outcomes. The purpose of this study is to examine the implementation feasibility of individualized community mobility plans.

Methods

A pre-test post-test one group design was used to determine if methodology and implementation procedures were feasible. Outcome measures were evaluated to determine if appropriate for future effectiveness research. Participants were six adults with intellectual and/or developmental disabilities who received the community mobility plans intervention over a period of 3–8 sessions. Community mobility plans use a cyclical process where the individual first develops self-determined community mobility goals, followed by a comprehensive assessment process, and individualized environmental and person-centered travel interventions.

Results

Participants demonstrated significant improvement between pre- and post-test scores on the measures of the Progressive Evaluation of Travel Skills ( t(5) = –4.481, p = .007) and Goal Attainment Scaling ( t(5) = –7.457, p =.001).

Conclusion

Community mobility plans may provide a feasible option to improve community mobility for individuals with intellectual and/or developmental disabilities, although further research is needed to determine effectiveness.

Multi-stakeholder perspectives on perceived wellness of Special Olympics athletes

BACKGROUND

Research to date with children and youth with intellectual and developmental disabilities (IDD) has previously focused upon specific aspects of health (e.g., physical activity, nutrition). A broader focus on 'wellness' takes a positive approach to health by addressing how individuals can lead meaningful lives by focusing on their unique strengths and resources across multiple wellness dimensions, rather than focusing on deficits.

OBJECTIVE

This study, conducted in partnership with Special Olympics (SO), aimed to understand the state of perceived wellness and wellness-promoting behaviours of children and youth with IDD from multi-stakeholder perspectives (i.e., SO athletes, caregivers, and coaches).

METHODS

A cross-sectional Likert survey methodology was employed to generate data on the perceptions of multiple stakeholders on different wellness dimensions identified through a literature review and consultations with SO stakeholders.

RESULTS

Athletes, caregivers and coaches generally agreed rather than disagreed with wellness statements, with the exception of coaches' responses regarding healthy nutrition. Athletes agreed more than caregivers and coaches that they engaged in some wellness promoting behaviours (i.e., calming oneself down, participating in their communities). Athletes and coaches were more likely to agree than caregivers about athletes' positive outlook.

CONCLUSION

Athletes' perceptions of their own wellness are unique from those of caregivers and coaches. Focusing on wellness can broaden understandings of how to support young people with IDD by drawing on their strengths and resources to foster optimal health and a sense of wellness in ways that are meaningful and relevant to them.

E-Health Interventions for Adult and Aging Population With Intellectual Disability: A Review

To answer the question about which e-health and e-therapy applications are being used with people with intellectual disabilities, we searched the PsycINFO, Medline, PubMed, ERIC, CINAHL, Scopus, Web of Science, and Cochrane databases. This is an extensive search. Inclusion criteria were academic journals and any design type that addressed the topic of interest. Studies that do not include adults or elderly, and studies that do not focus on people with disabilities but on third parties, were excluded. After an initial selection of 515 articles, 32 full-text articles were subjected to in-depth analysis leading to the final selection of 18 articles. We used the AAID framework definition of intellectual disability to analyze the dimensions explored by the selected studies and found that the majority of studies focused on the use of technology as supports to instrumental activities of daily life. The ISO classification of assistive products allowed us to identify that many e-health products are aimed at providing psychological or medical treatment. In summary, this review suggests that there is a very small number of studies focusing on the use of technology by older persons with intellectual disabilities. The studies present substantial limitations regarding generalization and replication and pay little attention to the maintenance of cognitive abilities in this population. These aspects, together with premature aging generally associated with many conditions that lead to intellectual disability, underscore the need to pay more attention to and develop e-health interventions for cognitive stimulation for this group.

Health Services Use and Costs for Americans With Intellectual and Developmental Disabilities: A National Analysis

Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed pattern of differences in rates of service use and costs when compared to the general population depending upon personal characteristics, health status, and type of health care service. Prescription medication costs were the primary driver of total health care expenditures for Americans with IDD. The presence of secondary chronic health conditions and poor mental health status were the consistent predictors of high expense users across types of health care. Study results are discussed in terms of implications for more nuanced evaluations of health care costs and need for recurring surveillance of health care for Americans with IDD in the years following passage of the Patient Protection and Affordable Care Act.