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Friedman C, Luxama CM. Mental and Behavioral Health, and Crisis Services for People with Intellectual and Developmental Disabilities in Medicaid Home- and Community-Based Services. J Autism Dev Disord 2024:10.1007/s10803-024-06441-z. [PMID: 38951311 DOI: 10.1007/s10803-024-06441-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/03/2024]
Abstract
People with intellectual and developmental disabilities (IDD) often have higher rates of comorbid mental health conditions compared to the general population. Yet, many people with IDD also have unmet needs for mental and behavioral health services. The aim of this study was to examine how states provided mental and behavior health, and crisis services to people with IDD in their Home- and Community-Based Services (HCBS) programs, the largest funding mechanism for Long-Term Services and Supports (LTSS) for people with IDD in the United States. We analyzed fiscal year (2021) Medicaid HCBS waivers for people with IDD from across the United States to examine if and how they provided mental and behavior health, and crisis services. States projected spending $968.9 million for mental and behavior health, and crisis services for 190,299 people with IDD. Applied behavior analysis services were provided at greater rates than positive behavior supports and other forms of behavior interventions. While most states provided mental and behavior health, and crisis services in their waivers, there were vast inconsistencies in how they did so, across states, waivers, and services. HCBS are a crucial safety net to ensure people with IDD, especially those who also have mental health disabilities, can live and thrive in their communities.
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Affiliation(s)
- Carli Friedman
- The Council on Quality and Leadership (CQL), 100 West Road, Suite 300, Towson, MD, 21204, USA.
| | - Carine M Luxama
- College of Nursing and Health Services, University of Massachusetts at Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
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Mullins LE, Scott V, Cox AD. Training programme for community service providers who support adults with intellectual disabilities: A systematic quantitative literature review of single-case research. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1191-1205. [PMID: 37632395 DOI: 10.1111/jar.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Research on training direct support professionals to address challenging behaviour exhibited by adults with intellectual disabilities is essential in generating effective training approaches for this sector. This systematic review's objective was to evaluate the effects of training types and whether specific training delivery components influenced outcomes. METHODS Following PRISMA (2020) guidelines, 16 single-case design studies were included that directly evaluated behaviour change of service providers training for adults with intellectual disabilities in community settings. Study quality was assessed using Horner et al. (Exceptional Children, 2005, 71(2), 165-180) criteria. The database searched included Academic Search Complete, CINAHL, Embase, ERIC, Psych Info, and Web of Science. RESULTS Descriptive analysis of effect size outcomes suggested that all training types were associated with improved outcomes. Further, in situ training was associated with improved service provider performance. Interestingly, feedback was associated with poorer service provider performance. CONCLUSIONS We provide possible explanations for this surprising outcome and propose future research.
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Affiliation(s)
- Laura E Mullins
- Department of Applied Disability Studies, Brock University, Saint Catharines, Canada
| | - Victoria Scott
- Department of Applied Disability Studies, Brock University, Saint Catharines, Canada
| | - Alison D Cox
- Department of Applied Disability Studies, Brock University, Saint Catharines, Canada
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Kersten M, Wilson NJ, Pracilio A, Howie V, Trollor J, Buckley T, Morphet J, Bryce J, Griffin K, Cashin A. A scoping review to inform an auditing framework evaluating healthcare environments for inclusion of people with intellectual disability and/or autism. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231174282. [PMID: 37217215 DOI: 10.1177/17446295231174282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
People with intellectual disability and/or autism are likely to be in hospital more often, for longer, and have poorer health outcomes. Few audit tools exist to identify their barriers in mainstream healthcare environments. This study aimed to identify evidence of audit characteristics of healthcare contexts specifically for people with intellectual disability and/or autism, for conceptual development of an auditing framework. A scoping review of evaluations of healthcare environments was completed in January 2023. Findings were presented using the PAGER framework. Of the sixteen studies identified, most originated in the UK, nine focused on intellectual disability, four on autism, and three were concerned with mixed diagnosis. Six domains for auditing healthcare environments were identified: care imperatives, communication to individuals, understanding communication from individuals, providing supportive environments of care, supporting positive behaviour, and actions to make things go well. Further research is recommended to refine an audit framework.
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Affiliation(s)
- Michelle Kersten
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Nathan John Wilson
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
| | - Amy Pracilio
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Virginia Howie
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, UNSW Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Thomas Buckley
- Susan Wakil Building, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Peninsula Campus, Frankston, VIC, 3199, Australia
| | - Julianne Bryce
- Australian Nursing and Midwifery Federation, Federal Office, Melbourne, VIC, 3000, Australia
| | - Ken Griffin
- Australian Primary Health Care Nurses Association, Melbourne, VIC, 3000, Australia
| | - Andrew Cashin
- Faculty of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
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Musa S, Dergaa I. A Narrative Review on Prevention and Early Intervention of Challenging Behaviors in Children with a Special Emphasis on COVID-19 Times. Psychol Res Behav Manag 2022; 15:1559-1571. [PMID: 35769177 PMCID: PMC9234312 DOI: 10.2147/prbm.s354428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background COVID-19 and the measures stemming from efforts to control it have affected the psychosocial wellbeing of children and adolescents. The increasing trend of challenging behavior has exerted further pressure on parents and schools. Understanding socioemotional development and interrelating triggers is the key to management. Early interventions prevent the future threat of mental illness and risky acts. Effective strategies are ones that primarily focus on strengthening parent-child interactions. Aim The purpose of this paper is to review the literature on the (i) psychosocial and behavioral impacts of COVID-19 on children/adolescents and (ii) approaches to identify determinants of challenging behaviors as a principal guide to effective interventional strategies for children and their families. Methodology Electronic database searches of PubMed, ScienceDirect, Medline, and Scopus were conducted to identify studies meeting the inclusion criteria that address the impact of COVID-19 on behaviors, contributing factors, and management in the context of families/schools. The content of the selected articles was themed under five categories, namely the developmental milestones, the Pyramid Model, the Positive Behavioral Support, the management strategies, and the impact of COVID-19 on children/adolescents' behavior. Results The present review demonstrates considerable influence of COVID-19 on children and adolescents' behavior and mental wellbeing. It stresses the importance of early family-based interventions focusing on the triggers of challenging behavior. Functional Behavioral Assessment and Behavioral Intervention Plan provide a systematic analysis with a strategic plan that support children's self-regulation and socioemotional intelligence. Regular behavioral screening is vital to promote prevention and early management. Conclusion Managing behavioral difficulties remains an area of deficit for parents, teachers, and health care providers. With a quality support, parents and schools will be able to clearly characterize the challenging behavior, understand the causes, reinforce parent-child interactions, and consequently, gain the strategic skills required to apply it within natural settings. Timely interventions will limit the risk of future misconduct and mental disorders.
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Affiliation(s)
- Sarah Musa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
| | - Ismail Dergaa
- Department of Preventative Health, Primary Health Care Corporation, Doha, Qatar
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Salgado-Cacho JM, Moreno-Jiménez MDP, Ríos-Rodríguez ML. Intensive Family Intervention as Support for Professional Treatment: Evolution of Symptoms in a Diagnosed Case of Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:400. [PMID: 35327776 PMCID: PMC8946976 DOI: 10.3390/children9030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
This article shows the progress achieved in a child who has received professional treatment combined with a family intervention at home. It discusses a 22-month-old patient identified as showing warning signs of autism spectrum disorder (ASD), a diagnosis that was subsequently confirmed through a standardized ADOS-2 test at 31 months of age. To establish the initial working objectives, a functional diagnosis was carried out at 23 months of age using the Battelle Developmental Inventory; a maturational delay was detected, situating the child at an age equivalent to 16 months. A professional intervention was designed in an early childhood care center, complemented by family intervention, so that the hours in which the child participated in learning experiences were increased. Notable advances were made in the areas of cognitive and motor skills, with more standard scores than when initially evaluated. Progress was also observed (though to a lesser extent) in other developmental areas such as language total, adaptive behavior, and self-help, while slight delays in the areas of socio-emotional development and reasoning and academic skills were found.
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Affiliation(s)
- José María Salgado-Cacho
- Faculty of Psychology, University of Málaga, 29010 Málaga, Spain; (M.d.P.M.-J.); (M.L.R.-R.)
- Hogar Abierto Foundation, 29001 Málaga, Spain
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Bosco A, Paulauskaite L, Hall I, Crabtree J, Soni S, Biswas A, Cooper V, Poppe M, King M, Strydom A, Crawford MJ, Hassiotis A. Process evaluation of a randomised controlled trial of PBS-based staff training for challenging behaviour in adults with intellectual disability. PLoS One 2019; 14:e0221507. [PMID: 31437228 PMCID: PMC6705827 DOI: 10.1371/journal.pone.0221507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes. AIMS To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability. METHOD The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used. RESULTS Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS. CONCLUSIONS PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care.
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Affiliation(s)
- Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Laura Paulauskaite
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ian Hall
- Community Learning Disability Service, Mile End Hospital, East London NHS Foundation Trust, London, United Kingdom
| | - Jason Crabtree
- Community Learning Disability Service, Mile End Hospital, East London NHS Foundation Trust, London, United Kingdom
| | - Sujata Soni
- Community Learning Disability Service, Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Asit Biswas
- Leicestershire Partnership NHS Trust & University of Leicester, Leicester, United Kingdom
| | - Vivien Cooper
- Challenging Behaviour Foundation, the Old Courthouse, Chatham, Kent, United Kingdom
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, United Kingdom
| | - Michael King
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
- Community Learning Disability Service, Camden and Islington NHS Foundation Trust, London, United Kingdom
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Friedman C, Crabb C. Restraint, Restrictive Intervention, and Seclusion of People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 56:171-187. [PMID: 29782229 DOI: 10.1352/1934-9556-56.3.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Restraint, restrictive interventions, and seclusion are hotly contested practices with inconclusive evidence of their effectiveness. Because the use of restraint and seclusion on people with intellectual and developmental disabilities (IDD) is controversial and its effectiveness doubtable, this study was conducted to explore if and how they were permitted in Medicaid HCBS 1915(c) waivers, the largest providers of long-term services and supports (LTSS) for people with IDD. To do so, 111 fiscal year 2015 IDD waivers from across the nation were examined to determine if and how states permitted restraint, restrictive interventions, and seclusion. Findings revealed an overwhelming majority of waivers permitted the use of restraint (78.4%) and restrictive interventions (75.7%). A smaller proportion (24.3%) allowed the use of seclusion.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, The Council on Quality and Leadership; and Caitlin Crabb, Department of Disability and Human Development, University of Illinois at Chicago
| | - Caitlin Crabb
- Carli Friedman, The Council on Quality and Leadership; and Caitlin Crabb, Department of Disability and Human Development, University of Illinois at Chicago
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