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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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2
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Prins P, Nijhof K. Prolonged exposure treatment for post-traumatic stress disorder: Single case studies in a sample of adults with mild intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13237. [PMID: 38616413 DOI: 10.1111/jar.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 01/09/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is common in adults with intellectual disabilities. Often there are additional disorders such as substance use, mood and anxiety disorders. The current study focuses on the feasibility and initial efficacy of prolonged exposure (PE) for PTSD in adults with mild intellectual disabilities. The secondary effect of PE on additional mood, anxiety and substance use disorders is also examined. METHODS A single case experimental design (N = 12) with an A (baseline)-B (intervention) phase including a follow-up measurement after 3 months was conducted. Time series and single time points measurements were performed. RESULTS Six participants dropped-out. The results showed a significant decrease in PTSD symptoms and a significant decrease in additional symptoms (social avoidance, anxiety and stress), among participants who completed treatment. CONCLUSION PE appears to be a feasible and effective treatment for PTSD in some adults with mild intellectual disabilities. Suggestions emerge from this study to make standard PE treatment more appropriate for adults with mild intellectual disabilities. Further research is needed to reduce drop-out in trauma treatment. Some suggestions for this are made in this study. Treatment of PTSD with PE did not appear to affect comorbid mood disorders. Further research is needed.
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Affiliation(s)
- Paul Prins
- Stevig, Nijmegen, The Netherlands
- Pluryn, Nijmegen, The Netherlands
| | - Karin Nijhof
- Pluryn, Nijmegen, The Netherlands
- Behavioral Science Institute Radboud University, Nijmegen, The Netherlands
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Westmore MR, Huang H. The Moderation Effect of Disability Status on the Associations Among ACEs, Mental Health, and Binge Drinking. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:412-430. [PMID: 38225878 DOI: 10.1080/26408066.2024.2303005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE Mental health and substance use social workers must be prepared to work with people with disabilities, as this population has higher rates of adverse childhood experiences (ACEs), and ACEs can lead to mental health and substance use problems. The study's purpose is to assess the moderating effect of disability on the interrelationships among ACEs, mental health, and binge drinking. MATERIALS AND METHODS Using data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) survey, we first used multigroup confirmatory factor analysis to establish the underlying factor structure of the ACEs questionnaire for respondents with and without disabilities. Next, we used multigroup structural equation modeling to assess the mediating effect of mental health difficulties on the association between ACEs and binge drinking for respondents with and without disabilities. RESULTS A three-factor measurement model (emotional or physical abuse, sexual abuse, and household dysfunction) demonstrated excellent model fits. Mental health difficulties significantly mediated the association between ACEs and binge drinking for all respondents. Disability status was a statistically significant moderator of a few associations, with more mental health variance explained by ACEs for the disabled respondents. Direct paths showed household dysfunction and sexual abuse had greater impacts on mental health for disabled respondents, and indirect paths showed these factors also had greater impacts on binge drinking among disabled respondents. DISCUSSION AND CONCLUSION To prevent mental health and binge drinking problems among disabled individuals, we need evidence-based interventions to identify their ACEs and provide accessible, trauma-informed treatments to them.
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Affiliation(s)
- Megan R Westmore
- School of Social Work, University of Texas at Arlington, Arlington, USA
| | - Hui Huang
- School of Social Work, University of Texas at Arlington, Arlington, USA
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Gouzman J, Soskolne V, Dekel R. COVID-19 pandemic among adults with intellectual disabilities: Implementing a social model of disability in crisis and trauma situations. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2024; 28:275-284. [PMID: 37584359 DOI: 10.1177/17446295231196207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
A growing body of evidence has attested to the higher impact of COVID-19 on individuals with intellectual disabilities (IDs) than on members of the general population during the pandemic, mainly showing their higher vulnerability. However, we believe it is important to better understand how their situation interacts with the specific circumstances of the pandemic. In this article we discuss recent findings regarding individuals with IDs through the lens of two theories - the social disability model and the ecological model of trauma and recovery - and propose an integration, namely a social model of disability in crisis and trauma situations. Such a model allows for a wider perspective on understanding the way people living with disabilities (PLWDs) cope in these situations, integrating the individual aspects of coping with the social and environmental ones.
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Affiliation(s)
- Julia Gouzman
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv-Yafo, Israel; Social Work Department, Assuta Medical Centers, Tel Aviv, Israel
| | - Varda Soskolne
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| | - Rachel Dekel
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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McKillop E, Spencer A, Marrington C. Clinicians' experiences of learning to use eye movement desensitisation and reprocessing therapy with people with intellectual disabilities: A qualitative study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13206. [PMID: 38332432 DOI: 10.1111/jar.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 11/29/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Eye Movement Desensitisation and Reprocessing therapy (EMDR) is a NICE recommended treatment for post-traumatic stress disorder within the general population. Ongoing research is now investigating the use of EMDR for individuals with intellectual disability. Alongside quantitative research efforts, it is beneficial to explore the qualitative experience of clinicians adopting EMDR in their practice. The current study interviewed newly trained EMDR therapists working in intellectual disability services. METHOD Participants (six Clinical Psychologists from an NHS learning disability service) had recently undertaken EMDR training as part of a wider randomised control trial (Trauma-AID). Interviews were qualitatively analysed using thematic analysis. RESULTS Three themes emerged; learning EMDR, conducting EMDR and external factors, with respect to clinicians' experiences. CONCLUSIONS Further research is needed to provide guidance and reassurance for clinicians currently using or hoping to use this therapy with people with intellectual disabilities.
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Affiliation(s)
- Eleanor McKillop
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Alison Spencer
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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Mayer B, Elbing U, Ostermann T. Trauma treatment using Narrative Exposure Therapy adapted to persons with intellectual disabilities or severe chronic mental disorders - a randomised controlled pilot study with an embedded observational study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1096-1112. [PMID: 37582663 DOI: 10.1111/jir.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Despite an increased likelihood of experiencing traumatic events and increased vulnerability, there are only few publications on trauma therapy for persons with intellectual disabilities (IDs). This pilot study for the first time investigates the feasibility and effectiveness of Narrative Exposure Therapy (NET) within this target group modified by Plain Language. METHODS A group of n = 10 participants with ID dual diagnoses and another group of n = 5 participants with severe and chronic mental disorders were separately stratified and randomised, then forming together an intervention group (n = 7) and a waiting list control group (n = 8). All participants were treated with NET attuned to their communication abilities by using Plain Language. Primary outcome was the post-traumatic stress measured with the Post-Traumatic Symptom Scale-10 before and after the intervention. In addition, the Adverse Childhood Experience Index was used for diagnostic purposes. Data were analysed using t-test for repeated measures and analysis of covariance. RESULTS Narrative Exposure Therapy and the randomised controlled trial study proved to be successfully conductible with participants with IDs in a congregated residential service. Although the corresponding effect size was high (partial eta square = 0.188), the between-group difference was not significant (P = 0.12). Analysis of the observational study resulted in a highly significant improvement for participants with IDs (P < 0.001; Hedges' g = 2.36) and in a significant improvement in participants with severe and chronic mental disorders (P < 0.013; Hedges' g = 1.52). Additionally, the participants with IDs show a significantly better reduction of symptom burden (P = 0.03; partial eta square = 0.327). CONCLUSIONS The results provide a first evidence for a possible and successful implementation of NET modified in Plain Language for persons with IDs and complex mental health support needs. Completeness in responding to the items of Post-Traumatic Symptom Scale-10 and Adverse Childhood Experience Index indicates the suitability of these instruments for both groups of participants. Although the group difference in the randomised controlled trial failed to achieve statistical significance mainly due to the small sample size, the results of the embedded observational study are promising for the conduct of further studies with the modified NET.
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Affiliation(s)
- B Mayer
- Residence Tilia Rheinau, Rheinau, Switzerland
| | - U Elbing
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - T Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
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Sappok T, Bayer M, Helmes A, Gabriel A, Wagner J, Styp von Rekowski A, Tergeist M. [Psychotherapy in disorders of intellectual development-Current evidence and practical implementation]. DER NERVENARZT 2023; 94:446-455. [PMID: 37129621 DOI: 10.1007/s00115-023-01472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/03/2023]
Abstract
People with a disorder of intellectual development (German draft of the ICD-11, which came into force on 1 January 2022) suffer more frequently from mental illnesses. According to the international treatment guidelines multimodal approaches should include not only psychopharmacological treatment, but also disorder-specific psychotherapeutic methods. These psychotherapeutic interventions have to be adapted to the communicative and cognitive abilities (performance diagnostics with IQ tests) as well as the emotional developmental stage (developmental diagnostics, e.g., with the scale of emotional development, short version, SED-S 2; [1]). To ensure this, the rules of simple language should be observed and when appropriate relatives or caregivers should be involved in the therapeutic process. The effectiveness of cognitive behavioral therapy has received most scientific attention, especially for affective disorders. Posttraumatic stress disorders can be validly treated with eye movement desensitization and reprocessing (EMDR). There is also good evidence for exposure therapy with reinforcement in the treatment of anxiety disorders.
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Affiliation(s)
- Tanja Sappok
- Medizin für Menschen mit Behinderungen, Medizinische Fakultät, Universität Bielefeld, Bielefeld, Deutschland.
- Universitätsklinik für Inklusive Medizin, Krankenhaus Mara gGmbH, Universitätsklinikum OWL der Universität Bielefeld, Campus Bielefeld-Bethel, Maraweg 21, 33617, Bielefeld, Deutschland.
| | - Mareike Bayer
- Klinische Psychologie Sozialer Interaktion, Institut für Psychologie, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Almut Helmes
- Arbeitsgruppe Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, Freiburg, Deutschland
| | - Anika Gabriel
- Arbeitsgruppe Rehabilitationspsychologie und Psychotherapie, Institut für Psychologie, Universität Freiburg, Freiburg, Deutschland
| | - Jessica Wagner
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Deutschland
- MindDoc Berlin, Berlin, Deutschland
| | | | - Marlene Tergeist
- Behandlungszentrum für psychische Gesundheit bei Entwicklungsstörungen, Ev. Krankenhaus Königin Elisabeth Herzberge, Berlin, Deutschland
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Baumunk MJ, Tang X, Rumrill SP, Conder S, Rumrill PD. Post-traumatic growth and trauma-informed care in vocational rehabilitation through the lens of the conservation of resources theory. Work 2023; 75:3-10. [PMID: 37092208 DOI: 10.3233/wor-236014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Trauma has high prevalent rates in populations of people with disabilities, and the effects of traumatic experiences can negatively impact employment. OBJECTIVE The purpose of this article is to review the existing literature regarding post-traumatic growth (PTG), trauma informed care (TIC), and the conservation of resources (COR) theory. METHOD We begin with an overview of PTG, TIC, and trauma in relation to disability and employment. Then, we review the personal, condition, object, and energy resources within the COR theory. RESULTS The remainder of the article focuses on applying PTG and TIC in State-Federal VR programs with a theoretical framework defined by COR. We conceptualize the application in four major VR phases: (a) eligibility determination, (b) rehabilitation plan development, (c) service provision, and (d) job placement. CONCLUSION By implementing TIC and considering the consumer's resources, VR counselors can help emphasize PTG throughout the process and prioritize PTG as the ultimate goal. The authors provide brief and preliminary implementation recommendations for VR counselors.
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Affiliation(s)
| | - Xiaolei Tang
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | - Sandy Conder
- Human Development Institute, University of Kentucky, Lexington, KY, USA
| | - Phillip D Rumrill
- Human Development Institute, University of Kentucky, Lexington, KY, USA
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Unwin G, Stenfert‐Kroese B, Rogers G, Swain S, Hiles S, Clifford C, Farrell D, Willner P. Some observations on remote delivery of eye‐movement desensitisation and reprocessing to people with intellectual disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2023. [DOI: 10.1111/jppi.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Gemma Unwin
- School of Psychology University of Birmingham Birmingham UK
| | | | - Gemma Rogers
- Kent and Medway NHS and Social Care Partnership Trust Kent UK
| | - Sophie Swain
- Midlands Partnership NHS Foundation Trust, The Redwoods Centre Shrewsbury UK
| | - Steve Hiles
- Swansea Trials Unit, Clinical Research Facility Institute of Life Science, Swansea University Swansea UK
| | | | | | - Paul Willner
- Department of Psychology Swansea University Swansea UK
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Moonen X, Festen D, Bakker-van Gijsel E, Vervoort-Schel J. A Dutch Perspective on Two Health Related Issues Regarding Children and Adolescents with Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11698. [PMID: 36141966 PMCID: PMC9517279 DOI: 10.3390/ijerph191811698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.
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Affiliation(s)
- Xavier Moonen
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
| | - Dederieke Festen
- Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Jessica Vervoort-Schel
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
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