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McLean KJ, Bishop L. Chronic Health Conditions Among Adults With Intellectual and Developmental Disabilities in a State Medicaid System. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:331-345. [PMID: 39197849 DOI: 10.1352/1944-7558-129.5.331] [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: 08/03/2023] [Accepted: 03/12/2024] [Indexed: 09/01/2024]
Abstract
Despite a growing number of adults with intellectual and developmental disabilities (IDD) and documented risk for adverse outcomes as they age, little is known about the health and healthcare patterns of adults with different IDD throughout adulthood. This study uses Wisconsin Medicaid claims data to characterize health conditions among adults with IDD. Results indicate high prevalence of asthma, diabetes, heart disease, and hypertension. Heart disease rates were particularly high, having been observed among 39% of autistic adults, 64% of autistic adults with intellectual disability (ID), 67% of adults with Down syndrome, and 75% of adults with ID only. Given there are no known biological differences underlying increased morbidities among most people with IDD, developing inclusive prevention measures should be prioritized in future research.
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Affiliation(s)
- Kiley J McLean
- Kiley J. McLean, A.J. Drexel Autism Institute, Drexel University; and Lauren Bishop, Sandra Rosenbaum School of Social Work and Waisman Center, University of Wisconsin-Madison
| | - Lauren Bishop
- Kiley J. McLean, A.J. Drexel Autism Institute, Drexel University; and Lauren Bishop, Sandra Rosenbaum School of Social Work and Waisman Center, University of Wisconsin-Madison
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Nicholson E, Mimmo L, Christophers L, Costa Sa ME, MacKeogh T. Facilitating choice when engaging young people with disabilities: reflections from co-researcher training. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:90. [PMID: 39187898 PMCID: PMC11348645 DOI: 10.1186/s40900-024-00626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/13/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND A collaborative approach is critical in inclusive research and should incorporate taking time to build relationships with co-researchers based on trust and shared understanding. Involvement can often be seen as tokenistic and in order to avoid this, it is important to provide opportunities for people to exercise choice throughout the research process. MAIN BODY The current paper outlines learnings from a co-researcher training process for young people with disabilities to identify the ways in which meaningful choice can be facilitated with this group. While conducting training of co-researchers in topics such as research methods, we were continuously led by the group with regards to the directions that the sessions took and promoted problem solving with the group to accommodate the unique needs of all members. The overall aim of a wider project was to develop research capacity in a group of young people with disabilities through co-researcher training and this paper will report on learnings from this work with regards to how we sought to provide opportunities for the co-researchers to exercise choice within research projects. Feedback from the group of young people highlighted the variety of needs and expectations that must be accommodated in such a process and therefore, allowing them to dictate the extent and manner of their engagement is key. Young people with disabilities are a heterogeneous group and therefore, some methodologies and ways of working required adaptation in order to facilitate meaningful choice and engagement for all. CONCLUSION Providing meaningful opportunities for demonstrating their choices, in relation to elements of research projects, is a critical component of facilitating a rights-based approach when conducting co-research and requires researchers to cede some level of control over the research process to co-researchers. This can be difficult to achieve in practice and researchers must continuously reflect on their own practice and be willing to change and adapt throughout the process.
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Affiliation(s)
- Emma Nicholson
- School of Psychology, Faculty of Health and Science, Dublin City University, Glasnevin Campus, Dublin 9, Ireland.
| | - Laurel Mimmo
- Sydney Children's Hospital Network, High St, Randwick, NSW, 2031, Australia
| | - Lauren Christophers
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Trish MacKeogh
- Central Remedial Clinic, Vernon Ave, Clontarf East, Dublin, D03 R973, Ireland
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Weiss MD, Daniolos PT, Coughlin K, Mulvaney-Day N, Cook B, Rosenblum D. A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth. J Child Adolesc Psychopharmacol 2024. [PMID: 38957953 DOI: 10.1089/cap.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.
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Affiliation(s)
- Margaret Danielle Weiss
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Peter T Daniolos
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Kevin Coughlin
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Benjamin Cook
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Debra Rosenblum
- Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population Level Mental Health Diagnoses for Youth with Intellectual/Developmental Disabilities Compared to Youth without Intellectual/Developmental Disabilities. Res Child Adolesc Psychopathol 2024; 52:1147-1156. [PMID: 38329685 DOI: 10.1007/s10802-024-01174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
There is evidence in the literature that youth with intellectual/developmental disabilities (IDD) experience mental health issues to a greater extent compared to youth without IDD. In addition, transition from pediatric to adult services may be a period of increased anxiety and mental health problems for these youth. This study used a retrospective cohort design using population level administrative health data to compare mental health diagnoses between youth with IDD and youth without IDD; particularly examining the period when youth transition from pediatric health services to adult health services. In addition, this study compared the mental health of youth with various types of IDD (Down syndrome, autism, fetal alcohol syndrome and other rarer diagnoses). Results showed that at the population level youth with IDD have greater odds of anxiety/depression or psychotic illness than youth without IDD. Adjusted odds of anxiety/depression or psychotic illness also varied with age, income level, sex, and type of IDD. Youth with fetal alcohol syndrome had the greatest odds of both anxiety/depression and a psychotic illness. Odds of anxiety/depression increased from age 15-19 years old. Odds of a psychotic illness increased from age 15 to age 24 years old.
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Affiliation(s)
- Sandra Marquis
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ON, M6J 1H4, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Davis A, Copeland-Linder N, Phuong K, Belcher H, van Eck K. Hospitalisation and mortality among privately insured individuals with COVID-19 in the United States: The role of intellectual disabilities and Neurogenetic disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:573-584. [PMID: 38369907 DOI: 10.1111/jir.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) and neurogenetic conditions (IDNDs) are at greater risk for comorbidities that may increase adverse outcomes for this population when they have coronavirus disease 2019 (COVID-19). The study aims are to examine the population-level odds of hospitalisation and mortality of privately insured individuals with COVID-19 with and without IDNDs IDs, controlling for sociodemographics and comorbid health conditions. METHODS This is a retrospective, cross-sectional study of 1174 individuals with IDs and neurogenetic conditions within a population of 752 237 de-identified, privately insured, US patients diagnosed with COVID-19 between February 2020 and September 2020. Odds of hospitalisation and mortality among COVID-19 patients with IDNDs adjusted for demographic characteristics, Health Resources and Services Administration region, states with Affordable Care Act and number of comorbid health conditions were analysed. RESULTS Patients with IDNDs overall had higher rates of COVID-19 hospitalisation than those without IDNDs (35.01% vs. 12.65%, P < .0001) and had higher rates of COVID-19 mortality than those without IDNDs (4.94% vs. .88%, P < .0001). Adjusting for sociodemographic factors only, the odds of being hospitalised for COVID-19 associated with IDNDs was 4.05 [95% confidence interval (CI) 3.56-4.61]. Adjusting for sociodemographic factors and comorbidity count, the odds of hospitalisation for COVID-19 associated with IDNDs was 1.42 (95% CI 1.25-1.61). The odds of mortality from COVID-19 for individuals with IDNDs adjusted for sociodemographic factors only was 4.65 (95% CI 3.47-6.24). The odds of mortality from COVID-19 for patients with IDNDs adjusted for sociodemographic factors and comorbidity count was 2.70 (95% CI 2.03-3.60). A major finding of the study was that even when considering the different demographic structure and generally higher disease burden of patients with IDNDs, having a IDND was an independent risk factor for increased hospitalisation and mortality compared with patients without IDNDs. CONCLUSIONS Individuals with IDNDs had significantly higher odds of hospitalisation and mortality after adjusting for sociodemographics. Results remained significant with a slight attenuation after adjusting for sociodemographics and comorbidities. Adjustments for comorbidity count demonstrated a dose-response increase in odds of both hospitalisation and mortality, illustrating the cumulative effect of health concerns on COVID-19 outcomes. Together, findings highlight that individuals with IDNDs experience vulnerability for negative COVID-19 health outcomes with implications for access to comprehensive healthcare.
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Affiliation(s)
- A Davis
- Disability Health Research Center, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - N Copeland-Linder
- Psychology Department, Notre Dame of Maryland University, Baltimore, MD, USA
| | - K Phuong
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - H Belcher
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA
| | - K van Eck
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Karimi M, Dhopeshwarkar R, Jiménez F, Ryan S, Plourde E. Improving Data Infrastructure for Person-Centered Outcomes Research on Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:231-241. [PMID: 38657962 DOI: 10.1352/1944-7558-129.3.231] [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: 05/22/2023] [Accepted: 11/28/2023] [Indexed: 04/26/2024]
Abstract
Individuals with intellectual and developmental disabilities (IDD) continue to experience disparities in health and well-being despite improved provisions of person-centered care. Patient-centered outcomes research (PCOR) translates evidence into practice for meaningful outcomes. This piece describes findings from an environmental scan and stakeholder outreach to identify and prioritize opportunities to enhance IDD PCOR data infrastructure. These opportunities include developing a standardized research definition; advancing data standards for service systems; improving capture of IDD at point of care; developing standardized outcome measures; and encouraging Medicaid data use for IDD research. Within this piece, we discuss the implications of addressing data gaps for enhanced research. While the identified activities provide a path towards advancing IDD PCOR data infrastructure, collaborative efforts between government, researchers, and others are paramount.
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Affiliation(s)
- Madjid Karimi
- Madjid Karimi, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
| | - Rina Dhopeshwarkar
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Frances Jiménez
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Sofia Ryan
- Rina Dhopeshwarkar, Frances Jiménez, and Sofia Ryan, Health Sciences Department, NORC at the University of Chicago
| | - Emma Plourde
- Emma Plourde, Office of Behavioral Health, Disability, and Aging Policy, Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
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Hickey EJ, Caudill A, Laufenberg H, Hrabik L, DaWalt L, Ausderau KK. Quality of life, satisfaction with care, and the experiences of adults with intellectual and developmental disabilities before and during COVID-19. Disabil Health J 2024; 17:101545. [PMID: 37980230 PMCID: PMC10999343 DOI: 10.1016/j.dhjo.2023.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities (IDD) experienced significant disruptions in their access to health care, support services, and essential daily activities such as work, leisure, and routine daily care during COVID-19. OBJECTIVE The purpose of this study was to describe overall experiences related to COVID-19 among adults with IDD, including the vaccination process, quality of life (QoL), and service satisfaction before and during the pandemic. METHODS A longitudinal statewide survey of adults with IDD receiving long-term care support using a combination of self- and care partner report was completed prior to (2017; n = 331) and during (2021; n = 206) the pandemic. RESULTS Qualitative results identified specific vaccine barriers, vaccine decision influencers, and general experiences during COVID-19 for adults with IDD. The importance of support staff, vaccine availability, disruption in daily activities, social context, and mental health implications were noted in responses to all three topics. Quantitative results showed lower QoL during COVID-19 (M = 2.99 vs. 3.14, p = .028); however, when reporter (self vs. care partner) and age were added to the model, differences between pre-vs. during-COVID were no longer significant. No significant differences in satisfaction of services were noted pre-vs. during-COVID-19. Ninety-six percent of respondents reported access to the vaccine, and 16 % experienced barriers getting the vaccine. QoL was associated with receiving the COVID-19 vaccine (r = 0.15, p = .036), level of agreement that the vaccine is safe (r = 0.17, p = .024), and level of agreement that getting the vaccine will help protect other vulnerable people in the community (r = .25, p = .001). Level of satisfaction with quality of services was also associated with level of agreement that the vaccine is safe (r = 0.15, p = .048). CONCLUSIONS Overall, a better understanding of service continuation, support practices, and experiences related to COVID-19 will prepare us for future environmental and health crises by identifying areas for improvement, intervention, and policy change to meet the ongoing needs of adults with IDD.
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Affiliation(s)
- Emily J Hickey
- Waisman Center, University of Wisconsin-Madison, University of Wisconsin-Madison, Madison, WI, USA.
| | - Allison Caudill
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Hannah Laufenberg
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Lynn Hrabik
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Leann DaWalt
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Karla K Ausderau
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA; Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
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Calatayud E, Oliván-Blázquez B, Sánchez Peña M, Aguilar-Latorre A, Tena-Bernal O. Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study. Exp Gerontol 2024; 185:112352. [PMID: 38128849 DOI: 10.1016/j.exger.2023.112352] [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: 03/30/2023] [Revised: 10/19/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training. AIMS This study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model. METHODS AND PROCEDURES 247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution. OUTCOMES AND RESULTS Both populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement. CONCLUSIONS AND IMPLICATIONS This study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.
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Affiliation(s)
- Estela Calatayud
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; Institute for Health Research Aragón (IIS Aragón), building CIBA, Avda, San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragón (IIS Aragón), building CIBA, Avda, San Juan Bosco, 13, 50009 Zaragoza, Spain; Department of Psychology and Sociology, Faculty of Social and Labour Sciences, University of Zaragoza, 50009 Zaragoza, Spain
| | - Marta Sánchez Peña
- Aragonese Tutelary Association for Intellectual Disability (ATADES), Sonsoles Residential Centre Termine Miraflores, s / n, 50630 Zaragoza, Spain
| | - Alejandra Aguilar-Latorre
- Institute for Health Research Aragón (IIS Aragón), building CIBA, Avda, San Juan Bosco, 13, 50009 Zaragoza, Spain; Department of Psychology and Sociology, Faculty of Human Sciences and Education of Huesca, University of Zaragoza, 22003 Huesca, Spain.
| | - Olga Tena-Bernal
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain; Aragonese Tutelary Association for Intellectual Disability (ATADES), Santo Ángel Occupational and Residential Centre, C / Ariza n°8, 50012 Zaragoza, Spain
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Speybroeck EL, Petrenko C, Tapparello C, Griffin K, Hargrove E, Himmelreich M, Lutke A, Lutke CJ, May M, Zhang S, Looney J, Kautz-Turnbull C, Rockhold MN. My Health Coach: Community members' perspectives on a mobile health tool for adults with fetal alcohol spectrum disorders. Digit Health 2024; 10:20552076241261458. [PMID: 38882255 PMCID: PMC11179453 DOI: 10.1177/20552076241261458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives Fetal alcohol spectrum disorders (FASD) affect the health and development of people across the lifespan. Adults with FASD experience significant barriers to care. Accessible and scalable solutions are needed. In partnership with members of the International Adult Leadership Collaborative of FASD Changemakers, an international group of adults with FASD, we developed a mobile health (mHealth) application based on self-determination theory (SDT), called "My Health Coach," to promote self-management and health advocacy. Methods This project follows an established user-centered design approach to app development and evaluation, allowing for feedback loops promoting iterative change. Research staff and ALC members co-led online focus groups (n = 26) and an online follow-up survey (n = 26) with adults with FASD to elicit feedback on completed design prototypes. Focus group transcriptions and surveys underwent systemic thematic and theoretical framework analysis. Results Analyses show overall positive impressions of the My Health Coach app. Participants were enthusiastic about the proposed features and tools the app will provide. Discussions and free responses revealed SDT constructs (autonomy, competence, relatedness) are a strong fit with participants' perceived outcomes shared in their evaluation of the prototype. Interesting recommendations were made for additional features that would further promote SDT constructs. Conclusions This project demonstrates advantages of community-engaged partnerships in FASD research. Adults with FASD have a strong interest in scalable mHealth tools and described the acceptability of our initial design. App features and tools promoted SDT constructs.
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Affiliation(s)
- Emily L Speybroeck
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Mt. Hope Family Center, Rochester, NY, USA
| | - Christie Petrenko
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Mt. Hope Family Center, Rochester, NY, USA
| | | | - Katrina Griffin
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - Emily Hargrove
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - Myles Himmelreich
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - Anique Lutke
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - C J Lutke
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - Maggie May
- The International Adult Leadership Collaborative of the FASD Changemakers, USA
| | - Shuo Zhang
- University of Miami, Coral Gables, FL, USA
| | - Janna Looney
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Carson Kautz-Turnbull
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Mt. Hope Family Center, Rochester, NY, USA
| | - Madeline N Rockhold
- Department of Psychology, University of Rochester, Rochester, NY, USA
- Mt. Hope Family Center, Rochester, NY, USA
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Vaitsiakhovich N, Landes SD. The association between the Patient Protection and Affordable Care Act and healthcare affordability among US adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1270-1290. [PMID: 37129079 DOI: 10.1111/jir.13037] [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: 06/27/2022] [Revised: 02/28/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access. METHODS Using a pre-ACA 2011-2013 sample and a post-ACA implementation 2014-2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost. RESULTS The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow-up medical care and eyeglasses due to cost in the post-ACA years. CONCLUSIONS The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow-up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.
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Affiliation(s)
- N Vaitsiakhovich
- Department of Sociology and Lerner Center for Public Health Promotion and Population Health, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - S D Landes
- Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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Zondlak AN, Oh EJ, Neiman PU, Fan Z, Taylor KK, Sangji NF, Hemmila MR, Scott JW. Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery. Ann Surg 2023; 278:e1118-e1122. [PMID: 36994738 DOI: 10.1097/sla.0000000000005863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions. BACKGROUND Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population. METHODS Using the 2012-2017 Nationwide Inpatient Sample, we conducted a retrospective cohort analysis of adult patients admitted for 9 common EGS conditions. We performed multivariable logistic and linear regression to examine the association between intellectual disability and the following outcomes: EGS disease severity at presentation, any surgery, complications, mortality, length of stay, discharge disposition, and inpatient costs. Analyses were adjusted for patient demographics and facility traits. RESULTS Of 1,317,572 adult EGS admissions, 5,062 (0.38%) patients had a concurrent ICD-9/-10 code consistent with intellectual disability. EGS patients with intellectual disabilities had 31% higher odds of more severe disease at presentation compared with neurotypical patients (aOR 1.31; 95% CI 1.17-1.48). Intellectual disability was also associated with a higher rate of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs. CONCLUSION EGS patients with intellectual disabilities are at increased risk of more severe presentation and worse outcomes. The underlying causes of delayed presentation and worse outcomes must be better characterized to address the disparities in surgical care for this often under-recognized but highly vulnerable population.
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Affiliation(s)
- Allyse N Zondlak
- University of Michigan Medical School, Ann Arbor, MI
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Esther J Oh
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Pooja U Neiman
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Kathryn K Taylor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Stanford University, Stanford, CA
| | - Naveen F Sangji
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Mark R Hemmila
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - John W Scott
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Santos T, Steinway C, Mastrogiannis A, Chen J, Woodward J, Riddle I, Spicer B, Berens J, Davis T, Cornacchia M, Wright C, Lindquist LA, Jan S. Caregiver support, burden, and long-term planning among caregivers of individuals with intellectual and developmental disabilities: A cross-sectional study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1229-1240. [PMID: 37530520 DOI: 10.1111/jar.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Long-term care planning (LTCP) is critical for individuals with intellectual/developmental disabilities. Objectives of this study were to investigate progression through LTCP, and associations between social support and: (1) LTCP and (2) burden among family caregivers. METHODS A cross-sectional survey was distributed to caregivers of individuals with intellectual/developmental disabilities in NY, OH, PA, and TX, exploring demographics, supports, burden, and LTCP behaviours. Bivariate and linear multiple regression analyses were used to investigate study objectives. RESULTS Caregivers (n = 405) were predominantly parents, female, non-Hispanic, and in the 'learning to plan' stage of LTCP. Caregiver-identified social support was associated with further progression in LTCP (p = .020) and lower caregiver burden (p < .001). CONCLUSION Social support was associated with further progression in LTCP, and associated with less burden, however fewer than 40% of caregivers reported having social support. Ongoing exploration of emotional/social needs of caregivers is necessary to better support these families.
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Affiliation(s)
- Telmo Santos
- Division of General Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Caren Steinway
- Division of General Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Ariana Mastrogiannis
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jack Chen
- Division of General Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
| | - Jason Woodward
- Division of Developmental and Behavioral Pediatrics, Cinncinati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Ilka Riddle
- Division of Developmental and Behavioral Pediatrics, Cinncinati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - Brittany Spicer
- Division of Developmental and Behavioral Pediatrics, Cinncinati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
| | - John Berens
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Davis
- Division of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Michelle Cornacchia
- Division of General Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Charmaine Wright
- Division of Internal Medicine, Division of Pediatrics, Christiana Care, Wilmington, Delaware, USA
| | - Lee A Lindquist
- Division of Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sophia Jan
- Division of General Pediatrics, Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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13
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Allen JD, Kunicki ZJ, Greaney ML. Mental Health of Brazilian Immigrant Women: The Role of Discrimination, Social Support, and Community Strengths. J Immigr Minor Health 2023; 25:1016-1024. [PMID: 37191876 PMCID: PMC10185951 DOI: 10.1007/s10903-023-01485-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/17/2023]
Abstract
Little is known about the mental health status of Brazilians living in the U.S. We assessed the prevalence and correlates of depression to guide the development of culturally relevant community-based mental health interventions. An online survey was conducted between July and August 2020 among a sample of Brazilian women living in the U.S. (age 18 and over, born in Brazil, English or Portuguese speaking) recruited through Brazilian social media pages and community organizations. The survey assessed depression using the Center for Epidemiological Study Depression Scale (CES-D-10), the Everyday Discrimination Scale (EDS), the Oslo Social Support Scale (OSSS), and community strengths (CS). We first assessed the correlation between CES-D-10 scores and EDS, OSSS, and CS. We found that half of the participants (52.2%) had CES-D-10 scores of 10 or greater, indicating the presence of depressive symptomatology. In a multivariable model controlling for significant covariates (age, time lived in U.S.), EDS was positively associated with CES-D-10 scores (β = 0.64, 95% CI = 0.45, 0.83), while OSSS was negatively associated with CES-D-10 scores (β = -0.53, 95% C I= -0.80, -0.27). No statistically significant relationship was observed between CES-D-10 and CS scores. In this sample of Brazilian immigrant women, depressive symptomatology was highly prevalent, and experiences of discrimination were associated with increased symptoms of depression. There is a need to understand and address mental health in Brazilian immigrant women.
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Affiliation(s)
- Jennifer D Allen
- Department of Community Health, Tufts University School of Arts and Sciences, 574 Boston Avenue, Medford, MA, 02155, USA.
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard Box G-BH, Providence, RI, USA
| | - Mary L Greaney
- Department of Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI, USA
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14
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Wallisch A, Boyd BA, Hall JP, Kurth NK, Streed Jr CG, Mulcahy A, McMaughan DJ, Batza K. Health Care Disparities Among Autistic LGBTQ+ People. AUTISM IN ADULTHOOD 2023; 5:165-174. [PMID: 37346996 PMCID: PMC10280185 DOI: 10.1089/aut.2022.0006] [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: 03/07/2023]
Abstract
Background Lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people and disabled people experience disparities in access to health care compared with others. However, we have yet to understand how health care disparities may be further exacerbated at the intersection of disability and LGBTQ+ identity, particularly among autistic people. Objectives The primary goals of this study were to (1) examine differences in unmet health care needs and health status between LGBTQ+ autistic people and straight/cisgender autistic people and (2) explore how state policies and demographics predict the unmet health care needs of the autistic LGBTQ+ people. Methods We conducted a cross-sectional analysis using data from the 2019 National Survey on Health and Disability that included a subsample of autistic participants, with 62 LGBTQ+ adults and 58 straight/cisgender adults. To address our first study goal, we used an independent samples t-test, and to address our second study goal, we used Poisson regression. Results The LGBTQ+ group reported significantly more days of poor physical and mental health, more co-occurring diagnoses, and more unmet health care needs than the straight/cisgender group. For LGBTQ+ people, protective state health care laws and a lower income resulted in significantly more health care needs being met. Conclusions Findings from this study suggest that the intersection of an LGBTQ+ identity and autism is associated with greater disparities in physical and mental health as well as unmet health care needs; however, state policies prohibiting discrimination of LGBTQ+ people may act as a protective factor and result in fewer unmet health care needs. Future research should examine additional structural factors that may mitigate health inequities for autistic LGBTQ+ people.
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Affiliation(s)
- Anna Wallisch
- Juniper Gardens Children's Project, University of Kansas, Kansas City, Kansas, USA
| | - Brian A. Boyd
- School of Education, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean P. Hall
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Noelle K. Kurth
- Institute for Health and Disability Policy Studies, University of Kansas, Lawrence, Kansas, USA
| | - Carl G. Streed Jr
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Abigail Mulcahy
- Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, Oregon, USA
| | - Darcy Jones McMaughan
- School of Community Health Sciences, Counseling, and Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Katie Batza
- Women, Gender and Sexuality Studies, University of Kansas, Lawrence, Kansas, USA
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15
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Marquis S, Lunsky Y, McGrail KM, Baumbusch J. Population level administrative data evidence of visits to the emergency department by youth with intellectual/developmental disabilities in BC, Canada. Am J Emerg Med 2023; 69:52-57. [PMID: 37058981 DOI: 10.1016/j.ajem.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION The literature indicates that youth with intellectual/developmental disabilities (IDD) have poor health and that access to health services decreases as they transition from pediatric to adult services. At the same time their use of emergency department services increases. The objective of this study was to compare use of emergency department services by youth with IDD to youth without IDD, with particular emphasis on the transition period from pediatric to adult health care services. METHODS This research used a population level administrative health data base for the province of British Columbia Canada for 2010-2019 to examine the use of emergency departments by youth with IDD (N = 20,591) compared to a population group of youth without IDD (N = 1,293,791). Using the ten years of data, odds ratios for visits to the emergency department were calculated adjusting for sex, income and geographical area within the Province. In addition, difference-in-differences analyses were calculated for age matched subsets of the two cohorts. RESULTS Over the ten year period, 40.60% of youth with IDD visited an emergency department at least once, compared to 29.10% of youth without IDD. Youth with IDD had an odds ratio of visiting an emergency department 1.697 (1.649, 1.747) times that of youth without IDD. However, when odds were adjusted for a diagnosis of either psychotic illness or anxiety/depression, the odds for youth with IDD visiting emergency compared to youth without IDD were reduced to 1.063 (1.031, 1.096). Use of emergency services increased as youth aged. Type of IDD also affected use of emergency services. Youth with Fetal Alcohol Syndrome had the greatest odds of using emergency services compared to youth with other types of IDD. DISCUSSION The findings from this study indicate that youth with IDD have higher odds of using emergency services than youth without IDD although these increased odds appear to be largely driven by mental illness. In addition, use of emergency services increases as the youth age and transition from pediatric to adult health services. Better treatment of mental health issues within this population may reduce their use of emergency services.
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Affiliation(s)
- Sandra Marquis
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, CAMH, 1025 Queen St West, Toronto, ONT M6J 1H4, Canada.
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, 201-2206 East Mall, Vancouver, BC V6T 1Z3, Canada.
| | - Jennifer Baumbusch
- School of Nursing University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
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16
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Bourne MJ, Smeltzer SC, Kelly MM, Mariani B. ADAPTATION AND TESTING OF THE DEVELOPMENTAL DISABILITY ATTITUDES IN NURSING CARE INSTRUMENT. J Nurs Meas 2023; 31:96-108. [PMID: 36941040 DOI: 10.1891/jnm-2021-0015] [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: 11/25/2022]
Abstract
Background and Purpose: Individuals with developmental disability (DD) often experience poor health outcomes, potentiated by healthcare inequities. Nurses have the potential to reduce these inequities through the quality of care provided. The quality of care provided by nursing students, the future generation of nurses, is affected by the attitudes of their clinical nursing faculty. The purpose of this study was to adapt and test an instrument to specifically measure the attitudes of clinical nursing faculty toward providing care to people with DD. Methods: The Disability Attitudes in Health Care (DAHC) instrument was adapted to create the new Developmental Disability Attitudes in Nursing Care (DDANC) instrument. Results: Content experts reviewed the DDANC for content validity (CVI = 0.88), followed by testing for internal consistency reliability (Cronbach's alpha = 0.7). The study respondents had overall positive attitudes toward the care of people with DD. Conclusions: The DDANC is an acceptably valid and reliable instrument to assess attitudes of clinical nursing faculty toward providing care to people with DD.
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Affiliation(s)
- Melissa J Bourne
- PhD Student, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
- Visiting Assistant Professor, Wegmans School of Nursing, St. John Fisher College, Rochester, NY, United States
| | - Suzanne C Smeltzer
- The Richard and Marianne Kreider Endowed Professor in Nursing for Vulnerable Populations, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Michelle M Kelly
- Associate Professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Bette Mariani
- Vice Dean for Academic Affairs, Associate Professor of Nursing, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
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17
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Khanlou N, Khan A, Kurtz Landy C, Srivastava R, McMillan S, VanDeVelde‐Coke S, Vazquez LM. Nursing care for persons with developmental disabilities: Review of literature on barriers and facilitators faced by nurses to provide care. Nurs Open 2023; 10:404-423. [PMID: 36000482 PMCID: PMC9834519 DOI: 10.1002/nop2.1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/04/2022] [Accepted: 07/05/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS To identify barriers and facilitators to nursing care of individuals with developmental disabilities (DDs). BACKGROUND Individuals with DDs experience health disparities. Nurses, although well positioned to provide optimal care to this population, face challenges. DESIGN Narrative review of extant published peer-reviewed literature. DATA SOURCES Electronic databases, ProQuest and EBSCO, were searched for studies published in English between 2000 and 2019. REVIEW METHODS Three reviewers reviewed abstracts and completed data extraction. Knowledge synthesis was completed by evaluating the 17 selected studies. RESULTS Emerging themes were: (1) barriers and challenges to nursing interventions; (2) facilitators to nursing care; and (3) recommendations for nursing education, policy and practice. CONCLUSION Nursing has the potential to be a key partner in supporting the health of people with DDs. IMPACT There is a need for specific education and training, so nurses are better equipped to provide care for people with DDs.
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Affiliation(s)
| | - Attia Khan
- Faculty of HealthYork UniversityTorontoOntarioCanada
| | | | - Rani Srivastava
- School of NursingThompson Rivers UniversityKamloopsBritish ColumbiaCanada
| | - Shirley McMillan
- Azrieli Adult Neurodevelopmental CentreCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
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18
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Dinora P, Prohn SM, Bogenschutz M, Broda MD, Lineberry S, West A. An Examination of Support Needs, Supports, and Outcomes for People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 61:65-78. [PMID: 36706006 DOI: 10.1352/1934-9556-61.1.65] [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: 03/25/2022] [Accepted: 10/17/2022] [Indexed: 05/16/2023]
Abstract
Researchers used a merged dataset to examine if more resources were expended on those with greater support needs and if support needs impacted personal outcomes when controlling for relevant personal and contextual factors. Results indicated that the amount of support a person receives had a direct relationship to their needs. However, we also found that people with the greatest needs had weaker personal outcomes suggesting that distribution of resources based on need may not result in equivalent outcomes. The authors suggest strategies at an individual and systems level to address the outcomes gap for people with the greatest support needs.
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Affiliation(s)
- Parthenia Dinora
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
| | - Seb M Prohn
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
| | - Matthew Bogenschutz
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
| | - Michael D Broda
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
| | - Sarah Lineberry
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
| | - Angela West
- Parthenia Dinora, Seb M. Prohn, Matthew Bogenschutz, Michael D. Broda, Sarah Lineberry, and Angela West, Virginia Commonwealth University
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19
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Special Considerations for Management of Diabetes in Adult Patients with Intellectual and Developmental Disabilities. Adv Med 2023; 2023:2955772. [PMID: 36755896 PMCID: PMC9902153 DOI: 10.1155/2023/2955772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic health condition that is very prevalent worldwide. It has been demonstrated that individuals with intellectual and developmental disabilities (IDDs) are at a disproportionately high risk for developing diabetes. Persons with IDDs are estimated to be 2-3 times more likely to develop DM compared to the general population. The elevated risk of developing diabetes within the population of adults with IDDs is multifactorial and includes contributions from genetics, lifestyle, medication use and misuse, boundaries to appropriate medical care, a higher incidence of comorbid mental health disorders, and others. Further, inadequate screening for and management of diabetes for these patients results in heightened risk for adverse cardiovascular events and inferior health care outcomes. To improve patient outcomes for this unique patient population, health care providers need to be well trained in the optimal modalities of screening, diagnosis, and management of diabetes in adults with IDDs. This requires the development of effective diabetes intervention and health promotion programs aimed at patients with IDDs, utilizing a patient-centered approach to screening and management, and conducting further research to assess the impact of these interventions.
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20
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Enhancing Care for Multimorbidity in Adults with Neurodevelopmental Disorders. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 10:1-5. [PMID: 36844637 PMCID: PMC9942652 DOI: 10.1007/s40737-023-00334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
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21
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Højberg LM, Helge EW, Pingel J, Wienecke J. The Health Effects of 14 Weeks of Physical Activity in a Real-Life Setting for Adults with Intellectual Disabilities. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:6817318. [PMID: 38655171 PMCID: PMC11022770 DOI: 10.1155/2022/6817318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 04/26/2024]
Abstract
Background The life expectancy of individuals with intellectual disabilities (ID) is reduced compared to the general population, and one of the main contributors to earlier death is inactivity. Aim To investigate how 14 weeks of physical activity (PA) in a real-life setting affects cardiovascular fitness, body composition and bone health of adults with ID. Methods Adults with ID were recruited into a PA-group (N = 52) or a control group (CON, N = 14). The PA-group participated in 14 weeks of PA, and body composition, cardiovascular fitness and bone health were assessed before and after the intervention. Outcomes and Results. Cardiovascular fitness and body composition improved from pre to post within the PA-group: Heart rates (HR) during the last 30 seconds of two increments of a treadmill test, were reduced (3.2 km/h: -4.4 bpm, p < 0.05; 4.8 km/h: -7.5 bpm, p < 0.001) and fat mass was reduced (-1.02 kg, p < 0.05). A between-group difference in favour of the PA-group, were observed in whole body bone mineral density (BMD) (0.024 g/cm2, p < 0.05). Conclusions and Implications. Fourteen weeks of PA performed in a real-life setting increased cardiovascular fitness, reduced fat mass and improved BMD in the weight-bearing skeleton in the PA-group. Increased and regular PA seems to be a promising tool to promote physical health in adults with ID.
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Affiliation(s)
- Laurits Munk Højberg
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Eva Wulff Helge
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Pingel
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Wienecke
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Department of Sport and Social Sciences, Norwegian School of Sport Science, Oslo, Norway
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22
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Bermejo-Martins E, Pueyo-Garrigues M, Casas M, Bermejo-Orduna R, Villarroya A. A Forest Bathing Intervention in Adults with Intellectual Disabilities: A Feasibility Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13589. [PMID: 36294168 PMCID: PMC9603293 DOI: 10.3390/ijerph192013589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Forest bathing practices benefit individuals' physical and mental health. A growing number of published studies provide evidence of such effects in diverse populations and contexts. However, no literature has been found that evaluates the effects of forest bathing on people with intellectual disabilities. In this paper, we present a quasi-experimental pre-post protocol for assessing the preliminary efficacy and feasibility of a forest bathing intervention in a group of adults with intellectual disability. An 11-weekly session program will be applied in the forests of the Ollo Valley, Navarre (Spain). The preliminary efficacy outcomes will be blood pressure, psycho-physiological coherence parameters and quality of life. The feasibility of the intervention will be assessed through data on barriers and facilitators of the implementation process and indicators of environmental comfort (physiological equivalent temperature and thermic perception). This study offers an opportunity for people with intellectual disabilities to benefit from a forest bathing intervention and explore its effects not only on their quality of life, but also on the improvement in their physiological and psychological state. This feasibility study is an essential step to explore crucial aspects for a future full-scale trial.
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Affiliation(s)
- Elena Bermejo-Martins
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Campus Universitario, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Pueyo-Garrigues
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Campus Universitario, 31008 Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Casas
- Department of Environmental Biology, Faculty of Science, University of Navarra, Campus Universitario, 31080 Pamplona, Spain
- Grupo de Humanidades Ambientales, BIOMA, 31008 Pamplona, Spain
| | - Raúl Bermejo-Orduna
- Department of Environmental Biology, Faculty of Science, University of Navarra, Campus Universitario, 31080 Pamplona, Spain
- Grupo de Humanidades Ambientales, BIOMA, 31008 Pamplona, Spain
| | - Ana Villarroya
- Department of Environmental Biology, Faculty of Science, University of Navarra, Campus Universitario, 31080 Pamplona, Spain
- Grupo de Humanidades Ambientales, BIOMA, 31008 Pamplona, Spain
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23
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Friebel R, Maynou L. Assessing The Dangers Of A Hospital Stay For Patients With Developmental Disability In England, 2017-19. Health Aff (Millwood) 2022; 41:1486-1495. [PMID: 36190892 DOI: 10.1377/hlthaff.2022.00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People with developmental disability have higher health care needs and lower life expectancy compared with the general population. Poor quality of care resulting from interpersonal and systemic discrimination may further entrench existing inequalities. We examined the prevalence of five avoidable in-hospital patient safety incidents (adverse drug reactions, hospital-acquired infections, pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis, and postoperative sepsis) for four developmental disability groups (people with intellectual disability, chromosomal abnormalities, pervasive developmental disorders, and congenital malformation syndrome) in the English National Health Service during the period April 2017-March 2019. We found that the likelihood of experiencing harm in disability groups was up to 2.7-fold higher than in patients without developmental disability. Patient safety incidents led to an excess length-of-stay in hospital of 3.6-15.4 days and an increased mortality risk of 1.4-15.0 percent. We show persisting quality differences in patients with developmental disability, requiring an explicit national policy focus on the needs of such patients to reduce inequalities, reach parity of care, and lower the burden on health system resources.
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Affiliation(s)
- Rocco Friebel
- Rocco Friebel , London School of Economics and Political Science and Center for Global Development Europe, London, United Kingdom
| | - Laia Maynou
- Laia Maynou, Universitat de Barcelona, Barcelona, Spain; London School of Economics and Political Science; and CRES-Universitat Pompeu Fabra, Barcelona
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24
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Franklin MS, Bush C, Jones KA, Davis NO, French A, Howard J, Greiner MA, Maslow GR. Inequities in Receipt of the North Carolina Medicaid Waiver Among Individuals with Intellectual Disability or Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:393-401. [PMID: 35353786 PMCID: PMC9462136 DOI: 10.1097/dbp.0000000000001075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined characteristics associated with receiving the North Carolina Home and Community-Based Services Waiver for intellectual and developmental disabilities (I/DDs) and its association with emergency department (ED) utilization. METHOD Through analysis of the North Carolina 2017 to 2018 Medicaid claims and enrollment data, we examined characteristics (age, sex, race and ethnicity, geography, diagnosis (intellectual disability [ID] with or without autism spectrum disorders or autism spectrum disorder without ID) associated with receiving the NC I/DD Waiver and the association of this Wavier with ED utilization. We identified patients with at least 1 International Classification of Diseases-10-CM diagnosis code for an ID or autism spectrum disorder. We excluded patients with missing county information and whose enrollment in the NC I/DD Waiver program began after October 1, 2017. RESULTS Only 22% of 53,531 individuals with I/DD in North Carolina received the Waiver. Non-Hispanic Blacks and Hispanic individuals were less likely to receive the Waiver than non-Hispanic White individuals. Adults (>21 years old), men, and urban residents were more likely to receive the Waiver. Individuals who received the Waiver were 31% less likely to use the ED. CONCLUSION Innovative strategies are needed to provide equitable access to the NC I/DD Waiver and provide services to the 14,000 people with I/DD currently waiting to receive the Waiver. Through the Waiver, those with I/DD can access preventative and therapeutic outpatient services and decrease their need for ED care. These findings highlight the need for policy reform to address inequities in access to the Waiver for individuals with I/DD.
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Affiliation(s)
| | - Christopher Bush
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Kelley A. Jones
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Naomi Ornstein Davis
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Alexis French
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jill Howard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | | | - Gary R. Maslow
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
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Prager BC, Broder SM, Natowicz MR. A picture is worth a thousand words: A proposal to incorporate video into the evaluation of adults with intellectual or developmental disability living outside the home. Front Public Health 2022; 10:887714. [PMID: 36091544 PMCID: PMC9451026 DOI: 10.3389/fpubh.2022.887714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/15/2022] [Indexed: 01/21/2023] Open
Abstract
Adults with intellectual or developmental disability (IDD) comprise 1-2% of the population worldwide. IDD is a significant risk factor for premature morbidity or mortality. This is likely due in part to preventable health conditions, which are modifiable with the intervention of direct care providers in areas including nutrition, promotion of an active lifestyle and effective identification of health or functional deterioration. Adults with IDD are also at increased risk for neglect or mistreatment, a finding that has been documented across multiple countries and in a variety of care settings. Contributing factors include resource availability, lack of person-centered care, management culture and care worker training. Practical and economical interventions may address the known disparities and challenges facing the large community of adults with IDD. To promote person-centered care, improve record-keeping/documentation, and aid in protecting the health and safety of this vulnerable population, we propose incorporation of a video into the evaluation of adults with IDD living outside the home.
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Affiliation(s)
- Briana C. Prager
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States,Medical Scientist Training Program, Case Western School of Medicine, Cleveland, OH, United States
| | - Sherri M. Broder
- Department of Bioethics, Case Western Reserve University, Cleveland, OH, United States
| | - Marvin R. Natowicz
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States,Pathology and Laboratory Medicine, Genomic Medicine, Neurological and Pediatrics Institutes, Cleveland Clinic, Cleveland, OH, United States,*Correspondence: Marvin R. Natowicz
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Akpinar S. Asymmetry of max grip force and max rate of grip force development among adolescents with and without intellectual disability. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:375-381. [PMID: 38699492 PMCID: PMC11062276 DOI: 10.1080/20473869.2022.2093083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/19/2022] [Indexed: 05/05/2024]
Abstract
The human body seems symmetrical but functional asymmetry can be observed for many tasks. One of the tasks observed the functional asymmetry is grip force and rate of grip force development (RGFD). To efficiently accomplish many tasks, it is important to measure those parameters in different ages and special groups. Thus, the purpose of the study was to test asymmetry of max grip force and max RGFD among adolescents with and without intellectual disability. 41 adolescents with (IQ between 50 and 70) and 41 adolescents without intellectual disability voluntarily participated to the study. Max grip force and max RGFD was measured using a force transducer with custom-made software. The statistical analysis displayed that adolescents without intellectual disability had higher max grip force and max RGFD with their both hands compared to adolescent with intellectual disability. Interestingly, whereas adolescent without intellectual disability displayed an asymmetry between the hands both for max grip force and max RGFD, adolescents with intellectual disability had asymmetry only for max grip force but not for max RGFD. Thus, adolescents with intellectual disability may have symmetrical neurological pathways. Individuals with intellectual disability should be provided with more physical activity and/or exercise opportunities including the bimanual movements with fast and ballistic actions.
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Affiliation(s)
- Selcuk Akpinar
- Department of Physical Education and Sport, Faculty of Sport Science, Nevsehir Haci Bektas Veli University, Nevsehir, Turkey
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Bendixen RM, Benevides T, Ideishi R, Smythe R, Taylor J, Umeda C, Kerfeld C, Jirikowic T. Community Conversations: Stakeholder-Identified Research Priorities to Foster Community Participation for Individuals With Intellectual and Developmental Disability. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:873415. [PMID: 36188970 PMCID: PMC9397812 DOI: 10.3389/fresc.2022.873415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
To identify future research priorities and meaningful outcomes focused on community-level interventions for children and youth with intellectual and developmental disabilities and families, a group underrepresented in research, we established a diverse patient-centered outcomes research (PCOR) community. We focused on engaging regionally and nationally-diverse stakeholders-individuals, families, healthcare professionals, community, and policy experts-in research development activities that would build partnerships and research capacity. This community of stakeholders also represented the matrix of systems, services, and programs that people frequent in their communities (e.g., cultural arts, worship, sports and recreation, and transportation). We present the engagement process and methods for including individuals with intellectual and developmental disabilities as stakeholders in research planning and processes. The results of planning, completing, and evaluating three face-to-face research capacity-building meetings and their subsequent stakeholder engagement activities include: (1) individuals with intellectual and developmental disabilities and their families clearly expressed a desire to be included and to feel good about their participation in community settings, (2) many of our stakeholders wanted action and change to happen in their communities now, and often did not realize or understand that research takes time, (3) organizations expressed a need for mentoring related to best practices for access and inclusive programming. Overarching issues around societal inclusion, equal opportunities, and life chances for individuals with intellectual and developmental disabilities and their families were front and center across communities and multi-stakeholder groups, and achieving change remains valued and a high priority.
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Affiliation(s)
- Roxanna M. Bendixen
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Teal Benevides
- Department of Occupational Therapy, Augusta University, Augusta, GA, United States
| | - Roger Ideishi
- Department of Occupational Therapy, George Washington University, Washington, DC, United States
| | | | - Joshua Taylor
- College of Education and Human Development, University of Maine, Orono, ME, United States
| | - Caroline Umeda
- Department of Occupational Therapy, Dominican University of California, San Rafael, CA, United States
| | - Cheryl Kerfeld
- Division of Physical Therapy, Seattle Public Schools, Seattle, WA, United States
| | - Tracy Jirikowic
- Department of Occupational Therapy, University of Washington, Seattle, WA, United States
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Ellem K, Harris P, Strnadová I. Emerging from the shadows: Digital stories of self‐advocates with intellectual disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kathy Ellem
- School of Nursing, Midwifery and Social Work University of Queensland St. Lucia Queensland Australia
| | - Paul Harris
- School of SHS—Human Services and Social Work Griffith University Brisbane Queensland Australia
| | - Iva Strnadová
- School of Education University of New South Wales Sydney New South Wales Australia
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Shady K, Phillips S, Newman S. Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-13. [PMID: 35669718 PMCID: PMC9148936 DOI: 10.1007/s40489-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00324-8.
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Affiliation(s)
- Kathryn Shady
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Shannon Phillips
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Susan Newman
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
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Mohan A, Roberts JA. Accommodating Developmental Disabilities in the Social Determinants of Health:: A Brief Inquiry into the Applicability of Metrics to the Lives of Individuals with Developmental Disabilities in Delaware. Dela J Public Health 2022; 8:50-55. [PMID: 35692997 PMCID: PMC9162396 DOI: 10.32481/djph.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This commentary outlines the methods and findings of a preliminary study examining the fitness of the Social Determinants of Health in their current conceptualizations for accommodating the specific and general experiences of individuals with developmental disabilities and suggests recommendations for both additional research and policy interventions. The study is based on research conducted with individuals with intellectual and developmental disabilities living in Delaware and other stakeholders working in this community. There is currently extensive literature concerning the validity and importance of including the social determinants of health in healthcare decision-making, but very little research exists around the intersection of developmental disabilities and these determinants. This commentary provides additional detail and added emphasis to calls previously made in this Journal to align social determinants with developmental disabilities and the importance of considering the SDOH in policy measures aimed at supporting this population. The ultimate aim of the work presented here is to explore how the State's interest in putting the SDOH to work generally can be aligned to accommodate the needs and interests of individuals with I/DD and to identify future research and policy interventions in support of these efforts.
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Affiliation(s)
- Ankita Mohan
- Delaware Division of Developmental Disabilities Services
| | - Jody A Roberts
- Delaware Division of Developmental Disabilities Services
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Blackman AL, Ruby SA, Bartle G, Reed FDD, Strouse M, Erath TG, Leon-Barajas M. Effects of a Systems-Level Intervention to Improve Trainer Integrity in a Behavioral Healthcare Organization. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:304-314. [PMID: 35252549 PMCID: PMC8889048 DOI: 10.1007/s41252-022-00245-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Direct support professionals (DSPs) play a critical role in health-related outcomes for individuals with intellectual and developmental disabilities (IDD) who reside in congregate living settings. Large behavioral healthcare organizations often rely on staff to function as peer trainers for newly hired DSPs. Organizations should adopt empirically supported training techniques to prepare peer trainers for their role and develop systems to ensure ongoing integrity of the training system. The purpose of this program description is to summarize consultation activities that attempted to create these systems. METHODS Staff members were trained to function as peer trainers, an assessment was conducted to determine the barriers to training in the natural environment, and a systems-level intervention informed by the assessment was implemented to improve peer trainer integrity. RESULTS The assessment revealed peer trainers were often unaware when they were expected to train and did not receive feedback or programmed consequences for training newly hired DSPs. A systems-level intervention containing a prompt (reminder) about upcoming training and feedback plus a monetary incentive produced improvements in trainer integrity. CONCLUSIONS A systems-level intervention based on an assessment can improve peer trainer integrity. Ensuring peer trainer integrity increases the likelihood that newly hired DSPs will implement health-related protocols with individuals with IDD.
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Affiliation(s)
- Abigail L. Blackman
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
| | - Sandra A. Ruby
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
| | - Grace Bartle
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
| | - Florence D. DiGennaro Reed
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
| | | | - Tyler G. Erath
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
| | - Marren Leon-Barajas
- Department of Applied Behavioral Science, University of Kansas, 4001 Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045-7555 USA
- GoodLife Innovations, Inc, Lenexa, KS USA
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Wise E, Holingue C, Klein A, Caoili A, Charlot L, Barnhill J, Beasley JB. Psychiatric Presentations and Medication Use in Older Adults With Intellectual and Developmental Disabilities. Am J Geriatr Psychiatry 2022; 30:65-77. [PMID: 34210596 DOI: 10.1016/j.jagp.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adults with intellectual and developmental disabilities (IDD) are living longer, yet research about the medical and psychiatric needs of older adults still lags behind that of younger individuals with IDD. The aim of this study was to assess age-related differences in the mental health presentations of adults with IDD. METHODS Fully deidentified data for adults 30 years and older were extracted from the START (Systemic, Therapeutic, Assessment, Resources, and Treatment) Information Reporting System, a deidentified database housed at the Center for START Services. Caregivers and START team documents reported psychiatric diagnoses, service use, recent stressors, and challenging behaviors. t Tests, Mann Whitney U tests, χ2 tests, and multinominal logistic regression models were used to compare the two age groups, 30-49 years (n = 1,188) versus 50 years and older (n = 464). RESULTS Older adults had more medical conditions, fewer reported psychiatric conditions, and were more likely to be taking more psychiatric medications compared to younger adults, after adjusting for demographic variables, disability level, and number of recent stressors. CONCLUSION Although older individuals reported fewer psychiatric diagnoses, they were more likely to take higher numbers of psychiatric medications and have more medical conditions. Clinicians and researchers ought to devote more attention to the healthcare needs of older adults with IDD, a vulnerable group exposed to polypharmacy and at risk of adverse events.
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Affiliation(s)
- Elizabeth Wise
- Department of Psychiatry and Behavioral Sciences (EW), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Calliope Holingue
- Department Neuropsychology (CH), Kennedy Krieger Institute, Baltimore, MD; Department of Mental Health (CH), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann Klein
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Andrea Caoili
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Lauren Charlot
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
| | - Jarrett Barnhill
- Department of Psychiatry (JB), University of North Carolina School of Medicine, Chapel Hill
| | - Joan B Beasley
- Center for START Services (AK, AC, LC, JBB), Institute on Disability/UCED, University of New Hampshire, Durham
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Grumi S, Borgatti R, Provenzi L. Supporting Parenting at Home-Empowering Rehabilitation through Engagement (SPHERE): study protocol for a randomised control trial. BMJ Open 2021; 11:e051817. [PMID: 34907057 PMCID: PMC8672000 DOI: 10.1136/bmjopen-2021-051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infants with neurodevelopmental disabilities (NDs) show emotional, cognitive and sociointeractive dysregulation dramatically impacting on caregiving behaviour. Early video-feedback interventions (VFIs) are effective in promoting sensitive parenting, which in turn supports infants' development, even in case of ND. In the light of limited resources of the healthcare systems, technological advances in telemedicine may facilitate the delivery of VFI to a greater number of families of infants with ND. To date, no study has implemented a telemedicine VFI (TVFI) for families of infants diagnosed with ND. METHODS AND ANALYSIS The Supporting Parenting at Home-Empowering Rehabilitation through Engagement project is a randomised controlled trial aimed at assessing the effectiveness of an early family-centred TVFI parenting support on dyads with infants diagnosed with ND. It includes two arms (TVFI vs Booklet Psychoeducational Intervention) and three assessment phases: T0, baseline; T1, immediate postintervention; T2, 6-month follow-up. ETHICS AND DISSEMINATION This study is funded by the Italian Ministry of Health and was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences. TRIAL REGISTRATION NUMBER The study protocol has been also registered on NIH Clinical Trials (protocol code NCT04656483; Pre-results).
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Gómez LE, Navas P, Verdugo MÁ, Tassé MJ. Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability. World J Psychiatry 2021; 11:1039-1052. [PMID: 34888172 PMCID: PMC8613764 DOI: 10.5498/wjp.v11.i11.1039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/17/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.
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Affiliation(s)
- Laura E Gómez
- Department of Psychology, University of Oviedo, Oviedo 33011, Asturias, Spain
| | - Patricia Navas
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Miguel Ángel Verdugo
- Department of Personality, Evaluation and Psychological Treatments, Institute on Community Integration, University of Salamanca, Salamanca 37005, Salamanca, Spain
| | - Marc J Tassé
- Department of Psychology and Psychiatry, The Ohio State University Nisonger Center-UCEDD, Columbus, OH 43210-1257, United States
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Fortney S, Tassé MJ. Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:492-504. [PMID: 34700348 DOI: 10.1352/1944-7558-126.6.492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
Previous research suggests that residence in non-metropolitan areas is associated with lower access to preventive care and poorer health. However, this research has been largely restricted to the general population, despite data demonstrating disparities in health status and access to healthcare services for people with intellectual and developmental disabilities (IDD). The current study examined several hypotheses involving the effects of rurality on access to preventive healthcare and services and health status: (1) individuals in non-metropolitan areas will have lower preventive healthcare utilization, (2) individuals in non-metropolitan areas will have poorer health outcomes, and (3) individuals in non-metropolitan areas will have poorer access to services. The current study uses data from the National Core Indicators (NCI) Adult Consumer Survey 2015-2016: Final Report which included Rural-Urban Commuting Area (RUCA) Codes for the first time. Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts.
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Affiliation(s)
- Stoni Fortney
- Stoni Fortney and Marc J. Tassé, The Ohio State University
| | - Marc J Tassé
- Stoni Fortney and Marc J. Tassé, The Ohio State University
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Bourne MJ, Smeltzer SC, Kelly MM. Healthcare inequities among adults with developmental disability: An integrative review with implications for nursing education. Nurse Educ Pract 2021; 57:103225. [PMID: 34649127 DOI: 10.1016/j.nepr.2021.103225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
AIM This integrative review synthesized research on the healthcare inequities experienced by adults with developmental disability in the United States and discussed implications for nursing education. BACKGROUND Individuals with developmental disability are living longer with chronic comorbidities and experience healthcare inequities. METHOD Application of inclusion criteria to database and ancestry searches resulted in 26 articles that were assessed for quality and analyzed thematically. RESULTS Three categories of inequity were identified: knowledge deficits, communication challenges and poor quality of care. Knowledge deficits and communication challenges can lead to frustration, errors and unmet needs. Poor quality of care encompasses the decreased availability and access to services, limited health promotion participation and higher rates of hospitalizations and complications for adults with developmental disability. CONCLUSION Healthcare inequities may be reduced by targeting patient and provider knowledge. Inclusion of developmental disability content and clinical experiences in nursing education may improve care and reduce inequities for this underserved population.
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Affiliation(s)
- Melissa J Bourne
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
| | - Michelle M Kelly
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA.
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Provenzi L, Grumi S, Rinaldi E, Giusti L. The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104048. [PMID: 34375793 DOI: 10.1016/j.ridd.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.
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Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisa Rinaldi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lorenzo Giusti
- Faculty of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Meehan E, Gallagher AL, Ryan J, Kerr C, O' Sullivan R, Galvin R, Manikandan M, Wormald A, Robinson K. Unmet healthcare needs in adults with childhood-onset neurodisabilities: a protocol for a systematic review. HRB Open Res 2021; 4:107. [PMID: 36071876 PMCID: PMC9399657 DOI: 10.12688/hrbopenres.13309.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background
Many adults with childhood-onset neurodisabilities, such as those with intellectual disability or cerebral palsy, report difficulties accessing the healthcare that they require when they are no longer eligible for paediatric services. Compared to the general population, this population is at greater risk of developing many ageing-related diseases and has higher rates of preventable deaths and premature mortality. Addressing unmet healthcare needs is essential to ensuring equitable access in a quality healthcare system. The aim of this systematic review is to synthesise the current available evidence related to unmet healthcare needs in adults with a range of childhood-onset neurodisabilities.
Methods
A systematic review of quantitative research studies of adults with a range of diagnoses that fall under the neurodisability umbrella and outcomes related to unmet healthcare needs will be undertaken. The Conducting Systematic Reviews and Meta-Analyses of Observational Studies (COSMOS-E) guidelines will be adhered to. Searches of key databases will be undertaken, and a two-phase screening process carried out by pairs of independent reviewers to select studies that meet the inclusion criteria. Data will be extracted using a purposefully designed form. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Tools. If it is possible to pool prevalence data, a meta-analysis will be undertaken. Where pooling of data is not possible, a structured synthesis approach will be used, and results will be presented in tables and summarised narratively.
Conclusions
In recent years, there has been increased emphasis placed on promoting positive ageing and improving the healthcare experiences throughout the lifespan for people with neurodisabilities. Findings of this systematic review can inform decision-making related to healthcare for this vulnerable population and has the potential to contribute to reducing preventable deaths and premature mortality and promoting positive and healthy ageing for this group.
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Affiliation(s)
- Elaine Meehan
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Aoife L. Gallagher
- School of Allied Health, University of Limerick, Limerick, Ireland
- Health Implementation Science and Technology Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jennifer Ryan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Rose Galvin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Manjula Manikandan
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Andrew Wormald
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
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Bobbette N, Lysaght R, Ouellette-Kuntz H, Tranmer J, Donnelly C. Organizational attributes of interprofessional primary care for adults with intellectual and developmental disabilities in ontario, Canada: a multiple case study. BMC FAMILY PRACTICE 2021; 22:157. [PMID: 34294044 PMCID: PMC8299637 DOI: 10.1186/s12875-021-01502-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
Background Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context. Methods A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis. Results Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population. Conclusions This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01502-z.
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Affiliation(s)
- Nicole Bobbette
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada.
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Hélène Ouellette-Kuntz
- Department of Public Health Sciences & Psychiatry (Division of Developmental Disabilities), Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Joan Tranmer
- School of Nursing, Faculty of Health Sciences & Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Milne-Ives M, Shankar R, Goodley D, Lamb K, Laugharne R, Harding T, Meinert E. Humanising health and social care support for people with intellectual and developmental disabilities: Protocol for a scoping review (Preprint). JMIR Res Protoc 2021; 11:e31720. [PMID: 35507388 PMCID: PMC9118084 DOI: 10.2196/31720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID) PRR1-10.2196/31720
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Rohit Shankar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Dan Goodley
- School of Education, University of Sheffield, Sheffield, United Kingdom
| | - Kirsten Lamb
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Richard Laugharne
- Cornwall Partnership National Health Service Foundation Trust, Bodmin, United Kingdom
| | - Tracey Harding
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Fleming V, Litzelman K. Caregiver resource utilization: Intellectual and development disability and dementia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1468-1476. [PMID: 34124823 DOI: 10.1111/jar.12889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/03/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities and their families have high need for support services. This study assessed resource utilization among caregivers of intellectual and developmental disabilities and other conditions. METHODS We assessed 366 caregivers of adults with intellectual and developmental disabilities, dementia or other conditions Regressions assessed group differences in number of agency contacts and frequency of service use. A secondary analysis assessed reasons for underutilization of services. RESULTS Caregivers of individuals with dementia contacted twice as many agencies as other caregivers and were more likely to report using suggested services. Agency contact and service utilization were similar among caregivers of adults with intellectual and developmental disabilities compared to other caregivers. Caregivers of adults with intellectual and developmental indicated that suggested services were unavailable to them. CONCLUSION The findings of this study shed light on challenges with access to and utilization of support services.
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Affiliation(s)
- Victoria Fleming
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristin Litzelman
- Department of Human Development & Family Studies, University of Wisconsin-Madison, Madison, WI, USA
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Tencza M, Forsythe L. Transition-of-care planning: Preparing for the future care of the individual with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:277-289. [PMID: 31714177 DOI: 10.1177/1744629519883453] [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: 06/10/2023]
Abstract
Individuals with an intellectual and developmental disability (IDD) are often harmed when faced with changes in their living or care circumstances. Their inability to make sudden quality of life choices puts them at a disadvantage due to cognitive and communication difficulties. A quality improvement project was conducted with adult habilitation agency clients with IDD. Use of evidence-based methods, team collaborative communication, patient safety guidelines, and adherence to agency mission and policies were instrumental in development of a transition-of-care plan form given to clients on admission or during scheduled manager visits. A follow-up survey resulted in significant quantitative data results showing the importance of future planning to the client and guardian.
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Affiliation(s)
- Mary Tencza
- 311285Pennsylvania State University, USA; Fortis Institute, USA
| | - Lydia Forsythe
- 177733Purdue University Global Nursing School, USA; Londes Strategic Healthcare Consulting, USA
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Adirim Z, Sockalingam S, Thakur A. Post-graduate Medical Training in Intellectual and Developmental Disabilities: a Systematic Review. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:371-381. [PMID: 33433827 DOI: 10.1007/s40596-020-01378-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/24/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID. METHODS Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model. RESULTS Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher. CONCLUSIONS There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.
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Affiliation(s)
| | | | - Anupam Thakur
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Bobbette N, Ouellette-Kuntz H, Tranmer J, Lysaght R, Ufholz LA, Donnelly C. Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review. JBI Evid Synth 2021; 18:1470-1514. [PMID: 32813389 DOI: 10.11124/jbisrir-d-19-00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities. INTRODUCTION Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population. INCLUSION CRITERIA This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care. METHODS This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors). RESULTS The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision. CONCLUSIONS To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.
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Affiliation(s)
- Nicole Bobbette
- 1School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada 2Department of Public Health Sciences & Psychiatry (Division of Developmental Disabilities), Faculty of Health Sciences, Queen's University, Kingston, Canada 3School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada 4Health Learning, Research & Practice, Wolters Kluwer Health, Toronto, Canada
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Phillips KG, Wishengrad JS, Houtenville AJ. Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:203-215. [PMID: 33910241 DOI: 10.1352/1944-7558-126.3.203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/18/2020] [Indexed: 06/12/2023]
Abstract
Inpatient hospitalizations for ambulatory care sensitive conditions (ACSC) among beneficiaries with and without intellectual and developmental disabilities (IDD) were examined using Medicaid and commercial claims from 2010-2014 in New Hampshire. IDD was defined with International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes using algorithms from the Centers for Medicare and Medicaid Services, and inpatient encounters were identified using the Healthcare Effectiveness Data and Information Set. In adjusted analyses, beneficiaries with IDD had more hospitalizations for ACSC than those without IDD in both insurance groups. Differences in patterns of ACSC prevalence, comorbidities, and hospital admissions between the commercially and Medicaid-insured groups show the value of using all-payer claims data, when possible, to understand health needs and health care utilization of insurance beneficiaries with IDD.
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Affiliation(s)
- Kimberly G Phillips
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
| | - Jeanne S Wishengrad
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
| | - Andrew J Houtenville
- Kimberly G. Phillips, Jeanne S. Wishengrad, and Andrew J. Houtenville, University of New Hampshire
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St John B, Gray M, Malzacher A, Hladik L, Lurie S, Ausderau K. Using photovoice with people with intellectual disability to illuminate definitions of health and factors influencing participation in health promotion. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:866-876. [PMID: 33660422 DOI: 10.1111/jar.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding the daily health experiences of people with intellectual disability is necessary to illuminate factors that may be influencing health and health disparities. The objective of this study is to understand how people with intellectual disability participate in and access health promotion. METHODS Ten adults with intellectual disability engaged in an adapted photovoice study. RESULTS Four themes emerged: Health Is Who We Are; Health is What We Do; Health Is Our Body, Mind, and Place; and Barriers and Facilitators. Participants communicated an understanding of health, a strong identity of themselves as being healthy, and diverse participation in health promotion. Additionally, participants identified specific resources and support necessary to pursue health. Participants' broad description of health aligns with understandings of the social determinants of health. CONCLUSION Participant's holistic view of health and experienced factors of health promotion should inform the development and implementation of inclusive health programming for people with intellectual disability.
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Affiliation(s)
| | - Megan Gray
- University of Wisconsin-Madison, Madison, WI, USA
| | | | - Libby Hladik
- University of Wisconsin-Madison, Madison, WI, USA
| | - Savanna Lurie
- University of Southern California, Los Angeles, CA, USA
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Hartz RM, Butler BL, Natale KR, Williams S, Luiselli JK. Effects of a peer-mediated performance improvement intervention on recording of child well-body checks by educational care-providers. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2021; 25:5-12. [PMID: 31064265 DOI: 10.1177/1744629519847309] [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: 06/09/2023]
Abstract
We report the effects of peer-mediated training as a performance improvement intervention on recording of well-body checks by classroom instructors at a specialized school for children and youth. The instructors were trained as peer mediators and then assumed performance monitoring responsibilities in the classroom. Compared to baseline phases in a withdrawal design, peer-mediation increased recording of well-body checks to near-100% among the instructors. Results of the study document positive training effects on a critical health and wellness objective, support and expand the limited research base concerning the effects of peer-mediated training, suggest further application of such training in human services settings.
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Bogenschutz M, Broda M, Lineberry S, Dinora P, Prohn S. Testing a Wellness Indicators Measure for People with Intellectual and Developmental Disabilities a. DEVELOPMENTAL DISABILITIES NETWORK JOURNAL 2021; 2:85-103. [PMID: 35721389 PMCID: PMC9201682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE People with intellectual and developmental disabilities (IDD) often have health and wellness issues that are not as good as people without disabilities. States are required to monitor health and wellness for people with IDD who use many disability services. However, there are few ways to monitor wellness between states or at different points in time. In this study, we share a new model that states may use to monitor wellness of people with IDD. METHODS We used data from a survey called the National Core Indicators (NCI) to develop this model. First, we developed the model using our state's data. Then, after we found a model that worked well, we tested that model using the National Core Indicators from the entire U.S. RESULTS Our final model worked well in both our state NCI data and the national NCI data. This is important because policies at both levels can affect the services that people with disabilities can use. Our model had three parts: heart health, mental health, and behavioral wellness. These are described more in the paper. We also used statistics to test some factors that might predict outcomes related to heart health, mental health, and behavioral wellness. Age, sex, where someone lives, and level of intellectual disability were all good predictors of all three categories of wellness that we studied. IMPLICATIONS The model of wellness that we developed worked well but should be tested using data from other individual states. It is very important to know about health and wellness right now since the services people with disabilities can use are changing in many states. We think our model can help planners and advocates understand how services affect wellness in a way that is easy to compare from state to state and at different points in time.
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Affiliation(s)
| | | | | | | | - Seb Prohn
- Virginia Commonwealth University, Richmond, VA
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Ervin DA, Hobson-Garcia D. Community Supports and COVID-19: Self-Determination in a Pandemic. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:453-457. [PMID: 33290529 DOI: 10.1352/1934-9556-58.6.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) is impacting people with intellectual and developmental disabilities (IDD) significantly. Early data on the impact of COVID-19 suggests that people with IDD are experiencing more severe health outcomes compared to the general population. In addition to their elevated health risks, people with IDD, like the rest of the population, are struggling with boredom, isolation, and loneliness as they shelter in place. As people with IDD seek a return to their jobs, friends and families, and the activities of their community, community-based provider organizations must strike a difficult balance between actions that are intended to protect the health and safety of people they support and actions that honor people's choices and encourage self-determination. Practical issues that community-based provider organizations must consider when striking the correct balance are discussed, and recommendations on ways to support people with IDD to make informed, self-determined choices during the pandemic are offered.
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Affiliation(s)
- David A Ervin
- David A. Ervin and Donyale Hobson-Garcia, Jewish Foundation for Group Homes
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Hospitalized Adults With Intellectual and Developmental Disabilities: Confronting Challenges. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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