challenges of a “dual diagnosis” august 2012 advocacydenver
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CHALLENGES OF A “DUAL DIAGNOSIS” AUGUST 2012 www.advocacydenver.org . INTRODUCTION. Co-Occurring Conditions Intellectual Disability and Psychiatric Disorders ‘Most Vulnerable Population’ High Risk Need for Integrated Treatment. PRESENTERS:. Catherine Strode, MPA Health Care Advocacy - PowerPoint PPT PresentationTRANSCRIPT
CHALLENGES OF A “DUAL DIAGNOSIS”
AUGUST 2012
www.advocacydenver.org
INTRODUCTIONCo-Occurring ConditionsIntellectual Disability and Psychiatric
Disorders‘Most Vulnerable Population’High RiskNeed for Integrated Treatment
PRESENTERS:
Catherine Strode, MPAHealth Care Advocacy Program and Outreach Coordinator
Sarah Avrin, Ph.D., DirectorAurora Center for Life Skills
DUAL DIAGNOSIS DEFINITIONSCo-existing ConditionsSubstance Abuse and Mental IllnessIntellectual Disability and Mental Illness “Dually Diagnosed”
INCIDENCE Three to Four Times Higher Than General
Population30 to 40% of ID Population Rate May be UnderestimatedSymptoms Misinterpreted‘Overshadowed’ By Intellectual Disability
COMMON MYTHS
All Behavior Due to Disability Psychotherapy Ineffective Medication Is ONLY Treatment
RISK FACTORS
Individuals With ID Are Highly VulnerableImpaired Cognition, Impaired
CommunicationOrganic Brain DamageChromosomal PredispositionPsychosocial Factors
PREVALENCE OF MENTAL DISORDERS
Anxiety Disorders Most CommonMore Schizophrenia Spectrum DisordersMore Phobic DisordersPresentation At Younger Age (Morgan, Leonard,
Bourke, Jablensky, BJPsych 2012)
CASE SCENARIO Medicaid/SSDI Client – 21 years oldFetal Alcohol Syndrome, Intellectual
Disability (IQ 55)Anxiety Disorder and Schizoaffective
DisorderPhysical AggressionRemoved From HomeMultiple Hospitalizations (Psych Unit)
BEHAVORIAL CRISIS
Verbal OutburstsActs of Physical AggressionSelf-InjuryProperty DestructionImpulsive Acts
HUMAN COSTS
Emotional TraumaLoss of OpportunityLoss of Potential Family Disruption
DIAGNOSIS IS DIFFICULT
• “Overshadowing” • Application of DSM-
IV• Disability Masks
Criteria• Behaviors
Misunderstood
Misinterpretation of Symptoms
COMMUNICATION CHALLENGES
VERBAL LIMITATIONS
ACCESS TO CARE CHALLENGESProviders Unfamiliar With Needs of
Individuals With IDProvider Clinics Inappropriate SettingsProviders Need Information From CaregiversProviders Don’t Accept Medicaid
SYSTEM SILOS
Separate SystemsDifferent TrainingDifferent PerspectivesBehavioral Management VS. Mental Illness
Treatment
SERVICE NEEDSCoordinated CareIntegration of Clinical and BehavioralCollaboration of ProvidersMore Trained Emergency Personnel
TREATMENT APPROACHESPsychiatric ServicesCounselingBehavior TherapiesFamily TreatmentCase ManagementPsychotropic medications
GAPS IN “DUAL DIAGNOSIS” TREATMENT
Insurance CoverageLack of Interagency ApproachLack of Short Term Care BedsLack of Short Term FacilitiesLack of Provider Education
PROFILE OF INTEGRATED TREATMENT
Comprehensive ApproachMultiple InterventionsInterdisciplinary team
AURORA CENTER FOR LIFE SKILLS
Team ApproachWide Range of ServicesPsychology, Case Management, Vocational,
Psychiatric Supports
QUESTIONS?Ask Dr. Sarah Avrin, Director Aurora Center for Life Skills
RESOURCESThe National Association for People With Dual Diagnosiswww.thenadd.org1-800-331-5362Research:Bhaumik, S., Tyrer, F., McGrother, C., & Ganghadaran, S.
(2008). Psychiatric service use and psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 52, 986-995.
Deb, S., Thomas, M., & Bright, C. (2001). Mental disorder in adults with intellectual disability. Journal of Intellectual Disability Research, 45, 495-505.
RESOURCES (CONTINUED) (Florida Developmental Disabilities Council, 2010).Morgan, V., Leonard, H., Bourke, J., & Jablensky, A. (2008).
Intellectual disability co-occurring with schizophrenia and other psychiatric illness: population-based study. The British Journal of Psychiatry, 193, 364-372.
(New Jersey Department of Human Services Dual Diagnosis Task Force Report, 2008)
Quintero, M., & Flick, S. (2010). Dual Diagnosis: When mental illness and developmental disabilities co-occur. Social Work Today, Sept./Oct. Issue.
Shook, N. (2005.) The Other Dual Diagnosis. Wisconsin Council on Developmental Disabilities.