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Health, Social, and Emotional Well-Being of Adults with Intellectual and Psychiatric Disabilities

Health, Social, and Emotional Well-Being of Adults with Intellectual and Psychiatric Disabilities. Ruth I. Freedman Boston University School of Social Work Sarah Taub & Giusi Chiri Human Services Research Institute AAMR Annual Meeting, Philadelphia, PA June 3, 2004. Background.

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Health, Social, and Emotional Well-Being of Adults with Intellectual and Psychiatric Disabilities

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  1. Health, Social, and Emotional Well-Being of Adults with Intellectual and Psychiatric Disabilities Ruth I. Freedman Boston University School of Social Work Sarah Taub & Giusi Chiri Human Services Research InstituteAAMR Annual Meeting, Philadelphia, PAJune 3, 2004

  2. Background • Emotional and behavioral disorders and mental illness are “…among the most common and least understood aspects of health and MR…” (Surgeon General’s Report, 2002) • Prevalence of dual diagnosis (developmental disability and psychiatric disabilities/mental disorders) ranges from 10 – 40% • Prevalence of psychotropic medication usage among persons with DD ranges from 30 – 50% (varies by type of residence)

  3. Background (continued) • Dual diagnosis is often associated with the presence of behavioral challenges • Presence of MR frequently “overshadows” the symptoms of mental disorders (Reiss & Szysko, 1983) • Persons with dual diagnosis face difficulties finding appropriate services; often get caught in-between two service systems

  4. Prior Research • Prior research primarily limited to: • small, non-probability samples • residents in institutional facilities • data obtained from administrative records • Limited empirical data about: • Community outcomes • Services and supports

  5. NCI Analysis • NCI analysis based upon: • Large random sample • Cross-state data (17 states) • Respondents in community and institutional settings • Data obtained from consumers and proxies on physical and behavioral health, services and supports, community outcomes

  6. Research Questions • Do persons with and without dual diagnosis differ in terms of: • Demographic and background characteristics • Health and behavioral status • Services and supports received • Social and emotional well-being • What factors predict whether or not a person: • has a dual diagnosis • receives clinical services • uses psychotropic medications

  7. MR only Dual dx n=2,453 29% n=6,048 71% Type of Diagnosis (n=8501)

  8. Age Groups (n=8350)

  9. Level of MR (n=8501)

  10. Type of Residence (n=7805)

  11. # Additional Disabilities (n=8501)

  12. Functional Characteristics

  13. Takes Psychotropic Medications

  14. Type of Psychotropic Medication

  15. Presence of Problem Behavior

  16. Frequency of Health Exams

  17. Services & Supports Received

  18. Vocational Supports Received

  19. Social & Emotional Well-Being

  20. Conclusion/Questions • Dual diagnosis more likely among less severely disabled – in terms of MR level, additional disabilities, and verbal abilities - Dual diagnosis is more difficult to assess with persons with severe disabilities - Does “diagnostic overshadowing” play a role? • People living in specialized facilities have highest odds of dual diagnosis, yet persons with dual diagnosis are also more likely to be mildly disabled - Why are mildly disabled persons with dual diagnosis placed in specialized facilities?

  21. Conclusion/Questions (continued) • Presence of behavior problems is strongly linked to dual diagnosis - Do behavior problems associated with dual diagnosis influence likelihood of placement in specialized facilities? • People living in family/relative homes are least likely to have a dual diagnosis - Are families more likely to seek out-of-home placements when a family member has a dual diagnosis? - Are families less likely to recognize/identify psychiatric problems in family members with MR?

  22. Conclusion/Questions (continued) • Dual diagnosis is a strong predictor of both use of clinical services and use of psychotropic medications - People with dual diagnosis are 5 times more likely to use clinical services than persons without dual diagnosis - People with dual diagnosis are 11 times more likely to use psychotropic medications than persons without dual diagnosis

  23. Conclusion/Questions (continued) • Our data analysis is not based upon a causal model - Findings show complex relationships between sets of variables - Dual diagnosis, problem behaviors, and type of living setting are strongly associated with use of clinical services and psychotropic medications - Does having a dual diagnosis influence these other variables or do these other variables influence whether one is dually diagnosed?

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