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Dual Diagnosis and Self-Determination: Any Relationship?

Dual Diagnosis and Self-Determination: Any Relationship?. Karen L. Hobden & Barbara W. LeRoy Developmental Disabilities Institute Wayne State University 268-4809 Woodward, Detroit, MI 48202. Dual Diagnosis.

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Dual Diagnosis and Self-Determination: Any Relationship?

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  1. Dual Diagnosis and Self-Determination: Any Relationship? Karen L. Hobden & Barbara W. LeRoy Developmental Disabilities Institute Wayne State University 268-4809 Woodward, Detroit, MI 48202

  2. Dual Diagnosis • Dual Diagnosis: co-occurring intellectual disability and mental health problems (NADD, 2007). • Historically, individuals with intellectual disabilities were assumed to be free from mental health concerns • Recent research has suggested that people with intellectual disabilities may be at an increased risk. (Deb, Thomas, & Bright, 2001)

  3. Assessment of a Dual Diagnosis • Mini PAS-ADD (Prosser & Moss et al., 1998) • A semi-structured interview • No background in psychology needed, but must be trained to administer the interview. • Asks questions of an informant who knows the individual well. • Reasonable validity and reliability.

  4. Mini PAS-ADD - 7 Subscales: • Depression • Anxiety • Expansive Mood Disorder (Bipolar) • Obsessive-Compulsive Disorder • Psychosis • Unspecified Disorder (including Dementia) • Autism

  5. Self-determination • At the core of person-centered planning. • Current best practice model for service delivery • The law in Michigan -- Individuals with intellectual disabilities must be given the opportunity to make choices regarding their needs and goals

  6. Our Research Goals • Evaluate the effectiveness of the Mini PAS-ADD in assessing mental illness in individuals with intellectual disabilities. • Examine the relationship between dual diagnosis and self-determination

  7. MORC • We conducted this research in collaboration with the Macomb Oakland Regional Center (MORC) • MORC serves 1000 adults with mild or moderate intellectual disabilities.

  8. Procedure • The Mini PAS-ADD was administered by a trained interviewer, typically in the informant's home or place of employment. • The interviewers were employees of MORC and were either psychologists or social workers. • The Mini PAS-ADD takes about 20 minutes to administer.

  9. Assessment of Self-determination • 22 Item Scale • Assessing choice making – living arrangements, community involvement, employment/finances • Completed by supports coordinator in collaboration with individual

  10. Self Determination Scale • Living arrangements – amount of choice exercised in terms of where they live, who they live with, what they eat, when they bathe, etc. • Community involvement – do they vote, attend a place of worship regularly, belong to cultural groups, clubs, or social organizations? • Employment/finances– do they have an ATM card, control over their budget, are they employed, do they make minimum-wage or higher?

  11. Our Sample • 231 participants (100 assessed on the Mini PAS-ADD, 151 on the SD Checklist). • 49% female; 51% male • The mean age was 49 (range of 18 to 87) • 89% White; 7% African-American • 86% had a guardian. • 62% had a pre-existing dual diagnosis

  12. Severity of Intellectual disability

  13. Type of Residence

  14. Results – Mini PAS-ADD • 29% had a dual diagnosis according to the Mini PAS-ADD • 4% Depression • 10% Anxiety • 3% Expansive Mood (Bipolar Disorder) • 11% Obsessive-Compulsive • 10% Psychosis • 5% Unspecified Disorder • 4% Autism

  15. Comparison of Diagnoses

  16. Mini PAS-ADD vs Diagnosis on File

  17. Pre-existing Diagnosis, but No Mini PAS-ADD: Why? • 57% taking psychotropic medication that could have reduced or eliminated symptoms. • Individuals’ symptoms may have stabilized over time • Some individuals may have been misdiagnosed.

  18. Diagnostic Match by Psychotropic Medication

  19. Results - Self-Determination by Diagnosis

  20. Self-Determination Rankings for Persons with Dual Diagnosis - Top Third

  21. Self-Determination Rankings for Persons with Dual Diagnosis - Middle Third

  22. Self-Determination Rankings for Persons with Dual Diagnosis - Bottom Third

  23. Conclusions - Mini PAS-ADD • Mini PAS-ADD is a quick, easy-to-use screen for psychiatric disorders in individuals with intellectual disabilities. • May be most effective in individuals not currently on psychotropic medication.

  24. Conclusions – Self Determination • No one is very self-determined • No overall differences by type of diagnosis • Some indication that people with a dual diagnosis have less choice in whether they: • Vote (χ²=6.42, p < 05) • Join social organizations or clubs (χ²=4.52, p < 05) • See family members regularly (χ²=10.47, p < 01) • Have their own phone (χ²=5.81, p < 05)

  25. Contact Info • Karen Hobden • email: khobden@wayne.edu • phone: 313-577-7980 • website http://ddi.wayne.edu/

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