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CHALLENGES OF A “DUAL DIAGNOSIS” AUGUST 2012 advocacydenver

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

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CHALLENGES OF A “DUAL DIAGNOSIS” AUGUST 2012 advocacydenver

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  1. CHALLENGES OF A “DUAL DIAGNOSIS” AUGUST 2012 www.advocacydenver.org

  2. INTRODUCTION • Co-Occurring Conditions • Intellectual Disability and Psychiatric Disorders • ‘Most Vulnerable Population’ • High Risk • Need for Integrated Treatment

  3. PRESENTERS: Catherine Strode, MPA Health Care Advocacy Program and Outreach Coordinator Sarah Avrin, Ph.D., Director Aurora Center for Life Skills

  4. DUAL DIAGNOSIS DEFINITIONS • Co-existing Conditions • Substance Abuse and Mental Illness • Intellectual Disability and Mental Illness • “Dually Diagnosed”

  5. INCIDENCE • Three to Four Times Higher Than General Population • 30 to 40% of ID Population • Rate May be Underestimated • Symptoms Misinterpreted • ‘Overshadowed’ By Intellectual Disability

  6. COMMON MYTHS • All Behavior Due to Disability • Psychotherapy Ineffective • Medication Is ONLY Treatment

  7. RISK FACTORS • Individuals With ID Are Highly Vulnerable • Impaired Cognition, Impaired Communication • Organic Brain Damage • Chromosomal Predisposition • Psychosocial Factors

  8. PREVALENCE OF MENTAL DISORDERS • Anxiety Disorders Most Common • More Schizophrenia Spectrum Disorders • More Phobic Disorders • Presentation At Younger Age (Morgan, Leonard, Bourke, Jablensky, BJPsych 2012)

  9. CASE SCENARIO • Medicaid/SSDI Client – 21 years old • Fetal Alcohol Syndrome, Intellectual Disability • (IQ 55) • Anxiety Disorder and Schizoaffective Disorder • Physical Aggression • Removed From Home • Multiple Hospitalizations (Psych Unit)

  10. BEHAVORIAL CRISIS • Verbal Outbursts • Acts of Physical Aggression • Self-Injury • Property Destruction • Impulsive Acts

  11. HUMAN COSTS • Emotional Trauma • Loss of Opportunity • Loss of Potential • Family Disruption

  12. DIAGNOSIS IS DIFFICULT Misinterpretation of Symptoms • “Overshadowing” • Application of DSM-IV • Disability Masks Criteria • Behaviors Misunderstood

  13. COMMUNICATION CHALLENGES • VERBAL LIMITATIONS

  14. ACCESS TO CARE CHALLENGES • Providers Unfamiliar With Needs of Individuals With ID • Provider Clinics Inappropriate Settings • Providers Need Information From Caregivers • Providers Don’t Accept Medicaid

  15. SYSTEM SILOS • Separate Systems • Different Training • Different Perspectives • Behavioral Management VS. Mental Illness Treatment

  16. SERVICE NEEDS • Coordinated Care • Integration of Clinical and Behavioral • Collaboration of Providers • More Trained Emergency Personnel

  17. TREATMENT APPROACHES • Psychiatric Services • Counseling • Behavior Therapies • Family Treatment • Case Management • Psychotropic medications

  18. GAPS IN “DUAL DIAGNOSIS” TREATMENT • Insurance Coverage • Lack of Interagency Approach • Lack of Short Term Care Beds • Lack of Short Term Facilities • Lack of Provider Education

  19. PROFILE OF INTEGRATED TREATMENT • Comprehensive Approach • Multiple Interventions • Interdisciplinary team

  20. AURORA CENTER FOR LIFE SKILLS • Team Approach • Wide Range of Services • Psychology, Case Management, Vocational, Psychiatric Supports

  21. QUESTIONS? • Ask Dr. Sarah Avrin, Director Aurora Center for Life Skills

  22. RESOURCES The National Association for People With Dual Diagnosis www.thenadd.org 1-800-331-5362 Research: • 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.

  23. 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.

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