Supporting Individuals with Developmental Disabilities and Mental Health
Supporting Individuals with Developmental Disabilities and Mental Health Needs and Behavioral Challenges Deborah M Spitalnik Professor of Pediatrics, RWJMS Executive Director, The Boggs Center Director, NJLEND Rutgers, The State University of New Jersey
The Boggs Center on Developmental Disabilities • New Jersey’s University Center for Excellence in Developmental Disabilities Education, Research and Service – The Administration on Intellectual and Developmental Disabilities Administration on Community Living, US Department of Health & Human Services • New Jersey’s Leadership Education in Neurodevelopmental Disabilities Program- NJLEND – The Bureau of Maternal and Child Health Services Resource Administration US Department of Health & Human Services 2
The Boggs Center on Developmental Disabilities Grants and Contracts with State Agencies, Foundations • Division of Developmental Disabilities – Children’s Placement Enhancement Project (CPEP) – Community Positive Behavior Supports – Training and Technical Assistance • Children’s System of Care – Under a subcontract with University Behavioral Health – Training and Intensive Technical Assistance • Department of Education – Positive Behavior Support in Schools (PBSIS)
Developmental Disabilities • Early onset &Persist though out Life Span • Life Span conditions – For Individual – For Family • Complexity – Disabilities & associated conditions – Services and Systems
Developmental Disabilities • • Umbrella term Concept: Political/advocacy origin Administrative definition Underlying neurological impairment Functional needs As a “condition” As a service eligibility
New Jersey Definition of Developmental Disabilities (As adopted in P. L. 1985, c. 145, s. 3) “Developmental Disability” means a severe, chronic disability of a person which: 1) is attributable to a mental or physical impairment or combination of mental or physical impairments; 2) is manifest before age 22; 3) is likely to continue indefinitely;
New Jersey Definition of Developmental Disabilities • • • 4) Results in substantial functional limitations in three or more of the following areas of major life activity, self-care, receptive and expressive language, learning, mobility, self-direction and capacity for independent living or economic self sufficiency; and
New Jersey Definition of Developmental Disabilities 5) reflects the need for a combination and sequence of special interdisciplinary or generic care, treatment or other services which are of life-long or extended duration and are individually planned and coordinated.
“Neurological Impairment” & Other Criteria • • • ID Autism Spectrum Disorders Epilepsy Cerebral Palsy Spina Bifida TBI
Three Part Challenge: Disability Dual Diagnosis Behavior 3 Behavior & MI Mental Illness Smith, P.
Historically • • Didn’t diagnose Individuals with ID/DD with MI No such thing as co-occurring disorders All difficulties attributed to disability Established two different systems of care – Government and insurance services – Education and training • Now recognize – ID/DD actually at risk for higher rates of MI – Not everyone with ID/DD shows behavior problems or MI symptoms Smith, P.
Biologic al Risk Factors Family Social for people with I/DD Physiolog ical Adapted from Engel 1980 12
Behavioral Challenges • Traditionally interpreted as a sequelae of a developmental disability – Behavior assessment and planning common for disability supports • More recently have been listed as symptoms for a psychiatric disorder • Maybe demonstrated by people who don’t have a disability and aren’t diagnosed 13
Three Part Challenge: Disability Dual Diagnosis Behavior 3 Behavior & MI Mental Illness Smith, P.
DM-ID 2 Companion Manual to DSM 5 • Presentation of symptoms in IDD • Supplement to DSM 5 to assist in diagnosis of DD/ID • http: //www. thenadd. org/ 15
• Journal of Mental Health Research in Intellectual Disabilities – An interdisciplinary research journal reporting original scientific and scholarly contributions to advance knowledge about mental health issues among persons with intellectual and developmental disabilities • NADD Press: publishing books and educational products concerning individuals with intellectual/developmental disabilities co-occurring with mental illness, topics include: – – – Diagnosis and Assessment Counseling and Therapy Psychopharmacology Social and Sexual Issues Autism Spectrum Disorder
Applied Behavior Analysis • Discipline initiated by Skinner to apply principles of conditioning to the modification of socially significant human behavior • A systematic approach for influencing socially important behavior through the identification of reliably related environmental variables and the production of behavior change techniques that make use of those findings 17
ABA Services • Practitioners of behavior analysis provide services consistent with the dimensions of ABA. Common services may include, but are not limited to: – – Conducting behavioral assessments Analyzing data Writing and revising behavior-analytic plans Training others to implement components of behavior plans – overseeing the implementation of behavior plans 18
Positive Behavior Support (PBS) • Where did it come from? – Response to debate over aversive consequence for self-injurious behavior • What it is: – Research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person's environment – PBS combines: • • Valued Outcomes Behavioral and Biomedical Science Validated Procedures Systems Change
Three Part Challenge: Disability Dual Diagnosis Behavior 3 Behavior & MI Mental Illness Smith, P.
Summary • For Intellectual or Developmental Disability – adaptive supports, functional accommodations, specialized teaching and inter-disciplinary planning • For diagnosed Mental Illness – appropriate treatment based on the diagnosis • For Behavior challenges – a behavior support plan based on Functional Assessment, developed using Positive Behavioral Supports, including application of Applied Behavior Analysis principles and technology • For people with two or all three – an integrated approach that adapts supports in each domain to the needs and impact of functioning or symptoms in the other domains
Autism Spectrum Services under EPSDT • Outside of the Autism Spectrum Disorder (ASD) Pilot within the Comprehensive Medicaid Waiver, NJ Family Care had not traditionally covered services for youth with Autism • CMS- July 2014 - federal directive • Autism services part of EPSDT • Equity for children on Medicaid with ASD • Requiring a Change in NJ Medicaid State Plan • Proposed NJ State Plan Amendment “SPA” process
Questions?
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