1. Idaho Real Choices: Individuals with Disability Increasing Community Integration Debra Larsen, Ph.D Kelly Davis, M.S. B. Hudnall Stamm, Ph.D.

2. Unique Characteristics of IRC Model of Community Integration (Objective 1) Participants Model of Participation Assessment Based Integration Planning and Implementation Monthly Data Collection and Telehealth Use

3. Participants N=23 57% female & 43% male Recruited by public advertisement, word of mouth and flyers Participation ranged from 7-15 months Age 6 to age 78 (mean=39; SD=22.8). Primary disabilities included –developmental disability/mental retardation (20%) –mental illness (35%) –physical impairment (45%). All adult participants endorsed having experienced at least 1 and up to 14 potential traumatic stressor

4. Model of Participation

5. Assessment Assessment Strategy and Content Comprehensive Nature of Life Domains (Objective 2) Strength-based Approach Specific Assessment Tools –Pragmatic Problem Solving Semi-structured Interview (PPS) –Community Integration Questionnaire (CIQ) –Life Status Review (LSR) –Community Experiences Survey (CES)—Medicaid/Medicare only –Beck Depression Inventory (BDI) –SF-12 Health Survey –Child Behavior Checklist (CBCL) –Stressful Life Experience Screen (SLES)

6. Integration Planning & Implementation Consumer Driven Approach Consumer Identified Integration Priorities Based on strengths and needs identified in assessment Self-Reliance Model: Plan specifies responsibilities –Specific responsibilities for participants & case manager

7. Monthly Data Collection Telehealth Support –Also consumer driven—utilized consumer chosen mode of communication-video phone, cell, or land line –Video Phones provided free of charge, preferred land line and cell phones –Cell phone primary with participants and case manager use of cell phone Process of Integration Quantity and Quality of Support –Regardless of mode, improvement across time & satisfaction with use of telehealth.

8. Quality of Life Differences & Change Patterns During Integration Integration improves quality of life Trauma and disability Adult males with physical disabilities and depression risk Not just one disability Disabilities and the family support system

9. Integration Improves Quality of Life Integration is especially potent in decreasing the negative impact of disability on emotional functioning This is true regardless of the disability type experienced Physical deterioration is related to age rather than disability type

10. Integration Improves Quality of Life SF-12 Mental Component Scores Across Participation

11. Integration Improves Quality of Life SF-12 Physical Component Scores Across Participation

12. Trauma and Disability Individuals with disabilities reported 3 times the exposure to potentially traumatic events Integration activities need to take into account potential trauma history and risks Reduced traumatic stress over time may be due to treatment or to integration effects…it is unclear Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack

13. Trauma and Disability Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Now Close Now Baseline Then Baseline 0 1 2 3 4 5 6 7 8 Natural disaster Man-made disaster Accident or injury Chemical/radiation Illness Death child/spouse Death of friend Kidnapping/hostage Terrorism/torture War Handled the dead Resp. for death/injury Weapon attack Child spank/hit Adult hit/choked Witnessed violence Child sexual contact Adult sexual assault Witness sex assault Other event Accident or injury Kidnapping/hostage Handled the dead Weapon attack Stressful Life Experience Screening Scores Across Participation

14. Adult Males with Physical Disabilities & Depression Risk Beck Depression Inventory-II Scores (means)

15. Adult Males with Physical Disabilities & Depression Risk SF-12 Mental Component Scores

16. Adult Males with Physical Disabilities & Depression Risk SF -12 Physical 2-way Interaction (Sex x Disability) Males reported great physical impairment Gender role implications possibly linked to depression

17. Not Just One Disability Of the 23 participants, 17 (75%) reported a secondary disability. This does not include secondary disabilities that are of a similar category (e.g., more than one physically disabling condition). 0 10 20 30 40 50 DD/MRMental IllnessPhysical Primary Secondary

18. Disabilities & the Family Support System Of the 45 family members (parents, spouses & siblings) currently residing with participants: – 27 (60%) reportedly experience at least one primary disability –7/45 (15%) also have a secondary disability of a different category.

19. Disabilities & the Family Support System

20. Quality of Life Differences & Change Patterns During Integration Integration improves quality of life Trauma and disability Adult males with physical disabilities and depression risk Not just one disability Disabilities and the family support system

21. Funding Credits This project is supported by the Center for Medicaid and Medicare Services (#18-P-91537/0 and #11-P-92045/0) through the Idaho Department of Health and Welfare and, in part, by grant # 1 D1B TM 00042-01 from the Department of Health and Human Services (DHHS) Health Resources and Services Administration, Office for the Advancement of Telehealth. The contents are the sole responsibility of the authors and do not necessarily represent the official views of the Center for Medicaid and Medicare or DHHS. Debra Larsen: larsdeb2@isu.edularsdeb2@isu.edu Kelly Davis: davikel2@isu.edudavikel2@isu.edu www.isu.edu/irh www.isu.edu/~bhstamm