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 “Overshadowing” Application of DSM-IV Disability Masks Criteria Behaviors Misunderstood Misinterpretation of Symptoms

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.