1. Health, Social, and Emotional Well-Being of Adults with Intellectual and Psychiatric Disabilities Ruth I. Freedman Boston University School of Social Work Sarah Taub & Giusi Chiri Human Services Research Institute AAMR Annual Meeting, Philadelphia, PA June 3, 2004

2. Background Emotional and behavioral disorders and mental illness are “…among the most common and least understood aspects of health and MR…” (Surgeon General’s Report, 2002) Emotional and behavioral disorders and mental illness are “…among the most common and least understood aspects of health and MR…” (Surgeon General’s Report, 2002) Prevalence of dual diagnosis (developmental disability and psychiatric disabilities/mental disorders) ranges from 10 – 40% Prevalence of dual diagnosis (developmental disability and psychiatric disabilities/mental disorders) ranges from 10 – 40% Prevalence of psychotropic medication usage among persons with DD ranges from 30 – 50% (varies by type of residence) Prevalence of psychotropic medication usage among persons with DD ranges from 30 – 50% (varies by type of residence)

3. Background (continued) Dual diagnosis is often associated with the presence of behavioral challenges Dual diagnosis is often associated with the presence of behavioral challenges Presence of MR frequently “overshadows” the symptoms of mental disorders (Reiss & Szysko, 1983) Presence of MR frequently “overshadows” the symptoms of mental disorders (Reiss & Szysko, 1983) Persons with dual diagnosis face difficulties finding appropriate services; often get caught in-between two service systems Persons with dual diagnosis face difficulties finding appropriate services; often get caught in-between two service systems

4. Prior Research Prior research primarily limited to: Prior research primarily limited to: –small, non-probability samples –residents in institutional facilities –data obtained from administrative records Limited empirical data about: Limited empirical data about: –Community outcomes –Services and supports

5. NCI Analysis NCI analysis based upon: NCI analysis based upon: –Large random sample –Cross-state data (17 states) –Respondents in community and institutional settings –Data obtained from consumers and proxies on physical and behavioral health, services and supports, community outcomes

6. Research Questions Do persons with and without dual diagnosis differ in terms of: Do persons with and without dual diagnosis differ in terms of: –Demographic and background characteristics –Health and behavioral status –Services and supports received –Social and emotional well-being What factors predict whether or not a person: What factors predict whether or not a person: –has a dual diagnosis –receives clinical services –uses psychotropic medications

7. Type of Diagnosis (n=8501) n=6,048 71% n=2,453 29% MR onlyDual dx

8. Age Groups (n=8350)

9. Level of MR (n=8501)

10. Type of Residence (n=7805)

11. # Additional Disabilities (n=8501)

12. Functional Characteristics

13. Takes Psychotropic Medications

14. Type of Psychotropic Medication

15. Presence of Problem Behavior

16. Frequency of Health Exams

17. Services & Supports Received

18. Vocational Supports Received

19. Social & Emotional Well-Being

22. Conclusion/Questions Dual diagnosis more likely among less severely disabled – in terms of MR level, additional disabilities, and verbal abilities Dual diagnosis more likely among less severely disabled – in terms of MR level, additional disabilities, and verbal abilities -Dual diagnosis is more difficult to assess with persons with severe disabilities -Does “diagnostic overshadowing” play a role? People living in specialized facilities have highest odds of dual diagnosis, yet persons with dual diagnosis are also more likely to be mildly disabled People living in specialized facilities have highest odds of dual diagnosis, yet persons with dual diagnosis are also more likely to be mildly disabled -Why are mildly disabled persons with dual diagnosis placed in specialized facilities?

23. Conclusion/Questions (continued) Presence of behavior problems is strongly linked to dual diagnosis Presence of behavior problems is strongly linked to dual diagnosis - Do behavior problems associated with dual diagnosis influence likelihood of placement in specialized facilities? People living in family/relative homes are least likely to have a dual diagnosis People living in family/relative homes are least likely to have a dual diagnosis - Are families more likely to seek out-of-home placements when a family member has a dual diagnosis? - Are families less likely to recognize/identify psychiatric problems in family members with MR?

24. Conclusion/Questions (continued) Dual diagnosis is a strong predictor of both use of clinical services and use of psychotropic medications Dual diagnosis is a strong predictor of both use of clinical services and use of psychotropic medications - People with dual diagnosis are 5 times more likely to use clinical services than persons without dual diagnosis - People with dual diagnosis are 11 times more likely to use psychotropic medications than persons without dual diagnosis

25. Conclusion/Questions (continued) Our data analysis is not based upon a causal model Our data analysis is not based upon a causal model - Findings show complex relationships between sets of variables - Dual diagnosis, problem behaviors, and type of living setting are strongly associated with use of clinical services and psychotropic medications - Does having a dual diagnosis influence these other variables or do these other variables influence whether one is dually diagnosed?