Clinical utility of a hybrid secondary and relapse prevention program in adults with mild intellectual disability in community residential and day habilitation settings.

BACKGROUND: Despite evidence that standard substance use disorder (SUD) treatment may be less effective in people with intellectual disability (ID), there is an absence of appropriate clinical tools with which to support them. OBJECTIVES: This study examined the clinical utility of an alcohol and other drug refusal skills intervention designed to be cognitively accessible to adults with ID METHODS: Thirty individuals at high risk for or in recovery from a SUD in developmental disability services (DDS) community residential and day habilitation settings participated in the two-week refusal skills group. Measures included pretest versus posttest improvement in refusal skill competency and baseline performance on a standardized verbal learning test. RESULTS: There was a strong effect for refusal skill acquisition (p < .001); and the magnitude of skill acquisition was predicted by group attendance (p < .001) and not by individual differences in verbal learning ability (p = .074) or efficiency (p = .35). CONCLUSIONS: The Refusal Skills Group is developmentally appropriate for people with mild ID in that: (1) they can learn and demonstrate refusal skills and (2) their skill acquisition is predicted more strongly by exposure to the intervention than by individual differences in learning characteristics. Delivering refusal skills in DDS settings familiar to clients increased their access to services and minimized disruption to their usual routines and schedules.

End-of-life trends and patterns among children in the US foster care system: 2005-2015.

Drawing on national, longitudinal Adoption and Foster Care Analysis, and Reporting System data (2005-2015), demographic, health, foster care, and geographic characteristics of decedents (N = 3653) aged 1-17 years were examined. On average, decedents were 6 years old, the highest proportion died as infants, and experienced significant trauma in their short lives either through maltreatment or exposure to parental substance use. A noted increase in Medicaid coverage among decedents over time suggests critical access to concurrent treatment and hospice care, but this is unavailable to children with private insurance. This study has policy implications related to the 2010 Affordable Care Act.

Serious Illness and End-of-Life Quality for US Foster Children: A National Study.

BACKGROUND:: Of the nearly 500 000 children in foster care, several hundred children die each year. Their quality of life at end of life is a matter of their foster care experience. OBJECTIVES:: The purpose of this study was to investigate whether serious illness was associated with foster care placement outcomes. METHODS:: US foster care data from 2005 to 2015 were used. Children who were younger than 18 years with residence in the United States were included. Serious illness (ie, physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Two foster care placement outcomes were created (ie, type of placement, placement instability). Using multinomial and logistic regressions, the influence of serious illness on placement outcomes was evaluated while controlling for demographic, geographic, prior trauma, and foster care support characteristics. RESULTS:: Fifty-seven percent of the children were placed with nonrelatives, 27% in group homes/institutions, and 17% with relatives. Twenty-eight percent experienced placement instability. Serious illness was significantly associated with nonrelative (relative risk ratio [RRR] = 1.97; 95% confidence interval [CI] = 1.58-2.45) and group home/institution placement (RRR = 2.67; 95% CI = 2.09-3.40). Serious illness was not significantly related to placement instability. Children with serious illness were no more likely than their peers to experience multiple foster care placements. CONCLUSIONS:: Foster care youth at end of life were more likely to be placed with nonrelatives or in group homes/institutions. They also did not experience the disruption and stress of being moved to multiple foster homes while seriously ill.

Prior Trauma Exposure and Serious Illness at End of Life: A National Study of Children in the U.S. Foster Care System From 2005 to 2015.

CONTEXT: Children in foster care suffer with serious illness at end of life. However, the relationship between prior trauma exposure and serious illness has received little empirical attention. OBJECTIVES: The objectives were to examine the prevalence and type of trauma exposure and investigate the relationship between prior trauma and serious illness among foster children at end of life. METHODS: We used national longitudinal foster care data. We included children who were younger than 18 years with residence in the U.S. Serious illness (i.e., physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Three measures of prior trauma exposure (i.e., maltreatment, drug/alcohol exposure, psychosocial stressors) were created. Using multivariate logistic regressions, we evaluated the influence of prior trauma on serious illness at end of life, while controlling for demographic, geographic, and foster care support characteristics. RESULTS: Sixty-eight percent of children experienced maltreatment, 28% exposure to parental drug/alcohol misuse, and 39% psychosocial stressors before entering foster care. Maltreatment was positively associated with physical health and developmental disabilities, whereas parental drug/alcohol exposure was inversely related to developmental disabilities. Psychosocial stressors contributed to the prediction of poor physical, mental, and developmental health. CONCLUSION: These findings suggest that trauma-informed end-of-life care may be a critical need among children in foster care with serious illness. Future directions are discussed, including collaboration between end-of-life clinicians and social service workers and the importance of future research to understand and improve the quality of health at end of life for this underserved population.

Foster Care Outcomes for Children With Intellectual Disability.

The promotion of speedy, permanent outcomes for foster children is a central child welfare policy goal. However, while children with intellectual disability (ID) are at greater risk for child welfare involvement, little is known about their case outcomes. This cross-sectional national study explores between-group foster care outcomes. Foster children with intellectual disability were more likely to have experienced an adoption disruption or dissolution but less likely to be reunified with a parent, primary caretaker or other family member. Implications for interagency collaboration in support of pre and post-foster care discharge support services are discussed.

Disparities in Substance Abuse Treatment Utilization Among Women with Intellectual Disability.

Despite concerns about health disparities among women with intellectual disabilities, little is known about substance abuse treatment access in this population. Using standardized performance measures, treatment initiation and engagement were examined retrospectively for women aged 18 to 64 (N = 3,752), men with (N = 5,732) and women without intellectual disability (N = 493,446). Logistic regression models of utilization were conducted. Women in the sample were less likely than men in the sample or women without intellectual disability to utilize treatment, suggesting both gender-related and disability-related barriers. Policy and practice implications for improving the health and welfare of women with intellectual disabilities are discussed.

Part of the job? Workplace violence in Massachusetts social service agencies.

Workplace violence is a serious and surprisingly understudied occupational hazard in social service settings. The authors of this study conducted an anonymous, Internet-based survey of Massachusetts social service agencies to estimate the incidence of physical assault and verbal threat of violence in social service agencies, understand how social service agencies collect data on workplace violence, and identify disparities in who is at risk in terms of staff education and training level and the work setting. The study gathered general descriptions of each agency and compiled incidence data on workplace violence that were collected by agencies in fiscal year 2009. The key findings of this descriptive study showed high rates of workplace violence against social services providers and a pattern of risk disparity, with significantly more risk for direct care versus clinical staff. These results are based on data routinely collected by social service agencies that typically remain unexamined. A research agenda that is sensitive to potential occupational health disparities and focuses on maximizing workplace safety in social services is needed.

Adults with dual eligibility for Medicaid and Medicare: access to substance abuse treatment.

Access to substance abuse treatment is a noted concern for people with disabilities. Although much is known about elders with dual eligibility for Medicaid and Medicare regarding any care utilization and expenditures, little is known about their younger counterparts and how substance abuse might contribute. Drawing on national Medicaid claims, treatment utilization was explored for adults with and without dual eligibility for Medicare. People with dual eligibility were less likely to both initiate and engage in treatment as compared to those without dual eligibility. Implications relate to how existing systems provide substance abuse treatment to people with disabilities.

Child welfare-involved youth with intellectual disabilities: pathways into and placements in foster care.

Existing literature suggests that youth with intellectual disabilities are at increased risk for child maltreatment. Little is known about youth with intellectual disabilities who are supervised by child welfare authorities or living in foster care. Reasons for child welfare system involvement and placement types are explored. In this cross-sectional exploratory study, we drew on data from the Adoption and Foster Care Reporting System (AFCARS) for youth in 46 states, the District of Columbia, and Puerto Rico. A sample of 17,714 youth with intellectual disabilities and a comparison group (n  =  655,536) were identified for 1999. Findings have implications for preventing the removal of youth from caregivers and the promotion of community inclusion of foster youth while in foster care.

Demographic and clinical characteristics of people with intellectual disabilities with and without substance abuse disorders in a Medicaid population.

Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.

Medicaid-covered alcohol and drug treatment use among people with intellectual disabilities: evidence of disparities.

For some, community inclusion facilitates access to alcohol and drugs and, therefore, the potential for developing substance abuse disorders. However, little is known about substance abuse treatment use among people with intellectual disabilities. Using standardized performance measures, substance abuse treatment utilization was examined for Medicaid-covered people with intellectual disabilities and substance abuse (N=9,484) versus people without intellectual disabilities (N=915,070). The sociobehavioral model of healthcare use guides multivariate logistic regression analyses of substance abuse treatment utilization patterns, revealing disability-related disparities. Factors associated with utilization included being non-White, living in a nonurban area, having a serious mental illness, and living in a state with a generous Medicaid plan for substance abuse treatment. Implications relate to health policy, service delivery patterns, and the need for cross-system collaboration in the use of integrated treatment approaches.

Disparities in access to substance abuse treatment among people with intellectual disabilities and serious mental illness.

People with intellectual disabilities (ID) have experienced increasing levels of community participation since deinstitutionalization. This freedom has facilitated community inclusion, access to alcohol and drugs, and the potential for developing substance abuse (SA) disorders. People with ID, who are known to have high rates of co-occurring serious mental illness (SMI), may be especially vulnerable to the consequences of this disease and less likely to use SA treatment. Using standardized performance measures for SA treatment access (initiation, engagement), rates were examined retrospectively for Medicaid beneficiaries with ID/SA/ SMI ages 12 to 99 (N = 5,099) and their counterparts with no ID/SA/SMI (N = 221,875). Guided by the sociobehavioral model of health care utilization, age-adjusted odds ratios and logistic regression models were conducted. People with ID/SA/SMI were less likely than their counterparts to access treatment. Factors associated with initiation included being nonwhite, living in a rural area, and not being dually eligible for Medicare; factors associated with engagement included all of the same and having a fee-for-service plan, a chronic SA-related disorder, or both. Social work policy and practice implications for improving the health of people with ID/SA/SMI through policy change, cross-system collaboration, and the use of integrated treatment approaches are discussed.

Understanding and overcoming barriers to substance abuse treatment access for people with mental retardation.

People with mental retardation have experienced increasing levels of freedom and access to community living over the past 40 years. This has included access to alcohol, illicit drugs and the potential for developing substance abuse and related problems. The manner in which people with mental retardation have handled this access has been recognized since the de institutionalization era began. Despite this recognition, documented barriers to accessing substance abuse treatment for people with mental retardation exist and there is an overarching lack of knowledge about accessible treatment approaches for this population. Policy and practice recommendations are presented for disability and rehabilitation social workers in order to better understand and combat barriers to substance abuse treatment.

Injury prevalence among children and adolescents with mental retardation.

Childhood injuries lead to increased morbidity and result in significant costs to public insurance programs. People with mental retardation, most of whom are covered by Medicaid, are at high risk for injury, which has implications for community inclusion, a central policy goal. Medicaid data from inpatient, outpatient, and long-term care settings represent an important new resource for injury surveillance in this population. Injury prevalence for 8.4 million Medicaid-eligible children in 26 states was measured using 1999 eligibility and claims data; 36.9% Medicaid beneficiaries ages 1 to 20 with mental retardation had at least one injury claim as compared with 23.5% of those without mental retardation. Prevalence rates are reported by gender and age for a variety of injury types.