Idaho Real Choices: Individuals with Disability Increasing Community Integration

Debra Larsen, Ph.DKelly Davis, M.S.

B. Hudnall Stamm, Ph.D.

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

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

Model of Participation

Implementation of Life Plan

Assessment atMonth 4-6

Taper Study Supports

Follow-up At Month 6-12

Sustainability Plans Implemented

Screening

Intake

Baseline Assessment,Development of

Life Plan

Start Case Management

Implementation of Life Plan

Assessment atMonth 4-6

Taper Study Supports

Follow-up At Month 6-12

Sustainability Plans Implemented

Screening

Intake

Baseline Assessment,Development of

Life Plan

Start Case Management

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)

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

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.

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

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

Integration Improves Quality of Life

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10

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70

Baseli

ne

Plannin

g

Impl

ement

Closing

Follo

w-up

Mentallly Ill

DD/MR

PhysicallyImpaired

SF-12 Mental Component Scores Across Participation

Integration Improves Quality of Life

SF-12 Physical Component Scores Across Participation

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10

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70

Younger

Older

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

Trauma and Disability

Now Close

Now Baseline

Then Baseline

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1

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8

Stressful Life Experience Screening Scores Across Participation

Adult Males with Physical Disabilities & Depression Risk

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2

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DD/MR Mental ill PhysicalImpaired

Female

Male

Beck Depression Inventory-II Scores (means)

Adult Males with Physical Disabilities & Depression Risk

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10

20

30

40

50

60

70

Female

Male

SF-12 Mental Component Scores

Adult Males with Physical Disabilities & Depression Risk

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20

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60

DD/MR Mental ill physicallyimpaired

Female

Male

SF -12 Physical 2-way Interaction (Sex x Disability)

Males reported great physical impairment

Gender role implications possibly linked to depression

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).

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10

20

30

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DD/MR Mental Illness Physical

Primary

Secondary

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.

Disabilities & the Family Support SystemFamily Members

01020304050

DD/MR MentalIllness

PhysicalDisability

Type of Disability

Perc

enta

ge o

f Fam

ily

Mem

bers

Primary

Secondary

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

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.edu• Kelly Davis: davikel2@isu.edu• www.isu.edu/irh• www.isu.edu/~bhstamm