The Los Angeles Mental Health The Los Angeles Mental Health And Developmental Disabilities And Developmental Disabilities

Education (LA MHaDDE) Education (LA MHaDDE) ProgramProgram

Alicia T. Bazzano, MD, MPH; Erica Schuster, BA; Alicia T. Bazzano, MD, MPH; Erica Schuster, BA; Agnieszka Spatzier, MPH; Peggie Webb, MA; Agnieszka Spatzier, MPH; Peggie Webb, MA;

Larry Schallert, LCSW; Danise Lehrer, LAc, LCSWLarry Schallert, LCSW; Danise Lehrer, LAc, LCSW

Westside Regional CenterWestside Regional CenterCulver City, CACulver City, CA

Sponsored by a MHSA grant from Sponsored by a MHSA grant from the Department of Developmental Services the Department of Developmental Services

Acknowledgements Acknowledgements

CA Mental Health Services Act (MHSA) grant & CA Mental Health Services Act (MHSA) grant & Department of Developmental Services (DDS)Department of Developmental Services (DDS)

Westside Regional CenterWestside Regional Center

Project Partners:Project Partners:– North Los Angeles County Regional CenterNorth Los Angeles County Regional Center– Los Angeles County Department of Mental HealthLos Angeles County Department of Mental Health– Solutions Building CollaborativeSolutions Building Collaborative– Westside Family Resource and Empowerment CenterWestside Family Resource and Empowerment Center

Back to BasicsBack to Basics

Developmental DisabilitiesDevelopmental Disabilities– Intellectual Disability, Autism, Cerebral Palsy, Intellectual Disability, Autism, Cerebral Palsy,

Epilepsy, Conditions similar to IDEpilepsy, Conditions similar to ID

– Served by Regional CentersServed by Regional Centers

Mental Health DisordersMental Health Disorders– Mood Disorders (depression, anxiety, bipolar Mood Disorders (depression, anxiety, bipolar

disorder), Thought Disorders (schizophrenia), disorder), Thought Disorders (schizophrenia), Personality Disorders (borderline personality), etc.Personality Disorders (borderline personality), etc.

– Served by LA Dept of Mental HealthServed by LA Dept of Mental Health

Fact vs. FictionFact vs. Fiction

Myth: those with DD cannot have mental illness Myth: those with DD cannot have mental illness

Myth: those with DD would not benefit from Myth: those with DD would not benefit from mental health treatmentsmental health treatments

Reality: systems existed in silos, with little Reality: systems existed in silos, with little meaningful interaction beyond referralsmeaningful interaction beyond referrals

Barriers to care: Barriers to care: – lack of shared infrastructure, sustained interagency lack of shared infrastructure, sustained interagency

relationships, and shared knowledge baserelationships, and shared knowledge base

Count Us In!Count Us In!

National research indicates that mental illness may occur National research indicates that mental illness may occur at at a a higher ratehigher rate in people with developmental disabilities in people with developmental disabilities – 20-30% have a dual diagnosis (20-30% have a dual diagnosis (Stress Vulnerability Stress Vulnerability

ModelModel))

California Statewide Needs Assessment (2006)California Statewide Needs Assessment (2006)– 16% of people served by the Regional Center are listed 16% of people served by the Regional Center are listed

as having co-occurring psychiatric conditions - as having co-occurring psychiatric conditions - underestimate of actual need due to data constraintsunderestimate of actual need due to data constraints

Treatment models Treatment models – Cognitive behavior therapy, dialectical behavior therapyCognitive behavior therapy, dialectical behavior therapy– Multi-modal to improve outcomesMulti-modal to improve outcomes

LA MHaDDE Program BeginningsLA MHaDDE Program Beginnings

Successful models use integrated approachSuccessful models use integrated approach– First steps: build relationships, share First steps: build relationships, share

knowledgeknowledge

Goals:Goals:– Educate on recognition, evaluation, treatment, Educate on recognition, evaluation, treatment,

referralreferral– Establish collaboration across systems of careEstablish collaboration across systems of care

What to do?What to do?

Actions:Actions:

1.1. Involve the communityInvolve the community

2.2. Understand the needUnderstand the need

3.3. Develop the curriculumDevelop the curriculum

4.4. Conduct and evaluate the trainingsConduct and evaluate the trainings

Plan-Do-Study-ActPlan-Do-Study-Act

PDSA modelPDSA model

– Form the TeamForm the Team

– Set AimsSet Aims

– Establish MeasuresEstablish Measures

– Test ChangesTest Changes

– Implement ChangesImplement Changes

Involve the CommunityInvolve the Community

Task Force of Stakeholders to oversee Task Force of Stakeholders to oversee programprogram– Recruit each stage of the service deliveryRecruit each stage of the service delivery– Include family members, clients & advocates, Include family members, clients & advocates,

medical professionals, mental health medical professionals, mental health professionals, educators, therapists, social professionals, educators, therapists, social workers, administrators, direct care providersworkers, administrators, direct care providers

Understand the NeedUnderstand the Need

Formal Needs AssessmentFormal Needs Assessment– Key informant interviewsKey informant interviews– Meet local MHSA and DMH Service Area Meet local MHSA and DMH Service Area

membersmembers– Written Survey to local medical professionals, Written Survey to local medical professionals,

mental health professionals, therapists, social mental health professionals, therapists, social workers, direct care providers, educators, family workers, direct care providers, educators, family members, and client advocatesmembers, and client advocates

Develop the CurriculumDevelop the CurriculumTrain by cohortsTrain by cohorts– CliniciansClinicians– Allied Health ProfessionalsAllied Health Professionals– Direct Service ProvidersDirect Service Providers– AdministratorsAdministrators

– Clients/family and advocates across cohorts Clients/family and advocates across cohorts

Focus on competenciesFocus on competencies– E.g., Participant conducts an appropriate differential diagnosis to E.g., Participant conducts an appropriate differential diagnosis to

identify common psychiatric diagnoses among those with identify common psychiatric diagnoses among those with developmental disabilitiesdevelopmental disabilities

Conduct and Evaluate the TrainingsConduct and Evaluate the Trainings

Target AudienceTarget Audience

Participants N

Psychologists, Therapists, Social WorkersDirect Support ProvidersService Coordinators/Case ManagersParents/OthersAdministratorsNursesPhysiciansOT, PT, SLPBehavioristsEducatorsInterns/Trainees

1961608867503728252516

9

TOTAL 701

ResultsResultsPre & Post questions from 2010 conference series

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Question 1 Question 4 Question 1 Question 2 Question 6 Question 3

May 8th May 12th June 9th

Pre-test Post-test

* significant at p<0.02** significant at p<0.05

***

* * * **

They Liked Us!They Liked Us!

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Id maladaptive behavioral symptoms and presentation of clientwith behavioral challenges and formulate a differential dx

Describe optimal observation/assessment documentation ofbehaviors to ensure that clinicians reading reports will take the

necessary steps

Learned a framework to address med, MH, and dev causes ofchallenging behaviors

Learned through cases and discussion about the complicatingfactors of id and addressing maladaptive behaviors

No

vem

be

r1

0th

No

vem

be

r 5

thM

ay

12

thM

ay

8th

Excellent and Good Average

OutcomesOutcomes

Cross-System CollaborationCross-System Collaboration– Replication of Santa Clarita Valley Dual Replication of Santa Clarita Valley Dual

Diagnosis Coordinating Council clinical case Diagnosis Coordinating Council clinical case management modelmanagement model

– Meetings to update MOUsMeetings to update MOUs

ResourcesResources– Reach Across LA website Reach Across LA website

http://www.reachacrossla.orghttp://www.reachacrossla.org

– LA MHaDDE Resource directoryLA MHaDDE Resource directory– LA MHaDDE Program manualLA MHaDDE Program manual

ChallengesChallenges

Recruitment specific to cohortRecruitment specific to cohort

EvaluationEvaluation– Survey completionSurvey completion– Measuring practice changes (observation)Measuring practice changes (observation)

Continuation of collaborationContinuation of collaboration

ConclusionsConclusionsOver 700 community-based clinicians, allied-Over 700 community-based clinicians, allied-health professionals, and direct support health professionals, and direct support providers participatedproviders participatedSelf-reported increases in knowledge, skills, and Self-reported increases in knowledge, skills, and practice changespractice changesImproved relationships between local Improved relationships between local organization personnel organization personnel A comprehensive network directory of local A comprehensive network directory of local resourcesresourcesA forum for regular, multi-system case A forum for regular, multi-system case management management

Next StepsNext Steps

Reach Across LA recently awarded two Reach Across LA recently awarded two new MHSA grants FY 2011-2014:new MHSA grants FY 2011-2014:

– Assessing Quality of Care for Dual Assessing Quality of Care for Dual DiagnosisDiagnosis

– Transition-Age YouthTransition-Age Youth

Questions?Questions?