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Idaho Real Choices: Individuals with Disability Increasing Community Integration
Debra Larsen, Ph.DKelly Davis, M.S.
B. Hudnall Stamm, Ph.D.
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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
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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
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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
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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)
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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
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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.
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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
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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
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Integration Improves Quality of Life
0
10
20
30
40
50
60
70
Baseli
ne
Plannin
g
Impl
ement
Closing
Follo
w-up
Mentallly Ill
DD/MR
PhysicallyImpaired
SF-12 Mental Component Scores Across Participation
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Integration Improves Quality of Life
SF-12 Physical Component Scores Across Participation
0
10
20
30
40
50
60
70
Younger
Older
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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
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Trauma and Disability
Now Close
Now Baseline
Then Baseline
0
1
2
3
4
5
6
7
8
Stressful Life Experience Screening Scores Across Participation
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Adult Males with Physical Disabilities & Depression Risk
0
2
4
6
8
10
12
14
16
18
20
DD/MR Mental ill PhysicalImpaired
Female
Male
Beck Depression Inventory-II Scores (means)
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Adult Males with Physical Disabilities & Depression Risk
0
10
20
30
40
50
60
70
Female
Male
SF-12 Mental Component Scores
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Adult Males with Physical Disabilities & Depression Risk
0
10
20
30
40
50
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
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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).
0
10
20
30
40
50
DD/MR Mental Illness Physical
Primary
Secondary
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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.
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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
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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
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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: [email protected]• Kelly Davis: [email protected]• www.isu.edu/irh• www.isu.edu/~bhstamm