A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
People with intellectual and developmental disabilities (IDD) have lifelong conditions that may affect their ability to communicate, learn, or make decisions. About a third of adults with IDD have a “dual diagnosis” of both IDD and a mental illness, and this number is increasing. According to earlier studies, people with a dual diagnosis of IDD and mental illness may experience serious behavior issues requiring them to be hospitalized or go to the emergency room (ER) frequently. People with a dual diagnosis may benefit from integrated, individualized services in the community from a team of providers who have expertise in both IDD and mental health services. A new community-based program, called Support Services Teams (SST), is designed to address the behavioral needs of adults with a dual diagnosis. Individuals who participate in SST are referred to teams of behavioral health professionals that include nurses, psychologists, behavior analysts, and other professionals. These professionals work with the individuals with dual diagnosis, their family members, and any staff who may provide support in a group home or independent living program to develop an individualized behavior services plan for preventing and responding to behavioral crises. SST focus on helping individuals receive tailored services in their homes and communities rather than having to receive services in more institutionalized settings. In a recent NIDILRR-funded study, researchers looked at a group of people with dual diagnosis who participated in SST. The researchers wanted to find out why these individuals were referred to SST and what types of services they received. The researchers also wanted to know whether participating in SST would result in fewer hospitalizations or visits to the ER.
Researchers at the Rehabilitation Research and Training Center on Developmental Disabilities and Health looked at data from 421 individuals with a dual diagnosis of IDD and mental illness who were enrolled in SST in a Midwestern state. These individuals were referred to SST between August 2010 and November 2011 and were at least 18 years old. The researchers looked at the reasons why these individuals were referred to SST, and the primary types of services they received. In addition, the researchers looked at Medicaid data that was available for 109 of these individuals during the year before they enrolled in SST and one full year after enrollment, and compared the following types of data between those two time periods: the number of times each individual was hospitalized or went to the ER; the number of prescriptions that each individual had; and the average cost per person for hospital admissions, ER visits, or prescription refills. Out of these 109 individuals, the researchers also looked separately at the data from 21 individuals who were admitted to a state-operated developmental center (SODC) for a brief stay while they were enrolled in SST. SODCs are residential programs that serve individuals with IDD who require treatment for severe medical and/or behavior needs. The researchers wanted to find out how enrollment in SST might benefit these individuals, who have more complex medical or behavioral needs.
The researchers found that most of the individuals referred to SST were male, white, and in their 20s or 30s. Each individual had an average of 3.7 reasons for referral, and about half had at least 4. The most common reasons for referral to SST were physical or verbal aggression, property destruction, and other behavioral concerns. The most common service delivered by SST was service planning, which involves developing, coordinating, and reviewing individualized intervention plans. Other services included observation and assessment in the individual’s home environment to determine any social, behavioral, or health needs, as well as training for family members and paid staff working with the individual.
When the researchers compared hospitalizations and ER visits for the 109 individuals before and after SST enrollment, they found that hospital admissions decreased significantly. About half of the individuals were hospitalized at least once during the year before SST, but only 35% were hospitalized during the year after enrollment. The cost per person for hospital admission also decreased from about $8,000 before SST enrollment to only about $3,000 after enrollment as individuals utilized community-based health services rather than more expensive hospital-based treatment. There was also a small, but not significant, decrease in the number of individuals who visited the ER, and in the total number of ER visits, after enrolling in SST. When the researchers looked at medication costs and usage, they found that there was no change for the majority of the participants who enrolled in SST, except for those who went to an SODC. The 21 individuals who stayed briefly at an SODC while in the SST program took fewer medications and had lower medication costs after enrolling in SST than before. The average length of an SODC stay was about 4 days per person. According to the authors, these reductions and the brief length of stay suggest that SODC stays may have focused on adjusting medications so the individuals could return safely to the community.
The authors noted that community-based behavioral support programs, like SST, may help people with IDD and mental illness to stay in their communities and out of the hospital. SSTs may encourage individuals with IDD and their care teams to turn to community-based services to address many medical and behavioral healthcare needs. For individuals with complex medical needs who may require brief inpatient stays to stabilize their medications, SSTs may be helpful in continuing to manage their medication needs effectively when they return to the community. Programs like SST may constitute a financial investment that ultimately reduces state Medicaid spending on hospital admissions, ER visits, or unnecessary prescriptions. The authors also argued that it could be beneficial to develop “stabilization homes” as an alternative to SODCs for some services such as behavioral crises or the need for medication adjustment. Future research may be useful to identify the longer-term impacts of programs like SST.
To Learn More
Frontline Initiative, a newsletter for Direct Support Professionals who support clients with IDD published by the Rehabilitation Research and Training Center on Community Living, covered various perspectives on effective supports for individuals with dual diagnoses in a recent issue: https://ici.umn.edu/index.php?products/view/561
NADD is a national organization which focuses on issues faced by individuals with developmental disabilities and mental health needs: http://thenadd.org/
To Learn More About this Study
Owen, R., Bowers, A., Heller, T., Hseih, and Gould, R. (2017) The impact of support services teams: Community-based behavioral health support interventions. Journal of Policy and Practice in Intellectual Disabilities, 14(3), 205-213. This article is available from the NARIC collection under Accession Number J77908.