Idaho Real Choices: Individuals with Disability Increasing Community Integration

1. Idaho Real Choices: Individuals with Disability Increasing Community Integration Debra Larsen, Ph.D Kelly Davis, M.S. B. Hudnall Stamm, Ph.D.

2. 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

3. 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 Participants

4. Model of Participation

5. 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)

6. 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

7. 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.

8. 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

9. 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

10. Integration Improves Quality of Life SF-12 Mental Component Scores Across Participation

11. Integration Improves Quality of Life SF-12 Physical Component Scores Across Participation

12. Then Baseline Then Baseline Then Baseline Then Baseline Then Baseline Now Baseline Now Baseline Now Baseline Now Baseline Now Baseline Now Close Now Close Now Close Now Close Now Close 8 8 8 8 8 7 7 7 7 7 6 6 6 6 6 5 5 5 5 5 4 4 4 4 4 3 3 3 3 3 2 2 2 2 2 1 1 1 1 1 0 0 0 0 0 War War War War War Illness Illness Illness Illness Illness Other event Other event Other event Other event Other event Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Child spank/hit Child spank/hit Child spank/hit Child spank/hit Child spank/hit Death of friend Death of friend Death of friend Death of friend Death of friend Natural disaster Natural disaster Natural disaster Natural disaster Natural disaster Adult hit/choked Adult hit/choked Adult hit/choked Adult hit/choked Adult hit/choked Terrorism/torture Terrorism/torture Terrorism/torture Terrorism/torture Terrorism/torture Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Chemical/radiation Chemical/radiation Chemical/radiation Chemical/radiation Chemical/radiation Death child/spouse Death child/spouse Death child/spouse Death child/spouse Death child/spouse Man-made disaster Man-made disaster Man-made disaster Man-made disaster Man-made disaster Witnessed violence Witnessed violence Witnessed violence Witnessed violence Witnessed violence Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Witness sex assault Witness sex assault Witness sex assault Witness sex assault Witness sex assault Adult sexual assault Adult sexual assault Adult sexual assault Adult sexual assault Adult sexual assault Child sexual contact Child sexual contact Child sexual contact Child sexual contact Child sexual contact Resp. for death/injury Resp. for death/injury Resp. for death/injury Resp. for death/injury Resp. for death/injury 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

13. 8 7 6 5 4 3 2 1 0 Then Baseline Then Baseline Then Baseline Then Baseline Then Baseline Now Baseline Now Baseline Now Baseline Now Baseline Now Baseline Now Close Now Close Now Close Now Close Now Close 8 8 8 8 8 7 7 7 7 7 6 6 6 6 6 5 5 5 5 5 4 4 4 4 4 3 3 3 3 3 2 2 2 2 2 1 1 1 1 1 0 0 0 0 0 War War War War War Illness Illness Illness Illness Illness Other event Other event Other event Other event Other event Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Weapon attack Child spank/hit Child spank/hit Child spank/hit Child spank/hit Child spank/hit Death of friend Death of friend Death of friend Death of friend Death of friend Natural disaster Natural disaster Natural disaster Natural disaster Natural disaster Adult hit/choked Adult hit/choked Adult hit/choked Adult hit/choked Adult hit/choked Terrorism/torture Terrorism/torture Terrorism/torture Terrorism/torture Terrorism/torture Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Accident or injury Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Handled the dead Chemical/radiation Chemical/radiation Chemical/radiation Chemical/radiation Chemical/radiation Death child/spouse Death child/spouse Death child/spouse Death child/spouse Death child/spouse Man-made disaster Man-made disaster Man-made disaster Man-made disaster Man-made disaster Witnessed violence Witnessed violence Witnessed violence Witnessed violence Witnessed violence Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Kidnapping/hostage Witness sex assault Witness sex assault Witness sex assault Witness sex assault Witness sex assault Adult sexual assault Adult sexual assault Adult sexual assault Adult sexual assault Adult sexual assault Child sexual contact Child sexual contact Child sexual contact Child sexual contact Child sexual contact Resp. for death/injury Resp. for death/injury Resp. for death/injury Resp. for death/injury Resp. for death/injury Trauma and Disability Stressful Life Experience Screening Scores Across Participation Then Baseline Now Baseline Now Close

14. Adult Males with Physical Disabilities & Depression Risk Beck Depression Inventory-II Scores (means)

15. Adult Males with Physical Disabilities & Depression Risk SF-12 Mental Component Scores

16. Adult Males with Physical Disabilities & Depression Risk SF -12 Physical 2-way Interaction (Sex x Disability) Males reported great physical impairment Gender role implications possibly linked to depression

17. Primary Secondary 50 40 30 20 10 0 DD/MR Mental Illness Physical 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).

18. 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.

19. Disabilities & the Family Support System

20. 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

21. 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