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The Los Angeles Mental Health And Developmental Disabilities Education (LA MHaDDE ) Program. Alicia T. Bazzano, MD, MPH; Erica Schuster, BA; Agnieszka Spatzier, MPH; Peggie Webb, MA; Larry Schallert, LCSW; Danise Lehrer, LAc, LCSW Westside Regional Center Culver City, CA - PowerPoint PPT Presentation
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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?
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