Dual Diagnosis and Self-Determination: Any

Relationship?

Karen L. Hobden & Barbara W. LeRoy Developmental Disabilities Institute

Wayne State University

268-4809 Woodward, Detroit, MI 48202

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Dual Diagnosis Dual Diagnosis: co-occurring intellectual

disability and mental health problems (NADD, 2007).

Historically, individuals with intellectual disabilities were assumed to be free from mental health concerns

Recent research has suggested that people with intellectual disabilities may be at an increased risk. (Deb, Thomas, & Bright, 2001)

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Assessment of a Dual Diagnosis

Mini PAS-ADD (Prosser & Moss et al., 1998)

A semi-structured interview No background in psychology needed, but

must be trained to administer the interview. Asks questions of an informant who knows

the individual well. Reasonable validity and reliability.

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Mini PAS-ADD - 7 Subscales:

1. Depression

2. Anxiety

3. Expansive Mood Disorder (Bipolar)

4. Obsessive-Compulsive Disorder

5. Psychosis

6. Unspecified Disorder (including Dementia)

7. Autism

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Self-determination

At the core of person-centered planning. Current best practice model for service

delivery The law in Michigan -- Individuals with

intellectual disabilities must be given the opportunity to make choices regarding their needs and goals

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Our Research Goals

Evaluate the effectiveness of the Mini PAS-ADD in assessing mental illness in individuals with intellectual disabilities.

Examine the relationship between dual diagnosis and self-determination

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MORC

We conducted this research in collaboration with the Macomb Oakland Regional Center (MORC)

MORC serves 1000 adults with mild or moderate intellectual disabilities.

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Procedure

The Mini PAS-ADD was administered by a trained interviewer, typically in the informant's home or place of employment.

The interviewers were employees of MORC and were either psychologists or social workers.

The Mini PAS-ADD takes about 20 minutes to administer.

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Assessment of Self-determination

22 Item Scale Assessing choice making – living

arrangements, community involvement, employment/finances

Completed by supports coordinator in collaboration with individual

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Self Determination Scale Living arrangements – amount of choice

exercised in terms of where they live, who they live with, what they eat, when they bathe, etc.

Community involvement – do they vote, attend a place of worship regularly, belong to cultural groups, clubs, or social organizations?

Employment/finances– do they have an ATM card, control over their budget, are they employed, do they make minimum-wage or higher?

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Our Sample

231 participants (100 assessed on the Mini PAS-ADD, 151 on the SD Checklist).

49% female; 51% male The mean age was 49 (range of 18 to 87) 89% White; 7% African-American 86% had a guardian. 62% had a pre-existing dual diagnosis

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Severity of Intellectual disability

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Type of Residence

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Results – Mini PAS-ADD 29% had a dual diagnosis according to the

Mini PAS-ADD 4% Depression 10% Anxiety 3% Expansive Mood (Bipolar Disorder) 11% Obsessive-Compulsive 10% Psychosis 5% Unspecified Disorder 4% Autism

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Comparison of Diagnoses

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Mini PAS-ADD vs Diagnosis on File

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Pre-existing Diagnosis, but No Mini PAS-ADD: Why?

57% taking psychotropic medication that could have reduced or eliminated symptoms.

Individuals’ symptoms may have stabilized over time

Some individuals may have been misdiagnosed.

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Diagnostic Match by Psychotropic Medication

Any Meds? Diagnostic Match No Yes

Different diagnoses given 7.7 14.8

Mini PAS ADD, but no pre-existing 15.4 3.3

Pre-existing diagnosis, but no Mini PAS-ADD

23.1 52.5

Diagnostic match 51.3 29.5

Pre-existing diagnosis not covered by PAS-ADD

2.6 0

Total 100 100

χ2 (4) = 14.89 p<.01

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Results - Self-Determination by Diagnosis

Dual Diagnosis SD Scale Total

No Yes % YES Living Arrangements

61.1 63.4 59.9

% YES Community Involvement

49.8 51.9 48.7

% YES Employment and Finances

37.7 35.7 36.4

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Self-Determination Rankings for Persons with Dual Diagnosis - Top Third

Rank Indicator % Present

1 Has unstructured Time 98.2

2 Shops in Community 95.9

3 Chooses TV Program 94.2

4 Has access to private space 91.8

5 Has a Bank Account 87.6

6 Chooses when to bathe 71.9

7 Lives in typical residence in the community

71.5

8 Chooses what to eat 63.9

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Self-Determination Rankings for Persons with Dual Diagnosis - Middle Third

Rank Indicator % Present

9 Plans/takes vacations 60.8

10 Chooses where to live 60.2

11 Attends Worship Service 43.3

12 Chooses personal doctor 37.6

13 Goes on spontaneous outings 37.5

14 Sees family members when chooses

33.5

15 Joins community organizations

29.4

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Self-Determination Rankings for Persons with Dual Diagnosis - Bottom Third

Rank Indicator % Present

16 Chooses roommate 29.4

17 Has personal budget 28.4

18 Has access to telephone for personal use

21.1

19 Has employment 15.2

20 Makes minimum wage or more 14.7

21 Votes in community elections 14.3

22 Uses ATM for discretionary funds

5.9

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Conclusions - Mini PAS-ADD

Mini PAS-ADD is a quick, easy-to-use screen for psychiatric disorders in individuals with intellectual disabilities.

May be most effective in individuals not currently on psychotropic medication.

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Conclusions – Self Determination No one is very self-determined No overall differences by type of diagnosis Some indication that people with a dual

diagnosis have less choice in whether they:

• Vote (χ²=6.42, p < 05)• Join social organizations or clubs (χ²=4.52, p <

05)• See family members regularly (χ²=10.47, p < 01)• Have their own phone (χ²=5.81, p < 05)

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Contact Info

Karen Hobden email: khobden@wayne.edu phone: 313-577-7980 website http://ddi.wayne.edu/