Psychologists Adherence and Carer Experiences with Best practice in - - PowerPoint PPT Presentation

Psychologists’ Adherence and Carer Experiences with Best practice in Intellectual Disabilities and Co-morbid Mental Ill Health

PsychDD Annual Conference 24 Nov 2017

Joyce Man, Specialist Psychologist

Primary supervisor Associate Professor Maria Kangas, Macquarie University Adjunct supervisor Professor Julian Trollor, UNSW Associate supervisor Snr Lecturer Naomi Sweller, Macquarie University

Thesis aims

2 OFFICE I FACULTY I DEPARTMENT

To explore:

• Australian psychologists’ perceptions of best practice

and assessment practices when working with individuals with an intellectual disability and co-morbid mental health disorders

• Carer experiences with mental health and disability

services

3 OFFICE I FACULTY I DEPARTMENT

THREE PHASES

First study: Explored assessment practices, training needs and barriers to evidence based practice of Australian psychologists working in ID via an online survey Second study: Explored perceptions of best practice, adherence to practice guidelines and impact of organisational factors via focus groups

4 OFFICE I FACULTY I DEPARTMENT

Final study:

• Explored experiences of carers via a mixed method study

using online surveys and face to face/phone interviews

• Assessed carer mental health literacy
• Explored barriers to help seeking

Literature Review

• Scarcity of research in use of evidence-based

practice in the field of ID (e.g. Burns & Ysseldyke, 2008)

• General consensus that mainstream EBP for

mental health disorders are not always directly applicable, hence, adaptations to mainstream practice are similarly required (Ali et al., 2013).

Edwards, Lennox, & White, 2007 found:

• Australian psychiatrists felt poorly equipped to

serve the MH needs of PWID.

• Psychiatrists acknowledged they treat PWID

from a symptom based as opposed to diagnosis driven methodology

Parental help seeking

Factors found to impact on help seeking:

• lack of trust and negative previous

experiences with professionals

• not knowing where to find help
• fear of dismissal of raised problems by

professional (Weiss & Lunsky, 2010).

Carer experiences with hospital settings

A review on hospital experiences of carers highlight a number of concerns:

• an over representation of individuals with an

intellectual disability in emergency services

• longer hospital stays
• institutionalised discrimination
• safety risks
• incorrect medication prescription
• not having basic self care needs met in acute

inpatient units (Iacono et al., 2014).

Formal training in ID

• In Australia, the study of ID generally forms a small component of

postgraduate coursework training in psychology.

• In the United States, few graduate psychology training offer training

in disabilities (Razza, Dayan, Tomasulo, & Ballan, 2014)

• Canadian students in graduate psychology training courses report

difficulty in obtaining adequate didactic and experiential

• pportunities in ID (Weiss, Lunsky & Morin, 2010).
• In the UK, doctoral students in clinical psychology are required to

complete a 6-month placement in a developmental disability community team (Scior et al., 2012).

Study 1 Aim

• Examine psychologists’ self-reported clinical

practices and competencies when working with adults with ID and co-morbid mental disorders

• Explore current assessment practices
• Investigate existing barriers in implementing

EBP

Method:

National survey completed by psychologists who work with PWID. 109 participated Purpose specific online survey developed

Section Three: Current clinical practices of psychologists who provide assessment of mental health concerns in adults with intellectual disabilities.

Results Demographic Characteristics

Range M SD Years of psychological experience 0- 37 10.55 9.31 Years of experience with ID 0- 42 11.98 9.32 Years in current role 0- 35 6.45 6

• 65% of psychologists (n = 68) more confident in

identifying mental health symptoms in adults with ID compared to making a formal diagnosis

• 51%, n = 54 reported adequate skills and training

to assess and diagnose mental health disorders in adults with ID.

• 49%; n = 52 considered themselves specialists in

mental health and ID in their current work roles

Clinical Competencies

• No differences found between Gov.

disability, NGO and private practice psychologists’ views on specialist role in mental health and ID or perceived adequacy of their skills in MH ax in adults with ID

Key Findings

• A larger proportion of psychologists consider MH

dx in PWID to be the role of psychiatrists

• Approximately half of the psychologists working in

ID consider themselves specialists in mental health and ID.

• Psychologists in government disability, NGO and

private practice settings reported similar views in clinical competencies in MH assessment for PWID and workplace training supports.

• Psychologists in general receive limited formal

training in ID and limited ongoing training in mental health and ID in their current workplace

• Training specific to the needs of psychologists

are needed to skill up the profession in MH and ID

Study Two Aims

• Explore psychologists’ perception of best

practice in dual disabilities in relation to current practice guidelines

• Explore adherence and barriers to adherence

to current Australian best practice guideline

• Examine workplace barriers and facilitators to

best practice implementation.

Method

• 8 semi structured focus groups with

psychologists from gov and non-gov disability

• rganisations (n=38)
• Referred to summary of The Guide- practice

guideline developed by the 3DN

Key findings

• Reasonable adjustments and adaptations
• Need for practice based evidence in

contributing to the evidence base

• Psychologists reported views consistent with

current Australian best practice standards

• Systemic barriers to EBP implementation

Study Three Aims

Explore:

• Carer satisfaction with a variety of services
• Help seeking barriers
• Mental health literacy
• Carer experiences with disability and mental

health services

Method

• 42 parents took part in an online national

survey

• 27 parents from the full sample completed

items on attitudinal barriers to help seeking and items based on three vignettes to assess mental health literacy in depression, challenging behaviour and mixed mental health and challenging behaviour presentations

Key findings

• Carers expressed dissatisfaction with inpatient

and community mental health services

• Carers showed good mental health literacy

based on responses from the depression and challenging behaviour vignettes and poorer literacy with mixed presentation.

• Few attitudinal barriers to help seeking

reported

• More negative than positive experiences with

mental health services -viewed to hold limited expertise in dual disabilities

• Carers reported the importance of

collaboration, applying special considerations to suit the needs of their child with an ID

• Difficulties in accessing appropriate services

Thesis- Key Implications

• Practice based research
• Accessible training in dual disabilities
• MH ax and dx
• EBP
• Reasonable adjustments
• Scientist practitioner model
• Accessible research in ID
• Specialist services and/or specialist units within

mainstream services

• Increased funding and support to mainstream

services

• Recognition of carer role
• Empowering families with information
• Balancing rights of individual with ID with

carer’s wishes and needs

• Increasing mental health literacy

References

Ali, A., Scior, K., Ratti, V., Strydom, A., King, M. & Hassiotis, A. (2013). Discrimination and other barriers to accessing health care: Perspectives of patients with mild and moderate intellectual disability and their carers. PLoS ONE 8(8): e70855. doi:10.1371/journal.pone.0070855 Edwards, N., Lennox, N., & White, P. (2007). Queensland psychiatrists' attitudes and perceptions of adults with intellectual disability. Journal of Intellectual Disability Research, 51(1), 75-81. Burns, M. K., & Ysseldyke, J. E. (2008). Reported Prevalence of Evidence-Based Instructional Practices in Special Education. The Journal of Special Education, 43(1), 3-11. Jensen-Doss, A. & Hawley, K.M. (2010). Understanding barriers to evidence-based assessment: clinician attitudes toward standardized assessment tools. Journal of Clinical Child and Adolescent Psychology, 39(6) 885-96. Iacono, T., Bigby, C., Unsworth, C., Douglas J. & Fitzpatrick, P. (2014). A systematic review of hospital experiences of people with intellectual disability. BMC health services research, 14(1), 505. doi: 10.1186/s12913-014-0505-5

Man, J., Kangas, M., Trollor, J. and Sweller, N. (2017), Clinical competencies and training needs of psychologists working with adults with intellectual disability and comorbid mental ill health. Clinical Psychologist, 21: 206–214. doi:10.1111/cp.12092 Munden, A. & Perry, D. (2002). Symptoms of depression in people with learning disabilities. Journal of Learning Disabilities, 6, 13-22. Razza, N.J., Dayan, L.S., Tomasulo, D. & Ballan, M.S. (2014). Intellectual disability and mental health: is psychology prepared? Advances in Mental Health and Intellectual Disabilities, 8(6), 381 – 389. doi:10.1108/AMHID-04-2014-0010 Scior, K., Baum, S., Dodd, K., Holmes, N., Hughes, K., & Rose, J. (2012). Good practice guidelines for UK clinical psychology training providers for the training and consolidation of clinical practice in relation to adults with learning disabilities (Revised Version). British Psychological Society. Weiss, J. A., Lunsky, Y., & Morin, D. (2010). Psychology graduate student training in developmental disability: A Canadian survey. Canadian Psychology, 51(3), 177. doi: 10.1037/a0019733

Currently available best practice guidelines

• Intellectual Disability Mental Health Core Competency

Framework: A Manual for Mental Health Professionals https://3dn.unsw.edu.au/idmh-core-competency-framework

• Department of Developmental Disability Neuropsychiatry

(2014). Accessible Mental Health Services for People with an Intellectual Disability: A Guide for Providers. https://3dn.unsw.edu.au/the-guide The Guide has been developed to provide a national framework of understanding and action for frontline mental health service providers with respect to people with an intellectual disability.

• Practice Guidelines for the Assessment and Diagnosis of Mental

Health Problems in Adults with Intellectual Disabilities

• nlinelibrary.wiley.com/doi/10.1046/j.1365-2788.2002.00421.x/full

These guidelines provide a summary of current knowledge regarding the assessment and diagnosis of specific psychiatric disorders in adults who have an ID based on clinical consensus.

• National Institute for Health and Clinical Excellence. (2016). Mental

health problems in people with learning disabilities (NICE: GID- CGWAVE0684). London: National Institute for Health and Clinical

• Excellence. https://www.nice.org.uk/guidance/ng54

What do they all have in common?

• Utilisation of evidence based assessments

specific to ID population

• Collaboration
• Reasonable adjustments
• Comprehensive, multi-format assessment
• Involvement of carers and systemic supports
• Person centred practices
• Reference to established mainstream

guidelines/diagnostic manuals

Resources

• Intellectual Disability – Mental Health First Aid

www.mhfa.com.au/cms/wp- content/uploads/2011/02/2nd_edition_id_manual_dec10.pdf This manual is for people working in human services to provide guidance on how to support people with an ID who are experiencing difficulties associated with mental health problems.

• Psychiatric and Behavioural Disorders in Intellectual and Developmental

Disabilities, Second Edition. Edited by Nick Bouras & Geraldine Holt. Cambridge University Press (2007) www.cambridge.org/us/academic/subjects/medicine/mental-health- psychiatry-andclinical-psychology/psychiatric-andbehavioural-disorders- intellectual-anddevelopmental-disabilities-2nd-edition

• Mental Health Services for Adults with Intellectual Disability: Strategies and
• Solutions. Edited by Nick Bouras & Geraldine Holt, Psychology Press (2010)

bjp.rcpsych.org/content/198/4/328.2.full

CENTRES FOR RESEARCH AND DEVELOPMENT IN INTELLECTUAL DISABILITY

National:

• Department of Developmental Disability Neuropsychiatry (3DN)

https://3dn.unsw.edu.au/

• Centre for Disability Studies

http://www.cds.med.usyd.edu.au/

• Centre for Developmental Disability Health Victoria (CDDHV)

www.cddh.monash.org

• The Queensland Centre for Intellectual and Developmental Disability

(QCIDD) http://www.qcidd.com.au/

• Victorian Dual Disability Service (VDDS)

www.svhm.org.au/services/VictorianDualDisabilityService

International:

British Institute of Learning Disabilities (BILD) www.bild.org.uk

• Estia Centre – United Kingdom

www.estiacentre.org

• An Association for persons with developmental

disabilities and mental health needs http://thenadd.org/

• International Association for the Scientific Study
• f Intellectual and Developmental Disabilities

https://www.iassidd.org/

Online training in MH and ID

• The CDDHV is an academic unit established by the Victorian State Government to

improve health outcomes for people with developmental disabilities through a range of educational, research and clinical activities. https://vdds.svhm.org.au/

• This e-Learning website has been developed by the Department of Developmental

Disability Neuropsychiatry as a free training resource to improve mental health

• utcomes for people with an ID.

www.idhealtheducation.edu.au

• American Association on Intellectual and Developmental Disabilities E-Learning

and Continuing Professional Education (AAIDD) http://aaidd.org/education/e-learning-and-ceus AAIDD (see Professional Associations and Interest Groups) offers online continuing education and training opportunities to intellectual and developmental disability professionals.

Questions?

Joyce.Man@benevolent.org.au