Stressors that Contribute to Emergency Service Use in Persons with IDD and Mental Health Needs

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1 Stressors that Contribute to Emergency Service Use in Persons with IDD and Mental Health Needs Joan B. Beasley, Ph.D. Research Associate Professor Director, Center for START Services University of New Hampshire, Institute on Disability

2 Background The START team provides emergency support Information gathering is a challenge, there is a focus on the externalized issues (aggression, came out of nowhere ) Goal is to improve overall understanding of challenges to provide more effective solutions Lack of understanding of medical issues, and their role in behavioral problems should be considered

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4 The START Model: Systems Linkage Approach Currently 23 teams operating or in development KEY: Enrich the system (avoid strain) Resources allocated to promote linkages (i.e. the use of a linkage team ) Resources allocated to fill in service gaps based on 3 A s of effectiveness Services provided across systems Outreach is key Develop a common language

5 Obstacles in Emergency Assessment Focus is on behavioral control Issues that occurred recently but not in the last few hours were overlooked Significant stressors were not mentioned until much further into the assessment process Framing of the solution was often complicated by a lack of understanding of the meaning of these stressors

6 The Recent Stressors Questionnaire (Charlot) 1. A checklist, based on evidence of stressors that can lead to onset of behavioral challenges in people with IDD 2. A tool to assess individuals with IDD who have behavioral challenges or are presenting in behavioral crisis 3. meant to help clinicians gather a broad range of information about factors that are known to contribute to alterations in mood, behavior and mental status 4. provides a starting point for the clinician to further explore the contribution of stressful events and factors to the current presenting problem

7 Aim To identify a method to gain improved knowledge of recent stressors that may contribute to current emergency service use in individuals with IDD and mental health needs To determine stressors that are more likely to contribute to emergency service use

8 Method Individuals ( N=967) referred to START (Systemic, Therapeutic, Assessment, Resources and Treatment) crisis prevention and intervention programs located throughout the U.S. at intake and at time of crisis contact 7/12-7/13: 30-element Recent Stressor s Questionnaire, a bio-psychosocial interview checklist developed by Dr. Lauren Charlot at UMASS Medical Center. Recent within prior 6 months Informants are the primary caregivers of the individual described START Coordinators conducted the interviews using the checklist The results presented show the frequency with which individuals indicated that a particular item had occurred (answered yes). There were no skipped questions in our data set.

9 Analysis The RSQ which consists of 30 yes or no response questions was combined into 5 domains for the purpose of a trend analysis Care changes Environmental changes Medical issues Support system stress Psychiatric Hospitalizations Comparisons were made within domains, and between domains in addition to between times of crisis and planned use

10 Hypothesis Based on review of the literature and prior experience, it was expected that there would be significant differences in stressors identified in emergency contact when compared to intake It was expected that medical problems and caregiving challenges would be more pronounced in the group at time of crisis

11 Population Description START service users (individuals with IDD/behavioral health care needs) From 9 teams in the U.S. Adults ages 18 and older Either in crisis (emergency n=460) or at risk for crisis (intake n=507) Chief complaint in crisis is most often aggression

12 Descriptive Data 57% male 10% no ID, 50% Mild ID, 28% Moderate, 10% severe, 2% profound Primary MH diagnoses: Anxiety, Depression, Autism Range 18-74; Mean age 34; Mode 23 42% live with their families and other natural supports; 50% paid supports

13 Reasons for Crisis Contact 5% 4% 3% 2% Aggression - all types Mental health symptoms 5% Decrease in ability to participate in daily functions At risk of losing placement 9% 50% Suicidal ideation/behavior Family needs assistance 9% Self-injurious Transition from hospital 13% Diagnosis and treatment plan assistance

14 Most Common Stressors

15 Further Analysis Between stressors Between emergency and intake Within Domains Between Domains

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17 Implications Changes in a person s care are stressful. This is not always considered. High rate of stressors on the list were identified, consistent with the prediction that medical issues and caregiving challenges would be present. Although slightly greater during times of crisis, stressors are fairly consistent at service entry and crisis assessments Providers should pay close attention to medication changes and other potential physical issues as these changes occur with a high frequency

18 Conclusions Based on the information collected, the hypothesis that there are statistically significantly differences in trends between intake and time of emergency contact is rejected

19 Limitations RSQ not validated No comparison group Very preliminary Follow-up needed

20 Conclusion/further exploration Are there other stressors to explain an emergency contact? Can consideration of stressors before ER use make a difference? Do the outcomes indicate that the use of the emergency room is not based on client needs alone but on some other factor(s)?

21 Next Steps Development of individual START Service Plan to incorporate issues identified in RSQ and other assessments at intake (rating the individual and the system; developing goals and timelines) Cross systems crisis prevention and intervention planning Caregiver education to develop a better understanding of stressors Data collection and analysis

22 Contact Website: Centerforstartservices.com