Obstacles and advocacy in children's mental health services: managing the Medicaid maze

Of federal programs available, Medicaid offers the greatest potential for serving children's mental health needs. Obstacles to children receiving services through Medicaid are largely determined by a state's policy of regulating services. State policies affect the delivery of mental health services for children in two ways: first, by determining which services to make available, and second, by specifying the conditions of access to those services. Accordingly, this article focuses on obstacles within states' policies that prevent effective utilization of services by children. Specifically, states' choices of eligibility criteria, services, and the procedural obstacles present within payment options are examined. Suggestions for future research are made.     

Poverty and people with intellectual disabilities

Epidemiological studies have consistently reported a significant association between poverty and the prevalence of intellectual disabilities. The available evidence suggests that this association reflects two distinct processes. First, poverty causes intellectual disabilities, an effect mediated through the association between poverty and exposure to a range of environmental and psychosocial hazards. Second, families supporting a child with intellectual disabilities and adults with intellectual disabilities are at increased risk of experiencing poverty due to the financial and social impact of caring and the exclusion of people with intellectual disabilities from the workforce. It is likely that the association between poverty and intellectual disabilities accounts in part for the health and social inequalities experienced by people with intellectual disabilities and their families. Implications for policy and practice are discussed in relation to the funding of services for people with intellectual disabilities and preventative approaches to addressing the health and social inequalities experienced by people with intellectual disabilities and their families.     

Self-reported emotional intelligence, burnout and engagement among staff in services for people with intellectual disabilities

This study examined the relationship among dimensions of self-reported Emotional Intelligence, Engagement and Burnout, using the Trait Meta-Mood Scale, Maslach Burnout Inventory and Utrecht Work Engagement Scale in a sample of Spanish professionals who work at institutions for people with intellectual disabilities. The results showed that Emotional Clarity was significantly associated with Personal Accomplishment (r=.25) and Dedication (r=.25). Further, Repair to moods was significantly correlated with all Engagement dimensions (.20 Vigor, .30 Dedication, .36 Absorption) and with Personal Accomplishment (.31). These findings extend previous research with college students in which Clarity and Repair to moods subscales were relevant predictors of well-being indexes and interpersonal functioning and suggest that the Trait Meta-Mood Scale subscales also show significant relationships with emotional functioning and work-related variables in a professional sample.     

A cascade of disparities: health and health care access for people with intellectual disabilities

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.     

Direct assessment of quality of care in secure residential treatment facilities for criminal offenders with intellectual disabilities

Direct assessment was used to evaluate quality of care in 2 secure residential treatment facilities for criminal offenders with intellectual disabilities. This population and type of setting have not been previously studied in this context. Observations were conducted of environmental condition, resident condition, resident activity, and staff member activity at various times of day over a period of 3 weeks in Facility 1 and 2 days in Facility 2. An additional analysis was conducted to determine the optimal number of observations needed to obtain a representative sample. Results indicated high levels of quality in terms of environmental condition and resident condition in both facilities. Data on resident and staff activities were more variable but generally consistent with previous research. Implications for the optimal number of observations are discussed, as well as limitations and future directions for research.     

Sociocultural studies of families of children with intellectual disabilities

This article reviews recent sociocultural studies of families of children with intellectual disabilities to introduce the range of research conducted from this perspective and to highlight the methodological, conceptual, and theoretical contributions of this approach to the study of mental retardation. Sociocultural studies examine families within their cultural, historical, and sociopolitical contexts. This type of research is comparative across different cultural groups, but is not limited to such comparisons. Sociocultural studies use varied theories and methods, but they share a focus on families' coproduction of meanings and practices related to intellectual disability; families' responses and adaptations to disability; and how their understandings and experiences are shaped within larger social institutions and inequities. Sociocultural approaches take into account community contexts that matter to families with members with mental retardation or developmental delay, and they examine the broader systems that define and position individuals with disabilities and their families. As a whole, these studies provide a more experiential and holistic view of families' beliefs and adaptations within sociopolitical worlds, and offer new tools by which to study the families of children with developmental delays within and across different cultural groups.     

Physical and motor skill training for children with intellectual disabilities

This study investigated the effectiveness of using special training machines for children with intellectual disabilities to strengthen their body's inner muscles and improve their ability to maintain standing posture and improve walking movement. The participants were 23 high school age boys with intellectual disabilities who had difficulties expressing greetings, and needed to be led by the hand when walking. Four special training machines were used for walking movements, for standing and walking balance, for leg-hip extension, and for ipsilateral movement in a sitting position. Each participant underwent 30 min. of training once a week over a 3-mo. period during school time. Body control ability required to perform each training exercise was improved over the training period. A significant improvement was observed in the 50-m dash, mean 10-m walk time, and 10-m obstacle course walk. The hip joint split angle showed a significant increase. Legal guardians all reported their child had "improved and/or progressed" for each of the targeted movements.     

Expressed emotion in families of children and adults with intellectual disabilities

Expressed emotion (EE) is a measure of the affective relationship between two people characterized by criticism, hostility, and emotionally over-involved attitudes. Outside of the field of intellectual disabilities, there has been considerable interest in EE as an environmental marker that explains variance in the severity and/or course of a number of psychiatric disorders. Researchers have also studied EE in parents and found strong associations with children's behavior problems. In this review, we focus on the data from 11 published studies of EE in families of children and adults with intellectual disabilities. We conclude that there is evidence for the presence of high EE in some families, and that this alone should concern researchers and clinicians and set an agenda for considerable future research effort. We also note a lack of attention to the measurement of EE in intellectual disability. In terms of the existing evidence base, we suggest that there is support for the hypothesis that behavior problems in children and adults with intellectual disabilities may be related to high EE in parents, and a small amount of data predicting over time support the putative causal effect of high EE on maintaining or exacerbating behavior problems. Given that EE is perhaps best conceptualized as the result of an interaction between caregivers and those cared for, there is a need to explore interventions that may help to remediate high EE within families. It is also important to understand from this position that EE may be a normative part of the experience of caring for someone under very stressful circumstances and not something for which families are blamed. Other future research priorities and some implications for practice are also discussed.     

Elimination of position-biased responding in individuals with autism and intellectual disabilities

Five individuals with autism or other developmental disabilities participated in paired-stimulus preference assessments during repeated baseline probes. All subjects initially showed a pronounced bias by typically selecting the stimulus placed in either the left or right position. Biased responding for 3 subjects was eliminated when training trials were conducted in which a stimulus of known lesser quality was presented as one of the choices. Reinforcer-quality training was unsuccessful for 2 subjects, as was a condition in which reinforcer magnitude was modified to favor unbiased responding. These subjects' biased responding was eliminated only when a correction procedure (repetition of error trials) was implemented.     

Curricular options and services for youth with disabilities

The purpose of this research was to identify and discuss the curricular options, modes of delivering services, and related instructional matters for youth with disabilities. To carry out that we gathered data in six high schools of various sizes and types. Based on a conceptual framework designed by Goodlad, we identified 12 research questions. Data of four types (observations, interviews, surveys, and documents) were gathered from all six sites in response to those questions. Reports were written for each of the high schools that included several recommendations. These recommendations were explained to individuals at the schools and researchers were apprised of the extent which the suggestions were either considered or put into practice. Results from the six schools with respect to the 12 research questions are summarized.     

Intelligent diagnosing of intellectual disabilities in offenders: food for thought

Research on offenders with intellectual disabilities (IDs) in the criminal justice arena is on the rise, reflected by a growing number of relevant publications each year. However, there is a long recognized methodological problem that hampers the comparability of empirical studies and that raises doubts about the accuracy of prevalence rates, comorbidities, and various correlates and characteristics. In this paper we will argue that the crux of the problem can, on the one hand, be found in the plurality of assessment methods for intelligence and adaptive functioning, which are not all sufficiently reliable and valid. On the other hand, assessment of IQ in criminal justice and mental health-related areas appears to be informed more by practical aspects and needs rather than grounded in a solid theoretical model. Hence, we suggest that the Cattell-Horn-Carroll (CHC) model of intelligence has potential value in this regard, and deserves a closer look. Finally, we will discuss its incorporation into, and possible implications for, criminal justice practice and future study designs.     

The organizational context of children's mental health services

This paper reviews what is known about the organizational context of children's mental health services and describes organizational constructs, conceptual models, research methods, and intervention strategies that can be used to link organizational context to service quality and outcomes. Using evidence from studies of business and industrial organizations as well as studies of children's service organizations, the paper presents a model of organizational effectiveness that depends on several contextual characteristics that include organizational culture, structure, climate, and work attitudes. These characteristics are believed to affect the adoption of efficacious treatments (EBPs [evidence-based practices]), adherence to treatment protocols, therapeutic alliance, and the availability, responsiveness, and continuity of services. Finally, 10 components of the ARC(Availability Responsiveness and Continuity) organizational intervention are described as examples of strategies that can be used to develop organizational contexts with the prescribed characteristics. Mental health researchers are encouraged to consider including these constructs, conceptual models, research methods, and intervention strategies in dissemination, effectiveness, and implementation studies that address the gap between research-based knowledge about mental health treatment and what is actually offered in the community.     

Comparison of arousal and preference assessment outcomes for sex offenders with intellectual disabilities

We compared outcomes of arousal and preference assessments for five adult male alleged sexual offenders with intellectual disabilities. Arousal assessments involved the use of the penile plethysmograph to measure changes in penile circumference to both deviant (males and females under the age of 18) and nondeviant (males and females over the age of 18) video clips. Paired‐stimulus preference assessments were arranged to present still images from the video clips used in the arousal assessments. Results showed correspondence between the assessments for four out of the five participants. Implications are discussed for the use of preference assessment methodology as a less intrusive assessment approach for sexual offender assessments.     

The usefulness of assessing suggestibility and compliance in prisoners with unidentified intellectual disabilities

Søndenaa, E., Rasmussen, K., Palmstierna, T. & Nøttestad, J. A. (2010). The usefulness of assessing suggestibility and compliance in prisoners with unidentified intellectual disabilities. Scandinavian Journal of Psychology, 51, 434–438. This present study explored the relationship of interrogative suggestibility (n = 133) and compliance (n = 118) to intellectual functioning among prison inmates. The Norwegian versions of the Gudjonsson Suggestibility Scale (GSS) and the Gudjonsson Compliance Scale (GCS) were used. The results supported previous findings of a negative correlation between the Gudjonsson scales and IQ, and the scales were found useful throughout the IQ range. The impact of a memory artifact was discussed in the light of recent studies and criticism of the scales.     

The influence of reporting mode on children's cued personal memories

The Autobiographical Memory Test (AMT) is widely used in research contexts to measure the extent to which participants (children or adults) report specific or general memories in response to cue words. Recalling fewer specific and more general memories (overgeneral memory) has been shown to be linked to depression in adults, but findings for youth, in particular, are mixed. Different versions of the AMT may be one contributing factor, yet this issue has received little research attention. The current study investigated the influence of reporting mode (written vs. spoken) on the specificity, length, and content of memories provided by 8- to 10-year-old children (N?=?48). No significant differences were found in the number of specific responses given in the written and spoken modes. On the other hand, the spoken mode elicited longer and more detailed memories, although most content differences were eliminated when memory length was controlled. These findings suggest that different reporting modes can influence the nature of the memories reported, but the absolute differences are relatively small.