Elspeth Slayter

Understanding and Overcoming Barriers to Substance Abuse Treatment Access for People with Mental Retardation

ABSTRACT People with mental retardation have experienced increasing levels of freedom and access to community living over the past 40 years. This has included access to alcohol, illicit drugs and the potential for developing substance abuse and related problems. The manner in which people with mental retardation have handled this access has been recognized since the de − institutionalization era began. Despite this recognition, documented barriers to accessing substance abuse treatment for people with mental retardation exist and there is an overarching lack of knowledge about accessible treatment approaches for this population. Policy and practice recommendations are presented for disability and rehabilitation social workers in order to better understand and combat barriers to substance abuse treatment.

Child Welfare-Involved Youth With Intellectual Disabilities: Pathways Into and Placements in Foster Care

Existing literature suggests that youth with intellectual disabilities are at increased risk for child maltreatment. Little is known about youth with intellectual disabilities who are supervised by child welfare authorities or living in foster care. Reasons for child welfare system involvement and placement types are explored. In this cross-sectional exploratory study, we drew on data from the Adoption and Foster Care Reporting System (AFCARS) for youth in 46 states, the District of Columbia, and Puerto Rico. A sample of 17,714 youth with intellectual disabilities and a comparison group (n  =  655,536) were identified for 1999. Findings have implications for preventing the removal of youth from caregivers and the promotion of community inclusion of foster youth while in foster care.

Addressing Alcohol and Drug Addiction Among People With Mental Retardation in Nonaddiction Settings: A Need for Cross-System Collaboration

People with mental retardation (MR) and addiction are an especially vulnerable population, yet evidence-based approaches to substance abuse (SA) treatment for this group are limited. Research suggests that SA-related services for this population are most likely received in nonaddiction settings that are generally focused on provision of mental health services to populations with MR and that might be unequipped for this work. This fact, combined with documented challenges to cross-system collaboration, suggests the potential for discontinuities in care for people with MR and SA. Recommendations for SA screening and a framework for cross-system collaboration are presented with specific recommendations for the ways in which social workers in both MR and SA service settings can promote positive client outcomes.

Injury Prevalence Among Children and Adolescents With Mental Retardation

Childhood injuries lead to increased morbidity and result in significant costs to public insurance programs. People with mental retardation, most of whom are covered by Medicaid, are at high risk for injury, which has implications for community inclusion, a central policy goal. Medicaid data from inpatient, outpatient, and long-term care settings represent an important new resource for injury surveillance in this population. Injury prevalence for 8.4 million Medicaid-eligible children in 26 states was measured using 1999 eligibility and claims data; 36.9% Medicaid beneficiaries ages 1 to 20 with mental retardation had at least one injury claim as compared with 23.5% of those without mental retardation. Prevalence rates are reported by gender and age for a variety of injury types.

Intimate Partner Violence Against Women with Disabilities : Implications for Disability Service System Case Management Practice

Violence against women is a top human rights issue for women with disabilities, a population that is more at risk for intimate partner violence (IPV). Existing research on violence against women with disabilities has pointed to the need for population-based sampling, the inclusion of women of non-White descent, and the use of literature-based definitions of IPV, conditions all met by this study. Women with disabilities were less likely to report past-year IPV in the form of verbal abuse, but more likely to report threats and physical violence. Case management implications relate to the need for disability-sensitive IPV assessment training at all state disability offices and the need to facilitate the accessibility of traditional IPV systems.

Demographic and Clinical Characteristics of People With Intellectual Disabilities With and Without Substance Abuse Disorders in a Medicaid Population

Little is known about the demographic and clinical characteristics of people with intellectual disabilities and substance abuse problems. Drawing on health care billing claims for people with Medicaid coverage aged 12-99 years, the characteristics of people with intellectual disability and a history of substance abuse (N=9,484) were explored and compared with people with intellectual disability but without substance abuse. Age- and/or gender-adjusted odds ratios were derived from logistic regression analyses to consider differences in demographic and clinical diagnoses. People with intellectual disability and substance abuse constituted 2.6% of all people with intellectual disability, most of whom had a diagnosis of mild or moderate intellectual disability. People with intellectual disability and substance abuse problems were, on average, 2 years older than the comparison group and less likely to be White. The sample was more likely than the comparison group to have serious mental illness or depression and substance abuse-related disorders were not prevalent. These data provide a comparison point for existing studies of mental health diagnoses as well as new information about substance abuse disorders. Implications relate to the identification of substance abuse among people with intellectual disabilities as well as the establishment of demographic and clinical correlates.

Not Immune: Access to Substance Abuse Treatment Among Medicaid-Covered Youth With Mental Retardation

Youth with mental retardation* (MR) have experienced increasing levels of participation in community life over the last 30 years. This freedom has facilitated access to community life beyond school settings; it has also created the potential for alcohol and drug use and for the development of substance abuse (SA). Little is known about access to SA treatment for youth with MR—an especially vulnerable population. Through the application of a set of standardized performance measures, this study examines SA treatment access among youth aged 12 to 21 with and without MR (N = 150,009). Guided by Andersen’s sociobehavioral model of health care utilization, multivariate logistic regression analyses modeled SA treatment initiation and engagement. Youth with MR and SA were less likely to initiate or engage in treatment. Engagement among youth with MR and SA was associated with being male and/or non-White. Implications relate to a need for improved treatment access for youth with MR and SA through cross-system collaboration.Youth with mental retardation* (MR) have experienced increasing levels of participation in community life over the last 30 years. This freedom has facilitated access to community life beyond school settings; it has also created the potential for alcohol and drug use and for the development of substance abuse (SA). Little is known about access to SA treatment for youth with MR—an especially vulnerable population. Through the application of a set of standardized performance measures, this study examines SA treatment access among youth aged 12 to 21 with and without MR (N = 150,009). Guided by Andersen’s sociobehavioral model of health care utilization, multivariate logistic regression analyses modeled SA treatment initiation and engagement. Youth with MR and SA were less likely to initiate or engage in treatment. Engagement among youth with MR and SA was associated with being male and/or non-White. Implications relate to a need for improved treatment access for youth with MR and SA through cross-system coll...

Substance Abuse and Mental Retardation: Balancing Risk Management With the “Dignity of Risk”

Substance abuse (SA) is a documented issue for many people with mental retardation/developmental disabilities (MR/DD). However, little empirical data exist regarding the appropriateness or effectiveness of prevention or treatment approaches for this population. Compounding this issue, access to SA treatment for this population is also limited, making social work case management a challenge. For social workers, the problem of SA among people with MR falls into a gray area between the facilitation of the “dignity of risk” and risk management. Discussions of Deborah Stones commentary on balancing liberty, equality, and security in social policy are presented in light of ways to encourage the implementation of the “dignity of risk.” Linking theory to practice, a baseline framework is provided for planning individualized, self-determination-oriented case management approaches for people with SA who have MR.

Medicaid-Covered Alcohol and Drug Treatment Use Among People With Intellectual Disabilities: Evidence of Disparities

For some, community inclusion facilitates access to alcohol and drugs and, therefore, the potential for developing substance abuse disorders. However, little is known about substance abuse treatment use among people with intellectual disabilities. Using standardized performance measures, substance abuse treatment utilization was examined for Medicaid-covered people with intellectual disabilities and substance abuse (N=9,484) versus people without intellectual disabilities (N=915,070). The sociobehavioral model of healthcare use guides multivariate logistic regression analyses of substance abuse treatment utilization patterns, revealing disability-related disparities. Factors associated with utilization included being non-White, living in a nonurban area, having a serious mental illness, and living in a state with a generous Medicaid plan for substance abuse treatment. Implications relate to health policy, service delivery patterns, and the need for cross-system collaboration in the use of integrated treatment approaches.

Foster Care Outcomes for Children With Intellectual Disability

The promotion of speedy, permanent outcomes for foster children is a central child welfare policy goal. However, while children with intellectual disability (ID) are at greater risk for child welfare involvement, little is known about their case outcomes. This cross-sectional national study explores between-group foster care outcomes. Foster children with intellectual disability were more likely to have experienced an adoption disruption or dissolution but less likely to be reunified with a parent, primary caretaker or other family member. Implications for interagency collaboration in support of pre and post-foster care discharge support services are discussed.