Project ECHO-AIDD: recommendations for care of adults with intellectual and developmental disabilities
| Date | 01 November 2023 |
| Pages | 292-309 |
| DOI | https://doi.org/10.1108/AMHID-06-2023-0019 |
| Published date | 01 November 2023 |
| Author | Olivia Mendoza,Anupam Thakur,Ullanda Niel,Kendra Thomson,Yona Lunsky,Nicole Bobbette |
Project ECHO-AIDD: recommendations
for care of adults with intellectual and
developmental disabilities
Olivia Mendoza, Anupam Thakur, Ullanda Niel, Kendra Thomson, Yona Lunsky and
Nicole Bobbette
Abstract
Purpose –This study aims to describe patients presented in an interprofessional, virtual education
program focused onthe mental health of adults with intellectual and developmentaldisabilities (IDD), as
well as presentinterprofessional recommendationsfor care.
Design/methodology/approach –In this retrospective chartreview, descriptive statistics were used to
describe patients. Content analysis was used to analyze interprofessional recommendations. The
authors used the H.E.L.P.(health, environment, lived experience and psychiatricdisorder) framework to
conceptualizeand analyze the interprofessionalrecommendations.
Findings –Themes related to the needs of adults with IDD are presented according to the H.E.L.P.
framework. Taking a team-based approach to care, as well as ensuring care provider knowledge of
healthand social histories, may help bettertailor care.
Originality/value –This project draws on knowledgepresented in a national interprofessional and
intersectoraleducational initiative,the first in Canada to focus on this population.
Keywords Developmental disabilities, Intellectual disability, Mental health, Psychiatric services,
Interprofessional education, Interprofessional care
Paper type Research paper
Introduction
Adults with intellectual and developmental disabilities (IDD) have increased health care and
social service usage due to unique medical, behavioral and social needs (Hensel et al., 2018;
Qureshi et al., 2020). They also face worse health outcomes than the general population
(Cooper et al.,2015;Krahn and Fox, 2014;Lin et al.,2021) and experience disparities in health
service usage; for example, adults with IDD receive less preventive care (Ouellette-Kuntz et al.,
2018), have increased rates of ambulatory and emergency care use and are hospitalized more
often than people without an IDD (Howlett et al., 2015;Lunsky et al.,2012). These disparities
were further exacerbated by COVID-19. In Ontario, Canada’s most populous province, the rate
of hospitalization and mortality from COVID-19 was more than twice as high among adults with
IDD than people without IDD (Lunsky et al., 2022a,2022b), and health-care usage in the first
year of the pandemic was much higher for those with IDD relative to the general population
(Durbin et al., 2022). Clinical and system contributors to these disparities include
communication impairments, challenges related to determining decision-making capacity,
limited training for health-care providers and the need for complex care coordination across
social and health services (Ailey et al., 2014;Lipinski et al., 2022;Ouellette-Kuntz et al., 2015).
Individuals with IDD are also at a high risk of having co-occurring psychiatric issues (Dias
et al.,2013
;Hollocks et al., 2019;Mazza et al.,2020;White et al.,2005) which can add
(Informationabout the
authorscan be found at the
end of this article.)
Received 13 June 2023
Revised 1 September 2023
Accepted 14 October 2023
The authors thank Dr Elizabeth
Grier for her assistance and
contributions, as well as the
service providers and their
patients whose experiences
have informed this work.
Declaration of interest: The
authors declare no potential
conflicts of interest with respect
to the research, authorship
and/or the publication of this
article.
Funding: This study was
funded by the Canadian
Institutes of Health Research
(Operating grant MS2-173090),
the Azrieli Foundation, the
Queen’s University Thomas M.
and Louise A. Brown Research
Studentship and the CAMH
Koerner Research Scholars:
Research Studentship Program
for Health Professional Trainees
(CAMH 2021-1096).
Author contributions: All
authors made substantial
contributions to the study
design, data analysis and
manuscript revision. All authors
approved the final submitted
version. O.M. attests that all
listed authors meet authorship
criteria and that no others
meeting the criteria have been
omitted.
DOI 10.1108/AMHID-06-2023-0019 VOL. 17 NO. 42023, pp. 291-308, ©Emerald Publishing Limited, ISSN 2044-1282 jADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIESjPAGE 291
complexity and additional challengestotheir care (Dawson et al.,2016). The diagnosis and
management of comorbid psychiatric issues can be complicated by impairments
associated with IDD, such as communication challenges, as well as the risk of diagnostic
overshadowing (Davis et al.,2008;Dias et al., 2013). Likewise, the presence of psychiatric
issues can exacerbate existing IDD-related challenges that these individuals face, such as
the possibility of exacerbating aggression with the use of anxiolytics for a co-occurring
anxiety disorder (Constantinoet al.,2020;Morgan et al., 2008).
Educational programs and competency frameworks for health-care providers have been
investigated as tools to improve outcomes for this group (Bartkowski et al., 2018;Bosco
et al.,2019
;Dagnan et al.,2018;Hassiotis et al., 2018;Klaver et al., 2020;Ring et al.,2018;
Singh et al., 2020). One internationally recognized educational approach is the Extension
for Community Healthcare Outcomes (ECHO ©) program, a virtual education program that
connects health-care and social service providers from different settings “spokes” with an
interprofessional specialist “hub” team to learn and share bestpractices (Arora et al., 2007).
Each ECHO session consists of a didactic presentation from the specialist “hub” team,
presentation of an anonymized complex case of a patient by a community provider and
ensuing discussion by the entire group. These discussions offer opportunities for Project
ECHO participants to share practical recommendations that providers can use. This model
has demonstrated success in improving provider knowledge and patient outcomes for
several health conditions including opioid use disorder (Salvador et al.,2021), HIV (Pollack
et al.,2020
) and dementia (De Witt Jansen et al.,2018).
In January 2020, Ontario ECHO Mental Health –Adult Intellectual and Developmental
Disabilities (ECHO-AIDD) was launched to specifically support health and social service
professionals working with adultswith IDD. ECHO-AIDD used videoconferencing
technology to connect providers across Canada with an interdisciplinary “hub” team of
clinicians to discuss complex patient cases, share knowledge and learn best practices to
support adults with IDD (Lunsky et al., 2022a,2022b;Thakur et al.,2021). This paper aims
to describe the characteristics of patients presented through ECHO-AIDD from January
2020 to May 2022 and provide insight into the scope of interprofessional care
recommendations.
Methods
Design
This study is a retrospective case review of interprofessional recommendations for the
mental health care of adults with IDD presented in ECHO-AIDD between January 2020 and
May 2022.
Participants/data
Fifty-one anonymized patientcases were presented by interdisciplinary health and social
service professionals through ECHO-AIDD between January 2020 and May 2022. There
were six cohorts of patients presented at different timepoints. Four of these cohorts were
limited to participants from Ontario, and two cohorts included participants from across
Canada. Of these cohorts, the firstgroup was presented prior to the onset of the COVID-19
pandemic, and the remaining five cohorts were presented during thepandemic. All the
cases presented in the ECHO-AIDD during thistime frame were included in this review.
Patient cases included demographic information, health and social histories, health and
social service usage and reasons for consultation. All the cases reviewed in thisstudy
involved a patient with a formal diagnosis of an intellectual and/or developmental disability,
and a co-occurring mental healthconcern. Cases were selected for presentation ifthe
PAGE 292 jADVANCES IN MENTAL HEALTH ANDINTELLECTUAL DISABILITIES jVOL. 17 NO. 4 2023
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