Overview and implications of Medicaid managed care for people with developmental disabilities

The inclusion of people with developmental disabilities in managed care as part of general efforts by states to enroll and Medicaid recipients in such plans was reviewed. Managed care was defined and the processes by which managed care organizations deliver services were explained. Escalating costs and utilization were discussed as the primary reason for the shift to managed care. The use of Medicaid Section 1115 waivers by states to include Medicaid recipients was explored. The relation between acute health care and long-term care, and the utilization patterns in each, were briefly described. Finally, elements of managed care that are particularly important to people with developmental disabilities, such as care coordination, maintenance of quality, and individual and family support, were discussed.     

Primary health care for people with learning disabilities

Health screening and education for people with learning disabilities is often given low priority by service providers, but the input of community nurses can make a great difference. Helen Cook charts the success of two teams.     

Characteristics of hospitalizations for people with developmental disabilities: utilization, costs, and impact of care coordination

Hospitalizations and the impact of care coordination were studied in two large databases for people with developmental disabilities. Acute care admissions for alternate years between 1983 and 1991 were analyzed and compared to the data for the nondisabled population of New Jersey. The statewide dataset included 22,294 admissions; the coordinated dataset included 692 admissions to a community hospital. Under the diagnostic-related group reimbursement system, admissions for the general population remained constant, whereas hospital days and average length of stay dropped during the study period. Increases in admissions (56%) and days (42%) were found for people with developmental disabilities. Their total hospital charges rose 206%, almost twice the rate for the general population. Care coordination moderated all of these differences.     

A review of research on physical exercise with people with severe and profound developmental disabilities

During the last two decades, a significant amount of research has examined physical exercise with people with severe and profound developmental disabilities. The research has followed three main objectives: 1) finding strategies for allowing the people to engage in physical exercise fairly independent; 2) improving the people's physical fitness; and 3) reducing the people's deviant behavior. This paper reviews the studies related to the aforementioned objectives and comments on the main findings and on the practicality and acceptability of physical exercise.     

Sexual health for people with learning disabilities

This article is based on work into the sexual health needs of people with learning disabilities, carried out by a working group of the RCN Family Planning Forum. Literature searches were conducted, and local initiatives, specialist services and information sources for training and education for clients and staff were identified. The authors' aim in this article is to increase awareness among those involved in the care of people with learning disabilities and those providing family planning and sexual health services, so that these services are appropriate, accessible and sensitive to the needs of this vulnerable client group.     

The sexual health needs of people with learning disabilities

The sexual health of people with learning disabilities raises important management and practice issues for health services, and should be examined in the context of the current policy emphasis on advocacy, person-centred services and social inclusion (Department of Health, 2001). People with learning disabilities may have limited access to mainstream health services, and sexual health and genitourinary medicine (GUM) services are no exception (DoH, 2001; 1998). They are often excluded from society, either because they are 'segregated' within specialist support services in the community or because they live in isolation with carers, and health and social care models do not always join up locally to meet their needs.     

Person-centered play therapy for adults with developmental disabilities.

Due to problems in communicating with psychologists, counselors, and other daily helpers, adults with developmental disabilities may experience a lifetime of daily routines that involve few if any opportunities for emotional expression, validation, and growth. This paper presents two case studies that utilize an adapted form of Child-Centered Play Therapy in working with adults with developmental disabilities (ages 22 and 24 yrs). Person-Centered Play Therapy is used to help two adults with developmental disabilities overcome behavioral and emotional difficulties. Results indicate positive growth and changes in self-expression, self-direction, self-efficacy, and emotional well-being. Changes are indicated both within sessions, and outside of sessions in a residential day treatment program. Possibilities for future work with this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual abuse treatment for persons with developmental disabilities.

Recent research by the Sexual Abuse and Disability Project at the University of Alberta included a survey of 119 sexual abuse (SA) victims with developmental disabilities (DDs). Their responses indicated that SA treatment services for people with DDs are typically inaccessible, unavailable, and inappropriate. Inadequate treatment services appear to be due to the paucity of qualified professionals in the area of SA and DDs coupled with the slow development of appropriate SA treatment approaches. The application of adapted therapy approaches for people with DDs and examples of adapted SA treatment for children and women abused as children are presented. SA treatment issues for the developmentally disabled are discussed for practitioners' considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The market for occupational medicine managed care

The metamorphosis of the health care market has opened a window of opportunity for occupational medicine programs and practices to assume a critical role in the delivery of managed occupational and personal health care services. This chapter offers practical suggestions and tips.     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Health care for women with learning disabilities

This article describes a research project exploring the basic health education ow women with learning disabilities. It demonstrated that preventive and well-woman needs were not being met. In response a joint venture was developed between a community learning disabilities team and local well woman and family planning services. The article describes how an informal and accessible clinic was established for women with learning disabilities.     

The primary care physician and managed care

I have explored the major options open to PCPs. There are multiple variations on these themes. While the Connecticut market is fluid, one thing is clear, the solutions will vary from place to place. Health-care reorganization is a local phenomenon. Individual doctor groups can have a major influence on the direction of their local market. The future is uncertain, but whatever happens in Connecticut it will be evolutionary. PCPs must understand the realities of the current marketplace and plan a strategy to work with those realities to achieve their long-term goals. The choices we make today will have ramifications flowing far into future decades. PCPs and their patients will have to live with the consequences of these decisions. Please choose wisely.     

Respite care for families of children with disabilities

The number of children with chronic health problems and resultant disabilities is increasing. Most of the care received by these children is provided by family members, often at severe economic and psychologic cost. One service that has appeared in the past two decades to assist family caregivers is respite services. This article describes the needs for respite identified by family members, the types of respite services available, the benefits of respite care to families, and the essential roles nurses can assume in assuring this essential service is available to families.