Mothers with Intellectual/Developmental Disabilities and Behavioral Health Conditions and Community Experts Provide Recommendations for Treatment/Services, Systems, and Research
Abstract
:1. Introduction
1.1. Background
1.1.1. Fertility Rates and Perinatal Complications
1.1.2. Co-Occurring Disorders
1.1.3. Treatment and Service Disparities
1.1.4. Lack of Support
1.2. Objective
2. Materials and Methods
2.1. The Implementation Team
2.2. Recruiting Participants and Supporting Participation
2.3. The Ideas Lab Workshop Sessions
2.4. Data Collection
2.4.1. Preliminary Survey and Participation
2.4.2. Detailed Workshop Notes
2.4.3. Brainstormed Statements
2.4.4. Post Ideas Lab Survey
2.5. Analysis
3. Results
3.1. Participants
3.2. Emerging Themes
3.3. Cross-Cutting Themes
3.3.1. Accessibility
3.3.2. Diversity
3.3.3. Adverse Experiences and Trauma
3.3.4. Trust
3.4. Substantive Themes
3.4.1. Services and Supports
3.4.2. Peer Support
3.4.3. Provider Practices and Training
3.4.4. Systems Navigation and Transformation
3.5. Research Recommendations
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Vetter, N.S.; Ilskens, K.; Seidl, N.; Latteck, Ä.D.; Bruland, D. Health literacy of people with intellectual disabilities: How meaningful is the social context for a target group-oriented model of health literacy? Int. J. Environ. Res. Public Health 2022, 19, 16052. [Google Scholar] [CrossRef] [PubMed]
- Akobirshoev, I.; Parish, S.L.; Mitra, M.; Rosenthal, E. Birth outcomes among US women with intellectual and developmental disabilities. Disabil. Health J. 2017, 10, 406–412. [Google Scholar] [CrossRef] [PubMed]
- Mitra, M.; Akobirshoev, I.; Valentine, A.; Brown, H.K.; Simas, T.A.M. Severe Maternal Morbidity and Maternal Mortality in Women with Intellectual and Developmental Disabilities. Am. J. Prev. Med. 2021, 61, 872–881. [Google Scholar] [CrossRef] [PubMed]
- Rubenstein, E.; Ehrenthal, D.B.; Mallinson, D.C.; Bishop, L.; Kuo, H.H.; Durkin, M.S. Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid. PLoS ONE 2020, 15, e0241298. [Google Scholar] [CrossRef]
- Rubenstein, E.; Ehrenthal, D.B.; Mallinson, D.C.; Bishop, L.; Kuo, H.H.; Durkin, M.S. Birth outcomes affecting infants of mothers with intellectual and developmental disabilities. Paediatr. Perinat. Epidemiol. 2021, 35, 706–716. [Google Scholar] [CrossRef]
- NICHD. About Intellectual and Developmental Disabilities. 2021. Available online: https://www.nichd.nih.gov/health/topics/idds/conditioninfo (accessed on 10 February 2023).
- Benevides, T.W.; Shore, S.M.; Palmer, K.; Duncan, P.; Plank, A.; Andresen, M.-L.; Caplan, R.; Cook, B.; Gassner, D.; Hector, B.L.; et al. Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism Int. J. Res. Pract. 2020, 24, 822–833. [Google Scholar] [CrossRef]
- Lin, E.; Balogh, R.; McGarry, C.; Selick, A.; Dobranowski, K.; Wilton, A.S.; Lunsky, Y. Substance-related and addictive disorders among adults with intellectual and developmental disabilities (IDD): An Ontario population cohort study. BMJ Open 2016, 6, e011638. [Google Scholar] [CrossRef]
- Van Duijvenbode, N.; Van Der Nagel, J.E.; Didden, R.; Engels, R.C.; Buitelaar, J.K.; Kiewik, M.; de Jong, C.A.J. Substance use disorders in individuals with mild to borderline intellectual disability: Current status and future directions. Res. Dev. Disabil. 2015, 38, 319–328. [Google Scholar] [CrossRef]
- Latteck, Ä.D.; Bruland, D. Inclusion of people with intellectual disabilities in health literacy: Lessons learned from three participative projects for future initiatives. Int. J. Environ. Res. Public Health 2020, 17, 2455. [Google Scholar] [CrossRef]
- Donetto, S.; Pierri, P.; Tsianakas, V.; Robert, G. Experience-based co-design and healthcare improvement: Realizing participatory design in the public sector. Des. J. 2015, 18, 227–248. [Google Scholar] [CrossRef]
- Steen, M. Co-design as a process of joint inquiry and imagination. Des. Issues 2013, 29, 16–28. [Google Scholar] [CrossRef]
- Voorberg, W.H.; Bekkers, V.J.J.; Tummers, L.G. A systematic review of co-creation and co-production: Embarking on the social innovation journey. Public Manag. Rev. 2015, 17, 1333–1357. [Google Scholar] [CrossRef]
- Brown, H.K.; Cobigo, V.; Lunsky, Y.; Dennis, C.L.; Vigod, S. Perinatal health of women with intellectual and developmental disabilities and comorbid mental illness. Can. J. Psychiatry 2016, 61, 714–723. [Google Scholar] [CrossRef]
- Potvin, L.A.; Lindenbach, R.D.; Brown, H.K.; Cobigo, V. Preparing for motherhood: Women with intellectual disabilities on informational support received during pregnancy and knowledge about childbearing. J. Dev. Disabil. 2020, 25, 15. [Google Scholar]
- Rubenstein, E.; Ehrenthal, D.B.; Nobles, J.; Mallinson, D.C.; Bishop, L.; Jenkins, M.C.; Kuo, H.-H.; Durkin, M.S. Fertility rates in women with intellectual and developmental disabilities in Wisconsin Medicaid. Disabil. Health J. 2022, 15, 101321. [Google Scholar] [CrossRef] [PubMed]
- Akobirshoev, I.; Mitra, M.; Valentine, A.; Simas, T.A.M. Racial and ethnic disparities in birth outcomes and labor and deliver charges among Massachusetts women with intellectual and developmental disabilities. Intellect. Dev. Disabil. 2020, 58, 126–138. [Google Scholar] [CrossRef] [PubMed]
- Blanck, P. The struggle for web eQuality by persons with cognitive disabilities. Behav. Sci. Law 2014, 32, 4–32. [Google Scholar] [CrossRef]
- Hughes-McCormack, L.A.; Rydzewska, E.; Henderson, A.; MacIntyre, C.; Rintoul, J.; Cooper, S.A. Prevalence of mental health conditions and relationship with general health in a whole-country population of people with intellectual disabilities compared with the general population. BJPsych Open 2017, 3, 243–248. [Google Scholar] [CrossRef] [PubMed]
- Ayre, K.; Khalifeh, H. Immigrant women and women with learning disabilities have complex mental health needs and service use in the perinatal period. Evid. Based Ment. Health 2017, 20, 55–57. [Google Scholar] [CrossRef]
- Mitra, M.; Long-Bellil, L.; Iezzoni, L.I.; Smeltzer, S.C.; Smith, L. Pregnancy among women with physical disabilitiees: Unmet needs and recommendations on navigating pregnancy. Disabil. Health J. 2016, 9, 457–463. [Google Scholar] [CrossRef] [PubMed]
- Mitra, M.; Parish, S.L.; Akobirshoev, I.; Rosenthal, E.; Moore Simas, T.A. Postpartum hospital utilization among Massachusetts women with intellectual and developmental disabilities: A retrospective cohort study. Matern. Child Health J. 2018, 22, 1492–1501. [Google Scholar] [CrossRef] [PubMed]
- Chapman, S.L.C.; Wu, L.T. Substance abuse among individuals with intellectual disabilities. Res. Dev. Disabil. 2012, 33, 1147–1156. [Google Scholar] [CrossRef] [PubMed]
- Letourneau, N.L.; Dennis, C.L.; Cosic, N.; Linder, J. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depress. Anxiety 2017, 34, 928–966. [Google Scholar] [CrossRef] [PubMed]
- Viswanathan, M.; Middleton, J.C.; Stuebe, A.M.; Berkman, N.D.; Goulding, A.N.; McLaurin-Jiang, S.; Dotson, A.B.; Coker-Schwimmer, M.; Baker, C.; Voisin, C.E.; et al. Maternal, fetal, and child outcomes of mental health treatments in women: A meta-analysis of pharmacotherapy. Psych. Res. Clin. Pract. 2021, 3, 124–140. [Google Scholar] [CrossRef]
- Potvin, L.A.; Brown, H.K.; Cobigo, V. Social support received by women with intellectual and developmental disabilities during pregnancy and childbirth: An exploratory qualitative study. Midwifery 2016, 37, 57–64. [Google Scholar] [CrossRef]
- Creswell, J.W.; Poth, C.N. Qualitative Inquiry and Research Design: Choosing Among Five Approaches; SAGE Publications: Thousand Oaks, CA, USA, 2016; p. 489. [Google Scholar]
- Fortuna, K.L.; Meyers, A.; Brooks, J.; Collins-Pisano, C.; Marceau, S. Co-production of the quality of patient-centered outcomes research partnerships instrument for people with mental health conditions. Patient Exp. J. 2021, 8, 148–156. [Google Scholar] [CrossRef]
- Shea, L.L.; Wong, M.Y.; Song, W.; Kaplan, K.; Uppal, D.; Salzer, M.S. Autistic-delivered peer support: A feasibility study. J. Autism. Dev. Disord. 2022, 12, 1–14. [Google Scholar] [CrossRef]
- Edwards, N.M.; Lieberman-Betz, R.; Wiegand, S. Parents with intellectual disability and mental health conditions: Early intervention providers’ perceptions. J. Intellect. Dev. Disabil. 2022, 14, 1–13. [Google Scholar] [CrossRef]
Cross-Cutting Themes | Substantive Themes |
---|---|
|
|
|
|
|
|
and relationships |
|
Treatment/Services Recommendations | Considerations for Mothers with IDD/BH |
---|---|
| Doulas with advanced skills and understanding of mothers with IDD/BH could be employed in existing programs/services or new specialized programs could be developed and paid for by Medicaid or other insurers. Birth plans were suggested as having a potential benefit to mothers, with a positive impact on babies. A further suggestion was that mothers with IDD/BH may benefit from having a support person or advocate to attend perinatal/doctor’s appointments with them. |
| Models to provide psychiatric consultation in the perinatal period could be adapted or enhanced to provide consultations specific to mothers with IDD/BH. This consultation service should be paid for by insurers. |
| Classes tailored to the physical, intellectual, and emotional strengths and challenges of mothers with IDD/BH would support meaningful participation and contribute to improved outcomes for mothers and babies. |
| Existing home visiting programs (e.g., nurse–family partnership home visitation programs) could be adapted or enhanced for mothers with IDD/BH, with the potential for support from Medicaid or other payers (e.g., state agencies). Visiting nurses with expertise in IDD/BH conditions could be associated with physicians managing the pregnancies of mothers with IDD/BH, often considered “high risk”. |
| Participants recommended programs or interventions to support mothers themselves, including a focus on self-care and developing and sustaining healthy relationships (e.g., dating, with partners, with family members and children). They emphasized the importance of focusing on the “person,” rather than the “disability”. Self-care interventions should include information, education, and concrete action steps. |
| Mothers must understand how to advocate for themselves and their children, within the family as well as with agencies and service providers. Mothers recommended a focus on concrete skills. A template for questions to have in hand before going to an appointment would be helpful. |
Systems Navigation/ Transformation Recommendations | Considerations for Mothers with IDD/BH |
---|---|
| Provide “one-stop shopping” for services and support for parents, children, and families. Encourage person-centered planning and supported decision-making, acknowledging that parents are the experts on their children. Lower bureaucratic barriers to accessing services. Establish multisystem and cross-sector partnerships with providers, school systems, parents, and advocacy organizations (e.g., learning collaboratives, communities of practice). Secure funding support from state agencies and Medicaid. |
| For example, improve public transportation, bus shelters, and accessible transportation options. Work with state agencies to improve education outcomes and employment rates for parents. Increase funding for IDD and IDD-related efforts. |
| Inform the agendas of agencies, non-profits, and parent groups regarding the experiences, needs, and capabilities of mothers with IDD/BH and their families. Create opportunities for parents, families, individuals, and allies to provide input and feedback when creating new policies and programs. |
| Invite additional and non-traditional stakeholders to participate in reflecting on and integrating the experiences, needs, and capabilities of mothers with IDD/BH and their families. Identify champions, leaders, key informants, and content experts and engage them in this work. |
| Inform legislative representatives to “get them on board” with the issues facing parents with IDD/BH and what they need to succeed. Connect with government officials and legislative commissions. Promote legislation to ensure that parents do not lose custody of their children simply because they live with disabilities. Meet with candidates running for office. Develop a simple platform and clear message regarding the experiences and needs of mothers with IDD/BH. |
Ideas Lab Themes | Research Recommendations |
---|---|
Accessibility |
|
Diversity |
|
Adverse Experiences/ Trauma |
|
Trust |
|
Services and Supports |
|
Peer Support |
|
Provider Practices and Training |
|
Systems Navigation/ Transformation |
|
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nicholson, J.; Mazel, S.; Faughnan, K.; Silverman, A. Mothers with Intellectual/Developmental Disabilities and Behavioral Health Conditions and Community Experts Provide Recommendations for Treatment/Services, Systems, and Research. Int. J. Environ. Res. Public Health 2023, 20, 5876. https://doi.org/10.3390/ijerph20105876
Nicholson J, Mazel S, Faughnan K, Silverman A. Mothers with Intellectual/Developmental Disabilities and Behavioral Health Conditions and Community Experts Provide Recommendations for Treatment/Services, Systems, and Research. International Journal of Environmental Research and Public Health. 2023; 20(10):5876. https://doi.org/10.3390/ijerph20105876
Chicago/Turabian StyleNicholson, Joanne, Shayna Mazel, Kristen Faughnan, and Allie Silverman. 2023. "Mothers with Intellectual/Developmental Disabilities and Behavioral Health Conditions and Community Experts Provide Recommendations for Treatment/Services, Systems, and Research" International Journal of Environmental Research and Public Health 20, no. 10: 5876. https://doi.org/10.3390/ijerph20105876