Showing papers by "Tamar Heller published in 2018"

Impact of Medicaid Managed Care on Illinois's Acute Health Services Expenditures for Adults with Intellectual and Developmental Disabilities.

Abstract: States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on costs by tracking Illinois's Medicaid acute health services expenditures for adults with intellectual and developmental disabilities (IDD) living in the community (n = 1,216) before and after their transition to MMC. Results of the difference-in-differences (DID) regression analysis using an inverse propensity score weight (IPW) matched comparison group (n = 1,134) design suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.

Caregiving Experiences and Outcomes: Wellness of Adult Siblings of People with Intellectual Disabilities

Abstract: The goal of this paper is to explore the wellness of adult siblings of people with intellectual disabilities (ID) related to caregiving experiences and outcomes, supports for siblings, gaps in the literature, and future directions to advance research in this area. Findings are shared from the literature on caregiver experiences of adult siblings of people with ID with a specific focus on outcomes related to wellness. Overall, siblings of people with IDD have positive outcomes in childhood while increased anxiety may happen in adolescence; outcomes for adults are mixed and need greater exploration. First five outcome areas are described related to wellness of adult siblings of people with ID: (1) impact on health and well-being, (2) financial impact, (3) cultural context, (4) sibling relationship quality, and (5) future caregiving. Secondly, supports that enhance wellness for siblings of adults with ID are discussed including peer/emotional support and knowledge of services and supports. Thirdly, gaps are identified and critiqued with ideas shared about ways to address the gaps in future studies such as investing in interventions that include and target adult siblings of people with ID to enhance wellness. Finally, future directions are proposed to advance sibling disability research in order to improve the wellness of adult siblings of people with ID and their families, including the value of doing research with a Disability Studies perspective.

Reported gum disease as a cardiovascular risk factor in adults with intellectual disabilities.

Abstract: Background Several risk factors for cardiovascular disease (CVD) have been identified among adults with intellectual disabilities (ID). Periodontitis has been reported to increase the risk of developing a CVD in the general population. Given that individuals with ID have been reported to have a higher prevalence of poor oral health than the general population, the purpose of this study was to determine whether adults with ID with informant reported gum disease present greater reported CVD than those who do not have reported gum disease and whether gum disease can be considered a risk factor for CVD. Methods Using baseline data from the Longitudinal Health and Intellectual Disability Study from which informant survey data were collected, 128 participants with reported gum disease and 1252 subjects without reported gum disease were identified. A series of univariate logistic regressions was conducted to identify potential confounding factors for a multiple logistic regression. Results The series of univariate logistic regressions identified age, Down syndrome, hypercholesterolemia, hypertension, reported gum disease, daily consumption of fruits and vegetables and the addition of table salt as significant risk factors for reported CVD. When the significant factors from the univariate logistic regression were included in the multiple logistic analysis, reported gum disease remained as an independent risk factor for reported CVD after adjusting for the remaining risk factors. Compared with the adults with ID without reported gum disease, adults in the gum disease group demonstrated a significantly higher prevalence of reported CVD (19.5% vs. 9.7%; P = .001). Conclusion After controlling for other risk factors, reported gum disease among adults with ID may be associated with a higher risk of CVD. However, further research that also includes clinical indices of periodontal disease and CVD for this population is needed to determine if there is a causal relationship between gum disease and CVD.

Building community capacity for person centered planning for people aging with intellectual disability.

Abstract: Evidence-based supports and interventions are needed to address the unique needs of individuals with intellectual disability (ID) as they age. This research evaluates the impact of an updated version of an evidence-based person-centered planning curriculum for older adults with ID (Heller et al., 1999, 2000). Revisions to the curriculum reflect new knowledge on ways to support health and wellness in this population. The researchers work closely with a community partner to build capacity for future implementation of the curriculum and person centered planning services. The researchers deliver the updated curriculum on a weekly basis at program sites of community partner, training a staff as a co-trainer in the process. The impact of the curriculum is evaluated using a randomized pre-post design with a control group. Both groups are compared at baseline, after the intervention, and at a six-month follow-up using both qualitative and quantitative methods.