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Dual Diagnosis
Psychiatric Medication
START Documentation
START Emergency Response
START Basics
100
We generally say that an individual is dully diagnosed when they have one of each of these two types of diagnoses?
What is an I/DD and a mental health/behavioral health diagnoses.
100
What amount of medication will help you if you remain in a stressful, unhappy life situation?
What is NO AMOUNT! People need meaning, value and real relationships! -Many people with IDD have had very few happy and successful life experiences -May have troubled relationships, few or no unpaid natural supports -Need services that help them find meaningful engagement, utilize their strengths, be accomplished -Need opportunities for socialization, to form meaningful relationships –to smile, have FUN! -Strength based approaches –a key START model component
100
This is the maximum length of time, in days, between when a new START case begins, and when the Cross Systems Crisis Prevention and Intervention Plan (CSCPIP) should be completed.
What is 45 days. Remember, a provisional plan can be completed during the intake process.
100
The START team must respond to an emergency situation in a period of time not to exceed ___ hours.
What is 2.
100
These are the 3 A's?
What are Access, Appropriateness and Accountability. Access - timely, available. Appropriateness - matches real needs, provides needed tools. Accountability - responsiveness, engaging, flexible, creative.
200
This is the most commonly reported symptom in individuals who are dully diagnosed and referred for START services.
What is aggression! Could also fall under another form of "externalizing behavior."
200
Which of the following is not a class of psychotropic medication? A) Mood stabilizers, B) Atypical Antipsychotics, C) Atypical Antidepressants, D) Benzodiazepines
What is C) Atypical Antidepressants. Antidepressants, however, are a class of psychotropic medication that are used for the treatment of major depressive disorder and other conditions, including dysthymia, anxiety disorders, obsessive compulsive disorder, eating disorders, ect. There are a number of important classes of antidepressants including SSRIs, SNRIs, tricyclic antidepressants, MAOIs, among others.
200
Following initial creation of a START Plan, updates should occur at which frequency during the first year of service? A) Monthly B) Quarterly C) Semi-annually D) Annually
What is B) Quarterly. The START Plan should be updated on at least a quarterly basis during the first year of service.
200
Which of the following is NOT required to be completed as part of the START emergency/crisis response process: A) START Emergency Assessment B) Aberrant Behavior Checklist C) Recent Stressors Questionnaire D) SIRS data
What is B) Aberrant Behavior Checklist.
200
The START model was originally developed by Joan Beasly in this year.
What is 1989.
300
Which of the following is not among the most commonly diagnosed psychiatric disorders in the I/DD population? A) PTSD, B) Depression, C) Anxiety, or D) Psychosis
What is Psychosis. There are higher occurrence rates of PTSD, Depression and Anxiety in the I/DD population than there is for Psychosis.
300
Which of the following FALSE regarding the pharmacological treatment of people with ID? A) Treated with psych medications at low to medium rates B) Treated with high rates of multi-drug regimens C) Treated for off label indications (ie, reduction in aggression, tantrums)
What is A - treated at low to medium rates. Not surprisingly, people with ID are treated with psychiatric medications at HIGH rates. Matson, J.L. & Neal, D. (2009) Psychotropic medication use for challenging behaviors in persons with intellectual disabilities: an overview. Research in Developmental Disabilities 30,572-86.
300
The Aberrant Behavior Checklist (ABC) should be completed at which of the following times? A) During intake, B) At least every six months after intake, C) At most annually, D) A and B
What is d) A and B. The ABC should be completed both at intake and at least every six months following intake to monitor changes.
300
An after-hours crisis response from the START on-call Coordinator is an example of A) Primary Intervention B) Secondary Intervention C) Tertiary Intervention D) Mobile Crisis Intervention
What is C) Tertiary Intervention. Tertiary interventions are geared toward "crisis management", and require more intensity with less resulting impact than primary and secondary interventions.
300
There are many factors which may contribute to the way a person feels or behaves, and all of these factors impact on one another and inform us about who the person is. Examples of influential factors include genetics, coping skills and family circumstances. What model of health does START employ when attempting to address each of these vulnerabilities?
What is a Biopsychosocial Model of health!
400
True or False: Genetic syndromes typically have little to no impact on the behavioral presentations of dully diagnosed individuals.
What is FALSE! Some genetic syndromes associated with I/DD increase the risk of psychiatric challenges. Down Syndrome --> Dep, OCD, Anx, obsessional slowness. Fragile X Syndrome --> ADHD, Anxiety. Tuberous Sclerosis --> Anxiety, depressed mood. Fetal Alcohol Syndrome (FAS) --> ADHD, Anx & Dep. Phenylketonuria (PKU) --> Depressed mood, GAD, phobias. Prader Willie Syndrome --> OCD, Depression
400
Confusion, lethargy, sedation, dehydration, GI distress, irritability, psychomotor agitation, increased food drive and weight gain. All of these are common what?
What are common medication side effects. Medical problems and medication side effects can often cause significant alterations in physical health, mood, behavior and mental status. Some side effects can even mimic acute psychiatric illness and play a key role in leading to a psychiatric referral.
400
As per the 2017 START QA Record Review Tool, the Comprehensive Service Evaluation (CSE) should be completed within how many days of receiving the service history records?
What is 30 days. The CSE is a valuable tool and allows us to complete an in-depth review of an individual's service history, as well as identify opportunities to strengthen existing service outcomes.
400
According to START, a crisis situation can often best be defined as: A) An aggressive behavior that cannot be managed B) Any incident resulting in police/hospital involvement C) Poor understanding of triggers and vulnerabilities D) A problem without the tools to address it
What is D) A problem without the tools to address it.
400
At what point is a START coordinator finished with their training? A) After the START coordinator training course B) After completing their agencies supplemental training C) After completion of their terminal degree program (eg, MS, PhD) D) Never
When is Never. START coordinators are life long learners, as we all should be. You are never done learning!
500
This is the bias that occurs when a clinician fails to recognize symptoms of a secondary condition that are independent from the individual's primary diagnoses. The clinician may miss-attribute additional conditions to existing I/DD or MH diagnoses.
What is Diagnostic Overshadowing. When we wrongly presume that overt symptoms are a consequence of an individual's mental illness, the individual is then forced to suffer from what's known as inadequate diagnosis or poor treatment. This may ultimately lead to compounded difficulties in the individual's quality of life and their behavioral presentation.
500
This syndrome is associated with a long history of treatment with neuroleptic medications. It often impacts multiple neurotransmitter systems, and can include visible withdrawal symptoms if the neuroleptic medications are suddenly stopped.
What is Neuroleptic Withdrawal Syndrome. Neuroleptic medications are among the most commonly prescribed with the IDD population. Studies have concluded that individuals with ASD are an "increasingly medicated population," and that once started, treatment most often continues with increasing numbers of psychoactive medications being utilized. Cessation of neuroleptic drugs after a long, sustained usage can result in neuroleptic withdrawal syndrome. This syndrome has many features in common with a mood disorder including insomnia, annorexia, hyperkinesis, irritability, agitation, etc. Esbensen, A.J., Greenberg, J.S., Seltzer, M.M. & Aman, M.G. (2009). Longitudinal investigation of psychotropic and non-pyschotropicmedication use among adolescents and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39, 1339–1349
500
All of the following are success measures for a Cross Systems Crisis Prevention and Intervention Plan, EXCEPT: A) Demonstrating a bio-psychosocial understanding of the person and system, B) Use of person-centered, strength-based language, C) Focus of treatment planning is the behavior, D) Focus of treatment planning is the underlying bio-psycho-social vulnerabilities
What is C) Focus of treatment planning is the behavior. In the START model, behavioral symptoms are viewed as an expression of underlying bio-psycho-social vulnerabilities, and these vulnerabilities drive the process of identifying effective and appropriate clinical interventions.
500
The primary function of the START face to face assessment during an emergency response is to: A) Provide support to the caregiver B) Stabilize the individual C) Provide respite for existing crisis services D) Gain a better understanding of the presenting problem so that more effective interventions can be established.
What is D) Gain a better understanding of the presenting problem in order to develop more effective interventions. Key components of the face to face intervention include effective communication, determining when the individual was last doing well, and gaining an understanding about medical, psychological, and/or social factors that may have contributed to the difficulty.
500
Which of the following is NOT a role of a START Coordinator? A) Provide hope, support and a safety net B) Freely share information you've learned C) Manage cases and coordinate services D) Respond to a system in need and try to facilitate change
What is C) manage cases and coordinate services. START Coordinators are NOT case managers/service coordinators. They are our valued partners, but they serve a different role outside the START coordinator's scope of practice.