The role of state agencies in mental health services for individuals with co-occurring intellectual and developmental disabilities and mental illness

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PROJECT SUMMARY/ABSTRACT The goal of the proposed fellowship is to prepare the applicant, Elizabeth Stone, for an independent research career focused on improving services and systems for underserved populations with mental illness, including those with co-occurring mental illness and intellectual or developmental disabilities (IDD). The proposed fellowship will help Ms. Stone prepare for a career as an independent investigator by allowing opportunities for individualized training toward three goals: (1) to attain proficiency in applying mixed methods approaches that integrate advanced statistical techniques with in-depth qualitative methods, (2) to build expertise in issues related to mental health services for individuals with co-occurring IDD and mental illness, and (3) to develop an in-depth understanding of the legal and regulatory framework through which state mental health and IDD agencies, independently and in coordination, impact mental health services for individuals with co-occurring IDD and mental illness. To achieve these goals, Ms. Stone will complete activities including mentored research, didactic and informal training, experiential learning, and attendance and presentations at seminars and conferences. Throughout the training period, she will be supported by a rich array of resources at the Johns Hopkins Bloomberg School of Public Health and a strong mentorship team with complementary expertise in health services research, mixed methods, advanced causal inference methods, and issues related to psychiatric services for individuals with co-occurring IDD and mental illness. The mentored research will consist of a mixed methods study focused on the role of state agencies in mental health services for individuals with co-occurring IDD and mental illness. Despite elevated prevalence of mental illness among people with IDD compared to the general population, those with both IDD and mental illness face significant barriers to the receipt of mental health care. This is due, in part, to fragmented mental health and IDD service delivery systems. In an attempt to address fragmentation, Texas restructured their Health and Humans Services (HHS) system in 2017, eliminating the state’s IDD agency and moving those programmatic and regulatory responsibilities to HHS, which also houses the mental health agency. The purpose of this integration was to improve access to and quality of services by decreasing administrative burden, better integrating similar services and programs, and clarifying lines of accountability and performance measures. The proposed research examines the effects of this agency integration on mental health service utilization and quality indicators among individuals with co-occurring IDD and mental illness using a concurrent mixed methods design combining in-depth qualitative interviews with state agency staff and IDD and mental health advocates with augmented synthetic control analyses of administrative insurance claims data. This proposed research is well-aligned with NIMH’s Strategic Plan Objective 4.1 to support research on improving the reach of mental health services through research with a focus on an important and underserved population.