The Impact of Mental Health Diagnosis and Behavioral Support Needs on Personal Opportunity Outcomes for Adults with Intellectual and Developmental Disabilities

Background

Literature suggests that people with intellectual and developmental disabilities (IDD) have higher incidences of mental health conditions than the general population (Esler et al., 2019; Scott & Havercamp, 2014). People with IDD also have high rates of behavioral support needs which are related to, but distinct from, mental health conditions (McCarthy et al., 2010). Behavioral support needs and mental health diagnoses impact quality of life outcomes for people with IDD, though the mechanisms by which they do so are unclear (Bradley et al., 2018).

This study sought to examine how predictors of a personal opportunity measure vary between people with IDD based on mental health conditions and behavioral support needs.

Methods

Data for this study primarily came from the Virginia 2017-2018 and 2018-2019 National Core Indicators In-Person Survey (NCI-IPS). The NCI-IPS is a face-to-face survey conducted by trained interviewers with adults with IDD. States randomly select a sample of adults with IDD who use at least one state-funded service to participate in the NCI-IPS each year. In Virginia, approximately 800 people participated in each survey year, for a total sample of 1620.

Variables from the NCI-IPS were used to classify respondents into one of four categories: those with 1) only mental health conditions, 2) only behavioral support needs, 3) both a mental health diagnosis and behavioral support needs, or 4) neither condition. Subsequent analyses were based on those four groupings. Personal opportunity scales for rights, social participation, and choice were developed and validated in a previous study (Authors, in press). Disability and demographic characteristics also came from the NCI-IPS. We ran a multigroup confirmatory factor analysis (MG-CFA) to test for measurement invariance between these groups. Finally, we used path analysis to examine how predictors of personal opportunity outcomes performed with each group.

Results

Multigroup CFA established configural (x² = 26.17 p = 0.10), metric (x ²= 57.57, p = 0.34), and scalar (x² = 25.51, p = 0.70) measurement invariance between the four groups. Bivariate comparisons of personal opportunity outcomes showed significant group differences, though patterns differed. For example, people with behavioral support needs had significantly lower rights and choice, but higher community participation. Higher support needs consistently predicted lower personal opportunity outcomes across groups. Type of residence, particularly living in a host home, more commonly predicted outcomes for respondents with behavioral support needs than for people with only mental health diagnosis or those with neither condition.

Implications

Measurement invariance between the four groups suggested that people with and without mental health conditions and/or behavioral support needs interpret personal opportunity measures similarly, which allows for direct comparisons of outcomes between groups. As such, we can be confident that differences in personal opportunity outcomes between groups are meaningful and that mental health conditions and behavioral support needs should be considered distinctly in services for people with IDD. Residence type was particularly important for people with IDD and behavioral support needs. Future research should consider the mechanisms by which host homes promote personal opportunity.