HRST Fundamental in Aiding Healthcare Workers with IDD Patients with Secondary Psychological Diagnosis In Times of COVID-19

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Many people with intellectual and developmental disabilities also live with psychological disorders (dual diagnosis). HRS explains why healthcare providers need better patient assessment tools to ensure accurate diagnosis and treatment for reducing mortality rates due to COVID-19.

Assessment methods are vital to bridging the dual diagnosis education gap for all healthcare providers during and after the COVID-19 pandemic.

We do not fully educate most physicians and nurses in communication best practices for effective diagnosis and treatment of dual diagnosis patients.

People with intellectual and developmental disabilities (IDD) have a higher potential for mortality from COVID-19 than most other groups, especially if they live in group homes.(1) But matters become more dire if they are also affected by a psychological comorbidity. According to Health Risk Screening, Inc.’s President Dr. Craig Escudé, physicians lack the training and experience necessary to diagnose these patients and improve health outcomes. “Patients with IDD and a secondary mental health condition often present communication challenges for physicians,” said Dr. Escudé. “Most healthcare providers lack the tools and education to effectively communicate with these patients for accurate diagnosis, which can increase the chances of mortality during this pandemic.”

Provider Communication Challenges with Dual Diagnosis Patients

There are a broad number of conditions that fall under the IDD umbrella, and each one has different, yet related, symptoms that range in severity. IDD patients who also live with psychological disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder, bipolar disorder, depression, and obsessive-compulsive disorder, are considered dual diagnosis patients. These types of mental health challenges are common, occurring in 30 to 35 percent of all persons with IDD.(2)

Many people living with a dual diagnosis also have interpersonal communication challenges.(3) The way these conditions present and affect individual patients can make communication, assessment, diagnosis, and treatment difficult for healthcare providers unfamiliar with dual diagnosis.

How to best work through these challenges and communicate effectively with dual diagnosis patients is a major issue for caregivers lacking experience with this patient population. While there are defined approaches for communication and supported decision making for those with IDD, dual diagnosis complicates the process.(4)

Socioeconomic hardships and corresponding governmental budget cuts have exacerbated the problem of providing educational support to IDD and dual diagnosis patient caregivers. Major cities are now cutting millions of dollars from agency and provider budgets for supporting those with developmental disabilities.(5)

“We do not fully educate most physicians and nurses in communication best practices for effective diagnosis and treatment of dual diagnosis patients. Recent research studies suggest that registered nurses, among other health providers, feel unprepared to support patients with IDD.(6) Despite this reality, things are slowly getting better,” said Dr. Escudé.

Dual Diagnostic Tools and Approaches for Better Treatment Outcomes

Communication and assessment training to better diagnose and treat dual diagnosis patients in any care setting should start in medical school. But medical school curriculums are not standardized, and training in these areas ranges from minimal to more inclusive modules, tools, experience, and instruction.(7)

Dual diagnosis patients and their caregivers face compounded obstacles to diagnosis, which often results in little to no treatment to mitigate other health risks. But recent research shows that Support Services Teams may help people with IDD who also have mental health conditions with personalized behavior services plans to help prevent and respond to behavioral crises.(8) Also, researchers at the UC Davis MIND Institute have updated and validated a series of tests, known as the Toolbox Cognitive Battery, originally developed by the National Institutes of Health (NIH). The NIH Toolbox helps assess cognitive ability and executive function in those with IDD. This information can then be used to help guide preventative care and treatment decisions.(9) These programmatic approaches are integral to improving the knowledge base of supporters and providers to better meet the healthcare needs of people with dual diagnosis.

Still, healthcare providers need simple, yet effective, tools to help them assess dual diagnosis patients for other health risks. Health Risk Screening, Inc.’s Health Risk Screening Tool (HRST), an easy-to-use web-based rating instrument, helps caregivers identify these risks and take action to prevent them. Recent studies validate the HRST’s predictive ability for mortality risk and recommend the tool be used to help verify healthcare needs and determine nursing care acuity for people with IDD.(10) Additionally, HRS’s eLearning courses, such as the Curriculum in IDD Healthcare and The Fatal Five, teach the fundamentals of IDD healthcare to supporters and clinicians who work with people with disabilities.

According to Dr. Escudé, the HRST and assessment methods are vital to bridging the dual diagnosis education gap for all healthcare providers during and after the COVID-19 pandemic:

“Physicians, nurses, caregivers, and medical and nursing students are generally in the same situation in terms of health screening and assessment support for those with IDD and a host of psychological conditions,” explained Dr. Escudé. They all need simple, web-based tools that provide proven assessment and evaluation support that bridges the gaps in their knowledge on communicating with patient populations with these conditions.” Using these tools can reduce risk, extend life expectancy, and improve the quality of life for people with disabilities across the country and globally.

About Health Risk Screening, Inc.:
Health Risk Screening, Inc.’s roots began in 1992. HRS is an industry leader in training courses, webinars, and materials to help at-risk populations. HRS’s focus is on developing tools and training for the person-centered support of these vulnerable populations. Through the education of government agencies and service providers, HRS aims to improve lives. One such tool is the Health Risk Screening Tool, of which HRS is the sole developer, producer, and distributor. The web based HRST is the most widely used and validated health risk screening instrument for people with intellectual and developmental disabilities. With unrelenting focus, HRS works to fulfill its mission of improving the health and quality of life for people faced with these types of vulnerabilities. For more information, visit

1.    Scott D. Landes et al. “COVID-19 outcomes among people with intellectual and developmental disability living in residential group homes in New York State,” Disability Health Journal, June 24, 2020,
2.    The Diagnostic Manual–Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability, Second Addition DM-ID-2, NADD,
3.    Emily Sohn. “The blurred line between autism and intellectual disability, Spectrum News, April 15, 2020,
4.    Clarissa Kripke, MD. “Adults with Developmental Disabilities: A Comprehensive Approach to Medical Care,” American Family Physician, May 15, 2018,
5.    Nancy Cutler. “After COVID, advocates say cuts further hurt New Yorkers with developmental disabilities,” Rockland/Westchester Journal News, July 1, 2020,
6.    Marie Appelgren et al. “Nurses’ experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach,” BMC Nursing, December 3, 2018,
7.    “Educating Medical Students about Disability,” Ohio State Nisonger Institute, January 2017,
8.    Support Services Teams May Help People with Intellectual and Developmental Disabilities and Mental Health Conditions Receive Support in Their Communities and Reduce Medicaid Costs, NAIRC, August 22, 2018,
9.    Validating Toolbox to evaluate cognitive processing in people with intellectual disability, Science Daily, February 24, 2020,
10.    Roszkowski, Thomas, Conroy, Ivy, Gravitt. An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People with Intellectual Disabilities, NCBI, March 2020,

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Karla Jo Helms
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