One doctor’s program for assessing health risk
For months, healthcare professionals have studied and investigated the effects of COVID-19 across age, gender, and racial lines with mixed results. We know the sick and elderly are at greatest risk for extreme cases, and we know certain racial groups are prone to more severe outcomes.
But another, less publicized group is equally vulnerable – individuals with intellectual developmental disabilities (IDD).
Dr. Craig Escudé, MD, FAAFP, FAADM is president of Health Risk Screening, Inc. He is only the seventh physician to receive the FAADM (Fellow of the American Academy of Developmental Medicine) designation. As such, Dr. Escudé is uniquely qualified to discuss the challenges faced by those with IDD.
“Sometimes people with disabilities are more sensitive to the changing of routines or environments or their support staff, and that presents additional challenges,” he explained. “And sometimes that comes out as an adverse behavior simply because the person is trying to communicate what they’re feeling.”
The health risks are compounded by the loss of available supports for this population. Many people with IDD require the help of others for activities for daily living, and with social distancing protocols in place, it becomes difficult to make these connections.
“Many people who provide this support are direct support professionals, so they are coming and going all the time and the job requires close contact with others,” Dr. Escudé said. “That may lead to an increased chance of exposure. Also, there are higher incidences with asthma, obesity, and other chronic conditions that we know increases the risk of serious illness with COVID-19. Especially if they have more severe or more profound levels of disability, they’re more likely to have restricted lung disease, have difficulty taking in deep breaths or clearing their lungs.”
People with disabilities communicate in different ways. Some communicate verbally, but others develop what professionals call ‘behaviors’ when they can’t express themselves verbally. “For instance, we see people who may bite their arm, hit their hand on a table, and that may be their way of expressing that something is bothering or hurting them,” said Dr. Escudé. “If you’re not familiar with the person, there may be a tendency to write off that behavior as something they’re doing simply because they have a disability.”
This makes it harder to identify body aches, chills, and other symptoms of general discomfort. Dr. Escudé does a lot of teaching unrelated to COVID-19 on the recognition of these issues. “Sometimes, these behaviors result from an underlying medical issue that’s being missed,” he said. “But they’re often placed on these psychotropic medications and end up having side effects from those.”
All ‘behaviors’ require further investigation in this field. It could be health related, but it could also be a social or environmental issue – something that medications won’t address.
Health Risk Screening Tool
Dr. Craig Escudé has developed a Health Risk Screening Tool (HRST) that is used by each state that can help identify those at most risk for serious consequences from illnesses such as COVID-19 and provide action steps to help mitigate that risk.
HRST has been validated by the Journal of Nursing of the Health Risk Screening Inc. for assessing mortality risk to plot a course of action that can save lives.
“It’s a web-based tool that asks questions in 22 different areas, including eating, bathroom habits, seizures, behavior considerations, and medications,” Dr. Escudé explained. “You’re asked some rather simple yes or no questions, and based on how those questions are answered the tool gives you a score.”
The result is an individual score in each area, plus an overall Health Care Level (HCL) between 1-6. Each level is correlated with an increased risk of mortality. “While it’s nice to know risks, it’s even better to know what can be done to reduce those risks,” said Dr. Escudé. “That’s where the tool really shines. It gives you action steps to take that can reduce those risks.”
The tool will ask specific questions:
- Does the person wake up crying at night?
- Does the person put their hands in their mouth on a regular basis?
- Does the person have a Pica? (an eating disorder in which a person eats things of no nutritional value)
Based on the answers, the tool will indicate possible causes (in this case, it could be a gastroesophageal reflux condition) and create the next steps to be taken for a thorough evaluation.
“Now the person gets treated, and you’ve reduced their risks for serious consequences as well as their own pain and suffering,” explained Dr. Escudé.
As it pertains to COVID-19, we seem to be in the midst of the long-discussed ‘second wave,’ and Dr. Escudé says people can’t drop their guards, especially as it pertains to people with disabilities.
“Not only do we need to sustain the sanitation measure, the hand-washing protocols – we need to teach them to people with disabilities. People with disabilities can indeed learn – they may require different teaching methods, but hygienic measures can be taught.”
Additionally, while social distancing has its place, there are costs involved. People with disabilities often feel isolated and not fully integrated into a community. Any increase in this isolation or feelings of loneliness can increase sadness and anxiety. The demand on mental health services has already increased, the instances of suicide, abuse, and neglect have increased. It’s certainly important to keep a healthy distance due to virus protocol, but people must also be aware of these unintended consequences of social distancing.
“We can expand other ways to connect with people,” said Dr. Escudé. “We’ve certainly learned a lot more about the use of electronic platforms and social media, virtual meeting software. There are alternate means of social inclusion and social interaction.”
Increased funding for programs that support people with disabilities is crucial because of the level of dependency, particularly in today’s environment. “Right now, many of these agencies are struggling,” lamented Dr. Escudé. “We need to try to beef up support and the funding system for these agencies and the people in these fields. The overall pay is very low, which can be difficult and challenging for these professionals.”
To learn more about Dr. Craig Escudé and the Health Risk Screening Tool, visit https://hrstonline.com/
