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Friedman C. Organizational Supports to Promote the Community Integration of People With Dual Diagnosis. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:101-111. [PMID: 33793781 DOI: 10.1352/1934-9556-59.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/16/2019] [Indexed: 06/12/2023]
Abstract
One of the most common reasons people with intellectual and developmental disabilities (IDD) return to institutions is because of maladaptive behaviors. This study's aim was to examine the impact organizational supports can have on the community outcomes of people with dual diagnosis-those with IDD and psychiatric disabilities. We analyzed secondary Personal Outcome Measures interview data from 533 people with dual diagnosis. Findings revealed people with dual diagnosis were significantly more likely to have community outcomes present when they received individualized organizational supports. In addition, we found a number of disparities in organizational supports, including related to guardianship, communication method, and residence type. A more robust service system is necessary to ensure people with dual diagnosis are integrated into their communities.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL | The Council on Quality and Leadership
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Friedman C. Managed Care and Value-Based Payment: The Relationship Between Quality of Life Outcomes and Emergency Room Utilization. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:22-38. [PMID: 33543275 DOI: 10.1352/1934-9556-59.1.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/22/2019] [Indexed: 06/12/2023]
Abstract
Although Medicaid managed care is a growing service model, there is a limited evidence base regarding quality and value-based payment standards for people with intellectual and developmental disabilities (IDD). This study examined the relationship between emergency room utilization and quality of life outcomes. We analyzed secondary Personal Outcome Measures quality of life and emergency room utilization data from 251 people with IDD. According to our findings, people with IDD with continuity and security in their lives and/or who participated in the life of the community had fewer emergency room visits, regardless of their impairment severity or dual diagnosis status. As such, the number of emergency room visits needed, and the potential expenditures associated, may be reduced by focusing on quality outcomes.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL | The Council on Quality and Leadership
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Friedman C. The Impact of Home and Community Based Settings (HCBS) Final Settings Rule Outcomes on Health and Safety. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:486-498. [PMID: 33290530 DOI: 10.1352/1934-9556-58.6.486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 06/12/2023]
Abstract
Despite physically relocating into the community, many people with intellectual and developmental disabilities (IDD) fail to be meaningfully included in the community. The Home and Community Based Services (HCBS) Settings Rule was introduced to expand community integration, person-centered services, and choice. The aim of this exploratory study is to examine the potential impact of HCBS Settings Rule implementation, specifically by examining how the presence of HCBS Settings Rule outcomes impact three areas of health and safety. We analyzed secondary Personal Outcome Measures data relating to the HCBS Settings Rule, and emergency room visits, abuse and neglect, and injuries data from 251 people with IDD. Findings indicate a clear need to improve HCBS Settings Rule related areas of people's lives.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL The Council on Quality and Leadership
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Friedman C. Quality of Life Outcome and Support Disparities Among People With More Severe Impairments. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2020; 58:513-524. [PMID: 33290537 DOI: 10.1352/1934-9556-58.6.513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/05/2018] [Indexed: 06/12/2023]
Abstract
People with intellectual and developmental disabilities (IDD) with more severe impairments often face service disparities. The aim of this study was to explore not only disparities in quality of life outcomes for people with IDD with severe impairments, but also disparities in the supports they receive from disability service organizations. Our analysis of Personal Outcome Measures interviews from 1,300 people revealed people with severe impairments experienced quality of life disparities in most domains, attributed to the fact that they also received fewer organizational supports than people with less severe impairments. By paying attention to person-centered outcomes, including these disparities, organizations' roles can shift from just providing services to supporting people to achieve the outcomes that are truly important to them.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL The Council on Quality and Leadership
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Spassiani NA, Meisner BA, Abou Chacra MS, Heller T, Hammel J. What is and isn’t working: Factors involved in sustaining community‐based health and participation initiatives for people ageing with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:1465-1477. [DOI: 10.1111/jar.12640] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 05/22/2019] [Accepted: 06/04/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Natasha A. Spassiani
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
- Department of Disability and Human Development University of Illinois at Chicago Chicago Illinois
| | | | - Megan S. Abou Chacra
- Surrey Place Toronto Ontario Canada
- Centre for Addiction and Mental Health Toronto Ontario Canada
| | - Tamar Heller
- Department of Disability and Human Development, University Center of Excellence in Developmental Disabilities for the State of Illinois University of Illinois at Chicago Chicago Illinois
| | - Joy Hammel
- Department of Disability and Human Development University of Illinois at Chicago Chicago Illinois
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Friedman C. The Influence of Residence Type on Personal Outcomes. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:112-126. [PMID: 30920914 DOI: 10.1352/1934-9556-57.2.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over the last 5 decades, the state institution census has decreased 85% in the United States. Despite these radical shifts away from institutionalization, people with intellectual and developmental disabilities (IDD) continue to struggle to be meaningfully included in the community. For these reasons, the aim of this study was to explore if and how residence type affects attainment of quality of life outcomes of people with IDD in the United States. To do so, we analyzed Personal Outcome Measures® interviews from approximately 1,350 people with IDD. Findings suggest much of what has historically been considered deinstitutionalization of people with IDD is transinstitutionalization, particularly with provider-owned or -operated settings. A systemic overhaul is needed to create an effective community infrastructure.
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Abstract
Abstract
Despite the difficulties people with disabilities may have garnering intimate relationships, intimate relationships may be particularly beneficial for people with disabilities as they result in greater self-acceptance, less internalized stigma, and more camaraderie. The aim of this study was to explore the intimate relationships of adults with disabilities (n = 1,443) in its many forms (from intimate friendships to romantic relationships). We particularly explored what factors increased the odds of adults with disabilities having intimate relationships, what supports resulted in increased likeliness to have intimate relationships, and what factors resulted in the presence of favorable intimate relationship outcomes. Our analysis revealed service organizations are key to enhancing the social and intimate relationships of adults with disabilities.
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Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL
- The Council on Quality and Leadership, Towson, MD
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Jaydeokar S, Piachaud J. Out-of-borough placements for people with learning disabilities. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.10.2.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
All people with learning disabilities should be able to choose from a variety of residential placements as a way of achieving greater community integration. However, many are still placed away from their borough of origin, resulting in complex consequences for them, and their families and for clinicians. This article explores the nature of the problem, defining the current issues, and examining the role of the stakeholders and the implications for psychiatrists working in this field.
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Sheerin F, Griffiths C, de Vries J, Keenan P. An evaluation of a community living initiative in Ireland. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2015; 19:266-281. [PMID: 25724915 DOI: 10.1177/1744629515573679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 06/04/2023]
Abstract
One of the central principles underpinning Irish intellectual disability policy is that of decongregation. Allied to this is the belief that life in community settings offers greater opportunities and richer experiences than does life in institutional settings. This study explores the experiences of a group of adults with intellectual disabilities who moved from residential settings to living units in the community. Using a qualitative descriptive approach, it considers the significance of that move for them and seeks to understand the extent to which their lives have changed. Whereas it emerges that this was a positive period in their lives, it is clear that a number of issues remain to be addressed and these provide useful information for similar developments in the future.
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Affiliation(s)
| | | | - Jan de Vries
- University of Dublin, Trinity College Dublin, Ireland
| | - Paul Keenan
- University of Dublin, Trinity College Dublin, Ireland
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Hensel JM, Lunsky Y, Dewa CS. The mediating effect of severity of client aggression on burnout between hospital inpatient and community residential staff who support adults with intellectual disabilities. J Clin Nurs 2013; 23:1332-41. [PMID: 24128052 DOI: 10.1111/jocn.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities (ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. BACKGROUND Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. DESIGN This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. METHODS Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. RESULTS Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion (EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. CONCLUSIONS Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. RELEVANCE TO CLINICAL PRACTICE There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe.
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Affiliation(s)
- Jennifer M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Young L, Ashman AF. Deinstitutionalisation in Australia Part II: Results from a Long-Term Study. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979504799103967] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Young L, Ashman AF. Deinstitutionalisation in Australia Part I: Historical Perspective. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/096979504799104029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McClimens A, Hyde M. Intellectual disability, consumerism and identity: to have and have not? JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2012; 16:135-144. [PMID: 22544482 DOI: 10.1177/1744629512445844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Here we consider the consumer society as it currently exists in the UK and examine its relationship and relevance to the population of individuals with intellectual disability. We do this through a reading of the associated literature on theories of shopping and consumption which we then contrast with research evidence as it applies to the lives of people with intellectual disability. By brining together these two perspectives we hope to shine some light on ideas around identity and choice. We then transfer these arguments to the health and social care sector. Here we ask whether an economic model which has been exposed as divisive and exclusionary should be used in the administration of social secutity benefits of the kind accesed by people with a range of disabilities. We conclude that the unchallenged advance of marketisation within health and social care may benefit those who are financially able but for those who are economically disadvantaged the choices offered are illusory at best.
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Chowdhury M, Benson BA. Deinstitutionalization and Quality of Life of Individuals With Intellectual Disability: A Review of the International Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2011. [DOI: 10.1111/j.1741-1130.2011.00325.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hamelin JP, Frijters J, Griffiths D, Condillac R, Owen F. Meta-analysis of deinstitutionalization adaptive behaviour outcomes: research and clinical implications. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011; 36:61-72. [PMID: 21314594 DOI: 10.3109/13668250.2010.544034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND A meta-analysis examined the effects of deinstitutionalisation on adaptive behaviour outcomes in persons with intellectual disability. The need for an updated review in this area is reflected by recent policy shifts in community care practices and the international status of deinstitutionalisation efforts. METHOD Twenty-three studies were compared using standardised mean effect sizes across 5 demographic, 4 methodological, and 1 outcome variable. RESULTS Moderate habilitative gains were found in 75% of adaptive behaviour domains. A weighted linear multiple regression revealed that larger effect sizes were significantly predicted by sample size and research design. Disability level also moderated the extent to which sample size affected the magnitude of effect sizes. CONCLUSIONS These results are discussed in relation to the implications they have for community services for persons with intellectual disability. The difficulties in accurately comparing studies with dissimilar procedures and contexts are also outlined.
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Affiliation(s)
- Jeffery P Hamelin
- Queens College and The Graduate Center, The City University of New York, USA.
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Hamelin JP, Frijters J, Griffiths D, Condillac R, Owen F. Meta-analysis of deinstitutionalisation adaptive behaviour outcomes: Research and clinical implications. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2011:1-13. [PMID: 21268681 DOI: 10.1080/13668250.2010.544034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Background A meta-analysis examined the effects of deinstitutionalisation on adaptive behaviour outcomes in persons with intellectual disability. The need for an updated review in this area is reflected by recent policy shifts in community care practices and the international status of deinstitutionalisation efforts. Method Twenty-three studies were compared using standardised mean effect sizes across 5 demographic, 4 methodological, and 1 outcome variable. Results Moderate habilitative gains were found in 75% of adaptive behaviour domains. A weighted linear multiple regression revealed that larger effect sizes were significantly predicted by sample size and research design. Disability level also moderated the extent to which sample size affected the magnitude of effect sizes. Conclusions These results are discussed in relation to the implications they have for community services for persons with intellectual disability. The difficulties in accurately comparing studies with dissimilar procedures and contexts are also outlined.
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Affiliation(s)
- Jeffery P Hamelin
- Queens College and The Graduate Center, The City University of New York, USA
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Ruddick L. Health of people with intellectual disabilities: A review of factors influencing access to health care. Br J Health Psychol 2011; 10:559-70. [PMID: 16238865 DOI: 10.1348/135910705x43769] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The rights and needs of people with intellectual disabilities are being acknowledged within Department of Health policies. In spite of this, however, it is frequently cited that people with intellectual disabilities are vulnerable to many health problems but have poor access to health-related services. There are many factors that can act as barriers to people with intellectual disabilities enjoying good health and accessing services. These include: (a) a lack of clarity regarding responsibilities for ensuring that health policies are operationalized; (b) social and residential aspects of life being emphasized within the quality of life framework for evaluating services for people with intellectual disabilities, with health as an under-represented domain; (c) a lack of reliable and valid measures that can be used with carers and people with intellectual disabilities to explore health, particularly in comparison to literature on the general population; (d) potential communication difficulties (between the person with intellectual disabilities, their carers and health staff) that can impact on decision-making processes from early identification of health problems through to the stage of gaining appropriate treatment. These areas are discussed giving rise to questions and challenges for policy makers, researchers and clinicians.
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Young L. Community and cluster centre residential services for adults with intellectual disability: long-term results from an Australian-matched sample. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2006; 50:419-31. [PMID: 16672036 DOI: 10.1111/j.1365-2788.2006.00788.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre. METHODS This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model. RESULTS Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group. CONCLUSIONS Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.
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Affiliation(s)
- L Young
- School of Medicine, The University of Queensland, Mayne Medical School, Herston Qld, Australia.
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Felce D, Emerson E. Living with support in a home in the community: predictors of behavioral development and household and community activity. MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2001; 7:75-83. [PMID: 11389561 DOI: 10.1002/mrdd.1011] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this article was to review studies of behavioral development and household and community activity among adults with mental retardation living in community residential services and to distill knowledge about the factors that influence outcome. Research points to behavioral development occurring across the full spectrum of disability but influenced by mental retardation syndrome and the acquisition of pivotal skills. However, engagement in household and community activities has been found to be strongly related to individual adaptive behavior. People with more severe mental retardation are vulnerable to leading lives characterized by underoccupation and lack of community involvement. Moving from institutional to community-based residential services may be accompanied by significant increases in adaptive behavior, but a plateau effect on subsequent development has also been reported. There is substantial evidence to suggest that key aspects of effective teaching technology may be absent in community-based residential environments. Community settings support greater engagement in household and community activities than institutions. Ordinary housing stock and normative architecture and standards of material enrichment are to be preferred. The use of normative housing constrains group living to relatively small scale, but there is little evidence that smaller size within this range is to be preferred to larger size. There is little evidence to suggest that higher staff-to-resident ratios lead to uniformly better outcomes, but staff orientation, working methods, and performance are important influences. Little is known about what precise characteristics of community location give rise to greater community integration. MRDD Research Reviews 7:75-83, 2001.
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Affiliation(s)
- D Felce
- Welsh Centre for Learning Disabilities, University of Wales College of Medicine, Meridian Court, North Road, Cardiff CF14 3BG, Wales, UK.
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Nøttestad JA, Linaker OM. Psychiatric health needs and services before and after complete deinstitutionalization of people with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 1999; 43 ( Pt 6):523-530. [PMID: 10622369 DOI: 10.1046/j.1365-2788.1999.00236.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Before total deinstitutionalization in Norway, many believed that the ordinary health care system could give people with intellectual disability the same or even better health care than that which they received in institutions. It was said that institutions created psychiatric problems, and that these would diminish or even disappear with the closing of these establishments. The present study is a prospective cohort study without a control group. It examines the frequency of mental health problems and the psychiatric health services which 109 subjects aged between 16 and 65 years received before (1987) and after (1995) deinstitutionalization. Mental health problems were defined as behavioural disturbances, and psychiatric disorders and symptoms. Psychiatric disorders were identified with the Psychopathology Instruments for Mentally Retarded Adults (PIMRA), which were filled in by the carers. Behaviour disturbances were identified as having occurred or not during the previous year. Psychiatric problems remained frequent, and there was a significant increase in behavioural problems in spite of total deinstitutionalization and improved physical living conditions. Access to qualified help, such as psychologists and psychiatrists, had been substantially reduced. Most mental health problems among people with intellectual disability are not solved by reorganization or deinstitutionalization, and such measures are no substitution for professional assistance.
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