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Larson SA, Caldwell J, Robinson G, Oteman Q. Housing and Long-Term Services and Supports for People With Intellectual or Developmental Disabilities From Racially and Culturally Minoritized Communities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 62:200-210. [PMID: 38802099 DOI: 10.1352/1934-9556-62.3.200] [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: 05/10/2023] [Accepted: 02/13/2024] [Indexed: 05/29/2024]
Abstract
This article describes research on the places people with intellectual and developmental disabilities (IDD) live and disparities in housing and long-term services and supports (LTSS) outcomes for people with IDD from racially and culturally minoritized groups. It also summarizes the conclusions and recommendations of the Housing and Long-Term Services and Supports strand of the 2022 State of the Science Conference on the Intersection of Diversity, Equity and Inclusion and Supports and Services for People with IDD, identifies limitations of the available research and recommends strategies to improve research, knowledge translation, and practices.
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Affiliation(s)
- Sheryl A Larson
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Joseph Caldwell
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Gregory Robinson
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
| | - Quinn Oteman
- Sheryl A. Larson, University of Minnesota, Institute on Community Integration; Joseph Caldwell, Brandies University, Community Living Policy Center; Gregory Robinson, Autistic Self Advocacy Network; and Quinn Oteman, University of Minnesota, Institute on Community Integration
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Werner S. Service use and perceptions of service effectiveness by parents of individuals with intellectual disabilities: comparing Jewish and Arab Israeli parental caregivers. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:957-968. [PMID: 30775831 DOI: 10.1111/jir.12611] [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: 11/07/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The relationship between ethnicity, service use and perceptions of service effectiveness is inconclusive. This study examined differences in service use and perceptions of service effectiveness between Israeli Jewish (Jewish) and Israeli Arab (Arab) parental caregivers of individuals with intellectual disabilities and dual diagnosis of psychopathology. METHODS Parental caregivers (n = 186) of individuals with intellectual disabilities or dual diagnosis, aged 10 to 30 years, completed a self-report questionnaire. RESULTS Arab parental caregivers perceived health services to be more accessible than did Jewish caregivers, but there was no difference between the two groups in the use of the services. Overall, greater enabling factors and accessibility were associated with higher use of education and social services. No differences were found between the groups in their perceptions of service effectiveness. CONCLUSION Arab family caregivers use education and social services less than do their Jewish peers, possibly because they have fewer enabling resources. The finding that both groups reported similar use of health services may be explained by a shared perception that informal help may not be suitable for dealing with situations of psychopathology. The similar perceptions of service effectiveness may be explained by extensive services available in Israel, to the satisfaction of both groups, or by the fact that participants perceived these services as their only alternative, and therefore fear losing them.
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Affiliation(s)
- S Werner
- Paul Baerwald School of Social Work and Social Welfare and the Center for Disability Studies, Hebrew University of Jerusalem, Jerusalem, Israel
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Chaidez V, Fernandez y Garcia E, Wang LW, Angkustsiri K, Krakowiak P, Hertz-Picciotto I, Hansen RL. Comparison of maternal beliefs about causes of autism spectrum disorder and association with utilization of services and treatments. Child Care Health Dev 2018; 44:916-925. [PMID: 30136409 PMCID: PMC6447086 DOI: 10.1111/cch.12612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 06/27/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND This study aimed to describe parental perceptions of the causes of autism spectrum disorder (ASD) in an ethnically diverse sample and explore whether these perceptions relate to treatment choices. METHODS The sample consisted of White (n = 224), Hispanic (n = 85), and Asian (n = 21) mothers of a child with ASD. A mixed methods approach was used in this secondary analysis focusing on parental perceptions about the causes of ASD and the relationship of these to utilization of services and treatment. RESULTS Environmental and genetic factors were most often believed to be the cause or one of the causes of ASD by mothers across all ethnic groups studied. Asian mothers were more likely to cite multiple causes. Environmental causes were associated with receiving 20 or more hours of autism-related services per week, whereas belief in environmental exposures and vaccines and medications as causes were associated with complementary-alternative medicine (CAM) use. CONCLUSION Our findings suggest that ethnic differences in autism causal beliefs and treatment choices may exist. Future research should be conducted to specifically confirm the findings, to understand parental motivation behind their service and treatment choices, and to gain more insight into the types, usage, and sources of CAM treatments. Clinicians can use parental autism causal beliefs in discussions about treatment recommendations.
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Affiliation(s)
- Virginia Chaidez
- Present address,Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, California
| | - Erik Fernandez y Garcia
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Lulu W Wang
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, California.,Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Kathleen Angkustsiri
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, California.,Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
| | - Paula Krakowiak
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, California,Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, California
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, California,Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, California
| | - Robin L Hansen
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, California.,Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California
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Fabius CD, Thomas KS, Zhang T, Ogarek J, Shireman TI. Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis. BMC Health Serv Res 2018; 18:773. [PMID: 30314479 PMCID: PMC6186063 DOI: 10.1186/s12913-018-3584-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS. METHODS We used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures. RESULTS Black HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest. CONCLUSIONS Findings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.
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Affiliation(s)
- Chanee D Fabius
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA.,Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
| | - Tingting Zhang
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
| | - Jessica Ogarek
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
| | - Theresa I Shireman
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Box G-S121(6), 121 S Main Street, Providence, RI, 02912, USA
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Harrington C, Kang T. Disparities in Service Use and Expenditures for People With Intellectual and Developmental Disabilities in California in 2005 and 2013. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2016; 54:1-18. [PMID: 26824130 DOI: 10.1352/1934-9556-54.1.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined service use and expenditures for people with intellectual and developmental disabilities (IDD) living at home and in the community in California in 2005 and 2013. The number of people assessed for IDD services increased, along with the percentage of individuals who did not receive any services between 2005 and 2013. Controlling for client needs, children age 3-21 were less likely than other age groups to receive any services using logistic regressions. All racial and ethnic minority groups were less likely to receive any services than were white populations. Females, younger people, and all racial and ethnic minority groups who received services had significantly lower expenditures, with wide geographic variations. The disparities by age, gender, race/ethnicity, and geography have persisted over time in California.
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Affiliation(s)
- Charlene Harrington
- Charlene Harrington, University of California San Francisco, Department of Social & Behavioral Sciences, San Francisco, California; and
| | - Taewoon Kang
- Taewoon Kang, University of California San Francisco, Institute for Health and Aging, San Francisco, California
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Gulley SP, Rasch EK, Chan L. Difference, disparity, and disability: a comparison of health, insurance coverage, and health service use on the basis of race/ethnicity among US adults with disabilities, 2006-2008. Med Care 2014; 52:S9-16. [PMID: 25222647 PMCID: PMC4166572 DOI: 10.1097/mlr.0000000000000129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, research on health disparities has begun to include people with disabilities as a minority population. However, there is a gap in our knowledge of whether, and to what extent, racial and ethnic disparities may affect the health or health care access of people with disabilities. OBJECTIVES We examined potential disparities in overall health, insurance coverage status, and health service use between non-Hispanic whites, non-Hispanic blacks, and Hispanics, among a nationally representative US sample of adults with and without disabilities (N=63,257), using both bivariate and multivariate methods. We tested 2 definitions of disparity. RESULTS Under the more conservative definition, we confirmed the presence of both racial and ethnic disparities in overall health, total annual health care visits, and the percentage reporting no doctor visit during the year among people with less severe disabilities; Hispanics also evidenced a disparity in rates uninsured relative to non-Hispanic whites in this group. Racial/ethnic disparities were less common among persons with more severe disabilities that affected activities of daily living or instrumental activities. CONCLUSIONS We conclude that the reduction of disparities between the populations of people with and without disabilities will require specific attention to racial and ethnic disparities in health, insurance coverage, and service use.
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Affiliation(s)
- Stephen P. Gulley
- Brandeis University, Waltham, MA
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Elizabeth K. Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
| | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD
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Lunsky Y, Tint A, Robinson S, Gordeyko M, Ouellette-Kuntz H. System-Wide Information About Family Carers of Adults With Intellectual/Developmental Disabilities-A Scoping Review of the Literature. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2014. [DOI: 10.1111/jppi.12068] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health; Toronto Ontario Canada
| | - Ami Tint
- Department of Psychology; York University; Toronto Ontario Canada
| | - Suzanne Robinson
- Department of Psychology; York University; Toronto Ontario Canada
| | - Marcia Gordeyko
- School and Child Clinical Psychology; Ontario Institute for Studies in Education; University of Toronto; Toronto Ontario Canada
| | - Hélène Ouellette-Kuntz
- Departments of Community Health & Epidemiology and Psychiatry; Queen's University; Kingston Ontario Canada
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Fjermestad KW, Stokke S, Wergeland GJH, Anticich S, Haugland BSM, Havik OE, Heiervang ER. Socio-Emotional Problems in Boys with Sex Chromosome Aneuploidies Compared to a Clinical Sample. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2013.876538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pollack HA. Health policy and the community safety net for individuals with intellectual disability. DEVELOPMENTAL DISABILITIES RESEARCH REVIEWS 2011; 17:44-51. [PMID: 22447755 DOI: 10.1002/ddrr.138] [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
This article explores social policy developments in the arena of intellectual and developmental disabilities. It begins by summarizing the challenges facing persons with intellectual disabilities and their caregivers in 1945. Families depended on a patchwork of over-crowded and under-funded large state institutions. Children with intellectual disabilities were marginalized from education and public services. Shame and stigma, along with the lack of community-based services, led many parents to institutionalize a child. The federal government provided almost no specific assistance for disabled individuals or to their families. Postwar America provided fertile ground for parents to act collectively through the emergence of the National Association of Retarded Children (NARC). Partly as a consequence of such organizing, the 1950s marked a surprising turning-point, in which the federal government expanded income support to disabled persons through measures such as Social Security's "Disabled Adult Child" program and, by the early 1970s, the advent of Supplemental Security Income (SSI). It also reviews the growth of Medicaid as the dominant payer of medical and social services at the boundaries between personal medical services, case management, education, and other social services. The article ends by summarizing current challenges in intellectual disability policy. It notes that the size, complexity, and expense of I/DD services poses inherent challenges, particularly to state and local governments in the current recession. Adjusting for inflation, 23 states actually reduced real spending on I/DD services between 2008 and 2009. Controlling for local conditions, politically conservative states enacted deeper cuts and spent a smaller fraction of state income on intellectual disability services than other states.
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Affiliation(s)
- Harold A Pollack
- University of Chicago School of Social Service Administration, 969 East 60th Street, Chicago, Illinois 60637, USA.
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Turk MA. Has the ADA improved the health of people with disabilities? Disabil Health J 2010; 3:225-6. [DOI: 10.1016/j.dhjo.2010.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 11/24/2022]
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Abstract
PURPOSE OF REVIEW There has been a drive to meet the needs of people with intellectual disabilities in an environment of resource scarcity. It is also recognized that intervention has the potential to improve social and economic welfare. Economic analyses can be used to inform decision makers about what additional investment is needed (if any) and the impacts on a range of stakeholders of intervention. RECENT FINDINGS There is a paucity of economic studies in intellectual disability. The lack of economic studies is a barrier to making policy and practice decisions for people with intellectual disabilities. In the period of review, 10 economic studies were found. SUMMARY Information on resource and cost implications of various treatments and support for people with intellectual disabilities is needed. Economic evaluation techniques can be used to inform decision making. We conducted a systematic review of the literature from January 2006 to February 2010. There was a paucity of economic studies in the field. Analyses assessing a wide range of outcomes alongside costs were the most widely used evaluation method in the review. There is a need for more economic studies in this area.
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