1
|
Burke KM, Shogren KA, Parente A, Alsaeed A, Myers AM, Aleong S. Self-Determination Research: Current and Future Directions. Behav Sci (Basel) 2024; 14:613. [PMID: 39062436 PMCID: PMC11274213 DOI: 10.3390/bs14070613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
This article summarizes the history, current status, and future directions of self-determination research across the globe, with a focus on applications to the education of students with intellectual and developmental disabilities and their transition from school to adult life. Research on the development, implementation, and outcomes of self-determination assessments and interventions is explored. Causal Agency Theory, a theoretical framework for understanding the development of self-determination as a psychological construct, is reviewed, along with research on the importance of self-determination for inclusion, psychological growth, and overall well-being. Specific approaches, models, and perspectives for addressing the support needs of students with intellectual and developmental disabilities, particularly during transitions, are discussed. Assessment and intervention aligned with Causal Agency Theory, including the Self-Determination Inventory and the Self-Determined Learning Model of Instruction, are introduced. Future directions and emerging areas of research are summarized, including issues related to cultural validity, integration of strengths-based approaches, emerging technologies, and systemic changes in schools and communities.
Collapse
Affiliation(s)
- Kathryn M. Burke
- Institute on Disabilities, Temple University, Philadelphia, PA 19122, USA; (A.P.); (S.A.)
| | - Karrie A. Shogren
- Kansas University Center on Developmental Disabilities, University of Kansas, Lawrence, KS 66045, USA; (K.A.S.); (A.A.); (A.M.M.)
| | - Andrea Parente
- Institute on Disabilities, Temple University, Philadelphia, PA 19122, USA; (A.P.); (S.A.)
| | - Abdulaziz Alsaeed
- Kansas University Center on Developmental Disabilities, University of Kansas, Lawrence, KS 66045, USA; (K.A.S.); (A.A.); (A.M.M.)
| | - Austin M. Myers
- Kansas University Center on Developmental Disabilities, University of Kansas, Lawrence, KS 66045, USA; (K.A.S.); (A.A.); (A.M.M.)
| | - Shawn Aleong
- Institute on Disabilities, Temple University, Philadelphia, PA 19122, USA; (A.P.); (S.A.)
| |
Collapse
|
2
|
Friedman C. The Impact of Emergency Pandemic HCBS Funding on the Continuity and Security of People with Intellectual and Developmental Disabilities. J Autism Dev Disord 2024; 54:1068-1077. [PMID: 36484965 PMCID: PMC9734720 DOI: 10.1007/s10803-022-05859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
This study's aim was to examine the impact of pandemic emergency Home- and Community-Based Services (HCBS) payments on the continuity and security of people with intellectual and developmental disabilities (IDD). Using a multilevel logistic regression, we analyzed secondary Personal Outcome Measures interviews from 738 people with IDD (March 2020 through April 2022), and state pandemic emergency HCBS payment data from 16 states. The odds of people with IDD experiencing continuity and security during the pandemic increased by 3% for every 1% states increased their payment rates, and by 398% when states offered retainer payments. Increased reimbursement rates and retainer payments can help providers maintain operations and promote the continuity and security of people with IDD.
Collapse
Affiliation(s)
- Carli Friedman
- CQL | The Council on Quality and Leadership, 100 West Road, Suite 300, Towson, MD, 21204, USA.
| |
Collapse
|
3
|
İsvan N, Bonardi A, Hiersteiner D. Effects of person-centred planning and practices on the health and well-being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1249-1269. [PMID: 36808669 DOI: 10.1111/jir.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/20/2022] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A person-centred service planning and practice approach (PCP) is one that is driven by service users' individual preferences, needs and priorities. The approach has been identified as a best practice and is codified in US policies that encourage and, in some contexts, require state systems of home and community-based services to adopt and demonstrate person-centred practice. However, there is insufficient research on PCP's direct impact on outcomes for service users. This study aims to contribute to the evidence base in this area by investigating the association between service experiences and outcomes of adults with intellectual and developmental disabilities (IDD) receiving state-funded services. METHODS The data for the study come from the 2018-2019 National Core Indicators® In-Person Survey that links survey responses with administrative records for a sample of 22 000 adults with IDD receiving services from 37 state developmental disabilities (DD) systems. Associations among service experiences and outcomes of survey participants are examined through multilevel regression techniques that include participant-level responses and state-level measures of PCP. The state-level measures are constructed by combining administrative records describing participants' service plans with the priorities and goals they expressed in response to the survey. RESULTS Case managers' (CM) accessibility and attentiveness to individual preferences, as reported by survey participants, are significantly associated with self-reported outcomes such as perceived control over life decisions and sense of health and well-being. Controlling for participants' experiences with their CMs, their reports of the person-centred content of their service plans have net positive associations with outcomes. After accounting for experiences with the service system as reported by participants, the state system's person-centred orientation, measured by the extent to which service plans across the state reflect participants' wishes for improving their social connections, remains a significant predictor of participants' sense of control over their daily lives. CONCLUSIONS This study contributes to the evidence base supporting PCP as a service model by identifying pathways that link person-centred service planning and delivery and person-centred orientation of state systems to positive outcomes reported by adults with IDD and by demonstrating the value of linking survey and administrative data. The key implication of the findings for policy and practice is that an overall person-centred orientation of state DD systems as well as PCP training for people who support planning for and delivery of direct supports will substantially improve the lives of adults with IDD.
Collapse
Affiliation(s)
- N İsvan
- Human Services Research Institute, Cambridge, MA, USA
| | - A Bonardi
- Human Services Research Institute, Cambridge, MA, USA
| | - D Hiersteiner
- Human Services Research Institute, Cambridge, MA, USA
| |
Collapse
|
4
|
Friedman C. Ableism, racism, and the quality of life of Black, Indigenous, people of colour with intellectual and developmental disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:604-614. [PMID: 36808800 DOI: 10.1111/jar.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Research indicates Black, Indigenous, people of colour (BIPOC) with intellectual and developmental disabilities face disparities in quality of life outcomes. This study's aim was to examine how ableism and racism impacted the quality of life of BIPOC with intellectual and developmental disabilities. METHODS Using a multilevel linear regression, we analysed secondary quality of life outcome data from Personal Outcome Measures® interviews with 1393 BIPOC with intellectual and developmental disabilities and implicit ableism and racism data from the 128 regions of the United States in which they lived (discrimination data came from 7.4 million people). RESULTS When BIPOC with intellectual and developmental disabilities lived in regions of the United States which were more ableist and racist, they had a lower quality of life, regardless of their demographics. CONCLUSION Ableism and racism are a direct threat to BIPOC with intellectual and developmental disabilities' health, wellbeing, and overall quality of life.
Collapse
Affiliation(s)
- Carli Friedman
- CQL
- The Council on Quality and Leadership, Towson, Maryland, USA
| |
Collapse
|
5
|
Johnson KE, Bailey CE, Weiss NR, Eidelman SM. Comparing Perspectives Between Different Agency Structures and Support Models. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:199-211. [PMID: 35640602 DOI: 10.1352/1934-9556-60.3.199] [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: 06/30/2020] [Accepted: 09/17/2021] [Indexed: 06/15/2023]
Abstract
The roles and responsibilities of direct support professionals (DSPs) are evolving. This qualitative study explores how DSPs perceive their role and explores those perceptions across DSPs working in traditional, intermediate, and innovative agencies, as defined for the study. Examining 440 DSP survey responses and interviews with 24 DSPs, we found that DSPs working in more individualized settings tended to have expanded role functions (focused on promoting self-determination and community engagement). DSPs working in more traditional settings tended to have more care-focused role functions (concentrated on activities of daily living, medication administration, and health and safety). The role perception of DSPs at intermediate agencies and role conflict due to competing responsibilities demonstrate a need to systemically transform future service delivery.
Collapse
Affiliation(s)
| | - Caitlin E Bailey
- Caitlin E. Bailey, National Leadership Consortium on Developmental Disabilities
| | - Nancy R Weiss
- Nancy R. Weiss and Steven M. Eidelman, University of Delaware
| | | |
Collapse
|
6
|
Friedman C. The Impact of Continuity and Security on Quality of Life. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:101-112. [PMID: 35297986 DOI: 10.1352/1934-9556-60.2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 06/14/2023]
Abstract
Continuity and security includes people with intellectual and developmental disabilities (IDD) not only having resources to meet their basic needs, but also includes the amount of change and disruption people have in their lives and the control they have over that change. We explored the impact of continuity and security on people with IDD's (n = 325) quality of life by analyzing Personal Outcome Measures interviews. Continuity and security not only significantly increased overall quality of life, but it also positively impacted two thirds of the different outcomes, ranging from health to relationships to rights. A stronger community infrastructure is needed to promote the continuity and security, and, by extension, quality of life of people with IDD.
Collapse
Affiliation(s)
- Carli Friedman
- Carli Friedman, CQL | The Council on Quality and Leadership
| |
Collapse
|
7
|
Ferdinand A, Massey L, Cullen J, Temple J, Meiselbach K, Paradies Y, Baynam G, Savarirayan R, Kelaher M. Culturally competent communication in Indigenous disability assessment: a qualitative study. Int J Equity Health 2021; 20:68. [PMID: 33648504 PMCID: PMC7923453 DOI: 10.1186/s12939-021-01402-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Indigenous people tend to exhibit a higher burden of disability than their non-Indigenous counterparts, and are often underserved by disability services. Engaging appropriately with Indigenous communities, families and individuals in the initial stages of disability assessment and planning is crucial in order to build trust and understanding of disability service models and ensure that Indigenous people receive support that is tailored to their needs and cultural realities. This article aims to identify key elements of culturally competent communication in Indigenous disability assessment and planning, and provide recommendations for strengthening capacity in this area. METHODS This qualitative research was designed to involve Aboriginal and Torres Strait Islander people at all stages and to reflect the views of Aboriginal and Torres Strait Islander researchers, people and families affected by disability and the community-controlled health sector. Semi-structured individual interviews were undertaken with staff implementing the National Disability Insurance Scheme (NDIS) (n = 4), NDIS participants (n = 24), disability support providers and organisational partners (n = 19) and Community Connectors (n = 8) in Queensland and the Northern Territory of Australia. Key themes derived from thematic analysis included appropriate and adequate engagement of individuals with disability and their families, the role of trusted relationships, and culturally safe and appropriate communication during planning meetings. RESULTS Overall, the research findings highlight that a low level of cultural competence in the initial stages of the disability assessment and planning process exacerbated participant confusion and distrust towards assessment staff and the NDIS. Given difficulties in communication, participant understanding of the NDIS was generally limited. The necessity of culturally safe and appropriate use of interpreters was stressed, as was the role of trusted individuals, including existing service providers, Community Connectors and family members in providing a solid base for participant understanding of the NDIS. CONCLUSIONS Cultural competence in disability assessment and planning can be strengthened through multi-level engagement with the Aboriginal community-controlled sector and community leaders. Implementing mechanisms to enable the involvement of families, trusted service providers and Community Connectors can support a more meaningful understanding of individuals' needs within their cultural context and in relation to their cultural roles.
Collapse
Affiliation(s)
- Angeline Ferdinand
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3011, Australia.
| | - Libby Massey
- MJD Foundation, Nightcliff, NT, 0814, Australia
- James Cook University, Cairns,, QLD, 4870, Australia
| | - Jennifer Cullen
- Synapse, Level 1/262 Montague Road, West End, QLD, 4101, Australia
| | - Jeromey Temple
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3011, Australia
| | - Kristy Meiselbach
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3011, Australia
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies and Genetic Services of Western Australia, King Edward Memorial Hospital, 374 Bagot Rd, Subiaco, WA, 6008, Australia
- Telethon Kids Institute and the Faculty of Health and Medical Science, Division of Paediatrics, University of Western Australia, Monash Avenue, Nedlands, WA, 6009, Australia
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, The Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, 3052, Australia
- University of Melbourne, Parkville, VIC, 3052, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, VIC, 3011, Australia
| |
Collapse
|
8
|
Young MJ, Regenhardt RW, Leslie-Mazwi TM, Stein MA. Disabling stroke in persons already with a disability: Ethical dimensions and directives. Neurology 2020; 94:306-310. [PMID: 31969466 DOI: 10.1212/wnl.0000000000008964] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/21/2019] [Indexed: 12/22/2022] Open
Abstract
Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.
Collapse
Affiliation(s)
- Michael J Young
- From the Departments of Neurology (M.J.Y., R.W.R., T.M.L.-M.) and Neurosurgery (T.M.L.-M.), Massachusetts General Hospital, Harvard Medical School; and Harvard Law School (M.A.S.), Boston, MA.
| | - Robert W Regenhardt
- From the Departments of Neurology (M.J.Y., R.W.R., T.M.L.-M.) and Neurosurgery (T.M.L.-M.), Massachusetts General Hospital, Harvard Medical School; and Harvard Law School (M.A.S.), Boston, MA
| | - Thabele M Leslie-Mazwi
- From the Departments of Neurology (M.J.Y., R.W.R., T.M.L.-M.) and Neurosurgery (T.M.L.-M.), Massachusetts General Hospital, Harvard Medical School; and Harvard Law School (M.A.S.), Boston, MA
| | - Michael Ashley Stein
- From the Departments of Neurology (M.J.Y., R.W.R., T.M.L.-M.) and Neurosurgery (T.M.L.-M.), Massachusetts General Hospital, Harvard Medical School; and Harvard Law School (M.A.S.), Boston, MA
| |
Collapse
|