Future Planning Among Families of Individuals With Intellectual and Developmental Disabilities: A Systematic Review

Medicaid long-term services and supports and caregiving needs of caregivers of individuals with intellectual and developmental disabilities

BACKGROUND

Long-term care services are funded primarily by Medicaid long-term services and support in the United States, where eligibility is based on care needs of the individual with intellectual and developmental disability alone. Impact of Medicaid waiver services on self-reported caregiver needs is not well understood.

METHOD

Caregivers (n = 405) of individuals with intellectual and developmental disabilities across four states (NY, OH, TX, and PA) completed an online survey.

RESULTS

Caregivers reported a moderate degree of burden and susceptibility of stress-induced health breakdown. Despite controlling for the activities of daily living of the care recipient, caregivers of individuals with Medicaid Waiver services reported greater difficulty managing medications (p = .013) and finding paid help (p < .001) than caregivers of individuals without services.

The impact of individuals with profound intellectual and multiple disabilities on peer relationships of typically developing siblings

INTRODUCTION/BACKGROUND

This study aims to determine the impact of a person with profound intellectual and multiple disabilities on peer relationships of their siblings.

METHODS

Information obtained from typically developing siblings of individuals with profound intellectual and multiple disabilities served as research material for this study. There were a total of 18 participants in the study. The analysis and interpretation were based on the procedures of grounded theory.

RESULTS AND CONCLUSION

The results of the study show that young adults with a brother or sister with profound intellectual and multiple disabilities have some difficulties in establishing relationships with their peers, especially those more intimate such as friendships or romantic endeavors. At the same time, research confirms that siblings of individuals with profound intellectual and multiple disabilities have high levels of empathy and understanding for others as well as sincere attachment to family.

'What if I'm no longer around?': An evaluative description of a structured group conversation about the care for persons with profound intellectual and multiple disabilities when they outlive their parents

BACKGROUND

Persons with profound intellectual and multiple disabilities (PIMD) increasingly outlive their parents. Therefore, we designed a structured group conversation to support family members and care professionals in exploring together how parental roles may be taken over by others when necessary.

METHOD

We conducted a mixed methods study, with a focus on the qualitative data, to describe and evaluate three group conversations.

RESULTS

Family members (n = 22) of persons with PIMD who live in residential care facilities and care professionals (n = 9) evaluated the structured group conversation as valuable. While both parties reported that the group conversation (re)sparked their attention for the topic, mostly family members planned to take concrete action as a result of it.

CONCLUSIONS

The group conversation encourages parents to communicate explicitly about the future care for their child with PIMD, and offers both family members and care professionals support in exploring this future care together.

Postschool Goal Expectations for Youth With Intellectual and Developmental Disabilities

Using National Longitudinal Transition Study 2012 data, this study explored parent and youth expectations in the areas of postsecondary education, employment, independent living, and financial independence. Compared to youth with other disabilities, youth with intellectual and developmental disabilities and their parents had much lower expectations for the four postschool goals, and parent expectations were much lower than youth's own expectations. Also, youth's race, along with their daily living skills and functional abilities, were positively associated with parent and youth expectations in several future goal areas. Our discussion highlights implications for improving the transition experiences of youth with intellectual and developmental disabilities.

Siblings FORWARD: Development of a New Program to Engage Siblings of Autistic Adults in Future Planning

The adult service system does not adequately meet the needs of autistic adults, prompting families to continue their supportive roles. Siblings frequently assume these roles when parents are no longer able to do so, often without preparation or planning. We received feedback on the proposed Siblings FORWARD (Focusing on Relationships, Well-being, and Responsibility aheaD) program concept, which would involve 6-7 individualized sessions over ~ 3 months and would facilitate siblings' proactive future planning involvement with their autistic family member. Siblings FORWARD would bolster siblings' skills, knowledge, and self-efficacy to engage in future planning with their family members. We report on perceived need for a sibling program and feedback on the proposed program goals, content, and design. Adult siblings (n = 13), autistic adults (n = 6), and service providers (n = 17) participated in individual interviews or focus groups. Data were systematically coded and analyzed using directed content analysis. Siblings, autistic adults, and service providers expressed high enthusiasm for the Siblings FORWARD concept. Participants indicated that the combination of skill-building and education would promote continued, collaborative future planning that persists after the formal program ends. They had positive impressions of the program concept, goals, content, and design, including the telehealth delivery model. Siblings and autistic adults reported wanting to participate in Siblings FORWARD. This uniform, strong enthusiasm for the Siblings FORWARD concept warrants moving forward to examine preliminary acceptability and feasibility. Ultimately, greater sibling involvement in family future planning may improve autistic adults' functioning through improved continuity of care and support across adulthood.

Parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability: A qualitative descriptive study

AIM

To describe parents' perspectives on reasonable adjustments in acute healthcare for people with intellectual disability (ID).

BACKGROUND

People with ID are vulnerable in terms of their health needs and marginalized when accessing and utilizing acute healthcare services. Reasonable adjustments are positive measures that can help alleviate health disparities. However, despite significant research advocating their use, evidence of implementation of reasonable adjustments in acute healthcare practice is limited.

DESIGN

A qualitative descriptive study.

METHODS

Qualitative semi-structured interviews were conducted with six parents of children with ID, who had accessed and used acute healthcare services. The interviews were conducted between January and May 2022, audio-recordings were transcribed and thematically analysed.

RESULTS

Parents described limited or no experiences of reasonable adjustments when accessing or utilizing acute healthcare services for their children. The findings are captured in three themes; describing the reality, understanding the impact and signposting the future. The findings highlight a lack of implementation of reasonable adjustments in acute healthcare which negatively impacts the experience of all stakeholders.

CONCLUSION

There is a pressing need for reasonable adjustments to be implemented at a strategic level across acute healthcare services, so that people with ID and their families can access person-centred acute healthcare when needed.

IMPACT

The research findings will inform researchers interested in reasonable adjustments and implementation research, and those interested in advocating for the rights of people with ID.

REPORTING METHOD

This study adhered to the Equator research reporting checklist: Consolidated criteria for reporting qualitative research: a 32-item checklist for interviews and focus groups.

PATIENT OR PUBLIC CONTRIBUTION

A parent of a child with an ID was part of the research team informing the design, data collection, data analysis and write-up of this article.

Caregiver support, burden, and long-term planning among caregivers of individuals with intellectual and developmental disabilities: A cross-sectional study

BACKGROUND

Long-term care planning (LTCP) is critical for individuals with intellectual/developmental disabilities. Objectives of this study were to investigate progression through LTCP, and associations between social support and: (1) LTCP and (2) burden among family caregivers.

METHODS

A cross-sectional survey was distributed to caregivers of individuals with intellectual/developmental disabilities in NY, OH, PA, and TX, exploring demographics, supports, burden, and LTCP behaviours. Bivariate and linear multiple regression analyses were used to investigate study objectives.

RESULTS

Caregivers (n = 405) were predominantly parents, female, non-Hispanic, and in the 'learning to plan' stage of LTCP. Caregiver-identified social support was associated with further progression in LTCP (p = .020) and lower caregiver burden (p < .001).

CONCLUSION

Social support was associated with further progression in LTCP, and associated with less burden, however fewer than 40% of caregivers reported having social support. Ongoing exploration of emotional/social needs of caregivers is necessary to better support these families.

Phenomenological Study on the Lived Experiences of Mothers Caring for Their Pubescent Children with Developmental Disabilities

PURPOSE

This phenomenological study explored and revealed the mothers' lived experiences of caring for pubescent children with developmental disabilities (DDs) in Korea.

METHODS

Data were collected from semistructured individual in-depth interviews with nine mothers. This study adopted Giorgi's phenomenological analysis, through which a general structure of mothers' caregiving experiences with their pubescent adolescents with DDs was formulated.

RESULTS

The lived experiences of mothers caring for pubescent children with DDs were clustered into four themes and nine subthemes from 19 meaning units: (1) not being allowed to take delight in child's growth due to unbalanced growth pace; (2) feeling marginalized along with the disabled child; (3) feeling like being kicked out of society slowly and permanently; and (4) rearrangement of care direction and purpose.

CONCLUSIONS

This qualitative study captured vivid experiences of mothers who care for pubescent children with DDs by illustrating these mothers' detailed physical, emotional, and relational difficulties in their caring. Most importantly, this study found that it is puberty that these mothers come to clearly understand that their children and their disabilities are inseparable and change the purpose and direction of childcare. The findings of this study can help health professionals better understand that these mothers are in urgent need for emotional support and need to be included in nursing care. And this study can be used as base data for increasing disability awareness for both healthcare workers and public in general.

Couple relationship experiences of siblings and siblings-in-law of persons with intellectual disabilities

BACKGROUND

This study examined how siblings and siblings-in-law of persons with intellectual disabilities experience the establishment of and processes within the couple relationship.

METHOD

In-depth semi-structured interviews with 12 siblings and 12 siblings-in-law of persons with intellectual disabilities were analysed using thematic analysis.

RESULTS

The participants did not perceive their special siblinghood as detrimental to their couple relationships. Siblings-in-law's prior acquaintance with persons with disabilities and professional support provided to the family of origin emerged as contributing factors. The effect of the siblinghood on the couple relationship was both positive and negative.

CONCLUSIONS

The findings support the importance of the acceptance of others who are different, including in couple relationships when a sibling or sibling-in-law has intellectual disabilities, and underscore the role of professional therapists.

Caregivers' perspectives on future planning for their adult children with intellectual disabilities in Romania

BACKGROUND

Much of the research and program innovation regarding future planning for adults with intellectual disabilities has occurred in countries with well-developed disability service systems. This study explored how family caregivers planned for their adult children's future caregiving needs in Romania, a country with a limited array of disability services.

METHOD

In this exploratory qualitative study, we conducted 30 face-to-face interviews with caregivers of adults with intellectual disabilities in Romania. We used thematic analysis to analyse the transcribed and translated interview data.

RESULTS

The majority of participants, while believing that future planning was necessary, had not engaged in planning and had no supports for planning. As there were few disability services, the majority of the participants reported that they could not engage in planning, and many avoided thinking about the future.

CONCLUSION

Romania and other countries with fewer disability services likely need alternative models of future planning than those that have been developed and tested previously.

Family Support for (Increasingly) Older Adults with Down Syndrome: Factors Affecting Siblings' Involvement

BACKGROUND

Life expectancy for people with Down syndrome is increasing, but older adults with Down syndrome are at greater risk of developing certain pathologies associated with ageing. When ageing parents can no longer look after their child with Down syndrome, their other children are often expected to shoulder this responsibility.

METHOD

We asked 120 adult siblings of a person with Down syndrome to complete a questionnaire on their current and anticipated relationships.

RESULTS

Most respondents considered these relationships to be positive, but they expressed concerns about the effects of ageing and about having to organise their sibling with Down syndrome's future life. We investigated the impact of factors relating to the respondents and to their sibling with Down syndrome (age, gender, social inclusion, protection regime) on these general tendencies.

CONCLUSION

Siblings need to be given support, for example, via discussion groups, to facilitate the transition to becoming caregivers.

Evaluation of peer-mediated systems navigation for ageing families of individuals with developmental disabilities

BACKGROUND

As individuals with intellectual and developmental disabilities (I/DD) age, services often diminish, with many family caregivers experiencing challenges finding and navigating services. The purpose of this study was to examine the benefits of a state-wide family support project for ageing caregivers (50+) of adults with I/DD in accessing and using services.

METHOD

A one-group pre-test-post-test design was used to determine if participation in the MI-OCEAN intervention grounded in the Family Quality of Life (FQOL) theory reduced ageing caregivers' (n = 82) perceptions of barriers to accessing, using and needing formal services.

RESULTS

After participating in the study, there was a reduction in reported barriers to accessing services. There was also greater use and reduced need for 10 of the 23 listed formal services.

CONCLUSIONS

Findings indicate that a peer-mediated intervention grounded in FQOL theory can be beneficial in empowering ageing caregivers by reducing perceived barriers to accessing services and increasing their use of advocacy and support services.

Evaluating the Benefits of a Family Support Program on the Health and Well-Being of Aging Family Caregivers of Adults with Intellectual and Developmental Disabilities

Providing care to a family member with intellectual and developmental disabilities (I/DD) takes a toll on the health of the caregiver and the family, especially as they age. Research shows that peer mediated family support programs can improve caregiver health and well-being. To date, most family support programs have focused on family caregivers of children and youth with I/DD. The purpose of this study was to examine the benefits of participating in the Michigan Older Caregivers of Emerging Adults with Autism and Neurodevelopmental Disabilities (MI-OCEAN) family support program grounded in the Family Quality of Life (FQOL) framework. Specifically, we examined the effect of participation on health care utilization, caregiver well-being, and perceptions of global FQOL for older caregivers of adults with I/DD. Quantitative analysis of data gathered from 82 caregivers (age 50 and older) indicated that study participation was associated with increased use of Medicaid and improved caregiver well-being (reduced burden, stress, depression; increased health satisfaction and FQOL). Future research is needed to examine the long-term impact of the family support programs in improving the health and well-being of older caregivers of adults with I/DD.

Subjective Poverty Moderates the Association Between Carer Status and Psychological Outcomes of Adult Siblings of People with Intellectual and Developmental Disabilities

Adult siblings are potentially important sources of care, support, advocacy, and friendship for their brothers and sisters with intellectual and developmental disabilities (IDD). Drawing on data about 851 adult siblings who completed an online national survey, we examined predictors and potential key moderators of siblings' mental distress, wellbeing, quality of life, and health outcomes. Moderated regression analyses indicated that siblings experiencing higher levels of subjective poverty; siblings with brothers and sisters with lower levels of independence; and siblings who are carers and also experiencing low levels of subjective poverty, had worse outcomes and may be in need of specific supports. Compared to normative samples, adult siblings of people with IDD had worse outcomes across the measures.

Transitions for older people with intellectual disabilities and behaviours that challenge others: A rapid scoping review

BACKGROUND

People with intellectual disabilities and behaviours that challenge others are living longer. This review aimed to explore what is known about the health and social care needs, experiences, service interventions and resources of and for this population as they transition to different care contexts in the UK.

METHOD

A rapid scoping review of published and unpublished literature was conducted based on collaborative working with key stakeholders and using systematic methods of data searching, extraction and analysis.

RESULTS

Consistent social work support, skilled staff, suitable accommodation, creative engagement with individuals and families to plan ahead, and timely access to quality healthcare are all required to promote successful transitions as people age, and to avoid unwanted/inappropriate transitions at points of crisis.

CONCLUSIONS

More research is needed to assess the types of services that this population can and do access as they age, the quality of those services, and the extent to which local commissioners are planning ahead for people with intellectual disabilities and behaviours that challenge others.

Care and support for persons with profound intellectual and multiple disabilities without parents: A qualitative exploration

BACKGROUND

Persons with profound intellectual and multiple disabilities (PIMD) increasingly outlive their parents. While this is expected to negatively affect them, little is known about the actual situation of persons with PIMD without parents.

AIM

To explore how parental roles are taken over by others, when persons with PIMD have outlived their parents, and how this affects the care and support for- and quality of life (QoL) of persons with PIMD.

METHODS

We interviewed seven siblings, and six professionals (N = 13) involved in the care and support for persons with PIMD without parents, and analysed the data thematically.

RESULTS

Siblings described a lack in family communication about the transition, yet felt responsible to fill the gap their parents left behind. Professional legal guardians felt professional responsibility towards their clients, yet described they had a limited assignment to fulfil. Professional caregivers underscored the importance of family in the care and support for persons with PIMD, while describing sometimes taking on extra responsibility for clients without parents.

CONCLUSIONS

Support aimed at facilitating a timely transfer of responsibilities, and at clarifying the content of these responsibilities, could better prepare both siblings and professionals to mitigate the impact of the loss of parents for persons with PIMD.

Growing up alongside a sibling with a disability: A phenomenological examination of growth and deficiency in adulthood

BACKGROUND

A growing literature underscores the role played by sibling throughout life particularly for siblings with disabilities. However, limited research focuses on how growing up with a sibling with a disability impacts adult personality and well-being.

AIMS

The current study is a qualitative examination of the long-term effects of growing up with a sibling who has a developmental disability, using both a deficiency and growth model perspective.

METHODS AND PROCEDURES

Participants included 20 adult siblings of individuals with disabilities interviewed using a semi-structured interview. Interviews were conducted via an online platform.

OUTCOMES AND RESULTS

Themes identified were: impact on personal character traits, social development through sibling and overcoming social challenges, impacts on religiosity, influence on career choice, influence on romantic relationships and finding a partner, and future planning and stress. Distinct patterns of growth were noted in areas of personal development, character traits, social development, and interpersonal skills. On the other hand, hardships and anxieties were noted in general with specific negative features relating to social embarrassment and concerns about how the sibling status will impact potential romantic partnerships and future family life.

CONCLUSIONS AND IMPLICATIONS

The current study highlights the long-term impact of growing up with a sibling with a developmental disability with empirical and clinical implications.

Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence

BACKGROUND

There are over 1 million adults with a learning disability in the UK, of whom approximately 20% displaying behaviours that challenge others. Two thirds of people with learning disabilities live in the family home. As they and their family carers age, both are likely to face particular difficulties and stresses, but there is little understanding of their experiences and needs. To address this evidence gap, our main objective is to undertake two rapid scoping reviews that will collectively focus on the health and social care needs, experiences, service interventions and resources of older people with learning disabilities and behaviours that challenge others, and their family carers. Both reviews will focus on issues relating to forward planning and transitions to different care contexts. The study is part of a research project funded by the National Institute for Health Research No.129491.

METHODS

We propose to address the need for evidence via two rapid scoping reviews. We will include published and unpublished (grey) literature, encompassing empirical research, policy and practice guidance and lay resources to support decision-making. We will search multiple electronic databases, hand search references lists, and use expert guidance to identify potential evidence. The following databases were used for research and grey literature: CINAHL; Healthcare Management Information Consortium (HMIC); NHS Evidence; Scopus; Turning Evidence Into Practice (TRIP); Web of Science (WoS); Google (first 5 pages); and Google Scholar (first 5 pages). For RR2, additional intended databases are the Carer Research Knowledge Exchange Network (CAREN) and Social Care Institute for Excellence (SCIE). Two reviewers will independently screen all citations and full-text articles for inclusion. One reviewer will extract data, with an independent review undertaken by the research team. Critical appraisal will depend on the nature of included evidence. Narrative synthesis will be collaboratively developed, with descriptive information presented in tables summarising study characteristics and thematic analysis of findings presented in the main text. Dissemination will be through journal publication, conference presentations and written short-form, easy-read versions of articles and audio-video clips for lay audiences.

DISCUSSION

We will consider the strengths and limitations of our reviews, considering their impact on findings. We will summarise the main findings and provide an interpretation linked to the review questions and objectives. We will consider the implications of our findings for policy and practice, as well as future research addressing the support of older people with learning difficulties and behaviours that challenge others, and their family carers, in the context of transition to different care contexts in the UK. The protocol has been registered as Vseteckova, J., Jordan, J., Tilley, E., Larkin, M., Ryan, S., and Wallace, L. (2021, December 4). Transitions for older people with learning disabilities and behaviours that challenge others, and their family carers: a merged protocol for two rapid scoping reviews of evidence. Retrieved from osf.io/jzrn9.

A Pilot Study of a Future Planning Program for Siblings of People With Intellectual and Developmental Disabilities

Given the increased longevity of people with intellectual and developmental disabilities (IDD), future planning programs are becoming increasingly common. However, although siblings are likely to fulfill caregiving roles for people with IDD, siblings have not been included in future planning interventions. The purpose of this study was to evaluate the outcomes and feasibility of the Sibling Training for Early future Planning (STEP) program. Using quantitative and qualitative data, 18 siblings of individuals with IDD participated in the study. After completing the STEP program, participants demonstrated significantly improved feelings of empowerment, disability connectedness, family communication, and knowledge of adult disability services. The STEP program was also feasible given high attendance, low attrition rates, and high participant satisfaction. Implications for research and practice are discussed.

Future planning for individuals with intellectual and developmental disabilities: Perspectives of siblings in South Korea

BACKGROUND

Future planning has emerged as a global issue for families of individuals with intellectual and developmental disabilities due to the longer lives and limited long-term services and supports in the adult disability system. While it has received greater attention, most future planning studies only included parents of individuals with intellectual and developmental disabilities within the context of European or American countries. The purpose of this study was to examine future planning among siblings of individuals with intellectual and developmental disabilities in South Korea.

METHOD

In this study, 185 Korean siblings of individuals with intellectual and developmental disabilities responded to a survey.

RESULTS

Few siblings engaged in future planning activities and reported a range of barriers to conduct future planning. Further, greater future planning involvement was associated with older siblings, greater advocacy level and greater sibling caregiving.

CONCLUSION

For future research, culturally relevant measures and intervention should be addressed.