Quality of life as context for planning and evaluation of services for people with disabilities

Use and Impact of COACH with Students who are Deaf-Blind

The purpose of this study was to evaluate the use and impact of COACH (Choosing Options and Accommodations for Children: A Guide to Planning Inclusive Education) with 30 students with deaf-blindness who attended general education classes in public schools. Interview and observational data were analyzed qualitatively while document data were analyzed quantitatively. The findings and discussion centered around five evaluation questions: (a) How do people use COACH? (b) Does the use of COACH result in educational program components referenced to valued life outcomes identified by parents and/or students? (c) How do educational programs developed using COACH differ from those developed prior to its use? (d) In what ways did the use of COACH effect relationships between parents and professionals? and (e) In what ways did the use of COACH effect valued life outcomes for students? Implications for planning in general education settings are discussed.

Parents' Perceptions after Inclusion of Their Children with Moderate or Severe Disabilities

This study investigated the perceptions of parents of 13 children with moderate or severe disabilities in relation to their child's education in inclusive general education settings. Parents were all Caucasian and were from seven different school districts in western New York State. Their children ranged in age from 5 to 20 years, with nine having experienced educational services in self-contained settings prior to being included in typical classrooms. Audio-taped interviews of parents lasting from 60 to 90 minutes were transcribed and analyzed following qualitative research methodology. Findings indicated that, regardless of the age of their child, parents of all 13 children reported very positive perceptions. Parents whose children had been educated previously in self-contained classes reported many academic, behavioral, and social outcomes that they felt would not have happened without the transition to age-appropriate general education classes. The findings add to the growing literature on inclusion and support the trend to provide educational services for students with moderate or severe disabilities in general education settings.

Life Satisfaction Reports of Adolescents with Learning Disabilities and Normally Achieving Adolescents

Reports of life satisfaction, as measured by the Multidimensional Students' Life Satisfaction Scale (MSLSS; Huebner, 1994b) of 80 adolescents diagnosed with a learning disability (LD) were compared to the reports of a matched sample of 80 normally achieving (NA) adolescents. The results provide preliminary psycho-metric support for the use of the MSLSS with adolescents with LD in research contexts. Contrary to studies of other groups of students with mild disabilities, comparisons of mean levels of overall life satisfaction and satisfaction in five specific domains (family, friends, school, self, and living environment) revealed no differences between adolescent students with LD and NA adolescents. Both groups of students reported positive overall and domain-specific life satisfaction levels. Implications for future research and delivery of services to adolescents with LD were discussed.

The quality of life of persons with TBI in the process of a comprehensive rehabilitation program

BACKGROUND

The aim of the research was to evaluate the effectiveness of the phased rehabilitation program in patients after traumatic brain injury, one developed by the authors and controlled by the strategic plan, pertaining to their quality of life compared to patients treated according to a standard, phased rehabilitation program.

MATERIAL/METHODS

The study included 40 patients of post traumatic brain injury treated at the Rehabilitation Clinic of the L. Rydygier Academy of Medical Sciences in Bydgoszcz and the Department of Medical Rehabilitation of the Cracow Rehabilitation Centre. An experimental group included 20 patients rehabilitated by a strategic approach and a control group consisted of 20 patients treated before the introduction of this approach. In assessing the effectiveness of rehabilitation, a structured interview was used with clinical observation and the Battery of Quality of Life Assessment. The study was conducted twice: before and after eight weeks of rehabilitation.

RESULTS

The quality of life of people after brain injury is affected by self-service difficulties, difficulties in meeting the physiological needs and loss of psychophysical comfort, decreased mobility, impaired cognitive functions and executive and social functions. There is no consistency between the stated (subjective) level of quality of life of the patient, and the depth of objectively measured disability resulting from the injury sustained.

CONCLUSIONS

A rehabilitation program controlled by a strategic plan, in collaboration with the patient treated subjectively is more effective in improving the quality of life, since the cooperating patient is more motivated to carry out individually designed goals. A rehabilitation program based on a strategic plan is worthy of recommendation for the treatment and improvement of patients after cranio-cerebral trauma.

An evaluation of the strategic approach to the rehabilitation of traumatic brain injury (TBI) patients

BACKGROUND

The objective of our study was to evaluate a goal-driven strategic plan for the step-by-step rehabilitation of traumatic brain injury (TBI) patients, with effectiveness measured in terms of quality of life, as compared to patients treated according to a standard, progressive rehabilitation program.

MATERIAL/METHODS

We studied 40 patients after TBI awakened from a long-term coma. The patients were divided into two equal groups: a control group (n=20) involving patients treated before the introduction of the strategic approach, and an experimental group (n=20) involving patients rehabilitated under the strategic approach. In evaluating the effectiveness of rehabilitation we used a structured interview with clinical observation and a scale for assessing the quality of life of patients after TBI.

RESULTS

The deterioration in the quality of life of TBI patients is mainly related to difficulties in satisfying physiological needs, self-care, reduced mobility and disorders of cognitive, regulatory, and social functions. In both groups, the feature most susceptible to rehabilitation related change was movement, while the least susceptible functions were associated with the use of different means of transport. This change is significantly greater in persons in the experimental group, as compared to controls.

CONCLUSIONS

We found that a rehabilitation program controlled by a strategic plan, with the cooperation of the patient, is more effective in improving the quality of life, as the patient is more self-motivated to individually designed objectives.

Quality of life in patients with neurocysticercosis in Mexico

The objective of this study was to compare quality of life measures in patients with neurocysticercosis (NCC) to those of a matched control group. The NCC outpatients and their controls were recruited from two neurology referral hospitals in Mexico City, Mexico during 2007-2008. The quality of life of 224 NCC patients was compared with 224 age-sex-hospital-day matched controls using the short form 12 v2 (SF-12 v2) quality of life survey. Medical chart reviews were also conducted for the NCC outpatients to evaluate presenting clinical manifestations. Compared with the controls, NCC patients had a significantly lower score for each of the eight domains of health evaluated and significantly lower Physical and Mental Component Summary scores. Chart reviews indicated that hydrocephalus (48%), severe headaches (47%), and epilepsy (31%) were the most common clinical manifestations in these NCC outpatients.

Quality of life in adults with an intellectual disability: the Evaluation of Quality of Life Instrument

BACKGROUND

The construct of quality of life (QoL) has been the focus of a great deal of recent research and has been operationalized in the assessment of the effectiveness of biomedical and rehabilitative interventions. Consequently, the effective measurement of QoL has become a relevant issue. QoL assessment should take account of both objective life conditions and reported satisfaction with those conditions, and should recognize that QoL has multiple domains. There is also evidence to suggest that it is useful to supplement such assessments with the evaluations of significant others within a multidimensional assessment perspective.

METHODS

The current study describes a further stage of testing and refinement of the Evaluation of Quality of Life Instrument (EQLI), which was designed to elicit from staff of health and social care services assessments of the level of satisfaction experienced by adults with an intellectual disability. Specifically, the EQLI's internal consistency, and construct, convergent and discriminant validity were analysed.

RESULTS

The EQLI appears to be a psychometrically valid measure for collecting data on the levels of satisfaction which, according to health and social services staff, might be experienced by individuals with an intellectual disability who attend residential institutions and community-based day centres. The factor analyses supported a three-factor structure for the EQLI and reliability estimates of scores on the three factors were in the moderate to high range. The data collected supported convergent and discriminant validity.

CONCLUSIONS

The results indicate that the EQLI is an effective measure for gaining staff perceptions of individuals who may be at risk of dissatisfaction with various QoL domains. The EQLI is as an instrument which, within a multidimensional assessment, could contribute to the identification of areas of user dissatisfaction with services.

Quality of life of men and women with borderline intelligence and attention deficit disorders living in community residences: a comparative study

The research studies the quality of life (QOL) of 127 men and women diagnosed as having a borderline IQ and ADHD living in two major residential programs of the Sharon region in central Israel in respect to their personal, disability, and social ecological variables. Core findings indicate that men and women differ significantly according to their educational background. Among those who studied in a regular educational environment, the main predictor of men's QOL is their monthly income, whereas the main predictor for women is their level of attention deficit symptoms. The only predictor of QOL among men who studied in a special education program is the quality of contact with their mothers, whereas no significant predictor is observed among women.

Predicting re-victimization of battered women 3 years after exiting a shelter program

This study examined interpersonal and ecological predictors of re-victimization of a sample of women with abusive partners. All women (N = 124) had sought refuge from a battered women's shelter 3 years earlier, and half the sample had been randomly assigned to receive free, short-term advocacy services immediately upon exit from the shelter. Results 2 years post-intervention revealed positive change in the lives of participants (C. M. Sullivan & D. Bybee, 1999), including a decrease in abuse for women who had worked with advocates. The current study examined intervention effects 3 years after the program ended, as well as other predictors of re-abuse. Nineteen percent of the original sample had experienced domestic violence between 2 and 3 years after shelter exit (65% by current partners, 35% by ex-partners). The advocacy program's effect on risk of re-victimization did not continue 3 years post-intervention. However, having worked with an advocate 3 years prior continued to have a positive impact on women's quality of life and level of social support. The risk of being abused 3 years post-shelter stay was exacerbated by a number of factors present 1 year prior, including women's (1) having experienced abuse in the 6 months before that point; (2) having difficulties accessing resources; (3) having problems with the state welfare system; and (4) having people in their social networks who made their lives difficult. Women were at less risk of abuse if, 1 year earlier, they (1) were employed; (2) reported higher quality of life; and (3) had people in their networks who provided practical help and/or were available to talk about personal matters. These findings support the hypothesis that access to resources and social support serve as protective factors against continued abuse.

Off the map: a critical geography of intellectual disabilities

A "critical geography of intellectual disabilities" is outlined. Drawing on personal experience and borrowing poetic inspiration, claims about the end of the institutional era for intellectual disabled people are disputed, and the continuing eugenic legacy, complete with its multiple stigmatizing effects, is emphasized. The extent of the social exclusion experienced by many people with intellectual disabilities in the wider community, linked to various poor quality of life indicators, is also given attention. Finally, speculations are raised about how to move beyond the "asylum" and the "ghetto", empowering intellectually disabled people in the process.

The meaning of life experiences: application of a meta-model to rehabilitation sciences and services

A motivational, developmental meta-model of the meaning of everyday life experiences is presented. The model proposes that there are 3 fundamental ways in which people establish meaning across the life span: the paths of belonging (relationships), doing (meaningful engagement in activities), and understanding oneself and the world. The principles of the model include intertwined, fundamental meanings of human experience; the indeterminacy of cause and effect; individual differences in preferences for ways of attaining meaning; the importance of commitments in life; and life-long adaptation and changes in meaning. The model provides an organizing framework that clarifies the assumptions of various disciplinary frames of reference with respect to establishing meaning in everyday life. Implications of the model are discussed for the rehabilitation sciences and rehabilitation service delivery.

Postmodern social work in interdisciplinary contexts: making space on both sides of the table

This paper describes a university-based, maternal child health, interdisciplinary training project designed to assist health professionals in working with neurodevelopmentally at-risk children and their families. It discusses a role for social work educators and practitioners that brings to the table varied, conceptual questions that are intertwined with more traditional social work intervention in a postmodern approach to interdisciplinary teaming. A case example illustrates the integration of these two approaches and the inquiries that social work can initiate to facilitate "making space" both between the team and family and between members of the team in a dynamic, postmodern, interdisciplinary context.

Perceived quality of life of adults with developmental and other significant disabilities

PURPOSE

The purpose of this qualitative study was to describe the perceived quality of life (PQOL) of adults with significant disabilities who were living in community settings.

METHODS

Six male and six female volunteers (mean age 48 years, standard deviation 14 years), half with developmental and half with acquired disabilities, were interviewed about their quality of life. The interviews were audio-taped and transcribed verbatim. Text units were identified in the narrative data and were coded, sorted, and entered in an Index Tree. Data analysis utilized the Constant Comparison Technique with underlying themes emerging in 11 areas.

RESULTS

The highest PQOL was noted in Health and Housing; the lowest in Transportation/Physical Accessibility and Employment. Deficits in Transportation/Physical Accessibility compromised PQOL in other areas. In regards to employment, seasonal, part-time and occasional work were common, and assistive technology and computers were rarely used to enhance employment capabilities. PQOL depended on the availability of appropriate supports and services, and tended to differ between those with developmental and those with acquired disabilities.

CONCLUSION

Policy makers and advocacy groups could best improve the PQOL for those with severe disabilities by facilitating transportation and employment services.

Toward assessing family outcomes of service delivery: validation of a family quality of life survey

BACKGROUND

The concept of family quality of life (QoL) has emerged as an important outcome of service delivery for individuals with disabilities and their families. The present study describes the process of developing a tool to measure family QoL.

METHODS AND RESULTS

A total of 1197 respondents participated in a national field test. Through factor analysis, the survey was refined in several ways: (1) the preliminary 10-domain structure was reduced to a five-domain structure; (2) a total of 41 items were selected for the revised survey; and (3) wordings were clarified.

CONCLUSIONS

The implications for future research and practice are discussed.

Contextualized behavioral support in early intervention for children with autism and their families

Parent education programs have become an effective mode of treatment delivery for teaching families effective behavioral strategies to manage challenging behavior in young children with autism. Functional assessment and functional communication training (FCT) are empirically validated procedures that have recently been introduced into parent education programming to help resolve challenging behaviors. The success of these procedures, however, is contingent on family members' ability to integrate them into the specific contexts in which challenging behaviors occur. Consequently, the application of these procedures in home settings necessitates consideration of the family context in the assessment and treatment planning process. A study is presented that investigated the use of information on family context (i.e., caregiving demands, family support, patterns of social interaction) to direct the assessment and intervention planning process. More specifically, information on family context was used to individualize behavioral support plans designed to support family use of functional communication training within important family routines. Through parent-investigator collaboration we individualized the manner in which functional communication training procedures were taught and implemented so they were contextually relevant. Utilizing a multiple baseline design, the challenging behaviors and functional communication of three children with autism were monitored across baseline, intervention (i.e., FCT, and contextulized FCT), and follow-up phases. Multiple routines for each participant were selected and monitored across all phases to evaluate changes in the dependent measures within training and generalization routines. A self-report questionnaire was administered intermittently to parents to determine if consideration of family context improved the "goodness of fit" of the functional communication training treatment packages across FCT and contextualized FCT intervention phases. Results from the study indicate that consideration of family context in the assessment and intervention planning process does not jeopardize and may contribute to the stability and durability of reductions in challenging behavior achieved with functional assessment and functional communication training procedures.

Comparing the quality of life of school-age children with and without disabilities

Quality of life of 76 school-age children with identified disabilities receiving special education services in public schools was compared to quality of life of 64 students without disabilities enrolled in Grades K-12. The Quality of Student Life Questionnaire (QSLQ) was used. Results indicated that the scores of students with disabilities were lower on all scales. The differences were significant in three of the four quality of life factors of the QSLQ scales: Satisfaction, p <.001, Well-Being, p <.01, Social-Belonging, p <.001, and total QSLQ scores, p <.001. Findings suggest that we have not yet achieved parity in quality of life for children with disabilities. The concept of quality of life is discussed in the context of needs for future intervention.

Resource utilization by children with developmental disabilities in Kenya: discrepancy analysis of parents' expectation-to-importance appraisals

The purpose of this study was to describe parental perceptions of eight physical and human resources available to meet the needs of children with developmental disabilities in Kenya. Specifically, the study assessed the discrepancy between the importance parents attached to specified resources and the expected use of those resources by their children with developmental disabilities. Discrepancy analysis was conducted on parents' expectation-to-importance appraisals of eight resources identified in previous research including, health, education, friendships, husband/wife, religious organization, community membership/acceptance, employment/work, and home. Overall, parental appraisal of likely access-to-importance was significantly related across all eight physical and human resource areas. Discrepancy scores ranged from negative, through zero, to positive, categorized underutilized, congruent, and over-utilized, respectively. Chi-square analyses were non-significant for gender across all resources with only slight gender differences noted on three resources. Most parents reported a match between expected use and importance in five of the eight community resources, health (57.4%), friends (54.6%), religious affiliation (59.8%), acceptance in the community (60.3%), and having one's own home (62.6%). However, "husband/wife" fell outside the congruent range (50.4%), with slight gender differences noted. Finally, two resource areas where the majority of parents reported noncongruence were educational programs and employment/career service.

The process through which an advocacy intervention resulted in positive change for battered women over time

A prior experimental evaluation of a community-based advocacy program for women with abusive partners demonstrated positive change in the lives of women even 2 years postintervention (C M. Sullivan & D. I. Bybee, 1999). The current study explored the complex mediational process through which this change occurred, using longitudinal structural equation modeling and formal tests of mediation. As hypothesized, the advocacy intervention first resulted in women successfully obtaining desired community resources and increasing their social support, which enhanced their overall quality of life. This improvement in well-being appeared to serve as a protective factor from subsequent abuse, as women who received the intervention were significantly less likely to be abused at 2-year follow-up compared with women in the control condition. Increased quality of life completely mediated the impact of the advocacy intervention on later reabuse. Discussion places advocacy for women in the context of other efforts that are needed to build an effective community response to preventing intimate violence against women.

Life quality vs the 'quality of life': assumptions underlying prospective quality of life instruments in health care planning

Quality of Life is a broad construct used in health planning, health economics, and medical decision-making. It is also a term that has a long currency in social and sociological literatures. This paper considers the assumptions underlying prospective QL instruments in an historical and contemporary context. It argues that as a tool in health planning and in clinical decision making life quality as a measurement has its origins in the early eugenics literature and the social policies that derived from it in first North America, the primary focus of this paper, and later in Europe. Reference to narrative and social literatures, as well as those involving coping and adaptation, are then used to critique the assumptions underlying this class of QL instruments. It concludes that to the degree now current prospective instruments reflect a purely physical perspective of "disease burden" irrespective of social conditions they create a context that works against life quality, and in some cases, the continuance of persons with physical differences.

Quality of life and traumatic spinal cord injury

OBJECTIVE

To determine associations between major outcome variables after traumatic spinal cord injury (SCI) and quality of life (QL).

SUBJECTS

Of a total population of 353 SCI patients, 320 participated, 261 men and 59 women living in the greater Stockholm area: 124 were tetraplegic, 176 were paraplegic, and 20 had no classified level. Mean age was 42 years (range, 17 to 78).

METHOD

The Swedish SF-36 Health Survey was used to assess QL. The SF-36 is a self-administered questionnaire containing 36 items, divided into 8 multi-item dimensions, covering physical function, physical and emotional role function, social function, bodily pain, mental health, vitality and overall evaluation of health. Neurologic, general medical, and psychosocial variables were obtained from the Stockholm Spinal Cord Injury Study (SSCIS) data base. QL indices were analyzed for the SCI group as a whole, as well as for subgroups. Descriptors for subgroups were demographic variables, presence or absence of common medical problems, and subjective evaluation of the degree of impact of the medical problem on well-being/daily activities.

RESULTS

QL in individuals with SCI was significantly lower in all subscales as compared with a normative population. No difference in QL was seen in subgroups according to extent of lesion, with the exception of physical functioning. Several medical complications such as neurogenic pain, spasticity, and neurogenic bladder and bowel problems were associated with lower QL scores.

SUMMARY

QL, as defined by SF-36, is better in persons injured many years ago, as compared with those recently injured, suggesting an adaptive process operating over a long period. The presence of complicating medical problems, such as severe pain, problematic spasticity, and incontinence, seem to have more negative effects on QL than the extent of SCI as such.

Life skills curricula for students with learning disabilities: a review of the literature

This article presents a review of the current literature on life skills curricula and instruction as they relate to students with learning disabilities. The review of life skills literature is organized into two sections: intervention and follow-up, follow-along studies. Based on the available research, several suggestions for designing research programs that address life skills curricula and instruction for students with learning disabilities are outlined.