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In this article, we demonstrate the potential of machine learning approaches as inductive analytic tools for expanding our current evidence base for policy making and practice that affects people with intellectual and developmental disabilities (IDD). Using data from the National Core Indicators In-Person Survey (NCI-IPS), a nationally validated annual survey of more than 20,000 nationally representative people with IDD, we fit a series of classification tree and random forest models to predict individuals' employment status and day activity participation as a function of their responses to all other items on the 2017-2018 NCI-IPS. The most accurate model, a random forest classifier, predicted employment outcomes of adults with IDD with an accuracy of 89 percent on the testing sample, and 80 percent on the holdout sample. The most important variable in this prediction was whether or not community employment was a goal in this person's service plan. These results suggest the potential machine learning tools to examine other valued outcomes used in evidence-based policy making to support people with IDD.

Vietnam ratified the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in 2015, signalling a commitment to the basic human rights of citizens with disabilities. Previous research has shown people with disabilities in Vietnam to be marginalised in society, often with limited educational or work opportunity, and with limited financial means. Using in-depth semi-structured interviews conducted in Vietnam and a thematic analysis approach to data interpretation, this article examines the current status of people with disabilities in Vietnam in relation to the core elements of the CRPD, from the perspectives of people with disabilities, their families, and professionals who support them. Findings suggest that, while Vietnamese society has made strides supporting people with disabilities, work remains to be done for the country to comply with the CRPD's core principles. Suggestions for future action are offered, including ways to support human rights of people with disabilities within cultural contexts.

BackgroundMethodsFindingsConclusionsAdults with intellectual and developmental disabilities (IDD) often have behavioral support needs that must be met in order to live in community settings. Pharmacotherapies are often used to meet such needs. We explored factors that predict medication for behavioral support among adults with IDD.We integrated three major U.S.- based IDD-specific datasets over multiple years, creating a large dataset. We used machine learning to build and test an algorithm to predict factors associated with the use of pharmacotherapies to address behavioral support needs for adults with IDD.Our algorithm correctly predicted the use of pharmacotherapies with about 79% accuracy. Top predictors of medication use to address behavioral support needs included disruptive behavior, use of medication to treat a mental health condition, and presence of an autism diagnosis.Use of behavior plans should be given more attention in conjunction with medication use, especially in relation to managing disruptive behavior. [ABSTRACT FROM AUTHOR]

Researchers and advocates have long called for improved research methods that better include people with intellectual and developmental disabilities (IDD), but challenges to doing so persist. Proxy responses are frequently used to circumvent some of these challenges, but may not fully capture the perspectives of people with IDD. The COVID-19 pandemic highlighted the possibility of consequences due to a lack of research about health outcomes for people with IDD, with documented disproportionate impact but little understanding about specific experiences for people with IDD. Using exploratory graph analysis (EGA) we explored the use of proxy responses on the COVID-19 Supplement of the National Core Indicators In-Person Survey. Findings suggest significant differences in response patterns between people who answered independently, via proxy, and with a mix of response types beyond what would be expected due to demographic differences in participants. [ABSTRACT FROM AUTHOR]

People with intellectual and developmental disabilities (IDD) often rely on Medicaid-funded services and supports to facilitate their daily living. The financial investment for these services is significant, yet little work has been conducted to understand how these investments affect life outcomes. This pilot study used a novel data integration approach to offer initial insights about how Medicaid expenditures relate to outcomes using Medicaid claims data, results of the National Core Indicators consumer survey, and data from the Supports Intensity Scale (SIS). Findings suggested that subpopulations of people with IDD who also had high behavioral needs or high medical needs had significantly higher expenditures than individuals with more typical SIS-assessed support needs. Regression analyses suggested mixed outcomes based on the factors we considered, including a finding that people with IDD who lived in sponsored residential care homes were more likely to engage in inclusive activities in the community than those who lived in larger congregate settings, or those who lived in a family home. Results of this pilot, when brought to scale, will be useful in examining the performance of state IDD service systems over time.

Case management (CM) is one of the most commonly used services by individuals with intellectual and developmental disabilities (IDD), but little is known about the workers who provide CM. This study used a mixed methods approach to gain understanding of the CM workforce in one U.S. state. An online survey was completed by 35 IDD service directors (87.5% of directors in the state); and 113 CMs and CM supervisors participated in semistructured interviews and focus groups. Results indicated an annual crude separation rate of 28.2%, and participants often complained that turnover resulted in caseload sizes that prevented optimal outcomes for people with IDD. A limited applicant pool, duties focused on regulatory compliance, and inadequate wages were cited as major challenges for CMs.

Self-directed home and community based services (HCBS) waiver services and supports for people with intellectual and developmental disabilities (IDD) have become a viable and widely used method of service provision in the United States. Grounded in theories of self-determination, previous literature on self-direction has suggested high satisfaction and positive outcomes for people who use self-directed programs as well as cost savings for state IDD service systems. This study explored the ways in which state IDD service administrators think about how self-direction may be used as a method of achieving cost savings while providing opportunities for people with IDD and their families to exercise choice and control. Informed by 54 high-level IDD service administrators in 34 states, and guided by a thematic analysis approach to data interpretation, the study found evidence that administrators typically see strong potential for self-direction to have cost-savings benefits, while also fostering choice. In the current political climate, the need for cautious fiscal stewardship may become a stronger driving force behind self-direction for people with IDD in the United States.

Having a sense of social inclusion and belonging, typically characterized by our personal relationships and community participation, is the central essence of life for most people, yet it remains elusive for many people with intellectual and developmental disabilities (IDD). This article summarizes the work of a diverse group of researchers and advocates to propose 6 big-picture, equity-based goals to drive future research in the field: (1) understanding the role of intersectionality, (2) understanding intimate relationships, (3) promoting formation of communities of care to support social inclusion, (4) understanding life course trajectories of social inclusion, (5) understanding social inclusion in virtual spaces, and (6) understanding how to promote social inclusion in the entire research process. [ABSTRACT FROM AUTHOR]

Families of children with autism spectrum disorder (ASD) play a central role in selecting interventions for their children. Despite the importance of understanding the factors that motivate early decisions about treatment, the literature has concentrated little attention on how and why parents of young children with ASD make decisions about services and supports. Using a collective case study design informed by a diverse sample, this study found a heavy reliance on formal and informal sources of support in guiding parents' early treatment decisions for their young children with ASD. The Internet also served as a primary source of informational support to families. Findings highlight the importance of family support initiatives including peer-to-peer family mentoring and decision support aides to assist families in critically evaluating online and print information regarding ASD.

OBJECTIVE: This article reports the findings from focus groups conducted with individuals who have spinal cord injuries (SCI) about their experiences with employment. The purpose was to obtain perspectives regarding their perceived barriers to employment and the supports that they need to achieve their employment goals. METHODS: Focus groups were conducted at scheduled times via telephone with 31 individuals with SCI; 16 were employed; 15 were unemployed. The recorded calls were transcribed and analyzed using NVivo10. RESULTS: Narratives from the focus groups revealed a number of trends related to the factors that facilitate and challenge employment for people with SCI. Content analysis resulted in four primary themes related to facilitation of employment: (a) learning to be a strong self-advocate, (b) acquiring job-specific training, (c) networking effectively, and (d) putting necessary supports in place. The participants' narratives also uncovered a number of barriers that a person with SCI must overcome in order to secure employment: (a) transportation issues, (b) difficulties with accommodations, and (c) perceptions of discrimination based on disability. CONCLUSIONS: This research was the first phase in a multi-phase research study on identifying and implementing knowledge translation (KT) strategies for increasing employment outcomes for individuals with physical disabilities. This research began identifying what individuals with SCI see as barriers and facilitators to successful employment and how people with disabilities obtain their information on supports and services., The Bureau of Labor Statistics (2016) reported the employment rate for individuals with any type of disability for 2015 as 17.5% versus 65.0% for those without disabilities. The National Spinal [...]

Turnover among direct support professionals (DSPs) in community support settings for individuals with intellectual and developmental disabilities (IDD) has been regarded as a challenge since tracking of this workforce began in the 1980s. This study utilized a group randomized controlled design to test the effects of a competency-based training intervention for DSPs on site-level turnover rates over a one year period. Results suggested that, compared with the control group, sites receiving the training intervention experienced a significant decrease in annual turnover, when multiple factors were controlled. Implications, including the importance of considering quality training as a long term organizational investment and intervention to reduce turnover, are discussed.

People with multiple sclerosis (MS) are known to face a multitude of challenges in the workplace and when seeking employment. Less has been written, however, about the subjective experiences of people with MS regarding their workforce participation. This study used phone-administered focus groups to investigate work-related experiences of a national sample of individuals with MS. Using a conventional qualitative content analysis approach, the researchers derived a set of three core themes, each with subordinate sub-themes. The three core themes were: (a) facing future uncertainty, (b) feeling a sense of loss, and (c) navigating the workplace. Findings are discussed within the context of existing literature., Multiple sclerosis (MS) is a chronic, unpredictable neurological disease characterized by cycles of relapses and remissions, although some people experience a steadily progressive course marked by a gradual decline in [...]

Self-directed programs that allow individuals with intellectual and developmental disabilities to exercise greater control over their finances have become increasingly common in recent years. At the same time, challenges in the recruitment, retention, and training of direct support workers in the field have grown more acute. In this article, the authors investigate the status of the direct support workforce for people using self-directed supports in 1 Midwestern state, based on the results of a statewide survey of service users. Although additional research is needed, the results of this study suggest that people who use self-directed funding options are satisfied with their ability to direct staffing, though challenges remain. Among these challenges, the presence of higher than expected wages but lower than expected benefits provision compared with traditional services may have serious policy and staff retention ramifications that affect the long-term viability of self-directed funding options. In addition, staff training remains a challenge, with service users in this sample reporting low rates of training beyond a general skill set. Implications of these findings are discussed.

Future life planning is a growing concern among families with children with disabilities. This article presents a needs assessment evaluating feasibility of a new model for future life planning for family caregivers, Lifetime Assistance, which will provide ongoing planning and monitoring for individuals with intellectual and developmental disabilities. Using surveys informed by a series of focus groups, data were gathered from older and younger parents in one midwestern state regarding the potential program. Study results indicate that respondents did not feel the current system of support was adequate for planning for their child's future, nor sufficient for monitoring the quality of life for their children in the future. Although almost all families had identified a person to support their family members when they were no longer able to do so, parental caregivers overwhelmingly identified the need for the Lifetime Assistance program and many were willing to pay for this service themselves. (Contains 5 tables.)

Despite the detrimental effects of incivility in the workplace, relatively little research examines peer-level incivility in social work education. Incivility literature from multiple countries has established that within the academy, individuals' bad behaviors coupled with nonexistent, weak, and inconsistent institutional policies as causes of the problem. This study analyzes qualitative data (n = 164) drawn from a larger survey (n = 243) collected from faculty members in social work education programs in the United States. The study explores personal experiences with incivility among social work faculty. In addition to the professional and personal impact of workplace incivility, three other themes emerge from these data: a discussion on how incivility occurs, the causes of incivility, and the role power and hierarchies have in supporting environments where these behaviors thrive. This study finds that incivility within social work education has negative long-term outcomes with implications for future job prospects, hiring decisions, and tenure and promotion. These data also confirm that consequences of microaggressions in the workplace are as harmful as overt acts of incivility. The study concludes with opportunities for leaders in social work education to identify and address individual behaviors while also assessing and addressing institutional oversight and response systems. [ABSTRACT FROM AUTHOR]

The Hmong, who began migration to the United States of America in the latter half of the 1970s, represent a largely unstudied segment of the Asian-American population. Traditional practices such as teenage marriage were widely reported in the early years after migration began, but have been left relatively unexamined more recently. Explicit focus on Hmong women has been largely absent in recent research. This paper examines the relationships between marriage patterns, education and earnings among Hmong women in the United States. Using results from a survey of 186 Hmong women, the results of this study indicate high rates of teenage marriage, as well as associations between early marriage, marital abuse, and both low earnings and lower levels of educational attainment among women married as teenagers compared to Hmong women who waited until adult age to marry. There were signs of encouragement, including higher than anticipated rates of educational attainment among the sample overall. Marital stressors such as spousal abuse remain prevalent, especially among Hmong women who married in their teenage years. Implications of this research are discussed for both practitioners and for future directions in research within the Hmong-American community. [ABSTRACT FROM AUTHOR]

•Summary: An online survey was completed by Hmong women in the United States (n = 186). The survey was distributed via listserves and websites frequently used by Hmong women, and solicited information about marital factors, presence and intensity of depressive symptoms, and socio-demographic circumstances.•Findings: The findings of this article indicate a significant relationship between marital abuse and depression among women married as teenagers when compared to non-abused women who married in adulthood. Excessive worry and feeling like everything takes great effort were the two most frequently reported indicators of depression reported by Hmong women in this sample. Additional marital and socio-demographic factors are explored in their relationship with depressive presentation.•Applications: These findings suggest that mental health practitioners working with Hmong women may need to be particularly attuned to issues of marital stressors related to traditional marriage practices and cultural stressors. [ABSTRACT FROM PUBLISHER]

This study investigated parental perceptions of the early signs, age of initial concern, age of diagnosis, and age of initial intervention for children with Autism Spectrum Disorders (ASD) in mainland China. A sample of 146 Chinese parents of children with ASD responded to an online survey. The findings suggested that parents were concerned about their child's development at a mean age of approximately three years, obtained an initial diagnosis at an average age of four years, and procured intervention for their child at an average age of four years-three months. The results also revealed that early indicators of ASD validated in the United States were among those used by Chinese parents, though some early signs may gain particular salience in the Chinese context. Additionally, educational implications and areas of future research are discussed. [ABSTRACT FROM AUTHOR]