Search

Youth departing from out-of-home care settings face numerous challenges as they adapt to new settings or return to placements that have been unsuccessful in the past. Although several thousand youth face this transition annually, little is known about their specific needs and risks at departure. To better identify needs and risks, we evaluated the discharge data of 640 youth served in a residential group care setting by addressing the following questions: (a) to what settings do youth depart following a stay in residential group care, (b) what are the demographic, family, educational, behavioral, and departure characteristics of youth at departure, and (c) do these characteristics differ for youth departing to different levels of restrictiveness? Results indicate significant differences on youth characteristics based on levels of restrictiveness at departure placement. As one might expect, youth departing to more restrictive placements presented a broad host of challenges across domains, while those departing to less restrictive settings demonstrated fewer needs and departed with greater educational and behavioral gains. Results provide support for the development and planning of targeted aftercare programs designed to promote the short and long term functioning of youth served in out-of-home care.

Using three waves of data from the National Survey of Child and Adolescent Well-Being, this study examines differences in cognitive, academic, and affective well-being of youth first placed in nonkinship foster care (N=259) and youth first placed in group care (N=89). To compare nonrandomized groups, propensity score matching was used. Results from hierarchical linear modeling suggest that both groups of youth show improved behavior and below-average academics over time. (Contains 6 tables.)

Current federal legislation identifies three goals for the child welfare system: safety, permanence, and family and child well-being. Unfortunately, child well-being becomes subordinate to the more easily achievable and measurable goal of permanence--returning children to the biological family, facilitating an adoption, or placing them with relatives. Most people assume that permanency leads to child well-being. However, there is little research, if any, documenting the development of children after permanency is established. The focus on permanence adversely affects the potential outcomes that could be achieved. Instead of viewing time in foster care as a significant developmental window for a child who has undoubtedly suffered, foster care becomes a "parking lot" where children are safely held pending more permanent arrangements. Cost and safety become the most important considerations while little attention is paid to improving child development and well-being. Residential group care, when done well, is one of the strongest links in the foster care system. This article discusses the current state of residential group care and the challenge it faces. (Contains 1 footnote.)

Inner-city public school classrooms, group homes, juvenile detention centers and facilities will be with Americans forever. Their populations can deflate, challenge, or improve any artist's skills and expertise. The author thinks of teaching artists who work these strenuous communities as soldiers of service, dedicated individuals who fight with their hearts and imaginations to reach the at-risk students and the embattled systems of education that surrounds them. A veteran of all these environs is playwright and teaching artist Dominique Cieri. This article presents an interview with Dominique Cieri on his decades of experience teaching and working with at-risk youth, in the juvenile justice system, and around the theme of the Holocaust.

Background: Studies have noted high rates of specific health disorders in adults with cerebral palsy (CP). However, it remains unclear how growing older with a lifelong neuromotor physical disability confers risk for health outcomes in adults who have both intellectual disability (ID) and CP. Aim: To assess the relationship between health status in older adults with ID either with or without coincident diagnoses of CP. Method: Health status data were drawn from 1373 adults aged 33 to 79 years with ID living in small group homes in New York State. Their health status was defined by the presence of common health disorders. Of these, 177 subjects had coincident CP. Prevalence data for nine diseases representing different organ systems were obtained and compared in individuals with and without CP. A Severity of Functional Impairment Index (SFII) was developed based on subjects' capabilities in activities of daily living (ADLs) and mobility. Two logistic regression analyses were conducted to determine if CP diagnosis was an independent predictor of health disorder prevalence, or rather exerted effects similar to those without CP via severity of functional impairment as determined by SFII scores. In addition, older age, gender, and severity of intellectual disability were examined as predictors of health disorder prevalence in all study subjects. Results: Individuals with CP had higher frequencies in four out of the nine health disorders (overweight/obesity, gastroesophageal reflux, urinary tract infections and dysphagia). Analysis revealed a statistically significant association between SFII score and CP diagnosis. CP diagnosis alone was a statistically significant predictor for all of the above four common disorders; however, after adjustment for SFII score was included in health disorder models, only dysphagia showed an independent correlation with a CP diagnosis. Conclusion: With the exception of dysphagia, impairment in ADLs and walking capabilities, and not CP diagnosis alone, accounted for disparities in specific diseases. Although the diagnosis of CP may be correlated with functional impairment, it alone may play a minor role in determining health trajectories in older persons with conjoint ID and CP.

Older people with intellectual disabilities sometimes live in older people's homes rather than homes for people with intellectual disabilities. Little is known about their quality of life in these homes. A non-equivalent comparison group design was used to compare the quality of life of 59 people in three groups; older people without an intellectual disability living in older people's homes (n = 20), older people with an intellectual disability living in older people's homes (n = 19) and older people with an intellectual disability living in intellectual disability homes (n = 20). Data were collected on participant characteristics, adaptive behaviour and three aspects of quality of life; community involvement, participation in domestic living and choice making. The three groups were comparable in terms of gender, ethnicity and additional impairments but the older people without an intellectual disability were older and had more adaptive skills than the other groups. Older people with an intellectual disability experienced better quality of life outcomes in terms of participation in meaningful activity and community access when they lived in intellectual disability homes compared with older people's homes. It was not possible to achieve reliability on the measure of choice-making. This study provides some evidence to suggest that older people with an intellectual disability may be best served in intellectual disability homes rather than older people homes and that it is an area of research which needs further exploration.

Background: Regular physical activity is one of the modifiable risk factors for coronary heart disease (CHD). With an increasing age profile and similar patterns of morbidity to the general population, persons with intellectual disabilities (ID) and their caregivers would benefit from data that indicate CHD risk factors. Knowledge of the CHD risk factors and the changes a physical activity intervention may have on theses risk factors will facilitate future intervention programmes. Methods: A cohort of 100 men and women between the ages of 21 and 73 years with ID living in a community group home in the North-West Province of South Africa was recruited. A CHD risk profile was compiled by means of a questionnaire and physical assessment that included resting blood pressure, body mass index, non-fasting glucose and cholesterol and cardiorespiratory fitness. A 12-week physical activity intervention was then conducted 3 days/week after which the baseline measurements were repeated. Results: The results indicated that 85% of the participants were inactive, while 67% were overweight and obese. Hypertension (6.1%) and smoking (6.1%) were relatively low in this population with ID. Glucose concentrations above the recommended cut-off values were observed in 28% of the participants. Total cholesterol concentrations above normal were measured in 23% of the participants. The physical activity intervention reduced inactivity to 50% and resulted in a significant increase in cardiorespiratory fitness and a decrease in percentage body fat in both men and women. Conclusion: Inactivity is a major risk factor in this population with ID living in a community group setting. The implementation of the physical activity intervention significantly reduced the risk factors for CHD.

Many residential group settings for people with learning difficulties do not provide individuals with the private space in which they can explore their sexual relationships in a safe and dignified manner. Lack of agreed private spaces seriously infringes the individual's human rights. Many people with learning difficulties who lack privacy have no other option but to escape to isolated public or semi-private spaces to be sexually active. This places individuals at risk. It is suggested that self-advocacy driven policy guidance must be developed which must require residential services to review their practice to ensure that they accommodate residents' need for privacy, whilst supporting them to lead safe sexual relationships.

Background: Typically people with intellectual disability have small, highly restricted social networks characterized by interactions with other people with intellectual disabilities, family members, and paid workers. The goal of "inclusion" has been central to policies that have shaped services over the past 30 years. It is an ill defined concept with disagreement about its meaning, the problems it seeks to overcome and how it should be realized. Method: Ethnographic and action research methods were used to support and collect data on the implementation of a programme, known as the "Community Inclusion Framework," in a group home for five adults with severe intellectual disabilities in Victoria, Australia. Results and Conclusions: A pattern of service delivery based on community presence rather than participation evolved and endured over 16 months. The findings show that most staff attached a different meaning to inclusion from that proposed in the "Community Inclusion Framework," disagreed with the proposed meaning or felt these residents were too different for it to be meaningful. This suggests that priority will only be accorded to activities that lead to inclusion if staff are convinced of the veracity of this and given strong and consistent direction and support.

Background: The level of resident's adaptive behaviour and staff facilitative practices are key sources of variation in outcomes for residents in community-based residential services. The higher the resident support needs the poorer their outcome. Although substantial investment has been made in values-based training for staff, their attitudes and the impact of these on practice is largely unexplored. Method and findings: The first study used ethnographic and action research methods to examine the daily lives of 25 residents with severe and profound intellectual disabilities (ID), who lived in five small group homes, and the attitudes of the staff supporting them. Thematic analysis of the data led to a proposition that although staff accept principles of inclusion, choice and participation for people with ID in general, they do not consider it feasible to apply these to the people with severe and profound ID to whom they provide support. The findings from a second study that used a group comparison design and administered a short questionnaire about staff attitudes to 144 direct-care staff and first-line managers working in disability services confirmed this hypothesis. Conclusions: The study suggests more focused attention is needed to staff understanding the values embedded in current policies and their application to people with more severe disabilities.

Background: The use of physical restraints has generated immense controversy in the delivery of services to individuals with intellectual disabilities. The current "zeitgeist" is that effective positive approaches obviate the need for using physical restraints. In a multiple baseline design, we sought to assess how training staff members in mindfulness affected their use of physical restraints for aggressive and destructive behaviours of individuals with intellectual disabilities. Methods: Twenty-three members of staff working in four group homes participated in a 12-week mindfulness-training programme. Objective data were collected on the number of incidents, staff observations of incidents, staff verbal redirections, restraints used, Stat medications administered, staff injuries and peer injuries. Data were collected during baseline, mindfulness training and mindfulness practice phases. Results: As mindfulness training progressed, the use of restraints decreased, with almost no use being recorded by the end of the study. Any use of physical restraints was correlated with new admissions and on-call staff who had not received training in mindfulness. Stat medications administered also decreased and staff and peer injuries were close to zero levels during the latter stages of mindfulness practice. Conclusions: Data from this initial study suggest that staff training in mindfulness is potentially beneficial to both staff and the individuals with intellectual disabilities, particularly in reducing the use of physical restraints and Stat medication for aggressive and destructive behaviours.

Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth's behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth's externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.

Objective: For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse--teen dating violence link. Methods: A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales. Results: Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63-67%) and nearly half of males (44-49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings. Conclusions: These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others. Practice implications: The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatology among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths' conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for "long-term," "unique" impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare. (Contains 6 tables.)

Youth entering residential care possess significant emotional and behavioral needs; yet, it is uncertain whether these needs have remained constant or are changing over time. This study examined mental health variables from the admission files of 1,047 youth entering residential group home care in 1995 and 2004. Sequential logistical regression analyses revealed that the mental health needs of youth admitted in 2004 were greater than those for youth in 1995 with regard to having multiple psychiatric diagnoses, being prescribed two or more psychotropic medications, and using alcohol or drugs. As such, these analyses should be replicated in other group homes as well as in other placement settings within the system of care. (Contains 2 tables.)

The "Restrictiveness of Living Environment Scale" has long been the primary way to conceptualize the "restrictiveness" of a child's living situation. However, changes in systems of care and other factors have created a need to revisit how restrictiveness is conceptualized and measured. A measure was created to assess an environment's level of restrictiveness and form the basis for empirically created general environment types. The measure was refined using expert review, cognitive interviewing, and pilot testing. Over 1,000 child organizations and older youth were invited to participate, with responses completed for 446 youth. The sample was reduced to 313 because of a large response from one setting. Cluster analysis produced a four-cluster solution suggesting low, moderate, elevated, and high restrictiveness for a simplified general environment typology. The data also suggest overlap among clusters and that settings with the same names can vary. Limitations are described, and plans for how the measure will be further developed are outlined. (Contains 3 tables.)

This study explored the relationship between four types of autonomy (health autonomy, informational autonomy, living autonomy, and financial autonomy) and the acceptance of five types of long-term care (adult day care, respite care, assisted living, unit care, and group home) for the elderly in Taiwan. Data were collected from 167 middle-aged and older people. The acceptance of five types of long-term care ranged from 75.9-84.9%. Financial autonomy and information autonomy were significantly related to acceptance of all five types of long-term care. Living autonomy is related to assisted living and group homes. Policy implications are discussed. (Contains 4 tables.)

Results are reported for 3 years of in-service training provided to managers and direct care personnel employed in community, residential, and vocational programs for developmentally disabled adults. The data demonstrate the efficacy of the training model in that 1015 (97%) of 1080 training objectives attempted were completed by the trainees at established criterion levels. Data also indicate that a high percentage of the trainees maintained skills at criterion levels. (Contains 6 tables.)

Fifty-three adolescent girls residing in community-based group-living child welfare programs were administered a standardized measure (SASS-2) in order to assess probability of a substance use/dependency disorder in this highly vulnerable population. Findings revealed that one third of the sample, and one half of the nonpregnant/parenting girls, met the diagnostic criteria for a substance use/dependency disorder. Probability of such a disorder was associated with aspects of the group living milieu including access to peers who also use drugs and lack of perceived pressure from staff to abstain from using drugs and alcohol. Results support the need for broad-based screening of group home youth, intensive interventions to address existing substance use problems, and staff training in prevention and identification of youth who use substances. Findings also suggest that pregnancy and parenthood represent a window of opportunity for changing the trajectory of substance use in adolescent teens in the child welfare system. (Contains 1 table.)

As the population ages, mobility limitations are associated with increased mortality and negative health-related states both in the general population and among people with intellectual disabilities. The influence of mobility limitations upon the lives and lifestyles of people with intellectual disabilities remains poorly understood. Specifically, the extent to which mobility limitations might limit residential options for individuals and families has not been evaluated. To determine the relationship between mobility limitations and place of residence for adults with intellectual disabilities, age 45 and older, a proxy-response telephone survey was completed for 128 adults with intellectual disabilities in Southeastern Ontario. A participant's place of residence was categorized as being "high support" (group homes and nursing homes) or "low support" (living alone, with family, roommates, or host family). People with a score of 12 or less on the Rivermead Mobility Index were considered to have a mobility limitation. The relationship between mobility limitations and high-support residential settings was analyzed using a multivariate logistic regression model. After adjusting for age, sex, and presence of cerebral palsy, communication problems and behavior problems, people with mobility problems had 3.6 times greater odds of living in high-support settings. Authors concluded that mobility limitations are associated with residence in "high-support" settings and that further investigation is needed to determine the direction of causality and to create programs and services that equalize opportunities.

To test the efficacy, acceptability, and appropriateness of a nutrition education and support program, 4 community-based group homes for adults with intellectual or developmental disabilities participated in a pilot intervention with extended baseline period and pre--post-test design. Adults (N = 32) with intellectual or developmental disabilities, 20 direct service staff, 4 managers of group homes, and 2 health specialists at private service providers participated in the intervention, consisting of a system of nutrition supports in nutrition education and guidelines, menu and meal planning, grocery shopping, and cooking designed for the special needs of this population. Positive impacts were found using the program, including fidelity measures, food systems changes and acceptability to users, planned and served foods, and cost changes associated with implementation.

Research indicates that adults with intellectual disabilities (ID) have high rates of overweight status/obesity (OSO). OSO is associated with several important risk factors for coronary heart disease (CHD). This study focused on assessing whether such risk factors are being identified in adults with ID who are receiving their healthcare in community settings, and comparing the rates of risk factors and appropriate preventive interventions with a sample of adults without ID from the same community. OSO rates and CHD risk factors were ascertained in a sample of 100 adults with ID from a medical chart review. All participants were residing in group homes in Monroe County, New York. These rates were compared with age-peer rates in the local general population. In addition, physician practices regarding weight and CHD risk factors were compared in the two study groups. As expected, rates of OSO were high in both groups. However, rates of obesity were proportionally higher in adults with ID. Hypertension rates were comparable in the two groups, although rates of dyslipidemia (high cholesterol) were higher in adults with ID. Medication prescription rates for hypertension and dyslipidemia were equivalent in both groups. There were more dietary recommendations and fewer exercise recommendations prescribed for adults with ID. These findings confirm that OSO rates are high in both adults with ID and those in the general population in one geographic area. High rates of CHD risk factors pose risks for premature mortality and morbidity in both groups. Because of factors that are not clear, but that merit further study, physicians may make different recommendations for diet and exercise in persons with ID compared with persons in the general population.

This article features the Target Community and Educational Services program, a salaried arrangement that allows students at McDaniel College to complete their studies while living with, and managing, clients with developmental disabilities. In what is believed to be the only arrangement of its kind in the U.S., full-time graduate students agree to work for the nonprofit Target agency as Community Living Managers (CLMs) who oversee everything from medical care to social outings. The program began in 1983, when several parents who were disgruntled with the quality of care their children were receiving in local group homes approached Dr. Donald Rabush, then chair of McDaniel's special education department. The parents wanted to do two things: (1) To reduce the turnover rate in homes; and (2) To encourage people who really want to be in the field. The program proved to be a win-win situation for the graduates and for the clients they worked with.

Background: The aim of this study was to evaluate active support (AS) training and to investigate changes to perceived engagement in domestic tasks, opportunities for choice, frequency of challenging behaviour, and level of support needs. Method: Participants were 12 adults with ID aged 27-57 years (M = 37 years) residing in three group homes, and their support workers. The support workers completed assessments on three occasions (at baseline, post-training, and at follow-up). Results: Residents' engagement in domestic tasks increased over time, and overall choice increased, although perceived choice in two life domains initially increased, but decreased to baseline levels at follow-up. Residents exhibited an overall decrease in anxiety, self-absorbed behaviour, disruptive behaviour, and problem behaviour in general. There was also an overall decrease in perceived support needs for five activity domains, with no change for one domain. Conclusions: The results contribute to a growing body of evidence demonstrating favourable outcomes of AS in terms of engagement and challenging behaviour in people with ID. Surprising results are presented for choice and perceived support needs, warranting further investigation. (Contains 4 figures.)

Group homes sometimes face significant neighborhood opposition, and municipalities frequently use maximum occupancy laws to close down these homes. This study examined how the number of residents in Oxford House recovery homes impacted residents' outcomes. Larger homes (i.e., eight or more residents) may reduce the cost per person and offer more opportunities to exchange positive social support, thus, it was predicted that larger Oxford Houses would exhibit improved outcomes compared to smaller homes. Regression analyses using data from 643 residents from 154 U.S. Oxford Houses indicated that larger House size predicted less criminal and aggressive behavior; additionally, length of abstinence was a partial mediator in these relationships. These findings have been used in court cases to argue against closing down larger Oxford Houses. (Contains 1 footnote.)

We examined the differential outcomes in residential treatment for youths with conduct disorder (CD)--with special attention paid to interactions with age and gender--in a sample of children and adolescents in 50 residential treatment centers and group homes across Illinois. Multi-disciplinary teams rated youths ages 6-20 (N = 457) on measures of mental health and other factors within 30 days of admission, about 7 months after admission, and at discharge. While both groups initially responded similarly to treatment, the CD group performed better relative to the non-CD group over the full course of treatment, showing healthier relative change on five outcomes variables and more significant improvement. Age range moderated the relationship between CD group membership and change in work/school performance. There were significant between groups differences within the youngest age group (6-11 years) in which the CD group worsened relative to the non-CD group.

Background: The primary communication partner for many people with profound intellectual disability (PID) who are living in supported accommodation is their disability support worker (DSW). The experiences of DSWs in interacting with people with PID have received limited attention in the literature. Method: The nature of interactions between people with PID and DSWs was explored from the perspective of three DSWs through an analysis of interview data using a phenomenological approach. Results: It was evident from the data that communicating in a way that was perceived to be the preferred style of the person with PID was important to the DSWs. This style, however, was often perceived to be in conflict with their employing organisation's policy and preferred practice. Conclusion: The descriptions in this study have implications for the conceptualisation of best practice in interacting with people with PID. Further research on interactions involving behaviours that may be perceived as inconsistent with concepts of age-appropriate interactions and professional boundaries is recommended.

In 2003 foster youth employed by a foster youth advocacy organization suggested that an evaluation of group home services to foster youth be conducted in Alameda County, California. This report presents the development and conduct of this evaluation study; how funding was obtained; and how foster youth were hired, trained, and employed to produce a timely and informative evaluation of the performance of 32 group homes where some of the foster youth formerly resided. The results of the study are described in another paper. This report contributes to evaluation practice in the newly emerging field of youth-led evaluations. The achievements of this project in utilizing group home clients to evaluate services with which they were familiar may stimulate other evaluators to develop similar projects, thereby enriching the development of our youth and promoting more informative evaluation findings.

In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes, and costs. There were no differences in the majority of lifestyle outcome measures. Fully staffed participants had better outcomes in money management and some health indicators. Semi-independent living participants had better outcomes for choice and community activities undertaken without staff support. Costs for semi-independent living were less. On balance, semi-independent living could offer certain cost-effective lifestyle advantages provided that sufficient attention is given to health, living, and financial well-being.

Background: Australian government policy regards people with intellectual disability (ID) as citizens with equal rights, which means that they should have access to the same opportunities as the wider community. Ageing in place is central to aged care policy in Australia for the general population. Method: This paper reviews policy to support the provision of similar opportunities to age in place for people with ID, and the reasons for its slow development. Results: Due to lifestyle patterns earlier in the life course, many people with ID experience a mid-life disruption to their accommodation, and may live in a group home as they age or may move prematurely to residential aged care. The absence of mechanisms to adjust disability funding as needs change, and the existence of policy that denies residents in group homes access to community-based aged care, forces disability services to "go it alone" to support ageing in place. Conclusion: Despite a national priority to improve the interface between the disability and aged care sectors, administrative and funding characteristics continue to obstruct the development of implementation strategies to support ageing in place for people with ID, which remain at the stage of an exploration of the issues. (Contains 1 note.)

Background: Adults with intellectual or developmental disabilities need dietary monitoring but are not likely to be able to provide accurate dietary intake data via traditional methods. Pilot study efforts to meet their support needs with a novel and practical approach to dietary intake data collection are described in this brief report. Materials and Method: Still photography kits were used by nine adult volunteer participants with intellectual disabilities who lived in group homes or in semi-independent living arrangements to capture images of the food they consumed over 24 h. Results: Use of photographs during dietary intake interviews improved the reliability of the participants' responses. Mean reliability ratings improved from "Indiscernible/Poor" (mean range 1.0-1.7) to "Good/Excellent" (mean range 3.6-5.0). Conclusions: Our preliminary data imply that "Food on Film" is an effective and appropriate tool for use in community settings and warrants further testing.

Background: The disability policy in Taiwan has traditionally emphasized residential care in large institutions and, more recently, medium-sized group homes. This paper compares the relative costs, services provided and outcomes between the traditional institutions, medium-sized group homes and new small-scale community living units that were launched in 2004 in Taiwan. Materials and Methods: Cross-sectional analysis was used to investigate the three current residential service models. A total of 248 participants with intellectual disabilities were interviewed, including all residents from the existing 25 small residential units and purposively sampled respondents from the other two residential models. Results: Outcomes for the Taiwanese participants were consistent with the existing literature on deinstitutionalization from Western societies. Small homes provided better subjective and objective quality of life than both medium-sized community-based units and traditional institutions. Conclusion: Participants living in small residential homes experienced better outcomes at lower cost than persons living in medium-sized group homes or institutions.

Objectives: An extensive literature base exists for behavioral parent training; however, few studies have focused on training direct care staff at group home and residential facilities for children. This study was conducted to determine whether a behavioral staff training program consisting of classroom training and in-home feedback would improve staff interactions with children at two group foster care homes. Method: Staff at both homes were trained, and direct observation measures were obtained on positive and negative interactions and lack of interactions. A multiple-baseline design across homes was used to assess staff interaction behavior. Results: Increases in both positive interactions and tool use were observed in the treatment phase, as were decreases in negative interactions for both group homes. Conclusions: The results suggest that training direct care staff, including social workers, to use behavioral strategies change patterns of interaction, resulting in a greater likelihood of improved relationships between staff and children. (Contains 2 tables and 4 figures.)

A national probability sample of children who have been in child welfare supervised placements for about one year identifies the characteristics (e.g., age, training, education, health, and home) of the foster parents, kinship foster parents, and group home caregivers. Caregiving respondents provided information about their backgrounds. Interviewers also used the HOME-SF to assess the caregiving environments of foster care and kinship care. Comparisons are made to other nationally representative samples, including the U.S. Census and the National Survey of America's Families. Kinship care, foster care, and group care providers are significantly different from each other--and the general population--in age and education. Findings on the numbers of children cared for, understimulating environments, use of punitive punishment, and low educational levels of caregivers generate suggestions for practice with foster families. (Contains 10 tables.)

The mindfulness procedure "Meditation on the Soles of the Feet" can help individuals with mild mental retardation control aggressive behavior. In this study, our aim was to teach this mindfulness technique, using a multiple baseline design, to 3 individuals with moderate mental retardation who were at risk of losing their community placements because of their aggressive behavior. These individuals initially found the procedure difficult to comprehend because they could not easily visualize past anger-producing situations, but mastery was achieved when we incorporated "recreating-the-scene" as a prompt and added a discriminative stimulus on the soles of the participants' feet. Aggressive behavior decreased with mindfulness training, and follow-up data showed that they managed their aggressive behavior in the community for at least 2 years and thus were able to retain their community placements. Appended is a summary of "Meditation on the Soles of the Feet Training." (Contains 1 figure.)

Background: Anti-psychotic medications are widely prescribed to people with intellectual disabilities and have a range of negative side effects. The aim was to identify the level of knowledge of anti-psychotic medications and their side effects among key carers or home managers of adults with intellectual disabilities living in residential group homes who are prescribed such medication. Method: The sample was 25 of the 30 adults on the caseloads of community nurses in one community learning disability team who lived in residential services and who were prescribed anti-psychotic medication. Key carers (n = 22) or home managers (n = 3) were interviewed about their knowledge of these medications and their side effects, the source of their knowledge and their needs for training. Results: Knowledge of potential side effects was somewhat limited. Only two were identified by the majority of respondents. Most respondents felt insufficiently informed and in need of further training. Conclusions: There is a role for an informed professional, such as a community nurse, to ensure that carers receive good, verbal and written information about such medications and their side effects at the time of prescription.

Training of direct care workers (DCWs) varies depending upon the setting in which they work and the state in which they are trained. Evidence points to the importance of adequate training as critical to DCW job satisfaction and reduction in turnover. Several approaches have been taken to enhance the training of DCWs with the objective that as job satisfaction increases, the quality of care provided to consumers will also be enhanced. Based on a sample of 644 DCWs across the nursing home, assisted living, and home health settings, we share DCWs' perceptions and recommendations for better training and continuing education. (Contains 3 tables.)

This study reports on the evaluation of a skills-enhancement training series for direct service providers in home care that was part of a federally funded state-level initiative to improve employee recruitment and retention. The gerontological training curriculum included content to improve problem-solving, communication, and stress management skills in order to increase professionalism and self-efficacy. While the first year of training utilized a network of "real-time" compressed video-teleconferencing broadcast to satellite sites statewide, these broadcasts were videotaped and accompanied by trained moderator-led scripted case study discussions at each of the sites during the second year. As the training series progressed, there was a linear increase in the likelihood that training would change the way participants performed their jobs in the future. Importantly, the training was more highly rated by the participants who had a greater commitment to pursuing their care work with geriatric clients. The merit of the program and implications of the results for the issue of employee retention are discussed. (Contains 3 tables and 2 figures.)

The dietary intake of adults with mental retardation among three different community residential settings was described and compared. Two dietary screeners were administered to 325 adults. The women's Fruit and Vegetable Screener scores from group homes were significantly higher than scores from those with family members and in semi-independent settings. No significant differences were found in dietary intake across residences for men. Overall, 0% to 6% of the participants consumed the recommended 5 or more fruits and vegetables per day, and 15% to 30% consumed the recommended [less than or equal to]30% or less of calories from fat. Results suggest that regardless of residential setting, men and women do not consume enough fruits and vegetables and consume too much dietary fat.

The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service were studied: structure, process, and client outcomes, specifically residents' increase in developmental assets leading to the ability to transition successfully to independent living by the age of 18 years. Data were collected at 32 group homes from 127 residents and 72 staff members using three questionnaires. Both structural and process aspects of services influenced residents' satisfaction with services. However, only the process of care predicted changes in residents' developmental assets. State-level regulatory agencies learned from these results that auditing only structural aspects of services was not sufficient to promote effective services. Further, one structure item and two process items were identified as less consistently occurring in the group homes: timely distribution of clothing allowances, healthy communication between staff and youth, and staff support of regular exercise for the residents. Focusing on these aspects of service first should promote more change in outcomes and satisfaction for foster youth residing in group homes. (Contains 4 tables.)

Background: The implementation and evaluation of Active Support in Australia is reported, the first such formal evaluation outside the UK. Method: Residents and staff of five group homes participated. Active Support was introduced by training staff in one home at a time. Effectiveness was assessed using direct observation of resident engagement in activity and of staff help, as well as written assessments of resident outcomes. Results: Staff help and resident engagement increased in four of five group homes. There was significantly greater participation in a wider variety of domestic activities, as well as more frequent and varied community participation. Change in resident engagement was positively related to change in staff help, but not related to residents' level of adaptive behaviour. Conclusions: Most of our findings were consistent with earlier UK studies. There was evidence of the successful transfer of Active Support training skills to an Australian training team. Nonsignificant trends towards reduced depression and increased adaptive behaviour warrant further investigation.

Background: The social inclusion of tenants living in two forms of supported living schemes--those clustered on one site and those dispersed in neighbourhoods--is contrasted with more traditional provision found on the island of Ireland, namely, small group homes, residential homes and campus-style settings. Methods: A standard pro forma based on measures used in past research was completed by the key-worker for each tenant or resident. In all, data were obtained on 620 persons, representing nearly all tenants in clustered schemes in Northern Ireland and over 40 of those in dispersed schemes. Results: People in either form of supported living tended to have greater levels of social inclusion as measured by their use of community amenities and social contacts than did those in small group homes or residential homes, with participants from campus-style settings having the lowest levels of social inclusion. Moreover, multivariate analyses confirmed that the accommodation variable was a significant influence in addition to the social competence of the person. Conclusions: Although there were few differences between the two models of supported living, further research could usefully focus on decisions to place persons in either form of accommodation and their impact on wider indicators of social inclusion.

Explored are the relationships among personality and emotional reactions, work-related strain, and experiences of burnout among staff exposed vs. not exposed to violence when caring for people with intellectual disabilities (ID). Questionnaires measuring personality, emotional reactions, strain and burnout, and exposure to violence were distributed to staff (n = 112) working in 22 group homes for people with ID aged 18 years and older in a community in northern Sweden. The results did not show evidence of a direct influence of personality variables on exposure to violence when working with people with ID and no direct relationships were found between exposure to violence and the staff members' personality traits as measured with the Temperament and Character Inventory and Rosenberg's Self-Esteem Scale. Although the influence of personality traits on how the staff members experienced violence could not be clearly determined, the authors found an association between personality and strain and the risk of burnout in that certain staff exposed to violence felt more emotionally exhausted than did staff who were not exposed. The knowledge of the relationships among violence, personality, and risk of burnout may be important for the understanding which staff need special supports when working with people with ID.

Background: Physical activity influences health in individuals and within populations. This study explored factors perceived as enabling or inhibiting participation in physical activity by adults with intellectual disability from a health promotion perspective. Method: Six focus group interviews were conducted: adults with intellectual disability (1 group, n = 9), direct care workers (1 group, n = 5), group home supervisors (2 groups, n = 9 and n = 6), managers (1 group, n = 4), and parents (1 group, n = 7). Results: Three major themes were identified from the focus group interviews: motivation for participation, social support, and political and financial support. Conclusions: The most critical issue was the lack of clear policies. Both day training centres and accommodation services would benefit from development of policies related to health-promoting physical activity. Flowing on logically from the development of policy would be much needed training and support of staff. (Contains 1 figure and 1 table.)

Objective: This qualitative study examined stakeholders' perceptions of the safety of youth ages 12 and older living in congregate care facilities within the New York City foster care system. The study explored the youth's physical safety, the safety of their personal belongings, the physical conditions of congregate care settings, and the relationship between staff quality and youth safety. Method: The study involved interviews with family court judges, representatives of private child welfare agencies, attorneys who represent children in foster care, social workers, representatives of advocacy and other relevant organizations in New York City, and former foster youth who had been placed in congregate care settings. Results: Safety in congregate care environments was an issue of significant concern. Threats to the youth's safety were found to emanate from peer-on-peer violence, stealing of personal belongings, inappropriate staff conduct, and the poor physical conditions of facilities. Youth's sense of safety was strongly linked to staff quality, including staff ability to relate effectively to youth and to maintain control of congregate care environments. Conclusions: Existing regulations in New York State appear to have had little effect in ensuring the safety of youth in many group and residential care facilities. Steps to improve safety outcomes for youth in these settings are proposed.

Group home caregivers of 24 institutionalized, male, high-functioning adolescents and young adults with Autism Spectrum Disorder, were interviewed with the Interview Sexuality Autism. Most subjects were reported to express sexual interest and to display some kind of sexual behavior. Knowledge of socio-sexual skills existed, but practical use was moderate. Masturbation was common. Many subjects were seeking physical contact with others. Half of the sample had experienced a relationship, while three were reported to have had sexual intercourse. The number of bisexual orientations appeared high. Ritual-sexual use of objects and sensory fascinations with a sexual connotation were sometimes present. A paraphilia was present in two subjects. About one third of the group needed intervention regarding sexual development or behavior.

The present study evaluates a training program with paraprofessional service providers at a community-based habilitation setting. Four staff were taught to implement alternative and augmentative communication instruction with an adult who had autism and mental retardation through a combination of instruction, demonstration, behavior rehearsal, and performance feedback. Training was conducted under natural conditions at the adult's group home residence. Three of the four staff were able to maintain near-100% instructional accuracy following initial training. The results add to the limited research literature concerning community-based training of direct-care personnel. (Contains 1 figure.)