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OBJECTIVE:Making decisions is central to the exercise of control over one's well-being. Many individuals with serious mental illness (SMI) experience limitations in their decision-making capacity. These individuals have often been placed under legal guardianship and substitute decision makers have been appointed to make decisions on their behalf. More recently, supported decision making (SDM) has emerged as a possible alternative in some cases. SDM involves recruitment of trusted supports to enhance an individual's capacity in the decision-making process, enabling him or her to retain autonomy in life decisions. This overview examines issues associated with decision-making capacity in SMI, frameworks of substitute decision making and SDM, and emerging empirical research on SDM. METHOD:This is an overview of the medical and legal literature on decision making capacity and supported decision making for persons with SMI. RESULTS:Many but not all individuals with SMI exhibit decrements in decision-making capacity and skill, in part due to cognitive impairment. There are no published data on rates of substitute decision making/guardianship or SDM for SMI. Only three empirical studies have explored SDM in this population. These studies suggest that SDM is viewed as an acceptable and potentially superior alternative to substitute decision making for patients and their caretakers. CONCLUSIONS:SDM is a promising alternative to substitute decision making for persons with SMI. Further empirical research is needed to clarify candidates for SDM, decisions in need of support, selection of supporters, guidelines for the SDM process, integration of SDM with emerging technological platforms, and outcomes of SDM. Recommendations for implementation of and research on SDM for SMI are provided.

Despite studies showing that students who have more self-determination—those who make more decisions and have more control over their lives—have more successful educational experiences and adult lives, research and scholarship document the existence of a "School-to-Guardianship Pipeline." There, educational professionals recommend that parents seek guardianship over their children with disabilities, without explaining or exploring other options that may preserve or build their self-determination. This article documents the importance of self-determination to life and educational outcomes for people with disabilities, and summarizes research showing how overbroad and undue guardianship—guardianships that remove more rights than necessary or that remove rights from someone who is able to exercise them independently or with support—can decrease quality of life. Then, the authors show how Supported Decision-Making can serve as an alternative to guardianship and a way to enhance self-determination, and recommend ways to incorporate supported decision-making into special education supports and services. [ABSTRACT FROM AUTHOR]

Iowa's emerging workforce of entrepreneurs with disabilities and the design of Iowa's Entrepreneurs with Disabilities (EWD) program were examined in an exploratory study. The study focused on the following issues: organizational characteristics of the EWD program; the characteristics of EWD applicants and their motivations for choosing self-employment; the impact of disability on potential success as an entrepreneur; the impact of participation in the EWD program; and questions for future study of entrepreneurs with disabilities. Data were collected from the following sources: (1) a literature review; (2) a review of Iowa's EWD program and its policies and procedures; (3) an analysis of more than 500 EWD program applications, and (4) telephone interviews with a stratified subsample of 30 EWD participants. Of the 30 EWD applicants interviewed, 25 (83%) reported having had incomes before the onset of their disability (median pre-disability income, $25,000). The following were among the recurrent themes mentioned by the interviewees: the economic implications of self-employment; independence and commitment to self-employment; health care and insurance needs associated with self-employment; encountering discrimination before and after self-employment; and the challenges of staying self-employed. The summary form of the structured and open-ended interview questions is appended. (Contains 299 footnotes.) (MN)

I. INTRODUCTION 356 II. OVERVIEW OF THE CRA 357 A. Background and Purpose of the CRA 357 B. Current CRA Regulatory Approach 359 C. Disability and the CRA 360 1. [...]

This article offers a glimpse of the Americans with Disabilities Act ("ADA") of 1990, as amended by the ADA Amendments Act of 2008 ("ADAAA"), at its 30th anniversary. It considers current issues before the courts, primarily legal cases from 2020 and 2021, and new questions in light of the COVID-19 pandemic, such the latitude of the ADA's antidiscrimination protections and its definition of disability. It provides a quick primer on the basics of the ADA: employment discrimination under Title I, antidiscrimination mandates for state and local governments under Title II, and commands to places of accommodation offering services to the public under Title III. The ADA at 30 remains a beacon for a future in which all people, regardless of individual difference, will be welcomed as full and equal members of society. [ABSTRACT FROM AUTHOR]