1994: new frontiers in mental retardation.
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Deinstitutionalization↗
Biomedical subjects
D Braddock
Publications and source records attributed to D Braddock.
Costs of family care for adults with mental retardation and related developmental disabilities.
"Out-of-pocket" spending by families supporting an adult family member with mental retardation or related developmental disability was characterized and estimated. Annualized nonreimbursed spending among a sample of 99 Chicago-area households was evaluated through survey and telephone interview across 10 categories of routine daily living expenses and disabilities-related services. The average annual out-of-pocket cost was $6,348. Average pre-tax income for the sample households was $37,657. Although wealthier households reported higher levels of spending, the percentage of household income represented by out-of-pocket costs increased significantly as family incomes decreased. Results were discussed in the context of families as a focus for service planning and public policy and the importance of the family to the nation's system of care.
Adult↗
Trends and milestones.
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Health Facility Size↗
Cardiovascular risk factor levels in adults with mental retardation.
Cardiovascular risk factors in a population of adults with mental retardation were examined. The subjects resided in three types of settings (16+ bed facility, group home, and natural family) and were measured on the following parameters: blood lipids, obesity, and smoking. The data were compared to a nonretarded population and to the guidelines established by the National Cholesterol Education Program. Results indicated that adults with mental retardation had cardiovascular risk profiles similar to those of individuals without mental retardation in the Framingham Offspring Study and that to the extent that cardiovascular health is a concern to the general population, it must also be a concern for individuals with mental retardation.
Adolescent↗
Compensation and turnover of direct-care staff in developmental disabilities residential facilities in the United States. II: Turnover.
A representative sample of more than 1,600 residential facilities nationwide was surveyed. Direct-care staff turnover was significantly higher in privately operated community facilities than in public institutions. Turnover was generally higher in private than in publicly operated community facilities. The most consistent correlate of turnover for all types of facilities was wages. Intra- and extra-organizational factors made unique contributions in predicting turnover.
Cross-Sectional Studies↗
Personal and family distress in homeless adolescents.
Previous research has indicated that homeless children exhibit high rates of behavioral and emotional problems and come from families characterised by conflict and rejection. Further, some evidence exists to show that family variables may relate to adolescent distress differently for homeless males and females. In this study, 117 homeless adolescents were compared to a sample of non-homeless youths on the self reported incidence of personal and family problems. The homeless children reported the highest incidence of all behavioral and emotional problems, parental marital discord, overprotection, and the lowest levels of parental care and acceptance. Sex effects were not evident in reported levels of personal or family problems. However, substantially more variance in the adolescents level of behavioral and emotional disturbance was predictable from family measures for females than males. Overall, the results point to the importance of incorporating family distress models in the understanding and remediation of adolescent homelessness.
Adolescent↗
Compensation and turnover of direct-care staff in developmental disabilities residential facilities in the United States. I: Wages and benefits.
This study was based on a representative national sample of more than 1,600 residential facilities serving individuals with developmental disabilities in all 50 states and the District of Columbia. The mean starting wage for direct-care workers in publicly operated institutions in FY 1990 was approximately 31% more than the wage for similar workers in privately operated facilities. The mean starting wage in private facilities was only about 3% above the poverty level for a family of three. Wages, in real economic terms, have declined significantly during the last decade. The wage differential between public and private facilities has doubled during the past 10 years. Implications of these findings for the field and for future research were discussed.
Caregivers↗
Prevalence of obesity in adults with mental retardation: implications for health promotion and disease prevention.
The purpose of this study was to determine the incidence of obesity among 364 adults (mean age, 36.8 years) with mental retardation living in four residential settings. Skinfold measurements were used to measure adiposity. Results indicated that rates of obesity were significantly higher among females, subjects with severe mental retardation had the lowest overall rates of obesity, and the institutional group had the lowest incidence of obesity. These findings indicate a need for more investigation into the caloric intake and energy expenditure of adults with mental retardation, specifically focusing on level of retardation and living arrangement.
Adolescent↗
Community mental health and mental retardation services in the United States: a comparative study of resource allocation.
OBJECTIVE: Preliminary studies suggest that during the 1980s, spending for community mental retardation services in the United States may have grown much more rapidly than spending for community mental health. The primary objective of this study was to test empirically the validity of this thesis on a national basis. An additional objective was to determine why such a distinction in community spending patterns might have evolved nationally. METHOD: The study used states as the units of analysis and employed a five-factor hierarchical regression to predict variance in mental health and mental retardation spending. Factors were state size, state wealth, degree of federal assistance, state civil rights activity, and strength of consumer advocacy groups. Strong roles for the civil rights and consumer advocacy factors were hypothesized. A collateral opinion survey in the 10 states exhibiting the greatest within-state difference in community mental health and mental retardation spending was also completed. RESULTS: Community mental retardation spending grew nearly four times more rapidly than community mental health spending in the 1980s. The consumer advocacy and civil rights factors were strongly associated with spending for community mental retardation services in the states, but these factors did not predict spending for community mental health services. CONCLUSIONS: Study recommendations included strengthening mental health family and consumer advocacy groups in the states and promoting systematic exchange between the mental health and mental retardation fields through joint state planning initiatives, studies, and conferences. The need for Medicaid reform is a unifying theme in both the mental health and mental retardation fields.
Community Mental Health Services↗
Politics, public policy, and the development of community mental retardation services in the United States.
Data emanating from the community services component of the Third National Study of Public Spending for Mental Retardation and Developmental Disabilities was analyzed. An empirical model of community services spending in the states was tested in a hierarchical regression analysis using cumulative community services fiscal effort in the states across 1977-1988 as the dependent variable. Strength of consumer advocacy organizations in the states coupled with states' historical orientations toward the adoption of policies promoting racial equality were highly significant predictors of state-by-state variance in community spending patterns. The implications of this and other findings emerging from the national study were discussed.
Community Mental Health Services↗
Current and future trends in state-operated mental retardation institutions in the United States.
Results of a national study of state-operated institutional care in the United States were presented. The relations among census reduction, staffing level, and resident cost were explored. Resident cost escalated dramatically in recent years, primarily because staffing levels in the states remained relatively stable, whereas the institutional census continued to decline. Econometric projections suggest that by the year 2000, the institutional census will fall below 55,000 persons, cost per resident will rise to more than $113,000 per year, and 28 to 51 institutions will close.
Budgets↗
Synthesis of research on the costs of institutional and community-based care.
Cost studies in the long-term care field are reviewed, with emphasis on those relating to people with developmental disabilities. Studies frequently stressed the cost-effectiveness of community programs but often had significant methodological problems. Among the predominant findings in the literature were: 1) the generally lower average costs per client in community programs versus institutional programs; 2) unexplained wide cost ranges in similar community programs; and 3) significant cost shifts among federal, state, and local governments associated with deinstitutionalization initiatives. The implications of these findings for public officials and the advocacy community are discussed.
Community Mental Health Services↗
Expression of LFA-1 by a lymphoblastoid cell line from a patient with monosomy 21: effects on intercellular adhesion.
Monosomy 21 (M21) is a rare aneuploid condition which in certain cases leads to reduced levels of chromosome 21 gene products. We have prepared an Epstein-Barr virus lymphoblastoid cell-line (LCL) from patient with M21 who has immunological abnormalities, and analysed the expression of lymphocyte function-associated antigen-1 (LFA-1). This heterodimeric leucocyte integrin consists of CD11a (alpha) subunits non-covalently associated with CD18 (beta) subunits coded, respectively, by genes on chromosomes 16 and 21. To determine whether monosomy 21 results in decreased expression of LFA-1, monoclonal antibodies were used to compare the expression of CD11a and CD18 on the M21 LCL with LCL from trisomy 21 (Down's syndrome, T21), normal controls and a possible case of leucocyte adhesion deficiency. In addition, phorbol-ester-induced homotypic adhesion, an LFA-1-mediated effect, was compared in these LCLs. The results are consistent with a gene dosage mediated reduction of LFA-1 expression by the M21 LCL.
Antigens, CD↗
Historical and contemporary issues in nursing home reform.
Historical developments leading to the enactment of nursing home reform legislation (P.L. 100-203) were discussed. The results of the nursing home component of a nationwide University of Illinois at Chicago study of public mental retardation/developmental disabilities spending were also presented. Approximately 51,000 individuals with mental retardation and related conditions resided in nursing homes in 1989. The cost of their care was approximately $900 million annually. Within the first 12 months of the enactment of P.L. 100-203, 46 states had requested an extension to the original mandated services deadline imposed under that legislation. Under P.L. 100-203 guidelines, state agencies estimated that nearly 40% of all nursing home residents with mental retardation might need to be relocated to alternative settings. Implementation issues were also discussed.
Eligibility Determination↗
Accreditation of developmental disabilities programs.
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Accreditation↗
Family reactions to institutional closure.
Determinants of families' reactions to their relatives' relocation (from a large developmental disability institution that was closing to smaller institutions) were examined. Ninety-four families responded to two surveys sent during closure and one year later asking about (a) reactions to the closure, (b) relative's medical status, (c) involvement with their relative, (d) appraisal of the situation, and (e) social support. Over time, families reported less stress and dissatisfaction with closure. Family reactions during closure were related to the relative's medical status, involvement with their relative, and appraisal of the situation, whereas family reactions one year later were related to appraisal, involvement with their relative, and social support.
Family↗
State government financial effort in mental retardation.
A comparative analysis of the level of financial effort exhibited in the states for financing mental retardation services was presented. States were ranked on a criterion (aggregate personal income) that compensated for differences in each state's financial capacity. During the FYs 1977-1984 period, on a nationwide basis, state governments spent increasingly more of their own funds for community services and increasingly less for institutional operations; however, combined institutional and community services spending was relatively stable. A hierarchical multiple regression analysis on three economic variables was performed: state size, wealth, and degree of federal assistance. All were very poor predictors of community services fiscal effort, implying the presence of more complex determinants of mental retardation spending. Degree of federal assistance was an important, inversely related, predictor of institutional fiscal effort.
Budgets↗