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Results for “DISABILITY EVALUATION”

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At least 343 records · Page 19Linked to original sources
PubMed1996

Medicaid-funded home care for the frail elderly and disabled: evaluating the cost savings and outcomes of a service delivery reform.

OBJECTIVES: In response to rising demand and increased costs for home care services for frail elderly and disabled Medicaid clients, New York City implemented cluster care, a shared-aide model of home care. Our objective: to evaluate the effects of cluster care on home care hours and costs, client functioning, depressive symptoms, and satisfaction. DATA SOURCES: Client interviews, conducted prior to implementation and again 16 months later; Medicaid claims records; home attendant payroll files; and vendor agency records. STUDY DESIGN: The study employed a pretest/posttest design, comparing 229 clients at the first seven demonstration sites to 175 clients at four comparison sites before and after cluster care implementation. Regression methods were used to analyze pre and post-intervention data. PRINCIPAL FINDINGS: Cluster care reduced costs by about 10 percent. Most savings occurred among the more vulnerable clients (those with five or more ADL/IADL limitations). Clients at cluster care sites who started out with fewer than five limitations appeared to decline somewhat more slowly than similarly impaired clients at comparison sites, while those with more than five ADL/IADLs tended to decline more rapidly. This difference was small-less than one limitation per year. Cluster care is associated with a significant decline in satisfaction but appears unrelated to depressive symptoms. CONCLUSIONS: Cluster care appears benign for home care clients with fewer limitations. For the more vulnerable, we recommend experimentation with low-cost interventions that might augment service and improve outcomes without reverting to traditional one-on-one care.

Activities of Daily Living↗
PubMed2003

Using microswitches with persons who have profound multiple disabilities: evaluation of three cases.

This study evaluated the effectiveness of microswitch programs in promoting and maintaining responding of persons with profound multiple disabilities. Three participants were provided one or two microswitches. Their responding (microswitch activation) produced favorite stimuli. Analysis showed that all participants increased responding significantly, albeit with clear differences among them, during the intervention period of a few weeks. Two participants continued with the microswitch program in the daily context and had 3-mo. follow-up data similar to the intervention data. One participant did not continue with the program (reportedly because of inconsistent/low responding) and so did not receive a follow-up assessment. Links between responding and vigilance conditions and stereotypy are discussed.

Adolescent↗
PubMedDate not supplied

The identification of high-school dropouts identified as learning disabled: evaluating the utility of a discriminant analysis function.

This study examined the utility of a linear discriminant function to distinguish between students identified as learning disabled (LD) who had either been released from high school under codes suggestive of school dropout (n = 213) or graduation (n = 92). The discriminant function was comprised of six variables--student ethnicity, reading ability, family intactness, family socioeconomic status, school transfers, and school-initiated interruptions. The analysis determined that differences between the LD dropout sample and LD graduate sample were sufficient to allow for a discrimination between the groups. On the basis of group differences the discriminant function that was constructed correctly classified 83% of the school dropouts and 46% of the school graduates, for an overall 73% accuracy rate. Those factors contributing most to the function were the number of district-initiated interruptions, school transfers, and family intactness. Based on the findings, implications for school districts and future research are noted.

Achievement↗
PubMedDate not supplied

Effects of respite care for children with developmental disabilities: evaluation of an intervention for at risk families.

Respite child care programs that provide temporary child care, support, and referral services to families of children with developmental disabilities are thought to be a critical component of formal social support interventions deemed necessary to promote healthy family functioning and prevent child maltreatment. This study describes sociodemographic characteristics, parenting stress levels, foster care placement, and founded child maltreatment rates in families of children with developmental disabilities who were using respite care services in a rural Midwestern state. Comparison of matched pre- and post-test Parenting Stress Index scores indicated significant decreases in Total Stress scores (t=3.27, df=86, p=0.0016), Parent Domain scores (t=3.55, df=86, p=0.0006), and Child Domain scores (t=2.2, df=86, p=0.02) following provision of respite care. Through logistic regression, it was determined that life stress, social support, and service level were significantly related to the occurrence of child maltreatment during enrollment ( p < 0.05). The investigator suggests that public health nurses can enhance their case management strategies when working with the parents of children with developmental disabilities by monitoring for caregiver burnout in addition to ensuring that the child is receiving care appropriate for his or her level of need.

Adult↗
PubMed2002

[Significance of medical data in work disability evaluation].

Research has shown that insurance doctors in assessing a claim mainly use information provided by the client, whose medical data are not checked with the attending physician, unless a refusal of or a reduction in the disability allowance is to be expected. Additionally, further medical investigations are hardly ever requested. After a year of absence company doctors hardly ever provide any information to the attending physicians, who in turn take just as little initiative with respect to employment disability. The significance of proper medical data for the claim assessment is limited; the majority of chronically ill individuals work and allowances are not given merely because of abnormalities or disorders. Medical data only become significant with reference to a problem analysis. This is often lacking; there is too little skepticism and too much compliance, which fits in with the conflict reducing function of being disabled for employment purposes. Providing more doctors so that more time and attention is available is not enough. Radical measures are needed to reduce the influx of claimants and to simplify the assessment process. Yet above all, greater responsibility should be given to the client and a different vision on employment and illness is also needed.

Chronic Disease↗
PubMed2000

Federal old-age, survivors, and disability insurance and supplemental security income for the aged, blind, and disabled; evaluating opinion evidence. Social Security Administration. Final rules.

We are revising the Social Security and Supplemental Security Income (SSI) regulations concerning the evaluation of medical opinions to clarify how administrative law judges and the Appeals Council are to consider opinion evidence from State agency medical and psychological consultants, other program physicians and psychologists, and medical experts we consult in claims for disability benefits under titles II and XVI of the Social Security Act (the Act). We are also defining and clarifying several terms used in our regulations and deleting other terms.

Expert Testimony↗
PubMed1996

Early identification of children with communication disabilities--evaluation of a screening programme in a Swedish county.

OBJECTIVE: The aim was to evaluate the effectiveness of an early screening programme for communicative disturbances in relation to the health status of the child at the age of 4 years. MATERIALS AND METHODS: A case-control study including 705 cases and 2451 controls was performed. RESULTS: Cases with communication disorders as well as other types of disabilities at 4 years of age showed a higher frequency of deviant screening results on each screening occasion. The sensitivity for the screening programme amounted to 24.8%, the specificity was 95.5% and the positive predictive value was 61.2%.

Autistic Disorder↗
PubMed2000

[Value of the ERGOS work simulator as a component of functional capacity assessment in disability evaluation].

The use of assessment instruments in evaluating functional capacity is an important element in the process of social-medical judgement of whether a person will likely be able to reintegrate into working life. Standardized work processes are used in simulating occupational reality over several hours, with all the requirements involved, and the performance found is contrasted with the requirements to be expected at a workplace. Time-tested in the U.S. for more than 20 years and applied throughout Germany for some two years now, the ERGOS work simulation system is presented in the article, using a case example for more detailed description. Using five different work stations, performance data are collected for job tasks such as carrying, working in kneeling position or overhead, and subjected to computer-based comparison with the job requirements information contained in relevant databases. This enables computerized identification of excessive demands, and hence may point to a need for further rehabilitative action. An important feature is objective assessment, as subjective information on the basis of observation or reports of painfulness are raised separately, hence do not influence the findings of the work simulation performed.

Computer Simulation↗
PubMed2001

Impairment and disability rating in low back pain.

LBP is one of the two most common forms of disability in Western society (mental illness is the other), and remains a thorny problem in the arena of disability evaluation. Disability evaluation after LBP differs whether the pain is work-related or not. If work-related, guidelines for disability evaluation differ by jurisdiction and type of employment (e.g., private vs. federal employee). When outside of the workplace, thresholds for disability differ between entitlement programs (Social Security Disability) and private insurance programs (long-term disability insurance). In the patient without obvious findings, the disability evaluating physician needs to be caring and compassionate and yet maintain an objective stance with the understanding that there may be significant psychosocial overlay in patients with nonobjective pain complaints. Although some would argue that objective independent medical evaluation is an oxymoron, psychiatrists have excellent training and perspective with which to do so. The patient suffering from catastrophic brain injury or spinal cord injury offers a useful contrast--on the most severe end of the disability spectrum--to the patient with persisting low back complaints but normal physical examination. As a society, we have to wisely manage the funds that comprise our social "safety net" in order to provide for persons with severe disability who cannot provide for themselves. It would then follow that patients with minor impairments/disabilities should receive minor (i.e., noninflated) ratings. Psychiatrists need to enable rather than disable their patients.

Adult↗
PubMed1996

Order effects in the administration of a forced-choice procedure for detection of malingering in disability claimants' evaluations.

100 disability claimants of the Social Security Administration referred for neuropsychological evaluation and 40 undergraduate college students asked to simulate brain damage were administered a measure for the detection of malingering, an abbreviated version of the Hiscock Forced-choice Procedure, and other neuropsychological tests. Half of each group was administered the Hiscock Procedure at the beginning of the battery; the other half was administered this test last. For both groups, the results indicated poorer performance on the earlier administration of the abbreviated Hiscock Forced-choice Procedure. Formal measures for detection of malingering should be an integral and early part of any neuropsychological evaluation in which the subject has a financial incentive to perform poorly.

Adult↗