“Where’s the human dignity in that?”: LGBTQIA + people with intellectual disability exploring sexual lives and respectful relationships

Abstract

For people with disabilities, sexuality remains a contested and restricted space. This research investigated how the Sexual Lives & Respectful Relationships (SL&RR) program might be adapted for people with intellectual disabilities who identify as LGBTQIA+. The program included co-developed materials and specifically curated narratives. It was received positively. The facilitators identifying as members of the LGBTQIA+ community was also reported as positive. While an inclusive program might be ideal, participants expressed the view that community attitudes (including those of other people with intellectual disability) might not yet be conducive to integrated human relationships programs.     

Involving People with Disabilities in Volunteer Roles

Abstract

According to the 2002 National Health Interview Survey, 33.7 million non-institutionalized Americans have limitations in usual activities. A recent poll on community participation found that, overall, people with disabilities have lower rates of community participation compared to those without disabilities. An analysis of that same poll concluded that people with disabilities continue to be treated as second class citizens by being excluded from the mainstream of everyday life. Social role valorization theory proposes creating and supporting socially valued roles for people who are kept at a social distance. It is through these valued social roles that they gain equal access to other opportunities that society has to offer. One such socially valued role is that of a community volunteer. Volunteer activities can foster a social environment where people with disabilities are seen as credible coping individuals. This paper reports the results of a survey of twenty-six community agencies which regularly use volunteers. The purpose of the survey was to identify barriers to volunteer opportunities for people with disabilities and to explore openness to methods to remove the barriers through community collaborations.     

The Emergence and Attributes of Second-Generation Community Support Systems for Persons with Serious Mental Illness

Abstract

This paper examines the original model of community support for people coping with psychiatric disabilities and illuminates four emergent factors that are bringing about what the author identifies as second-generation community support systems. The author discusses the important role of recovery in refraining the purpose and aims of second-generation community support systems and draws implications for how case management can function within these systems to make them more responsive to recipients.     

Estimating the Expense of a Mandatory Home- and Community-Based Personal Assistance Services Benefit Under Medicaid

Abstract

Personal assistance services (PAS) are essential for many people of all ages with significant disabilities, but these services are not always available to individuals at home or in the community, in large part due to a significant bias toward institutions in the Medicaid program. This study aims to provide an estimate of the expense of a mandatory personal assistance services (PAS) benefit under Medicaid for persons with low incomes, low assets, and significant disability.

Design and methods: We use year 2003 data from the Survey of Income and Program Participation to estimate the number of people living in households who would be eligible, based on having an institutional level of need and meeting financial criteria for low income and low assets, combined with additional survey data on annual expenditures under Medicaid programs providing PAS.

Results: New expenditures for PAS are estimated to be $1.4–$3.7 billion per year (in 2006 dollars), depending on the rate of participation, for up to half a million new recipients, more than a third of whom would be ages 65 and older. These estimated expenditures are a tenth of those estimated by the Congressional Budget Office for implementing the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).

Implications: Creating a mandatory PAS benefit for those with an institutional level of need is a fiscally achievable policy strategy to redress the imbalance between institutional and community-based services under Medicaid.     

Opening Doors to Disability

ABSTRACT

This paper describes and analyzes a community intervention class project in a university community that led to the establishment of an officially recognized campus organization, Open D.O.O.R.S. (Disability Organization for Opportunity, Resources, and Services), to address issues of people with disabilities. It emphasizes the need for providing students knowledge of community strategies at a time when the profession is facing increased social problems and fewer social resources.     

Effective Responses to Offenders with Intellectual Disabilities: Generalist and Specialist Services Working Together

Abstract

Despite policies of deinstitutionalisation, many people with intellectual disabilities in developed western countries continue to live in mainstream institutional settings, such as correctional facilities, rather than in the community with support from disability services. This paper reports on the life stories of 10 people with intellectual disabilities, who had been imprisoned in adult correctional facilities in Queensland. The pathways taken by these 10 people into and out of prison are marked by significant abuse, neglect, and poverty. Significant disparity and disconnection is also displayed between the policies and service approaches, particularly between the disability, mental health, and correctional systems in Queensland. Based on these findings, a framework for practice, which spans both generic and specialist services, is suggested.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

Introduction to the special issue: Family Support of Persons with Disabilities Across the Life Course

ABSTRACT

Family members are a key source of services and supports for people with disabilities across the life course, helping people to remain living at home and in the community. As part of an effort to generate a strategic plan for research on family caregiver experiences and supports, this issue includes four literature reviews on the current state of research, each specific to a life course stage. This introduction presents a framework that combines life course and ecological perspectives to organize the existing literature of family caregiver support and to identify gaps in existing research, as well as opportunities for future investigations.     

Creating employment opportunities for people with disabilities in healthcare: the Bristol Employment Collaborative

Unemployment is a significant problem among working-age adults with disabilities. The Bristol Employment Collaborative (BEC), one of five Regional Employment Collaboratives in Massachusetts, brings together State agencies, community employment service providers, educational institutions, local businesses, economic development organizations, and people with disabilities to design and implement regional strategies to enhance employment opportunities and outcomes for people with disabilities. Launched in 2009, BEC has developed an innovative model to train people with disabilities to become personal assistance services workers, a healthcare occupation with high demand. The case study describes the strategic planning process undertaken by BEC partners to develop a certificate program to be offered by the local community college. The first class enrolled in September 2010 and graduated ten weeks later. Innovative approaches such as the one being pursued and developed by the BEC could help address both unemployment for people with disabilities and the labor shortages in the healthcare sector.     

Using a logic model to evaluate the Kids Together early education inclusion program for children with disabilities and additional needs

Despite clear evidence that learning and social opportunities for children with disabilities and special needs are more effective in inclusive not segregated settings, there are few known effective inclusion programs available to children with disabilities, their families or teachers in the early years within Australia. The Kids Together program was developed to support children with disabilities/additional needs aged 0–8 years attending mainstream early learning environments. Using a key worker transdisciplinary team model, the program aligns with the individualised package approach of the National Disability Insurance Scheme (NDIS).AimThis paper reports on the use of a logic model to underpin the process, outcomes and impact evaluation of the Kids Together program.MethodsThe research team worked across 15 Early Childhood Education and Care (ECEC) centres and in home and community settings. A realist evaluation using mixed methods was undertaken to understand what works, for whom and in what contexts. The development of a logic model provided a structured way to explore how the program was implemented and achieved short, medium and long term outcomes within a complex community setting.Discussion and conclusionKids Together was shown to be a highly effective and innovative model for supporting the inclusion of children with disabilities/additional needs in a range of environments central for early childhood learning and development. The use of a logic model provided a visual representation of the Kids Together model and its component parts and enabled a theory of change to be inferred, showing how a coordinated and collaborative approached can work across multiple environments.     

Neighborhood Experiences and Community Integration

Abstract

This exploratory study examines the social interactional aspect of community integration among persons with psychiatric disabilities. Six focus groups were conducted with 18 mental health consumers in three publicly sponsored community residential programs and 11 staff members providing services to these consumers. Mental health consumers reported both positive and negative experiences in their interactions with community residents. Despite perceived differences between persons with psychiatric disabilities and their neighbors, consumers considered reciprocity and mutual accommodation to be critical for building social relationships in their communities. Mental health providers suggested that social integration can be facilitated by developing independent living and social skills, by overcoming self-stigma and institutional and homeless mindsets, and by having a supportive community of consumers.     

Pentru Voi Fundatia

SUMMARY

This paper presents the philosophy, history, and mission of Pentru Voi Fundatia as a sustainable “best practice” model of interdisciplinary community development (ICD). It is based on positive social, economic, organizational, and/or physical changes that improve the general welfare of the community while providing services to a specific vulnerable population. The Pentru Voi Bakery, one of many programs operated for persons with intellectual disabilities by the Foundation, is used to showcase the key elements of successful ICD. These elements are partnerships, integration, innovation, and transferability. While all community development projects are inherently different, other NGOs interested in creating sustainable programs that utilize the collective agency of local, regional, and international partners can learn from this example. Community Development literature and social entrepreneurship literature are reviewed and discussed as they relate to the Pentru Voi model. Pentru Voi is framed as a practice model based upon the qualities of best practice outlined by the International Labor Office.     

Community Integration of Older People with Developmental Disabilities in Hong Kong

ABSTRACT

To understand the community integration of adults with developmental disabilities in Hong Kong, a comprehensive measure includes four dimensions, pertaining to social activity, social services, interpersonal behavior, and people involved in social interaction. Applying this measure to 692 adults (aged 15–62), the territory-wide study finds that these adults lack company for out-of-home activities and community activities despite their higher knowledge, assertiveness, social interaction, and feeling accepted in the community. With the strengthening of many conditions (including knowledge and community support) for community integration, the adults tend to have greater need for empowerment to enhance their active participation in community activities.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

‘It is like being put through a blender’: inclusive research in practice in an Australian university

Abstract

How can university-based researchers committed to a position of solidarity with, and activism alongside, people with disabilities maintain such a stance in the metric-driven environment of the modern university? How can the academy ensure there is the opportunity for people with disabilities to contribute to production of the knowledge in which they have most at stake, in a wider environment where access to basic services for people with disabilities is precarious? In this article we draw on our experience as a team of university-based and community-based researchers with and without disabilities to reflect on these questions, using a framework of reflexive solidarity to consider practical strategies for strengthening the relationship between disability activism and the academy.     

Community Care in Taiwan

SUMMARY

This article explores the policy definitions and the funder roles of central and local governments in community care in Taiwan. The notion of community care has been adopted in Taiwan following the model of Hong Kong but the main question of the article is whether this has resulted in actual service provisions at the community level, forming an alternative to institutional care. The data has been collected from several sources: policy documents, official statistics, surveys, general reports, funding provision reports, and empirical studies. The results show that neither central nor local authorities are seriously involved in caring for elderly people or persons with disabilities in Taiwan's communities. In Taiwan, community care for these groups of people still means, in practice, informal care provided by female family members without any support from public policies.     

Disability Through the Lens of Culture

ABSTRACT

Effective social work requires cultural sensitivity and competency. Until recently, there was little discussion of culture outside of the contexts of race or ethnicity. This article is an exploration of the key components of culture with application to the community of people with disabilities. The language, history, stigmatization, economic concerns, common behaviors, and practices of people with disabilities are highlighted. A literature review of sensitivity and competency in cross-cultural practice is provided. The article furnishes insights into the lived experience of disability. Suggestions to help practitioners reduce the risks of harm and improve service to this population are presented. Content on disability culture is proposed for social work educators to infuse into core curriculum or add to diversity electives.     

A Critical Analysis of the Social Work Literature on Disabilities

Abstract

The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twenty-five categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.     

Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey

Abstract

Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum survey was developed and sent to 237?U.S. OB-Gyn program directors. University/military programs were compared to community-based programs. Results: 115 OB-Gyn residency program directors responded (48.5% participation); 37.9% university/military and 43.2% community OB-Gyn Program Directors appraise the resident curriculum as “not well” preparing residents to manage sexual health therapies upon graduation. Topics not sufficiently covered include human sex trafficking, sexual health for women with disabilities, and cultural competency. Conclusions: This study identifies opportunities in OB-Gyn residency female sexual health education.