Psychoeducational assessment of students with intellectual disability: professional-action framework analysis.

BACKGROUND: The right to educational inclusion for students with intellectual disability (SWID) requires the development of good assessment and intervention practices from holistic perspectives not exclusively focused on the academic limitations that SWID may present. These practices are settled in Spain, via regulations drawn up by each Autonomous Community (AC). The variety of existing regulations demands a critical review of the decisions taken to promote the inclusion of those students. METHOD: current regulations-in-force in each AC that regulate attention to diversity (AD) have been were analyzed by using a checklist that includes the variables that defining each stage of the AD process and the ways of providing supports that favor the development, learning and participation of SWID. RESULTS: attention to diversity measures in each AC emphasize organizational and curricular issues, with no AC following holistic approaches in both assessment and intervention, but rather neglecting self-determination and the promotion of quality of life for SWID. CONCLUSIONS: guidelines for the development of new legal frameworks and professional practices based on the latest evidence-based models of attention to SWID and on the results are discussed.

'A disease that makes criminals': encephalitis lethargica (EL) in children, mental deficiency, and the 1927 Mental Deficiency Act.

Encephalitis lethargica (EL) was an epidemic that spread throughout Europe and North America during the 1920s. Although it could affect both children and adults alike, there were a strange series of chronic symptoms that exclusively affected its younger victims: behavioural disorders which could include criminal propensities. In Britain, which had passed the Mental Deficiency Act in 1913, the concept of mental deficiency was well understood when EL appeared. However, EL defied some of the basic precepts of mental deficiency to such an extent that amendments were made to the Mental Deficiency Act in 1927. I examine how clinicians approached the sequelae of EL in children during the 1920s, and how their work and the social problem that these children posed eventually led to changes in the legal definition of mental deficiency. EL serves as an example of how diseases are not only framed by the society they emerge in, but can also help to frame and change existing concepts within that same society.

A quantitative assessment of educational integration of students with Down syndrome in the Netherlands.

BACKGROUND: In the Netherlands, as in many other countries, there are indications of an inclusive school policy for children with Down syndrome. However, there is a lack of studies that evaluate to what extent this policy has actually succeeded in supporting the mainstreaming of these students. METHOD: For the period 1984-2011, the number of children with Down syndrome entering regular education and the percentage of children still in regular education after 1-7 years were estimated on basis of samples from the database of the Dutch Down Syndrome Foundation. These estimations were combined with historical demographic data on the total number of children with Down syndrome in primary school age. Validity of the model was examined by comparison of the model-based estimations of numbers and percentages in regular education with relevant available empirical data from the Dutch Ministry of Education and from Dutch special schools. RESULTS: The percentage of all children with Down syndrome in the age range 4-13 in regular primary education has risen from 1% or 2% (at the very most about 20 children) in 1986-1987, to 10% (about 140 children) in 1991-1992, to 25% (about 400) in 1996-1997, to 35% (about 650) in 2001-2002 and to 37% (about 800) since 2005-2006. The proportional increase stopped in recent years. CONCLUSION: During the 1980s and 1990s, clearly more and more children with Down syndrome were in regular education, being supported by the then existing ad hoc regulations aimed at providing extra support in regular education. In the Netherlands, in 2003, these temporary regulations were transformed into structural legislation for children with disabilities. With regard to the mainstreaming of students with Down syndrome, the 2003 legislation has consolidated the situation. However, as percentages in regular education stayed fairly constant after 2000, it has failed to boost the mainstreaming of children with Down syndrome. The results of this study are discussed in the context of national and international legislation and educational policy.

Beyond terminology: the policy impact of a grassroots movement.

This article discusses the history of the grassroots movement led by self-advocates and their families to replace the stigmatizing term "mental retardation" with "intellectual disability" in federal statute. It also describes recent and pending changes in federal regulations and policy to adopt the new terminology for Social Security and Medicaid.

Pushing the employment agenda: case study research of high performing States in integrated employment.

Organizational variables, including policies, practices, collaborations, and funding mechanisms resulting in high performance in integrated employment, were described through case study research in 3 states. Findings address how contextual factors, system-level strategies, and goals of the system are related as well as how they sustain systems change. Strategies such as flexibility in funding and practices; communication of values through data, rewards, and funding incentives; and innovation diffusion through relationships and training were most successful when they were embedded within the context of a solid values base, a network of dedicated stakeholders, and clarity about systemic goals. Implications are presented with respect to state systems, community rehabilitation providers as partners in planning, and future leadership in the field.

A guide to educational services and financial assistance for children with disabilities.

Pediatricians, family physicians, and surgical specialists are the main providers of medical care for children with disabilities. Physicians who treat these children often find themselves wallowing in a confusing mass of acronyms, laws; agencies, regulations, criteria, and bureaucracy. By defining and explaining some of the current laws and regulations related to services and financial assistance for children with disabilities, this article will help physicians serve these children more effectively.

On the importance of helping families: policy implications from a national study.

This study is a companion to our 4-year study (Birenbaum, Guyot, & Cohen, 1990) on financing health care for individuals with autism or severe mental retardation. We reported on nonmedical expenditures and opportunity costs pertaining to maintaining a child or young adult with serious developmental disabilities in the home or in residential care and discussed policy implications for assisting their families. We proposed that (a) personal care and family support should be included in health care requirements, (b) family-centered care should be promoted, (c) appropriate programs and care should be provided for young adults no longer in school, (d) financing and organizing of family supports and subsidies should be administratively simple, (e) Medicaid should be expanded to increase use of home- and community-based services, and (f) financial support should be provided to families.

Medicaid program; prohibitions on FFP for educational and vocational training for institutionalized individuals--HCFA. Final rule.

This final rule revises and clarifies the meaning of the prohibition against the use of Federal financial participation (FFP) for vocational training and educational activities in intermediate care facilities for the mentally retarded (ICFs/MR) and in psychiatric facilities or programs providing psychiatric services to individuals under age 21. It resolves issues that have been raised by the States and courts regarding the method and criteria that have been used by HCFA to determine which services are not eligible for FFP because of the educational and vocational training services exclusion.

Learning disabilities in New Zealand: where kiwis and kids with LD can't fly.

Learning disabilities (LD) has never been officially recognized as a category of special education in New Zealand. This article discusses the main reasons for the rejection of the LD category. The education system in New Zealand is described, and the nature of special education is outlined to provide a context for considering LD. Attempts by the parent group SPELD (New Zealand Federation of Specific Learning Disabilities Associations) to have "specific learning disabilities" (SLD) recognized in legislation are discussed, along with reasons for the rejection of these attempts by state education officials. It is concluded that LD/SLD will never be recognized as such in New Zealand. The needs of students with LD may potentially be met by new policies for "high incidence" special needs. But teachers' lack of skills and strategies for working with a range of learning difficulties is seen as an impediment to students with LD being adequately helped in the foreseeable future.

Reimbursement of ICFs/MR program costs based on client resource use.

In this article we have described the impetus, research, and recommendations for a new reimbursement system based on client resource use for ICFs/MR in Minnesota. Research to develop a targeted reimbursement strategy has been completed and a proposal for basing program rates on client resource use developed. Residents (N = 913) in a stratified sample of 65 facilities were assessed and staff resource use determined. Results showed that although predictors in the area of personal interaction, integration, and independence, activities of daily living, special treatment/medical complexity, and behavior accounted for a significant amount of variation in resource use, the unaccounted for variation was sufficiently large to support recommending a system that will base program rates on individual client resource use and the historical costs of individual facilities. Key design issues were also discussed.

Early intervention practices with families of children with handicaps.

A survey to examine the degree to which early intervention activities currently focus on the family was distributed to service providers for birth to 6-year-old children with handicaps from six randomly selected states. Most goals selected by providers were child-focused clinical goals, although family intervention goals were cited frequently. Forty-percent of the sample reported spending no time with families during a typical week. Published programs or curricula were rarely used as a basis for working with families. Service providers reported that they successfully achieved goals set for many of their families, yet they also encountered several problems, including insufficient time for family services. Comparisons were made between providers working with 0- to 3-year-old children and those working with 3- to 6-year-old children. Suggestions concerning the implementation of the family-focused agenda of P.L. 99-457 were made.

Rules: the new institutions.

Despite the pervasive philosophy of normalization and the more recent emphasis on "quality assurance," service provision in today's Medicaid-funded residential environment has become more regulation-oriented and less person-oriented. In this article, this argument was presented in the context of rule-governed versus contingency-shaped behavior of caregivers. The culpable process was identified as the coercive enforcement of inaccurate rules, which precludes responsive staff action and generates adverse consequences. The impenetrable system of rules was compared to the "old institutions," and solutions were advanced to bring staff members more in contact with the natural contingencies of teaching and caring.