Current services and outcomes of formerly institutionalised and never-institutionalised US adults with intellectual and developmental disabilities: A propensity score matching analysis.

BACKGROUND: Deinstitutionalization research shows better services and outcomes relative to institutional life but has not compared formerly institutionalised and never-institutionalised service users. METHODS: We used propensity score matching (PSM) to match formerly institutionalised and never-institutionalised participants on six personal characteristics. Data came from the 2018 to 2019 National Core Indicators In-Person Survey. We excluded current institution residents, and states with 25% + of missing data on former institutionalisation. RESULTS: Overall, 15.5% of participants in the 29-state full sample had lived in an institution for 1 year or more. Findings from the PSM sample showed that former-institution residents were more likely to use congregate living arrangements and less likely to live with family. They experienced more loneliness, less support-related choice, and had a consistent pattern of disability service-focused social connections. CONCLUSIONS: Many former institution residents remain disadvantaged relative to matched peers. There is a need to identify factors to enhance services and outcomes following deinstitutionalization.

Community participation and staying home if you want: US adults with intellectual and developmental disabilities.

BACKGROUND: Requiring adults with intellectual and developmental disabilities to go on community outings with co-residents and staff is contrary to community-living policy's focus on person centredness and choice of activities/companions. METHOD: We analysed 2018-19 National Core Indicators data from 36 US states concerning 7968 adults living in staffed, non-family, multi-client settings. The focus outcome was being able to stay home if you want when others in your home go out. RESULTS: The 42.0% of participants who could stay home were more likely to go out with friends, family or alone, and less likely to go out with staff. Those who could stay home participated in a similar variety of community activities and went out more often to shop or for errands. CONCLUSIONS: Individuals who could stay home likely had more choice about where, when and with whom they went out. Strategies for greater person-centredness are proposed.

Racial and ethnic disparities in educational achievement and aspirations: findings from a statewide survey from 1998 to 2010.

Educational achievement and attainment are associated with health outcomes across the entire life span. The objective of this study was to determine whether racial/ethnic disparities in academic achievement and educational aspirations have changed over time. The study used data from the Minnesota Student Survey (MSS) from 1998, 2001, 2004, 2007, and 2010. The MSS is administered to adolescents in public secondary schools, charter schools, and tribal schools. Measures of academic achievement and educational aspirations were examined by race/ethnicity, poverty status, and family structure. Chi square tests evaluated differences in the above proportions. The analytic sample included 351,510 adolescents (1998, N = 67,239; 2001, N = 69,177; 2004, N = 71,084; 2007, N = 72,312; and 2010, N = 71,698). Study participants ranged in age from 13 to 19 years (mean = 15.9, SD = 1.6). Most were white (81.7 %), followed by 5.4 % Asian American/Pacific Islander, 4.3 % Black/African American, 2.7 % Hispanic/Latino, 1 % American Indian, and 4.9 % mixed race. Results showed that academic achievement fluctuated amongst all the racial/ethnic groups, but there were significant race/ethnic disparities at every time point. Overall, academic aspirations increased over time among the adolescents. Poverty was associated with poorer academic indicators for white youth, but not consistently for other racial/ethnic groups of youth. Family structure, however, was significantly associated with the educational indicators across all racial and ethnic groups. Despite many efforts to improve educational outcomes, there remain significant disparities in educational achievement and aspirations related to race-ethnicity and social status. Findings have implications for efforts to improve adolescent health at both individual and community levels.

Prime time: 18-month violence outcomes of a clinic-linked intervention.

Prime Time, a youth development intervention, aims to reduce multiple risk behaviors among adolescent girls seeking clinic services who are at high risk for pregnancy. The purpose of the current study was to examine whether Prime Time involvement produced changes in relational aggression, physical violence, and related psychosocial and behavioral outcomes. Qualitative case exemplars illustrated social contexts of intervention participants with differing longitudinal patterns of relational aggression and physical violence. Data were from a randomized efficacy trial with 13-17 year-old girls (n = 253) meeting specified risk criteria. Intervention participants were involved in Prime Time and usual clinic services for 18 months, control participants received usual clinic services. Participants in the current study completed self-report surveys at baseline and 18 months following enrollment. Outcomes analyses revealed significantly lower levels of relational aggression perpetration in the intervention group versus controls. In contrast, Prime Time involvement did not result in significant reductions in physical violence. Exploratory dose-response analyses indicated that reductions in relational aggression may have been most pronounced among girls actively involved in Prime Time case management and peer leadership activities. Qualitative findings suggested that the intervention's emphasis on modeling and building supportive relationships contributed to reductions in relational aggression. This study contributes to what has been a very limited evidence base regarding effective approaches to preventing violence among high-risk adolescent girls. Findings suggest that offering youth development interventions through clinic settings hold promise in reducing violence risk among vulnerable youth.

Brief report: Associations between adolescent girls' social-emotional intelligence and violence perpetration.

This study examined associations between social-emotional intelligence (SEI) and two measures of violence perpetration (relational aggression and physical violence) in a cross-sectional sample of high-risk adolescent girls (N = 253). We evaluated three aspects of SEI: stress management, intrapersonal, and interpersonal skills. Results of a multiple linear regression model accounting for participants' age, race/ethnicity, and experiences of relational aggression victimization indicated that girls with better stress management skills were less likely to perpetrate relational aggression. A parallel model for perpetration of physical violence showed a similar pattern of results. Study findings suggest that SEI, and stress management skills in particular, may protect adolescent girls - including those who have been victims of violence - from perpetrating relational aggression and physical violence. Interventions that build adolescent girls' social and emotional skills may be an effective strategy for reducing their perpetration of violence.

Survey of Minnesota parent attitudes regarding school-based depression and suicide screening and education.

School-based depression screening and education programs are recommended for addressing the high rates of children's mental illness. The objectives of this study were to (1) identify Minnesota parent attitudes regarding the provision of school-based depression and suicide screening and education and (2) identify predictors of parent support for these school-based programs. A random sample of 1,300 Minnesota households with children ages 5-18 years was surveyed by mail. Chi-square tests and regression analyses were used to detect differences in parent support for depression and suicide screening and education across demographic categories, and parent beliefs and knowledge about depression and suicide. The response rate of eligible households was 43 % (N = 511). Overall, 84-89 % of parents supported school-based depression and suicide screening and education. After adjusting for all variables, parent support for depression screening was associated with greater knowledge [OR 8.48, CI(1.30-55.21)] and fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.12)]. Support for suicide screening was associated with fewer stigmatizing beliefs [OR 0.03, CI(0.01-0.10)]. Support for depression education was associated with fewer stigmatizing beliefs [OR 0.32, CI(0.10-1.00)] and lower educational attainment [OR 0.59, CI(0.40-0.89)]. Support for suicide education was associated with greater knowledge [OR 7.99, CI(1.02-62.68)], fewer stigmatizing beliefs [OR 0.26, CI(0.07-0.92)], and lower educational attainment [OR 0.60, CI(0.38-0.94)]. Parent support for school-based depression and suicide screening and education was high. Parent education to decrease stigmatizing beliefs and increase knowledge about depression and suicide may increase support among the minority of parents who do not endorse such programs.

Direct Support Professionals and COVID-19 Vaccination: A Comparison of Vaccinated and Unvaccinated Direct Support Professionals.

Direct support professionals (DSPs) may be at increased risk of contracting COVID-19 due to the proximal nature of their work. In response to the pandemic a three-wave study was launched to understand experiences of DSPs. An on-line national survey found that 70% of DSPs were vaccinated. Vaccinated DSPs were older and had higher education levels. Among the unvaccinated, 56% reported concerns about COVID-19 vaccination safety. Unvaccinated DSPs were more likely to report that the people they supported were also unvaccinated. Encouraging DSPs to get vaccinated to protect the people they support is essential. Paid time off, arranging for vaccinations, and setting an expectation for vaccination may encourage vaccination uptake among DSPs.

Direct Support Professionals and COVID-19 Vaccination: A Comparison of Vaccinated Early Adopters and In-Betweeners.

Direct support professionals (DSPs) are at increased risk of contracting COVID-19. A four-wave survey series was conducted, in part, to understand DSPs' COVID-19 vaccination experiences. Fourth wave data were used to compare those vaccinated against COVID-19 when they became eligible (early adopters) and those waiting at least three months before vaccination (in-betweeners). Findings indicated that in-betweeners were more likely to be female, younger, and people of color with lower education levels and annual incomes, with employers requiring COVID-19 vaccination to remain employed. COVID-19 vaccination motivators included protection for self, family, or people supported; an employer who mandated COVID-19 vaccination; and having had COVID-19 or knowing someone who did.

Participation and Companions for Socially Inclusive Community Activities by U.S. Adults With Intellectual and Developmental Disabilities.

We investigated socially inclusive participation in mainstream community groups and religious services by U.S. adults with intellectual and developmental disabilities using weighted secondary analyses of 2018-2019 National Core Indicators data. Overall, 34.4% participated in community groups and 42.4% in religious services. Some 45.0% had an unmet desire for community-group participation, whereas most (75.0%) attended a religious service as often as preferred. The type of companion varied by living arrangements and age group. Attending community groups and religious services were each strongly associated with better friendship outcomes but were not related to loneliness. The large unmet demand for community-group participation reveals a major gap. The friendship outcomes underline the benefits of socially inclusive community participation.

The Direct Support Workforce: An Examination of Direct Support Professionals and Frontline Supervisors During COVID-19.

Direct support professionals (DSPs) and frontline supervisors (FLSs) have critical roles in home and community-based services for people with intellectual and developmental disabilities. Low wages and high levels of responsibility created a long-term crisis in recruitment and retention and are exacerbated by the COVID-19 pandemic. A national sample of DSPs and FLSs were compared on demographics and work-related circumstances using data from the third Direct Support Workforce COVID-19 Survey. Significant differences were found in demographics, hours worked, wages, wage augmentations, and quality of work-life. Policy recommendations to address the worsening workforce crisis are provided.

Examining Choice and Control for People With IDD Over Time.

Choice making is an important aspect of everyone's life in terms of fully becoming an adult within a democratic society. People with intellectual and developmental disabilities (IDD) are at risk for diminished choice making due to various factors, including guardianships; dependence on supports that are not person-centered; and, in some cases, limited capacity to express one's desires effectively. Independent Monitoring for Quality (IM4Q) data for 9,195 and 9,817 for adult services users with IDD were analyzed across two types of choice. Repeated measures mixed regression examined choice over time after controlling for age, support needs, residence type, and community type. We found significant increases in everyday choice making among IDD service users in Pennsylvania, but not in support-related choice. This study is the first to our knowledge to consider change in choice making, an important indicator of rights and inclusion for persons with IDD. By comparing three waves of data from the state of Pennsylvania (2013, 2016, and 2019), we were able to detect changes in choice making over time among home and community-based service (HCBS) users with IDD.

Using the Independent Monitoring for Quality Program to Examine Longitudinal Outcomes for People With Intellectual and Developmental Disabilities.

The purpose of this study is to lay a foundation for illustrating the importance of longitudinal data collection by sharing the results of the Independent Monitoring for Quality (IM4Q) program in Pennsylvania designed to collect data over time on the quality of services for adults with intellectual and developmental disabilities. In this article, we report on the history and characteristics of the IM4Q program, describe the key variables of interest, and highlight the trends in the key variables over 3 years of data collection (2013, 2016, and 2019). The descriptive results indicate mixed trends for the three areas of focus: comparable rates of people employed in community-based settings, less support-related choice, and better everyday choice-making outcomes.

Parent perceptions of neighborhood: relationships with US youth physical activity and weight status.

Context is important for understanding and making change to improve health outcomes. The purpose of this study was to examine the relationship between parent perceptions of neighborhood and youth aerobic physical activity and weight. This study is a secondary data analysis of 64,076 parents and guardians of children and adolescents (6-17 years) participating in the 2007 National Survey of Children's Health. Logistic regression models were used to evaluate the relationship between neighborhood characteristics, including constructs for social capital, physical condition, resource availability, and safety, and youth likelihood of meeting healthy standards for physical activity and weight. Neighborhood characteristics, including social capital, resource availability, and safety were significantly associated with increased likelihood of youth achieving healthy physical activity and normal weight parameters even with adjustment for individual and family-level demographic and behavioral characteristics. Findings support neighborhood assessment during behavioral counseling and continued exploration of neighborhood context as a means to positively impact youth physical activity and weight outcomes.

Incentives, Wages, and Retention Among Direct Support Professionals: National Core Indicators Staff Stability Survey.

Direct support professionals (DSPs) provide a range of supports in a variety of settings to people with intellectual and developmental disabilities (IDD) who count on these supports to live, work, and contribute in their communities. Despite this, high annual DSP turnover rates are problematic. DSP turnover is disruptive to people who receive supports as the lack of stable, reliable supports can negatively impact their important day-to-day outcomes (e.g., safety, community participation, and choice). Turnover also comes at a cost to provider organization in the hiring and training of new employees. To retain DSPs, organizations offer incentives (e.g., bonuses, retirement plans, health insurance). This study utilized National Core Indicators® (NCI®) Staff Stability Survey 2018 data to examine the relationships between wages, different types of incentives, including benefits (e.g., paid time off, access to health insurance, disability insurance, wage bonuses, health incentives programs, etc.) to annual turnover in participating states in the United States. Results indicated that incentives were not positively associated with DSP retention. Staff wages were the most notable factor associated with differences in DSP retention rates, along with the state in which the organization was located as well as organization vacancy rates.

Direct Support Professional and Frontline Supervisor Perspectives on Work-Life in a Pandemic.

Direct support professionals (DSPs) and frontline supervisors (FLSs) play an invaluable role in delivering home and community-based services to people with intellectual and developmental disabilities (IDD). DSPs provide support with employment, community living, developing social connections, health and well-being, and many other areas. FLSs' primary responsibility is to provide direction and guidance to DSPs in their work; however, they also frequently provide direct support to people with IDD. This workforce has been in crisis with high turnover and vacancy which threaten the inclusion of individuals with disabilities in their communities. The COVID-19 pandemic exacerbated an already fraught situation.

Adolescent condom use consistency over time: global versus partner-specific measures.

BACKGROUND: The conundrum of measuring condom use consistency, particularly with adolescents, has left researchers with a cacophony of strategies, thereby limiting comparability and interpretation. OBJECTIVE: The aim of this analysis was to compare and contrast two measures of condom use consistency, global versus partner specific, and their relationships with key covariates, using trajectory groups differentiated by stability of condom use consistency over three time points. METHOD: Using self-report data from sexually active girls (aged 13-17 years) in a clinic-based intervention study aimed at lowering risk for early pregnancy, this analysis compared two measures of self-reported condom use consistency: (a) a global measure: overall condom use consistency in the past 6 months and (b) a partner-specific measure: condom use consistency with the most recent sex partner in the last 6 months. Using a subjective rule-based approach, the adolescent girls in the study (n = 151) were classified into trajectory groups representing their condom use consistency at three time points (baseline and 6 and 12 months). Then, using bivariate methods, trajectory groups were compared on four baseline covariates (age, treatment condition, hormonal use in the last 6 months, and number of sex partners in the last 6 months) and three time-varying covariates measured at baseline and at 6 and 12 months (hormonal use stability, stability of primary sex partner, and stability of number of sex partners). RESULTS: For the trajectory groups formed using the global measure of condom use consistency, stability of the primary sex partner differed significantly between trajectory groups. For the partner-specific trajectory groups, two baseline and one time-varying covariate relationships were significant: hormonal use in the 6 months prior to baseline, number of sex partners in the past 6 months (baseline), and stability of the primary sex partner (time varying), with hormonal use stability (time varying) trending toward significance. DISCUSSION: The larger number of significant covariate relationships with the partner-specific trajectory groups suggests greater utility in assessing partner-linked behavior rather than a global measure. Despite limitations of the analytic strategy, this study sheds light on a measurement conundrum that has been an obstacle to comparing and contrasting indicators of condom use consistency during adolescence.

Examining youth hopelessness as an independent risk correlate for adolescent delinquency and violence.

Prior research has identified a relationship between youth hopelessness and violence perpetration within specific groups of young people. The purpose of this study was to evaluate the relationship between youth hopelessness and violence perpetration in a population-based sample of adolescents. This study is a cross-sectional analysis of data from 136,549 students in the 6th, 9th, and 12th grades responding to the 2007 Minnesota Student Survey. Logistic regression models were used to evaluate the relationship between hopelessness and youth violence perpetration, including comparison analyses for gender and race/ethnic subgroups as well as adjustment for a measure of poor-low affect. One in four youth (25.1%) reported levels of hopelessness at least enough to bother them in the previous month. Moderate-high levels of hopelessness exhibited a statistically significant independent relationship with a range of violence-related outcomes for youth subgroups: delinquent behavior, weapon carrying on school property, and all forms of self-directed violence. Relationships between hopelessness and interpersonal and intimate partner violence suggest a greater contribution by poor affective functioning for some groups. Interventions designed to reduce youth violence perpetration may benefit from increased strategies to address youth hopelessness as well as youth mental health in general.

Predictors of Annual and Early Separations Among Direct Support Professionals: National Core Indicators Staff Stability Survey.

Direct support professionals (DSPs) provide a broad range of supports in a variety of settings to people with intellectual and developmental disabilities (IDD) that enables people to live, work, and participate in their communities. Despite the crucial importance in ensuring supports for community participation of people with IDD, high rates of annual turnover among DSPs in organizations that employ them have been documented for decades. This study utilizes National Core Indicators Staff Stability data from 2016 to examine the impact of organizational- and state-level factors related to DSP turnover, including annual DSP turnover and the percentage of DSPs who left their positions after less than 6 months. At the organizational level, a higher turnover rate in the last 12 months was significantly related to lower DSP wages and to not offering health insurance. At the state level, a higher turnover rate in the last 12 months was significantly related to a lower percentage of people living in individualized settings and lower per capita Medicaid spending. For early turnover at the organizational level, a higher percent of leavers within 6 months of tenure was significantly related to not offering paid time off and health insurance, higher vacancy rates, higher proportion of part-time DSPs, and lower overall staff sizes.

Active Support Training, Staff Assistance, and Engagement of Individuals With Intellectual and Developmental Disabilities in the United States: Randomized Controlled Trial.

Two non-U.S. quasi-experimental studies reported Active Support training was associated with increased engagement in individuals with IDD, but no randomized controlled trials (RCTs) exist. We evaluated effects of Active Support training on staff assistance, and social and nonsocial engagement in 75 individuals with intellectual and developmental disabilities (IDD) in U.S. group homes. We detected no significant effects of active support training. Individuals with more skills and less challenging behavior engaged more in nonsocial activities. Younger individuals with more skills living in homes with fewer staff changes were more socially engaged. Factors associated with nonsocial engagement mirrored those reported in Qian, Tichá, Larson, Stancliffe, & Wuorio, (2015) . Staffing-related implementation challenges and statistical power limited our ability to detect differences.

Psychotropic Medication Use for Adults with Autism Spectrum Disorder who Receive Services and Supports Through Adult Developmental Disability Services in the United States.

Individuals with autism spectrum disorder (ASD) have higher rates of co-occurring diagnoses and use of psychotropic medication prescriptions than people with other developmental disabilities. Few studies have examined these trends in samples of people with intellectual and developmental disabilities (IDD) with and without ASD. Using a random sample of 11,947 adult IDD service users from 25 states, co-occurring diagnoses and psychotropic medication use were compared for those with and without ASD. Regardless of diagnosis, individuals with ASD had higher percentages of psychotropic medication use. Controlling for co-occurring condition, age, gender, and ID level, a diagnosis of ASD predicted number of medications used. Further research is needed to understand why individuals with ASD are prescribed more medication, more often, than similarly functioning groups of individuals without ASD.