Personal characteristics and competence of people with mental retardation living in foster homes and small group homes.

In this 1986-1987 study, the demographic and diagnostic characteristics, problem behaviors, self-care skills, community living skills, domestic expectations, and program goals for personal competence of 336 persons with mental retardation living in a national sample of 181 foster care and small group care settings with 6 or fewer residents was assessed. The findings indicated relatively more severe cognitive impairment among persons in small ICFs-MR, less severe cognitive impairment and fewer functional limitations among non-ICF-MR group home residents, and more functional limitations among residents in foster homes. Neighborhood integration was relatively high for foster home residents, but there were fewer expectations for their development of home and community living skills. Implications for future research and program development in small, community-based residential settings were discussed.

Placement practices in specialized foster homes and small group homes for persons with mental retardation.

Resident functional and personal characteristics (e.g., gender, race, age, and level of mental retardation), placement histories, and projected placements of a nationally representative sample of 336 persons with mental retardation living in a total of 181 small, specialized foster care homes and group homes with 6 or fewer residents were compared. In addition, the extent to which resident characteristics differentiate between persons placed in specialized foster care homes or small group homes was assessed. Results indicate that there are some differences in resident characteristics across facility type, including communication and toileting skills, age, and mobility. Overall, results showed that small foster and group homes successfully serve a variety of people and that placement generally lasts for several years.

Social integration of older persons with mental retardation in residential facilities.

The findings from a study of the social integration of a national sample of 370 older persons with mental retardation were reviewed. Individuals were selected from a national sample of all facilities owned, operated, or licensed by developmental disabilities agencies having one or more persons 63 years of age or older with mental retardation (N = 235). Facilities included foster care, small group homes (3 to 15 residents), large private facilities, and large state-operated facilities. Information was obtained on resident activities and relations considered to be indicators of social integration through extensive questionnaires completed by primary caregivers. Comparisons of the differences in community integration among residents living in different types of residential facilities were presented. The relative contribution of individual and facility characteristics to the social integration of older persons with mental retardation was explored with hierarchical multiple regression analysis.

Programs and services received by older persons with mental retardation.

Findings from a study of the programs and services received by a national sample of older persons with mental retardation were reviewed. Individuals were selected from a national sample of all facilities owned, operated, or licensed by developmental disabilities agencies having one or more persons 63 years of age or older with mental retardation. Facilities included foster care, small group homes, large private facilities, and state-operated facilities. One or two residents per facility were studied. A total of 370 individuals in 235 facilities were surveyed (10% of all eligible facilities). Comprehensive information on resident characteristics, day program participation, and services received was gathered through extensive questionnaire and telephone interviews of primary careproviders and directors of the day programs attended by individuals in the resident sample. Differences in programs and services received were presented by facility type.

Persons with mental retardation in nursing homes in 1977 and 1985.

Findings from the 1977 and 1985 National Nursing Home Surveys with respect to residents with mental retardation were compared. The single most notable finding was that very little changed over the 8-year period. The size of the mentally retarded population changed little (remaining at an estimated 40,500), the characteristics of the population remained essentially the same, and the services received by residents with mental retardation in 1985 remained at essentially the same low levels as those found in 1977. Implications of the findings as they relate to the initiative begun with the passage of P.L. 100-203 in 1987 and the forthcoming regulations to guide its implementation were discussed.

Factor structure of maladaptive behavior across the lifespan of persons with mental retardation.

Data obtained on a sample of persons with mild to profound degrees of mental retardation (N = 8255) and ranging from birth to 98 years of age were factor analyzed to provide information on the structure of maladaptive behavior relative to age and degree of mental retardation. Using the Problem Behavior scales of the Inventory for Client and Agency Planning, two principal factors emerged for children with mild to profound degrees of retardation: Internalized Maladaptive and Externalized Maladaptive. For adolescents and young adults, a three-factor solution which varied by degree of retardation was most appropriate. For middle and older adults, three- and four-factor solutions were identified across all ages and degrees of retardation. Across all samples as many as six different types of dimensions were identified, indicating that the structure of maladaptive behavior may well be influenced by age and level of mental retardation.

Longitudinal change and interstate variability in the size of residential facilities for persons with mental retardation.

Changes in the size and type of operation of residential facilities for persons with mental retardation in the United States over the past 2 decades were discussed and current (June 30, 1988) interstate variability in residential services along these same dimensions examined. Considerable progress was noted nationally in securing relatively small, community-based residential opportunities for persons with mental retardation. However, this progress has not been uniformly realized in all states or for all types of facilities. Standards for federal policy that would make the official national commitment to community-based services more consistent among all the states were considered.

Longitudinal patterns in ICF-MR utilization, 1977-1986.

The development of the ICF-MR program and the issue to which the ICF-MR program was intended to respond was briefly reviewed. National and state-by state statistics on changing patterns and interstate variations in use of ICF-MR services as of June 30, 1977, June 30, 1982, and June 30, 1986 were presented and ICF-MR problems and issues were discussed within the context of the evolving system of long-term care.

Permanency planning for children and youth: out-of-home placement decisions.

This article advocates the extension of "permanency planning" in out-of-home placements to include those children and youth with developmental disabilities. It discusses permanency planning and notes its promise in improving the opportunities of all children and youth to grow up in a stable family environment. There is a need for major initiatives in this area: 78% of children and youth with developmental disabilities who are placed in long-term care have no such protections. Though some states currently operate programs according to the principles of permanency planning, significant changes in existing federal policy are recommended to require permanency planning in federally supported out-of-home care for all children, including those with severe disabilities.

Movement of developmentally disabled individuals among out-of-home residential facilities.

This paper reported on the movement of a large (N = 2271) probability sample of the nation's residents of public (PRF) and community (CRF) residential facilities for developmentally disabled children and adults. Estimates placed the national population at 217,410 in all facilities--73,709 in CRFs and 143,701 in PRFs--in the fall of 1978, when the sample was selected, although extrapolation from subsequent surveys suggest that the CRF numbers should be about 100,000. In the winter of 1979 direct care staff and administrators completed detailed information about each resident sampled, about themselves, and about their facilities. In 1980 they were asked if their residents had moved exactly one year later. Most residents (91%) had not moved; 1.3% had died; and about 8.5% had moved. Most moves featured greater integration into the community. Multivariate analyses indicated very little difference between moved and unmoved residents. Among moved subjects, three dimensions accounted for 62% of the common variance in placement status: (a) ability, (b) age, and (c) autonomy.

A national study of prescribed drugs in institutions and community residential facilities for mentally retarded people.

PIP: The prevalence of psychotropic and nonpsychotropic drug prescriptions in institutions and community residential facilities in 1978-79 was assessed. The data were gathered as an incidental part of a comprehensive national interview study of the characteristics of residential facilities and their residents. The study included 2271 retarded individuals in 236 residential facilities in the US. Facilities were selected through a 2-stage probability sample design in such a way that the probability of a facility's selection was proportionate to its size (number of residents) and so that the distribution of sample facilities across census regions and size classes was in close agreement with the distribution of facilities nationally. Interviews at 75 institutions and 161 private facilities were conducted between September 1978 and April 1979. Demographic information about individual residents, including date of birth, date of admission, previous type of residential placement, age, height, weight, diagnosed degree of retardation, and diagnosis of epilepsy, autism, or mental illness, was obtained from each resident's records. The staff person most familiar with each resident was then identified and interviewed about the resident. Care persons were asked whether and for what purpose drugs were prescribed for each resident. 75.8% of institutionalized residents and 54.3% of community facility residents were reported to be receiving at least 1 type of regularly prescribed medication. Percentages reported for specific drugs should be considered minimums, because drug names were not always elicited if the drug's purpose was known. Drugs not named, but reported to be prescribed for a chronic health condition, epilepsy, a psychiatric problem, for sleeping, or for birth control, were listed with "other" within tentative categories. Multiple regression was used to examine the relationships among drug use and several resident and facility characteristics. The institutionalized and community-based samples were combined for these analyses. Drugs reported to be prescribed for chronic health problems most frequently were used by older, nonambulatory residents who had health problems. Use of antiepilepsy drugs was most closely associated with a history of seizures. Only 1.3% of community facility residents and 1.6% of institutionalized residents whose records did not document epilepsy were reported to be receiving antiepilepsy drugs. Psychotropic drugs most often were prescribed for residents with behavior problems or for those with a recorded mention of mental illness or autism. Older, heavier, and more severely retarded residents also were more likely to receive psychotropic drugs. Contraceptive drugs were predicted by age, sex, ability, and minority status. Younger and less retarded women were more likely to receive birth control methods, as were minorities.^ieng

National census of residential facilities: a 1982 profile of facilities and residents.

A national census of all state-licensed residential facilities for mentally retarded persons was conducted in 1982. This census enumerated 243,669 mentally retarded residents living in 15,633 facilities on June 30, 1982. Information on characteristics of facilities (e.g., type, location, size, type of operator, reimbursement rates) is presented along with demographic/functional characteristics of residents (e.g., age, level of retardation, previous and subsequent placement). The census verified the existence of an extensive variety of residential living alternatives available to mentally retarded people.

Maladaptive behavior of mentally retarded individuals in residential facilities.

Results of a national interview study of 2,271 mentally retarded residents in 236 public and community residential facilities were reported. Maladaptive behavior was more prevalent among residents of public residential facilities, particularly among new admissions and readmissions, but the frequency at which residents performed various types of maladaptive behavior and the responses elicited from direct-care staff members were similar in public and community facilities. Implications for the deinstitutionalization process were discussed.