Community services landscape in Canada: survey of developmental disability agencies.

A survey of support services for adults with development disabilities living in community settings in Canada was conducted. Information gathered on services and changes occurring in the community services landscape is discussed. Along with a diminution of government's role in funding and guiding service provision, Canada has witnessed the emergence of private-for-profit services, a relatively recent phenomenon in human services. Differences between the private-for-profit and nonprofit sectors are discussed, including a greater propensity in the nonprofit agencies to engage in advocacy and community education. Overall, evidence indicates that some services are beginning to incorporate individualized approaches to funding and support. Implications for government and for services of emergent patterns of support are noted.

Canadian Independent Living Centres: impact on the community.

There is now widespread interest in developing social policies and practices that are grounded in principles of independent living. The Independent Living (IL) paradigm reflects a shift in thinking away from traditional approaches to supporting persons with disabilities. Independent Living Centres (ILCs), which started in the early 1970s in the United States, and in the 1980s in Canada, are now a major force in the promotion of the IL concept worldwide. The guiding principles of these consumer-driven centres include: promoting an empowerment philosophy that incorporates consumer control/self-direction over decision-making; offering cross-disability support; providing options/choice and flexibility; and encouraging inclusion and full participation. Despite their prevalence, a surprisingly limited body of research exists on the impact of ILCs. A survey was used to investigate the impact of ILCs in Canada on their communities of interest (groups connected to the ILCs). Surveys were sent to formal organizations, informal groups, and family/friends. A final response rate of 52.6% was achieved (111 of 211 surveys returned). Overall, moderate to good levels of familiarity, involvement, and impact were found. The results affirmed the importance of independent living centres to individual empowerment, community change, and the IL movement.

Independent living centres: an innovation with mental health implications?

The findings of a national study of Independent Living Centres (ILCs) in Canada suggest that the ILCs are a potentially powerful innovation for the consumer/survivor movement. Independent Living Centres are non-profit, cross-disability, consumer-driven, community-based centres which promote both individual empowerment and community change. The IL and mental health reform paradigms share in the development of empowerment theory, acknowledge the importance of consumer driven organizations, and utilize a socio-political analysis of disability which goes beyond the person and recognizes the environment as problematic. Accordingly, the reform paradigm seeks innovative services which are separate from the traditional mental health system. Before this can fully become a reality, mental health professionals need to increase their knowledge of the IL philosophy and ILC practice. Similarly, ILCs need to increase their knowledge of consumer/survivor empowerment and recovery and carefully assess any barriers that exist in terms of consumers/survivors accessing the ILCs. Collaboration between the IL movement and mental health will increase the likelihood of ILCs becoming a stronger resource for consumers/survivors.

Clinical experience with Goal Attainment Scaling in geriatric care.

OBJECTIVES: This article presents a qualitative evaluation of the utility of Goal Attainment Scaling (GAS) in geriatric care. GAS is an individualized outcome measure particularly suited for clients with multiple complex problems, such as are commonly served by geriatric programs. METHODS: Semistructured interviews were completed with 24 clinicians in four hospital or community-based geriatric services where GAS has been used. An inductive analysis was used to identify themes. RESULTS: GAS was described as resulting in shorter lengths of stay, more focused care, and improved team functioning. GAS was perceived as having greater use for functional (versus medical) goals, when clinicians had more direct control over treatments, when patients were involved in goal-setting, and when goals were set by an interdisciplinary team. DISCUSSION: GAS has affected both care practices and patient outcomes. This study illustrates the clinical impacts an outcome measure can have, as well as the use of qualitative methods for this type of research.

Life in the community: four years after the closure of an institution.

Life experiences of 18 people 4 years after deinstitutionalization were examined. The ecological approach included observation in people's homes, interviews with the 18 individuals and people in their social networks, and a survey of other service providers. Because this research was a follow-up to an earlier study of the process of closing an institution, the findings are particularly significant for future institution closures and individual planning practices. Three major implications were noted: (a) the need to treat deinstitutionalization as a process; (b) the need to pursue alternatives to the 4- or 5-bed group home, which currently dominates community residential services; and (c) the need for community-based support services to develop new, more effective approaches to community integration.

Normalization and integration: a look at the Swedish experience.

Quality service provision is seen as an integral and essential element of the normalization effort in Sweden. Results of the present study suggest that Sweden's well-developed system of comprehensive services and support for individuals with mental retardation ensures a level of security and material well-being that allows these people to live and function within society-at-large. Considered in relation to Nirje's (1980) elaboration of integration as it pertains to normalizing the life conditions of persons with mental retardation, functional and physical integration are clearly evident in many community settings. At the same time, other indicators of integration, such as social relations and association with people without mental retardation, suggest that social integration continues to challenge the community living endeavors in Sweden in much the same way as it does in North America.