Staff attitudes towards people with intellectual disabilities in Japan and the United States.

BACKGROUND: Staff attitudes may affect choices available to persons with intellectual disabilities (ID). This study examined attitudes towards people with ID among staff working with people with ID in Japan and the United States. METHOD: Attitudes of staff working with people with ID in Japan and the United States were compared using the Community Living Attitudes Scale, Intellectual Disabilities Form. Responses were examined via multivariate analysis of variance. RESULTS: In unadjusted analyses, Japanese staff exhibited a greater tendency towards Sheltering and Exclusion of people with ID and lower endorsement of Empowerment and Similarity of people with ID. After controlling for covariates, the country effect was no longer significant for Sheltering and Exclusion. Age and education were significantly associated with attitudes in the adjusted model. CONCLUSIONS: While attitudes in Japan appeared less supportive of community inclusion of people with ID, some of the differences between countries were attributable to other staff characteristics such as age and education. Findings provide new information about how attitudes of staff in each country compare with each other.

Social network variables in alcoholics anonymous: a literature review.

Alcoholics Anonymous (AA) is the most commonly used program for substance abuse recovery and one of the few models to demonstrate positive abstinence outcomes. Although little is known regarding the underlying mechanisms that make this program effective, one frequently cited aspect is social support. In order to gain insight into the processes at work in AA, this paper reviewed 24 papers examining the relationship between AA and social network variables. Various types of social support were included in the review such as structural support, functional support, general support, alcohol-specific support, and recovery helping. Overall, this review found that AA involvement is related to a variety of positive qualitative and quantitative changes in social support networks. Although AA had the greatest impact on friend networks, it had less influence on networks consisting of family members or others. In addition, support from others in AA was found to be of great value to recovery, and individuals with harmful social networks supportive of drinking actually benefited the most from AA involvement. Furthermore, social support variables consistently mediated AA's impact on abstinence, suggesting that social support is a mechanism in the effectiveness of AA in promoting a sober lifestyle. Recommendations are made for future research and clinical practice.

Diagnostic overshadowing reviewed and reconsidered.

Diagnostic overshadowing is a robust bias negatively affecting the accuracy of clinicians' judgments about concomitant mental illness in persons with mental retardation and mental illness. Reviewing 12 studies, we examined moderators of diagnostic overshadowing. Most client and clinician-based demographic variables have had limited usefulness. However, clinicians' cognitive complexity has been found to negatively affect overshadowing. Causal mechanisms of overshadowing remain largely unexplored, and diagnostic overshadowing has yet to be empirically demonstrated outside a single methodological approach. Areas needing further research are discussed and the recommendation made that researchers (a) better specify clinical decisions composing overshadowing, (b) attend to the type of processes by which diagnostic overshadowing occurs, (c) increase appreciation of environmental or situational variables related to overshadowing, and (d) engage in more comprehensive exploration of overshadowing using qualitative and other diverse methodologies.

Understanding dignity in the lives of homeless persons.

The current investigation is a planned, systematic study of dignity as critical to understanding the experience of homelessness and improving services and programs for the homeless. Specifically, we conducted a thematic content analysis of interviews with 24 homeless men and women to identify their perception of specific environmental events that validate and invalidate dignity. In addition, we explored the impact that these events have on homeless persons. Eight types of events were identified that sustain dignity such as being cared for by staff and having resources available to meet basic needs. Eight types of events were found that undermine dignity, such as being yelled at or insulted by staff persons and having staff use rules in an excessive and arbitrary way. Two outcomes followed the sustenance of dignity including increased self-worth and motivation to exit homelessness. Three outcomes followed the undermining of dignity including anger, depression, and feelings of worthlessness. The results suggest that dignity is an important variable to consider in understanding the experience of homelessness. Policies and programs that support validating the dignity of homeless persons are encouraged.

Strengthening parent-community member relations on agency boards: comparative case study.

Relations between parents of children with developmental disabilities and other community members on agency boards can be difficult to negotiate. In this comparative study of the boards of three community agencies, we examined the forces that influence the quality of parent-community member relations. The results suggest that when differences between groups are acknowledged and respected at the same time that similarities are recognized and valued, board operations are more likely to be successful and focused on providing effective services. The case descriptions included here suggest that an organization's ability to manage the tension between intergroup differences and similarities is influenced by (a) organizational history of intergroup relations, (b) group identification, and (c) organizational practices that bridge group differences. Action implications are discussed.

Advocate development in the field of developmental disabilities: a data-based conceptual model.

We proposed a taxonomy of advocate development in the field of developmental disabilities derived from the systematic evaluation of a Partners in Policymaking program. Three developmental stages evolved: beginner, involved, and activist. Self-reports of advocacy actions and outcomes were collected from 3 participants with disabilities and 21 parents before and during training. A follow-up, semi-structured telephone interview was conducted 5 months after training ended. Results indicate significant improvements in the number of actions and outcomes reported by all participants. The activist group had the largest gains in actions and outcomes; they reported twice as many outcomes as did the other participants. The implications of the proposed taxonomy for participants' recruitment in advocacy training programs were discussed.

Awareness, action, and collaboration: how the self-advocacy movement is empowering for persons with developmental disabilities.

In response to stigmatization and lack of opportunities in the United States, a self-advocacy movement by and for persons with developmental disabilities has grown. In parallel, in the empowerment literature in the social sciences, authors have sought to conceptualize the process of becoming empowered. There is little in the empowerment literature that fosters an understanding of the self-advocacy movement. In this paper, four relevant principles of empowerment (which concern gaining awareness of societal discrimination, individual rights, and personal strengths; taking action through participation in community organizations; and working collaboratively with supportive advisors) were considered. Through awareness, action, and collaborative support, self-advocates can transform themselves from marginalized targets of discrimination to respected citizens.

Bridging the two cultures of dual diagnosis: research and service.

Common goals for research and service in dual diagnosis are identified. Three major barriers to the integration of research and service are explored: (a) differences in culture, (b) negative history, and (c) competition for limited resources. Applied research concerning diagnosis, treatment, behavioral recording, and organization and management development can encourage greater cooperation. To promote the integration of the research and service, joint conferences and publications are recommended as well as graduate training programs and agencies that emphasize both research and service. A vigorous policy initiative is needed to obtain private and public support for integrating research and service in dual diagnosis.