Recent mortality patterns in California.

Mortality among people with developmental disabilities was reviewed using recent data obtained from the California Department of Developmental Services. The time interval for this report was 1991-1995. We defined two study cohorts: one beginning in January 1991 and a second in April 1993. The latter period represented the years of implementation of the Coffelt settlement. Our primary interest was in the Coffelt period cohort. Statistically significant association with increased rates of mortality was found for community residence. A trend of declining mortality was noted for the community facilities from 1991-1995, but not for the developmental centers.

Evaluation of the journals of the American Association on Mental Retardation.

Perceptions of members of the American Association on Mental Retardation (AAMR) regarding the extent to which the organization's journals, the American Journal on Mental Retardation (AJMR) and Mental Retardation (MR) assist its members in adding to their knowledge and in carrying out their professional responsibilities were obtained. The 3-page survey was mailed with AAMR membership dues renewal notices for 1988. Surveys were returned by 1,619 members, 24.8% of the paid membership as of May 1988. Survey data were analyzed on the basis of division membership and occupational category for both journals.

Comparative survey of drug use in a community service system.

Drug use patterns in Colorado's community services system were surveyed. A psychotropic drug use rate of 18.6% in a reporting population of 1,282 persons compares favorably to rate reported elsewhere in the literature as well as to rates concurrently used in the state's institutional settings. Substantial experience with psychotropic and anti-convulsant medications across all residential settings were observed. Drug combinations and psychiatric diagnoses were also reported for the population surveyed.

Mortality in a large southeastern facility for persons with mental retardation.

Mortality rates for institutionalized persons with mental retardation were presented. Rates were provided for two time intervals, 1974 through 1979 and 1980 through 1985, and by age, race, and gender. Consistent differences between black and white residents or by gender were not indicated. However, significant improvement in mortality did occur between the two time periods. Persons with profound retardation were found to have higher mortality than those whose retardation was mild to severe. Respiratory disease was the most prevalent cause of death among the individuals with profound mental retardation, whereas heart disease and cancer were the most common causes of death among persons with mild, moderate, or severe retardation. Aging of the population was noted over the period of the study, indicative of the increasing frailty of the institutionalized population.

Staff turnover as a function of performance in a public residential facility.

The relationship between employee turnover and performance was measured for 144 leavers and 144 stayers across 32 positions in a large institution for mentally retarded people. Performance ratings for employees leaving the organization were significantly lower than for those who stayed. These performance differences occurred most significantly with involuntary dismissals and among direct-care technicians who comprise a major part of the institution's work force. The overall results suggest that the organization is not ejecting its best workers and that a substantial portion of the turnover is functional.

Foundation care: a treatment model for nonambulatory profoundly mentally retarded persons.

Two treatment models, Intermediate Care Facilities for the Mentally Retarded (ICF/MR) and Foundation Care, were compared with respect to their use in the institutional treatment of nonambulatory profoundly mentally retarded persons. Foundation Care is focused on physical and social environmental components of caregiving through emphases on health, nourishment, nurturance, stimulation, and play, with the goal of habilitation. Subjects were randomly assigned to the treatment models. We hypothesized that when compared to ICF/MR, the Foundation Care unit would use more resident-oriented management practices, have different caregiver resident interaction, and have residents who would exhibit more behavioral complexity. Baseline, 6-month, and 1-year measurements were made. Results supported the first and third hypotheses. Caregiver resident interaction was similar for both groups; however, Foundation Care staff used more tactile modalities and contingent interaction. We conclude that Foundation Care may be an appropriate alternative level of care for the nonambulatory profoundly retarded person.

Cross-organizational job satisfactions of technician-level staff members.

Job satisfactions of technicians were assessed in three medium to large public residential facilities using the Job Descriptive Index. Technicians in a fourth, much smaller facility provided separate reliability and validity data on the Job Descriptive Index. In general, the job satisfactions of technicians as measured by this scale were lower than those of workers in industrial settings, particularly with respect to pay. Correlational analyses revealed no significant relationship between client characteristics and satisfaction scores. Staffing patterns did, however, affect technician satisfactions in several areas.

Technician losses in public residential facilities.

A cross-organizational longitudinal survey was undertaken of state-operated residential facilities to gauge the extent to which technician-level work forces are affected by turnover and absenteeism. Twelve facilities participated in this study for a period of 9 months. Monthly turnover rates ranged from .6 to 4.9 percent, with a average of 2.4 percent. Turnover rates appeared to be influenced by the size, location, and staffing patterns of the individual institution. With respect to absenteeism, the average "lost time rate" was 6.7 percent. Various standards suggest that absenteeism exceeding 4.5 percent disrupts recommended staffing ratios. One may conclude that employee withdrawal, whether in the form of avoidable turnover or unscheduled absenteeism, represents a serious managerial problem for many institutions.

Technician turnover and absenteeism in public residential facilities.

Residential institutions have historically had problems attracting and retaining reliable unskilled personnel to fill technician-level positions. Even though there is little empirical evidence to support a relationship between staff stability and resident habilitation, there assuredly are such effects. A first step toward assessing these effects, and toward controlling costly technician withdrawal behavior (specifically, turnover and absenteeism), is the use of a common set of measures. The precipitants of employee withdrawal may be categorized into three areas that are subject to empirical investigation and intervention: extra-institutional factors, intra-institutional management, and factors surrounding the individual worker. Predictive research, for selection purposes, has not yielded much information that would be of use to administrators. Traditional and more recent explanations were reviewed and some direction suggested for further research.