Use and alternatives to coercive measures in inpatient residential care facilities for adults with disabilities: study protocol of a mixed-methods study

BackgroundIn Germany, the use of coercive measures such as physical or chemical restraints in certain settings has been the focus of high court decisions, political debates, and scientific research in areas like psychiatric care. Such encroachments on fundamental rights could easily be overlooked in the case of residents in inpatient residential care facilities for adults with disabilities. However, little data are available on this issue. This study aims to investigate the types, frequencies, and characteristics of the use of coercive measures as well as the reasons and justifications of their use. Possible alternatives to these measures and contextual conditions will also be identified.MethodsThe study is based on an explorative, multi-phase, cross-sectional design, which consists of a mixed-methods approach including several forms of data collection and analysis bringing together forensic, sociological, pedagogical and medical perspectives and expertise. First, the entirety of the approximately n = 880 residential care facilities for adults with disabilities in the study area will be surveyed by an online questionnaire. Participating passive observations will be carried out in n = 5 selected residential care facilities (24 hours per facility), with an approximate total of n = 150 residents. In these facilities, organizational documents such as house rules and residential documents such as medication plans will also be collected and analysed. Focus groups will be conducted in each of the five facilities including residents, staff, and legal guardians of the residents.DiscussionThis study will address important gaps in the current research by providing different forms of empirical data on the use or avoidance, causes, contexts, and alternatives to coercive measures in inpatient residential care facilities for adults with disabilities. This study is the first in Germany to combine a general overview (survey) and detailed insight (observations, document analysis, focus groups) approach to this issue. These findings will provide a basis for further research in the field as well as for the management of coercive measures in practical settings.

Inclusão escolar de jovens e adultos com deficiência: vivências e possibilidades na escola pública

Este estudo emerge das leituras e discussões envolvendo a inclusão educacional de jovens e adultos com deficiência na escola regular do estado Ceará e se configura como uma ferramenta para a reflexão sobre os papéis desempenhados por gestores, professores e alunos no processo de inclusão desses alunos, bem como sobre a responsabilidade da escola na promoção de uma educação de qualidade para todos. Este estudo, cujo objetivo é analisar a situação de desenvolvimento do processo de inclusão de jovens e adultos com deficiência na escola pública brasileira, especificamente no contexto do estado do Ceará, a partir do exame de como as ações de apoio a esses alunos têm sido geridas por gestores e professores, com vistas à aprendizagem significativa e ao bem-estar do aluno, assim como das perspectivas dos alunos sobre o processo de inclusão na escola regular noturna, está vinculado ao projeto de doutorado desenvolvido na Universidade de Coimbra, que aborda a inclusão escolar de alunos com deficiência na modalidade Educação de Jovens e Adultos (EJA). Os resultados evidenciam que as mudanças não conseguem incluir todas as pessoas, em todas as suas necessidades e continuam privilegiando alguns, enquanto excluem sistematicamente muitos outros, exigindo um redesenho do contexto educacional brasileiro, que privilegie as experiências e saberes dos alunos e intensifique as relações com as comunidades onde o processo educativo se consolida.Palavras-chave: Escola regular noturna; Educação de Jovens e Adultos; Inclusão de alunos com deficiência.School inclusion of youth and adults with disabilities: experiences and possibilities in public schoolABSTRACTThis study emerges from readings and discussions involving the educational inclusion of young people and adults with disabilities in regular schools in the state of Ceará and is configured as a tool for reflection on the roles played by managers, teachers and students in the process of inclusion of these students, as well as on the school's responsibility in promoting quality education for all. This study, whose objective is to analyze the situation of development of the process of inclusion of young people and adults with disabilities in Brazilian public schools, specifically in the context of the state of Ceará, from an examination of how actions to support these students have been managed by managers and teachers, with a view to meaningful learning and student well-being, as well as the students' perspectives on the inclusion process in the regular night school, is linked to the doctoral project developed at the University of Coimbra, which addresses the inclusion of students with disabilities in the Education of Young People and Adults (EJA) modality. The results show that the changes cannot include all people, in all their needs and continue to privilege some, while systematically excluding many others, requiring a redesign of the Brazilian educational context, which privileges students' experiences and knowledge and intensify relations with the communities where the educational process is consolidated.Keywords: Regular night school; Education for Youths and Adults; Inclusion of students with disabilities.Inclusión escolar de jóvenes y adultos con discapacidad: experiencias y possibilidades em la escuela públicaRESUMENEste estudio surge de lecturas y discusiones que involucran la inclusión educativa de jóvenes y adultos con discapacidad en las escuelas regulares del estado de Ceará y se configura como una herramienta de reflexión sobre los roles que desempeñan los directivos, docentes y estudiantes en el proceso de inclusión de estos, así como sobre la responsabilidad de la escuela de promover una educación de calidad para todos. Este estudio, cuyo objetivo analizar la situación de desarrollo del proceso de inclusión de jóvenes y adultos con discapacidad en las escuelas públicas brasileñas, específicamente en el contexto del estado de Ceará, a partir de un examen de cómo se han gestionado las acciones de apoyo a estos estudiantes, por administradores y profesores, con miras a un aprendizaje significativo y el bienestar de los estudiantes, así como las perspectivas de los estudiantes sobre el proceso de inclusión en la escuela nocturna regular, está vinculado al proyecto de doctorado desarrollado en la Universidad de Coimbra, que aborda la inclusión de estudiantes con discapacidad en la modalid Educación de Jóvenes y Adultos (EJA). Los resultados muestran que los cambios no pueden incluir a todas las personas, en todas sus necesidades y seguir privilegiando a algunas, mientras que excluyen sistemáticamente a muchas otras, requiriendo un rediseño del contexto educativo brasileño, que privilegie las experiencias y conocimientos de los estudiantes e intensifique las relaciones con las comunidades donde se consolida el proceso educativo. Palabras clave: Escuela nocturna regular; Educación para Jóvenes y Adultos; Inclusión de estudiantes con discapacidad.

LGBTQ+ Ally Education for Adults with Disabilities

The authors - a faculty member from the humanities, a chief diversity officer and a student leader - offer a "lessons-learned" essay in which they describe providing an LGBTQ+ ally education workshop to a group of adults with developmental disabilities. We describe the the obstacles and the payoffs of collaboration across academic units and roles and a commitment not merely to adapt curriculum with accessiblity in mind but to radically reimagine it, and, in the process, more fully coming to embrace the idea of universal design.

Trends in Informal and Formal Long-Term Care Use Among Older Adults With Disabilities in Japan

Whether increased formal long-term care (LTC) reduces informal LTC use by serving as a substitute or has a complementary role that boosts both informal and formal LTC use has been an important issue for evaluating LTC policy effectiveness. We described trends in in-home LTC use among older adults and LTC availability in relation to changes in LTC policy in Japan. In addition, we examined whether these trends differ by living arrangements, gender, income, and disability levels. We used five waves of repeated cross-sectional data starting in 1999 to 2017. The use of both informal and formal LTC types combined increased until 2006 and then gradually decreased while remaining higher than in 1999. Although implementing the LTC program may have temporarily contributed to the complementary use of both LTC types, eligibility limitations brought about by LTC reform potentially reduced the effects of formal LTC’s complementary role.

CAPABLE Program Improves Disability in Research and Implementation Settings

Interventions to reduce disability are crucial for older adults with disabilities to avert unnecessary hospitalizations or nursing home placements and improve daily life. Developed and tested at one research site, multiple health systems and community based organizations have since implemented CAPABLE. All published or peer reviewed tests of CAPABLE were reviewed (six studies, 11 sites) with a total of 1087 low-income community-dwelling older adults with disabilities. Participants were an average age of 74-79, cognitively intact, and self-reported difficulty with one or more activities of daily living (ADL). These trials were reviewed by extracting the participants’ scores on main outcomes, ADLs and IADLs, and when available, fall efficacy, depression, pain and cost savings. All studies yielded improvements in ADL and IADL limitations, with small to strong effect sizes. Studies with the complete dose of CAPABLE showed more improvement in ADLs and cost savings than the studies that implemented a decreased dose.

Utilization and Expenditures of High-Need, High-Cost Older Adults With Disabilities

The factors that lead people to have high needs for care can vary greatly, with implications for the best approaches to serving their needs. One high need group of interest is older adults with disabilities and multiple comorbidities. There is variation in need within this group. Of particular interest is the subset that is both high need and high cost (HNHC). We present work describing Medicare and Medicaid utilization and expenditures for this high need group and the HNHC subset. Over 7.6 million people were identified as high need; 13.6% of them also were defined as HNHC. Patterns of utilization differed between these groups, with the HNHC group more likely to use inpatient care and nursing home care, but less likely to use community-based long-term services and supports. These findings have implications for the development of care models that might best meet the needs of this population.

Examining the Risk of Potentially Preventable Hospitalization in Adults With Congenital and Acquired Disabilities

Introduction Adults with congenital (cerebral palsy/spina bifida (CP/SB)) or acquired disabilities (spinal cord injury (SCI) or multiple sclerosis (MS)) are more likely than those without disability to develop medical complications. Little is known about potentially preventable hospitalizations (PPH) among adults with disabilities. PPHs are preventable if a patient had timely access to care. Our objective was to estimate PPH risk for each of the aforementioned disabilities. Methods We used private payer claims data from 2007-2017 to identify adults (18+) with diagnoses of CP/SB (n=10,617), SCI (n=5,173), and MS (n=6,198). Adults without these disabilities were included as controls. We propensity score matched individuals for age and sex. Logistic regression models with repeated measures were subsequently applied, adjusting for age, sex, race/ethnicity, health indicators, U.S. census divisions, and socioeconomic variables. Odd ratios (OR) were compared over 4-years of follow up. Results Adults with CP/SB, SCI, and MS had higher odds of any PPH compared with adults without disability [CP/SB: (OR=4.10; 95% CI: 2.31-7.31); SCI: (OR=1.67; 95% CI: 1.21-2.32); and MS: (OR=1.48; 95% CI: 1.00-2.25)]. Use of preventative services reduced the PPH risk. For example, wellness visit reduced the odds of PPH by almost half [CP/SB: (OR=0.52; 95% CI: 0.41-0.67); SCI: (OR=0.57; 95% CI: 0.45-0.71); and MS: (OR=0.53; 95% CI: 0.40-0.66)]. Conclusions Adults with disabilities are at greater odds of PPH compared to adults without disabilities. Clinical guidelines for use of preventative care for adults living with disabilities need to be accordingly updated.