The importance of dignity and choice for people assessed as having intellectual disabilities

Individuals assessed as having an intellectual disability often spend a significant amount of time in day treatment/day habilitation programs after they graduate from school. The quality of these programs varies widely and is not federally legislated. The purpose of the current study is both to explore factors that lead to higher satisfaction for participants in these programs and to better understand what participants want in a program. Using a grounded theory approach, researchers interviewed 25 participants, staff, and family members in focus group settings to collect qualitative data. Interviews focused on what worked and what could be improved at a program located in Western New York. Using the constant comparative method, themes emerged from the data that pointed to the importance of dignity and choice in a day program to facilitate empowerment, higher levels of satisfaction and self-confidence.

A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015

Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

Escape-Motivated Bathroom Visits: Effects of Activity Scheduling, Cuing, and Duration-Fading in an Adult With Intellectual Disability

We report the case of a woman who had intellectual disability, made frequent bathroom requests, and spent excessive time in the bathroom at a day-habilitation center. Functional behavioral assessment suggested that frequency and duration of bathroom requests were escape-motivated. Intervention was directed at reducing the reinforcing effects of visiting the bathroom through (a) activity scheduling, (b) cuing the woman to exit the bathroom according to a fixed time limit, and (c) gradually reducing the time limit to an acceptable duration. Compared with a baseline phase, intervention was associated with decreased bathroom requests and duration of bathroom visits that were maintained at 2-month follow-up. We discuss clinical implications of these findings and recommendations to practitioners.

Day Habilitation Services for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services Waivers

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are one of the largest providers of long-term services and supports for people with intellectual and developmental disabilities (IDD). HCBS waivers also play a prominent role in providing day habilitation services for people with IDD. The purpose of this study was to examine how HCBS waivers allocate day habilitation services for people with IDD. HCBS waivers providing day habilitation services for people with IDD were analyzed to determine service utilization and projected expenditures. In fiscal year 2014, HCBS waivers projected US$5.62 billion of funding for day habilitation services; however, there was wide variance across services in terms of projected total spending, spending per participant, and reimbursement rates.