Coleman-Turner Chair and Professor of Psychiatry University of Colorado Anschutz Medical Campus-Senior Associate Vice President, University of Colorado System
Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), g... more Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), group home (N = 39), or with one or more family members (N = 106) were evaluated on body composition, blood lipids, and health behaviors. Subjects in the institutional group had lower body weights than those in the group home and natural family settings ( p < .001) and also had lower BMIs and percent body fat levels compared to those in the natural family ( p < .001). The institutional group also had lower total cholesterol and LDL-C levels than the group home and natural family groups (p < .001) and lower TG and ratio of total cholesterol to HDL-C than the natural family group (p < .01). Although overall use was quite limited, residents in the group home setting smoked more cigarettes, drank more alcohol and coffee, and exercised less than those in the institution and natural family ( p < .001). Group home residents also exercised less. Health promotion and disease prevention initiatives for persons with mental retardation living in group homes, in supported living placements, and with their natural families should be undertaken and carefully evaluated
Table 2 State Utilization of the Home and Community-Based Services (HCBS) Waiver Program: FY 1998... more Table 2 State Utilization of the Home and Community-Based Services (HCBS) Waiver Program: FY 1998 HCBS/SSI as % of total Total HCBS community community Waiver Rank/State spending spending participants 1 Utah 2 Vermont 3 Alabama 4 New Hampshire 5 South Dakota 6 Nebraska 7 Colorado 8 Wyoming 9 Arizona 10 Rhode Island 11 New Mexico 12 Kansas 13 Oregon 14 Delaware 15 Oklahoma 17 Florida 18 Kentucky 19 Wisconsin 20 North Dakota 20 Missouri 21 Alaska 22 Maryland 23 Tennessee 24 Hawaii 25 West Virginia 26 Georgia ...
Current trends in mental retardation services in the Commonwealth of Massachusetts were investiga... more Current trends in mental retardation services in the Commonwealth of Massachusetts were investigated using the New England region, the state of Michigan, and the United States as comparative frames of reference. Our goal was to analyze recent structural, financial, and programmatic trends in Massachusetts and the New England region to close state institutions and implement community and family support services. Massachusetts in particular illustrates the policy choices and challenges facing many American states engaged in restructuring their service delivery systems. New England is an extremely dynamic and innovative region that is providing significant national leadership in the provision of alternatives to institutional care.
Trends in family support spending and new programmatic initiatives across the country during the ... more Trends in family support spending and new programmatic initiatives across the country during the 1990s are summarized. Nationally, total spending for family support exceeded $1 billion in 2000. Between 1990 and 2000, spending for such services in the United States grew from 1.5% to 4% of total resources expended by state MR/DD agencies. However, we found considerable state variability in level of resources allocated to support families providing care to a member with developmental disabilities. Programmatic initiatives include trends toward family-directed services, targeted programs for special populations, such as ethnic minorities and aging caregivers, and the slow expansion of cash subsidies. Recommendations for the future course of policy in this area are provided.
Essential public policy features of the national movement to return institutionalized mentally re... more Essential public policy features of the national movement to return institutionalized mentally retarded people to community settings include issues related to institutional census trends, class action litigation, cost &quot;savings,&quot; and funding. The deinstitutionalization of retarded people is following a different course from that of the mentally ill; it started later and is occurring more gradually. Right-to-habilitation lawsuits in Alabama and Pennsylvania illustrate the class action suit; gains from litigation in the 1970s have been mixed, however. Comprehensive community care is not necessarily any cheaper than comparable institutional care. Trends in state construction expenditures, the Reagan Administration&#39;s proposal for block grants, and impending human services budget cuts are current funding issues. So that advocates of the disabled can more closely monitor future developments in state and federal policy, three continuing annual studies are proposed: a comparison of states&#39; funding of programs for retarded people; and evaluation of nationwide data obtained in accreditation surveys; and a historical and contemporary description of the operations of each of the 50 state service systems.
The monograph summarizes national, reoional, and state expenditure data for mental retardation (M... more The monograph summarizes national, reoional, and state expenditure data for mental retardation (MR) /developmental disabilities (DD) services from fiscal year 1977-84. Data were compiled through responses of mR/ro state agency officials to data extracted frOm state excecutive bt et documents. The project was designed to (1) develop a mothodoLgy for accomplishing annual or biennial updates of MR/DD spending trends in the states and throughout the, nation and (2) to determine comparative funding levels and patterns for community and institutional services in the 50 states. The report displays digitally plotted graphics in four topic areas: expenditure data'aggregated across the 50 states for the 8-year period; the ratio of institutional expenditures (including state and federal funds for state-operated facilities and centers, and state schools) per dollar of community expenditures for each state; nationwide fiscal trends and service statistics in income maintenance and special education programs (including Sodal Security Disability Insurance and Public Law 94-142); and state-by-state comparative data on institutional and community services expenditures. (CL)
This analysis of survey activities of the Accreditation Council for Services for Mentally Retarde... more This analysis of survey activities of the Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons (ACMRDD) is designed to provide program administrators and state agency officials with comprehensive descriptive information on 296 surveys conducted by the council from 1980 through 1984. Part I of this report summarizes the ACMRDD survey process, the method of the study, and the agency classification system used by the-project. Part II presents study results in five sections: (1) analysis by type of agency (large or small, public or private, residential or nonresidential); (2) agency and client characteristics in the most recently surveyed agencies; (3) analysis of this data by type of agency; (4) the impact of previous surveys on the agencies' success with accreditation; and (5) identification of critical accreditation standards. 1The third part of the report presents a summary, suggests additional research, and offers recommendations to the ACMRDD and to agencies seekiag accreditation. Among recommendations for the use of the survey are improving and consolidating formats for data collection and modifying the survey application form to facilitate completion by the applicant agency and to consistently solicit relevant data. It is also recommended that those agencies comtemplating the survey should conduct a simulation of the actual survey experience. Twenty tables and 13 charts supplement the text, and eight appendices, makingrip nearly half the document, include survey and data collection formats, statistical summary of agency and client characteristics, enumeration and ranking of critical standards, and enumeration of standards with which all agencies were assumed to be in compliance. (C3) PUBLIC POLICY MONOGRAPH SERIES NUMBER 20 ACMRDD ACCREDITATION: ANALYSIS OF NATIONWIDE SURVEY RESULTS,
To identify trends in institutional reform and 'deinstitutionalization of the developmentally dis... more To identify trends in institutional reform and 'deinstitutionalization of the developmentally disabled, 34 administrative documents emanating from a federally funded planning grant program were examined. Documents were gathered in response to a survey letter to state Developmental Disabilities Councils, and fact sheets summarizing the documents were prepared. A comparison technique evaluated the presence of legislative, organizational, budgetary and client centered trends. Data produced such recommendations as the need in Alaska and Minnesota for public information about available community services, and in Michigan and Vermont for community mental health centers to assume responsibility for providing community based services. Also identified were critical deficiencies impeding deinstitutionalization (including lack of alternative residential services) and institutional reform (such as insufficient public funding). (Included in three appendixes are state document fact sheets.) (CL)
Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), g... more Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), group home (N = 39), or with one or more family members (N = 106) were evaluated on body composition, blood lipids, and health behaviors. Subjects in the institutional group had lower body weights than those in the group home and natural family settings ( p < .001) and also had lower BMIs and percent body fat levels compared to those in the natural family ( p < .001). The institutional group also had lower total cholesterol and LDL-C levels than the group home and natural family groups (p < .001) and lower TG and ratio of total cholesterol to HDL-C than the natural family group (p < .01). Although overall use was quite limited, residents in the group home setting smoked more cigarettes, drank more alcohol and coffee, and exercised less than those in the institution and natural family ( p < .001). Group home residents also exercised less. Health promotion and disease prevention initiatives for persons with mental retardation living in group homes, in supported living placements, and with their natural families should be undertaken and carefully evaluated
Table 2 State Utilization of the Home and Community-Based Services (HCBS) Waiver Program: FY 1998... more Table 2 State Utilization of the Home and Community-Based Services (HCBS) Waiver Program: FY 1998 HCBS/SSI as % of total Total HCBS community community Waiver Rank/State spending spending participants 1 Utah 2 Vermont 3 Alabama 4 New Hampshire 5 South Dakota 6 Nebraska 7 Colorado 8 Wyoming 9 Arizona 10 Rhode Island 11 New Mexico 12 Kansas 13 Oregon 14 Delaware 15 Oklahoma 17 Florida 18 Kentucky 19 Wisconsin 20 North Dakota 20 Missouri 21 Alaska 22 Maryland 23 Tennessee 24 Hawaii 25 West Virginia 26 Georgia ...
Current trends in mental retardation services in the Commonwealth of Massachusetts were investiga... more Current trends in mental retardation services in the Commonwealth of Massachusetts were investigated using the New England region, the state of Michigan, and the United States as comparative frames of reference. Our goal was to analyze recent structural, financial, and programmatic trends in Massachusetts and the New England region to close state institutions and implement community and family support services. Massachusetts in particular illustrates the policy choices and challenges facing many American states engaged in restructuring their service delivery systems. New England is an extremely dynamic and innovative region that is providing significant national leadership in the provision of alternatives to institutional care.
Trends in family support spending and new programmatic initiatives across the country during the ... more Trends in family support spending and new programmatic initiatives across the country during the 1990s are summarized. Nationally, total spending for family support exceeded $1 billion in 2000. Between 1990 and 2000, spending for such services in the United States grew from 1.5% to 4% of total resources expended by state MR/DD agencies. However, we found considerable state variability in level of resources allocated to support families providing care to a member with developmental disabilities. Programmatic initiatives include trends toward family-directed services, targeted programs for special populations, such as ethnic minorities and aging caregivers, and the slow expansion of cash subsidies. Recommendations for the future course of policy in this area are provided.
Essential public policy features of the national movement to return institutionalized mentally re... more Essential public policy features of the national movement to return institutionalized mentally retarded people to community settings include issues related to institutional census trends, class action litigation, cost &quot;savings,&quot; and funding. The deinstitutionalization of retarded people is following a different course from that of the mentally ill; it started later and is occurring more gradually. Right-to-habilitation lawsuits in Alabama and Pennsylvania illustrate the class action suit; gains from litigation in the 1970s have been mixed, however. Comprehensive community care is not necessarily any cheaper than comparable institutional care. Trends in state construction expenditures, the Reagan Administration&#39;s proposal for block grants, and impending human services budget cuts are current funding issues. So that advocates of the disabled can more closely monitor future developments in state and federal policy, three continuing annual studies are proposed: a comparison of states&#39; funding of programs for retarded people; and evaluation of nationwide data obtained in accreditation surveys; and a historical and contemporary description of the operations of each of the 50 state service systems.
The monograph summarizes national, reoional, and state expenditure data for mental retardation (M... more The monograph summarizes national, reoional, and state expenditure data for mental retardation (MR) /developmental disabilities (DD) services from fiscal year 1977-84. Data were compiled through responses of mR/ro state agency officials to data extracted frOm state excecutive bt et documents. The project was designed to (1) develop a mothodoLgy for accomplishing annual or biennial updates of MR/DD spending trends in the states and throughout the, nation and (2) to determine comparative funding levels and patterns for community and institutional services in the 50 states. The report displays digitally plotted graphics in four topic areas: expenditure data'aggregated across the 50 states for the 8-year period; the ratio of institutional expenditures (including state and federal funds for state-operated facilities and centers, and state schools) per dollar of community expenditures for each state; nationwide fiscal trends and service statistics in income maintenance and special education programs (including Sodal Security Disability Insurance and Public Law 94-142); and state-by-state comparative data on institutional and community services expenditures. (CL)
This analysis of survey activities of the Accreditation Council for Services for Mentally Retarde... more This analysis of survey activities of the Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons (ACMRDD) is designed to provide program administrators and state agency officials with comprehensive descriptive information on 296 surveys conducted by the council from 1980 through 1984. Part I of this report summarizes the ACMRDD survey process, the method of the study, and the agency classification system used by the-project. Part II presents study results in five sections: (1) analysis by type of agency (large or small, public or private, residential or nonresidential); (2) agency and client characteristics in the most recently surveyed agencies; (3) analysis of this data by type of agency; (4) the impact of previous surveys on the agencies' success with accreditation; and (5) identification of critical accreditation standards. 1The third part of the report presents a summary, suggests additional research, and offers recommendations to the ACMRDD and to agencies seekiag accreditation. Among recommendations for the use of the survey are improving and consolidating formats for data collection and modifying the survey application form to facilitate completion by the applicant agency and to consistently solicit relevant data. It is also recommended that those agencies comtemplating the survey should conduct a simulation of the actual survey experience. Twenty tables and 13 charts supplement the text, and eight appendices, makingrip nearly half the document, include survey and data collection formats, statistical summary of agency and client characteristics, enumeration and ranking of critical standards, and enumeration of standards with which all agencies were assumed to be in compliance. (C3) PUBLIC POLICY MONOGRAPH SERIES NUMBER 20 ACMRDD ACCREDITATION: ANALYSIS OF NATIONWIDE SURVEY RESULTS,
To identify trends in institutional reform and 'deinstitutionalization of the developmentally dis... more To identify trends in institutional reform and 'deinstitutionalization of the developmentally disabled, 34 administrative documents emanating from a federally funded planning grant program were examined. Documents were gathered in response to a survey letter to state Developmental Disabilities Councils, and fact sheets summarizing the documents were prepared. A comparison technique evaluated the presence of legislative, organizational, budgetary and client centered trends. Data produced such recommendations as the need in Alaska and Minnesota for public information about available community services, and in Michigan and Vermont for community mental health centers to assume responsibility for providing community based services. Also identified were critical deficiencies impeding deinstitutionalization (including lack of alternative residential services) and institutional reform (such as insufficient public funding). (Included in three appendixes are state document fact sheets.) (CL)
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