Date Presented 03/26/20
Systems of support for adults with intellectual and developmental disabilities are moving from institutional, congregate-based settings to the community. Understanding a person’s unique strengths, hopes, and dreams for the future can help guide provision of community-based supports that align with their choices. Person-centered planning (PCP) is embraced by many state agencies across the United States. OTs have unique skill sets and can play a vital role in the PCP process.
Primary Author and Speaker: Meghan Blaskowitz
Additional Authors and Speakers: Sarah Howard, Taylor Martin
PURPOSE: Systems of support for adults with intellectual and developmental disabilities (IDD) have evolved from institutional to community-based settings. Institutional settings, including sheltered workshops, are closing across the US, with greater provision of community-based day, employment and residential supports (Braddock et al., 2017). While the demand for community-based supports for adults with IDD has grown, the utilization of occupational therapy (OT) services in these settings remains low. OT practitioners use a person-centered planning (PCP) approach during intervention with adults with IDD. This study aims to measure the impact of person-centered planning on provision of community supports for adults with IDD during transition from a sheltered workshop.
DESIGN: This longitudinal study aims to investigate the impact of a PCP approach on goal attainment for adults with IDD in transition to a community-based supported employment program, Community Participation Services (CPS). An OT consultant and OT student (OTS) researchers used purposive sampling to recruit 58 adults with IDD to participate in PCP interviews. PCP interviews were conducted in 2018, prior to the sheltered workshop closure. Follow-up visits were conducted one year later with 26 participants. Six follow-up visits remain and will be completed by the end of 2019 (projected sample = 32).
METHODS: Participant demographics were collected at the initial PCP interview and descriptive statistics analyzed. The OT/OTS researchers supported participants with IDD to set personal, employment, and community inclusion goals using Goal Attainment Scaling (GAS). GAS was used to track participants’ goals and assess for change one year later. GAS scores were rated on an ordinal scale from: -2 (‘much less than expected’) to -1 (‘somewhat less than expected), 0 (‘expected outcome’), +1 (‘somewhat more than expected’), +2 (‘much more than expected’). Change in GAS scores was analyzed using frequency data and a binomial test.
RESULTS: Of the original sample (n=58), only 32 participants remained in CPS following sheltered workshop closure. 26 participants were lost to follow-up: 14 left the agency to seek services elsewhere; 8 obtained a job and no longer needed supported employment; and one died. The remaining participants ranged in age from 24 to 70 years (mean age = 43.6 years). The sample was mostly male (56%), and White/Caucasian (72%) and Black (19%). 91% of participants had mild-moderate ID, and 72% a comorbid mental health diagnosis. The participants set a total of 67 person-centered goals. They did not make statistically significant progress on these goals (binomial test = 25.0; p = .051). Almost 58% of goals set did not move from the original baseline rating of -2. Of goals where progress was made: 24% moved from -2 to -1; 28% from -2 to 0; 16% from -2 to +1; and 32% from -2 to +2.
CONCLUSION: Despite a strong motivation to achieve their personal goals, only 5% of adults with IDD leave sheltered workshops for community employment (National Council on Disability, 2012). Barriers to PCP/goal attainment for this sample included high staff turnover, long waitlists for job coaches, and family influence. The transition from institutional to community-based care presents a unique opportunity for OTs. However, many agencies do not employ OTs, signaling a need for the profession to advocate for greater utilization of OT in community-based settings. OT practitioners can support adults with IDD as they transition to the community by: training direct support staff to use PCP strategies in interactions with adults with IDD; providing direct intervention in social/job skills; and assessing for community accessibility, all aimed at closing disparity gaps for adults with IDD.
References
Braddock et al. (2017). The State of the States in Intellectual and Developmental Disabilities (IDD). Coleman Institute and Department of Psychiatry, University of Colorado, 2017. Retrieved from http://stateofthestates.org.
National Council on Disability. (2012). Sub-minimum Wage and Supported Employment. Retrieved from https://ncd.gov/sites/default/files/NCD_Sub Wage_508.pdf.
