Residential Care Facilities for the Developmental Disabilities
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Abstract
Residential care facilities have replaced larger institutions to enable people live well in the society. Actually, this solves any tussle related to whether to institutionalize the disability care services or provide community services, in the countries that have fully developed policies. Different chronic conditions due to mental and physical impairments are experienced globally at unequal rates. About one billion people globally making up a rate of 15% have a form of disability (CDC, 2015). According to CDC (2015), developmental disabilities occur among all ethnic, racial and socioeconomic groups with a projection that about 15% of the children aged between 3 to 17 years have one or more chronic physical or mental impairments in the United States of America (USA). Increased diagnosis of the case is as result of increased awareness and monitoring of children development to identify any abnormality (Gerhardt &Lainer, 2010). The increase has created a large demand for services to those who suffer from such conditions, increasing far beyond the available resources pushing the states and the people affected to find ways of establishing an effective system of care for such individuals. During the research, staff members that work with individuals with developmental disabilities, OT, PT, SLP Therapy services staff members and clinicians will also be interviewed. Governing body policies will also be reviewed. Program Evaluation on effects on quality of care and life achievement or goals will be conducted for persons with developmental disability. The study will focus on assessing such programs to establish their effectiveness and the benefits that the target individuals achieve from them. Cross sectional study design will help understand the effectiveness of the residential care facilities in the area where they operate and the role of the governments. Descriptive design will be engaged to explore systematically the benefits the disabled get from such services and where the facilities do not meet the expectation of the people.
Table of Contents
1.2 Statement of the Problem.. 3
1.4 Objectives of the Study. 4
Chapter 2 Literature Review.. 7
2.2 Needs of Someone with Developmental Disabilities. 7
2.3 How health care providers diagnose IDD’s. 8
2.4 Who Governs the Developmental Disabilities. 9
2.5 Services or Treatment Beneficial to Developmental Disabled and Quality Measure. 9
2.6 Regulations required to be maintained at the Group Homes. 11
2.7 Severities of Government Cuts When Residential Facilities are Non-profit 11
2.8 Significant Improvement or Growth on a Long Term Basis. 12
2.9 Basic Requirements for Residential Facilities for the Developmentally Disabled. 12
3.4 Data Sources and Instruments. 15
3.5 Data Analysis and Presentation. 16
3.6 Ethical Considerations. 16
Chapter 1 Introduction
1.1 Background
Residential care facilities have lately replaced larger institutions as a focus to enable people live well in the society. Actually, this solves any tussle related to whether to institutionalize the disability care services or provide community services, in the countries that have fully developed policies. This is focused on improving the provision of developmental disability services with a reflection of institutionalization with possible reforms where need be. In as much as the issues of effectiveness of the residential care facilities have been resolved in other countries, many countries people with disability still live with their families thus no focus on developing services that should support them.
Developing residential care facilities in areas that have never had institutional facilities however can be easier. The residential care facilities can be developed without going through the phase of institutional facilities, and ensuring their effectiveness for the services provided. Different regions globally experience different chronic conditions due to mental and physical impairments at unequal rates. Children develop at their own pace, thus it may be difficult to tell when one starts experiencing developmental disability. However, developmental screening can be conducted to help in identifying any delay, which then is followed by tests to ascertain that there is actually a delay in terms of development.
It is reported that about one billion people globally making up a rate of 15% have a form of disability (CDC, 2015). According to CDC (2015), developmental disabilities occur among all ethnic, racial and socioeconomic groups with a projection that about 15% of the children aged between 3 to 17 years have one or more chronic physical or mental impairments in the United States of America (USA). People with developmental disorders equally needs healthcare interventions and programmes for their wellbeing, and this have solicited for the development of the establishment of care centers.
Increase in the prevalence of the conditions is unclear, as controversy surrounds the explanations given about the increase. It is argued that increased diagnosis of the case is as a result of increased awareness and monitoring of children development to identify any abnormality (Gerhardt &Lainer, 2010). The increase has created a large demand for services to those who suffer from such conditions, increasing far beyond the available resources pushing the states and the people affected to find ways of establishing an effective system of care for such individuals. The increased establishment of institutions for care of people with disabilities on the other hand comes because of people feeling that the disabled are unproductive and required specialized care.
The movement from the institutional care delivery system to the community system is intended to ensure acceptance and understanding of people with disabilities within the communities and the societies they exist in. There are major transitions in care delivery systems that the administrations and caregivers offer to the disabled. The service delivery systems gear towards the different needs of those with the developmental disabilities across the lifespan (Gerhardt &Lainer, 2010). People have been embracing the need for people with special needs to learn and actualizing the need for them to be employed as a desirable intervention for them. Much as such programmes are not achieving a lot as desired, the responsible groups keep demanding them.
The services rendered for this course allow individuals within their communities or homes for individuals with similar needs for different services availed. Such services are intended to cost less than it would cost for a similar case in an institution. The standards are also set for such service provisions by the relevant authorities in order to control the services and ensure they focus on the needs of the people. Such regulations and services need to be reviewed to identify if they meet the needs of the people and to if any review is required so that they remain relevant to the needs and capacity (Mansell& Beadle-Brown, 2010).
1.2 Statement of the Problem
In the past decade, there has been an increase in developmental disability related disorders globally. The rise in cases is because of increased research and the set-up of disability monitoring and evaluation units by the global health institutions. These centers help in identifying abnormalities related to child development and monitor their progress. Countries such as the US and Canada have set laws to regulate the care for the people with developmental disabilities and on setting up institutions of care for such people. It is the responsibility of every state to ensure the well-being of every individual. The facilities need to be effective to provide necessary services to individuals. The only way to achieve the effectiveness of the facilities for care of those with the disabilities is to set sound policies and workable regulations given proper funding. The governments and international bodies are striving to ensure that the persons with disability enjoy equal rights as the rest through the determined service delivery structures.
1.3 Purpose Statement
The purpose of this research is to evaluate the effectiveness of Residential Care Facility for the Developmental Disabilities in services provided in a specific state. It further examines steps taken in creating awareness to people within the communities of the affected persons and identifying regulations and services that exists and contributes to ensuring service delivery as per the needs of the people. It also investigate the commitment of states to implement and sustain residential care programs in ensuring continuity in the provision of care efficiently to the person in need of the services.
1.4 Objectives of the Study
- To establish the benefits of residential care facilities to people with developmental disability
- To identify the needs of persons with disability and how the services provided benefit them.
- To discuss the effectiveness of the diagnosis and treatment offered to persons with developmental disability.
- To explore funding and regulations by states towards developmental disability.
1.5 Research Questions
- What are the needs of someone with developmental disabilities and significant improvements for the long run?
- What are the steps taken to diagnose and assess IDD’s?
- What services or treatments are beneficial to people with developmental disability?
- What are the regulations required to be maintained at the residential care facilities to ensure the quality of care?
- How does government funding provided and regulations impact service delivery to persons with developmental disability?
1.6 Hypothesis
H0Residential Care Facilities for the Developmental Disabilities in Services Provided are most effective systems for care delivery.
H1Residential Care Facilities for the Developmental Disabilities in Services Provided are ineffective systems for care delivery.
1.7 Need for research
At the time when governments are feeling that too much funds are going to waste, and the ongoing crusade for evidence-based care, there is need to justify the spending on the care of people with developmental disability. The research aims at evaluating the efficiency of the recent structure set for care delivery and how the services benefit the needs of the people with disability. Governments are increasingly identifying places where resources are going to waste and cutting the funding. Some healthcare services and more specifically the services delivered to those with developmental disability are not seen to be serving the purpose they were intended for. The research findings are therefore important in communicating the areas where there is need to improve on the service and practice to ensure that the intended people benefit in the short and long term sustainably. Residential facility audits will help identify the effectiveness of the service delivery model and the extent to which it serves the intended purpose. The administrators can rely on the findings to inform their policy decisions in terms of funding and regulations.
Definition of Term: Developmental Disability
This disability manifests in individuals from an earlier age and before the age of 22 constituting substantial disability to the affected individual attributed to mental retardation and related responsive and developmental conditions and its related diverse mental or physical impairments.
1.8 Scope and Limitation
The study is cross-sectional and tends to cover places that have developed the residential care facilities for individuals with developmental disabilities with well-structured funding, policies and regulations. It tries to establish the effectiveness of residential care programs and how the target groups benefit from them. It develops the understanding of the effectiveness of the efforts made in identifying and managing developmental disabilities in prenatal, newborn, and early life stages. The information on the situation from the reviews presented from the literature to the development disorders will influence the outcome of the study reducing any bias.
1.9 Theoretical Framework
The world is now experiencing an increase of different developmental disorders in different places across ethnic, cultural, age and socio-economic background. The increase in cases of the developmental disorders is due to the expanded service delivery and the exposure of caregivers to methods and criteria available in assessing and diagnosing the developmental disorders. There is also increased rate of cutting of funding by the governments caused by the feeling that the funds are not effectively serving their intended purpose. This again is because of increased crusade and acceptance of the concept of evidence based care that governments base their arguments on to cut the funding. Other criteria are also developed in assessing the disorders related to development and other conditions meet the criteria of admission as developmental disorders.
There is international concern of the effective way of offering services to individuals with developmental disorders. The shift is from the institutionalized way of service delivery to community or residential care delivery and governments are increasingly approving policies and funding that ensures service delivery to persons with developmental disorders are effected. There are also criteria set for assessing and monitoring cases of developmental disorders and steps taken to verify the cases. There are also means set for ensuring that people with disability are understood by their communities and integrated there in. Education, healthcare promotion and provision and employment channels are set to ensure that people with disability benefit from every program.
Chapter 2 Literature Review
2.1 Evidence-Based Care
Countries focus on evidence based medical care, using such concept to ration services and funds to healthcare institutions. Governments cut many funds on a yearly basis from services provided for developmental disabled individuals and within health care because of the belief that most of the services provided are not needed (Kelly & Cronin, 2011). This approach exists everywhere even as other people believe that the concept of evidence-based care is simply a cover up for rationing since it sounds bad in real life. The advances in world healthcare reforms and advancements evident that the considerably interconnected are widespread and does not seem to go away any sooner.
United States specifically can advance in terms of high performing residential care facility that is capable of offering long-term services to people with disability and chronic conditions. According to Reinhard, Kassner and Houser (2011), the responsible people have sought to shift focus from institutional based care and nursing homes, to include a broader range of care options. Such moves are boosted by legislations that offer administrations options of funding to create a care system that meets the demands of the local needs. There is need therefore to develop systems that helps in measuring the progress of the services towards meeting the needs of the disabled (Reinhard, Kassner and Houser, 2011).
2.2 Needs of Someone with Developmental Disabilities
People with developmental disabilities are commonly diagnosed with Cerebral Palsy, autistic, bipolar, behavioral, severe long term problems, learning disorders and Down Syndrome. As Wahlstrom, Bergstrom &Marttila (2014), explained, people with disability need sound care with positive attitude and respect both directly or indirectly with communication that meet their needs and according to their level of understanding. One must be able to communicate in a way that can be understood by them and express things in a way that they would comprehend. They also need modified health care, that is not rigidly based on knowledge of a person based on information about health implications of such disability (Bergstrom, Marttila &Wahlstrom, 2014). Even as much as more conditions that are acute take priority in the people with disabilities, they need health promotion and disease prevention as they suffer all the same the effects as the rest. Residential care system should incorporate all the necessary care functions that may be required. Assessment to determine each time the needs of the people with disability in every community can be conducted in order to improve the efficiency of delivery.
Shannon and Tappan (2011) explained that specialized education is also necessary for persons with disabilities. Just as education among other rights is subjected to everyone, they are not an exception. The parents’ perceptions and that of other members of the society must be enlightened so that they realize the persons with disability equally require services as the rest. Many people lack understanding about the developmental disabilities, thus even the care service provided in their localities may not benefit them. The service providers must thus develop avenues of monitoring and evaluating children within their localities to identify any abnormality in their development (Shannon and Tappan, 2011). Improved screening boosts in the identification of developmental abnormalities in children and therefore capacity of the residential care facilities need to enable assessment of the situations with a proper referral link for any allegations that cannot be verified at their levels.
2.3 How health care providers diagnose IDD’s
Criteria on the conditions appropriate for screening children for developmental disability must be set in a way that benefits the child and capable of reducing mortality (Paschos and Sheehan, 2013). It is necessary that the newborns be subjected to compulsory regular medical assessments through their development in childhood to earlier detect any anomaly. The diagnoses must those that directly benefit the child from as early as birth through the childhood development. The service providers monitor the development of a child and measure what is to be achieved at each stage.
Paschos and Sheehan (2013) argue that in case of any delay in development detected, the practitioner must further establish if the delay is normal or if is abnormal and recommend further care, either corrective or that will keep the child from further complications. The practitioners also essentially obtain some information on the history of the child from the parents on the development of the child. The primary care provider also engages with the child in structured activities to assess the attention of the child and the social-emotional relatedness. The provider can also get to know the child’s use of gesture, imagination and the ability to engage in a conversation (Paschos and Sheehan, 2013).
2.4 Who Governs the Developmental Disabilities
According to Caldwell (2010), states and governments govern the developmental disabilities through set rules and regulations. It is incumbent upon the state to allocate funds and determine the manner in which services will be offered to individuals with disabilities. Such services must reflect the standards set by the regulations and be offered in response to the needs of the individuals. Governments can set criteria for identifying persons with disability and how their conditions are handled and managed through the set levels of care (Caldwell, 2010). Some regions, such as in the USA, have set waivers and criteria for persons with disabilities in order to ensure that services are offered to them and their wellbeing maintained.
2.5 Services or Treatment Beneficial to Developmental Disabled and Quality Measure
It is important to have quality measurement indicators that can be used to measure the effectiveness of service delivery. The services that are beneficial to persons with developmental disabilities includes but not limited to, assessment, monitoring, health education and promotion, learning, employment and medical attention. Generally, all the rights enjoyed by every single individual should be emulated for the persons with disability. They need special attention; understanding and communication that will make them feel comfortable in their environment. Byrne, Hurley & James (2007) argued that the services must be accessible, such as the mental health assessment and treatment services, the emergent service, family services and support, positive perception and access to physician care.
The services need to be implemented in an acceptable set of standards with effective communication of information among care providers, continuous existence of necessary service and support together with standardized functioning assessment tools (Byrne, Hurley & James, 2007). It is important that the services meet the individual and family perception of satisfaction, being culturally sensitive, responsive and comply with the set laws and regulations. The services must subject the affected person to quality life improvement both functionally and clinically with early long term mortality improvement (Byrne, Hurley & James, 2007).
To ensure continuity of service delivery, there must be a clear protocol between the health services and the developmental disability services. Timely communication of any relevant plans to the residential care services is also essential. Frequency of injuries must be measured in terms of the staff, client, and the severity of critical care because of disability service delivery. Technologies can be incorporated in the event of service delivery, cost cut and procedures put in place to ensure efficient use of resources to benefit several individuals (Byrne, Hurley & James, 2007). Services of trained staff with knowledge and skills on care of developmental disabilities, and their perception on satisfaction of care will be beneficial more.
2.6 Regulations required to be maintained at the Group Homes
There need to be regulations and laws set to control the manner in which assessment and identification of people with developmental disabilities and the manner in which the service delivery systems operate. There may be bodies or departments set to deal with issues related to the health and service delivery to the disabled. There are also standards set for the care facilities to meet in terms of the areas they operate and the people they serve. Licensing rules are set to ensure that the facilities meet some minimal set standards and comply with the regulatory requirements of the areas they operate (Fitsimmons, 2012).
2.7 Severities of Government Cuts When Residential Facilities are Non-profit
In countries such as the USA, health funding and billing is almost a concern of everyone. As discussed by Kelley (2009), there are legislations, which dictate the level of funding and where to fund at each time. The perception of higher funding in some states may lead to the care facilities for chronic conditions that deliver subsidized services to individuals. Such facilities are not for profit and government provides funding most commonly for essential needs and services offered at such levels with the clients only paying a minimal amount or for advanced care.
There is increased debate by the people on how much should be spent on healthcare, with states allocating annual funding for the healthcare services. There is therefore much to be done in ensuring waste and unnecessary spending in health care are avoided if the cost is really to be brought down. Any medical error, fraud, non-evident transactions as well as inefficient products should be avoided. Inappropriate use of service costs and services that do not provide value for the patients, and the available resources must be maximally used to offer services to the advantage of the affected for prevention of disease and promotion of health (Kelley, 2009).
The focus of every government is to balance the GDP with the spending. Percentage is allocated for every expenditure and is maintained and be exploited in a manner that higher benefit is achieved at a minimal cost. Therefore, any healthcare service that do not deliver quality or benefits to a patient, or that which replicates a service provided in another avenue can be eliminated to minimize cost without reducing quality. The government funding focus on the quality of health care services, the outcome of services and improving health status of its population (Kelley, 2009). The services offered in terms of care or administrative much therefore deliver the highest efficiency that reflect the intended purpose of a program and any avoidable error, or scenario that will affect physical ability of a person avoided.
2.8 Significant Improvement or Growth on a Long Term Basis
The significant growth or improvements will be ensured if every responsible state agency on the provision of developmental disability services has the necessary resources to actively undertake and enforce the necessary functions. As discussed by Gettings (2009), special initiatives that ensures community inclusion and reflecting independence and productivity of the beneficiaries of the services ensures sustainability on long-term basis. Funds must be availed on necessary premises and the service providers trained on maximizing the use of resources without waste to ensure that any resource available is used to fully benefit individuals (Gettings, 2009). Availing the residential facilities with necessary equipment and tools for service provision, continued training and ascertaining qualifications needed to provide high quality services over time also ensures sustainability. Technical assistance and favorable policies help residential agencies in their operations. Workforce stabilization must also be considered critical in effort to improve quality of services in the long-run (Gettings, 2009).
2.9 Basic Requirements for Residential Facilities for the Developmentally Disabled
Every state administration or departments have regulatory requirements that must be met by set-up facilities that provide services to developmentally disable. There are regulatory standards and criteria that are pre-set for any institution that offers services must comply to in order to be licensed. The facilities that are set up or run in areas that the states have specific interest over a group that the same facility targets may benefit from specific waivers that the government may offer. The centers must define their services and ensure that they are those that encourage earlier detection, target improvement of physical and clinical wellbeing and are not likely to cause harm to the individuals targeted. The services must be cost effective and those that comply by the set regulations.
Chapter 3 Methodology
This section will describe and explain the study research procedures that are used in the study. It will describe the data collection techniques, the process of collecting the data, means and methods of data analysis. The section also describes the research design, target population, the sampling design and how the final analysis of the data will be handled. This discusses on the research area, study design, sampling and sampling techniques or respondents of the study. Instrument of data collection and the statistical treatment of data will help give the actual picture of where the data was generated and where the research is relevant.
During the research, staff members that work with individuals with developmental disabilities, OT, PT, SLP Therapy services staff members and clinicians will also be interviewed. Governing body policies will also be reviewed. Program Evaluation on effects on quality of care and life achievement or goalswill be conducted for persons with developmental disability.
3.1 Study Area
This study focuses on the American states that have developed the community or residential care facilities for the disabled. The study will focus on assessing such programs to establish their effectiveness and the benefits that the target individuals achieve from them. It will do cross-examination of data on the situation of such states, the level of funding and the policies and regulation focused on managing developmental disabilities.
3.2 Research Design
The study design will be cross sectional study design that will help understand the effectiveness of the residential care facilities in the area where they operate and the role of the governments. Descriptive design will be engaged to explore systematically the benefits the disabled get from such services and where the facilities do not meet the expectation of the people. This method is not dependent much on sample size and can generate meaningful results where survey is carried out. The design is expected to give an accurate description of the subject matter since it is too complex to be answered by a simple YES or NO yet expedient data is must be generated.
3.3 Target Population
The target populations are the people with disability, care providers and the facility managers of the residential facility systems within the states with approved similar systems. So generally, the study will focus on the countries where the residential or the community care facilities are legally set and running. There will be no sampling for this study since it will be based mostly on secondary data and observations based on the subject of the study.
3.4 Data Sources and Instruments
This study will not have sampling methodology or technique since it will be based on figures already available and the information provided by the responsible agencies in responding to outbreaks. Data will be collected through the review of the secondary data that are relevant to the study together with internet surveys and checklists. Data from WHO and CDC will be of importance for understanding the situation on the ground and conduct analysis of resources and online surveys in order to come up with data necessary for concluding this study.
How residential audits are evaluated?
The internet surveys will be structured to establish the preparedness of the global health partners and disease centers in terms of equipment possession and expertise to generate data from previous epidemics that had occurred. Literatures on developmental disabilities and interview of staff members, managers and clinicians will be applied to obtain the relevant information.
3.5 Data Analysis and Presentation
Before the analysis, all responses from surveys and the entries in the checklist will be checked for reliability and verification. The data collected will be analyzed both qualitatively using brief explanations and quantitatively using descriptive statistics method such as tables, percentage and pie charts. The data will be collected and then edited for ensuring comprehensiveness and accuracy of the tools used. Data will be analyzed using descriptive statistics to get frequencies, percentages, tables, graphs and pie charts. The data may also be analyzed using scientific package for social sciences. Data will be organized and summarised in a manner that answer the study questions. Data editing and classification will be conducted according to the attributes.Content analysis of the results of the surveys and interviews were conducted to establish main themes from the respondents. Quantitative approach will be employed to analyse the quantifiable data for presentation.
3.6 Ethical Considerations
Obtaining informed consent from the respondent is reasonable before getting any information and justifying relevance of the research is essential. Every information obtained should be to the knowledge of the relevant respondents and sensitive information must be granted higher level of confidentiality. Appropriate research methods will be used and any form of bias avoided with no personal interest of the researcher.The findings and recommendations will only be used in interventions and policy formulation averting adverse effect to respondents.
Proposed period
The research is intended to take place within six weeks with the possibility for extension if the need is to provide flexibility and response to any matter that may arise from the study. The subject matter is complex and requires sufficient time commitment for all the desired results relating to the study objectives.