Impact of Budget Cut on Disability Services
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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. Institutionalizing facilities is focused on improving the provision of developmental disability services with a reflection of institutionalization with possible reforms where need be. Much as the issues of effectiveness of the residential care facilities have been resolved, many people with disability still live with their families thus no focus on more funding of services that should support them.
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 need health interventions and programs for their wellbeing, which require enough funding to undertake.
The Increase in prevalence of the conditions is unclear, as controversy surrounds explanations given about the increase. It is argued that there is increased diagnosis of the case as result of increased awareness and monitoring of children’s development to identify any abnormality (Gerhardt & Lainer, 2010). The increase creates a significant demand for services among those who suffer from such conditions, growing far beyond the available resources. The movement from the institutional care system to the community system is intended to ensure acceptance and understanding of people with disabilities within the communities and societies they exist. There are significant 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 actualize the need for them to be employed as a desirable intervention for them. Much as such programs are not achieving a lot as desired, the responsible groups keep pushing for them, as governments keep on cutting costs.
The services rendered to such cases are intended to cost less than it would cost for a similar case in an institution. The standards set for the service provision by the relevant groups control the services to ensure they focus on needs of the people. Regulations and services require review to identify if they meet the needs of the people and relevance to their needs and capacity (Beadle-Brown & Mansell, 2010).
1.2 Statement of the Problem
There has been an increase in developmental disability related disorders globally in the recent past that can be attributed to increased research and the set-up of disability monitoring and evaluation units. Several countries such as Canada have set laws to regulate the care for the people with developmental disabilities and establish institutions of care for such people and how they are funded. The facilities need funding to provide necessary services to persons with disability, but authorities keep on agitating for sound policies and workable regulations for funding of such institutions. 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. Such services, however, have to be accounted for, and the need for funding proved to receive state funding. There has been increased cut on funds where the services and resources are not well accounted for, and this in one way or another may influence disability service.
1.3 Purpose Statement
This research seeks to establish the impact of the budget cut on Developmental Disability services provided in a specific state. Cut in budgets may be instigated by different government policies and priorities or as per the needs of specific services. The research therefore, tries to expose the contributing factors to budget cut and the preceding effects. The research must also focus on steps taken in ensuring that even with the budget cuts the services needed are primarily provided to the right people appropriately. It is also critical to identify regulations and services that exist and contribute to ensuring service delivery as per the needs of the people with disability. It will also investigate the commitment of states to implement and sustain residential care programs in providing continuity in the provision of care efficiently.
1.4 Objectives of the Study
1. To identify needs of persons with disability and on how services provided benefit them
2. To determine factors, that may lead to budget cuts on disability services.
3. To explore regulations and fund for developmental disability services
1.5 Research Questions
1. What are the needs of someone with developmental disabilities and significant improvements in the end?
2. How can the available resources be exploited to ensure continued service delivery even upon budget and funding cut?
3. What are the regulations required to be maintained at the residential care facilities to ensure the quality of care with the resources availed?
4. How does government funding provided and regulations impact service delivery to persons with developmental disability?
1.6 Hypothesis
H0Budget cut impacts Residential Care Facilities for the Developmental Disabilities Services.
H1Budget cuts do not affect Residential Care Facilities for the Developmental Disabilities Services.
1.7 Need for research
At the time when governments are feeling that too many funds are going to waste on 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 a developmental disability are not seen to be serving the intended purpose. The research findings are, therefore, essential for communicating the areas where there is need to improve the service and practice to ensure that the proposed people benefit in the short and long term. Residential facility audits will help identify the effectiveness of the service delivery model and extent to which it serves the intended purpose. The administrators can rely on 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. It constitutes substantial disability to the affected individual attributed to mental retardation and related responsive and developmental conditions and its associated 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 impact of the budget cut on residential care programs, developing 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 and surveys of funding disability disorders will influence the outcome of the study reducing any bias.
1.9 Theoretical Framework
The world experiences an increase in developmental disorders in different places across ethnic, cultural, age, and socio-economic background. Increase in cases of the disorders is due to the expanded service delivery and exposure of caregivers to methods and criteria available in assessing and diagnosing the developmental disorders. There is also increased rate of cutting off funding by the governments caused by the feeling that the funds are not serving their intended purpose. This on one hand is due to the increased crusade and acceptance of the concept of evidence-based care that governments base their arguments on to cut the funding.
There is the international concern about the effective way of offering services to individuals with developmental disorders. The shift is from the institutionalized way of service delivery to the community or residential care delivery; governments are increasingly approving policies and funding that ensure service delivery to persons with developmental disorders is accomplished. There are criteria set for assessing and monitoring cases of developmental disorders and steps taken to verify the cases. The governments are only committed to funding such services that can well be accounted for, and serve the needs of the target groups.
Chapter 2 Literature Review
2.1 Evidence-Based Care
Countries focus on evidence-based care, using such concept to ration services and funds to healthcare institutions. Governments cut many funds on a yearly basis from services provided for developmentally disabled individuals and within health care because of the belief that most of the services provided are not needed (Cronin & Kelly, 2011). This approach exists all over even as people believe that the concept is simply a cover up for rationing since it sounds bad in real life. With the advances in healthcare reforms, it is evident that evidence-based care considerably interconnected is widespread and is not seemingly going away any sooner.
The United States of America can improve in terms of residential care facility offering long-term services to people with disability and chronic conditions. According to Houser, Kassner Reinhard (2011), the responsible people seek 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 administration options for funding to create a care system that meets the demands of the local needs. There is need therefore to develop systems that help in measuring the progress of the services towards meeting the needs of the disabled (Houser, Kassner Reinhard, 2011).
2.2 Needs of Persons 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 Bergstrom, Marttila & Wahlstrom, (2014), explained, people with disability need sound care with positive attitude with 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 to modify health care that is not rigidly based on general knowledge of a person but on information about health implications of such disability (Bergstrom, Marttila & Wahlstrom, 2014). Even as much as acute conditions take leading priority of the people with disabilities, they need health promotion and disease prevention as they suffer all the same effects as the rest. The 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 line with the budgetary allocations to avoid deficits.
Shannon and Tappan (2011) considered specialized education vital for persons with disabilities just as education, among other rights is subjected to everyone without exception. The parents’ perceptions and that of other society members 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 areas to identify any abnormality in their development (Shannon and Tappan, 2011). Improved screening boosts 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 for the conditions appropriate for screening children for developmental disability must be set in a manner reducing mortality and benefiting a child (Paschos and Sheehan, 2013). It is necessary that newborns be subjected to compulsory regular medical assessments through their development in childhood to detect any anomaly earlier. The diagnosis directly benefit the child from as early as at birth and through the childhood development stages. 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 reasonable or abnormal and recommend further care; either corrective or that will keep the child from further complications. The practitioners also necessarily 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 (Pashas 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 provided in response to the needs of the individuals. Governments can establish criteria for identifying persons with disability and on how their conditions are handled and managed by the set levels of care (Caldwell, 2010). Some regions, such as in the USA, have established waivers and criteria for persons with disabilities to ensure that services are provided 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 to measure the effectiveness of service delivery. The services beneficial to persons with disabilities include but not limited to, assessment, monitoring, health education and promotion, learning, employment and medical attention. All the rights enjoyed by every single individual should be emulated for the persons with disability. They need personal 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 an explicit protocol for the health services and developmental disability services. 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 the care of developmental disabilities, and their perception of satisfaction with care will be beneficial more.
2.6 Regulations required to be maintained at the Group Homes
There is need to have rules and laws 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 people they serve. Licensing rules are established to ensure that the services 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 that 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 to be brought down. Any medical error, fraud, non-evident transactions and 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. The percentage is allocated for every expenditure, maintained and 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. Government funding focuses on the quality of health care services, outcome and improvement of health status of the population (Kelley, 2009). The services offered in terms of care or administrative must, therefore, deliver the highest efficiency that reflects the intended purpose of a program and any avoidable error, or scenario that would affect the 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 for the provision of developmental disability services has the necessary resources to undertake actively and enforce the necessary functions. As discussed by Gettings (2009), particular initiatives that ensure community inclusion and reflecting independence and productivity of the beneficiaries of the services ensure sustainability on long-term basis. Funds must be availed on necessary premises and service providers trained on maximizing the use of resources without waste to ensure that any support available is used to benefit the target group fully (Gettings, 2009). Availing well equipped residential care facilities, continued training and ascertaining qualifications needed to provide high-quality services over time also ensure sustainability. Technical assistance, favorable policies and workforce stabilization highly help residential agencies in their operations and quality improvements (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 the disabled. There are regulatory standards, and criteria that are pre-set that any institution that offers services must comply to in order to be licensed. The facilities are set up or run in areas that the states have specific interest in a group that the same service targets may benefit from specific waivers that the government may offer. The centers must define their services and ensure that there 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 comply with the set regulations.
Chapter 3 Methodology
This section will describe research procedures used in the study, data collection techniques, the process of collecting data, means and methods of data analysis, research design, target population, the sampling design and how the final analysis of the data will be handled. The instrument of data collection and 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 goals will 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 benefits that the target individuals achieve from them. It cross-examines data on the situation of such states, the level of funding and policies and regulation focused on managing developmental disabilities.
3.2 Research Design
The study design will be cross-sectional and will help understand the effectiveness of the residential care facilities in the area where they operate and the role of the governments. The descriptive model will be engaged to explore systematically the benefits the disabled get from the 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 the survey is carried out. The design is expected to give an accurate description of the subject matter since it is complex to be only answered by a YES or NO yet expedient data is needed.
3.3 Target Population
The study will target people with disability, care providers, and facility managers of the residential facility systems within states with approved similar systems. Therefore, the study will focus on the state where residential or 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 information provided by the responsible agencies in responding to outbreaks. Data will be collected through the review of secondary data that are relevant to the study together with internet surveys and checklists. Case study will be important for understanding the situation on the ground and conduct an analysis of resources and online surveys in order to come up with data necessary for concluding this study. The internet surveys will help 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 interviews will be used to obtain more information.
3.5 Data Analysis and Presentation
Before the analysis, all responses from surveys and the entries in the checklist will be verified for reliability. The data collected will be analyzed both qualitatively using brief explanations and quantitatively using descriptive statistics methods such as tables, percentage and pie charts. The data will be collected and then edited to ensure comprehensiveness and accuracy of the tools used. Descriptive analysis generates frequencies, percentages, tables, graphs and pie charts. The data may also be analyzed using scientific package for social sciences. Data will be organized and summarized in a manner that answers 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 central themes from the respondents. The quantitative approach will be employed to analyze the quantifiable data for presentation.
3.6 Ethical Considerations
Obtaining informed consent from respondents is vital before getting any information and justifying the relevance of the research is essential. 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 six weeks with the possibility of extension if the need be for flexibility and response to any matter arising from the study. The subject matter is complex and requires sufficient time commitment if all the desired results relating to the study objectives are to be achieved.
Chapter 4 Findings
The research will focus on finding the impact of the budget cut on disability services. Data collected from the palsy facility and administrators will be essential in explaining impact of the budget cut on service delivery. Mainly, all surveys and data collection tools sent out will be obtained to enhance the accuracy of information presented. The targeted service providers and administrators have the necessary information that can be used to establish facts of the matter. Complete surveys and responses from the focus groups are necessary for accuracy and validity of any research. The finding will be organized in representations that are easy to understand and relate the concepts of the study.
Chapter 5 Analysis of Findings
After collecting data, proper analysis will be conducted and related to the study objectives to achieve the aim of the research. The findings will answer the research questions on needs of people with developmental disabilities and the significant improvements made. The study will also relate how available resources are used to ensure continued service delivery even amid regulations and deficits. The findings will be scrutinized and presented in comparison to the hypothesis to determine whether they support or refute the hypothesis. It is possible that the data may generate unexpected data from the ground, but focus is on answering the questions of the study. The findings will support the basis of the study in advancing the study area.
Chapter 6 Conclusions and Recommendations
The research findings will be critical in informing the decision-making process in administrative organs and influencing service delivery to the people with developmental disability. The recommendations will be based on results of analysis of the data generated from surveys and literature analysis. Based on the personal analysis, suggestions can be made from the study comparing to the previous discoveries and future prospects. There will be clarity on how the recommendations can be applied and on any other possible research that may arise from the study. The study will expand the understanding of budget cut implications on service delivery.