Bibliography: leaves 168-172. / The primary focus of this dissertation was work with a group of children who were experiencing problems in reading and to formulate strategies which incorporates an innovative approach using music. Many learning problems encountered today could be avoided if children's earliest backgrounds were rich in songs, poems set to music, nursery rhymes and musical games. It is necessary for a child to experience rhythm in every possible way to enable him to read with a flowing rhythm and a pleasant intonation. A child must be able to feel and experience the rhythm of the spoken word by repeating rhymes, phrases, chanting children's names, for example. This is done by tapping the word, using body movements (clapping, stamping) and transferring this rhythm to percussion instruments while experiencing the speech rhythm. Many approaches have been used with children who are disabled readers and none use music as a tool. The progress of these children has therefore been slow, tedious and not always successful. Music has not been used before as an approach to assist children with reading disabilities. In this dissertation it has been proved that music helps children overcome their reading problems, as it is the only approach which offers total involvement of the child and therefore the best results are achieved. All children involved in the research enjoyed the activities and derived great pleasure from performing them unaware that the process of remediation was taking place.

Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are state and federally funded income programs that can provide steady health insurance, increasing access to healthcare and other needed services. It has been previously demonstrated that approval for social security disability benefits can lead to better access to housing and long-term subsidies, reduce emergency department usage and recidivism rates, and address systemic problems within the community. However, it has previously been shown that individuals experiencing homelessness are more likely to receive an unfavorable award decision, despite having more severe healthcare treatment needs compared to the general population. In Massachusetts, the state award rate for homeless applicants has averaged 22-33% over the past 2 years, compared to 45% for non-homeless cases awarded. The primary objective of this research study was to investigate applicant and application characteristics associated with disability outcomes among patients at the Boston Health Care for the Homeless Program (BHCHP) Barbara McInnis House (BMH) Medical Respite Unit and to explore the effect of advocacy in increasing access to benefits for those who qualify. The target population for this study was individuals experiencing homelessness who were admitted to the BHCHP BMH Medical Respite Unit and received assistance with an application or maintenance of Social Security benefits between the fiscal years of 2013 and 2018. The variables of interest included age, gender, race/ethnicity, preferred language, primary diagnosis, and housing status of the applicant. Presence or absence of medical advocacy letter and request of DDS mandated consultative examination were application characteristics of interest. The outcome variables were determination time and application decision. This chart review was retrospective and no patients were engaged with directly. All data of interest was pulled from the BHCHP electronic health record or the Microsoft Access database used for tracking application characteristics and outcomes of disability applications. It was shown that advocacy and assistance with the application process for SSI and SSDI produced an allowance rate for people experiencing or at risk of homelessness considered in this study that was almost twice the allowance rate for the homeless population in the state of Massachusetts and was significantly higher than the state general population. Despite the increase in allowance rate, the application determination times were significantly longer for the population of interest in this study as compared to the general population. The median age of applicant population decreased over the timeline of the study, but the median age of those approved did not change at the same rate. Under the age of 40 and mental health diagnosis, as opposed to over the age of 40 and non-mental health diagnosis, were associated with statistically significant lower odds of approval for disability benefits. Medical advocacy letters were found to aid in access to benefits for those with mental health primary diagnoses. Common denial reasons included inability of the Social Security Administration (SSA) to contact the applicant, missed DDS mandated consultative exam by the applicant, and inadequate documentation to demonstrate severity of the disability. Barriers included severe mental illness, cognitive disorders, chronic physical health conditions, substance use disorders, and lack of accurate record keeping of when, where, and why an individual was treated at a facility. Individuals experiencing or at risk of homelessness face many systemic and institutionalized barriers to obtaining disability benefits that they qualify for and deserve. Analysis of current gaps in access to disability benefits could help illustrate how the current system harbors barriers to deter and deny people benefits, especially those who have low literacy, are poor, and have no access to advocates who could potentially help to garner attention to areas in need of intervention. Advocacy can help increase access to benefits and can help individuals achieve better health outcomes by offering a means of preventative care.

Youth with intellectual and developmental disabilities (ID/DD) face significant barriers to social inclusion (Hill, Davis, Prout, & Tisdall, 2004; Koller, Pouesard, & Rummens, 2018; Simplican, Leader, Kosciulek, & Leahy, 2015) that are counter to their fundamental rights (Browne & Millar, 2016) and associated with negative social and emotional outcomes (e.g., Koller et al., 2018). It is therefore critical that research uncover strategies for removing these barriers. Extracurricular activities provide an important context for fostering social inclusion of youth with ID/DD, and federal law has language specific to ensuring students with disabilities access to extracurricular activities (Individuals with Disabilities Education Improvement Act, 2004, § 614[d][1][A][i]; U.S. Department of Education, 2011). However, relatively few students with ID/DD participate in extracurricular activities compared to students with other disabilities and students without disabilities (e.g., Lipscomb et al., 2017). States hold increasingly significant power and autonomy over the implementation of federal educational policy (Knackstedt, Leko, & Siuty, 2018). Yet, heretofore there has been no systematic, state-level analysis of policies related to social inclusion for youth with ID/DD in extracurricular activities. This study provides a state-level analysis of policies related to social inclusion of youth with ID/DD in extracurricular activities. Directed content analysis found that states varied widely in their number and content of policies regarding inclusion of students with disabilities in extracurricular activities. No states used the terms inclusion or social inclusion in their policies, highlighting the divide between academia and policy in defining and examining special education issues. There was no finding of a formal, regular mechanism federally or by states to measure and report extracurricular activity participation for students with disabilities. Through the lens of a rights-based, leisure justice, socio-ecological framework, several areas for potential research were identified and recommendations are provided for researchers, federal and state policymakers, school districts, extracurricular program staff, students, and families. These results can inform stakeholders of potential avenues for increasing participation of youth with ID/DD in extracurricular activities, and in turn can help to optimize the social inclusion of youth with ID/DD.

The self-perceived hearing aid benefit of 38 participants was examined. Of the 38 subjects, 8 were found to have an auditory processing disorder as measured by the Dichotic Sentence Identification (DSI). When compared to the non-APD subjects, there were essentially no significant differences on the APHAB or COSI outcome measures. However, two of the 5 scales of the CHPI did show significant differences. In conclusion, these results do not support the notion of APD having a negative effect on hearing aid benefit. No finding in this study was robust and although there were several trends supporting that APD may impede an individual from receiving their full potential of benefit, this finding is not necessarily so.

Persons with disabilities tend to be in poorer health compared to those without disabilities, and timely coordination of care is essential for maintaining optimal health and wellness. The problem addressed in the Care Coordination Referral Project was the lack of timely access to health care and preventive care services for clients with disabilities in the organization for which this project was developed. Using the appraisal of guidelines research and evaluation II model, the purpose of this DNP project was to analyze and synthesize the evidence-based literature to support the project and develop an online health care resource manual and protocol. The practice- focused question focused on evidence from literature that supported the development of a resource manual and protocol to provide care coordination to patients with disabilities. The literature indicated that timely access to care was essential to a patient's overall health and well-being. The manual and protocol were approved by an organizational team and included in the patient care plan. Results of a summative evaluation showed that team members agreed that the project objectives were met, the project was appropriate to the setting, and that strong leadership was demonstrated throughout the project. The findings of this project show that providing the resource manual for the nurses might improve the overall health and well- being of patients with disabilities through access to health care and preventive care services access.

Students with learning disabilities (LDs) represent 9% of students attending college, and college administrators must comply with a large number of federal requirements outlining the provision of educational services for students with LDs, including offering support groups. Nurse-facilitated support groups, held within the university setting, could provide effective social support, increasing likelihood of college success among students with LDs. The purpose of this project was to develop a plan for implementing nurse-facilitated support groups for students with LDs within the student health services (SHS) department at a university designed to improve their coping skills on personal, social, and academic levels. Guided by the Logic Model, a plan for implementing nurse-facilitated support groups within the SHS department was developed and presented to university stakeholders. Components of the plan included a support group structure, curriculum, evaluation tools, steps for piloting the program, and a proposed timeline for implementing the program. The stakeholders acknowledged the potential benefits of initiating a program of nurse-facilitated support groups for students with LDs to assist in attaining their academic goals. However, additional analysis of the program and refining and other disabilities to assist in attaining their academic goals; however, additional analysis of the program and refining the proposed student self-evaluation tool were needed before implementing the program. Nurses in a SHS department staff are effective support group facilitators for students with LDs. This study holds the potential for positive social change by enhancing personal, social, and academic coping skills with nurse-facilitated support groups who may help students with LDs reduce their risk of experiencing burnout and enhance the likelihood of academic success.

Parenting can be very challenging, especially when raising a disabled child. Children with disabilities require more supports and are more likely to be abused. The parent-child relationship is an important factor in ensuring child welfare. Little research has focused on identifying the impact of parenting characteristics on raising a child with a disability. The purpose of this study was to examine whether parenting style, parenting competence, and parenting stress were predictors of parent-child relationship quality in parents of children with disabilities ages 3 to 12 years. This study was quantitative and used multiple linear regression to identify predictor variables of the quality of the parent-child relationship. A convenience sample of 244 parents identified through a Qualtrics participant pool completed online surveys. Minuchin's structural family theory was used to guide this research and identify how challenges, such as raising a child with a disability, can cause distress when families are unable to adapt and parents are unable to maintain authority. Parenting factors were assessed using the Parenting Stress Index-4 Competence subscale, the Parenting Stress Index-4 SF, and the Parenting Styles and Dimensions Questionnaire. The quality of the parent-child relationship was assessed using the Parent-Child Relationship Inventory. The results of this study indicated that all parenting factors examined were significant predictors of the parent-child relationship quality. Age of the child was not a predictor. These findings have positive social change implications and can be used to increase practitioner knowledge of the impact of these parenting characteristics on parent-child relationship quality. Modification of treatment models could improve parenting behaviors, reduce parental stress and incidents of child abuse, and assess for the most conducive parenting styles for raising a disabled child.

Although benefits of assistive technology (AT) to people with disabilities are widely apparent, barriers, primarily funding, still inhibit access to needed AT. All agencies receiving federal funding are required to show no discrimination with regard to age, race, disability, and gender. This case study of a state run agency providing funding for AT to enable independent living among people with disabilities involved analyzing spending data from 2003 2008 to determine who used the fund, what was purchased, and whether it was equitably distributed according to age, ethnicity, gender, and population density. Additionally variables predictive of amount spent per person were also sought. Results indicated the fund was equitably distributed according to ethnicity and gender, but not age and population density. Age, gender, population density, and device type were found to have main effects with an interaction between device type and primary cause of disability in predicting the amount spent per person. (210 pages)

Employees in the field of human services can influence the health and rate of progress of the clients they serve. A human service supervisor’s responsibilities include identifying why an employee may be performing poorly and provide an effective intervention to ensure improved performance. The Performance Diagnostic Checklist for Human Services (PDC-HS) has been used in treatment clinics to identify the variables that can contribute to poor employee performance, and subsequently recommend an intervention to improve performance. The special education classroom is a human service setting in which special education teachers supervise paraeducator’s skills and performance. A paraeducator’s role includes providing instruction to students. Discrete trial instruction is an effective method for students requiring specialized instruction to acquire new skills and concepts. Poor instruction can have an adverse impact on a student’s performance resulting in a slow rate of progress or regression. Special education teachers are trained in specialized instruction, behavior management and classroom organization, but are rarely prepared to supervise and train other adults. Additional challenges are time to provide professional development and training preparation, given the background and experience of paraeducators. Research has demonstrated that a systematic approach for training and performance evaluation is required in order to provide quality instruction. This research evaluated the effectiveness of the PDC-HS, as completed by classroom teachers, in a public school special education setting to improve the performance of paraeducators for discrete trial instruction. Three teachers first identified which paraeducators were not correctly implementing the steps for discrete trial instruction. They then used the PDC-HS to determine why their paraeducators were performing poorly and which interventions could improve their performance. The results indicated that a lack of training was contributing to poor performance and a Behavior Skills Training (BST) package would most likely increase their performance. The BST package began with defining the steps for discrete trial instruction, modeling the steps, practicing the steps and providing feedback on progress. Once the paraeducator was able to correctly demonstrate the steps with an adult, they were able to continue instruction with their students. The data demonstrated that their performance significantly increased after they were provided BST. The social validity results indicated that the teachers had a positive experience using the PDC-HS. All teachers reported that this was the first time they had consistently taken data on a paraeducator’s performance and were appreciative of the training and pleased with the results. The results also indicated that all were unaware of their paraeducator’s skill in discrete trial instruction and saw the value and outcomes of using data analysis for both the paraeducators and the students they were working with.

Magister Artium (Psychology) - MA(Psych) / Despite the increase in South African trauma studies over the years, few studies focus on distinct groups, such the group represented by students with disabilities (SWD) - 1% of the total student population at universities. Recent studies established widespread exposure to trauma amongst the general student population. This study investigated exposure to trauma amongst SWD and the role of fortitude in psychological outcomes. Fortitude is defined as the ability to manage stress well and to remain emotionally steady. The objectives of this study included: i) assessing the prevalence of exposure to trauma amongst SWD; ii) investigating the association between such exposure and posttraumatic stress disorder (PTSD); iii) investigating the role of fortitude in this association; and iv) identifying demographic correlation concerning exposure to trauma and PTSD.