The patient centered care (PCC) model is recommended by the Institute of Medicine for individuals with intellectual and developmental disabilities. The problem identified in this quality improvement (QI) project was that PCC practices had not been included in the training curriculum within the organization. Framed within the plan-do-study-act model of QI, the purpose of this project was to develop an educational initiative on PCC that included a curriculum plan, a pretest/posttest, a protocol, a revision of the training policy, and an implementation and evaluation plan. Drawing upon the evidence-based literature and using a team approach, a curriculum plan on PCC practices was developed which included a pretest/posttest to evaluate staff knowledge on the curriculum before and after the training. Three content experts from the committee approved the curriculum and validated the pretest/posttest items. The content validation index was 0.99 showing that each item reflected the content and objectives of the curriculum. As well, a training protocol was developed which identified the steps for provision of the curriculum to maintain consistency for all users. The training policy was revised to set expectations for all staff for the incorporation of the PCC practices into the organization. This initiative will be implemented into the organization using Kurt Lewin’s model of change to guide PCC practices. A recommendation was made to add a small section on “people’s first language” to the training to preserve patients’ dignity and respect during communication. This project contributes to social change by promoting PCC practices among healthcare workers thus limiting healthcare disparities and improving access for persons with intellectual developmental disabilities.

Workplace turnover is destructive to organizations both financially and operationally. The cost of selecting and replacing the wrong candidate for a position ranges from a few thousand to several million dollars. The goal for this correlational study was to assess the efficacy of an applicant test instrument for identifying key personality traits of direct service professionals (DSP) in the developmental disabilities arena which correlate with successful job tenure and decrease turnover cost. The theoretical framework that grounded this study was the poor job fit theory. The population studied consisted of DSP's hired by an organization in Glynn County, GA. Anonymous candidates' data were obtained by the screening test and stratified into 2 categories: successful employees (48 of those remaining in their position for a year or longer) and unsuccessful employees (48 of those remaining in their position less than 1 year),the secondary historical data from the test instrument were analyzed via a binary multiple logistics regression model. Since inferential statistical analysis results revealed no statistical significance (at the .05 level) of any of the 5 test category variables for predicting successful employment (a year or longer) or unsuccessful employment (less than a year), The analysis revealed that the Talent Acquisition - Healthcare Services Profile - Clinical Test is not a successful screening tool for the subject population. When organizations hire the right candidates for healthcare positions, beneficial social change can occur when a higher quality of care is delivered, making a positive contribution to the lives of the caregivers, patients, and patients' families.

The primary purpose of the current study was to determine which variables influence or change response allocation among mand topographies. The variables evaluated consisted of response effort, schedule of reinforcement (extinction), changes in concurrent schedules arrangements, and availability of visual stimuli (i.e., a communication card). The stability of responding was evaluated across more than one reinforcement context (escape, attention, and tangible) for each of the 2 participants. Finally, a concurrent schedules arrangement was used to evaluate response allocation among card touches, manual sign, microswitch touches, and vocalizations. Results of the evaluation suggested that response allocation varied across reinforcement contexts in baseline and when responding was challenged. However, variations in response allocation were not uniform across all challenges and reinforcement contexts. Problem behavior continued to be exhibited at low levels throughout the evaluation even when mild punishment procedures were implemented. These results are discussed in terms of changes in patterns of responding across reinforcement contexts, variability in response allocation among available response options, and persistence of responding when challenges are implemented.

Thesis (Ph. D.)--University of Washington, 1981. / Bibliography: leaves [135]-141.

Current literature on the developmentally disabled indicates they represent a large untapped labor pool that is significantly inhibited in its inclusion in the community. To address this unnecessary isolation, Right in the Community (RitC), a voluntary agency in Cobb County, Georgia, wanted to innovate its service offering by providing meaningful and sustainable work opportunities for those that are severely developmentally disabled. The Competing Values Framework (CVF) offers a dynamic and robust theoretical framework that has been adapted to explain many business factors in addition to organizational effectiveness. Based on a fourteen-month action research engagement at RitC, I adapted the CVF to concentrate on the dimensions of organizational focus, strategy formation and motivational traits to understand and guide service innovation in a voluntary organization. My research aided RitC’s development of a program to provide meaningful and sustainable work opportunities for those that are severely developmentally disabled. From a theoretical standpoint, I have added new knowledge on managing service innovation in voluntary organizations and adapted CVF for understanding and guiding service innovation in that particular context.

It is well known that individuals with disabilities have poor postsecondary outcomes. As a result, state and local education agencies are held accountable for the post-school achievements of their students with disabilities. The purposes of this study were (a) to determine the extent to which the transition components of Individualized Education Program (IEP) documents were compliant with the transition requirements of the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA), (b) to determine the extent to which the transition components of the IEP documents provided evidence of best practices, (c) to determine the effects that disability category and ethnicity had on compliance and practices as evidenced in the transition components of the IEP documents, and (d) to determine the relationship between overall compliance and best practices. The sample for the study included 212 secondary students who had a developmental disability, an emotional disorder, or a learning disability and who were African American, Caucasian, or Hispanic. Several types of analyses were conducted including descriptive, multiple logistic regression, and Spearman's rho correlation. The overall level of compliance was 2.03 (SD = 1.238). The range of possible scores was 0 - 5, with 0 indicating that none of the components of compliance were 100 percent compliant, and 5 indicating that all of the components were 100 percent compliant. The overall level of best practices as evidenced in the IEP documents was 4.89 (SD = 1.569). The range of possible scores was 0 - 8, with 0 indicating that there was no evidence of any of the practices in the IEP document, and 8 indicating that evidence of all the practices was found in the IEP document. A student's disability category and ethnicity were found to be influencing characteristics for increasing or decreasing the probability of an IEP document being compliant and/or having evidence of best practices. A statistically significant correlation of r = .429 was found between the overall levels of compliance and best practices, indicating that as the level of compliance increased, so too did the level of best practices evident in the IEP document.

This study aimed to investigate the differences in parenting stress, coping ways, and family functioning variables of families with a preschool-aged child with autism from Turkey and from the United States (U.S.) and to find out how the factors of parenting stress, coping ways, and social support predict the adaptability of the families in terms of cohesion and flexibility in families of children with autism from Turkey and from the U.S. For this study, only the mothers of a child with autism aged between two and seven years old are included from both cultures. Multivariate Analyses of Covariance (MANCOVA) were conducted for comparing the mothers from both cultures in terms of parentig stress, coping ways, and family functioning variables. According to these analyses, while mothers did not diffenentiate for parenting stress variable, both groups of mothers were found to use different coping ways and to show different family functioning characteristics. Turkish mothers were found to use more problem-focused coping ways than their American counterparts. Moreover, mothers from Turkey were found to report higher flexibility and enmeshment than mothers from the U.S. In order to find out the predictors of family cohesion and flexibility, series of Hierarchical Multiple Regression Analyses were conducted for both groups of mothers separately. These analyses revealed different predictors of family cohesion and flexibility for mothers of children with autism from Turkey and from the U.S. The differences in group comparison and regression analyses were discussed in accordance with the relevant literature.

The importance of early recognition and intervention for developmental delays is increasingly acknowledged, yet high rates of under-enrollment and 1-3 year delays in entry to the public early intervention system continue. Much research has examined developmental screening in health and child care settings, but less well understood is what prompts parents to identify problems and seek help for their children. This mixed methods study rooted in the Health Belief Model and Social Support Theory examined child, parent, family, and community level factors related to parent recognition (awareness and concern) and response (help-seeking and enrollment in services), including formal and informal sources of appraisal, informational, instrumental, and emotional support. Phase 1 examined responses from 27,566 parents of children ages 0-5 using the 2007 NSCH to quantify the type and number of parent concerns regarding their child's development in eight developmental domains, rates of enrollment in public intervention or private therapy, and factors associated with increased or decreased likelihood of concern or services enrollment. Regression analyses indicated that the likelihood of parent developmental concern and enrollment in public or private services differed by: child age, sex, health status, and type of developmental delay; parent and family characteristics (e.g. maternal race/primary language, reading to the child, etc.); pediatrician inquiry about concerns; insurance type; and child care type. Maternal age, education, marital status, and family structure and income were controlled for in all three models, but did not consistently contribute to likelihood of concern or services across outcomes. Phase 2 of the study utilized purposive, convenience, quota sampling via community agencies to invite 6 Spanish and 17 English speaking parents of high and low socioeconomic status to share their experiences in recognizing and responding to developmental concerns in their children (ages 2 weeks-4 ½ years) via 18 interviews and 2 focus groups. Participants also completed demographic, developmental status (PEDS), and knowledge of infant/child development (KIDI) questionnaires. About half of participants reported behavior (54%), social (50%), or speech concerns (54%); over a third had academic (38%), receptive language (42%), or self-help concerns (33%); and roughly 15% reported fine motor (17%) or gross motor (13%) concerns. Parents described in detail observations that first sparked developmental concerns, their decision-making processes in help-seeking and timelines for services; types and sources of social support; and facilitators and barriers related to recognition and help-seeking. The average score on the infant questionnaire was 50% correct and 65% on the prekindergarten questionnaire (range 32-91%). The results of this study describe child (sex, age, health status, type of delay), parent (age, education, race, ethnicity, home language, perception of susceptibility and severity of child delay), family (siblings, income, reading to the child, relative child care, social support), and community (pediatric practices, source of medical care, insurance, community support and referral coordination)factors related to early identification of developmental delays and access to public early intervention and private therapy services. Findings can be used to inform and improve community education, developmental screening, and Child Find outreach efforts. This study also contributes to our understanding of how parents interface with early intervention systems and both formal and informal parenting supports in the community, and identifies triggers for parental recognition and help-seeking for developmental delays and preferred entry points and pathways to assessment services. Recommendations include additional research on the causes, risk factors, co-morbidities, onset, and stability of diagnosis for developmental delays; continued development and universal implementation of valid and reliable screening and assessment tools, particularly for infants and toddlers; education campaigns to increase provider, parent, and public knowledge about developmental expectations, the importance of early intervention, and intervention options; further expansion of free, culturally appropriate programs to support child development for children with and without developmental delays and to strengthen formal and informal social supports for parents; improved referral coordination and timelines; and ongoing evaluation research to further demonstrate the efficacy of a variety of intervention service delivery models.

Children with autism exhibit deficits in joint attention initiations, which are crucial to development of language and social skills (Bakeman & Adamson, 1984; Rollins, Wambacq, Mathews, & Reese, 1998; Whalen, Schreibman, & Ingersoll, 2006). Showing an object to a communication partner is an example of a joint attention initiation. A systematic synthesis of interventions targeting joint attention initiations was conducted to guide the development of an intervention for teaching showing behavior. In this study, a video modeling intervention was implemented with four young children with autism. Sessions were conducted during play sessions with the researcher in each participant’s typical therapy context. Following a prescribed baseline, the video modeling intervention was implemented. The video provided a model of an individual showing a toy to a communication partner with narration explaining the four components of the showing behavior: gaining the partner’s attention, making eye contact, extending the toy toward the partner, and commenting on the toy. Following the first four intervention sessions, verbal feedback and practice was added with the video model. The effects of this intervention on accuracy (percentage of components completed) and frequency of showing behavior and generalization to a small group setting with peers were evaluated using a multiple baseline across design across participants. Results indicate that accuracy and frequency of showing behavior increased when the video modeling intervention was implemented. The acquisition, performance, and generalization of showing behavior in relation to the video modeling intervention are discussed. Implications for teaching joint attention initiations and directions for future research are presented. / text

Syftet med denna studie är att undersöka hur några lärare i grundsärskolans senare årskurser beskriver att de arbetar för att motivera sina elever till lärande och kunskapsutveckling. Studien baseras på fem, enskilda, strukturerade forskningsintervjuer med öppna frågor med lärare som arbetar i grundsärskolans senare årskurser, både inriktning träningsskola och grundsärskola. Resultatet analyseras med hjälp av Vygotskijs sociokulturella teoretiska perspektiv där motivation, lärande och kunskapsutveckling främst skapas i ett sammanhang, i samspel med andra människor, och i miljön runt omkring. Resultatet visar att samtliga lärare som deltog anser att arbetet med att motivera eleverna till lärande och kunskapsutveckling är viktigt men inte helt enkelt. De menar att undervisningen måste utgå från elevernas erfarenheter och intressen för att eleverna ska känna sig motiverade. Även tydlighet, lust och goda relationer nämns som viktiga faktorer i motivationsarbetet. Min studie visar att lärare i grundsärskolan menar att de kan påverka elevernas motivation till lärande och kunskapsutveckling genom att aktivt använda sig av olika motiverande strategier. Studien visar också att de motivationsfaktorer som forskningen lyfter fram utifrån elever i grundskolan stämmer väl överens med elever i grundsärskolan. Dessutom menar lärarna att motivationsarbetet kan vara viktigare och ha en större betydelse för dessa elever. Genom att ta tillvara den erfarenhet och kunskap som lärarna jag intervjuat delat med sig av är min förhoppning att andra kan ta till sig dessa strategier och på så sätt öka motivationen hos de elever de möter. / The aim of this study is to explore how some teachers who taught students in grade 6-9 in schools for students with intellectual disabilities describe their work to motivate their students in their learning process and knowledge development. The study is based on five individual, structured research interviews with open questions with teachers working with students with mild, moderate and severe intellectual disabilities in grades 6-9. The results are analyzed by Vygotskys socio-cultural theoretical perspective where motivation, learning and knowledge are mainly created in a context of interaction with other people and the environmental setting. The result shows that all participating teachers believe that efforts to motivate students in their learning process and knowledge development are important but it is easier said than done. They argue that teaching must be based on students' experiences and interests to make students feel motivated. Even clarity, desire and good relations mentioned as important factors in the motivational process. My study shows that teachers in schools for students with intellectual disabilities believe that they can affect students' motivation in their learning process and knowledge development by actively using different motivational strategies. The study also shows that the motivation factors the research emphasize on the basis of elementary school students correspond well with students in schools for students with intellectual disabilities. Further, the teachers believe that work of motivation can be more important and have a greater importance for these students. By taking advantage of the experience and knowledge of what the teachers shared in their interviews, my hope is that others will be able to embrace these strategies and thus increase the motivation of the students they meet.