Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians.

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The purpose of this study was to examine the relationship between professional characteristics and training of building level school administrators in Virginia and their knowledge of special education law. The research question was, to what extent and in what manner can school administrators' knowledge of special education law be explained based upon administrative position, school level, number of special education courses, number of school law courses, and experience? Knowledge of special education law was a total score on a survey instrument developed by Hines (1993) and updated to include eight areas of the 1997 Amendments to IDEA. A second part of the instrument collected information on professional characteristics and training. The survey was mailed to school building administrators throughout Virginia. The subjects in the study were randomly selected from Virginia public K-12 schools. Sampling was stratified by school level and wealth. The data were analyzed using a step-wise regression. Number of special education courses accounted for 4% of the variation in knowledge. Number of school law courses completed also entered into the analysis but had an inverse correlation with knowledge. The average knowledge score for administrators in this study was 18 or 56% correct. Identification of factors which have the greatest influence on principal knowledge of special education law can be used to plan effective preparation of school building administrators. School building administrators who are knowledgeable of special education law can ensure the protection of the rights of disabled students, build positive relationships within the community, and avoid costly litigation. / Ed. D.

This study examined the policy letters and verbal testimony transcripts submitted by interest groups to the United States Department of Education (USDE) in response to the proposed regulations pertaining to the implementation of the 1997 reauthorization of P. L. 105-17, Individuals with Disabilities Education Act (IDEA). Specifically, this study analyzed the emerging themes in the area of discipline. Responses were received from the following interest groups: (a) school administrators, (b) parents, (c) teachers, (d) state educational agencies (SEAs), (e) national educational organizations, and (f) members of the United States Congress. In addition to analyzing the emerging themes, the study compared these themes to ones found in the current literature and court cases.

The individuals with disabilities are disproportionately vulnerable to hazards. However, there is very little research inquiry focused on evacuation environments and the behavior of individuals with disabilities. The most widely applied computational method used to study how effective the built environment facilities emergency evacuations in individuals-based modeling. Current pedestrian evacuation models rarely include individuals with disabilities in their simulated populations due to there being very few empirical studies of the evacuation behavior of individuals with disabilities. As a result, the models do not replicate accurate patterns of pedestrian or evacuation behavior of a heterogeneous population, which results in the evacuation needs of individuals with disabilities being generally overlooked. To begin addressing this limitation, our research group at Utah State University (USU) has performed empirical research to observe the microscopic evacuation behavior of individuals with disabilities in heterogeneous population contexts. The purpose of this research was to: (1) develop and analyze evacuation curves to understand and assess evacuation strategies for heterogeneous populations, and (2) analyze the microscopic behavior of evacuees at exit doors necessary for developing credible and valid pedestrian and evacuation models. Doing so will contribute to evacuation models which replicate accurate patterns of pedestrian and evacuation behavior of heterogeneous populations, leading to the consideration of the evacuation needs of individuals with disabilities.

The objective of this dissertation was to study walking behaviors of pedestrian groups involving individuals with disabilities. To this end, large scale controlled walking experiments were conducted at Utah State University (USU) to examine walking behaviors in various walking facility types, such as passageway, right angle, oblique angle, queuing area, bottleneck, and stairs. Walking experiments were conducted over four days involving participants with and without disabilities. Automated video identification and semi-structured questionnaires were used to collect revealed and stated walking data. This study provided statistical analysis and models to study three different aspects of operational walking behaviors. Firstly, walking speed was examined as one of the most important behavioral variables. The differences in crowd walking speeds were carefully noted in analyzing the effects of adding individuals with disabilities and the impacts of different indoor walking facilities. Results showed that the presence of individuals with disabilities in a crowd significantly reduces the overall crowd speed. Statistical analysis also provided to compare walking speeds of pedestrian groups involving individuals with disabilities in different walking environments. Secondly, the dissertation proposed a framework to study the interactions of different pedestrian groups. Specifically, a mixed time headway distribution model was used to examine the time headway between followers and different leader types. In addition, the implications of interaction behaviors were studied based on the capacity of the queuing area behind the doorway. Results revealed that: (1) individuals with disabilities had significant effects on capacity reduction; (2) individuals with visual impairments and non-motorized ambulatory devices had the minimum capacity reduction effects in queuing area; and (2) individuals with motorized wheelchairs and individuals with mobility canes had the maximum capacity reduction effects in queuing area. Lastly, this study explored how a heterogeneous mix of pedestrians (including individuals with disabilities) perceive and evaluate operational performance of walking facilities. Both trajectory and survey data sources were used, and an ordered statistical approach was applied to analyze pedestrian perceptions. Results indicated that individuals with disabilities were less tolerant of extreme congested environments. Furthermore, analysis showed that the Level of Service (LOS) criteria provided in HCM does not follow the actual perceptions.

The purpose of this study was to identify educators' beliefs indicating the most preferred support for students with disabilities in the general education classroom setting. This study examined professional educators' attitudes regarding four student supports (motivation, accommodations/modifications, academic improvements, and social issues) for students with disabilities in the inclusive classroom. In addition, the goals of this study included public school educators' attitudes toward the aforementioned four areas of support, specifically within three student ethnic groups (Hispanic, African American, and Whites). The final goal of the study was to compare the attitudes of each of the organizational roles (administrators, general education teachers, special education teachers, and others) regarding motivation, accommodations/modifications, academic improvements, and social issues of students with disabilities participating in general education inclusive classrooms. The findings from this research indicate: 1. Educators perceive accommodations/modifications to be the most beneficial support to offer all students with disabilities in the general education inclusive classroom. 2. Educators perceive accommodations/modifications to be the most beneficial support to offer all students with disabilities in the general education inclusive classroom, regardless of ethnic origin. The results of this study reveal no difference in educators' attitudes within the three student ethnic groups. 3. Administrators, general education teachers, and the organizational role of other professionals in the school believe the primary focus for student support in the inclusive classroom should be on incorporating appropriate accommodations/modifications. 4. Special education teachers perceive academic improvements (differentiated instruction) as their first preference of student support for children with disabilities in the inclusive classroom. The overall findings in this study clearly reveal a pattern of educators' preferences regarding the four student supports for students in special education programs. Accommodations/modifications is the first focus of support for educators to implement, followed by academic improvements (differentiated instruction). The pattern continues with educators indicating motivation to be the third student support and social issues to be the fourth preference.

Siblings of individuals with disabilities are a unique group in disability-related careers. This group of professionals has been minimally explored in research. The researcher utilized qualitative methodology to explore perceptions of siblings with respect to their career and familial experiences in the disability field. Findings indicated that siblings entered the field for various reasons. Siblings shared positive and negative experiences from the disability field from both family life and career involvement. Siblings also provided information about the impact of their career on the role as a sibling. Finally, discussion and implications for practice and research are included.

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