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The participant is a 61-year-old woman, diagnosed with a generalized anxiety disorder and profound intellectual disability who was referred to a behavior-disorders clinic, to increase cooperation with routine dental procedures. I used a behavioral treatment package consisting of stimulus fading, differential reinforcement, and extinction to establish tolerance of, and cooperation with, routine dental procedures. Results showed that cooperative responding varied throughout the progression of teaching the prerequisite steps (sitting in a chair, sitting in a variety of chairs, then working on sitting in the dental chair). However, by the end of the study, the participant engaged in the behavior of open mouth for 30 s and tolerated/cooperated with the experimenter using a plastic visual inspection tool for 30 s. Further research should evaluate the effectiveness of a similar treatment package to develop a more streamlined and systematic framework to improve compliance and tolerance.

The Individual with Disabilities Education Act (IDEA) mandates that a transition plan be in place for students with disabilities by the time they turn 16. This plan aims to facilitate the child’s movement from high school “to post-school activities, including postsecondary education, vocational education, integrated employment (including supported employment), and continuing and adult education, adult services, independent living, or community participation,” (20 U.S. C. 1401 (34)). Despite these mandates, studies have shown that youth with disabilities are having poor post-school outcomes when compared to their peers (Lindsay at el., 2019; Lipscomb et al., 2018; Rowe et al., 2021; Test, Mazzotti et al., 2009). Occupational therapy practitioners (OTP) are well situated to collaboratively work as part of the Individualized Education Plan (IEP) team with transition planning (Kardos & White, 2005). The OTP is distinctly qualified to assist the IEP team with developing goals, improving activities of daily living, assisting with staff and student training, and determining student occupational interests. Transition interventions are a widely variable and unregulated area of practice for school-based OTPs. Opportunity Café represents a solution to the problem of poor post-school outcomes for students with intellectual and developmental disabilities (IDD). This transition intervention applies evidenced based practices to guide education teams, students, and families through the transition planning process. It fulfills a need mandated by the IDEA for IEP teams to support the transition needs of students with IDD and provides an inclusive workplace to facilitate growth. Opportunity Café is a dynamic community-based replicable program that can impact student success. Program guidelines, methods for program dissemination, evaluation, and funding are discussed.

BACKGROUND/RATIONALE: Persons with intellectual and developmental disabilities (pIDD) face barriers to quality health care, including psychiatric care, that result in worse health outcomes. While the mental healthcare community is increasing attention towards the psychiatric needs of pIDD, there continues to be a deficit of knowledge regarding psychiatric conditions, including suicidality. Engaging in community-based participatory research (PAR) with pIDD is the ethical way to address these deficits. An academic researcher (AR) must first educate herself on lessons from disability rights activism and disability bioethics. OBJECTIVE: Apply the intertwining history and principles of disability rights movements and disability bioethics to lessons learned from previous PAR with pIDD in order to propose a PAR project that aims to alleviate knowledge deficits regarding suicidality in pIDD. METHODS/APPROACH: Historical research will focus on landmark texts in disability rights movements and disability bioethics. Lessons learned from previous PAR is mostly obtained from reflexive accounts on behalf of the AR and outside of psychiatry. Analyzing these sources will result in a proposal of six principles that can guide the AR when ethically engaging in PAR with pIDD. RESULTS: The AR must understand the history of society valuing non-disabled lives over disabled lives, inclusive of pIDD, and the social model of disability as it relates to the human variation model. When engaging with pIDD, the AR can question the traditional definition of vulnerable populations, challenge the group to progress beyond informed consent, continually support a capacity-building approach to research and power-sharing skills, and embrace empowerment to enact political change. DISCUSSION: ARs, pIDD, and pIDD advocates must not accept the dearth of knowledge regarding psychiatric conditions, including life-threatening suicidality, in pIDD. The medical community should prioritize PAR with persons with pIDD to elucidate psychiatric conditions in pIDD that result in more efficacious and compassionate treatment. This proposal outlines major principles through which the AR can move forward ethically by engaging in PAR with pIDD. / Urban Bioethics