Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.
The following article reviews the current literature addressing toilet training individuals with autism and other developmental disabilities. The review addresses programs typical to toilet training the developmental disability population, most of which are modeled after the original Foxx and Azrin [Azrin, N. H., & Foxx, R. M. (1971). A rapid method of toilet training the institutionalized retarded. Journal of Applied Behavior Analysis 4, 89–99; Foxx, R. M., & Azrin, N. H. (1973). Toilet training persons with developmental disabilities: A rapid program for day and nighttime independent toileting. Harrisburg, PA: Help Services Press] rapid toilet training methods. Components of such programs are isolated and described in their contribution to toilet training models. Studies are then reviewed and compared for participant and study characteristics. Individual studies validating toilet training programs are then discussed in light of their program components and efficacy. Shortcomings to currently available programs are highlighted and future areas of study are suggested.
Despite change toward more individualized support, group homes are likely to remain for people with severe intellectual disability. As such, the search continues for ways to determine and maintain the quality of these settings. This article draws on in-depth qualitative analysis of participant observations conducted over 9-12 months in seven group homes for 21 people with a severe and profound level of intellectual disability. It explores the conceptualization of good outcomes and support for this group in terms of their quality of life and staff practices. The qualitative indicators of good outcomes for this group using quality of life domains can be used by auditors, community visitors, funders, advocates, or family members to guide observation and judgements about group homes.
Large-scale reviews of research in deinstitutionalization and community living were last conducted about 10 years ago. Here we surveyed research from 1997 to 2007. Articles were included if the researchers based the study on original research, provided information on the participants and methodology, compared residential arrangements for adults with intellectual disability, and were published in English-language peer-reviewed journals. Sixtyeight articles were found. In 7 of 10 domains, the majority of studies show that community-based services are superior to congregate arrangements. These studies provide more evidence of the benefits of deinstitutionalization and community living and continue to indicate variability in results, suggesting that factors other than the basic model of care are important in determining outcomes.
Societal views on the rights of persons with disabilities have changed over the last few decades. Evolutions are reflected in international conventions, as the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) developed to guide policies and practices. However, knowledge about the implementation of the Convention remains limited. In addition, another important construct, quality of life (QOL), has gained increasing prominence in the field of disability. This construct has evolved from a sensitizing notion to a measurable construct that provides a framework to assist organization and systems transformation.
The present research focused on the implementation of the UNCRPD articles to assist organizations and systems in the support provision practice. The study is a preliminary step toward implementation, looking for consensus on cross-culturally referenced indicators of QOL outcomes. The methodology chosen to find cross-cultural consensus was an international modified Delphi study to determine the relation and alignment among UN Convention articles, QOL domains, and measurable indicators. A total of 153 experts (self-advocates, professionals, family members, academics, and experts in law) from 11 countries evaluated the indica-
tors. The Delphi study resulted in finding at least one indicator per convention article/QOL domain pairing. Thus, an international pool of cross-cultural indicators was identified to assist the implementation of the Convention articles. The study provides a first exploration of using the QOL framework to implement the UNCRPD. Although international indicators have been found per convention article/QOL pairing, challenges exist in regard to the further translation process into practice between policy and research, and vice versa. Efforts should continue to determine not only the relations among convention articles and measurable indicators, but also associated strategies for realizing the aim of the Convention in local policies and practices.