Group Home Settings Research Articles

Editorial: The case for more action and more research into healthcare provision and health inequalities for people with intellectual disabilities

Accessible SummariesAge, Sex, and Constitutional Factors Whittle et al. identify how sex impacts mental health service use for women with intellectual disability. Sheerin et al. highlight how age‐specific needs are unmet due to service gaps. Burke et al. identify how age‐related healthcare risks for bone health are different for people with intellectual disability.Living and Working Conditions van den Bemd et al. reported the recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Skoss et al. report on the infrastructure of group home settings in Australia and how after COVID‐19 people living in these settings receive fewer healthcare services.Individual Lifestyle Factors Lunsky et al. explored the use of a ‘check‐in tool’ to support people with intellectual disability proactively.Community and Social Networks Donaldson et al. and Karas et al. highlight systemic issues with eyecare and examine the impact of peer‐to‐peer support and community advocacy on improving access to eye care. Schormans et al. examine the lack of social and community support for homeless youth with intellectual disability. Sykes et al. highlight reasonable adjustments and influence of community and familial attitudes in influencing breast and cervical cancer screening access. Earle et al. detail how broader societal and cultural norms affect menstrual health support. Heslop and Lauer found limited evidence about preventing specific avoidable causes of death in people with intellectual disability and outline the need for ‘whole population’ policy changes. Iffland et al. found that lung infections, choking, flu and heart problems were much more likely to be a contributing cause of deaths for people with intellectual disability. Hatton et al. explore the impact of COVID‐19 on access to health services and highlight severe disruptions during the pandemic which persisted and worsened postpandemic. Beeken et al. detail how stakeholder engagement in research and policymaking can improve health and address health inequalities.

How Has Therapeutic Recreation Supported Adults Living with Complex Disabilities? A Scoping Review on Recreation Therapy Practices across Service Settings

Persons living with complex disabilities may require support with activities of daily living to support their health and well-being, and leisure engagement is no exception. Recreation therapists can support individuals living with complex disabilities to live a higher quality of life. Unfortunately, there is limited understanding regarding the role of recreation therapy (RecT) in the care of individuals living with complex disabilities due to individualized client needs and the wide range of possible supports within the RecT scope of practice. This scoping review aimed to provide a comprehensive overview of the role of RecT with individuals living with complex disabilities across a variety of service settings. We searched seven electronic databases for articles that described the role of RecT in the care of people with complex disabilities since 2006. Two reviewers conducted title, abstract, and full-text screening, as well as forward, backward, and reference list citation searches. We analysed the findings using a narrative synthesis approach due to the heterogeneity of the included articles. Searches yielded 15 articles that met the inclusion criteria. These articles described RecT services across different settings (e.g., no defined setting, living with family or in group home, or living in institution/facility). A CTRS or CTRS/L was identified in one-third of the articles, while other articles described the presence of a therapeutic recreation specialist/professional or recreation therapist. One-third of the articles reported the use of one or more formal or standardized assessments. Nine articles reported a specific intervention, with the most common intervention type being related to fitness and sport (6 articles). Nine articles also reported patient/client outcomes, including outcomes related to emotional wellness (6 articles), physical health (5 articles), social outcomes (4 articles), autonomy and independence (3 articles), and community integration or inclusion (2 articles). This review discusses the role of RecT in supporting persons with complex disabilities. There is a need to explore and expand RecT delivery options to support people living with complex disabilities. While there seems to be evidence on the benefits of RecT for this population, there is limited literature available in some service settings (e.g., group home settings) which should be explored in future studies.

“Dual jurisdiction? It doesn’t work like that:” Practitioner decision-making at the juvenile justice and child welfare nexus

Researchers have studied juveniles at the intersection of child maltreatment and delinquency for several years. These studies capture the prevalence and outcomes of youth who navigate child welfare and juvenile justice systems, otherwise known as crossover youth. What is lacking in the literature is an investigation into the complex decisions and processes occurring at the intersection of these two systems. The current study draws on interviews (N = 15) with juvenile justice and child welfare practitioners operating in the St. Louis Metropolitan, Missouri area to examine the practices of those serving dual system youth. The findings demonstrate how the siloed nature of juvenile justice and child welfare influences decision-making in a way that routinely ‘transfers dual system youth back and forth between the two systems. Moreover, youth are routinely transferred in two related ways: 1) through practitioners in one system shifting responsibility to the alternative system in a way that “hands off” youth, and 2) through local bureaucratic practices and reform initiatives that shift responsibility to the alternative provider. Substantively, these findings hold implications for researchers studying crossover youth, practitioners in social service settings, and youth who are served through a widened net of punishment that is increasingly blurring the boundaries of child welfare needs (e.g., housing and mental health services) and mechanisms of control (e.g., surveillance and group home settings).

Factors associated with use of medication for behavioral challenges in adults with intellectual and developmental disability

Background/AimsPersons with intellectual or developmental disabilities and who exhibit challenging behaviors are often prescribed medication to control behavior. Little is known about the environmental factors that may be associated with taking these medications. Methods and outcomesThis study examined the association between individual and intermediate or environmental factors and the documented use of medication for clients with intellectual or developmental disabilities (IDD) who exhibit challenging behavior, using the 2014−15 National Core Indicators Adult Consumer Survey dataset. Results and conclusionsIndividual-level variables associated with a higher likelihood of taking medication for persons with IDD exhibiting challenging behaviors included being of younger age, male gender, having moderate or severe intellectual disability, being ambulatory, communicating verbally, having a behavioral plan, requiring support for behavioral challenges, and having a history of mental illness. Environment-level variables included infrequently eating out and having less everyday choice. This study found that restrictions in opportunities to make choices in their life was associated with a greater likelihood of being on a medication for persons with IDD who exhibit challenging behavior. Living in group home settings also increased the likelihood of medication use. A limitation of the study is a lack of information on why medications were prescribed and whether they were intended to treat the challenging behavior. ImplicationsThis work has important implications for health providers, as addressing malleable social factors may provide an avenue for reducing challenging behaviors without the need for medication.

Pain and distress in people with severe or profound ID in Victoria, Australia: Utility of behavioural assessment tools

Pain is often unrecognised and untreated in people with ID. In the absence of self-report, the use of structured behavioural pain assessment tools is best practice for identifying pain in this group. The aim of this research was to explore the utility of the Abbey Pain Scale and The Distress and Discomfort Assessment Tool (DisDAT) for use by residential support workers and family members of adults with severe or profound ID who live in group home settings. Participants were 17 residential support workers and six family members and provided information about 23 adults with severe or profound ID. Participants completed one of the two tools every 2 weeks for 3 months and indicated whether they thought the individual was content, distressed or experiencing pain. In total, 131 completed tools were returned (80 Abbey Pain Scales and 51 DisDATs). The results indicated that higher total pain scores on the Abbey Pain Scale appear to correspond to a report of pain or distress. A range of behaviours from the Abbey Pain Scale were reported to be present when the individuals with ID were reported to be in pain, such as vocalisations and facial expressions, but these and other behaviours were also observed when the individual was reported to be distressed. Similarly, using the DisDAT, there were behaviours that were present when individuals were reported to be experiencing pain which, for the most part, were also reported when individuals were reported to be distressed. Although neither of the tools appeared to distinguish between pain and distress, it is evident that both tools have utility in the assessment of distress. This is a promising finding as it may be that the tools can be used to signal that an individual with severe or profound ID is distressed and that pain is a factor to be considered.

Youth, prosociality, and child welfare: an investigation of positive peer influence and youth prosocial behavior in group home care

Only a limited number of studies have investigated the association between positive peer influence and youth prosocial behavior in child welfare. None of such studies has been completed in group home setting for youth. This study aimed to examine if positive peer influence is associated with (or predicts) youth prosocial behavior. The Ontario Looking After Children (OnLAC) database was used for analysis. There were 875 participants (males and females) aged 10 to 17 who were surveyed in group homes in 2010–2011. A full regression analysis found strong association between positive peer influence and youth prosocial behavior. The main predictive effect of gender was observed to be modestly associated with youths’ prosocial behavior as demonstrated by the adjusted and unadjusted main predictive effects (OR = .67 and .63). There was a significant positive peer influence by group home size interaction and its moderating effect was such that positive peer influence significantly predicted youths’ prosocial behaviors in small homes (incremental ORs of 2.00 and 4.49), but not in large homes. Findings show that positive peer influence informs youth prosocial behaviors in group homes.

An evaluation of token and monetary reinforcement on physical activity exhibited by adults with intellectual disabilities in a group home setting.

An evaluation of token and monetary reinforcement on physical activity exhibited by adults with intellectual disabilities in a group home setting.

Applying Genomic Epidemiology to Characterize a COVID-19 Outbreak in a Developmentally Disabled Adult Group Home Setting, Arizona.

Individuals living in congregate settings, including those in group homes, have been disproportionately impacted by COVID-19 and may be at increased risk of exposure or infection due to underlying illness. In mid-May 2020, local public health officials responded to an outbreak of COVID-19 among staff and residents associated with a multi-residential group home that provides care for adults with intellectual and developmental disabilities. Samples were collected at 16 of the homes. In four of the homes all the residents tested positive, and in the remaining 12 houses where samples were collected, all residents tested negative. Of the 152 individuals tested, 15/58 (25.9%) residents and 27/94 (28.7%) staff were positive for SARS-CoV-2, including eight hospitalizations and four deaths. Phylogenetic analysis of genomes from this outbreak in the context of genomes from Northern Arizona shows that very few mutations separate the samples from this outbreak. A potential transmission network was developed to illustrate person-place epidemiologic linkages and further demonstrates the dynamic connections between staff and residents with respect to each group home location. Epidemiologic and genomic evidence correlate, and suggest that asymptomatic infected staff likely introduced and spread COVID-19 in this setting. Implementation of public health prevention measures alongside rapid genomic analysis can help guide policy development and guide management efforts to prevent and mitigate future outbreaks.

Trauma responsive care model: An Aotearoa New Zealand research informed practice model for residential group homes

INTRODUCTION: This article presents a research-informed model of trauma responsive care for use in residential care practice social work settings with children and young people in Aotearoa New Zealand. The model was developed from a qualitative project which sought to address the research question “Does the quality of relationships with staff members have a positive impact on outcomes for children who reside in group home settings?”METHODS: Using semi-structured, in-depth interviews, eight children were interviewed regarding their experience of relationships while living within supervised group homes (SGHs). In order to gain multiple perspectives on this topic, six biological parents and two legal guardians of children were interviewed and focus group discussions were held with staff members from three SGHs. Thematic analysis was used to identify key themes identified from the findings.FINDINGS: Five dominant themes were identified from the children’s and parent’s interviews. The central theme was the importance of relationships; that relationship is the key when working with children who have experienced trauma. Children who have experienced trauma need to feel safe in the context of relationships and benefit from bottom-up interventions in order to heal from their traumatic experiences.CONCLUSION: A research-informed model of trauma responsive care was constructed from study findings informed by two principal bodies of knowledge: (1) attachment theory; and (2) neuroscience. The resultant trauma responsive care model provides a framework of strategies for anyone working with children in residential care settings who have experienced trauma and/ or attachment difficulties.

Response to the COVID-19 Pandemic Among Posthospital Brain Injury Rehabilitation Providers

Rehabilitation after significant acquired brain injury (ABI) to address complex independent activities of daily living and return to family and community life is offered primarily after initial hospitalization in outpatient day treatment, group home, skilled nursing, and residential settings and in the home and community of the person served. The coronavirus 2019 pandemic threatened access to care and the health and safety of staff, persons served, and families in these settings. This article describes steps taken to contain this threat by 7 leading posthospital ABI rehabilitation organizations. Outpatient and day treatment facilities were temporarily suspended. In other settings, procedures for isolation, transportation, cleaning, exposure control, infection control, and use of personal protective equipment (PPE) were reinforced with staff. Visitation and community activities were restricted. Staff and others required to enter facilities were screened with symptom checklists and temperature checks. Individuals showing symptoms of infection were quarantined and tested, as possible. New admissions were carefully screened for infection and often initially quarantined. Telehealth played a major role in reducing direct interpersonal contact while continuing to provide services both to outpatients and within facilities. Salary, benefits, training, and managerial support were enhanced for staff. Despite early outbreaks, these procedures were generally effective, with preliminary initial infections rates of only 1.1% for persons served and 2.1% for staff. Reductions in admissions, services, and unanticipated expenses (eg, PPE, more frequent and thorough cleaning) had a major negative financial effect. Providers continue to be challenged to adapt rehabilitative approaches and to reopen services.

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Thematic section on child and youth complex trauma: Promoting social courage to shift practices, policies and research

Individualized Apartment Accommodation for People With Intellectual Disability: Protocol for a Qualitative Study Examining the Well-Being and Support Outcomes Linking Housing and Health.

BackgroundUnderstanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting.ObjectiveThe aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided.MethodsQualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings.ResultsAs of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020.ConclusionsThis paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them.International Registered Report Identifier (IRRID)DERR1-10.2196/18248

Promoting Physical Activity in Group Home Settings: Staff Perspectives through a SWOT Analysis.

Purpose: The aim of the study was to investigate perceptions of staff about the promotion of physical activity (PA) in selected group residences of Hong Kong (HK), some of which had experienced a multi-component PA program. Method: Focus group interviews with nineteen staff members from four group homes (two of which received the program) were conducted. Findings: A SWOT analysis provided important insights into residential staff views about key influences on the quality of PA programs for residents with intellectual disabilities (ID). Positive (strengths and opportunities) and negative (weaknesses and threats) influences were identified. They were associated with characteristics of residents, staff, and group residence. Increasing age and low motivation are impediments to PA engagement of adults with ID. Staff competence and prior unsuccessful experience in promoting PA are also implicated. Conclusion: The PA program quality is mediated by the quality of staff interpersonal interactions with their clients and their commitment in encouraging such adults with ID to join and persistent in PA as well as staff seeking external resources and support as well as using initiative to adapt PA promotion activities in their specific group residential context.

Token‐economy‐based contingency management increases daily steps in adults with developmental disabilities

AbstractAdults with developmental disabilities are less likely to meet physical activity guidelines than typically developing counterparts. Contingency management (CM) interventions increase physical activity in sedentary adults. The current study systematically replicated previous research among sedentary adults diagnosed with developmental disabilities living in a residential group home, using a token economy in the context of a CM intervention. Using a changing criterion design, participants (N = 4) were given tokens contingent on meeting increasing step goals over 8 weeks, tracked via a Fitbit Flex™. CM increased the number of steps substantially for three of four participants. These findings extend previous research supporting the use of token‐based CM interventions for increasing daily steps among individuals with developmental disabilities. Because the current study was conducted in a residential group home setting, it may offer a long‐term sustainable approach to improving the health of some individuals living with developmental disabilities.

Ableism and its discontents: Food as a form of power, control, and resistance among disabled people living in U.S. Institutions

Food insecurity is a significant problem in the U.S., disproportionately impacting people with disabilities. Yet, little scholarship exists about disability and food, particularly on people in institutions, with even less from disabled people’s perspectives. This article presents two ethnographic examples from different types of “community placements.” These first-hand accounts by disabled people explore the shape that food insecurity takes in different institutional group-home settings, and how one balances the competing needs of health and freedom. They demonstrate how notions of power, control, and resistance, and underlying ableist assumptions about “appropriate bodies,” play out on a day-to-day basis. They highlight an acute awareness by the occupants themselves of these power dynamics and thus, how cautious they were to be critical of their care providers. They further document how severely disabled people can, and cannot, exercise control over what, when, where, and with whom they eat—with implications for both nutrition/health and sociality/inclusion.

Qualitative evaluation of a physical activity health promotion programme for people with intellectual disabilities in a group home setting.

There is a lack of health promotion programming designed to change the physical activity environment of the group home setting. The Menu-Choice programme assists staff in creating physical activity goals alongside residents with intellectual disabilities and provides strategies to incorporate activity into the group home schedule. The purpose of this study was to complete a process evaluation of Menu-Choice utilizing qualitative methods. Twelve participants, who completed a 10-week pilot intervention (n=7 staff, mean age 42; n=5 residents, mean age 52), participated in face-to-face interviews. Participants represented five group home sites involved in the intervention. Meta-themes included: (i) Programme training, (ii) Programme implementation, (iii) Programme physical activity, (iv) Programme barriers, (v) Programme facilitators and (vi) Programme feedback. Changes in programme training and simplified programme materials are needed to accommodate identified barriers for implementation. The importance of obtaining increased agency support and policy change is highlighted.

Reducing attention maintained bizarre speech in an adult woman.

Differential reinforcement for alternative behaviors and extinction for bizarre speech were used as a behavior intervention protocol for a 45-year-old woman living in a residential group-home setting. A functional behavior assessment consisting of behavioral interviews and direct observation suggest

Formative evaluation on a physical activity health promotion program for the group home setting

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.

Activities of daily living and transition to community living for adults with intellectual disabilities

Background: As adults with intellectual disability (ID) in Ireland move to the community from residential settings, the changed environment is intended to increase opportunities for occupational engagement, autonomy and social relationships. It is important to consider how increased resources and opportunities available within the community can be optimized to promote engagement and quality of life.Aims: This paper investigates if and how ADL and IADL performance of people ageing with ID is related to place of residence.Methods: ADL and IADL performance of adults with ID in Ireland across different living situations was analyzed using descriptive and bivariate analysis of data collected from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS TILDA).Results: Greater ability to perform ADL and IADL was noted in those living in independent or community group home settings when compared to traditional residential settings. Place of residence was strongly related to ADL and IADL performance.Conclusion and significance: Given that people with ID will likely require physical and social supports to complete ADL and IADL when transitioning to community living from residential settings, an occupational justice perspective can inform occupational therapists working with people with ID, facilitating successful transitions to community living.

Short-Term Impact of a Teen Pregnancy-Prevention Intervention Implemented in Group Homes

PurposeYouth living in group home settings are at significantly greater risk for sexual risk behaviors; however, there are no sexual health programs designed specifically for these youth. The study's purpose was to assess the effectiveness of a teen pregnancy-prevention program for youth living in group home foster care settings and other out-of-home placements. MethodsThe study design was a cluster randomized controlled trial involving youth (N = 1,037) recruited from 44 residential group homes located in California, Maryland, and Oklahoma. Within each state, youth (mean age = 16.2 years; 82% male; 37% Hispanic, 20% African-American, 20% white, and 17% multiracial) in half the group homes were randomly assigned to the intervention group (n = 40 clusters) and the other half were randomly assigned to a control group that offered “usual care” (n = 40 clusters). The intervention (i.e., Power Through Choices [PTC]) was a 10-session, age-appropriate, and medically accurate sexual health education program. ResultsCompared to the control group, youth in the PTC intervention showed significantly greater improvements (p < .05) from preintervention to postintervention in all three knowledge areas, one of two attitude areas, all three self-efficacy areas, and two of three behavioral intention areas. ConclusionsThis is the first published randomized controlled trial of a teen pregnancy-prevention program designed for youth living in foster care settings and other out-of-home placements. The numerous significant improvements in short-term outcomes are encouraging and provide preliminary evidence that the PTC program is an effective pregnancy-prevention program.