Provision of community residences to people with developmental disabilities: Why some states are succeeding.

摘要

Over the course of the last quarter century, public policy determining residential services for people with developmental disabilities (DD) has shifted from providing institutional care to community-based services. However, there are great variations in the extent to which states have implemented the policy of deinstitutionalization and development of community residential alternatives. This dissertation explores the question of why these variations exist and the means by which some states have been able to narrow the gap between policy and practice.; Factor and regression analyses were performed on a 1988 data set of economic, social, and demographic variables assembled from reliable secondary sources confirming that neither the proportion of the population living in DD community residences nor in institutions is associated with the wealth of a state. Regressions showed that federal funding, and in particular the Medicaid ICF/MR (intermediate care facility for the mentally retarded) program, is a strong predictor of the extent to which states provide DD residential services.; Telephone interviews were conducted with both DD administrators and executives of the Arc in the ten leading states in terms of the proportion of the population residing in community residences. From this group, three states--New Hampshire, Rhode Island, and Wisconsin--each in a different stage of developing community residential services, were identified for further case study. In addition, Iowa, which, in 1988 had the largest proportion institutionalized, was studied.; Court orders have been the single most important reason that states have established community residences for people with developmental disabilities. However, it is apparent that political culture also plays a role. Strong leadership in DD services and some central control over Medicaid-financed community residential programs are also critical. States which are developing extensive community residential services have usually either closed or are in the process of closing most of their institutions. Finally, states which are leaders in providing DD community residences are generally no longer establishing group homes but have moved, instead, to non-facilities-based programs.