From institution to community: A case study of the deinstitutionalization of persons with mental retardation.

摘要

Statement of the problem. Over the last few decades the total population of persons with mental retardation in state-operated public residential facilities (PRFs) has steadily declined. Today there are about 80,000 mentally retarded residents in these PRFs. The majority of these residents are either severely or profoundly retarded and many have multiple handicapping conditions.; The increased level of impairment among PRF clients poses serious challenges to the deinstitutionalization movement in the 1990s. In order to understand deinstitutionalization from a macro and micro perspective, this study traced the evolution of the movement from the early 1900s to the late 1980s and examined the determinants of placement recommendation at one of Massachusetts state schools for the mentally retarded.; Theoretical and methodological perspective. The conceptual framework for the study was rooted in the "ecobehavioral" model. This model emphasizes the matching of clients to residential environments appropriate to client need and functioning. In order to test this model, 100 clients recommended for community placement into either an ICF/MR-A or a supervised apartment were compared with 100 clients projected for continued stay in the state school for FY 1986-87. Key variables were used to build an empirical model for predicting community placement recommendation. Quantitative findings were compared with the findings from a series of interviews with key clinical and administrative staff at the state school.; Findings. The study findings indicated that clients were being recommended for placements in accordance with their presenting needs and characteristics. Specifically, medical need, length of institutionalization, and level of functional impairment were shown to be the primary determinants of recommended placement in or outside the state school.; Social policy implications. The results of the study suggest that while client-based factors play an important role in the placement decision, organizational- and political-based factors are also at play. Based on placement similarities among "stayers" and "leavers", the findings also suggest that many of the clients projected for continued stay at the state school may indeed be appropriated for placement in the community over the short-term. This raises important implications for more rapid phasedown of Massachusetts state schools and stronger federal/state incentives for community residential programming.