Bradley K. Hill

Prevalence and Implications of Maladaptive Behaviors and Dual Diagnosis in Residential and Other Service Programs

Maladaptive behaviors among mentally retarded people present service problems that act a serious barriers to their personal development and to opportunities for social integration. Given the seriousness of this issue, there is clearly a need to describe the extent and nature of problems or maladaptive behaviors, including the incidence of dual diagnosis of mental retardation and mental illness, among retarded individuals. This concern has often been expressed by service personnel in studies that assess their training needs (Bruininks, Thurlow, Nelson, & Davis, 1984). It is also evident from numerous research reports over a 50-year period that serious maladaptive behaviors among mentally retarded people limit their development of adaptive skills and their integration into schools, families, residential placements, employment, and social settings.

Factor structure of maladaptive behavior across the lifespan of persons with mental retardation

Data obtained on a sample of persons with mild to profound degrees of mental retardation (N = 8255) and ranging from birth to 98 years of age were factor analyzed to provide information on the structure of maladaptive behavior relative to age and degree of mental retardation. Using the Problem Behavior scales of the Inventory for Client and Agency Planning, two principal factors emerged for children with mild to profound degrees of retardation: Internalized Maladaptive and Externalized Maladaptive. For adolescents and young adults, a three-factor solution which varied by degree of retardation was most appropriate. For middle and older adults, three- and four-factor solutions were identified across all ages and degrees of retardation. Across all samples as many as six different types of dimensions were identified, indicating that the structure of maladaptive behavior may well be influenced by age and level of mental retardation.

Trends in Residential Services for People Who are Mentally Retarded: 1977–1982

This paper summarizes and compares the results of two national surveys of residential facilities for people who are mentally retarded. The results from 1977 and 1982 national surveys of all state-licensed, state-contracted, or state-operated facilities demonstrate a residential population of static total size but changing characteristics. Most notable were a decreasing number of children in out-of-home residential care and an increasing proportion of persons who are severely/profoundly handicapped in community-based residences. The number of smaller facilities increased substantially.

Factors related to job stability of direct-care staff of residential facilities for mentally retarded people.

Direct-care staff turnover has frequently been cited as a major problem in the management of both public and nonpublic residential facilities. This article reports on a follow-up study of over 100 direct-care staff one year after an initial interview. Staff members were employees of facilities in a national, stratified random sample of public and nonpublic facilities. Demographic, experiential, job satisfaction, geographical, and institutional factors related to occupational status at the time of the follow-up are reported.

Permanency Planning for Children and Youth: Out-of-Home Placement Decisions

This article advocates the extension of “permanency planning” in out-of-home placements to include those children and youth with developmental disabilities. It discusses permanency planning and notes its promise in improving the opportunities of all children and youth to grow up in a stable family environment. There is a need for major initiatives in this area: 78% of children and youth with developmental disabilities who are placed in long-term care have no such protections. Though some states currently operate programs according to the principles of permanency planning, significant changes in existing federal policy are recommended to require permanency planning in federally supported out-of-home care for all children, including those with severe disabilities.

Movement of developmentally disabled individuals among out-of-home residential facilities

This paper reported on the movement of a large (N = 2271) probability sample of the nations residents of public (PRF) and community (CRF) residential facilities for developmentally disabled children and adults. Estimates placed the national population at 217,410 in all facilities--73,709 in CRFs and 143,701 in PRFs--in the fall of 1978, when the sample was selected, although extrapolation from subsequent surveys suggest that the CRF numbers should be about 100,000. In the winter of 1979 direct care staff and administrators completed detailed information about each resident sampled, about themselves, and about their facilities. In 1980 they were asked if their residents had moved exactly one year later. Most residents (91%) had not moved; 1.3% had died; and about 8.5% had moved. Most moves featured greater integration into the community. Multivariate analyses indicated very little difference between moved and unmoved residents. Among moved subjects, three dimensions accounted for 62% of the common variance in placement status: (a) ability, (b) age, and (c) autonomy.

Discriminant analysis of intellectual ability groups with measures of adaptive behavior

Abstract Interest in the differential diagnostic capabilities of instruments designed to measure adaptive behavior has greatly increased in recent years. The purpose of the present investigation was to examine the differential diagnostic potential of the Scales of Independent Behavior (SIB). It was hypothesized that a multiple discriminant function analysis, with SIB cluster domain scores as independent variables, would lead to the correct group classification of 479 subjects (303 nonretarded, 54 educable mentally retarded (EMR) and 122 trainable mentally retarded (TMR) subjects). A linear combination of scores from the four SIB cluster domains explained 63% of the variance between groups and correctly classified 76% of the subjects by group membership. Findings support the use of the SIB as a significant contributor to the process of differential diagnosis, with concomitant implications for improving decision-making practices pertinent to classification for service and program placement purposes.

Habilitative Functions and Effects of Residential Services

Residential services are a major aspect of the habilitative experiences and training provided to persons with developmental disabilities. Data on the contemporary status and recent evolution of residential services for persons with developmental disabilities are presented along with identification of major concepts guiding changes in residential services. The manner in which these concepts relate to factors associated with treatment effectiveness are reviewed. The paper concludes with an examination of the available literature relating residential facility size and location to habilitation outcomes.

A Response to the GAO Report, “Disparities Still Exist in Who Gets Special Education”

A September, 1981, General Accounting Office (GAO) report concluded that among the central objectives of Public Law 94–142, the priorities of serving the previously unserved and the most severely handicapped “may have been realized.” However, data gathered on 401 school-age children who were part of a nationally representative sample of 2,271 individuals living in residential facilities for mentally retarded persons found that at the same time the GAO study was conducted, substantial numbers of sample members were not in school programs and 8% were in no day programs whatsoever.