Carl F. Calkins

Personal self-determination and moderating variables that impact efforts to promote self-determination

The purpose of this second article in the special topic issue from the National Training Initiative on Self-Determination is to provide detail with regard to how we understand the self-determination construct and to discuss moderator variables and how such variables impact the design and implementation of interventions to promote self-determination. Moderator variables are baseline factors that define subgroups with greater versus lesser intervention response. That is, they are factors that need to be taken into account, a priori, when designing interventions so that the intervention might address unique needs or characteristics of the people for whom the intervention is intended.

A social ecological approach to promote self-determination

This article describes a social-ecological approach for promoting and enhancing self-determination among individuals with developmental disabilities. A five-level model is presented, based on the interaction of person and environmental factors, that identifies a series of social mediator variables (i.e., social effectiveness, social capital, social inclusion), which the authors believe can successfully influence self-determination improvement efforts and enhance the efficacy of self-determination interventions. The impact of these mediators on intervention outcomes is considered within an interactional, social-ecological context of person-specific (individual characteristics) and environment-specific (provision of opportunities to make choices) contexts. This approach will guide the activities of a five-year National Training Consortium on self-determination involving five universities and funded by the U.S. Administration on Developmental Disabilities. The expected long-term outcomes associated with this initiative include improved self-determination options, greater social inclusion, and enhanced quality of life for people with developmental disabilities.

The Role of Social Competence in the Community Adjustment of Persons with Developmental Disabilities Processes and Outcomes

This paper reviews literature and professional practices which affect the community adjustment and adaptation of developmentally disabled persons. The role of social competence in determining satisfactory adjustments to community-based vocational and residential settings by adult persons with developmental disabilities is explored. The paper is divided into five sections. Section one briefly reviews the community adjustment status of persons with developmental disabilities. Section two discusses the construct of social competence in terms of definitional issues and social validation approaches within community-based vocational and residential settings. Section three describes three types of adjustment (behavioral, social, personal) that are considered important to successful community adaptation. Section four reviews the consequences that accrue to developmentally disabled persons from adjustment failure in vocational and residential settings. Finally, section five advocates for adoption of a social ecological approach in the study of community adjustment for developmentally disabled persons and presents a series of recommendations governing future efforts in this area.

Healthcare access and disparities in chronic medical conditions in urban populations.

Objectives The purpose of this study was to identify barriers and disparities in healthcare access and the factors associated with them in an urban population. Methods Eligible patients were consented and enrolled randomly from the inpatient internal medicine unit at Truman Medical Center, Kansas City, Missouri, a 250-bed hospital recognized for its broad range of acute and chronic diseases seen in its inpatient and outpatient care. They had one or more of the following chronic medical conditions (CMCs): congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypertension, chest pain, or cirrhosis. One hundred patients were interviewed regarding challenges they have encountered as consumers and their understanding of CMCs. Results Interview results indicate patients’ understanding of their CMC, the associated needs for self-management, and the potential health consequences are contributing factors leading to repeated visits to the emergency department. Conclusions Our study suggests that access to the following health-focused services has the potential to reduce the rate of emergency department visits and hospitalizations, morbidity, mortality, and the burden of cost. These services include adequate access to and utilization of primary care characterized by preventive care, early detection of acute illness, ongoing chronic disease management through easy access to primary providers, and adequate health literacy about CMC.

Lessons Learned in Scaling up Effective Practices: Implications for Promoting Self-Determination within Developmental Disabilities.

The publics increasing demands for greater accountability and a better return on investment from research supported by federal funding requires that organizations studying and solving problems in areas like health, education, disability, and child mental health document the impact of their work. Human service and educational professionals agree that implementation science is the missing link that connects research outcomes to the delivery of effective practices. Implementation science informs the scaling up of effective practices and addresses critical issues like social marketing, adoption decisions, capacity building, training, technical assistance, consumer participation and satisfaction, and long-term impact. There has been a dearth of evidence-based scaling up efforts in the field of developmental disabilities, particularly in relation to self-determination, yet the demonstrated benefits of self-determination justify its scaling up and broad-based diffusion. This article addresses the following topics: (1) definition and overview of scaling up, (2) seminal examples of practices that have successfully scaled up, (3) levers and incentives for scaling up self-determination, (4) generic scaling up issues, (5) the National Training Initiative in Self-Determination template for scaling up efforts to promote self-determination, and (6) concluding remarks. Significant issues addressed include the use of evidenced-based practices in promoting scaling up, reliance on nationally recognized metrics to operationally define self-determination and measure scaling up outcomes, and the need to focus on sustainability of disseminated and adopted practices. In this regard, the state summit approach to the scaling up of self-determination within developmental disabilities systems provides an exceptional opportunity for collaboration and the forging of working partnerships among important elements of the national developmental disabilities service delivery network.

The Missouri Developmental Disability Resource Center: A Web site responding to the critical need for information of parents with a child with a disability

One of the greatest problems for parents who have a child with a developmental disability is a lack of access to information. Parents have a critical need to learn the specifics of their child’s disability, the best treatment practices, and how the broader service delivery system works (Bradley, 1992; Rinck, Calkins, Green, & Stadler, 1986). The Missouri Developmental Disabilities Resource Center Web site [http://www.moddrc.com] was created as an innovative method of meeting the information needs of this underserved population. Challenges to the adoption of this innovative model are highlighted, and some options for addressing these issues are discussed.

Patterns of Psychotropic Medication Use Among Older Persons with Developmental Disabilities

While the prevalence of psychotropic drug use among older persons has been widely investigated, use of these agents in older persons with developmental disabilities has received little attention. We found this latter group to be prescribed more polypharmacy, antipsychotic, and antianxiety agents than were younger peers. Those who lived in more restricted residential settings (e.g., in skilled nursing facihties or in rural areas) had higher prevalence rates of antipsychotic drug use. In light of these findings, implications for policymakers are described. Measures to ensure the appropriateness of the prescription should be established. Better monitoring of polypharmacy and drug side effects should be initiated. Active programming should continue throughout the lifespan and training should be conducted for service providers.

Introduction to the Special Issue on Scaling Up Efforts to Promote the Self-Determination of People with Developmental Disabilities

Funding for articles in this special topic issue was provided by The U.S. Department of Health and Human Services, Administration for Families and Children, Administration on Developmental Disabilities through contract number HHS-2008-ACF-ADD-DD-OO81 awarded to the Institute for Human Development at the University of Missouri, Kansas City. Additional funding was provided by the U.S. Department of Education, Institute of Education Sciences grant number R324B070159 and the National Institute on Disability Rehabilitation Research grant number H133A031727, both awarded to the Kansas University Center on Developmental Disabilities, University of Kansas and Grant #H133B080009, awarded to the Rehabilitation Research and Training Center on Aging with Developmental Disabilities: Lifespan Health and Function, University of Illinois at Chicago. Opinions expressed herein, however, do not necessarily reflect the policy or position of the Administration on Developmental Disabilities or the U.S. Department of Education, and no official endorsement should be inferred. Correspondence should be sent to Carl Calkins, Institute for Human Development, University of Missouri, Kansas City, 215 W. Pershing, 6th Floor, Kansas City, MO 64108. E-mail: calkinsc@umkc.edu

A Comparison of Preschool and Elderly Community Integration/Demonstration Projects at the University of Missouri Institute for Human Development.

This article reviews two community integration projects at the University of Missouri-Kansas City Institute for Human Development which illustrate model development across the life-span. The preschool project is aimed at successfully mainstreaming preschoolers who are handicapped with their nonhandicapped peers through the use of trained volunteers. The elderly project is directed at increasing community integration of elderly persons with developmental disabilities by using nonhandicapped elderly volunteer companions. A description of each project, including project goals, methods, and preliminary results is provided to develop a frame of reference for a comparative discussion of the strengths, weaknesses, and outcomes in these community-based demonstration projects. Three common variables are discussed: use of trained volunteers, changes in attitudes and knowledge by nonhandicapped volunteers, and measured outcomes for clients. The costs and benefits of model development are summarized.

The implementation of postgraduate training programs through state and local resources

A profile of implementation strategies for funding postgraduate training programs using local or state resources is described. The need for those implementation strategies as well as basic principles for successful implementation is documented. Two programs are briefly described--a University Affiliated Program (UAP) in western New York and a UAP in Missouri--as the basis for generating implementation strategies. Finally a discussion is provided reviewing the strengths and weaknesses of these strategies.