John F. Kosciulek

Defining social inclusion of people with intellectual and developmental disabilities: An ecological model of social networks and community participation §

Social inclusion is an important goal for people with intellectual and developmental disabilities, families, service providers, and policymakers; however, the concept of social inclusion remains unclear, largely due to multiple and conflicting definitions in research and policy. We define social inclusion as the interaction between two major life domains: interpersonal relationships and community participation. We then propose an ecological model of social inclusion that includes individual, interpersonal, organizational, community, and socio-political factors. We identify four areas of research that our ecological model of social inclusion can move forward: (1) organizational implementation of social inclusion; (2) social inclusion of people with intellectual and developmental disabilities living with their families, (3) social inclusion of people along a broader spectrum of disability, and (4) the potential role of self-advocacy organizations in promoting social inclusion.

Relationship of family schema to family adaptation to brain injury

The relationship between family schema and family adaptation to brain injury was investigated. Participants were 87 primary caregivers of persons with brain injuries in Wisconsin who are part of a comprehensive, longitudinal study of family adaptation to having a member with a brain injury. Stepwise multiple regression of variables measuring family schema on family adaptation indicated that manageability and meaningfulness were predictive of family adaptation. Thus the hypothesis that family adaptation can be predicted from variables measuring family schema was supported. Family intervention and research implications are discussed.

Structural Analysis of the Consumer-Directed Theory of Empowerment

This investigation tested the hypothesized structural model of the consumer-directed theory of empowerment (CDTE). Participants were 159 consumers with disabilities who were receiving services at a Clubhouse Model community rehabilitation program (CRP) in a large midwestern city. Data were gathered through participant completion of a self-report questionnaire designed to assess the level of consumer direction in the CRP service provision process, as well as the level of participant community integration, empowerment, and quality of life. Structural equation modeling techniques were used to test the structure of the CDTE. Although model respecification was necessary to obtain adequate fit, results provided support for the hypothesized CDTE structure. Additional longitudinal data on larger samples are required to further assess the structure of the CDTE and enhance its usefulness to rehabilitation counselors for service delivery, program evaluation, and policy analysis applications.

Stress, appraisal and coping following mild traumatic brain injury

Purpose: The present study tested a portion of the stress, appraisal and coping (SAC) model proposed by Godfrey, Knight and Partridge. Methods: Using data gathered from 94 individuals who had sustained a traumatic brain injury, path analysis results indicated that a model based on Godfrey et al.s SAC model did not fit the sample data. Based on relevant statistical output, previous research and theory, a re-specified model was tested. Results: The final model was shown to meet common statistical measures for establishing model fit. The final model indicated that higher levels of perceived stress were predictive of higher levels of self-reported depression, higher levels of depression were predictive of lower levels of dispositional hope and dispositional hope was predictive of increased life satisfaction and work productivity. Conclusions: The present findings hold implications for both research and for clinical practice. The findings do suggest the need for additional research to further clarify factors that contribute to emotional adjustment following traumatic brain injury.

Structural Equation Model of the Consumer-Directed Theory of Empowerment in a Vocational Rehabilitation Context

One model that is potentially useful in the rehabilitation field is the Consumer-Directed Theory of Empowerment (CDTE; Kosciulek, 1999a). However, additional empirical data are needed to further develop and critically evaluate the CDTE. To accomplish this task, the purpose of this study was to test the hypothesized structural model CDTE in a vocational rehabilitation context. Using data on 721 vocational rehabilitation consumers drawn from the Longitudinal Study of the Vocational Rehabilitation Services Program database, structural equation modeling results provided support for a revised version of the CDTE. Findings provide data useful for guiding future CDTE-related research and practice.

Differentiation of three brain injury family types

The purpose of this study was to advance the research on brain injury families by differentiating between families with one of three family types. Participants were 76 primary caregivers of individuals with brain injuries recruited through the brain injury association of a Southern state in the US. Families were classified as Balanced (n = 33), Mid-range (n = 24), or Extreme (n = 19) type using the Family Adaptability and Cohesion Evaluation Scales II (FACES II). Three two-way discriminant analyses were performed using eight variables to discriminate between the family types. Results indicated that the affective and cognitive functioning of the family members with the brain injuries, family adaptation, and primary caregiver age were the strongest factors that differentiated the three family types. These findings suggest that Balanced, Mid-range, and Extreme families are distinct subgroups within the brain injury family population. The results, thus, may be beneficial for improving the efficacy of family intervention following brain injury and facilitating the development of long-term family supports.

Ethnic Differences in Parental Beliefs of Attention-Deficit/Hyperactivity Disorder and Treatment

Objective: A survey study was conducted to explore ethnic differences in parental beliefs about the causes and treatments of ADHD and whether these beliefs predicted treatment preference. Method: Ethnically diverse parents of 5- to 12-year-old children with ADHD (n = 58) and without ADHD (n = 61) completed a questionnaire developed by the authors that asked them to rate statements about biological and psychological causes of ADHD and their beliefs about medication and behavioral treatment. Results: There were no significant ethnic differences in how parents viewed causes of ADHD. Beliefs about behavioral treatment revealed significant group differences, as ethnic minority (e.g., African American, Latino) parents rated behavioral treatments more positively than did Caucasian parents. Beliefs about biological causes predicted medication treatment and combined treatment use. Conclusion: Dissemination of information regarding evidence-based treatments should be given special attention as it may influence parents’ decisions to pursue specific treatments based on their beliefs. (J. of Att. Dis. 2010; 13(6) 584-591)

Implications of Consumer Direction for Disability Policy Development and Rehabilitation Service Delivery

People with disabilities too often are denied the opportunity to exercise control over the most basic aspects of daily life. Consumer direction (CD) is a philosophy and an orientation whereby informed consumers have control over the policies and practices that directly affect their lives. It is a mechanism by which individuals with disabilities can develop the skills to take control of their lives and their environment. The primary tenet of this paper is that increased CD in disability policy development and rehabilitation service delivery will lead to increased community integration, empowerment, and quality of life for people with disabilities. In this paper, the concept is presented as a guide for disability policy development and rehabilitation service delivery. Consumer choice, the current status of people with disabilities in U.S. society, and the need for CD are discussed. An overview and definition of CD are presented, and the underlying assumptions are described. A conceptual framework, issues surrounding measurement and operationalization, and five examples of CD are presented. Finally, the implications of CD relative to consumer and service provider roles, the empowerment of people with disabilities, and potential benefits are discussed.

A Multidimensional Approach to the Structure of Consumer Satisfaction with Vocational Rehabilitation Services

The purpose of this investigation was to examine the dimensions underlying consumer satisfaction with vocational rehabilitation services. Participants were 223 consumers who received services from a state rehabilitation agency in a midwestern state. Data were gathered via mail survey through participant completion of a self-report questionnaire. A two-dimensional configuration of 14 consumer satisfaction stimuli yielded the following dimensions: (a) satisfaction related to case management versus employment and (b) satisfaction related to consumer choice versus customer service. Findings suggest that consumers view satisfaction as a multidimensional construct. Implications for the measurement of consumer satisfaction and use of consumer satisfaction data in vocational rehabilitation program evaluations are discussed.

Implications of depression in rheumatoid arthritis: do subtypes really matter?

OBJECTIVE To examine depressive disorders and health status in patients with rheumatoid arthritis (RA), controlling for potential confounds. METHOD Subjects (n = 426) completed measures of depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and health status (Arthritis Impact Measurement Scales 2 [AIMS2]), via cross-sectional survey. Subjects (n = 299) with few depressive symptoms (CES-D < or = 10) were not evaluated further. Subjects with CES-D > or = 11 were interviewed using the Primary Care Evaluation of Mental Disorders to diagnose major depressive disorder (MDD; n = 46), dysthymic disorder (DD; n = 21), or minor depressive disorder (MND; n = 18). RESULTS Regression analyses examined differences between the depressive disorders on AIMS2 subscales. Health status scores were similar between the depressive disorder subcategories; significant differences were found between MDD and MND on AIMS2 Physical scores and MDD and DD on AIMS2 Symptom scores. CONCLUSION Regarding health status, presence of depression itself seems to overshadow differences between depression subtypes; antidepressant treatments/referrals for persons with concomitant RA and any depressive disorder subtype appear warranted.