VR Employment Outcomes of Individuals with Autism Spectrum Disorders: A Decade in the Making

This study utilized hierarchical linear modeling analysis of a 10-year extant dataset from Rehabilitation Services Administration to investigate significant predictors of employment outcomes for vocational rehabilitation (VR) clients with autism. Predictor variables were gender, ethnicity, attained education level, IEP status in high school, secondary disability status, and total number of VR services. Competitive employment was the criterion variable. Only one predictor variable, Total Number of VR Services, was significant across all 10 years. IEP status in high school was not significant in any year. The remaining predictors were significant in one or more years. Further research and implications for researchers and practitioners are included.     

Education rights and the special needs child

A child with a disability has a federally protected right to special education and related services when he or she needs them to benefit from education. The term "disability" is not limited to physical disability but rather includes mental disability, including mental retardation, serious emotional disturbance, autism, traumatic brain injury, specific learning disabilities, and other health impairments. A parent may request that a child be evaluated by the school district for special education and related services. The law sets forth specific guidelines for the evaluation, assessment, and eligibility determination. Unique to each child, the IEP is the written plan that documents the child's special education and related services. The initial IEP is developed at a meeting among parents, various school personnel, and others whom the parents may wish to invite. Parents are an integral part of the team and are involved in all decisions by the team. The IEP must be reviewed annually, with attention given to whether educational objectives have been met. For a child with mental health issues, the IEP likely contains "related services," such as counseling, and measurable goals to improve behaviors in the school setting. When a child's condition is such that he or she cannot benefit from education in the regular school setting, other placements are considered. The school district maintains the ultimate responsibility of the cost of all such education placements, including residential care. A child with behaviors that result in frequent suspensions should have a functional analysis assessment by the school psychologist. The results of the assessment can be used to create a behavioral intervention plan. (If the school refuses to perform an assessment or develop a plan, the usual remedy of a due process hearing is available to the parents.) This plan should address problem behaviors and include strategies for redirecting the child's behavior. Even if a special education child is "expelled" from school, the district maintains the responsibility of providing FAPE. For this reason, districts--even in their own interests--should be proactive in dealing with these children, which often has not been the case. The Supreme Court has said that a child with services under IDEA (a child with an IEP) must receive some benefit from his or her education [31]. The issue of "how much benefit is enough benefit" is still troubling to parents and schools alike. The court also has ruled that related services, even costly ones such as a one-to-one nursing aide, must be provided if a qualifying child needs such services to access education [29]. Children with disabilities were long excluded from the public education system in this country. Obvious exclusion rarely occurs in the current education system, although exclusion through isolation does. Children with disabilities, especially mental disabilities, need and deserve the same educational benefit offered to children without those differences.     

Parents’ Perspectives of Collaboration with School Professionals: Barriers and Facilitators to Successful Partnerships in Planning for Students with ASD

Both parents and school professionals (e.g. teachers, administrators, related service providers) are stakeholders in the Individualized Education Plan (IEP) process. Despite the fact that the inclusion of parents as full members in the process has been mandated by the Individuals with Disabilities Education Act since it was originally passed in as PL 94-142 in 1975, parents continue to report encountering barriers to equitable participation. To probe the barriers and facilitators to full team membership, we administered a mixed-methods survey study to parents of students with autism spectrum disorder (ASD) (n = 135) exploring the nature of their perceptions of collaboration. Common barriers to collaboration included opportunities to provide input, communication difficulties with school teams, and negative perceptions of school professionals. School administrator actions identified as facilitators of collaboration included attendance at IEP meetings, quick response to phone calls, and assistance with acquiring resources. Parents reported low levels of perceived disability-specific staff knowledge regarding ASD. Quantitative findings from this survey sample indicate that a large number of parents of children with ASD reported experiencing difficulty and/or were not included in the special education collaborative process. Implications and recommendations for school administrators and teams are discussed.     

Addressing the informational needs of healthcare professionals in dementia care: an explorative study in a Chinese society

Many healthcare professionals in Hong Kong are now working in dementia care, but little is known about their informational needs in this area. This study explored the level of knowledge about dementia that healthcare professionals perceived themselves as having, and the informational needs of dementia care. 320 respondents, who were primarily nurses, social workers, and rehabilitation therapists, completed a questionnaire designed for this study. While 65% reported having sufficient knowledge of dementia, only 40% expressed having adequate knowledge of dementia-related services. Respondents who had relevant clinical experience demonstrated a significantly higher self-perceived knowledge level of dementia (p=0.000) and dementia-related services (p=0.000). The respondents ranked information leaflets (68%), the mass media (65%), and workshops (53%) as the three popular sources for obtaining dementia-related information. Similar to their western counterparts, over 75% of respondents expressed the need to lean more about clinical management and service provisions for people with dementia and their families. To enhance the knowledge of healthcare professionals about dementia care, it is recommended that healthcare professionals be encouraged to participate in continuing education programmes, and that education/resource centres for dementia care be developed to address the learning needs of local practitioners.     

Teacher and Child Predictors of Achieving IEP Goals of Children with Autism

It is encouraging that children with autism show a strong response to early intervention, yet more research is needed for understanding the variability in responsiveness to specialized programs. Treatment predictor variables from 47 teachers and children who were randomized to receive the COMPASS intervention (Ruble et al. in The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) were analyzed. Predictors evaluated against child IEP goal attainment included child, teacher, intervention practice, and implementation practice variables based on an implementation science framework (Dunst and Trivette in J Soc Sci 8:143–148, 2012). Findings revealed one child (engagement), one teacher (exhaustion), two intervention quality (IEP quality for targeted and not targeted elements), and no implementation quality variables accounted for variance in child outcomes when analyzed separately. When the four significant variables were compared against each other in a single regression analysis, IEP quality accounted for one quarter of the variance in child outcomes.     

The effect of cognitive education on the performance of students with neurological developmental disabilities

A cognitive education program was developed to facilitate acquisition of cognitive skills and address the learning deficits of adolescent students with neurological, developmental disabilities, and autism. This study examined the outcomes of incorporating mediated cognitive education into special education classrooms. Cognitive education provided cognitive training utilizing REHABIT materials through mediated teaching. Following a matched pair model, forty-six students were assigned to either a treatment or a control group. All students received weekly instruction in Individual Educational Program (IEP) goals. Curriculum areas included IEP objectives in reading, math, social skills, health, science and social studies. Students in the control group received regular classroom instruction. Students in the treatment group participated in cognitive educated one hour per week replacing thirty minutes of reading and thirty minutes of math. Pre and posttest comparisons on measures of intelligence, achievement and adaptive behavior showed those students in the treatment group attained higher scores across measures.     

"I'm supposed to be in charge": self-advocates' perspectives on their self-determination support needs

In this qualitative interview study, we explored the perceptions of adults with intellectual disability regarding interpersonal or social supports needed to express their own self-determination. Specifically, 10 adults, all members of a self-advocacy group, were asked to discuss their understanding of the term self-determination and ways in which support staff have either supported or inhibited their self-determination. Ten themes characterizing supportive and impeding staff actions were identified. The need for greater exploration of environmental and social influences on self-determination is emphasized.     

Patientenverf��gungsgesetz

Current legal regulations concerning the right of self-determination of subjects who are not competent to give consent have been in force since 2009. According to the new regulations, such subjects can exercise their right of self-determination through a legal guardian who will assess and impose their will. If there is an operative advance directive covering the specific case, the guardian is bound by the provisions laid down in it. Although primarily intended for end-of-life decisions, the law applies in all cases of a subject's inability to give consent, including the context of mental illness. It allows the persons concerned to define certain aspects of medical treatment in advance. On the one hand, the right of self-determination of mentally ill people is thus strengthened. On the other hand, the new regulations can also cause significant ethical conflict involving patients and their representatives as well as family members and practitioners. The present contribution presents the consequences of the amendment for the treatment of mentally ill people. Case studies are described in order to illustrate the new regulations in clinical situations.     

The Michigan Supported Education Program

With the advent of improved pharmacological treatments, empirically tested psychiatric rehabilitation techniques, and an increased emphasis on the empowerment of mental health consumers, many adults with psychiatric disabilities now have a realistic chance of reentering their communities and reestablishing meaningful and productive lives. Because work is a fundamental component of adjustment in adult life, helping individuals obtain and maintain jobs has been viewed as the sine qua non of psychiatric rehabilitation.More recently, however, rehabilitation practitioners have realized that many adults with psychiatric disabilities have the desire and the requisite motivation and educational background to attend college (1). Hence rehabilitation practitioners have recognized that helping individuals restart their postsecondary educational pursuits is a desirable, valid, and viable option (2,3).Supported education is being used increasingly to encourage adults with mental illness to enroll in and complete postsecondary education by providing assistance, preparation, and ongoing counseling (4). Several reports have suggested that supported education programs contribute to positive outcomes such as graduation, acquisition of marketable skills, employment, and positive self-esteem (5,6,7). In this month's column, Carol Mowbray, Ph.D., describes the Michigan Supported Education Program and provides a rationale and empirical validation for its inclusion as an integral modality of psychiatric rehabilitation.     

Training the future neurology workforce

OBJECTIVE: To address training demands on future neurologists, the American Academy of Neurology (AAN) surveyed its US members as to their views about training the future neurology workforce. METHODS: The survey was mailed to 575 US neurologists and 425 residents/fellows. Respondents (54%) were asked about their perceptions of current and future educational programs and settings needed to improve practice competence; issues related to subspecialization; and the role of non-neurologists in providing neurologic care. Views of neurologists were compared with those of neurology residents/fellows. RESULTS: Most respondents support additional training in outpatient, community, and staff model health maintenance organization settings. The majority of respondents oppose a required fifth year of training or a yearly competency examination, but neurologists who have a subspecialty interest and residents/fellows favor elective certification and higher fees by subspecialists. General neurologists oppose these ideas. Most neurologists feel that primary care physicians, nurse practitioners, and physician assistants can manage uncomplicated neurologic problems, although residents/fellows are less willing to accept the role of nonphysician providers for neurologic services. CONCLUSIONS: Neurology educational programs should consider addressing deficiencies that today's practitioners perceive. Increasing subspecialization, although favored by most neurologists, creates a challenge for the neurologic community as neurologists without subspecialty training see this trend as a threat to their livelihood.     

General practitioners' educational needs in intellectual disability health

Background The community general practitioner (GP) has a central role in the provision of primary health care to people with intellectual disability (ID) as an indirect result of deinstitutionalization in Australia. This population, however, continues to experience poor health care compared to the general population. The current paper describes results from a questionnaire that aimed to identify the perceptions of practising GPs on the standards of health care for people with ID, the adequacy of prior training, and their interest in further education in relation to nine health care areas. Method A questionnaire was posted to a selective sample of 1272 practising GPs in Victoria selected from a database from the Centre for Developmental Disability Health Victoria and the Victorian Medical Directory of GPs registered with the Australian Medical Association. Data were available for 252 respondents with a response rate of 28.5%. Results The health areas in which many GPs reported to be inadequately trained were the same as those areas that were perceived as being of a poor standard. These areas were behavioural or psychiatric conditions, human relations and sexuality issues, complex medical problems, and preventative and primary health care. Ninety four per cent of respondents were interested in further education in at least one of the nine health care areas, with the most frequently nominated areas being behavioural or psychiatric conditions, syndrome‐specific medical problems, human relations and sexuality issues and collaboration with government services. General practitioners did not nominate complex medical problems or preventative and primary health care for further education as frequently as they identified care in these areas to be substandard and their prior training inadequate. Conclusions The findings from the current research are discussed in relation to the implications for development of educational programmes based on learning needs identified by the GP. The most frequently nominated health care areas in all three questions were behavioural or psychiatric conditions and human relations and sexuality issues. Reasons for incongruence between the frequency of responses for complex medical problems and preventative and primary health care are explored.     

Exploring the perceptions of self-determination of individuals with intellectual disability

Interviews were conducted with 17 individuals who had intellectual disability to expand our understanding of the impact of self-determination in their life. Themes emerging from the interviews were grouped into three categories: meaning of self-determination, learning about self-determination, and dreams for the future. Participants described self-determination as being able to make choices and be in control of one's life and setting as well as being able to work toward goals and engage in advocacy. Participants discussed the importance of supports for expressing self-determination and identified environmental characteristics that promoted and inhibited self-determination. Overall, their perceptions confirm the importance of promoting personal development of skills and attitudes associated with self-determination and systems change to create environmental opportunities for self-determination and causal agency. Implications for future research and practice are discussed.     

Tertiary Education Students' Attitudes to the Harmfulness of Viewing and Distributing Child Pornography

Little research has examined public support for criminalising viewing and distributing child exploitation material (CEM). Using an online survey of 431 undergraduate students from Australia, we explored perceptions of the harmfulness of CEM. The majority of respondents agreed that viewing and distributing CEM lead to further production and had a negative effect on victims. Although 93% of respondents agreed that CEM involving real child victims should be illegal, 22% did not agree that CEM involving pseudoimages should be illegal. Those who demonstrated higher levels of agreement with explanations of the harmfulness of CEM were more likely to be female, to have achieved postsecondary qualifications, to have never viewed pornography, to support censorship of pornography, and to believe that CEM involving pseudoimages of children should be illegal. The implications of these findings are discussed.     

Private practitioners' perceptions of the changes in their use of treatment modalities following participation in managed care panels

Private practicing social workers, psychologists, and psychiatrists were surveyed to assess their perceptions of how their use of treatment modalities has changed since joining managed care panels. Social work respondents report that they perceive managed care organizations as certifying them to practice individual therapy more since joining managed care panels than they practiced individual therapy prior to joining managed care panels. However, they perceive managed care organizations as certifying them to practice group and family therapy less often since joining managed care panels. Psychologist respondents report that they perceive managed care organizations as certifying them less often for all treatment modalities except individual therapy. Likewise psychiatrist respondents report they perceive managed care organizations as certifying them less often for all treatment modalities except medication management. These results have potential implications for educators and practitioners interested in pursuing careers in solo or group practice.     

National Survey of Clinical Neuropsychology Postdoctoral Fellows

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.     

National survey of clinical neuropsychology postdoctoral fellows

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.     

The job-finding module: training skills for seeking competitive community employment.

The opportunity to return to work is often the culmination of extensive and collaborative efforts by clients, psychiatrists, and allied mental health and rehabilitation practitioners. Successful vocational placement and tenure is a victory not only for each individual client but also for the comprehensive set of services and supports established to foster this self-determination. Much as a chain is only as strong as its links, successful job placement must be viewed as but one link in a comprehensive rehabilitation program. Our research in competitive community employment placement over the past decade has resulted in the development of the Job Finding Module, as our contribution to one link of this evolving chain of necessary treatment and rehabilitation services for the seriously mentally ill.     

Consumer and Practitioner Perceptions of the Harm Reduction Approach in a Community Mental Health Setting

Harm reduction in community mental health settings can be effective in engaging persons with co-occurring disorders in services. In this qualitative study, personal interviews and grounded theory methods were used to explore the experiences of 21 mental health practitioners and 15 consumers with co-occurring disorders at a community mental health housing program that uses harm reduction. Results indicate that while harm reduction enhanced therapeutic alliances, ethical and emotional tensions between practitioners and consumers regarding their views on self-determination and tolerance of drug-related behaviors were also evident. These tensions are explored and implications for practice and education are provided.     

重症肌无力患者和家属的健康素养对健康教育的影响

目的通过测评重症肌无力(MG)患者及家属的健康素养,分析影响健康素养的因素以及健康素养对患者和家属掌握MG健康教育内容的意义。方法纳入106例MG患者及101名家属,采用国际公认的健康素养问卷测评他们的健康素养。采用自行设计的MG健康教育内容,随机对被调查者采用医生讲述或患者自行阅读的宣教方式,采用相应的问卷评价患者和家属对健康教育内容的掌握情况。采用独立样本t检验、秩和检验和卡方检验进行单因素分析,采用Logistic回归进行多因素分析。结果患者和家属健康素养为优的比例无统计学差异(P>0.05)。患者和家属健康素养优者中教育程度高者比例均高于健康素养差者(P<0.05,P<0.01)。患者中健康教育得分高的比例高于家属(P<0.01)。患者健康教育得分高者中年轻者比例,家属健康教育得分高者中年轻者和教育程度高者比例均高于健康教育得分低者(均P<0.01)。多因素分析发现,教育程度是影响患者(OR=3.12,P=0.045)和家属(OR=8.82,P=0.001)健康素养的独立影响因素,患者中年龄(OR=7.68,P=0.001)而家属中教育程度(OR=3.25,P=0.013)是健康教育得分的独立影响因素。结论教育程度既是MG患者和家属健康素养的决定因素又是健康教育效果的重要影响因素,年龄也是健康教育效果的重要影响因素,在制定个体化的MG教育方案时需要考虑。