智力残疾的社会服务宏系统及职业问题

由于智力残疾人生活在一个广泛的复杂系统中,要有效提高对智力残疾者的服务,需要各学科间的团队合作。政策制定者需要考虑临床心理学家的建议,以及服务受用者及其家属的情况。对智力残疾人的同意能力和决定能力的评估也是重要和有实际意义的。     

老龄智力残疾人面临的问题及其干预

目前老龄智力残疾人口越来越多。老龄智力残疾人主要面临生活转变、未来生活规划及情感理解等问题。本文从评估和管理疾病、看护者压力以及心理学家扮演何种角色等方面讨论对老龄智力残疾人实施的干预措施。     

智力残疾人的现状与康复

智力残疾,是指人的智力明显低于一般人的水平,并显示出适应行为的障碍。据1987年全国残疾人抽样调查推算,我国有智力残疾人约1,017万人,占五类残疾人总数的19.69％,位居第二。近几年来,随着我国残疾人事业的发展,智力残疾人的康复工作在一些地区不同程度地开展起来,并取得了一定的经验。但由于缺乏对智力残疾人现状的整体分析,因而在从预防、教育、心理、医疗、职业、社会等方面对智力残疾人进行全     

智力残疾人的健康状况与健康服务研究

目的探讨智力残疾人的健康状况、影响因素与健康服务发展状况,为发展智力残疾人的健康服务提供循证支持。方法基于ICF功能和残疾的理论与方法分析智力残疾人主要功能障碍,运用流行病学方法分析智力残疾人的主要疾病、功能障碍表现、致病和致残因素。结果美国智力残疾现患率约为1.1%,中国为0.75%。智力残疾人主要健康问题为超重、肥胖、营养不良、口腔问题、消化系统疾病等;主要功能障碍有认知障碍、孤独症谱系障碍、视觉或听觉障碍、学习障碍、运动障碍、广泛性发育障碍等;因智力残疾导致的继发性障碍会加重在概念技能、社会技能和实用技能等方面的障碍程度。生物学和环境两方面的因素是智力残疾人致病和致残的主要健康风险因素。结论现代健康服务要关注智力残疾人的健康状况与健康行为的特殊性,提升智力残疾人的健康服务能力,提高智力残疾人健康水平。     

智力残疾人康复需求与康复服务发展状况Logistic回归分析研究

目的探讨智力残疾人的康复需求特点与康复服务发展状况及其影响因素。方法以250654名智力残疾人省级康复需求与康复服务实名制数据为样本数据,统计分析智力残疾人的康复需求特点和康复服务发展状况,Logistic回归分析其相关因素。结果在智力残疾人的康复需求报告中,报告率从高到低依次为护理47.8%、药物37.2%、功能训练26.1%、辅助器具19.8%和手术1.3%。智力残疾人报告获得的康复服务从高到低依次为护理43.5%、药物29.3%、功能训练27.2%、辅助器具19.6%和手术0.8%。根据Logistic回归模型发现,年龄和残疾等级对智力残疾人康复需求的报告与获得康复服务的概率存在显著影响(P<0.001)。结论智力残疾人康复需求主要表现为护理、药物和康复训练。接受的康复服务与康复需求具有相同的结构。由于智力残疾人功能的复杂性,重度或极重度残疾人更强调护理照料服务,轻度残疾人则需要功能训练。发展针对智力残疾人的康复服务,应该根据其智力功能和社会适应行为特点,开发康复服务项目,提供个别化的精准康复服务。     

中国内地智力残疾人康复服务的现状与对策

据1987年全国残疾人抽样调查统计推算，中国目前有智力残疾人1182万。为了使智力残疾人能够平等地享受康复和教育的权利，自20世纪80年代以来，中国政府将智力残疾人的康复、教育纳入国家经济和社会发展规划，制定了一系列的政策、法规，使智力残疾人的康复、教育服务在近二十多年有了飞跃性的发展。     

智力残疾人康复需求与康复服务发展状况研究

目的探讨智力残疾人的康复需求与康复服务发展状况,为开展智力残疾人精准康复服务工作提供支持。方法采用河南省2016年度全国残疾人基本服务状况和需求实名制专项调查数据,对其中167,872名智力残疾人,从医疗服务与救助、辅助器具和康复训练3个方面进行分析。结果 56.4%智力残疾人有康复需求,且不同年龄、户口性质和残疾等级的智力残疾人,康复需求有非常高度显著差异(χ2 976.42, P 0.001)。受人口统计学变量、家庭经济状况、交通状况、对相关知识和信息的了解等因素影响,仅有19.0%智力残疾人获得康复服务。结论智力残疾人康复服务需求大,康复服务覆盖率低。要加大对智力残疾人康复服务的供给,制定精准康复服务实施方案,提高智力残疾人康复服务质量。     

智力残疾人生存质量与自然支持的相关性研究

目的：通过对成年智力残疾人生存质量现状、内在期望和得到支持的评价，分析成年智力残疾人生存质量与自然支持系统的相关性。方法：2005年8月-12月选择北京市8个区县的成年智力残疾214人为研究对象，完成成年智力残疾人生存质量问卷调查，并对调查结果进行分析及统计学处理。结果：成年智力残疾人对生存质量的主观期望显著高于得到的支持程度和实际现状；成年智力残疾人的生存质量现状与得到的支持程度显著相关。结论：成年智力残疾人的康复工作应针对智力残疾人生存质量的主观期望与实际现状、支持程度之间的差距，提供支持和建立自然支持系统，提高成年智力残疾人的生存质量。     

智力结构理论有哪些主要学说？各自代表人物是谁？

答：其学说有3个。（1）智力的二因素与多因素学说：它们的代表人物分别是英国心理学家斯皮尔曼和美国心理学家瑟斯顿。（2）智力的层次结构学说：其代表人物是英国心理学家费农。（3）智力的三维结构学说：代表人物是美国心理学家吉尔福特。     

北京市智力残疾人康复需求分析

目的调查北京市智力残疾人的康复需求情况。方法以第二次全国残疾人抽样调查中北京市738名智力残疾人为研究对象,调查其康复现状与需求。结果63.69%的智力残疾人需要社区和家庭服务,73.31%需要康复训练与服务;智力残疾人的医疗服务需求能基本得到满足,但康复训练需求远高于得到的服务,辅助器具需求很低,就业安置需求较高。结论应建立智力残疾人个案管理系统,多途径地满足不同年龄和残疾程度智力残疾人的康复需求。     

失能老年人出院准备度现状及其影响因素分析

[目的]描述失能老年人的出院准备度水平,探讨其影响因素。[方法]采用一般资料及疾病状况调查表、出院准备度量表、出院指导质量量表、社会支持评定量表对青岛市5所三级甲等医院的220例失能老年人进行调查。[结果]失能老年人的出院准备度总分为(93.28±16.32)分,各维度标准化得分从高到低分别为预期获得的帮助、个人状态、适应能力。多元线性回归分析显示,出院指导质量、感知可获得的社会支持、对社会支持利用度、自理能力、住院时间等是失能老年人出院准备度的影响因素。[结论]失能老年人的出院准备度有待提高,医务人员应加强和改进对失能老年人及其主要照顾者的出院指导,加强人文关怀,帮助失能老年人建立有效的社会支持系统,尤其重视自理能力低、住院时间长的失能老年人病人,提高其出院准备度,保障出院后安全。     

A Comparison of Quality of Life Outcomes for People with Intellectual Disabilities in Supported Employment,Day Services and Employment Enterprises

Background Policy objectives for people with intellectual disabilities include day service modernization and the promotion of paid employment and quality of life. Quality of life is under represented as an outcome measure in vocational research. This research compares subjective and objective quality of life, and quality of work environment for adults with intellectual disabilities in supported employment, employment enterprises and day services with non‐disabled workers in community employment. Methods Comprehensive Quality of Life Scale, and Work Environment Scale were collected for people with intellectual disabilities: 17 supported employees; 10 employment enterprise workers; 10 day service attendees; and 17 non‐disabled work colleagues of supported employees. Results Supported employees reported higher objective quality of life than employment enterprise workers and day service attendees. Non‐disabled co‐workers reported higher objective quality of life and autonomy at work than the three groups of people with intellectual disabilities. Supported employees reported higher subjective quality of life than non‐disabled co‐workers. Conclusions The findings support the utility of supported employment as a means to provide constructive occupation and enhanced quality of life to people with intellectual disabilities. However, closing the gap with respect to non‐disabled co‐workers on objective quality of life measures represents a challenge and will require improving the quality of job finding and workplace support and the training provided.     

社区失能老年人自我同情及影响因素研究

目的了解社区失能老年人自我同情现状并分析其影响因素,为提高社区失能老年人自我同情提供参考。方法采用便利抽样的方法选取长春市南关区6所社区的355名失能老年人为研究对象,采用一般资料调查表、自我同情量表及社会支持评定量表对其进行调查。结果失能老年人自我同情总分为(71.02±10.75)分,社会支持总分为(33.08±8.43)分;自我同情与社会支持呈正相关(P<0.01),多元线性回归分析结果显示,性别、文化程度、病程、性格特征、社会支持是社区失能老年人自我同情主要影响因素。结论社区失能老年人自我同情处于中等水平,医护人员应关注女性、文化程度低、病程长、性格内向、社会支持度较差的失能老年人,实施针对性干预措施,提高其自我同情水平。     

Community Integration or Community Exposure? A Review and Discussion in Relation to People with an Intellectual Disability

Background This paper reviews the issue of integration as it applies to people with an intellectual disability. A compelling finding is the almost exclusive orientation of the literature to physical integration within the general community of non‐disabled people. Moreover, it seems to be generally assumed that the more frequently people experience such integration the better their lives will be. Methods We question the validity of this assumption on several grounds. It is social, not physical integration, that has a reliable positive influence on well‐being. This is an important conclusion as some disabled people find effective social integration with the general community extremely difficult to achieve. Because of this, the consequences of an overly enthusiastic program of integration for such people has more potential to be more stressful than beneficial. Results We further argue that, as integration is being pursued to benefit the individual, the essential goal of service provision should be to achieve a sense of community connectedness, rather than being concerned with physical integration within the general community. Conclusion It is proposed that such connectedness is more likely to be achieved within the community of people with an intellectual disability.     

The beginnings of care for cripples in Lower Franconia and its development into the modern rehabilitation of the physically handicapped

On the example of Lower Franconia, a predominantly rural region which has maintained its boundaries in both world wars, the author describes the historical development of services for disabled persons since the beginning of this century. Jakob Riedinger may justly be termed the father of cripple care in Lower Franconia, having initiated the establishment, in 1910, of the first vocational rehabilitation facility for physically disabled people in Würzburg. Starting out from the provision of vocational services, further developments in particular after the 2nd world war entailed a growing recognition of the psychosocial situation of disabled persons as the basis of rehabilitative action. Several facilities have hence been established for providing holistic, early services for the physically disabled, where educators, physiotherapists, occupational and speech therapists, social workers and psychologists are involved, along with the orthopaedic doctor, in the care of physically disabled children and youths.     

Cohesion and parents' social relations in families with a child with disability or chronic illness.

We studied how a child's physical or intellectual disability or diabetes affected family cohesion, the parents' social life, work and leisure-time activities, and whether there was any association between the parents' social relations and family cohesion. The parents of 89 children aged 12-17 years returned a questionnaire and were interviewed by a social worker. Family cohesion increased in all the groups by an average of 27%. The effect was smallest in the families of children with diabetes, whereas in the families with intellectual or physical disability family cohesion increased from 6 to 13 times more often compared to the families of children with diabetes. The increased family cohesion was not associated with the change in the parents' social relationships, work, career or leisure-time activities; the importance of these activities did not decrease even though family cohesion increased. However, a child's chronic illness or disability affects the everyday life of the family, for instance 71% of the parents with diabetic children thought that the regularity of family life increased and about a half of the parents with physically or intellectually disabled children had to change their hobbies because of the child. In planning treatment and rehabilitation for a chronically ill or disabled child more attention should be paid to the whole family and its needs, not only to the child.     

沿海地区失能老年人家庭照护品质与照护者社会支持的相关研究

目的:探讨沿海地区失能老年人居家照护品质与照护者社会支持系统的相关性。方法:采用分层整群随机抽样法,收集唐山市沿海地区2 155名失能老年人及其家庭照顾者的一般情况,应用失能老年人家庭照护品质量表、社会支持量表进行不同维度测评,应用方差分析法对不同分级社会支持的照护品质单项评分和总分进行比较,应用Pearson相关分析法分析失能老年人家庭照护品质与社会支持的相关性。结果:照护者高水平与低水平社会支持的照护品质各单项评分及总分相比较,差异均有统计学意义(P<0.01),高水平与中等水平社会支持比较,除水分获得、家庭成员的需求满足2项评分,其余项目差异均有统计学意义(P<0.01);中水平与低水平社会支持比较,除去舒适程度、皮肤的完整性、照顾者与残病老人的关系品质、照护者获得个人成长、照顾者情绪的影响5项,其余项目差异均有统计学意义(P<0.01)。失能老年人家庭照护品质评分与照护者的社会支持程度呈正相关(r=0.608,P<0.01)。结论:照护者受社会支持程度影响失能老年人家庭照护品质,注重照护者的社会支持,提高失能老年人家庭照护质量。     

Enabling Integration in Sports for Adolescents with Intellectual Disabilities

Background Promoting the health and social participation of adolescents with intellectual disability is important as they are particularly vulnerable to encountering difficulties in those areas. Integration of these individuals in integrated sports is one strategy to address this issue. Methods The main objective of this study was to gain a better understanding of the factors associated with the integration of adolescents with intellectual disability in sports alongside their non‐disabled peers. Individual interviews were completed with 40 adolescents with intellectual disability and their parents, while 39 rehabilitation staff participated via either a discussion group or self‐administered questionnaires. The Disability Creation Process (DCP) theoretical model was used to frame the analysis and the presentation of the findings (The Quebec Classification: Disability Creation Process. International Network on the Disability Creation Process/CSICIDH, Québec, QC, 1998). Results Various personal and environmental factors that have an impact on integration in sports were identified by participants. For example, attitudes, practical support, individuals’ experiences in sports and in integrated settings as well as behaviour control emerged as important elements to consider. Conclusions Integration in integrated sports can engender a lot of benefits for individuals with intellectual disability, their parents and non‐disabled athletes. However, many barriers need to be removed before such benefits can be more widely realized.     

Interrogative Suggestibility,Memory and Intellectual Disability

Background Psychologists are often asked to prepare reports on suspects, complainants and witnesses with intellectual disabilities for court. Increasingly, the Gudjonsson Suggestibility Scales are being used as part of the assessment process. This paper critically examines the use of the Gudjonsson Suggestibility Scales with adults with intellectual disabilities and considers alternative explanations for test data. Argument It is argued that the scales have been developed in a way that significantly disadvantages people with intellectual disabilities compared with those of average ability. The scales are more likely to elicit acquiescent responses from people with intellectual disabilities as participants are questioned on information they can barely recall. Drawing on models of memory developed in the field of cognitive neuroscience, it is argued that this is a consequence of examining unimodal input into semantic memory, which is impaired in people with intellectual disabilities. Police interviews are rarely concerned with semantic memory alone but with autobiographical event memory of multimodal input. Research on people with intellectual disabilities' event memory shows higher levels of accuracy, less of a tendency to acquiesce and greater resistance to suggestion. Conclusions Currently, the Gudjonsson Suggestibility Scales are the only tests available for the assessment of interrogative suggestibility. However, psychologists using these scales with adults with intellectual disabilities should do so with caution as their validity is questionable. Studies of intellectually disabled adults' autobiographical event memory show that they can provide reasonably accurate accounts of events and resist questions designed to alter their account.     

Corneal Graft and Cataract Surgery in Patients with Moderate to Severe Intellectual Disability

Background Intraocular surgery in patients with intellectual disability can be hazardous. Our aim was to determine the outcomes of surgery on all such patients seen in a consultant‐led service, and to assess the overall risks and benefits. Materials and Methods A retrospective chart review of patients with moderate to severe intellectual disability, operated upon over a 9‐year period was undertaken. Thirty‐four eyes of 21 patients were operated upon and procedures included four penetrating keratoplasties, five combined penetrating keratoplasties with cataract extractions, and 25 cataract extractions alone. Results Most patients achieved a beneficial outcome, noted by their carers, such as better mobility and social interaction. Three patients had major post‐operative complications, all associated with corneal grafts. Only seven patients were, within the context of conventional busy outpatient clinics, deemed capable of co‐operating with a formal visual acuity assessment either pre‐ or post‐operatively. Conclusions Cataract and corneal graft surgery in individuals with intellectual disability is beneficial, and referral to an ophthalmologist should be considered as intellectual disability need not necessarily be a contraindication for surgery. The authors recommend that these patients should be assessed in a dedicated ophthalmology clinic setting for the intellectually disabled, where there should be better facilities for appropriate visual assessment tailored to the patients’ abilities.