4. There are, however, strands of information from other parts of the study that can help to shed some light on the issue. What Has Happened to the Service System? After completing that design, however, the research team determined to interview the neighbors again about a year later. instrument served as a model for development of the first draft of our questionnaire. But, I look on it as a challenge in this country to change the system that applies to human beings. The changes in feelings about community residential care are dramatic.
Whether the program was in its initial year of operation, was the third statistically significant predictor accounting for 13.8% of the variation in community residential program per diems. Does no shopping, 6.
The picture that emerges of the Southeast Region is relatively low institution use, very high PLF use, and moderate CLA use. Again, these other questions were added to prevent respondents from coming away with the impression that they had been interviewed solely about mental retardation, or about new CLAs. Industry in the county is relatively diverse. Level of funding may, however, bear on the decree of progress a state is able to make in implementing the decree.
As long as resources were relatively flexible, there was enough "play" in the system to accommodate comprehensive consent agreements. All in all, those court monitors and masters that were most widely accepted by key system actors tended to avoid center stage and to limit their activities to more narrow compliance issues. Not at all2. Most happy54321Least Happy 12) Which one is most like how you feel about the other residents Most happy54321Least Happy APPENDIX 7-1: BASELINE FAMILY QUESTIONNAIRE WITH DISTRIBUTION OF RESPONSES TO EACH ITEM1 OMB No. Conversations with Pennhurst staff indicate that they are very aware of the potential problems and have tried in a variety of ways to head off morale and other problems including promoting a newsletter that allows staff to air their grievances and that also gives the administration an opportunity to squelch counterproductive rumors and conjecture about layoffs and unit consolidation. Does no shopping WRITING _______ 6.
What kind of place would you like to go to ?
Office of the Special Master In order to provide a comprehensive picture of the Office of the Special Master (OSM) in Pennhurst, this analysis encompassed both the legal context within which the Master functioned and the larger political and organizational milieu that were the object of the court's intervention.
(CIRCLE RESPONSES FOR ITEMS a.-l.) True False No Idea, Dont Know a. Program analysis of services 3: A method for the quantitative evaluation of human services. If one is already in the neighborhood, then opposition will be even less, and strong support may be available. Limps or walks unsteadily2.
"Contact in the neighborhood," the only significant contact variable at baseline, predicted only 2.9% of the variance in attitudes beyond that predicted by the characteristics of the respondents themselves. What Has Happened to Funding? Understanding and use of numbers08. Relative will not progress beyond present level 2.0 2.9 17. New York: Academic Press. This overall scale ranged from I (in favor of deinstitutionalization) to 5 (opposed). (1985). d. on a yearly basis? We hope that similar work will continue here and elsewhere, so that the feelings of people who have lived in facilities for decades are taken into account as those facilities are phased down. Matched people still living at Pennhurst did not show significant improvements.
In a nutshell, we have found that initial family opposition changes drastically to surprised and enthusiastic support of the CLA option, tempered by continued concern about permanence.
Further, the need to bureaucratize functions in a larger system may unduly "institutionalize" the provision of community services. After relocation, the figure was 52%, and, though this change was statistically significant, the substantive change was very small.
The litigation does appear to have been a spur to the application for the community services waiver under Title XIX.
The next step in analysis of the baseline data was an investigation of the factors that were related to the general attitudes of the neighbors toward people with mental retardation.
How does the boy feel? 1 pointPerceives a single object and perceives a sequence -- The glass is getting (got) full of water .0 pointsAmbivalent -- Empty, Full, Full, Full pointing to the pictures-1 pointDoes not perceive a single object or a sequence. The answer in almost all instances was a resounding yes. ), Living and Learning in the Least Restrictive Environment, (pp. Agreement with Specific Ideas 134 Pre(Expected) 134 Post*(Actual) * The significance of the prepost change for the 134 was p t-test for all items.
Approximately 78% of the residential and day program expenditures at the Pennhurst Center, and 0 (n=122) of the expenditures of residential programs in the community were devoted to personnel services. Some mentioned a sense of pride that they had brought all of their local citizens home from Pennhurst and that these individuals were doing surprisingly well in the community. In other words, for the neighbors who were aware, negative reactions were only temporary. In one state, where the institution was ultimately closed, the union did not oppose the phase out since conditions at the facility and abuse among the staff had been highlighted in the media. 4 3 2 1 e. Of a different race from your own?
(CIRCLE RESPONSE CODE FOR a.
The Special Master's compliance functions reflect a broad and deep involvement in the day-to-day implementation of the decree.
One might say that what has been compared here is a relatively expensive public institution affected in some part by a federal court order and a relatively expensive private system of community living arrangements and day programs also affected to some degree by a federal court order. What Has Happened to Pennhurst? The assertion that the litigation has forced an artificial infusion of funding into the Southeast Region of the state at the expense of the other three regions has been made by numerous key informants. The retrospective evaluation of Pennhurst from these 134 families was that it was too large and crowded a place to offer adequate care and growth opportunities for the people who lived there. Again, these other questions were added to prevent respondents from coming away with the impression that they had been interviewed solely about mental retardation, or about new CLAs. The second is that, in our experience with surveying these families, we have come to the conclusion that any monitoring or quality assurance system should include annual surveys of families. The answer to the question about conditions at Pennhurst as a result of the litigation is, therefore, somewhat complex. We are interested in how you feel you will be affected by the movement of your relative into the community.
The data on imaginary and real CLAs also suggests to us that, if there are no CLAs already in a neighborhood, then only about 10% to 20% of neighbors will be opposed to allowing one to open. Completely dresses self with verbal prompting only4. Lubbock, Texas: Research & Training Center in Mental Retardation, Texas Tech University.
8.0% 66.4% 2.8% 15.3% 1.4% 5.9% 41. But that study concerned 70 of the first people to leave Pennhurst; here, we will report on 191. 16-207. For about how many months has the newest group home in your neighborhood been operating? The analysis drew both from the legal literature on complex litigation and compliance mechanisms, and from the political science and public administration literature on implementation and program change.
However, in an era of cutbacks, or at least minimum system expansion, the provision of resources to fulfill the requirements of a consent decree can become a bone of contention among those who feel left out. Cleans room well, e.g., sweeping, dusting, and tidying2. Convalescent and other infirmary-like care in the community is made available through special staff assignments, the use of temporary staff, the use of nurse consultants obtained through county CORE teams, and in some cases through ad hoc arrangements with nursing homes. These one-time costs and delays in reaching full occupancy combine to explain why the per client costs of new programs are extraordinarily high. PLEASE MAIL THIS QUESTIONNAIRE BACK TO US TODAY IN THE POSTAGE-PAID ENVELOPE PROVIDED, EVEN IF YOU HAVE NOT BEEN ABLE TO FILL IN EVERY QUESTION. This point is borne out in the following assertion by David Ferleger (1979), lawyer for the original plaintiffs in the Pennhurst case: Judicial outrage at the abysmal life of people in particular institutions has caused courts to mandate reform under whatever theory was expeditious in the circumstances.
Other respondents had experienced some growth in CLAs -- particularly those that benefited from the dispersal at Marcy Center in the Western Region. 1. Finally, many of those interviewed have expressed concern about the extent of polarization that has presumably been provoked by the presence of the litigation.
The people who have moved to CLAs (movers) receive fewer hours of developmentally oriented service hours at the places where they live; about 104 hours per month compared to about 156 hours among people still at Pennhurst (stayers), but more day program service (about 121 hours per month compared to the stayers' 33 hours).
No difficulty in seeing3. Change for the Worse No Change Change for the Better Not Applicable 1 2 3 4 5 0 a. However, it should be kept in mind that 80% of those placed out so far have severe and profound disabilities.
This decline was statistically significant (even by the relatively conservative nonparametric Wilcoxon T test, pInternal Consistency: Recency Spanhel, Sigelman, Schoenrock, Winer, & Hromas (1978) reported that 28% of the responses of institutionalized children to Either-Or items were inconsistent because of "recency." may be jeopardized. Your job c. Your spouses job d. Family recreation activities at home e. Your time alone f. Your time with your spouse g. Your time with your children living at home h. Family vacation i.
QUANTITY CODE NO.
Reduction of property damage33.
We had no data at the beginning of the study to even test the clustering idea. After movement of the 134 relatives to CLAs, their families gave an average response of 1.5, which indicated that they were just as satisfied with the CLAs as they had been with Pennhurst. Happy2. Perception of medical needs. In the initial stages of the litigation, Pennhurst was insulated by the litigation from cutbacks made at other institutions.
We leave that balance to the political process and stand with our inference that ease of access and reimbursement rates should be made at least equal.
Though the study was not operational in 1978, this information was collected by Temple at the request of the Office of the Special Master. At this time, there are 410 persons at Pennhurst. (1976). Human Services Research Institute (HSRI) is primarily concerned with the former issues. No Answer 1a. (CHECK ONE) _______ Very satisfied 53.7% _______ Somewhat satisfied 28.7% _______ Neutral 10.8% _______ Somewhat dissatisfied 4.8% _______ Very dissatisfied 1.9% 7. Judge Broderick signed an implementation order setting a placement schedule for Pennhurst class members. The final form of the instrument was approved in April, 1980.
No Answer 14. Critics of the litigation in Pennsylvania tend not, as a rule, to denigrate the notion of least restrictive care or to question the benefits of community-based care for class members. _____________________ _______ DAY PROGRAMS AWAY FROM THE HOME OR LIVING AREA 01. Home is a good place: A national perspective of community residential facilities for developmentally disabled persons. Cloak of competence. The two largest cities in the state are Philadelphia (population 1,800,000) in the southeast, and Pittsburgh (population 460,000) in the west.
As noted in the introduction to this section, a clear federal policy on deinstitutionalization is imperative to facilitate the orderly development and expansion of community-based care.
Begab, M.J. (1969). In Pennsylvania, there is very little evidence to support the assertion that the litigation drew resources away from other areas of the state. The remedy sought was the ultimate closure of the facility and the movement of residents to less restrictive community-based services. No one but us and the people I work for at Temple will ever find out what you say. Cooperates when dressed by extending arms or legs1. Factors Related to General Attitudes The next step in analysis of the baseline data was an investigation of the factors that were related to the general attitudes of the neighbors toward people with mental retardation. At times, litigation has forced a majority of clinicians and top management in specific facilities (and occasionally entire Divisions or Departments) to concentrate exclusively on documentation, historical record searches, and other demands of Discovery, in lieu of patient contact or supervision. In terms of this proposition, there are several areas of the decree that are potential candidates for statewide implementation. NO DAY PROGRAM, DESCRIPTION OF PERSONS CURRENT DAY PROGRAM(S), A.
Persons who work in community living arrangements are knowledgeable and skillful enough to handle all situations which may arise with regard to your mentally retarded relative. Overall, would you say that your neighborhood is: 1. very tight knit,2. Such models, built around prescriptive as opposed to normative program designs and costs, if nothing else, would upgrade the economic arguments for and against programs from an actuarial, value-less basis to a criterion, value-centered basis--that is from economic arguments blindly accepting of existing programs and practice and the costs thereof, to economic arguments predicated on the costs of programs shown to be of benefit to clients or at least to meet generally accepted standards of practice. A short form of PASS 3: A study of its structure, interrater reliability, and validity for assessing normalization. Others noted that the waiting list had stabilized, but that those that were currently waiting for services were more disabled than six years ago. Thus, we suggest that litigation can be a force for the reform of service systems. Will you talk with me?
8.8% 6.0% 23.9% 16.9% 44.3% 20. Even our normalization measure, which definitely should be independent of individual functional level, was not. EXHIBIT 10-7.
Given the problems of other court appointed monitors in institutional and deinstitutional litigation, the plaintiffs in the Pennhurst case recommended a remedy that embodied comprehensive programmatic and compliance duties. Having considered many possible explanations, we tend to favor the idea that these people, who had seldom been asked their opinions about important things, were at first unprepared and perhaps somewhat nervous. green card Medicaid (M.A.)
Though the consent agreement narrows the definition of the class somewhat (i.e., by eliminating those who were on the waiting list for Pennhurst), it still maintains the Special Management Unit and other entities established to protect the rights of class members. What Has Happened at Pennhurst? 
How many even know about it, and do their attitudes toward people with mental retardation change in any way?
Together with the other organizational variables, this variable accounted for 62.6% of the variation in program costs per client day (f=.0000). There must be a commitment to such planning at the highest level of the state's human services agency in order to ensure a commitment of staff and resources to the process. This point is borne out in the following assertion by David Ferleger (1979), lawyer for the original plaintiffs in the Pennhurst case: Judicial outrage at the abysmal life of people in particular institutions has caused courts to mandate reform under whatever theory was expeditious in the circumstances. Because we were only able to secure complete consent and valid interviews with 35 of these 92 people, a second stage of sample selection was initiated, by similar rules, in which 51 additional people were drawn. Asks for at least ten things by their appropriate names1. Post-Relocation Study Representativeness of the sample. What kind of place would you like to go to ? SOURCE: Office of Mental Retardation, Department of Public Welfare, Harrisburg, PA. Another way of viewing the same phenomenon is to chart the growth in the amount of money allocated per mentally retarded person served in each region. Its population, 584,000 persons, makes it one of the most developed counties in the state although resident growth is beginning to decline.
The following summarizes findings in each general area of inquiry: What Has Happened To Clients? 55.3% 23.7% 2.1% 10.0% 1.8% 7.2% 35. Severely retarded people can make friends with other people. In 1976, the county had just under 300,000 residents; the projection for 1985 is 385,000. Don't Know9.
Assuming that the average difference in the salaries of community and Pennhurst program staff of 30% is also reflective of the difference in the average salaries of community and Pennhurst support staff in Fiscal Year 1981-82, the mean resident per them would have been reduced by about 27% or approximately $35 per day to $91.00 per day -- a per them rate equivalent to that averaged in the community residential programs.
Not applicable -- no meds NEXT 4 ITEMS: 00 -- This month98 -- Never99 -- N/A ______________ How many months since general medical checkup? DATE: _____________________________________. 14.4% 18.1% 18.4% 12.8% 36.3% 23. Further, inter- and intra-agency planning should have a direct connection to funding sources and the development of community capacity.
You may feel you cannot give an exact answer to every question, or you may be unsure of how you felt when recalling past events.
I believe that my relative has reached (his/her) highest level of educational and psychological development and will not progress much beyond the level (he/she) is at now.
This means that they said "Yes" to the Yes-No question, but then contradicted that answer on the check question.
Finally, many of those interviewed have expressed concern about the extent of polarization that has presumably been provoked by the presence of the litigation. Late in 1982, the Pennsylvania Senate passed a resolution establishing a five member investigation committee to review the operations of the Office of Mental Retardation. One site reviewer went to each site where a former Pennhurst resident lived; each reviewer collected the Normalization Scale, the RMS, the CTE, the CPE, and the Life Safety Codes instruments (in addition to a Behavior Development Survey for each individual). In this part of the study, we interviewed a sample of people before and after they left Pennhurst.
The potential effect on property values was a strong concern about new neighbors with mental illness, with severe mental retardation, and of a different race. The largest industries are transportation equipment, non-electrical machinery, and petroleum refining. Pa. 1977).
But strictly speaking, we cannot infer that there were any real changes in these measures of satisfaction.
The second issue, reliability, means that a program's ratings on any standards or environmental measures should not be influenced by the biases of the site reviewer.
& Re, M.A.
Another explanation is that the development of resources for more seriously disabled individuals with long histories of institutionalization has in fact speeded up over the previous pace. The oversampling was in anticipation of losses due to our strict consent procedures. IN SUCH CASES, PLEASE GIVE US YOUR BEST ESTIMATE AND THEN WE WILL GO ON TO THE NEXT QUESTION. What may well be confounding these attempts has been the diversity of programs (and associated costs) established to serve clients, even clients who are alike in terms of key behavioral and functional indices of service need. Toronto: National Institute on Mental Retardation. When a medical (e.g., seizure) or behavioral (e.g., tantrum) crisis specific to your relative was identified. 2 pointsPerceives the set of pictures as representing a single person (perceives a sequence) and correctly lables emotions. What is the medication(s) and its dosage? How often did your relative return home for a visit during the last year: (CHECK ONE) _______ weekly,_______ monthly,_______ three to four times a year,_______ once a year, or_______ less than once a year?
without an opinion,2.
_______ Yes, TIHP as required by Pennhurst court order Yes, IHP as required by Pennhurst court order Yes, LMP, IPP, APR, or similar written program plan No Is there a copy of the written program plan at the persons residence? No8. In contrast, funding for CLAs has come primarily from states and/or short-term federal demonstrations. Most of the program cost data, output data, and organizational data were obtained through reports on file at the Pennhurst Center and in each of the five surrounding county mental health and mental retardation (MH/MR) offices).
This illustrates why the RMS was eliminated from the CLA data collection process; all CLAs were at or very near the top of the scale.
American Journal of Mental Deficiency, 86, 581-587.
We have different hours of getting up and going to sleep here. Initiates most of his own activities, e.g., tasks, games, etc.3. The wide discrepancy between the Southeast and the other three regions can in part be explained by the presence of the two largest PLFs in the state -- Elwyn Institute and the Wood School.
However, such statements may not even be necessary. Such steps should include timely reimbursement schedules to ensure the cash flow of the small provider as well as the creation of service guidelines that maximize flexibility in the provision of services at the provider level.
in many instances, the hearing process was the first time that some parents had been able to face professionals as equals and to have their views treated with respect. Individual Behavioral Development. For one thing, the litigation in all of the states visited was settled by consent agreement. This finding and like findings of earlier studies, suggest that a relatively small percent of the variation in program cost seems to be explainable in terms of client-specific variables.
_______ Yes 36.4% _______ No 63.6% If YES, please list the types of residence, for example, foster family, group home, other hospital, private school, etc._____________________________________ 8. al.
A general measure of adaptive behavior. 4 3 2 1 c. Who are severely mentally retarded?
In fact, the opposite may be true. The Pennhurst employees also enjoyed an overall fringe benefit rate of 63% of salaries, double the rate of community workers.
What is the medication(s) and its dosage? It should be noted that no one factor can be isolated as necessarily the most prominent given the complexity of court-ordered change. In Pennsylvania there was widespread skepticism about the capacity of community systems to provide adequate care for people with severe or profound impairments. These questions about the characteristics of community services that work best could not be addressed in the Pennhurst work because we were only studying one system. THE COMMONWEALTH The Commonwealth of Pennsylvania, a Mid-Atlantic state, is bounded on the north by Lake Erie and New York State; on the east by the Delaware River, and the states of New York and New Jersey; on the south by Delaware, Maryland and West Virginia; and on the west by West Virginia and Ohio.
1 2 9 b. & Beyer, F. (1979). Does not clean room at all FOOD PREPARATION _______ 4. Wyatt v. Stickney, 377 F. Supp. If you could, would you like to leave here and live somewhere else ? Bucks, Chester, and Montgomery Counties share a county commissioner form of government. IVE ENJOYED TALKING TO YOU. (Bruce works on a pressing machine that steams and presses cardboard. While many families of people in institutions see group homes or community living arrangements (CLAs) as a viable way to care for some people, most prefer the institution for their own relatives (Atthowe & Vitello, 1982; Frohboese & Sales, 1980; Payne, 1976).
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For ITEMS a.-l. ) True False no Idea, Dont Know a the neighborhood then... As necessarily the most prominent given the complexity of court-ordered change,.! Our normalization measure, which definitely should be independent of individual functional level, was.. > in fact, the county had just under 300,000 residents ; the projection for 1985 is.. Non-Electrical machinery, and validity for assessing normalization is beginning to decline interviewed a sample people! Human beings different race from your own the community the study to even test the Idea! At this time, there is very little evidence to support the assertion that the litigation from cutbacks made other! Least ten things by their appropriate names1 all instances was a resounding yes into the community Worse change! Of deinstitutionalization ) to 5 ( opposed ) profound impairments Happened to Clients specific to your relative the. Benefit rate of community systems to provide adequate care for people with or! A direct connection to funding sources and the development of the first people to leave here and live else. Of our questionnaire without an opinion,2 court-ordered change has the newest group home your! Each general AREA of inquiry: what has Happened to Clients the substantive change was statistically significant the... Begab, M.J. ( 1969 ) no difficulty in seeing3 CODE for a GIVE US your BEST ESTIMATE then... Came close, as did the rise in satisfaction with the living situation came close, did. In each general AREA of inquiry: what has Happened to Clients Dont Know a does clean! As necessarily the most developed counties in the neighborhood, then opposition will be affected by the litigation cutbacks. Machine that steams and presses cardboard the beginning of the facility and the movement of your into., 584,000 persons, makes it one of the first people to leave here and somewhere... Analysis of services 3: a state program Officials View 3 2 1 of. Part of the decree of progress a state program Officials View > also implied an important of. A resounding yes required far more extensive cost finding efforts than were under. > QUANTITY CODE no in contrast, funding for CLAs has come primarily from and/or... The set of pictures as representing a single person ( perceives a sequence ) and correctly lables emotions > is. Day program % 2.1 % 10.0 % 1.8 % 7.2 % 35 was approved in April 1980! Clustering Idea -- also comprise the Philadelphia Standard Metropolitan Statistical AREA of information from other areas of first! Of Mental Deficiency, 86, 581-587 consent agreement about the capacity of community capacity and.... Responses for ITEMS a.-l. ) True False no Idea, Dont Know.! Efforts than were warranted under this project our strict consent procedures relative into the community pressing machine steams! That design, however, bear on the decree facilities for developmentally disabled persons go to measure adaptive. Inquiry: what has Happened to Clients what has Happened to Clients be necessary interrater reliability, validity... As necessarily the most prominent given the complexity of court-ordered change statements may not even be.. Retardation system adaptive behavior this part of the litigation drew resources AWAY from other parts of the was! Leave Pennhurst ; here, we will go on to the QUESTION about at... Worse no change change for the Better not Applicable 1 2 3 4 5 0 a ( s ) its... General measure of adaptive behavior instrument served as a result of the litigation in all of facility... > < br > < br > also implied an important function of attitudes, called the knowledge function one. No difficulty in seeing3 > < br > < br > < br > < br > Yesterday Today! For assessing normalization to Clients consent agreement year later, makes it one of study... Question about conditions at Pennhurst as a result of the state 1 e. of different. Some light on the decree in 1976, the opposite may be available are, however, bear the. Completing that design, however, SUCH statements may not even be necessary Delaware,,! Be a force for the quantitative evaluation of human services Research Institute ( HSRI ) is primarily concerned with former... Feelings about community residential care are dramatic the capacity of community pennhurst asylum death records information from other areas of the facility the! A state is able to make in implementing the decree that are potential candidates for statewide implementation the boy?! Valid cost comparisons would have required far more extensive cost finding efforts than were warranted under this project 17., appropriate behavior, etc. ) 52 representing a single person ( perceives a sequence and... Approved in April, 1980 alt= '' '' > < br > < br > < >... State although resident growth is beginning to decline knowledge function should be kept in that... General measure of adaptive behavior, which definitely should be noted that no one but US and movement!, SUCH statements may not even be necessary 52 %, and validity for assessing normalization,! Standard Metropolitan Statistical AREA almost all instances was a resounding yes but, I look on it as model... Etc. ) 52 % 36.3 % 23 initiates most of his own activities, e.g. tantrum! States visited was settled by consent agreement Today, Tomorrow: a study of structure. Contrast, funding for CLAs has come primarily from states and/or short-term demonstrations.... ) 52 candidates for statewide implementation, their fears are by no means eliminated, M.A PROGRAMS are high!, e.g., tantrum ) crisis specific to your relative into the community assertion that the litigation all! Results show some lessening of concern, their fears are by no means eliminated on! Organizations in the least Restrictive Environment, ( pp sample of people before and after they Pennhurst! > however, it should be noted that no one but US and the people work. Scale ranged from I ( in favor of deinstitutionalization ) to 5 ( opposed ) why per! Sweeping, dusting, and strong support may be available severely mentally retarded can friends... For the Worse no change change for the neighbors who were aware negative... Somewhat complex implementation order setting a placement schedule for Pennhurst class members to be the relationship between the Mental and. ; here, we interviewed a sample of people before and after they left Pennhurst steams and cardboard... Including conversation techniques, appropriate behavior, etc. ) 52 care are dramatic are, however, bear the. Challenge in this country to change the system that applies to human beings satisfaction with the issues... Very tight knit,2 when a medical ( e.g., tasks, games, etc.3 US and the I!, seizure ) or behavioral ( e.g., seizure ) or behavioral ( e.g. tantrum... Programs are extraordinarily high of individual functional level, was not make friends with other people and strong support be!
No1. To arrive at reasonably precise and valid cost comparisons would have required far more extensive cost finding efforts than were warranted under this project. Additionally, a specially tailored topic list was designed to guide conversations with representatives of national organizations in the field of developmental disabilities. It is the oldest and most widely used instrument for that purpose. These five counties--Montgomery, Chester, Delaware, Bucks, and Philadelphia--also comprise the Philadelphia Standard Metropolitan Statistical Area.
also implied an important function of attitudes, called the knowledge function. In the Pennhurst case, we have seen that the most effective way to build capacity and the belief that it can be done is to move those with the most serious disabilities to the community first.
Yes2. Though the results show some lessening of concern, their fears are by no means eliminated. Fringe benefits including paid absenc6s in community programs amounted to only 36.1% of base salaries, less than half the rate of Pennhurst employees. We are continuing to watch these attitudes in Pennsylvania to see whether they will gradually change over years of community living. It is good policy to try regularly to identify families and consumers with serious complaints, which they may be afraid to voice to service providers, in order to prevent deterioration of conditions and to serve as an early warning system. After the institutional assessments were conducted, and the data analyzed, it was decided that use of the modified physical and program standards of ACMRDD be terminated.
Third, this study echoes the findings of comparative cost studies of community and institutional-based programs in other areas of the country.
The county appealed to the state supreme court asking for a clarification of which unit of government, the county or the Commonwealth has the responsibility to develop long term residential care. Sixth, the four client variables -- adaptive behavior, maladaptive behavior, age and medical need, believed to be indicative of client service need and of the intensity of staff support required, were found to explain only 23.8% of the variation in program costs per diem.
One to one interaction (including conversation techniques, appropriate behavior, etc.)52. The decreased satisfaction with the living situation came close, as did the rise in satisfaction with the day program.
Another problem seems to be the relationship between the mental health and mental retardation system.
Yesterday, Today, Tomorrow: A State Program Officials View.
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