RehabWire - Volume 6, Number 7, September 2004

RehabWire for September looks at community-based rehabilitation services. These may include job training, independent living services, physical rehabilitation, or even medication supervision.

NIDRR Projects: Research in the New Millennium.

Integrating Assertive Community Treatment (ACT) and Illness Management and Recovery (IMR) for Clients with Severe Mental Illness (SMI), Indiana University Purdue University Indianapolis (IUPUI) (H133G030106) led by Michelle P. Salyers, PhD. Bonnie Gracer, Project Officer.
Abstract: This project targets the subgroup of 20 percent of consumers with severe mental illness identified with the most severe disabilities, that is, the subgroup most often excluded from rehabilitation services and mental health treatment. The project involves: (1) the systematic integration and high-fidelity implementation of two evidence-based practices for consumers with severe mental illness: assertive community treatment and illness management and recovery; (2) enhancing integration by employing a consumer specialist on treatment teams in a well-defined role; and (3) providing the first empirical test of a comprehensive package of techniques designed to help consumers learn to manage their own illness and foster recovery. Outcome measures include achievement of recovery goals, such as competitive employment and independent living, as well as indicators of illness management, such as prevention of hospitalization.
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Increasing States’ Allocations of Medicaid Dollars to Community-Based Care: Where Might Policy Intervene? University of Maryland/Baltimore County (H133G010023) led by Nancy Miller, PhD. Phillip Beatty, Project Officer.
Abstract: This research project examines factors that influence community-based care expenditures for different subgroups of individuals with disabilities. Analyses focus on Medicaid 1915(c) waiver expenditures, examining the effect of a set of state-level variables shown in previous work to be related to state fiscal effort, on expenditures for five segments of the population: the frail elderly, individuals with developmental disabilities, younger people with disabilities, persons with AIDS, and children with a variety of disabling conditions. Research examines the extent to which states can redirect institutional dollars to community-based care without increasing total long-term care expenditures. Community-based care services are, on average, noticeably less costly than institutional services; if the site of care is the community rather than the institution more individuals are able to access care. By focusing on Medicaid 1915(c) waiver programs, this project provides important cost effectiveness information not presently available.

National Training Institute for Frontline Supervisors (NTIFFS), University of Minnesota (H133G030058) led by Sheryl Larson, PhD. Joyce Y. Caldwell, Project Officer.
Abstract: This project refines, tests, and delivers a national train-the-trainer and technical assistance model to assist community organizations that provide supports and services to persons with developmental and other severe disabilities to recruit, retain, and train direct support and frontline supervisor staff members. The model includes: (1) assisting organizations to assess their recruitment and retention challenges; (2) providing web-based training on recruitment and retention strategies; (3) conducting 2 intensive train the trainer institutes for 10-15 organization representatives; (4) supporting organizational representatives to provide training to 70-100 frontline supervisors; (5) providing on-site as well as remote technical assistance support and training to organizational representatives; (6) supporting technical assistance efforts by organizational representatives for frontline supervisors; (7) supporting ongoing follow-up measurement to assess the effectiveness of interventions and to guide future intervention work; and (8) developing project products and reports to share the project outcomes with policy makers, provider organizations, and other interested persons.
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Missouri Arthritis Rehabilitation Research and Training Center (MARRTC), University of Missouri (H133B031120) led by Jerry C. Parker, PhD. Theresa San Agustin, MD, Project Officer.
Abstract: The purpose of the Missouri Arthritis Rehabilitation Research and Training Center (MARRTC) is to provide leadership at the national level in support of three key objectives: to reduce pain and disability, to improve physical fitness and quality of life, and to promote independent living and community integration for persons with arthritis of all ages in the United States. State-of-the-science rehabilitation research addresses the needs of persons with arthritis in several areas including: (1) home and community-based self-management programs, (2) benefits of exercise and physical fitness, and (3) technologies available to the broad populations of persons with arthritis in the environments where they live, learn, work, and play.
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Assistive Technology in the Community, Washington University (H133A010701) led by David B. Gray, PhD. Bonnie Gracer, Project Officer.
Abstract: This project promotes AT as a means of increasing participation in major life activities by people with disabilities. Project activities include: (1) assessing the use, disuse, injury, and effects that AT has on the participation of people with disabilities in major life activities, to determine what technologies are of the most benefit in community settings; (2) implementing a community-based AT program in collaboration with Paraquad, a nationally recognized Center for Independent Living, to improve the satisfaction of participants in their self-chosen life activities; (3) educating consumers, independent living staff, educators, health care professionals, AT industry leaders, and public policy-makers about the influence AT has on major life activities.
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New Research: Selections from REHABDATA

Taylor, R. R., Braveman, B., Hammel, J. (2004) Developing and evaluating community-based services through participatory action research: Two case examples. American Journal of Occupational Therapy (AJOT), 58(1), 73-82. NARIC Accession Number: J47162.
Abstract: Article identifies key principles of participatory action research that can be used to develop and evaluate community-based occupational therapy services. The participatory action research approach generally involves six steps: (1) delineating the problem, (2) choosing action, (3) design and assessment, (4) engaging in action, (5) data collection, and (6) reflexive knowledge. This approach is illustrated using two case examples of programs for individuals with chronic fatigue syndrome and those with autoimmune deficiency syndrome.

Haley, S. M., Andres, P. L., Coster, W. J., Kosinski, M., Ni, P., Jette, A. M. (2004) Short-form activity measure for post-acute care. Archives of Physical Medicine and Rehabilitation, 85(4), 649-660. NARIC Accession Number: J47515.
Abstract: Article describes the use of item pooling and item response theory methods to develop six short-form instruments for outcome assessment across post-acute rehabilitation settings. Inpatient and community-based short forms were developed for each of three activity domains: physical and movement, applied cognition, and personal care and instrumental. The items pools used to create the short forms, collectively referred to as the Activity Measure for Post-Acute Care, were developed from large item pools that included items from existing instrument used in current post-acute settings and from new items based on the World Health Organization’s International Classification of Functioning, Disability and Health framework. Items were selected for inclusion on the short forms to maximize content coverage and information value at each stage of functional recovery and to minimize ceiling and floor effects.

Sharma, M. (2004) Viable methods for evaluation of community-based rehabilitation programs. Disability and Rehabilitation, 26(6), 326-334. NARIC Accession Number: J47534.
Abstract: Research review examines viable and practically feasible qualitative methods for evaluation of community-based rehabilitation programs. Case studies, focus groups, nominal groups, participatory techniques, content analysis, and key informant interviews are analyzed. Issues in qualitative designing, sampling, data collection, analysis, and interpretation are discussed.

Carpenter, C., Forman, B. (2004) Provision of community programs for clients with spinal cord injury: Use of qualitative research to evaluate the role of the British Columbia paraplegic association. Topics in Spinal Cord Injury Rehabilitation, 9(4), 57-72. NARIC Accession Number: J47570.
Abstract: Article describes a qualitative focus group research study designed to evaluate the effectiveness of the British Columbia Paraplegic Association in assisting people with spinal cord injury to meet their goals in the community. The importance of basing health services and policy decisions on research that involves the intended recipients is discussed. Authors discuss the research process and results and how the findings contributed to program revision and development. Recommendations are made for ongoing program and service planning.

Collins, T., Baraw, F., Place, R., Miller, G. (2004) Newport, Vermont business and economic development assessment: 2003-2004. NARIC Accession Number: O15275.
Abstract: Report describes study conducted to identify opportunities for business development in Orleans County, Vermont. Data was gathered through community records, census data, and interviews with community leaders and business owners. Report summarizes: (1) the demographics and history of the area, (2) the strengths of the community as reported by community leaders and business owners, (3) opportunities for business expansion or creation, (4) concerns and obstacles to economic development as seen by current business owners, and (5) recommendations for building on strengths, addressing concerns, and taking advantage of existing opportunities.

(2004) PAS: Center for Personal Assistance Services Bulletin, 1(2). NARIC Accession Number: O15382.
Abstract: Newsletter provides the latest news on issues relating to personal assistance services (PAS), home and community-based services, the PAS workforce, and workplace PAS. In this issue: PAS Center website, new paper published on nursing home transitions, in-home support services update, new online report tracks State systems change activity, expanding workplace PAS in Iowa, PAS focus groups, and selected conferences.

Niemann, S., Greenstein, D., David, D. (2004) Helping children who are deaf: Family and community support for children who do not hear well. NARIC Accession Number: R08457.
Abstract: Book is a resource to help families, caregivers, communities, and health workers build the communication skills of infants and young children who are deaf or cannot hear well. Authors explain how deafness affects a child’s ability to learn language and develop mentally and socially. Topics include: why young children need to learn a spoken or sign language, and how to teach them; assessing how much a child can hear; developing communication, listening, and social skills; supporting parents; educating a deaf child; preventing sexual abuse; and preventing deafness. Appendices include information on hearing aids, cochlear implants, and child development. A resource list of organizations and printed materials that can provide additional information about deafness and young children is also provided.