Predictors of primary health care utilization by former residents of institutions in Ontario

For years institutionalization has been the primary method of service delivery for persons with developmental disabilities (DD). However, in Ontario the last institution was closed on March 31, 2009 with former residents now residing in small, communitybased homes. This study investigated potential predictors of primary health care utilization by former residents. Several indirect measures were employed to gather information from 60 participants on their age, health status, adaptive functioning level, problem behaviour, mental health status and, total psychotropic medication use. A direct measure was used to gather primary health care utilization information, which served as the dependent variable. A stepwise linear regression failed to reveal significant predictors of health care utilization. The data were subsequently dichotomized and the outcomes of a logistic regression analysis indicated that mental health status, psychotropic medication use and, an interaction between mental health status and health status significantly predicted higher primary health care usage.

Effectiveness of personal planning for residents re-entering the community during the facility initiative in Ontario

This paper reports on the relocation of people with intellectual disabilities (ID) from large-scale provincially run institutions that took place in Ontario as part of the Facility Initiative. Three case studies were examined in order to report on this process as experienced by those who lived and worked through it. Specifically, the planning process conducted by the Ministry of Community and Social Services (MCSS) to assist each person with hislher transition to community living was examined using the current standard of practice in person- centered planning approaches. Effectiveness was evaluated as the ability to apply a person-centered approach across settings and people, as well as what factors facilitated or hindered its application. Results show that, in general, the personal plans do not appear to reflect the pre-transition experience of the person. Also, the transitional planning process did not appear person-centered nor facilitate further person-centered planning in the community.

Invisible disability, visible people: a closer look at the experiences of teachers with learning disabilities /

Throughout their schooling experiences, students with learning disabilities (LD) face numerous academic and socioemotional challenges. Some of these individuals rise above these obstacles to obtain a postsecondary education and become professionals. Recently, there have been a number of individuals with learning disabilities who have chosen a career in teaching. There is a lack of research that documents the experiences of teachers with learning disabilities. The purpose of this qualitative study is to gain an understanding of the challenges that the teachers with learning disabilities strive to overcome and the supports that they receive ^^^ch facilitate their inception into teaching. Four teachers with learning disabilities were the participants in this collective case study research. Data were collected through semistructured interviews. These data were coded, collapsed into themes, and the results were presented in a narrative form. The resultant 9 themes are: (a) Perspectives on School Experiences, (b) Identification and Effective Accommodations, (c) Isolation, Frustration, and Support, (d) Awareness of Learning Disability at Age 18, (e) Disclosure of Learning Disability, (f) Negative Impact of the Learning Disability Label, (g) Desire, Drive, and Obstacles, (h) Empathy, Compassion, and Self-Concept, and (i) Critical Views of Colleagues. The themes reflect the common experiences among participants. The discussion brings forth new information that is not found in other research. The impHcations of this research will interest teacher federations, parents of students with LD, teachers, and educational researchers.

Therapeutic riding : learning and recovery for people with disabilities

The purpose ofthis study was to explore the process oftherapeutic riding as an experiential and holistic approach to learning and recovery for people with disabilities as perceived by the providers oftherapeutic riding. To enhance the connection between theory and practice and to suggest future research, the researcher endeavoured to develop a theory that contributed to the knowledge base oftherapeutic riding, animal-assisted therapy and education, experiential education, and experiential therapy in addition to contributing to connections among them. This topic was investigated because ofthe lack ofresearch about the process of therapeutic riding, particularly from learning and a recovery perspective. Few studies have addressed how therapeutic riding outcomes are achieved or how the therapeutic riding process actually works. This study was identified as grounded theory using qualitative data through interviews and narrative reflections with therapeutic riding providers, a researcher's journal, field notes, and written documents. Grounded theory analysis was used to analyze the qualitative data. This consisted ofdoing open, axial, and selective coding. This study provided detailed descriptions ofthe research approach, researcher's involvement, participant and site selection, data collection and analysis, methodological assumptions and limitations, credibility established, and ethical considerations. The findings ofthe data analysis revealed the theme ofrelationships as central to the learning and recovery process oftherapeutic riding for people with disabilities. The significance ofthe team relationships, the horse and rider relationship, and the providers and rider relationship was found. The essential components ofthe learning and recovery process were presented in a diagram in the selective coding phase. Goals oftherapeutic riding included psycho-education; behavioural and social; physical; and equestrian. Parts ofthe process ofhow outcomes were achieved included motivation; "opens new doors;" risk; task analysis; control; communication; and environmental factors. Outcomes of therapeutic riding included independence and mobility; confidence; and transfer abilities or skills. The implications ofthese findings for theory, practice, and further research were also. explored.

Wrap around analysis of the affordances and constraints for girls with physical disabilities participating in physical activities /

This is a qualitative study exploring the physical activity patterns of a group of women with physical disabilities through their lifespan. In-depth interviews were done with a group of 6 women aged 1 9 to 3 1 . The data were analyzed via content and demographic strategies. Participants in this study reported that their physical activity patterns and their experiences related to their physical activity participation changed over their lives. They were most physically active in their youth (under 14 years of age) and as they reached high school age (over 14 years of age) and to the present time, they have become less physically active. They also reported both affordances and constraints to their physical activity participation through their lifespan. In their youth, they reported affordances such as their parents' assistance, an abundance of available physical activity opportunities, and independent unassisted mobility, as all playing an important factor in their increased youth physical activity. In adulthood, the participants' reported less time, fewer opportunities for physical activity, and reliance on power mobility as significant constraints to their physical activity. The participants reported fewer constraints to being physically active in their youth when compared to adulthood. Their reasons for participation in physical activity changed from fun and socialization in their youth instead of for maintenance of health, weight, and function in adulthood. These affordances, constraints and reasons for physical activity participation were supported in the literature.

An inquiry into the barriers to participation within the fitness industry for people living with mobility challenges

This qualitative study was designed to inquire about the barriers to participation within the fitness industry for people living with mobility challenges. i\n examination of the insights, stolies~ and experiences with barriers through interviews gi ven by 4 people living with mobility challenges (PMC) formed the core of the research. An analysis of the interviews from the 4 PMC informants was performed at t\\/O levels. First, a content analysis served to identify general and specific categories related to barrier issues within various fitness environments. Secondly, in-depth thematic analyses of the entries related to the insights and stories from the 4 informants which emerged from the content analysis of the data gave rise to fi ve thematic statements. From the thematic statements a fitness industry awareness protocol was created in the fonn of a statement response questionnaire. The protocol, which was given to 4 fitness assessors/trainers, \vas used to provide a snapshot of the fitness industry's readiness to work vvith disability. Throughout the process, the four PNIC informants formed a collaborati vely involved group of coresearchers, adding their voices to the narrative of the fitness-barrier experience. The result of the study suggests that barriers to participation within the fitness industry for PMC exist in various forms and levels of severity. The results also suggest that the fitness industry needs to better prepare their people and environment for working with people with physical disabilities, such as PMC, and provide a more open and positi ve environment for participation. Within the context of any fitness-related environment, recognizing that barriers to participation do exist, and acknowledging and accepting people with disabilities for who they are as indi viduals, will serve to develop a relationship where fitness practitioners and people with disabilities can work towards creating an inviting, inclusive, accessible, and barrier-free fitness environment for all.

Experiences and meaning of the aquatic environment for individuals with physical disabilities

This study examines the experiences and meaning of physical activity in the aquatic environment to enhance social, cultural and political understanding of its impact in the lives of individuals with physical disabilities. Interviews, lived experience descriptions and artifacts present an explanation of the felt sense oftheir bodies as they engage in swimming or scuba diving. 11 Combining written, verbal and visual descriptions generated by informants provides a detailed account of the unique qualities of physical activity in the water for those with physical disabilities. Participants' descriptions highlight that context is an important aspect of physical activity among individuals with physical disabilities through discussion of motility and the role of the lived body. Aspects of the aquatic environment create a setting that facilitates forgetfulness of the lived body's presence. Instructors and participants alike will benefit from learning the difference between the object body and the lived body, listening to the body's voice as they participate in physical activity .

Breaking the silence : exploring the workplace experiences of six women with learning disabilities

In the current economic climate, employees are expected to upgrade their skills in order to remain productive and competitive in the workplace, and many women with learning disabilities! may feel doubly challenged when dealing with such expectations. Although the number of people with reported learning disabilities who enter the workforce is expected to increase, a dearth of research focuses on work-related experiences of women with learning disabilities; consequently, employers and educators often are unaware ofthe obstacles and demands facing such individuals. This qualitative narrative study sheds light on the work experiences of women with diagnosed or suspected learning disabilities. The study used semistructured interviews to explore their perspectives and reflections on learnlng in order to: (a) raise awareness of the needs of women with learning disabilities, (b) enhance their opportunities to learn in the workplace, and (c) draw attention to the need for improvement of inclusiveness in the workplace, especially for hidden disabilities. Study findings reveal that participants' learning was influenced by work relationships, the learning environments, self-determination, and taking personal responsibility. Moreover, the main accommodation requested was to have supportive and understanding work relationships and environments. Recommendations are made for future research and workplace improvements, most notably that no employees should be left behind through an employee-centered approach.

Investigation of Changes in Prescribed and Voluntary Job Roles in Community Service Delivery for People who have Intellectual Disabilities after the Implementation of the 3 Rs; Rights, Respect and Responsibility Project

The purpose of this thesis was to explore whether there is change in organizational citizenship behaviours in community agency staff following agency adoption of a rights - based service philosophy. Four community agency support staff were interviewed to investigate how residential care providers in services for persons who have intellectual disabilities describe their voluntary job related behaviours following training about human rights. The major finding was that the participants were actively engaged in displaying civic virtue, courtesy, and altruism discretionary behaviours. There was evidence of a post rights training shift in communication patterns with support staff reporting that they used language that prom,oted and advocated for human rights, and reported increased communication exchanges among persons supported by the agency, support staff and managers. Participants also suggested that the individuals they support asserted their rights more frequently and they were more active in their own life choices following rights training.

Managing Risk in a Culture of Rights: Providing Support and Treatment in Community-Based Settings for Persons with Intellectual Disabilities who Sexually Offend

People with intellectual disability who sexually offend commonly live in community-based settings since the closing of all institutions across the province of Ontario. Nine (n=9) front line staff who provide support to these individuals in three different settings (treatment setting, transitional setting, residential setting) were interviewed. Participants responded to 47 questions to explore how sex offenders with intellectual disability can be supported in the community to prevent re-offenses. Questions encompassed variables that included staff attitudes, various factors impacting support, structural components of the setting, quality of life and the good life, staff training, staff perspectives on treatment, and understanding of risk management. Three overlapping models that have been supported in the literature were used collectively for the basis of this research: The Good Lives Model (Ward & Gannon, 2006; Ward et al., 2007), the quality of life model (Felce & Perry, 1995), and variables associated with risk management. Results of this research showed how this population is being supported in the community with an emphasis on the following elements: positive and objective staff attitude, teamwork, clear rules and protocols, ongoing supervision, consistency, highly trained staff, and environments that promote quality of life. New concepts arose which suggested that all settings display an unequal balance of upholding human rights and managing risks when supporting this high-risk population. This highlights the need for comprehensive assessments in order to match the offender to the proper setting and supports, using an integration of a Risk, Need, Responsivity model and the Good Lives model for offender rehabilitation and to reduce the likelihood of re-offenses.

Bridging the Conceptualization of Youth with Intellectual Disabilities to Sentencing under the YCJA

The current study examined how disability and the concepts of risk, need and responsivity are understood by criminal justice professionals and inform their perceptions of young offenders with ID at sentencing under the ‘different but equal’ philosophy. Semi-structured interviews were conducted with 11 lawyers and 8 mental health workers across 6 major urban areas in Ontario. Participants primarily perceived ID through a medical discourse, overlooking social and structural barriers that, in some cases, may hinder adherence to sentencing dispositions. Specifically, participants discussed balancing the reduced culpability of offenders (e.g., intent) – justifying lenient sentencing – with public safety concerns (i.e., ID viewed as a barrier to rehabilitation) – justifying increasing the severity of sentences. Participants assessed clients with ID and their risks, needs and responsivity within the context of other legal factors: criminal history, severity of the offence, and YCJA objectives. Participants articulated the importance of tailored courthouse identification programs, services/funding, and education/training.

Elaborative interrogation as a learning technique for students with learning disabilities

This study examined whether or not students with learning disabilities could effectively use a question and answer strategy known as elaborative interrogation. This technique involved students answering why they thought facts based on familiar animal stories were true. Thirty students from a provincial demonstration high school (for students with learning disabilities) were assigned to one of two study conditions, (a) elaborative interrogation or (b) reading for understanding. Three students, one from the experimental condition and two from the control did not complete the study. Both conditions required that the students learn 36 facts concerning six familiar animals. Immediately following the study session the students completed a free-recall test, a matched association test and a questionnaire regarding their perceived difficulty of the animal stories. After 30 days a matched association test was completed. The oneway ANOVA, 2 x 2 split plot ANOVA and Tukey's Honestly Significant Test were used to determine significance. There was no significant difference in the two conditions for free recall retention. There were significant differences in the elaborative interrogation condition for the immediate matched association test and for the 30-day matched association test. The probability of the students' responses in the elaborative interrogation were measured to determine the effects of adequate responses on long-term retention. It was found that the adequate responses were more likely to promote retention than inadequate responses. In conclusion, long-term retention of factual information was significantly better in the elaborative interrogation condition in comparison to the reading for understanding control. For future research, the dependent measure, free recall should be given both verbally and in written format. In addition, extra time should be allowed for processing of the new information to occur.

Making the transition from secondary to post-secondary education : a retrospective study of students with learning disabilities

The purpose of this study was to investigate what students with Learning Disabilities perceive are the personal characteristics they possess and services they require to assist them to complete secondary school and to continue their education in a postsecondary setting. Twenty-one students (12 female and 9 male) participated in the study which consisted of an interview and completion of a questionnaire. The central findings were as follows: 1) the participants perceived that personal characteristics were important in secondary school and still remain of importance at th~ postsecondary level; 2) Many of the typical accommodations and services supposed to be provided in secondary schools were not provided to the participants in this study; 3) the participants believed that they had more academic than social problems. Recommendations for future research in this field are based on findings related to the transition of LD students from secondary school to postsecondary education.

School integration and the friendships of youth with developmental disabilities

- The present study was an investigation into the effect ofschool integration on the friendships ofyouth with developmental disabilities and their peers without disabilities. The youths, their parents, and their teachers provided insights into the youths' friendships. A qualitative paradigm was used in this research. The researcher guided the collection and analysis ofthe data with the phenomenologicallifeworld existentials of body, space, time, and human relation (Van Manen, 1990). Individual interviews were conducted with each youth, and group interviews were conducted with each triad (a youth, their parent(s), and their teacher) to discuss the youth's friendships and the supports necessary to facilitate the friendships. Through phenomenological analysis of the data, four thematic statements emerged: friendships are far from perfect, to have a friend you have to be a friend, parents as choreographers offriendship, and teachers as reluctant partners in friendship facilitation. Based on the results ofthis study, it was concluded that the development of friendships between youth with developmental disabilities and their peers without disabilities was happening in integrated school settings. However, it was also evident that the support ofteachers and parents alike were required to facilitate the development and maintenance ofsuch friendships. Recommendations for practice are discussed, including the need for active participation by the youth's parents in the facilitation offriendships, and the use ofa "circle offriends" to facilitate friendship development. Also discussed are the recommendations for further research, including the need for the youth's friends to be interviewed regarding their friendships with the youth with disabilities, and the need for researcher observation ofth~ friendships in action. Further research could also explore the role ofthe mother versus the father in facilitating friendships, and the role of recreation and leisure opportunities in the ,development offriendships.