150 Years of Movement Toward Community in the United States James W. Conroy, Ph.D. The Center for Outcome Analysis www.eoutcome.org
Jan 02, 2016
150 Years of Movement Toward Community in the United States
James W. Conroy, Ph.D.The Center for Outcome Analysiswww.eoutcome.org
What is the Purpose of Human Services? Are people better off? Is this measurable? Yes, No, and partly . Today: the case of segregated models for citizens with disabilities How do we know theres a better way than institutional segregation? 40 years of studies and learning about whats really important..One message: The evidence is very strong about DI
Outline1. History & Trends2. Personal Journey3. The Science: How do we know people are better off?4. Economy of Scale ConceptsThe overall message: Overwhelming data, the evidence is VERY STRONG for small, family-like, community living
Very Big Versus SmallInstitution versus CommunityThis is a settled issueMedia exposure, scandals, court decisions, and a large body of researchInstitutions have declinedCommunity options are preferred in every way
Source of The Institutional ModelBrought to the U.S. in 1848By Samuel Gridley HoweFrom a model program in GermanyThe vision was a self-sufficient agrarian communityFree from pressures of normal lifeProtected, safe, healthyMassachusetts School for Idiotic Children (Fernald)
Regimentation 1915
Howe Changed by 1866: all such institutions are unnatural, undesirable, and very liable to abuse. We should have as few of them as is possible, and those few should be kept as small as possible.Such persons [with disabilities] ... should be kept diffused among sound and normal persons.
150 Years of Institutionalization
Chart2
Braddock2006ResCostAvgs
Braddock 2006 data
16+ Private ICF/MR16+ State Operated
Institutional Decline, Community Rise
Chart4
1250
12753
1300
13255
1350
14157
1480
15559
1640
16861
1730
17663
1800
18565
1920
19367
1941
1941.5
1872
1844
1816
1739
16612
15816
15420
14424
13928
13233
12638
12044
11549
11055
10662
10372
10075
9782
9490
9194
8899
82104
76110
72117
68123
63135
58150
54165
50185
48205
46220
45235
43255
43275
42300
41325
40350
39.5365
39380
38390
37400
Institution
Community
Inst&Comm2008
YearInstitutionCommunity
521250
53127
541300
55132
561350
57141
581480
59155
601640
61168
621730
63176
641800
65185
661920
67193Number of People in Home & Community Based Waiver Programs, Developmental Disabilities
681941
691941.5
701872
711844
721816
731739
7416612
7515816
7615420
7714424
7813928
7913233
8012638
8112044
8211549
8311055
8410662
8510372
8610075
879782
889490
899194
908899
9182104
9276110
9372117
9468123
9563135
9658150
9754165
9850185
9948205
0046220
0145235
0243255
0343275
0442300
0541325
0640350
0739.5365
0839380
0938390
1037400
Inst&Comm2008
125
127
130
132
135
141
148
155
164
168
173
176
180
185
192
193
194
194
187
184
181
173
166
158
154
144
139
132
126
120
115
110
106
103
100
97
94
91
88
82
76
72
68
63
58
54
50
48
46
45
43
43
42
41
40
39.5
39
38
37
Number of Americans in Public Institutions (DD) 1950-2010
CA2 Round 7
0
53
0
55
0
57
0
59
0
61
0
63
0
65
0
67
1
1.5
2
4
6
9
12
16
20
24
28
33
38
44
49
55
62
72
75
82
90
94
99
104
110
117
123
135
150
165
185
205
220
235
255
275
300
325
350
365
380
390
400
Number of Americans in Home & Community Based Waiver Programs (DD) 1950-2010
CA2 Transposed
1250
12753
1300
13255
1350
14157
1480
15559
1640
16861
1730
17663
1800
18565
1920
19367
1941
1941.5
1872
1844
1816
1739
16612
15816
15420
14424
13928
13233
12638
12044
11549
11055
10662
10372
10075
9782
9490
9194
8899
82104
76110
72117
68123
63135
58150
54165
50185
48205
46220
45235
43255
43275
42300
41325
40350
39.5365
39380
38390
37400
Institution
Community
Number of People in Home & Community Based Waiver Programs, Developmental Disabilities
OK 2009
PA 1992
IN 1999
Institution
Community
NCI data 2006
nlivherg PEOPLE IN THIS HOMEdcig DECISION CONTROL INVENTORY SCORE, 0 TO 100intg TOTAL # INTEGRATIVE ACTIVITIES LAST MONTHpiqlg PERSONAL INTERVIEW SATISFACTION SCALEqlng QUALITY OF LIFE NOW, 0 TO 100qlchngg CHANGE IN QUALITY OF LIFE FROM LAST YEAR TO NOWstfwwpgstfsatcglikewwpgipsg INDIVIDUALIZED PRACTICES SCALE, 0 TO 100ersg ENVIRONMENTAL RATING SCALEprogresg REPORTED PROGRESS ON GOALS, 0 TO 100eppg
1Mean78.63031573962.541666666789.92195767282.321335127549.8969780222.75510204080.7948717949993.310439560459.464285714381.362318840679.440187006
N494836493049393915284638
2Mean74.986947622750.207792207884.53157349983.202095784349.40916455343.02272727271.76666666679.049180327985.906394330358.032786885280.309523809583.2236612594
N777746765277606146617063
3Mean68.359617031658.63218390885.858375420982.658361753249.40237824852.67528735631.24193548399.584615384678.744658119762.518656716479.308943089482.556122449
N868748873987626548678270
4Mean53.764017728134.919191919280.252798252881.23947131336.79846938783.49183006541.51020408169.228260869669.167263895559.030612244977.363636363685.993299949
N100993710256102989292989979
5Mean47.825471293831.551724137978.741736694779.649330554540.24165649173.38706896551.67148014449.130434782668.683776829263.626325088377.797408716184.0037176365
N29029085290162290277276275283283224
6Mean42.740285021322.722037652377.822718448681.819133708738.22288056183.83204134371.69977678579.353535353569.208593003166.92093541276.241778774385.2384014517
N902903139903489903896891898898892749
7Mean52.078714633228.315789473776.782881075679.557582142238.21840122243.83395989972.57894736849.210526315869.22562817364.342105263278.194444444475.6425060447
N1331334113362133133133133133132115
8Mean47.859535182729.115183246178.312501918980.845853707735.8012063053.71727748691.82198952889.378947368468.959338721270.026315789578.453752181580.5754443531
N1911914719098191191190189190191181
9Mean43.313683465531.410526315883.778739778781.022493131931.46798853323.56944444441.8759.437575.53390186274.179687580.409722222279.0166325922
N959521966996969696969686
10Mean56.536960664140.830188679279.261405261487.137155297543.41256569523.46069182392.50980392169.607843137373.224161459580.673076923181.803921568684.6503326605
N535313532353515151525149
11Mean61.283470206335.181818181880.014430014488.592657342747.02380952383.0719696970.66666666679.772727272772.743764172362.857142857184.606060606196.4682539683
N2222722622212221212221
12Mean43.682773109215.62562.857142857169.419642857130.714285714340.8759.7565.947802197868.7580.458333333375.0595238095
N881858888886
13Mean75.238095238119.66666666678676.7857142857252.94444444443.3333333333967.216117216153.333333333377.666666666773.3333333333
N332323333331
14Mean54.117647058825.666666666785.25641025644.61111111110.66666666678.666666666777.301587301678.333333333386.666666666798.2142857143
N3333333333
15Mean19.21880.1923076923753.955.49.867.6666666667737190.4047619048
N55515555555
TotalMean48.916211158630.09122459180.573804143681.458205229939.188558943.60398120671.75347400939.316279069870.411543301266.335431654777.711380063983.4420966115
N20172017523202010942022194319351883194619831690
nlivherg PEOPLE IN THIS HOMEdcig DECISION CONTROL INVENTORY SCORE, 0 TO 100intg TOTAL # INTEGRATIVE ACTIVITIES LAST MONTHpiqlg PERSONAL INTERVIEW SATISFACTION SCALEqlng QUALITY OF LIFE NOW, 0 TO 100qlchngg CHANGE IN QUALITY OF LIFE FROM LAST YEAR TO NOWstfwwpgstfsatcglikewwpgipsg INDIVIDUALIZED PRACTICES SCALE, 0 TO 100ersg ENVIRONMENTAL RATING SCALEprogresg REPORTED PROGRESS ON GOALS, 0 TO 100eppg
1Mean78.662.589.982.349.92.80.89.093.359.581.479.4
2Mean75.050.284.583.249.43.01.89.085.958.080.383.2
3Mean68.458.685.982.749.42.71.29.678.762.579.382.6
4Mean53.834.980.381.236.83.51.59.269.259.077.486.0
5Mean47.831.678.779.640.23.41.79.168.763.677.884.0
6Mean42.722.777.881.838.23.81.79.469.266.976.285.2
7Mean52.128.376.879.638.23.82.69.269.264.378.275.6
8Mean47.929.178.380.835.83.71.89.469.070.078.580.6
9Mean43.331.483.881.031.53.61.99.475.574.280.479.0
10Mean56.540.879.387.143.43.52.59.673.280.781.884.7
11Mean61.335.280.088.647.03.10.79.872.762.984.696.5
12Mean43.715.662.969.430.74.00.99.865.968.880.575.1
13Mean75.219.786.076.825.02.93.39.067.253.377.773.3
14Mean54.125.785.34.60.78.777.378.386.798.2
15Mean19.218.080.275.04.05.49.867.773.071.090.4
TotalMean48.930.180.681.539.23.61.89.370.466.377.783.4
N20172017523202010942022194319351883194619831690
EconomyOfScaleCharts
nlivherg PEOPLE IN THIS HOME123456789101112131415Total
MeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. DeviationMeanNStd. Deviation
dcig DECISION CONTROL INVENTORY SCORE, 0 TO 10078.6303157394924.395776485974.98694762277721.984114215668.35961703168623.327316893253.764017728110026.03940727147.825471293829025.759970283342.740285021390223.099607125852.078714633213322.992857762947.859535182719120.009950792543.31368346559521.441833320256.53696066415321.112298362761.28347020632215.304017931243.6827731092824.459948459875.2380952381317.155550855954.1176470588310.188534162219.2514.609753521548.9162111586201724.9722367665
intg TOTAL # INTEGRATIVE ACTIVITIES LAST MONTH62.54166666674838.829117355550.20779220787736.830457098258.6321839088736.988406399434.91919191929928.876117088631.551724137929024.10959149122.722037652390318.517691889628.315789473713318.969021164929.115183246119121.671648465331.41052631589523.644303320440.83018867925325.694758406735.18181818182219.860552823215.62589.515964030419.6666666667317.009801096225.666666666732.309401076818512.845232578730.091224591201725.3856779734
piqlg PERSONAL INTERVIEW SATISFACTION SCALE89.9219576723611.886671650384.5315734994612.691748220385.85837542094814.67547790680.25279825283712.68531806378.74173669478512.2166490977.822718448613911.162981595576.78288107564114.159943569578.31250191894712.015487712783.7787397787218.545181064479.26140526141314.872393082380.014430014478.47049221862.85714285711.86225.455844122780.573804143652312.8122009869
qlng QUALITY OF LIFE NOW, 0 TO 10082.32133512754910.483875344583.20209578437613.37247970782.65836175328710.710864789281.23947131310213.515347670979.649330554529012.758568234881.819133708790312.041399143279.557582142213312.982744686780.845853707719012.243403174281.02249313199610.527851209887.1371552975539.295725605188.5926573427229.444687023469.4196428571812.570410296276.785714285733.092947870785.256410256438.882311833780.192307692359.430322719681.4582052299202012.1914444226
qlchngg CHANGE IN QUALITY OF LIFE FROM LAST YEAR TO NOW49.8969780223023.949228049749.40916455345224.398761284849.40237824853922.423708798136.79846938785622.918960681540.241656491716222.82497796138.222880561848918.404469163438.21840122246219.304621537535.8012063059822.200480721931.46798853326910.165019126743.41256569522317.251927902447.0238095238611.45069533730.7142857143512.71498794212520751.39.18855894109420.3266565064
stfwwpg2.7551020408495.06141129593.0227272727775.83523835382.6752873563873.7231821973.49183006541023.71834845193.38706896552904.06293133413.83204134379032.90417261543.83395989971332.57093178853.71727748691912.22790934163.5694444444962.38724273493.4606918239532.80265269333.071969697221.8057622814482.0873770282.944444444431.05847549354.611111111131.63582576273.9553.063902743.603981206720223.2929867237
stfsatcg0.7948717949392.64753596651.7666666667602.52020087081.2419354839622.20792524721.5102040816982.80001803371.67148014442772.71809868891.69977678578962.85442711242.57894736841333.06547372961.82198952881912.16180680281.875962.3541676372.5098039216512.67860074680.6666666667211.52752523170.87581.80772153353.333333333332.88675134590.666666666731.15470053845.454.92950301751.753474009319432.7346532784
likewwpg9391.37649440329.0491803279611.8746220029.5846153846650.89951910239.2282608696921.02820937789.13043478262761.49094765219.35353535358911.16389329399.21052631581331.14846822619.37894736841900.93919866079.4375961.36738320979.6078431373510.77661911839.7727272727220.75162162359.7580.70710678129308.666666666731.15470053849.850.44721359559.316279069819351.2153017017
ipsg INDIVIDUALIZED PRACTICES SCALE, 0 TO 10093.3104395604158.314363280985.90639433034615.070735240178.74465811974811.806997693269.16726389559217.828891477368.683776829227516.294203977769.208593003189814.061685899969.22562817313314.922742036668.959338721218913.238114509475.5339018629610.849773218273.22416145955111.850342771272.7437641723218.386773900665.9478021978813.94246332467.216117216135.075606762177.301587301631.099714798567.6666666667511.093040861570.4115433012188314.7443023365
ersg ENVIRONMENTAL RATING SCALE59.46428571432820.336943473458.03278688526118.263777642462.51865671646716.697640542459.03061224499814.725287935263.626325088328313.989933865766.92093541289814.806401580964.342105263213312.85074110970.026315789519015.391688202474.17968759618.104074240780.67307692315217.79592501762.85714285712113.469542361568.75819.039432764753.3333333333311.547005383878.3333333333328.86751345957357.582875444166.3354316547194615.7084701087
progresg REPORTED PROGRESS ON GOALS, 0 TO 10081.36231884064613.392613790280.30952380957012.434993145279.30894308948211.510450966377.36363636369910.880518998377.797408716128311.62487385976.241778774389211.413897468478.194444444413211.349714375278.453752181519110.8298934780.4097222222969.95480772781.8039215686519.814315274884.6060606061226.567223700280.458333333387.048443484677.666666666738.736894948186.6666666667312.85820101477159.433981132177.7113800639198311.392438818
eppg79.4401870063821.902570525183.22366125946317.855822324882.5561224497020.024738943885.9932999497915.27429153884.003717636522416.468694983385.238401451774914.419770725675.642506044711522.034621377780.575444353118117.985478357179.01663259228621.866804813284.6503326605499.486050600496.46825396832110.060286906375.0595238095610.189739069973.33333333331.98.214285714333.092947870790.404761904855.3891898683.4420966115169016.8492911255
CostXSizePA
Report
SizetPROD2 HOURS PRODUCTIVE DAY ACTIVITY/MONTH 09tCISATIS CONS INTVW SATISFACTION 09tCICHOIC CONS INTVW CHOICEMAKING 09tCIINTEG CONS INTVW INTEGRATION 09tepp2 Elements of the Planning Process Scale 09tDCI Decision Control Inventory 09tQLT Quality of Life Then 09tQLN Qualilty of Life Now 09tQLCHNG Quality of life change 09tfrnyrstfrnPCPtfrncont
1Mean44.334056399192.022023809587.986111111174.820075757680.03458517872.826223586477.950818537679.52221314482.08125716993.33760144920.49091847273.8502169197
N461200180176366460409461409460323461
Std. Deviation51.820605170611.420087859322.056174227219.741362935113.19757753719.205358515611.048899719510.85048552637.94812226464.35269019160.8915019875.1055468511
2Mean38.796791443994.577625570888.83597883678.359788359877.377533577557.75617064977.289240200978.77355487651.52264153015.21292335120.3795358656.3978609626
N187736363150187167187167187158187
Std. Deviation49.510848060511.159626872115.361926707718.609219550613.170196689121.991681407810.377510738110.92431030267.11209563255.80810193080.81943807835.1639773495
3Mean42.944444444498.98989898998087.96296296381.543778801861.297742849277.63204537477.17490842490.88177951087.32583333350.3212.0444444444
N36111093136313631363536
Std. Deviation57.36198066143.350126050915.811388300813.888888888913.371808287218.89693970210.55383145878.6714579959.70463382235.52790964110.70061597556.3460423863
6Mean6093.827160493889.814814814877.777777777856.732486263751.568100358479.662698412779.6626984127-05.03611111110.356.8888888889
N189991618181818181018
Std. Deviation52.58047054148.536615238213.028932666211.78511301989.932799840515.66760813359.49147610139.43200235370.61249494696.91247392410.7472170598.6875765855
TotalMean43.189458689592.975784170387.948473282476.251621271178.74754020467.668204436777.807535797579.20601181821.81256077264.08629576790.4434093795.026994302
N702293262257563701625702625701526702
Std. Deviation51.547850462411.163296243920.155652180419.184791661213.678292991921.134439074110.791887185610.73158672217.71407833965.03442143910.85640251295.6614232492
ReportSize1236Total
MeanNMeanNMeanNMeanNMeanN
tPROD2 HOURS PRODUCTIVE DAY ACTIVITY/MONTH 0944.346138.818742.93660.01843.2702
tCISATIS CONS INTVW SATISFACTION 0992.020094.67399.01193.8993.0293
tCICHOIC CONS INTVW CHOICEMAKING 0988.018088.86380.01089.8987.9262
tCIINTEG CONS INTVW INTEGRATION 0974.817678.46388.0977.8976.3257
tepp2 Elements of the Planning Process Scale 0980.036677.415081.53156.71678.7563
tDCI Decision Control Inventory 0972.846057.818761.33651.61867.7701
tQLT Quality of Life Then 0978.040977.316777.63179.71877.8625
tQLN Qualilty of Life Now 0979.546178.818777.23679.71879.2702
tQLCHNG Quality of life change 092.14091.51670.931-0.0181.8625
tfrnyrs3.34605.21877.3365.0184.1701
tfrnPCP0.53230.41580.3350.4100.4526
tfrncont3.94616.418712.0366.9185.0702
Satisfaction 5 points
Integration
Size1234 PlusTotal
MeanMeanMeanMeanMeanN
tPROD2 HOURS PRODUCTIVE DAY ACTIVITY/MONTH 0944.338.842.960.043.2702
tCISATIS CONS INTVW SATISFACTION 0992.094.699.093.893.0293
tCICHOIC CONS INTVW CHOICEMAKING 0988.088.880.089.887.9262
tCIINTEG CONS INTVW INTEGRATION 0974.878.488.077.876.3257
tepp2 Elements of the Planning Process Scale 0980.077.481.556.778.7563
tDCI Decision Control Inventory 0972.857.861.351.667.7701
tQLT Quality of Life Then 0978.077.377.679.777.8625
tQLN Qualilty of Life Now 0979.578.877.279.779.2702EPP
tQLCHNG Quality of life change 092.11.50.9-0.01.8625
tfrnyrs3.35.27.35.04.1701
tfrnPCP0.50.40.30.40.4526DCI
tfrncont3.96.412.06.95.0702
Total Service Hours Per Month121.5127.7163.267.0
Quality of Life Change from Last Place Lived
Total Hours of Service & Support Per Month
CostXSizePA
92.0220238095
94.5776255708
98.9898989899
93.8271604938
CostXSizePA CLAs
74.8200757576
78.3597883598
87.962962963
77.7777777778
Size&AB OK
80.034585178
77.3775335775
81.5437788018
56.7324862637
Sheet1
72.8262235864
57.756170649
61.2977428492
51.5681003584
2.0812571699
1.5226415301
0.8817795108
-0
121.5
127.7
163.2
67
121.5
127.7
163.2
67
Report
size92categorizedlargestchga9278changemsidp92sihome92choice92intfrq92si92suma92summ92summs92thrs92srimp92ghms92pq92
1Mean17.8888888889-04.10204081637.857142857196.88775510250.979915775834.9387755102113.714285714319.938775510242.285714285713.03163265316.313541666727.244897959257.8
N937494949494949494949484940
Std. Deviation26.1459578352.857738033210.446779603414.484186779612.557478393611.900931383552.153382825421.35220519453.01667700234.330127018919.40565950671.4249244365.592147069213.1815722186
2Mean9.90909090910.05714285713.16847826093.668478260986.818149313546.9858617421.369565217493.793478260919.47282608742.326086956518.081256.412137681221.692307692357.1793478261
N44140184184184183184184184184184184182184
Std. Deviation13.65831918192.86072745338.70643790886.935604336220.693900105815.900249087729.025791203730.54908727263.05850434043.797061549119.14929965241.25333096757.31635918838.1102652089
3Mean14.7873831776-0.02883355180.93840985442.344904815279.723199969738.66963508069.109742441275.129899216119.438969764842.36618141124.21644270256.640767790317.314058956960.2056179775
N428763893893891893893893893893893890882890
Std. Deviation15.3277733773.05448460414.52838736065.626428001821.771286924714.575858040914.182635013329.79215993143.08146561363.968098498523.8780838291.16081718426.22506427899.5716686786
4Mean12.70149253730.28378378380.35465116281.895348837281.412278172437.91083099916.651162790779.372093023318.76162790742.029069767422.02810077526.644186046516.674418604762.4069767442
N67148172172170170172172172172172172172172
Std. Deviation14.54878410563.07290228332.75231564295.42795249620.440761139115.131189839211.896008905528.13149844843.38315982983.785826638916.95215024891.13627575686.40803928649.7745078481
5Mean12.21052631580.29473684211.11.7579.148757309935.90302787787.108333333380.891666666718.441.458333333328.77055555566.902542372917.704347826161.6
N3895120120120119120120120120120118115120
Std. Deviation12.94720651233.86163256245.84448314174.385326947616.113475830912.08560954611.858263674226.90374871053.31637140984.176556889522.43689768751.26467196955.50274877579.9040777613
6Mean19.21212121210.44736842111.53968253972.338624338681.45119743838.519503546111.015873015986.460317460319.507936507942.29100529124.29594356266.951146384518.058201058261.0634920635
N33114189189189188189189189189189189189189
Std. Deviation11.13484838183.0601408536.06303430685.894609890216.303350685211.523406217916.754001170425.1779784293.33041919224.101760590517.25508639520.8237786524.33341776347.0640075477
7Mean10.5714285714-0.47826086962.15277777782.333333333361.408450704236.61265432110.402777777874.097222222219.194444444442.041666666729.6442129636.798611111111.708333333364.8611111111
N723727271727272727272727272
Std. Deviation20.2308110142.72812898287.06241733795.096256565933.466354090916.257908010712.450080289630.63605522093.02402999883.628671040620.80764973841.20573015696.082617811211.215313419
8Mean10.02083333330.73134328360.36764705880.588235294170.653594771226.19631185813.455882352967.367647058820.117647058843.308823529420.56593137256.872549019614.920634920665.3382352941
N4867686868686868686868686368
Std. Deviation16.38043667532.35862112743.0316953131.260600355923.750843220416.16680449284.832828730535.60894756412.01878796032.558318903121.67094263850.91564513286.18870351557.4123944086
15Mean10.125-0.242.22222222220.194444444462.569444444419.51058201065.222222222250.666666666720.055555555643.194444444442.76759259266.11203703713.969696969760.8611111111
N1625363636363636363636363336
Std. Deviation23.28912478681.89912260446.02903029920.576662537822.428347107415.32309884127.830749320527.97039250962.61800845192.265510909832.45851123361.01694072126.82589210517.6984331533
TotalMean13.90144927540.09844192631.3269770052.438025799279.811343967138.642982127210.67302299579.282669657919.356702187342.297812675323.8342774356.663534046117.709163346660.6363636364
N6901412178317831778177817831783178317831783177717571771
Std. Deviation15.45146897213.04459141835.63361187166.047924106621.971533861215.240889844818.856364934530.58860961923.12399365693.894718680122.34051769131.15458791976.62441738839.4629762695
size92categorizedlargest1234567815Total
MeanMeanMeanMeanMeanMeanMeanMeanMeanMeanNStd. Deviation
chga927817.99.914.812.712.219.210.610.010.113.969015.4514689721
chgm92782.51.52.22.40.82.00.52.52.42.17094.4511753144
changea2.90.3-0.0-0.50.92.7-2.11.83.80.4141211.6649055703
changem-0.00.1-0.00.30.30.4-0.50.7-0.20.114123.0445914183
sidp924.13.20.90.41.11.52.20.42.21.317835.6336118716
sihome927.93.72.31.91.82.32.30.60.22.417836.0479241066
choice9296.986.879.781.479.181.561.470.762.679.8177821.9715338612
intfrq9251.047.038.737.935.938.536.626.219.538.6177815.2408898448
si9234.921.49.16.77.111.010.43.55.210.7178318.8563649345
suma92113.793.875.179.480.986.574.167.450.779.3178330.5886096192
summ9219.919.519.418.818.419.519.220.120.119.417833.1239936569
summs9242.342.342.442.041.542.342.043.343.242.317833.8947186801
thrs9213.018.124.222.028.824.329.620.642.823.8178322.3405176913
srimp926.36.46.66.66.97.06.86.96.16.717771.1545879197
ghms9227.221.717.316.717.718.111.714.914.017.717576.6244173883
pq9257.857.260.262.461.661.164.965.360.960.617719.4629762695
Report
Size99abc ADAPTIVE BEHAVIOR 98, 0 TO 100cbc CHALLENGING BEHAVIOR 98, 0 TO 100eppcprogresc REPORTED PROGRESS ON GOALS, 0 TO 100nsrvc NUMBER OF SERVICES IN WRITTEN PLANsrvhrscdphrscdcic DECISION CONTROL INVENTORY SCORE, 0 TO 100intc TOTAL # INTEGRATIVE ACTIVITIES LAST MONTHnqolnowanqolnowcqolnc QUALITY OF LIFE NOW, 0 TO 100qlchngc CHANGE IN QUALITY OF LIFE FROM LAST YEAR TO NOWstfsatccstfwwpclikewwpcipsc INDIVIDUALIZED PRACTICES SCALE, 0 TO 100pqc PHYSICAL QUALITY SCALE, 0 TO 100normc NORMALIZATION SCALE, 0 TO 100
1Mean54.719251336966.135084427859.091880341974.16726791734.731707317137.023437518.121951219561.789099919634.51411.268292682972.007853257914.69494047620.60606060610.97172619058.562586.674245294971.666162407771.2837837838
N40411833413241384041413332332832293837
Std. Deviation19.329786491820.867281235931.307155644513.16743480283.570884976134.755677151419.428323553524.70393716422.847319317605.375985445718.115825714727.1961167232.24915809161.14833781132.031009601217.164737109312.092730340721.4668444058
2Mean52.038027332168.119658119753.451132201170.90708070384.856.578767123323.008333333352.144206494238.713.966666666712.355555555680.148341242129.20090948940.31818181820.87752525259.057471264482.321480018173.820321263873.7689393939
N90904483907390909090908078886687898788
Std. Deviation19.444914000418.179972963234.10397611769.57173172133.288386100558.353149561421.580735856623.439601710422.81062732810.18051113454.37128297611.013511185916.31541459532.14714702210.70517314611.637896565416.457201698610.355798862214.7639890115
3Mean46.846384880273.603793466865.167855020868.02934731114.068493150761.074626865717.109589041146.091045252429.684931506813.958904109613.465753424780.389172642733.60580147550.41428571430.77935606069.042253521182.584579772176.078472489278.1828703704
N73733467736773737373737171704471727172
Std. Deviation21.266489837817.593965214633.170970665511.38659569632.194239726153.334511378915.638104854522.001540354217.18516536660.19988581222.369260267710.205772998714.45649123922.20337591540.83146979351.792337816713.09166484368.792054946814.9577694448
4Mean47.660427807585.536858974453.205128205166.84681637814.2553.948863636413.479166666747.704976395520.854166666713.645833333313.687583.335281739532.87240537240.27083333330.9662162162976.716870599874.085634277571.5277777778
N48481344484448474848484745483748474748
Std. Deviation19.160931389411.986589610937.462707002515.89619995333.205712985442.427077642513.681777885224.082307727812.20915175292.02631185072.02280876989.767251080119.21305159592.23834649580.73505150661.798344392314.47492298477.912273879112.2562925091
15Mean44.652406417160.98901098973.133012820571.45904195014.357142857153.535714285725.142857142940.110453545219.142857142913.928571428610.857142857175.730519480520.35714285711.92857142860.93055555569.285714285757.491496598669.608446294763.0952380952
N141481414141414141414111014614141114
Std. Deviation14.738940443522.16425743931.466747389912.09936742321.645840578257.42234364313.74412961624.631119834811.48147097820.26726124195.90771520149.722047367217.23520101992.49505004460.47556009861.266647387622.719483219712.060825798626.6975553705
TotalMean49.829482393372.086466165459.042235067969.84423368244.466165413554.479347826119.029135338350.417140935431.316981132113.909774436112.654135338379.527073018828.88453648520.46245059290.8881215478.992063492180.465451989473.995950348373.6486486486
N265266117241266230266262265266266242236253181252251254259
Std. Deviation19.801290816519.003901226633.661646621712.20482226132.986886742151.341569145118.34049923223.915412781920.36460960060.87703313433.951680058812.136590892219.17961972362.22619085360.81375763141.744637917216.78072042359.961974494316.6156291321
Size99123415Total
MeanMeanMeanMeanMeanMeanNStd. Deviation
abc ADAPTIVE BEHAVIOR 98, 0 TO 10054.752.046.847.744.749.826519.8012908165
cbc CHALLENGING BEHAVIOR 98, 0 TO 10066.168.173.685.561.072.126619.0039012266
eppc59.153.565.253.273.159.011733.6616466217
progresc REPORTED PROGRESS ON GOALS, 0 TO 10074.270.968.066.871.569.824112.2048222613
nsrvc NUMBER OF SERVICES IN WRITTEN PLAN4.74.84.14.34.44.52662.9868867421
srvhrsc37.056.661.153.953.554.523051.3415691451
dphrsc18.123.017.113.525.119.026618.340499232
dcic DECISION CONTROL INVENTORY SCORE, 0 TO 10061.852.146.147.740.150.426223.9154127819
intc TOTAL # INTEGRATIVE ACTIVITIES LAST MONTH34.538.729.720.919.131.326520.3646096006
qolnc QUALITY OF LIFE NOW, 0 TO 10072.080.180.483.375.779.524212.1365908922
qlchngc CHANGE IN QUALITY OF LIFE FROM LAST YEAR TO NOW14.729.233.632.920.428.923619.1796197236
stfsatcc0.60.30.40.31.90.52532.2261908536
stfwwpc1.00.90.81.00.90.91810.8137576314
likewwpc8.69.19.09.09.39.02521.7446379172
ipsc INDIVIDUALIZED PRACTICES SCALE, 0 TO 10086.782.382.676.757.580.525116.7807204235
pqc PHYSICAL QUALITY SCALE, 0 TO 10071.773.876.174.169.674.02549.9619744943
normc NORMALIZATION SCALE, 0 TO 10071.373.878.271.563.173.625916.6156291321
Table 17. Indicators of Basic Lifestyle Quality by Size of Home for Adult HCBS and
ICF/MR Recipients in Five* States
Persons with Disability in Residence
Lifestyle Indicator12 to 34 to 67+TotalTotal
N%N%N%N%N%
Ever Feel Lonely
No/rarely32555.40%26456.20%16551.70%8943.60%843
Sometimes19733.60%15533.00%8927.90%7838.20%51932.80%
Yes- often6511.10%5110.90%6520.40%3718.10%21813.80%
Total587100.00%470100.00%319100.00%204100.00%1580
Ever Afraid at Home
No/rarely49682.00%37879.40%25576.60%15676.50%1285
Sometimes8914.70%6914.50%5416.20%3718.10%24915.40%
Yes- often203.30%296.10%247.20%115.40%845.20%
Total605100.00%476100.00%333100.00%204100.00%1618
Likes Home/Place Lives
No254.00%183.70%246.90%2110.00%885.30%
In-between315.00%316.40%288.10%157.10%1056.30%
Yes56290.90%43889.90%29485.00%17482.90%146888.40%
Total618100.00%487100.00%346100.00%210100.00%1661
*Home size was not available in individual records for one of the 6 states
LonelyNo/RarelyYes/OftenEver AfraidNo/RarelyLikes HomeYes
155.411.1182.0190.9
2 to 356.210.92 to 379.42 to 389.9
4 to 651.720.44 to 676.64 to 685.0
7 plus43.618.17 plus76.57 plus82.9
Personal Choice Scale by Size, 2006, NCI
Level of Intellectual Disability
Persons with DD in HomeTotalSig.
MeanMeanMeanMeanMeanLevel of Personal Choice, 9 item scale
1.791.561.261.031.62511.62
1.561.391.220.771.3162 to 31.31
1.381.241.10.821.274 to 61.20
1.361.230.950.650.9987 plus0.99
TotalN=861N=467N=354N=405N=2,0871,2,3,4
Mean1.571.361.130.751.29
Main Effects: Level of Intellectual Disability (F=203.800, p < .001); Size of Residence (F=40.820, p < .001); Level of ID vs. Size of Residence (F=2.289, p < .05); R Squared = .373
1 Mild > moderate, severe and profound; 2 Mild > moderate > severe and profound; 3 Severe > profound; 4 Profound < mild, moderate, severe
5 1 person home > 2-3, 4-6, and 7 + person homes; 6 2-3 >1, 4-6, and 7+; 7 4-6 > 1, 2-3, and 7+; 8 7+ < 1, 2-3, and 4-6.
1.62
1.31
1.2
0.99
Disecomies of Scale: Too Big, Too Much Bureaucracy and Waste
Size # UnitsCost Per Unit
1000$100
2000$80
3000$65
4000$55
5000$50
6000$50
7000$50
8000$55
9000$63
10000$72
11000$89
12000$100
Economies of Scale: Efficiency
Size # UnitsCost Per Unit
1000$100
2000$80
3000$65
4000$55
5000$50
6000
7000
8000
9000
10000
11000
12000
Steady Costs - More Size, Same Price
Size # UnitsCost Per Unit
1000$100
2000$80
3000$65
4000$55
5000$50
6000$50
7000$50
8000
9000
10000
11000
12000
100
80
65
55
50
50
50
55
63
72
89
100
Number of Units Made
Cost Per Unit
100
80
65
55
50
6000
7000
8000
9000
10000
11000
12000
Number of Units Made
Cost Per Unit
100
80
65
55
50
50
50
8000
9000
10000
11000
12000
Number of Units Made
Cost Per Unit
55.81-3
50.866.4
50.765.9
52.266.4
CLA
ICF
$1000s Per Year
55.8
50.8
50.7
52.2
CLA
Size of Home
$1000s Per Year
Adaptive Behaviro Gain Over 6 Years
By Number of People Living in the Home
16.3
26.7
35.8
4-54.5
61.7
7-10-0.4
Oklahoma, 1990-1996
The version of the graph in this file is for transfer to PowerPoint, and therefore has no titles.
1-34-89-1617+
CLA55.850.850.752.2
ICF66.465.966.4
6.3
6.7
5.8
4.5
1.7
-0.4
Size of Community Home
Points Gained
Gains in Self-Care Over 6 Years:Oklahoma Data, 1990-1996, 850 People
Movement from Institution to CommunityFrom large, segregated, historically state of the art settingsTo small, integrated, more recent models of what a home means
For 100+ Years, What Did America Do With People Like Mike?Diagnose himExclude him from schoolTell his parents that he needed medical careThat he could never learn and would bring no joy to the familyThat he needed to live in a large facility
Change Began in 1970A personal note1970, just out of UniversityNo idea what to do with a degree in Physiological PsychologyGot a strange job by pure chanceWorking on a national survey of people with developmental disabilitiesRight at the national peak of institutions
Went to Collect Scientific DataAt an institution named Pennhurst State School and HospitalLocated near Valley Forge, the cradle of American libertyI was surprisedAnd sickened
Pennhurst: Poor Conditions2800 people lived thereIt was designed for 700People were left in cribs all day and nightBroken bones went untreatedProblem people had all teeth pulledBathing was often a hose sprayed at a group in a room with a floor drainWhy treat human beings this way?
Skewed Values in America1968: The average cost per person at Pennhurst was $5.90 per dayThe average cost of keeping a leopard at the Philadelphia zoo was $7.15 per dayIn the richest nation on Earth..
I Believed Then That We Should Improve the InstitutionsSpent 12 years working on thisWe worked in a model institution, built in 1972, not overcrowded, and with access to huge resources in money and University faculty and studentsI was able to show scientifically that tremendous resources did result in minor skill development and small improvements in qualities of life
But We Got A Big SurpriseIn the midst of Americas efforts to create good institutionsA U.S. Federal Court declared Pennhurst to be Unconstitutional by its very natureBecause it was specifically and consciously designed to segregateAnd because the peoplehad lost skills (theyhad been harmed)
Judge Ordered All People Should Have a Chance to Live in SocietyI was a skepticDeinstitutionalization in the mental illness field had been a disaster and a disgraceI thought this would be, tooSo I wanted to do research on this
The Pennhurst Longitudinal StudyBegan in 1979Largest such study ever doneTracked 1,154 peopleVisited every person every yearSurveyed every family every yearMeasured qualities of life, satisfaction, costs(This process still continues in 2013)
Purposes of Pennhurst Longitudinal Study Track 1,154 people Are these people better off? In what way(s)? How much? At what cost?
The Outcomes Adaptive behavior Challenging behavior Health Health care Medications Services Productive activity Employment Physical quality Self-determination Individualization Integration Third party opinion Personal interviews (satisfaction) Family surveys (satisfaction)
What Kind of People?Average age 39 years at the beginning of the studyHad lived at Pennhurst an average of 24 years64% male33% had seizures13% blind4% deaf18% unable to walk50% nonverbal47% less than fully toilet trained40% reported to be violent at times86% severe or profound
What Kind of Community Homes?Community Living Arrangements3 peopleVery different policy from FinlandLive-in or shift staff24 hour staffingWith licensing, monitoring, and case management oversight
Pennhurst Class Members:Adaptive Behavior Development
Pennhurst Class Members: Improved Self-Control of Challenging Behavior
AB Growth
59.7
79
80
81
82
70.8
71.7
72.9
75.2
AB Average Score
Pennhurst Longitudinal Study:Adaptive Behavior Growth, 1978-1986
CB Improvement
18.04
79
80
81
82
18.27
18.47
18.67
18.8
CB Average Score
Initial Fam Att
0.09
0.05
0.14
0.09
0.63
Pennhurst Longitudinal Study:Initial 1979 Family Attitude Re: Community Placement
FamSat91
6
20
18
104
272
# of Families
Pennhurst Class Members in 1991:Family Satisfaction with Community Homes
PLS Costs
25000210001000
3000360001000
Federal
State
Local
Pennhurst Longitudinal Study:Who Pays?
Fam Perc Happy
43
32
25
0
0
Number of Families
Pennhurst Longitudinal Study:Family Perceptions of ChangeIn Person's General Happiness Since Moving, 1985
CT Fam PP
1859
1113
136
63
330
1986
1990
Number of Families
Mansfield Longitudinal Study:Changes in Family Attitudes Re: Community Placement
CTFamSat90
2
14
12
51
111
Number of Families
CT Family Survey 1990: How Satisfied Are You With Your Relative's Community Home?
Movers LMR
38.5
30.1
16.1
15.3
Percent
Percent of Movers
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
CT Percent Gain by LMR
28.4
9.5
1.3
5.3
AB Gain
Percent Gain from Baseline
Connecticut Movers, 1985-1991:Percentage Gain in Adaptive Behavior
Costs by LMR
182
168
191
161
Avg. Cost
Per Diem Costs
Total Costs by Level of Retardation
CT Cons Sat 90
0.52188552190.7044025157
0.36026936030.241509434
0.11784511780.0540880503
Congregate
Community
How Satisfied Are You With Your Current Home?1092 CT Class Members in 1990
Age X AB Gain
3.9
4.7
Points of Gain
Movers Who Were Under 60 and Over 60 in 1985:Adaptive Behavior Gains from 1985 to 1990
PA&CT DI Data
Pennhurst Longitudinal Study: Adaptive Behavior Growth, 1978-1986
7859.7
79
80
81
82
8370.8
8471.7
8572.9
8675.2
Pennhurst Longitudinal Study: Challenging Behavior Improvement, 1978-1986
7818.04
79
80
81
82
8318.27
8418.47
8518.67
8618.80
Pennhurst Class Members in 1991:
Family Satisfaction with Community Homes
Dissatisfied6
Somewhat Dissatisfied20
Neutral18
Somewhat Satisfied104
Very Satisfied272
Pennhurst Longitudinal Study: Initial Family Attitudes Toward Community Placement, 1979
Strongly Agree9%42
Agree5%24PLS Family Satisfaction with Pennhurst, 1979
Unsure14%66Very Satisfied0.54
Disagree9%42Satisfied0.29
Strongly Disagree63%297Neutral0.11
472Dissatisfied0.05
Very Dissatisfied0.02
1.01
Pennhurst Longitudinal Study: Family Perceptions of Change in General Happiness, 1985
Much Happier43
Happier32
Same25
Less Happy0
Much Less Happy0
Pennhurst Longitudinal Study: Who Pays?
InstitutionCommunity
Federal$25,000$3,000
State$21,000$36,000
Local$1,000$1,000
$47,000$40,000
Mansfield Longitudinal Study: Changes in Family Attitudes Toward Community Placement
19861990
Strongly Agree1859
Agree1113
Unsure136
Disagree63
Strongly Disagree330
8181
CT Family Survey 1990
How Satisfied Are You With Your Relative's Community Home?
Very Dissatisfied2
Somewhat Dissatisfied14
Neutral12
Somewhat Satisfied51
Very Satisfied111
190
CT SPI Comparisons
CT Deinstitutionalization of Mansfield 1985-1991
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
LevelPercent
Profound38.5
Severe30.1
Moderate16.1
Mild15.3
100
Percentage Gain in Adaptive Behavior
LevelAB Gain
Profound28.4
Severe9.5
Moderate1.3
Mild5.3
Total Costs by Level of Retardation
LevelAvg. Cost
Profound182
Severe168
Moderate191
Mild161
CT Data for AB Gain by Age
Amount of Adaptive Behavior Gain From 1985 to 1990
Under 60 in 19853.9
60 or Over in 19854.7
CT Data for Gain by Health Status
CT Data for Consumer Satisfaction 1990
How satisfied are you with your current home or living arrangement?
CongregateCommunity
3.Very satisfied155560
2.Somewhat satisfied107192
1.Unsatisfied or very unsatisfied3543
2977951092
CongregateCommunity
3.Very satisfied52%70%
2.Somewhat satisfied36%24%
1.Unsatisfied or very unsatisfied12%5%
Studies
PANHLAOKCTCANCKSINNJ
Court-Ordered?YesYesYesYesYesYesYesNoNoNo
Number of People1100600268380590120090088200575383
Number of Years14359544212
Community Model3 person4 to 6VariedSupp LivVaried4 to 64 to 62 by 4Supp Liv4 to 6
Average Age43392525443746433936Age at placement, average
% Severe/Profound86%66%68%8686%68%26%100%67%7%Only for Movers
% Nonambulatory18%21%17%27%23%28%12%58%23%13%Only for Movers
Areas of Study
MTS only
Court-Ordered?Number of PeopleNumber of YearsCommunity ModelAverage Age% Severe/ Profound% Nonamb-ulatoryYears
PAYes1100143 person4386%18%78-92
NHYes60034 to 63966%21%79-86
LAYes2685Varied2568%17%80-86
OKYes3809Supp Liv2586%27%90-99
CTYes5905Varied4486%23%85-90
CAYes120044 to 63768%28%94-99
NCYes90044 to 64626%12%92-99
KSNo8822 by 443100%58%97-99
INNo2001Supp Liv3967%23%98-99
NJNo5724 to 6367%13%89-93
STSNoVaried5578%
5383
MTS Beh Change
CT 569 People Longitudinal Design
Adaptive
19851990
49.554.0
Challenging
19851990
79.080.2
MTS Beh Change
AB Growth
Points on Scale of 100
Adaptive Behavior Growth Among Mansfield Movers, 1985-1990
State Outcomes
79
80.2
Points on Scale of 100
Improvement in Control of Challenging Behavior Among Mansfield Movers, 1985-1990
DC Costs
Adaptive Behavior Data
State# of YearsTime-1AverageAdaptiveBehaviorScoreTime-2AverageAdaptiveBehaviorScoreGainon100PointScalesPercent from Baseline
Pennsylvania14 years39.850.210.4
New Hampshire8 years53.062.39.3
Louisiana7 years56.264.28.0
Oklahoma6 years41.347.46.2
Connecticut5 years49.554.04.5
California3 years44.746.72.0
North Carolina2 years52.754.82.2
Kansas1 year33.134.81.7
Indiana.5 year46.448.82.4
New Jersey2 years78.280.62.457 people moved to community
Challenging Behavior
State# of YearsTime-1AverageChallengingBehaviorScoreTime-2AverageChallengingBehaviorScoreGainon100PointScales
Pennsylvania14 years77.787.39.6
New Hampshire8 years79.678.6-1.0
Louisiana7 years80.984.13.2
Oklahoma6 years89.793.53.8
Connecticut5 years79.080.21.2
California3 years68.176.48.3
North Carolina2 years87.789.41.7
Kansas1 year78.681.32.7
Indiana.5 year72.169.9-2.2
New Jersey2 years92.989.8-3.1Negative outcome!
Integration Changes
State# of YearsTime-1 Integrative Activities ScoreTime-2 Integrative Activities ScoreChange
Pennsylvania14 years9.2
New Hampshire8 years10.0
Louisiana7 years
Oklahoma6 years2.77.14.4
Connecticut5 years4.38.84.5
California3 years3.47.64.2
North Carolina2 years1.86.24.4
Kansas1 year0.87.77.0
Indiana.5 year2.77.44.7
New Jersey3 years4.511.97.4
CT Inst's
3577017000
4234019000
4380022000
4818026000
5329030000
5767034000
6424038000
6241540822
6241544000
6971548500
7920553000
8614057221
10110559000
10147062000
12446565000
12410068000
10840572000
12702075000
12848084000
14016086000
150197.588000
16133091000
172188.7594000
CT
US
$ Per Person Per Year
Growth of Costs of Public Institutions, CT and US
DI #s & $
3058
2887
2932
2965
2860
2866
2802
2690
2577
2430
2342
2157
1943
1727
1626
1545
1426
1333
1273
1218
1141.5
1073.1
Number of People
YEARINSTCOMMCOST
52125012510001.0
1300130
56135013514001.4
1480148
60164016418681.9
1730173
64180018022502.3
1920192
68194119530503.1
1872189
72181618764006.4
16612178
76154201741500015.0
13928167
80126381642494424.9
11549164
84106621684082240.8
10075175
8894901845722157.2
9088991876200062.0
92761101866800068.0
94681231917500075.0
956313519884000est.
965815020886000est.
975416521988000est.
Small ICFHCB
81
829985
83
84
85
8621165
87
88
89
90
913847951027
92
93
94
California Institutional PopulationCosts Per Day Per PersonBraddock Data:My old data from Harvard Graphics
What's This??YearPeopleCost
7797647751771241950746
789480786278143
799165797079147
808828808680165
8185578110381180
828145821078217619551285
8376998311183173
8474588412484185
8572308514520785207207
8669588616622786227227
876804871722298722922919601868
8867728817722588225225
89673867388920424989249249
90672267229021124990249249
91672067209122525491254254
9266836629922292399223923919652361
93641293238Est93238
94604894260Est94260
95544595282Est95282
96482396297Est96297
974200Est97310Est97310Est19704635
984000Est98323Est
197511000
National Institutions, MR and MH
YEAR
YearMRMH198024944
1950125510
129520
133531
137542
141555198544271
195514555947556
14955454516
15354957221
157544
161538199065000
196016453270000
16752775000
17351680000
17750583300
180490199586500
196518747589000
19245293500
193426199897500
193399
189370
1970186338
184308
181275
173249
166216
1975161193
154178
146163
139150
132141
1980126133
120125
115118
110111
106105
1985103100
10095
9790
9487
9185
19908883
8382
7781
7180
6779
19956378
5777
5276
49
46
200043
Kansas Institutional PopulationsCosts Per Day Per Person
77145677119
78140678127
79137979129
80132780136
81130581137
82131682134
83132783128
84136084127
85134585134
86129486150
87122387164
88114988185
891052673889207
901017672290224
911015672091229
92943662992235
9389793234
9483694244
9574195268
9669696272
97596Est97282Est
98496Est98292Est
Connecticut Public Institutional PopulationsCosts Per Day Per Person
7730587798
78288778116
79293279120
80296580132
81286081146
82286682158
83280283176
84269084171
85257785171
86243086191
87234287217
88215788236
89194389277
90172790278
91162691341
92154592340
931426-11993297
941333-9394348
951273-6095352
961218-5596384
971142Est97412Est
981073Est98442Est
99472Est
Costs Per Year Per Person
YearCTNation
773577017000
784234019000
794380022000
804818026000
815329030000
825767034000
836424038000
846241540822
856241544000
866971548500
877920553000
888614057221
8910110559000
9010147062000
9112446565000
9212410068000
9310840572000
9412702075000
9512848084000
9614016086000
9715019888000Est
9816133091000Est
9917218994000Est
In 1996, CT expended $639 million in the developmental disabilities area# Dollars% Dollars# People
Of the $639, $173 was expended for congregate careCongregate17300000027073552%171627%100815.850815851
The remaining $466 was expended for community services and supportsCommunity46600000072926448%464873%100258.17555938
639000000100000000%6364100%
No point to be made from that analysis
&A
Page &P
Pennhurst: Strong Initial Family Resistance to Community Idea
DI #s & $
YEARINSTCOMMCOST
52125012510001.0
1300130
56135013514001.4
1480148
60164016418681.9
1730173
64180018022502.3
1920192
68194119530503.1
1872189
72181618764006.4
16612178
76154201741500015.0
13928167
80126381642494424.9
11549164
84106621684082240.8
10075175
8894901845722157.2
9088991876200062.0
92761101866800068.0
94681231917500075.0
956313519884000est.
965815020886000est.
975416521988000est.
Small ICFHCB
81
829985
83
84
85
8621165
87
88
89
90
913847951027
92
93
94
197511000
National Institutions, MR and MH
YEAR
YearMRMH198024944
1950125510
129520
133531
137542
141555198544271
195514555947556
14955454516
15354957221
157544
161538199065000
196016453270000
16752775000
17351680000
17750583300
180490199586500
196518747589000
19245293500
193426199897500
193399
189370
1970186338
184308
181275
173249
166216
1975161193
154178
146163
139150
132141
1980126133
120125
115118
110111
106105
1985103100
10095
9790
9487
9185
19908883
8382
7781
7180
6779
19956378
5777
5276
49
46
200043
California Institutional PopulationCosts Per Day Per PersonBraddock Data:My old data from Harvard Graphics
What's This??YearPeopleCost
7797647751771241950746
789480786278143
799165797079147
808828808680165
8185578110381180
828145821078217619551285
8376998311183173
8474588412484185
8572308514520785207207
8669588616622786227227
876804871722298722922919601868
8867728817722588225225
89673867388920424989249249
90672267229021124990249249
91672067209122525491254254
9266836629922292399223923919652361
93641293238Est93238
94604894260Est94260
95544595282Est95282
96482396297Est96297
974200Est97310Est97310Est19704635
984000Est98323Est
Kansas Institutional PopulationsCosts Per Day Per Person
77145677119
78140678127
79137979129
80132780136
81130581137
82131682134
83132783128
84136084127
85134585134
86129486150
87122387164
88114988185
891052673889207
901017672290224
911015672091229
92943662992235
9389793234
9483694244
9574195268
9669696272
97596Est97282Est
98496Est98292Est
Connecticut Public Institutional PopulationsCosts Per Day Per Person
7730587798
78288778116
79293279120
80296580132
81286081146
82286682158
83280283176
84269084171
85257785171
86243086191
87234287217
88215788236
89194389277
90172790278
91162691341
92154592340
931426-11993297
941333-9394348
951273-6095352
961218-5596384
971142Est97412Est
981073Est98442Est
99472Est
Costs Per Year Per Person
YearCTNation
773577017000
784234019000
794380022000
804818026000
815329030000
825767034000
836424038000
846241540822
856241544000
866971548500
877920553000
888614057221
8910110559000
9010147062000
9112446565000
9212410068000
9310840572000
9412702075000
9512848084000
9614016086000
9715019888000Est
9816133091000Est
9917218994000Est
In 1996, CT expended $639 million in the developmental disabilities area# Dollars% Dollars# People
Of the $639, $173 was expended for congregate careCongregate17300000027073552%171627%100815.850815851
The remaining $466 was expended for community services and supportsCommunity46600000072926448%464873%100258.17555938
639000000100000000%6364100%
No point to be made from that analysis
Pennsylvania Public Institutional PopulationsCosts Per Day Per Person
YearPeopleYearCost/Day
77918977151
78819678172
79777879183
80805480158
81781281167
82684382193
83677983191
84636284186
85580785193
86560086176
87496287186
88442688191
89415189214
90404390214
91392591215
92380792228
933739-6893227
943616-1239422921
953460-1569525011
963272-1889626115
973000Est97276Est
982650Est98291Est
992350Est99306Est
&A
Page &P
#Inst1850-1969
0
1
2
3
4
6
8
10
13
20
35
55
80
110
145
180
212
213
211
209
220
233
248
262
283
# of Institutions
150 years data
1950125
Entire United States, 1850 to 2000129
Number of PeopleNumber of Facilities
1850018500133
18550.118551137
18600.318602141
18652186531955145
1870418704149
1875618756153
1880818808157
188511188510161
1890141890131960164
189518189520167
190027190035173
190536190555177
191045191080180
19155519151101965187
1920651920145192
1925751925180193
1930851930212193
1935951935213189
194010519402111970186
19451151945209184
19501251950220181
19551451955233173
19601641960248166
196518719652621975161
19701861970283154
19751611975275146
19801261980255139
19851031985230132
19908819901951980126
1995631995170120
2000432000140.115
150 # people
0
0.1
0.3
2
4
6
8
11
14
18
27
36
45
55
65
75
85
95
105
115
125
145
164
187
186
161
126
103
88
63
43
1000s of People
150 # Inst's
0
1
2
3
4
6
8
10
13
20
35
55
80
110
145
180
212
213
211
209
220
233
248
262
283
275
255
230
195
170
140
# of Institutions
PA&CT OutcmDat
Pennhurst Longitudinal Study: Adaptive Behavior Growth, 1978-1986
7859.7
79
80
81
82
8370.8
8471.7
8572.9
8675.2
Pennhurst Longitudinal Study: Challenging Behavior Improvement, 1978-1986
7818.04
79
80
81
82
8318.27
8418.47
8518.67
8618.80
Pennhurst Class Members in 1991:
Family Satisfaction with Community Homes
Dissatisfied6
Somewhat Dissatisfied20
Neutral18
Somewhat Satisfied104
Very Satisfied272
Pennhurst Longitudinal Study: Initial Family Attitudes Toward Community Placement, 1979
Strongly Disagree63%297Strongly Agree9%42
Disagree9%42PLS Family Satisfaction with Pennhurst, 1979Agree5%24
Unsure14%66Very Satisfied0.54Unsure14%66
Agree5%24Satisfied0.29Disagree9%42
Strongly Agree9%42Neutral0.11Strongly Disagree63%297
472Dissatisfied0.05
Very Dissatisfied0.02
1.01
Pennhurst Longitudinal Study: Family Perceptions of Change in General Happiness, 1985
Much Less Happy0Much Happier43
Less Happy0Happier32
Same25Same25
Happier32Less Happy0
Much Happier43Much Less Happy0
Pennhurst Longitudinal Study: Who Pays?
InstitutionCommunity
Federal$25,000$3,000
State$21,000$36,000
Local$1,000$1,000
$47,000$40,000
Mansfield Longitudinal Study: Changes in Family Attitudes Toward Community Placement
19861990
Strongly Agree1859
Agree1113
Unsure136
Disagree63
Strongly Disagree330
8181
CT Family Survey 1990
How Satisfied Are You With Your Relative's Community Home?
Very Dissatisfied2
Somewhat Dissatisfied14
Neutral12
Somewhat Satisfied51
Very Satisfied111
190
CT SPI Comparisons
CT Deinstitutionalization of Mansfield 1985-1991
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
LevelPercent
Profound38.5
Severe30.1
Moderate16.1
Mild15.3
100
Percentage Gain in Adaptive Behavior
LevelAB Gain
Profound28.4
Severe9.5
Moderate1.3
Mild5.3
Total Costs by Level of Retardation
LevelAvg. Cost
Profound182
Severe168
Moderate191
Mild161
CT Data for AB Gain by Age
Amount of Adaptive Behavior Gain From 1985 to 1990
Under 60 in 19853.9
60 or Over in 19854.7
CT Data for Gain by Health Status
CT Data for Consumer Satisfaction 1990
How satisfied are you with your current home or living arrangement?
CongregateCommunity
3.Very satisfied155560
2.Somewhat satisfied107192
1.Unsatisfied or very unsatisfied3543
2977951092
CongregateCommunity
3.Very satisfied52%70%
2.Somewhat satisfied36%24%
1.Unsatisfied or very unsatisfied12%5%
PLS AB
59.7
79
80
81
82
70.8
71.7
72.9
75.2
AB Average Score
Pennhurst Longitudinal Study:Adaptive Behavior Growth, 1978-1986
PLS CB
18.04
79
80
81
82
18.27
18.47
18.67
18.8
CB Average Score
PLS T1 Fam
0.63
0.09
0.14
0.05
0.09
PLS FamSat91
6
20
18
104
272
# of Families
Pennhurst Class Members in 1991:Family Satisfaction with Community Homes
PLS FHappy91
0
0
25
32
43
Number of Families
Pennhurst Longitudinal Study:Family Perceptions of ChangeIn Person's General Happiness Since Moving, 1985
PLS Costs
25000210001000
3000360001000
Federal
State
Local
Pennhurst Longitudinal Study:Who Pays?
CT Fam PP
1859
1113
136
63
330
1986
1990
Number of Families
Mansfield Longitudinal Study:Changes in Family Attitudes Re: Community Placement
CTFamSat90
2
14
12
51
111
Number of Families
CT Family Survey 1990: How Satisfied Are You With Your Relative's Community Home?
CT Cons Sat 90
0.52188552190.7044025157
0.36026936030.241509434
0.11784511780.0540880503
Congregate
Community
How Satisfied Are You With Your Current Home?1092 CT Class Members in 1990
Movers LMR
38.5
30.1
16.1
15.3
Percent
Percent of Movers
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
CT Percent Gain by LMR
28.4
9.5
1.3
5.3
AB Gain
Percent Gain from Baseline
Connecticut Movers, 1985-1991:Percentage Gain in Adaptive Behavior
Costs by LMR
182
168
191
161
Avg. Cost
Per Diem Costs
Total Costs by Level of Retardation
Age X AB Gain
3.9
4.7
Points of Gain
Movers Who Were Under 60 and Over 60 in 1985:Adaptive Behavior Gains from 1985 to 1990
AB Gain Graph, OK
6.3
6.7
5.8
4.5
1.7
-0.4
Number of People in the Home
Points of Gain in Independence
Size&AB OK
Adaptive Behaviro Gain Over 6 Years
By Number of People Living in the Home
16.3
26.7
35.8
4-54.5
61.7
7-10-0.4
Oklahoma, 1990-1996
The version of the graph in this file is for transfer to PowerPoint, and therefore has no titles.
Studies
PANHLAOKCTCANCKSINNJ
Court-Ordered?YesYesYesYesYesYesYesNoNoNo
Number of People1100600268380590120090088200575383
Number of Years14359544212
Community Model3 person4 to 6VariedSupp LivVaried4 to 64 to 62 by 4Supp Liv4 to 6
Average Age43392525443746433936Age at placement, average
% Severe/Profound86%66%68%8686%68%26%100%67%7%Only for Movers
% Nonambulatory18%21%17%27%23%28%12%58%23%13%Only for Movers
Areas of Study
MTS only
Court-Ordered?Number of PeopleNumber of YearsCommunity ModelAverage Age% Severe/ Profound% Nonamb-ulatoryYears
PAYes1100143 person4386%18%78-92
NHYes60034 to 63966%21%79-86
LAYes2685Varied2568%17%80-86
OKYes3809Supp Liv2586%27%90-99
CTYes5905Varied4486%23%85-90
CAYes120044 to 63768%28%94-99
NCYes90044 to 64626%12%92-99
KSNo8822 by 443100%58%97-99
INNo2001Supp Liv3967%23%98-99
NJNo5724 to 6367%13%89-93
5383
STSNo730Varied5578%29%
MTS Beh Change
CT 569 People Longitudinal Design
Adaptive
19851990
49.554.0
Challenging
19851990
79.080.2
MTS Beh Change
49.5
54
AB Growth
Points on Scale of 100
Adaptive Behavior Growth Among Mansfield Movers, 1985-1990
State Outcomes
79
80.2
Points on Scale of 100
Improvement in Control of Challenging Behavior Among Mansfield Movers, 1985-1990
DC Costs
Adaptive Behavior Data
State# of YearsTime-1AverageAdaptiveBehaviorScoreTime-2AverageAdaptiveBehaviorScoreGainon100PointScalesPercent from Baseline
Pennsylvania14 years39.850.210.4
New Hampshire8 years53.062.39.3
Louisiana7 years56.264.28.0
Oklahoma6 years41.347.46.2
Connecticut5 years49.554.04.5
California3 years44.746.72.0
North Carolina2 years52.754.82.2
Kansas1 year33.134.81.7
Indiana.5 year46.448.82.4
New Jersey2 years78.280.62.457 people moved to community
Challenging Behavior
State# of YearsTime-1AverageChallengingBehaviorScoreTime-2AverageChallengingBehaviorScoreGainon100PointScales
Pennsylvania14 years77.787.39.6
New Hampshire8 years79.678.6-1.0
Louisiana7 years80.984.13.2
Oklahoma6 years89.793.53.8
Connecticut5 years79.080.21.2
California3 years68.176.48.3
North Carolina2 years87.789.41.7
Kansas1 year78.681.32.7
Indiana.5 year72.169.9-2.2
New Jersey2 years92.989.8-3.1Negative outcome!
Integration Changes
State# of YearsTime-1 Integrative Activities ScoreTime-2 Integrative Activities ScoreChange
Pennsylvania14 years9.2
New Hampshire8 years10.0
Louisiana7 years
Oklahoma6 years2.77.14.4
Connecticut5 years4.38.84.5
California3 years3.47.64.2
North Carolina2 years1.86.24.4
Kansas1 year0.87.77.0
Indiana.5 year2.77.44.7
New Jersey3 years4.511.97.4
CT Inst's
3577017000
4234019000
4380022000
4818026000
5329030000
5767034000
6424038000
6241540822
6241544000
6971548500
7920553000
8614057221
10110559000
10147062000
12446565000
12410068000
10840572000
12702075000
12848084000
14016086000
150197.588000
16133091000
172188.7594000
CT
US
$ Per Person Per Year
Growth of Costs of Public Institutions, CT and US
US Deinst
3058
2887
2932
2965
2860
2866
2802
2690
2577
2430
2342
2157
1943
1727
1626
1545
1426
1333
1273
1218
1141.5
1073.1
Number of People
People in Connecticut's Institutions, 1977-1998
PA DI #s
PA DI #s
Thousands
Deinstitutionalization of People with Mental Retardation in the United States
PA DI $
PA DI $
9189
8196
7778
8054
7812
6843
6779
6362
5807
5600
4962
4426
4151
4043
3925
3807
3739
3616
3460
3272
3000
2650
2350
People in Pennsylvania's Public Institutions, 1977 to 1999
151
172
183
158
167
193
191
186
193
176
186
191
214
214
215
228
227
229
250
261
276
291
306
Cost/Day
Dollars Per Day
Costs of PA's Public Institutions
Pennhurst: 1991 Community Family Satisfaction
DI #s & $
YEARINSTCOMMCOST
52125012510001.0
1300130
56135013514001.4
1480148
60164016418681.9
1730173
64180018022502.3
1920192
68194119530503.1
1872189
72181618764006.4
16612178
76154201741500015.0
13928167
80126381642494424.9
11549164
84106621684082240.8
10075175
8894901845722157.2
9088991876200062.0
92761101866800068.0
94681231917500075.0
956313519884000est.
965815020886000est.
975416521988000est.
Small ICFHCB
81
829985
83
84
85
8621165
87
88
89
90
913847951027
92
93
94
197511000
National Institutions, MR and MH
YEAR
YearMRMH198024944
1950125510
129520
133531
137542
141555198544271
195514555947556
14955454516
15354957221
157544
161538199065000
196016453270000
16752775000
17351680000
17750583300
180490199586500
196518747589000
19245293500
193426199897500
193399
189370
1970186338
184308
181275
173249
166216
1975161193
154178
146163
139150
132141
1980126133
120125
115118
110111
106105
1985103100
10095
9790
9487
9185
19908883
8382
7781
7180
6779
19956378
5777
5276
49
46
200043
California Institutional PopulationCosts Per Day Per PersonBraddock Data:My old data from Harvard Graphics
What's This??YearPeopleCost
7797647751771241950746
789480786278143
799165797079147
808828808680165
8185578110381180
828145821078217619551285
8376998311183173
8474588412484185
8572308514520785207207
8669588616622786227227
876804871722298722922919601868
8867728817722588225225
89673867388920424989249249
90672267229021124990249249
91672067209122525491254254
9266836629922292399223923919652361
93641293238Est93238
94604894260Est94260
95544595282Est95282
96482396297Est96297
974200Est97310Est97310Est19704635
984000Est98323Est
Kansas Institutional PopulationsCosts Per Day Per Person
77145677119
78140678127
79137979129
80132780136
81130581137
82131682134
83132783128
84136084127
85134585134
86129486150
87122387164
88114988185
891052673889207
901017672290224
911015672091229
92943662992235
9389793234
9483694244
9574195268
9669696272
97596Est97282Est
98496Est98292Est
Connecticut Public Institutional PopulationsCosts Per Day Per Person
7730587798
78288778116
79293279120
80296580132
81286081146
82286682158
83280283176
84269084171
85257785171
86243086191
87234287217
88215788236
89194389277
90172790278
91162691341
92154592340
931426-11993297
941333-9394348
951273-6095352
961218-5596384
971142Est97412Est
981073Est98442Est
99472Est
Costs Per Year Per Person
YearCTNation
773577017000
784234019000
794380022000
804818026000
815329030000
825767034000
836424038000
846241540822
856241544000
866971548500
877920553000
888614057221
8910110559000
9010147062000
9112446565000
9212410068000
9310840572000
9412702075000
9512848084000
9614016086000
9715019888000Est
9816133091000Est
9917218994000Est
In 1996, CT expended $639 million in the developmental disabilities area# Dollars% Dollars# People
Of the $639, $173 was expended for congregate careCongregate17300000027073552%171627%100815.850815851
The remaining $466 was expended for community services and supportsCommunity46600000072926448%464873%100258.17555938
639000000100000000%6364100%
No point to be made from that analysis
Pennsylvania Public Institutional PopulationsCosts Per Day Per Person
YearPeopleYearCost/Day
77918977151
78819678172
79777879183
80805480158
81781281167
82684382193
83677983191
84636284186
85580785193
86560086176
87496287186
88442688191
89415189214
90404390214
91392591215
92380792228
933739-6893227
943616-1239422921
953460-1569525011
963272-1889626115
973000Est97276Est
982650Est98291Est
992350Est99306Est
&A
Page &P
#Inst1850-1969
0
1
2
3
4
6
8
10
13
20
35
55
80
110
145
180
212
213
211
209
220
233
248
262
283
# of Institutions
150 years data
1950125
Entire United States, 1850 to 2000129
Number of PeopleNumber of Facilities
1850018500133
18550.118551137
18600.318602141
18652186531955145
1870418704149
1875618756153
1880818808157
188511188510161
1890141890131960164
189518189520167
190027190035173
190536190555177
191045191080180
19155519151101965187
1920651920145192
1925751925180193
1930851930212193
1935951935213189
194010519402111970186
19451151945209184
19501251950220181
19551451955233173
19601641960248166
196518719652621975161
19701861970283154
19751611975275146
19801261980255139
19851031985230132
19908819901951980126
1995631995170120
2000432000140.115
150 # people
0
0.1
0.3
2
4
6
8
11
14
18
27
36
45
55
65
75
85
95
105
115
125
145
164
187
186
161
126
103
88
63
43
1000s of People
150 # Inst's
0
1
2
3
4
6
8
10
13
20
35
55
80
110
145
180
212
213
211
209
220
233
248
262
283
275
255
230
195
170
140
# of Institutions
PA&CT OutcmDat
Pennhurst Longitudinal Study: Adaptive Behavior Growth, 1978-1986
7859.7
79
80
81
82
8370.8
8471.7
8572.9
8675.2
Pennhurst Longitudinal Study: Challenging Behavior Improvement, 1978-1986
7818.04
79
80
81
82
8318.27
8418.47
8518.67
8618.80
Pennhurst Class Members in 1991:
Family Satisfaction with Community Homes
Dissatisfied6
Somewhat Dissatisfied20
Neutral18
Somewhat Satisfied104
Very Satisfied272
Pennhurst Longitudinal Study: Initial Family Attitudes Toward Community Placement, 1979
Strongly Disagree63%297Strongly Agree9%42
Disagree9%42PLS Family Satisfaction with Pennhurst, 1979Agree5%24
Unsure14%66Very Satisfied0.54Unsure14%66
Agree5%24Satisfied0.29Disagree9%42
Strongly Agree9%42Neutral0.11Strongly Disagree63%297
472Dissatisfied0.05
Very Dissatisfied0.02
1.01
Pennhurst Longitudinal Study: Family Perceptions of Change in General Happiness, 1985
Much Less Happy0Much Happier43
Less Happy0Happier32
Same25Same25
Happier32Less Happy0
Much Happier43Much Less Happy0
Pennhurst Longitudinal Study: Who Pays?
InstitutionCommunity
Federal$25,000$3,000
State$21,000$36,000
Local$1,000$1,000
$47,000$40,000
Mansfield Longitudinal Study: Changes in Family Attitudes Toward Community Placement
19861990
Strongly Agree1859
Agree1113
Unsure136
Disagree63
Strongly Disagree330
8181
CT Family Survey 1990
How Satisfied Are You With Your Relative's Community Home?
Very Dissatisfied2
Somewhat Dissatisfied14
Neutral12
Somewhat Satisfied51
Very Satisfied111
190
CT SPI Comparisons
CT Deinstitutionalization of Mansfield 1985-1991
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
LevelPercent
Profound38.5
Severe30.1
Moderate16.1
Mild15.3
100
Percentage Gain in Adaptive Behavior
LevelAB Gain
Profound28.4
Severe9.5
Moderate1.3
Mild5.3
Total Costs by Level of Retardation
LevelAvg. Cost
Profound182
Severe168
Moderate191
Mild161
CT Data for AB Gain by Age
Amount of Adaptive Behavior Gain From 1985 to 1990
Under 60 in 19853.9
60 or Over in 19854.7
CT Data for Gain by Health Status
CT Data for Consumer Satisfaction 1990
How satisfied are you with your current home or living arrangement?
CongregateCommunity
3.Very satisfied155560
2.Somewhat satisfied107192
1.Unsatisfied or very unsatisfied3543
2977951092
CongregateCommunity
3.Very satisfied52%70%
2.Somewhat satisfied36%24%
1.Unsatisfied or very unsatisfied12%5%
PLS AB
59.7
79
80
81
82
70.8
71.7
72.9
75.2
AB Average Score
Pennhurst Longitudinal Study:Adaptive Behavior Growth, 1978-1986
PLS CB
18.04
79
80
81
82
18.27
18.47
18.67
18.8
CB Average Score
PLS T1 Fam
0.63
0.09
0.14
0.05
0.09
PLS FamSat91
6
20
18
104
272
# of Families
PLS FHappy91
0
0
25
32
43
Number of Families
Pennhurst Longitudinal Study:Family Perceptions of ChangeIn Person's General Happiness Since Moving, 1985
PLS Costs
25000210001000
3000360001000
Federal
State
Local
Pennhurst Longitudinal Study:Who Pays?
CT Fam PP
1859
1113
136
63
330
1986
1990
Number of Families
Mansfield Longitudinal Study:Changes in Family Attitudes Re: Community Placement
CTFamSat90
2
14
12
51
111
Number of Families
CT Family Survey 1990: How Satisfied Are You With Your Relative's Community Home?
CT Cons Sat 90
0.52188552190.7044025157
0.36026936030.241509434
0.11784511780.0540880503
Congregate
Community
How Satisfied Are You With Your Current Home?1092 CT Class Members in 1990
Movers LMR
38.5
30.1
16.1
15.3
Percent
Percent of Movers
Level of Retardation Labels of People Who Moved from Institution to Community in CT, 1985-1991
CT Percent Gain by LMR
28.4
9.5
1.3
5.3
AB Gain
Percent Gain from Baseline
Connecticut Movers, 1985-1991:Percentage Gain in Adaptive Behavior
Costs by LMR
182
168
191
161
Avg. Cost
Per Diem Costs
Total Costs by Level of Retardation
Age X AB Gain
3.9
4.7
Points of Gain
Movers Who Were Under 60 and Over 60 in 1985:Adaptive Behavior Gains from 1985 to 1990
AB Gain Graph, OK
6.3
6.7
5.8
4.5
1.7
-0.4
Number of People in the Home
Points of Gain in Independence
Size&AB OK
Adaptive Behaviro Gain Over 6 Years
By Number of People Living in the Home
16.3
26.7
35.8
4-54.5
61.7
7-10-0.4
Oklahoma, 1990-1996
The version of the graph in this file is for transfer to PowerPoint, and therefore has no titles.
Studies
PANHLAOKCTCANCKSINNJ
Court-Ordered?YesYesYesYesYesYesYesNoNoNo
Number of People1100600268380590120090088200575383
Number of Years14359544212
Community Model3 person4 to 6VariedSupp LivVaried4 to 64 to 62 by 4Supp Liv4 to 6
Average Age43392525443746433936Age at placement, average
% Severe/Profound86%66%68%8686%68%26%100%67%7%Only for Movers
% Nonambulatory18%21%17%27%23%28%12%58%23%13%Only for Movers
Areas of Study
MTS only
Court-Ordered?Number of PeopleNumber of YearsCommunity ModelAverage Age% Severe/ Profound% Nonamb-ulatoryYears
PAYes1100143 person4386%18%78-92
NHYes60034 to 63966%21%79-86
LAYes2685Varied2568%17%80-86
OKYes3809Supp Liv2586%27%90-99
CTYes5905Varied4486%23%85-90
CAYes120044 to 63768%28%94-99
NCYes90044 to 64626%12%92-99
KSNo8822 by 443100%58%97-99
INNo2001Supp Liv3967%23%98-99
NJNo5724 to 6367%13%89-93
5383
STSNo730Varied5578%29%
MTS Beh Change
CT 569 People Longitudinal Design
Adaptive
19851990
49.554.0
Challenging
19851990
79.080.2
MTS Beh Change
49.5
54
AB Growth
Points on Scale of 100
Adaptive Behavior Growth Among Mansfield Movers, 1985-1990
State Outcomes
79
80.2
Points on Scale of 100
Improvement in Control of Challenging Behavior Among Mansfield Movers, 1985-1990
DC Costs
Adaptive Behavior Data
State# of YearsTime-1AverageAdaptiveBehaviorScoreTime-2AverageAdaptiveBehaviorScoreGainon100PointScalesPercent from Baseline
Pennsylvania14 years39.850.210.4
New Hampshire8 years53.062.39.3
Louisiana7 years56.264.28.0
Oklahoma6 years41.347.46.2
Connecticut5 years49.554.04.5
California3 years44.746.72.0
North Carolina2 years52.754.82.2
Kansas1 year33.134.81.7
Indiana.5 year46.448.82.4
New Jersey2 years78.280.62.457 people moved to community
Challenging Behavior
State# of YearsTime-1AverageChallengingBehaviorScoreTime-2AverageChallengingBehaviorScoreGainon100PointScales
Pennsylvania14 years77.787.39.6
New Hampshire8 years79.678.6-1.0
Louisiana7 years80.984.13.2
Oklahoma6 years89.793.53.8
Connecticut5 years79.080.21.2
California3 years68.176.48.3
North Carolina2 years87.789.41.7
Kansas1 year78.681.32.7
Indiana.5 year72.169.9-2.2
New Jersey2 years92.989.8-3.1Negative outcome!
Integration Changes
State# of YearsTime-1 Integrative Activities ScoreTime-2 Integrative Activities ScoreChange
Pennsylvania14 years9.2
New Hampshire8 years10.0
Louisiana7 years
Oklahoma6 years2.77.14.4
Connecticut5 years4.38.84.5
California3 years3.47.64.2
North Carolina2 years1.86.24.4
Kansas1 year0.87.77.0
Indiana.5 year2.77.44.7
New Jersey3 years4.511.97.4
CT Inst's
3577017000
4234019000
4380022000
4818026000
5329030000
5767034000
6424038000
6241540822
6241544000
6971548500
7920553000
8614057221
10110559000
10147062000
12446565000
12410068000
10840572000
12702075000
12848084000
14016086000
150197.588000
16133091000
172188.7594000
CT
US
$ Per Person Per Year
Growth of Costs of Public Institutions, CT and US
US Deinst
3058
2887
2932
2965
2860
2866
2802
2690
2577
2430
2342
2157
1943
1727
1626
1545
1426
1333
1273
1218
1141.5
1073.1
Number of People
People in Connecticut's Institutions, 1977-1998
PA DI #s
PA DI #s
Thousands
Deinstitutionalization of People with Mental Retardation in the United States
PA DI $
PA DI $
9189
8196
7778
8054
7812
6843
6779
6362
5807
5600
4962
4426
4151
4043
3925
3807
3739
3616
3460
3272
3000
2650
2350
People in Pennsylvania's Public Institutions, 1977 to 1999
151
172
183
158
167
193
191
186
193
176
186
191
214
214
215
228
227
229
250
261
276
291
306
Cost/Day
Dollars Per Day
Costs of PA's Public Institutions
Different Question: Has Your Relatives General Happiness Changed Since Moving?
DI #s & $
YEARINSTCOMMCOST
52125012510001.0
1300130
56135013514001.4
1480148
60164016418681.9
1730173
64180018022502.3
1920192
68194119530503.1
1872189
72181618764006.4
16612178
76154201741500015.0
13928167
80126381642494424.9
11549164
84106621684082240.8
10075175
8894901845722157.2
9088991876200062.0
92761101866800068.0
94681231917500075.0
956313519884000est.
965815020886000est.
975416521988000est.
Small ICFHCB
81
829985
83
84
85
8621165
87
88
89
90
913847951027
92
93
94
197511000
National Institutions, MR and MH
YEAR
YearMRMH198024944
1950125510
129520
133531
137542
141555198544271
195514555947556
14955454516
15354957221
157544
161538199065000
196016453270000
16752775000
17351680000
17750583300
180490199586500
196518747589000
19245293500
193426199897500
193399
189370
1970186338
184308
181275
173249
166216
1975161193
154178
146163
139150
132141
1980126133
120125
115118
110111
106105
1985103100
10095
9790
9487
9185
19908883
8382
7781
7180
6779
19956378
5777
5276
49
46
200043
California Institutional PopulationCosts Per Day Per PersonBraddock Data:My old data from Harvard Graphics
What's This??YearPeopleCost
7797647751771241950746
789480786278143
799165797079147
808828808680165
8185578110381180
828145821078217619551285
8376998311183173
8474588412484185
8572308514520785207207
8669588616622786227227
876804871722298722922919601868
8867728817722588225225
89673867388920424989249249
90672267229021124990249249
91672067209122525491254254
9266836629922292399223923919652361
93641293238Est93238
94604894260Est94260
95544595282Est95282
96482396297Est96297
974200Est97310Est97310Est19704635
984000Est98323Est
Kansas Institutional PopulationsCosts Per Day Per Person
77145677119
78140678127
79137979129
80132780136
81130581137
82131682134
83132783128
84136084127
85134585134
86129486150
87122387164
88114988185
891052673889207
901017672290224
911015672091229
92943662992235
9389793234
9483694244
9574195268
9669696272
97596Est97282Est
98496Est98292Est
Connecticut Public Institutional PopulationsCosts Per Day Per Person
7730587798
78288778116
79293279120
80296580132
81286081146
82286682158
83280283176
84269084171
85257785171
86243086191
87234287217
88215788236
89194389277
90172790278
91162691341
92154592340
931426-11993297
941333-9394348
951273-6095352
961218-5596384
971142Est97412Est
981073Est98442Est
99472Est
Costs Per Year Per Person