In the primary, the Republican and Democratic parties select two candidates who then vie for the three available seats in the general election. There had been quite a change in Robert's home, as well. The assumption is that the plaintiffs, because of their uncompromising stand on the phase down of Pennhurst State Center, have charged the political environment and invited a negative response from a variety of groups that otherwise would have remained unorganized or at least at bay had the litigation not been brought. Level of resources employed. & Friedman, P.R. CLA funding is secure 3.8 2.7 19. The litigation also appears to have contributed to increases of waiting lists in the Southeast Region (but not in other parts of the state) because of publicity surrounding the lawsuit and the concentration of resources on class members. Consumer Interviews -- Satisfaction. Together, they had a direct influence on the quality of the court protections and procedures developed pursuant to the decree. The student-teacher ratio is about the same in Chester as it is in other Southeastern counties. These relationships may not lead to the same conclusions as multivariate techniques, and moreover the methods used here assume that the variables are all related in simple linear fashion. Research on the vocational habilitation of the retarded: The present, the future. (3) Were there changes in attitudes after the CLAs entered the neighborhoods? In a nutshell, we have found that initial family opposition changes drastically to surprised and enthusiastic support of the CLA option, tempered by continued concern about permanence. The reasons cited include the counties' weakened bargaining position with providers in contract negotiations because of the court pressure for placement. Households and families number an estimated 191,000 and 152,000 respectively. How often did your relative return here for a visit from Pennhurst during the last 5 years? The qualitative analyses further indicate that inter- and intra-agency planning at the state level is crucial to the success of any comprehensive deinstitutionalization activity. Scientifically, this is not the end of the story. A matched comparison of the developmental growth of institutionalized and deinstitutionalized mentally retarded clients. The distribution of level of retardation labels was about the same for our sample and the population, as well. An Educational Service Center provides special education and vocational education for exceptional children in various parts of the county. Legal documentation must be shown. Cleans room but not thoroughly1. In order to gain an understanding of some of the potential systemic effects that the litigation may have had in the state, project staff developed a list of questions for the Department of Public Welfare that included requests for data comparing fiscal and service development and utilization trends in the Southeast Region with the rest of the state. 6). Names people or objects when describing pictures3. _______ 1. Indeed, the continued emphasis on normative, as opposed to prescriptive, cost analyses and funding arguments could well lead to the widespread underfunding of community programs just as institutional programs have been underfunded for so many years. For one thing, only then can comparisons be made across local jurisdictional boundaries. ______________ How many goals or objectives are present in the written program plan? Perske, R., & Perske, M. (1980). 5. At a four day training session held late in 1983, site reviewers were retrained in the Normalization Scale, and were trained in the use of the three other environmental instruments (GHMS, PQI, Life Safety Codes). Toileting03. 1 2 3 4 5 16. ), Litigation and the Mentally Disabled. A few (3 - 5)3. This new approach, if combined with emphasis on the constitutional rights to freedom from harm and nondiscriminatory habilitation, makes possible a direct attack on the very concept of institutionalization as a method of providing services to retarded people. For instance, anecdotal information provided by those canvassed suggests that counties vary widely in both their perception of need and their level of resources. For day programs, the community settings showed somewhat lower costs per person day, but considerably higher costs per hour of direct care staff time. Although cautions against perfectly confident generalization to the population, or to facilities in other states, must be applied to the Pennhurst results, we believe that some general policy implications can be drawn. With respect to individuals with severe behavioral and medical problems there does not appear to be a higher proportion of such persons left at Pennhurst compared to the relative numbers residing in the community. Temple University, Philadelphia, PA, September 1984. Pennsylvania was originally called the Keystone State because of its central location among the thirteen colonies. (Enter 99 if male) ______________ How many months since exam by a dentist? How frequently do you attend religious services? What is clear is that the Southeast Region of Pennsylvania has significantly higher per them rates for community living arrangements than other regions and has a higher growth rate in CLA beds, but the region is a distant second in CLA beds per capita. 1 2 9 b. Among both families and professionals, we would suggest vigorous efforts to provide the most up to date information; particularly for families of people who may move out of institutions. Learn appropriate classroom behavior (sitting still, being quiet, paying attention, performing assigned activities, etc.)71. strongly opposed? This is contradictory to one of the implicit aims of small, more individually tailored residential and day programs. One respondent opposed the move because CLAs did not have the advantage of having all the necessary facilities (medical, recreational, educational) on the premises and another respondent objected on the grounds that the court decision to move the relative to a CLA was a violation of parental rights. The question of whether these public attitudes can change, then, should be viewed from the perspective of theories on stereotypical attitudes. Learn to plan excursions (day trips, vacations, etc.) (Enter number of goals, 01 to 99; blank if not applicable) ______________ How many weeks since the Case Manager visited this person at the residence? Hearing (using hearing aid, correction of other ear problems, etc.)22. Are you usually happy or sad ? Having considered many possible explanations, we tend to favor the idea that these people, who had seldom been asked their opinions about important things, were at first unprepared and perhaps somewhat nervous. All agreed, however, that the the litigation played a role in increasing demand because of the publicity surrounding the case and the increased visibility of community services. Each individual was given a normalization score, an RMS score, an ACMRDD physical standards score, and an ACMRDD program standards score. In Pennsylvania, there is very little evidence to support the assertion that the litigation drew resources away from other areas of the state. We are continuing to watch these attitudes in Pennsylvania to see whether they will gradually change over years of community living. In many ways, this change in course pressed the courts even deeper into the fabric of the mental disabilities system as those seeking reform sought to redress structural rather than discrete wrongs. Complex systems will only tolerate change for discrete periods of time before organizational forces begin to blunt the edges of such change and accommodate the reform into the larger political, social and administrative context. : 085-R-0370EXPIRES: April, 1982 Family Impact Survey for Pennhurst Study This is a survey of families with a relative who is a Pennhurst resident. In part, this reluctance stems from direct experience with other consent decrees and in part it is the result of a growing consensus among such individuals that the price paid for consent is not worth the benefits that may be conferred on the system. Yes -- go back2. (We must emphasize that this concern about reliability was only about our normalization measure as we applied it with single site reviewers -- our work did not use the full PASS-3 scale.) CLA funding is secure 3.8 2.7 19. There are a number of apparent explanations for the finding that the costs per client day of residential programs, on average, were higher in Fiscal Year 1981-82 at the Pennhurst Center than the costs per client day of comparable residential programs in the community. What Has Happened to State Policy? This is a difficult proposition to address given the lack of any systematic survey of providers in the Southeast Region and in the rest of the state where Pennhurst class members have been placed. Have class members placed out of Pennhurst as a result of the decree fared better in small group settings than they fared at the institution? The cost differential can be traced almost entirely to differences in salaries and fringe benefits between the state employees at Pennhurst and the private employees in the community programs. References Aloia, G.F., Beaver, R.J., & Pettus, W.F. Philadelphia: Temple University Developmental Disabilities Center. Toronto: National Institute on Mental Retardation. Post-opening, an increase in contact in the neighborhood had no effect on attitudes, regardless of whether the respondent was aware of the CLA. How much greater could not be ascertained Medical Programs A straightforward comparative analysis of the medical program costs at the Pennhurst Center and in the community was not possible since (1) the nature and intensity of the medical services offered at the Pennhurst Center and in the community differed in major respects, and (2) the costs of services provided by the multiplicity of private practitioners in the community serving members of the plaintiff class could not be obtained. Frequently has toilet accidents during the day1. The responses were on a 5-point scale from "very satisfied" (1) to "very dissatisfied" (5). We found, in 1980, that 83% of the families of people living at Pennhurst expressed satisfaction with the institution, and 72% said they were unlikely to agree with any decision to move their relatives to CLAs. It was therefore possible to treat the seven smile face items as ordinal scales, calculating average scores on each one before and after relocation, and to use routine statistical tests of significance of change. A few things did emerge that were very clear. In the regression analyses, we forced individual characteristics to enter the equation first, because the nature of the question we were asking was whether environmental variables could account for individual growth above and beyond the growth that was accounted for by unchangeable individual characteristics (e.g., sex, age, or level of retardation). divorced,4. Exhibit 10-2 plots these changes. Payne, J.E. The Pennhurst Center boasts a medical emergency response system capable of producing a physician at a client's side within three minutes. The questions were: Baseline: If your relative were to be selected for movement from Pennhurst to the community, how likely would you be to agree with this decision? During the mid to late 1970s, litigation strategies changed as lawyers and plaintiffs became more sophisticated about the strengths and shortcomings of the lawsuit as a tool for system change. The attitudes of these neighbors became less positive from pre-opening to six months post-opening, but, by 20 months post-opening, attitudes had returned to baseline levels. The judge ordered that every person get a chance to live in a regular home in a regular community with whatever supports and services they needed to thrive.

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This should be especially true given the fact that funds for the placement of individuals out of Pennhurst have in part been deducted from the Pennhurst budget. Not observed within the last 4 weeks2. 1 2 9 b. This suggested that neighbor attitudes were already becoming more positive by the time of our six month post-opening interviews (and this was part of the rationale for the decision to conduct a third wave of interviews). IF YES, GO TO QUESTION 8.) Attitudes of parents of institutionalized mentally retarded individuals toward deinstitutionalization. No Answer 3. But there were others who might have an important viewpoint regarding the advisability of the person's participation as well: program staff and families. Though Pennsylvania was treated as an exception to the trend of settlement in mental retardation cases, the response of the Commonwealth may increasingly become the rule. We have Saturdays and Sundays to ourselves. Will not engage in assigned activities, e.g., putting away toys, etc. Least restrictive alternative 2.9 1.6 23. Recognizes no words or signs COMPLEX INSTRUCTIONS (Check ALL statements that apply) _______ a. Community residential programs spent an average of 1,902 hours of direct staff time per client, 84 hours more than the 1,753 hours of direct staff time per client at the Pennhurst Center. Findings of the Quantitative Studies The Human Impacts of the Deinstitutionalization of Pennhurst The part of the Pennhurst Study that was conducted by the Temple University Developmental Disabilities Center/UAF was designed to answer just one major question: are people better off? Both quantitative and qualitative data indicate that case management is a critical function in any community service system. Reduction of behaviors that disrupt others activities34. This was the primary finding of the baseline study. One of the questions posed to all key informants during the last round of interviews was whether or not the decree hastened the development of community resources in the Southeast Region. EXHIBIT 7-6. The question we asked was, "Overall, how satisfied are you with the services your relative is receiving from (Pennhurst/the CLA)?" In part, this reluctance stems from direct experience with other consent decrees and in part from a feeling that the price paid for consent is not worth the benefits. Because our cost analyses showed that community-based care was less expensive than Pennhurst, but that nearly all of the difference was caused by lower wages and benefits for community program employees, we recommend that administrators and advocates at all levels avoid the claim that tax dollars can be "saved" by switching to community-based services. Clears table of breakable dishes and glassware2. Though the consent agreement narrows the definition of the class somewhat (i.e., by eliminating those who were on the waiting list for Pennhurst), it still maintains the Special Management Unit and other entities established to protect the rights of class members. Third, because most of the savings arise from what seems to be marked pay differences, we conclude that the savings may be temporary. The major source of federal income that had not been tapped for the development of community resources prior to the Judge's order was Medicaid funding for intermediate care facilities for mentally retarded persons (ICF/MRs). Never has toilet accidents4. The spotlight of the lawsuit also made the process more self-conscious and apparent. Industry in the county is relatively diverse. Yes -- go back2. Our data are powerful enough to suggest increased federal incentives for non-institutional care. To the best of your knowledge, are the following statements true or false? The three instruments took approximately 1/2 hour to administer, the same as in the previous year. Hence although the five years of Federal funding are over, work in this crucial area will continue into the foreseeable future. That is not a desirable property for any set of environmental scales or standards. In J.L. After the Baseline Survey, we telephoned the families of each of the next 134 people who moved to CLAs; only the families of people who had already been in a CIA for six months were telephoned for the Post-Relocation Survey.

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