Endorsing a Bully

Disability Rights Washington is presenting their “Breaking Barriers” awards fundraiser this month.  Below is information from the Disability Rights Washington Website which describes this award.

Ex-Commissioner (Seattle Commission for People with Disabilities) Shaun Bickley, was chosen as the recipient for the Advocacy Award.  There are many of us in the disability community who have been victims of Shaun Bickley’s online malicious and cruel attacks, slander and libel.  We are upset about Bickley’s violations of the First Amendment as a Commissioner, falsified data and information Bickley presented to the Commission, the previous Mayor, the previous Director of the  Office of Labor Standards and the Seattle City Council.

In addition to the above allegations (all well documented in public records), Bickley had extreme disregard for the by-laws and code of conduct of the Seattle Commission for People with Disabilities.  In fact, after Mayor Durkan did not re-appoint Bickley to the Commission, Bickley took it upon himself to return to the Commission the next month and have himself voted in as the co-chair with a Commission appointed seat.  Bickley continues to refer to himself as the Co-Chair of the Commission despite not being appointed by the City Council.  This is a violation of the by-laws but evidently, Bickley is not held accountable to those by-laws.

“Bully”  is the least offensive description that many who have encountered Shaun Bickley use to describe his actions towards others.

How has it come to be that a BULLY is being honored as a recipient of this “Breaking Barriers” award?

 2018 DRW Breaking Barriers Awards! 

September 29, 2018

Each year, Disability Rights Washington presents its Breaking Barriers Awards.  These prestigious awards honor a business, an elected official or public servant, and an advocate with a disability for breaking barriers to advance the rights of and improve the lives of people with disabilities in Washington State. Specifically, Disability Rights Washington will present the following awards:

  • Advocacy Award
  • Public Policy Award
  • Business Leader Award

Advocacy Award

Disability Rights Washington presents this award to an advocate with a disability who has made significant contributions in the past year to advance the rights of people with disabilities in Washington State.

Breaking Barriers 2018 - Shaun Bickley

 

Missing – Common Sense

This is been a year long battle with The Seattle Commission for People with Disabilities regarding their rapid elimination of special certificates that can allow specific people with specific disabilities to work at a specific job for a wage that may be less than the minimum wage.  While they are calling these certificates “discrimination”, the certificates  can actually provide people with an alternative for community integration that they may not have now.
This Commission and those organizations that have signed onto this thought process believing that just raising the wages will enhance these people’s lives have forgotten to ask the affected people themselves.  Some very important information regarding critical issues that people with disabilities who have significant support needs and how those needs are going to be accommodated have not been addressed.
This is the fallout of making laws without collaboration and without addressing the concerns of those who are directly involved.  The Commission refused to address a variety of concerns from stakeholders saying that those concerns didn’t matter and had nothing to do with the certificates or elimination of sub-minimum wage.
The facts are very different – there were 8 employees in Seattle who were making a sub-minimum wage  –   6 were at Ballard Locks making between $9.00 and $10.50 an hour and 2 other employees at community sites who earned  $11.01 and $11.25 an hour.  (The Commission reported extremely inaccurate information via a press release stating that there were “at least 130 disabled workers in the city of Seattle making subminimum wage, most making under $1.60/hr.  The lowest-paid worker under these exemptions in Seattle makes 20 cents an hour”   SCPWD Press Release June 22 2017
The totally false information The Commission released to the press (and previously to the former Mayor and Councilmember Herbold) was discovered as a mistake by the then co-chair of The Commission.  This error was pointed out to the person of contact on the Press Release who refused to issue a correction.  The author stated – press release already went out, if we receive follow up we can discuss that with those people.  He also stated that he would believe the documents he got from Department of Labor over what someone told him.  Unfortunately, this person was not able to read the document from DOL correctly and made this huge mistake in numbers of employees and their wages.  Commission will not amend press release
This is how the Commission responds to those who questioned their numbers:
April 13 2018 second chance from Commission - spam and deliberately false information
Before this issue goes any further under such faulty research and data collection, stop and listen to those whose lives were and will be directly affected by these changes.
I continue to ask the Commission about accountability and transparency – they feel threatened and harassed by me and want to have me banned from Commission meetings.
Maybe the Commissioners should actually read some of the comments I have shared and read the research and documents they presented regarding recommendations.  While doing that, they should research what has happened in those other states who have changed their laws – are the people working, have their lives improved?  These are all issues that need to be addressed before more action is taken.

Email from Shaun Bickley regarding City Council – do not share

The Seattle Disability Commission is proud to be among the first organizations to call for an end to Washington’s exemption to minimum wage laws, which allow employers to pay disabled people, and only disabled people, less than minimum wage.

A current copy of the letter can be found here: https://docs.google.com/…/1cCT_IL6I3HLcmYKdK5QhdNamqQ…/edit…

If your business or organization (operating in the state of Washington) would like to be added, please email sbickley@arcofkingcounty.org . Text is below:

We, the undersigned organizations, oppose the practice of paying workers with disabilities subminimum wage. On April 13, 2018, Seattle joined the states of Alaska, New Hampshire, Vermont and Maryland, in ending the outdated practice of allowing subminimum wage employment of people based on their disabilities. We do not believe workers should be discriminated against on the basis of disability and join the growing coalition advocating for an end to state laws that allow such discrimination.

We believe all workers should be fairly compensated and are entitled to the same minimum wage protections regardless of their disability status. We hope the State of Washington will join other states and cities in taking the lead to put an end to this unfair employment practice.

Sincerely,

Able Opportunities, Inc.
Allies in Advocacy
The Arc of King County
The Arc of Snohomish County
ASUW Student Disability Commission
AtWork!
Autistic Self Advocacy Network
Autistic Women & Nonbinary Network
Community Employment Alliance
Disability Rights Washington
Downtown Emergency Service Center (DESC)
Geeks Without Bounds
Morningside
National Federation of the Blind of Washington
Open Doors for Multicultural Families
People First of Snohomish County
People First of Washington
Seattle Commission for People with Disabilities
Seattle LGBTQ Commission
Self Advocates in Leadership (SAIL)
Sherwood Community Services
TASH
Washington ADAPT
Washington CAN
Washington Low Income Housing Alliance
Working Washington
Work Opportunities

SAIL – (Self Advocates in Leadership) is The Arc – Washington State

I have had issues with the group SAIL – Self-Advocates in Leadership (Washington) for some time since I have witnessed this group dis-regard self-advocates who may not agree with the agenda of this group.  SAIL has typically had a representative testify every year to various committees in Olympia claiming that all institutions should be closed.   SAIL has had consistent messages that oppose person-centered planning with regards to choice of residential setting.  This group claims to represent ALL people with disabilities and fails to understand the heterogeneous make up of this population.

This past year the previous Self-Advocacy Coordinator  who actually worked for the Arc of Washington (Noah Seidel) took a position in the Washington State Developmental Disability Ombudsman Office. SAIL did not renew their non-profit status with the Washington State Secretary of State and the organization non-profit status expired February 28, 2017 and  SAIL administratively Dissolved  as of July 3, 2017.

SAil is not registered with Wash state

Facebook clipping dated August 28, 2017

The Arc – Washington State posted a Job Announcement for Self-Advocacy Coordinator on September 19, 2017

Sail Coordinator

Self-Advocacy Coordinator – The Arc – Washington State

SAIL is now run by The Arc – Washington State and the new Self-Advocacy Coordinator is Cheryl Monk.  SAIL is not an independent organization managed and lead by people with developmental disabilities as many are led to believe but is some sort of committee within The Arc- Washington State.

SAIL coordinator Cheryl Monk

 

There are other Self-Advocates in our state that do not promote the same agenda as the members of The Arc – SAIL.  These self-advocates have a variety of experiences and want to preserve choice for everyone.

One such self-advocate is a young man who lived at Fircrest for 6 years.  He moved to supported living during March 2016.  Even though he has a guardian, it was his choice to move and he has worked with his residential team, community, family, friends, employer, job coach and healthcare providers to make this transition a success.  The supports are critical for him to remain in supported living and the collaboration is essential to make it all work.

But he hears things and picks up on what goes on in the community.  When he hears news about Rainier or Fircrest closing, his anxiety spikes.  While at Fircrest he heard talk about this very often and he had lived at Frances Hadden Morgan Center prior to it’s closure – an experience that was traumatizing for many.  The threat of losing his home again was a real threat while he lived at Fircrest.

This is his message to our legislators – he will not be testifying as a self-advocate in front of legislative committees but his message is just as important as those who belong to The Arc – Washington

 

Addendum:

This post has offended some self-advocates.  The militant activism by some DD Self-Advocates is cause for concern.  The lack of ability to understand that others have different needs and desires, that caregivers, friends and family members of those who require intensive and extensive support needs are valuable as advocates for the people they support are major problems.

It’s very unfortunate that those self-advocates who refuse to collaborate with other advocates have a persecution complex against those who advocate for better services and the funding to support those services.  Those who advocate with and for people with IDD are not advocating from a “pro-institution” position but from a “pro-person centered planning” position.  There is no ulterior motive to pit one group against another – we’re all in this together.

Ivanova says I am wrong about The Arc

DD Ombudsman – Washington State

I have had contact with the new Office of the Developmental Disabilities Ombudsman in Washington State.  This is a critical organization for those with intellectual and developmental disabilities to be aware of regarding any concerns pertaining to their care and services received.  It is especially important for those who live in the State Operated Intermediate Care Facilities (ICFs) since these residents have no other objective advocate to review their concerns or complaints.

DD Ombuds logo

With that being said, I do have some reservations about reporting concerns to the DD Ombudsman.  The Protection & Advocacy Agency (Disability Rights Washington) which has been very vocal with their agenda of closing the ICFs, is the independent non-profit agency that was awarded the contract to administer the DD Ombudsman Program.  The Region 3 Ombudsman (Noah Sidel) was the previous Self-Advocacy Coordinator with The Arc of Washington working with Self Advocates in Leadership (SAIL) and has testified many times to legislative committees with the position that the ICFs need to be closed.

Given the history, it is very difficult to trust that the above biased agendas will not be pushed forward by the DD Ombuds office if concerns of those residing in the ICFs are reported.  I know that ICF residents and families have been reluctant to make any complaints regarding concerns out of fear their complaints will be used as “proof” that the ICF needs to be closed.   The history is that rather than looking at the problem and fixing it, the problem is used as a reason to close the ICF.

The problem is that when residents of state operated facilities make allegations the investigations are done by non-objective, state employees.  Many times these investigators are not healthcare providers and are not able to assess if the care provided met the community standard of care (medical and nursing care to be specific).  Once the Residential Care Services (under the Department of Health and Human Services) the facility administration or the State Investigative Unit have “investigated” and made their report, there is no ability to appeal or have an outside, non-DSHS employee review the allegations.

If state law were followed with regards to medical and nursing care of these residents, the oversight of the care would be provided by the Department of Health.  The management of nursing care and practice would be done by Registered Nurses – not non-nurse administrators.  Complaints regarding nursing or medical care would be reviewed by healthcare professionals not investigators who are not licensed healthcare providers.

These are systemic problems that need to be addressed.  My hope is that by bringing these critical problems to the attention of the DD Ombudsman, appropriate legislation will be written which will bring the oversight of the healthcare of residents in the ICF in compliance with the Washington State Law.

Below are some letters that describe the allegations and specific State Laws which were allegedly violated.  My intention regarding this information is so that these systemic problems are identified and corrected.  I support a full continuum of care and the ICF is a critical part of that continuum.  This information is not to be used in the agenda of closure but to address the issue of quality care and appropriate oversight of healthcare.
document for DD Ombuds

letter to Mr. Hakim regarding systemic issues of healthcare neglect at Fircrest

Letter to Senator Keiser regarding issues at Fircrest and DD Ombudsman 2017

Systemic Errors in Medication Administration at Fircrest

ODDO-Advisory-Committee-Meeting-Minutes-9.16.17

DD-Ombuds-Annual-Report-2017-Final

DD Stakeholder Survey for DD Ombudsman

SAIL – Self Advocates in Leadership

SAIL headerWe hear much about Self-Advocacy and there are many trainings out there for people to learn to become self-advocates.  This is part of becoming more independent and able to make choices.  Yet, these trained self-advocates are only a minor part of the population of people with intellectual and developmental disabilities.

The agenda of many of these self-advocacy organizations may actually be against services and choices that many of their peers would advocate for.  The problem is that the peers who are not involved in these self-advocacy trainings (for a variety of reasons) are not able to communicate thier needs and choices in a typical manner. Therefore, the majority of people with intellectual and developmental disabilities are not represented by these self-advocacy groups.

 

Sail 2018 legislative agenda

When trained self-advocates voice their agendas and state that this is what people with IDD advocate for, they mislead our legislators and policy makers.

Again, it is important to understand the disability of intellectual AND developmental disabilities – by the very nature of the disability the people affected by it are, in most cases, unable to communicate their needs and choices to those who do not know them.  The people with IDD may not even be aware of or care about the issues that the trained-self advocates choose to concentrate on.

Yesterday I decided to take my son to a SAIL (Self Advocates in Leadership) meeting in Seattle.  My son is aware that I go to our state capital and communicate with people in our government.  He is aware of some of the names that he hears me say and gets excited when I say I am going to meet with one the legislators he has heard of.

I told him that we were going to a meeting for people with disabilities.  I have no idea if he understood what I was even talking about because he doesn’t really consider himself “disabled” or needing any type of special adaptation or accomodation.   He knows that he’s not able to do some things that his siblings do – such as drive  – but he’s totally fine with that and if you asked him if he wanted to learn to drive he would crack up laughing.   My son accepts how he is and is happy.  He has been disabled his whole life and his reality is that he does things differently than his typical siblings.  He is aware that his siblings do things that he doesn’t do  – but that’s totally okay with him becuase he is able to do the things that are important to him.  In that respect, they are all the same.    He is extremely happy with his life!

So the topics and discussions at the SAIL meeting were of absolutely no interest to him. Due to the length of the meeting and total lack of interest on my son’s part, we did leave the meeting early since it was also clear that his noise level and interest in other things besides what was being discussed were extremely distracting to at least one of the speakers.

One speaker, who happens to be on the Seattle Commission for People with Disabilities, appeared very disturbed by my son.  The speaker had to stop and complain several times to one of the meeting co-chairs about the distractions and even said that he could not talk with such distractions.  After about the 4th time this speaker started to talk it was very clear that he was getting agitated by my son’s noise but the co-chair told him to just keep talking and not to worry about the “distraction” (my son’s noise)

When my son kept trying to look at his You-tube videos or listen to Pandora or ask Siri about various people he knows, he would either get very excited and laugh or get angry with me for trying to encourage him to be quite.  He then started focusing on the time and saying “we will leave at 3 o’clock” for about 45 minutes and then we did leave at 3 PM.

It’s too bad because I think SAIL did discuss a topic that my son does have an opinion about – that of the intermediate care facility.  He is adament about these communities staying open and providing homes and care to those who need to live there.  This is something that he does understand from his experience – an experience that most in that room did not have – or at least not in recent years.

My son shows great concern about Fircrest (the ICF/ID in our neighborhood and where he lived for 6 years) closing.  He can name the other Residential Habiliation Centers in our state that are often in the news with regards to funding cuts and closure.  He did live at Frances Haddon Morgan Center (FHMC)for 1 year but was able to move to the RHC in our neighborhood prior to the closure of FHMC.  My son often asks “What happened to Frances Haddon?”

It is clear to me that this self-advocate meeting was meaningless to my son yet he is one of the many who need advocacy.  It’s shameful that the agency that is geared towards self-advocacy is unable to accommodate the needs and opinions of those who most need an advocate and fail to see the broad spectrum of needs and choices of the population.

I’m really curious how these self-advocacy groups work with people similar to my son and how they reach out and learn what issues are important to them?  Or is this population forgotten and silent when it comes to advocacy?

 

 

 

Guardians are not the “bad guys”

As a parent and guardian of my young adult son with complex developmental disabilities which include an intellectual disability, I am continually made aware of the “fact” from trained self-advocates that my opinion has nothing to do with what may be best for my son and that, as a guardian, I am only self-serving.  Also, since I do not have a developmental disability myself, I have no knowledge of what it is like to live with a developmental disability – more specifically an intellectual disability.

I fully support trained self-advocates in their mission to advocate for a meaningful life experience and to shape public policies to which affect the lives of people with developmental disabilities.  I do not believe that the trained self-advocates have a full understanding of the needs and supports that people with complex, profound or intellectual disabilities (IDD) would choose.  I also do not believe that these trained self-advocates understand the issues of needing a caregiver 24 hours a day to assist with ALL aspects of daily living and how the guardian is involved in helping a person to have a meaningful life experience.

The legal guardian has a court-ordered responsibility to speak on behalf of and in the best interest of the person for whom they represent.  The guardian, together with other caretakers, and the person needing the supports work as a team and the guardian can be the spokesperson for the person with IDD.

I understand there are many people with IDD who are able to speak up and advocate for themselves and ask for what they need and that’s great. Unfortunately, just by definition of this particular disability,  only the people with the characteristics of “mild” ID may be able to live independently with minimal support and/or intermittent support during times of uncertainty.

Unless trained self-advocates are providing the day in and day out, 24 hour care needed by the people who experience  the “moderate,” “severe,” or “profound” characteristics of IDD, they have no concept of the needs, supports and choices that these people would make and have no right to speak on their behalf.  Since by definition, this population is unable to advocate for their needs and supports, the guardians, caretakers, family members, community members, healthcare providers, and friends who know the person best are the the most appropriate advocates for this population.

Denying guardians participation in advocacy on behalf of the people they care for is an act of discrimination against this population.  The slogan “Nothing about us, Without us” includes the guardians when they are speaking in the best interest of the person who they have the legal responsibility to make decisions for.

The table below clearly differentiates the severity categories in the classification of those diagnosed with intellectual disability.

clinical characteristics of Intellectual Disabilities

This discrimination is practiced by many organizations and advocates who claim they are advocating for those with disabilities.  In the response I received from Alex Clardy, Legislative Assistant for Seattle City Councilmember District 1 Lisa Herbold, it is clear they do not understand how this population communicates and the discrimination practices greatly limit the ability of the policy makers to fully understand how these issues will affect the people who work these jobs.

“The PwD Commission received no comment opposing the elimination of the subminimum wage certificates. Some people contacted Councilmember Herbold’s office concerned that people need the subminimum wage to get jobs.  Yet, no people with disabilities contacted Councilmember Herbold’s office to say so.  Since the PwD Commission, through their individual lived experiences, can speak to these issues best, Councilmember Herbold asked that I share with you excerpts from the PwD Commission letter that outlines several specific points as evidence against these concerns specifically and opposing the subminimum wage as a policy. “

( I will comment on the so-called “evidence” which the Seattle Commission for People with Disabilities (PwD Commission) provided to the City Council in another blog post)

It needs to be noted that there are no representatives with IDD on the PwD Commission and they totally disregard the guardians and the collective experience of the guardians, caretakers, friends and community members of people with IDD.  The PwD Commission is exclusionary when it comes to people with IDD.

Another group – Self Advocates in Leadership has the following items in their 2018 legislative agenda:

Sail 2018 legislative agenda

Are they suggesting that supported decision making replace guardians?  Is this logical for the people who live with severe forms of IDD?

 

 

It’s not Scientific Research – part 2

The Policy Report that Susanna Frame refers to as “scientific research” is not scientific research but a literature review looking at one aspect of life. The Policy Brief she shares is not a scientific research and the authors note that for those with severe intellectual disabilities with complex support needs there has been a huge gap in the research.

Promoting choice and person centered supports comes with an added responsibility to ensure that individuals and families are given the opportunity to have accurate information about the many complexities involved with their care.

While the deinstitutionalization movement started with great intentions – this movement has gotten out of hand without a grip on the reality of the situation.

Wolf Wolfensberger (1934-2011) was instrumental in the formulation of the concept of personal value and meaningful integration and inclusion of people with intellectual disabilities.

“Wolfensberger (2003) has indicated that the advent of the ideologies of radical individualism coupled with radical self-determination and the derivative constructs of ‘choice’, self-advocacy and empowerment has resulted in many people with ID being turned loose without any, or without sufficient, supports, guidance, tutelage or outright controls.  Wolfensberger singles out for particular criticism the kind of assertiveness training promoted by People First and other collective advocacy groups. “(Jackson, 2011)

There are several groups that are supported by public funds that partake in this radical advocacy movement.  They refuse to collaborate with others who are more holistic, take a strident tone and alienate those who may question their tactics or ideology.   The Arc, SAW (Self-Advocates Washington), SAIL (Self Advocates in Leadership), Parent to Parent, Washington State Parent Coalitions for Developmental Disabilities are several of these organizations which have become wedded to this radical agenda of black/white choices.

These groups are working with for-profit vendors to polarize advocates to “community” or “institutionalization” to the complete exclusion of true choice and alternatives.  The politicization of the research agenda which is dictated by external bodies is doing our citizens a great disservice.

This so-called “investigation” by Susannah Frame from King 5 plays right into this agenda.  It has been clear from the start of the biases and lack of research and facts.  The complexities of the issues have not been addressed nor has there been any information given as to why advocates may not agree with the “choice” that they are told is the “right” choice.   Many question the credibility and ethics of the authors of the reports and the so-called “scientific” research.

While it seems that community cost is less by the limited data that is provided, it is not really about cost – nor is it really about choice – it is about something else – it’s about an ideology that is going to lead to disaster if no one is allowed to question it.

Paradoxically, instead of being genuinely enabling, empowering and liberalizing, ideology is being deployed to support policies which benefit the for-profit vendors.  This is big business and many community vendors are making a large profit from the care of vulnerable people.

Scott Livengood, CEO of Alpha Supported Living, would be able to tell you that his company cannot accommodate many residents with the high support needs of Yusuf – the young man portrayed in the recent segment.

Alpha Supported Living does a great job of supporting Yusef and others but some of these agencies are not so well staffed or managed well.   Records indicate that Yusef’s daily personal care comes to about $370.00 a day – yes that is less expensive than the daily care rate at the RHC but what is missing from this information is the cost of all the other aspects of care – food, shelter, health care, transportation – just to highlight a few costs that can add up rather quickly.

Any Supported Living Provider will say that they cannot afford to care for people with this level of care with the low rate of reimbursement that they receive from our state.  The funding for this care comes from the Home and Community Based Service Waiver (HCBS) and each state has a different program for funding.

While it has been stated that Washington is decades behind – the facts show otherwise.  There are 12 states that do not have any large State-Operated ICFs but that does not mean that they do no not have private ICFs or nursing homes or utilize those services from an ICF in another state.  In order to move people from the ICF to a dispersed community setting, it would be critical to know what the resources are in the community and if there is funding available to provide the specialized services and to sustain them.

The chart below has data taken from The State of the States (the same resource that Susannah Frame used for her information).  One can see that every state has some residents in an ICF/ID or nursing home.  It is also important to note the HCBS per capita spending for those who live in dispersed community settings.  The states with fewer people in larger facilities spend much more per capita on the HCBS waivers.

Washington, with a HCBS cost of $87.00 is below the national average of $129.00.  Those states with no large state-operated facilities spend an average of $175.00 per capita on HCBS waivers.  This care also comes with a cost. It needs to be noted that the HCBS costs do not include cost of living expenses such as rent, food, medical care which are all included in the ICF/ID costs.

If this was all about cost we would not be having these discussions.

Data taken from “The State of the States in Developmental Disabilities” Fiscal Year 2013 and Centers for Medicaid and Medicare Home and Community Based Spending FY 2013

Graph sorted by percent of ID residents in /ID and Nursing Facilities

HCBS spending per capita and ID residents 2013

 

Graph sorted by State spending on HCBS waivers FY 2013

HCBS spending with ID Residents

 

King 5 “Last of the Institutions” Part 4

 

Resources used:

 

Ailey, Sarah H., et al. “Factors related to complications among adult patients with intellectual disabilities hospitalized at an academic medical center.” Intellectual And Developmental Disabilities 53, no. 2 (April 2015): 114-119.

Arnold, Samuel R. C., Vivienne C. Riches, and Roger J. Stancliffe. 2014. “I-CAN: The Classification and Prediction of Support Needs.” Journal Of Applied Research In Intellectual Disabilities 27, no. 2: 97.

Bershadsky, Julie, Sarah Taub, Joshua Engler, Charles R. Moseley, K. Charlie Lakin, Roger J. Stancliffe, Sheryl Larson, Renata Ticha, Caitlin Bailey, and Valerie Bradley. 2012. “Place of Residence and Preventive Health Care for Intellectual and Developmental Disabilities Services Recipients in 20 States.” Public Health Reports 127, no. 5: 475-485

Bigby, Christine. “Known well by no-one: Trends in the informal social networks of middle-aged and older people with intellectual disability five years after moving to the community.” Journal Of Intellectual & Developmental Disability 33, no. 2 (June 2008): 148-157.

Centers for Medicaid and Medicare, 2015. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013: Home and Community-Based Services were a Majority of LTSS Spending June 30, 2015, s.l.: Centers for Medicaid and Medicare.

Cooper, Sally-Ann, et al. “Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis.” BMC Family Practice 16, no. 1 (August 2015): 1.

Erickson S, LeRoy B. Health literacy and medication administration performance by caregivers of adults with developmental disabilities. Journal Of The American Pharmacists Association: Japha [serial online]. March 2015;55(2):169

Felce, David. “Costs, Quality And Staffing In Services For People With Severe Learning Disabilities.” Journal Of Mental Health 3.4 (1994): 495-506.

Friedman, Carli, Amie Lulinski, and Mary C. Rizzolo. “Mental/behavioral health services: Medicaid home and community-based services 1915(c) waiver allocation for people with intellectual and developmental disabilities.” Intellectual And Developmental Disabilities 53, no. 4 (August 2015): 257-270.

Hamden, AnnNewton, RichardMcCauley-Elsom, KayCross, Wendy. “Is Deinstitutionalization Working In Our Community?.” International Journal Of Mental Health Nursing 20.4 (2011): 274-283.

Hamelin, Jeffery P., et al. “Meta-Analysis Of Deinstitutionalisation Adaptive Behaviour Outcomes: Research And Clinical Implications.” Journal Of Intellectual And Developmental Disability 36.1 (2011): 61-72.

Hewitt, Amy. “Presidential Address, 2014—Embracing complexity: Community inclusion, participation, and citizenship.” Intellectual And Developmental Disabilities 52, no. 6 (December 2014): 475-495.

Jackson, R. “Invited review: Challenges of residential and community care: ‘the times they are a‐changin’.” Journal Of Intellectual Disability Research 55, no. 9 (September 2011): 933-944.

Kelly, Susan, and Yani Su. “Psychotropic and anticonvulsant medication: Individuals with intellectual and developmental disabilities who transitioned to the community from an institution.” Intellectual And Developmental Disabilities 53, no. 4 (August 2015): 289-300.

Lakin K, Prouty R, Polister B, Coucouvanis K. Data Briefs: Change in Residential Placements for Persons with Intellectual and Developmental Disabilities in the USA in the Last Two Decades. Journal Of Intellectual And Developmental Disability [serial online]. June 1, 2003;28(2):205-10.

Larson S, Lakin C, Hill S. Behavioral Outcomes of Moving From Institutional to Community Living for People With Intellectual and Developmental Disabilities: U.S. Studies From 1977 to 2010. Research & Practice For Persons With Severe Disabilities [serial online]. Winter2012 2012;37(4):235-246.

Luckasson, Ruth, and Robert L. Schalock. “Standards to guide the use of clinical judgment in the field of intellectual disability.” Intellectual And Developmental Disabilities 53, no. 3 (June 2015): 240-251.PsycINFO, EBSCOhost (accessed November 28, 2015).

Mansell, Jim, and Julie Beadle-Brown. “Deinstitutionalisation and community living: Position statement of the Comparative Policy and Practice Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities.” Journal Of Intellectual Disability Research 54, no. 2 (February 2010): 104-112

Martinez-Leal, R., et al. “The Impact Of Living Arrangements And Deinstitutionalisation In The Health Status Of Persons With Intellectual Disability In Europe.” Journal Of Intellectual Disability Research 55.9 (2011): 858-872

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