Journal of Disability Policy Studies

The authors evaluated a managed care model developed for use by community-based providers to improve health care outcomes for low-income Latinos with disabilities and chronic illnesses. Through this model, Medicaid enrollees with special health care needs were identified and received enhanced primary care, on-site mental health and addiction services, care coordination, and support services based on their levels of need. The goal of the demonstration was to determine whether capitation would be a catalyst to transform typical primary care delivery processes to provide enhanced, culturally competent care to patients with complex health care and psychosocial needs. Despite a significant investment in outpatient services, the intervention was cost effective due to a dramatic decline in inpatient care for a few enrollees. For most enrollees, care was slightly more expensive due to enhanced outpatient medical and mental health care. Enrollees expressed high satisfaction with the intervention.

This study describes consumers who hire friends, family members, or strangers as paid personal assistants and compares service satisfaction among the three groups. From surveying 511 consumers of self-directed home care services, the authors found that consumers who hire friends as workers are younger and more educated than consumers who hire family members and strangers, and they are more impaired than consumers with strangers as workers. The friend cohort experiences more stability with their personal assistants than does the stranger cohort but not as much stability as the family cohort. On some dimensions of consumer satisfaction, friends as workers are perceived by consumers to be either the same as or better than strangers, but they also are perceived as either the same as or worse than family workers. Using friends as paid workers is an important resource. Researchers and policy makers should further explore this approach because the need for home-based personal assistance continues to increase.

This article examines topics found in reading standards for K–12 education and then examines the standards from a perspective of accessibility for students with a variety of sensory and learning disabilities. The article begins by first determining how broad or limiting states' reading standards are in coverage and whether focus on particular standards limits options for students to use multiple methods of interaction with print (e.g., accessing print through visual, audio, tactile, or multiple modalities). A review of standards found that state standards generally fall into the following categories: the acquisition of specific skills; the knowledge of the elements or conventions in language; literacy as an interactive, thinking activity; literacy as a problem-solving tool; and literacy as a catalyst for personal growth. With the exception of specific skill standards, all standards have the potential to be accessed through different modalities.

Ethical and legal principles are provided for reviewing the ethics of recent cases of biomedical research abuse involving persons with decisional impairments or legal incapacity who were unable to understand the risks and benefits of the research to which they were subjected. Research abuse continues to occur despite guidance from the Nuremburg Code, the Declaration of Helsinki, the U.S. Belmont Report, extensive federal regulations governing human participant research, and several professional and disciplinary codes of ethics with which, the authors believe, the majority of researchers comply. Contributing to research abuse are weaknesses in the institutional review board and research ethics board review process; conflicting opinions about applicable ethical principles; mounting evidence of pervasive conflicts of interest; and dubious conflated research and marketing practices involving researchers, pharmaceutical and medical device manufacturers, and government research sponsors and regulatory agencies. Several recommendations are made to correct identifiable weaknesses and failures in the governance of biomedical research.

Autistic spectrum disorders (ASD) present numerous challenges for early diagnosis and intervention. Recent research has concentrated on identifying symptoms of ASD in infants and toddlers. This article examines the feasibility of detecting ASD in infants and toddlers using early behaviors related to ASD and the impact that recent government policy changes and professional guidelines for family practitioners and pediatricians have had on early screening for young children with ASD. Empirical evidence from retrospective video analysis implies that ASD may be detected in infants and toddlers. Recent policy changes and guidelines for pediatricians and other practitioners recommend more intense efforts be made for developmental surveillance and referrals, but the impact of these policies on practice and on the lives of children with ASD and their families has been limited. Policy recommendations are made.