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National Core Indicators (NCI) is a collaborative effort between the National Association of State Directors of Developmental Disabilities Services [1] (NASDDDS), ADvancing States and the Human Services Research Institute [2] (HSRI) in the United States. The purpose of the program, which began in 1997, [3] is to support state human services systems to gather a standard set of performance and outcome measures that can be used to track their own performance over time, to compare results across states, and to establish national benchmarks.
The primary aim of NCI is to collect and maintain valid and reliable data about the performance of public human service systems. NCI states and project partners use NCI data not only to improve practice at the state level but also to add knowledge to the field, to influence state and national policy, and to inform strategic planning initiatives.
Through participation in the program, NCI states make a commitment to share information with stakeholders so that data can be used for policy change and quality improvement. To that end, the National Core Indicators website [4] provides public access to NCI data and current information about how the results are being used at the state and national levels to support policy, research, and advocacy efforts. [5]
Today NCI is an umbrella terms that refer to a performance measurement system that tracks progress toward person-centered outcomes in the fields of intellectual and developmental disabilities, aging and disabilities, and more. NCI is composed of two initiatives: National Core Indicators--Intellectual and Developmental Disabilities (NCI-IDD) and National Core Indicators--Aging and Disabilities (NCI-AD).
The primary aim NCI-IDD is to hear directly from service users and to collect and maintain valid and reliable data about the performance of state public IDD systems and the outcomes experienced by participants in the system. NCI-IDD states and project partners work to generate data that can be used to improve long-term care policy and practice at the state and national level, and to contribute to knowledge in the IDD field.
From the beginning of NCI-IDD there has been a commitment to transparency and to making survey results public. This makes it possible to compare state results with national norms and to assess the strengths and weaknesses of the state IDD systems.
The NCI-IDD team and member/partner organizations have worked over more the two decades to go beyond just publishing the state and national results in order to assist public managers to identify trends, to develop tools to use the data for quality improvement, and to commit to ensuring that the data collection protocols reflect the most current issues and concerns in the IDD field. Tools have included the development of data briefs on specific areas of interest such as employment, dual diagnosis, self-directed services, and autism spectrum disorders. To inform the field, the results of analyses of the multi-state dataset have been published in academic research journals and presented at conferences.
The NCI-IDD portfolio comprises an In Person Survey, three family surveys (TheAdult Family Survey, TheFamily/Guardian Survey and TheChildren/Family Survey) and State of the Workforce Survey.
The In-Person Survey is completed with a minimum of 400 individuals (per participating state) who are 18 years of age or older and receiving at least one paid service in addition to case management. There are over 100 key outcome indicators in the survey that are designed to gather valid and reliable data across five broad domains: individual outcomes; family outcomes; health, welfare and rights; staff stability; and system performance. The survey has three components; background data, and two interview sections. The background data is most frequently completed by service coordinators prior to the face-to-face survey and includes information about general demographics; where people live, work, health information, etc. The interview part of the survey must be conducted face to face with the individual receiving services. The first section can only be answered by the individual. The second section of the survey may be completed by a proxy if the interviewer determines the individual cannot answer for him or herself or if the individual does not want to respond [6] the NCI team provides training for interviewers who administer the survey. Completed surveys are entered using a secure online data entry system designed by HSRI.
The Adult Family Survey is completed by a minimum of 400 respondents (per participating state) who have an adult family member with I/DD living in the family home. This survey is mailed out to families to be completed. Returned survey information is entered into a secure on-line data entry system designed and managed by HSRI. States report response rates of between 35%- 40%.
The Family/Guardian Survey is completed with a minimum of 400 respondents (per participating state) who have an adult family member with I/DD living outside the family home. This survey is mailed out to families to be completed. Returned survey information is entered into a secure on-line data entry system designed and managed by HSRI. States report response rates of between 35%- 40%.
The Children/Family Survey is completed with a minimum of 400 respondents (per participating state) who have a child family member with I/DD living in the family home. This survey is mailed out to families to be completed. Returned survey information is entered into a secure on-line data entry system designed and managed by HSRI. States report response rates of between 35%- 40%.
The State of the Workforce Survey is completed by all provider agencies (within participating states) supporting adults with I/DD in residential, employment, day services and other in-home or community inclusion programs. The survey is intended to capture information about the direct support professional (DSP) workforce such as turnover, vacancy rates, wages, types of services provided, and benefits offered. Each state provides HSRI with agency emails and the provider agencies respond directly into HSRI's on-line data entry system.
The National Core Indicators-Aging and Disabilities (NCI-AD™) is an initiative designed to support states’ interest in assessing the performance of their programs and delivery systems in order to improve services for older adults and individuals with physical disabilities. NCI-AD’s primary aim is to collect and maintain valid and reliable data that give states a broad view of how publicly-funded services impact the quality of life and outcomes of service recipients.
NCI-AD brings an important value proposition to the field of aging and disability services through development of indicators and outcomes that assess quality of life, community integration, and person-centered services. The project program helps address long-recognized gaps in assessing outcomes in long term services and supports (LTSS) service systems that go beyond measures of health and safety to address important social, community, and person-centered goals as well as quality of life.
Data for the project are gathered through annual in-person surveys and a provider survey administered in each participating state, every state does not participate in each survey every year. NCI-AD Project Team interprets each state's data and produces reports that can support state efforts to strengthen LTSS policy, inform quality improvement activities, and compare their performance with national norms.
The NCI-AD portfolio comprises an Adult Consumer Survey and State of the Workforce Survey.
The Adult Consumer Survey (ACS) is completed with a minimum of 400 individuals (per participating state) who are 18 years of age or older and receiving at least one paid service in addition to case management. The indicators that make up the ACS go beyond simple measures of health and safety; they also address important personal outcomes such as community engagement, independence, decision-making, self-direction and other person-centered components of a quality life. And the data fill a crucial gap in performance measurement systems in aging and disability: information about the experience of people receiving services directly from those people themselves. The survey has two components; background data, and an interview section. The background data includes information about general demographics; where people live, work, health information, etc. The interview part of the survey must be conducted face to face with the individual receiving services. Parts of the survey may be completed by a proxy if the interviewer determines the individual cannot answer for him or herself or if the individual does not want to respond. The NCI team provides training for interviewers who administer the survey. Completed surveys are entered using a secure online data entry system designed by HSRI.
The State of the Workforce Survey is completed by all provider agencies (within participating states) supporting the Aging and Disability population in residential, day services and other in-home or community inclusion programs. The survey is intended to capture information about the direct support worker (DSW) workforce such as turnover, vacancy rates, wages, types of services provided, and benefits offered. Each state provides HSRI with agency emails and the provider agencies respond directly into HSRI's on-line data entry system.
Data from NCI surveys are aggregated and analyzed in reports produced yearly. [7] These data are used to support state efforts to strengthen long-term care policy, [8] inform the conduct of quality assurance activities, and compare performance with national norms. Additionally, NCI data have been used as the basis of data briefs [9] on specific areas of interest such as employment, dual diagnosis, self-directed services, and autism spectrum disorders, and the results of analyses of the multi-state dataset have been published in academic research journals [10] and presented at conferences. NCI has also been cited as a "Resource on Autism" by NBC News. [11] NCI indicators contribute to the calculation of state rankings in United Cerebral Palsy's report The Case for Inclusion. [12]
Data from the National Core Indicators surveys also provide a rich source of data on demographics, personal characteristics, work status, and services received. These data, together with NCI data on outcomes, have been used in many peer-reviewed research articles and presentations. [13] [14] [15] [16] [17] [18] NCI data is available to researchers through a data request process.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) is one of the National Institutes of Health (NIH) in the United States Department of Health and Human Services. It supports and conducts research aimed at improving the health of children, adults, families, and communities, including:
Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and independent living". Developmental disabilities can be detected early on and persist throughout an individual's lifespan. Developmental disability that affects all areas of a child's development is sometimes referred to as global developmental delay.
The Rehabilitation Act of 1973 is a United States federal law, codified at 29 U.S.C. § 701 et seq. The principal sponsor of the bill was Rep. John Brademas (D-IN-3). The Rehabilitation Act of 1973 replaces preexisting laws to extend and revise the authorization of grants to States for vocational rehabilitation services, with special emphasis on services to those with the most severe disabilities, to expand special Federal responsibilities and research and training programs with respect to individuals with disabilities, to establish special responsibilities in the Secretary of Health, Education, and Welfare for coordination of all programs with respect to individuals with disabilities within the Department of Health, Education, and Welfare, and for other purposes.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.
The American Association on Intellectual and Developmental Disabilities (AAIDD) is an American non-profit organization focusing on intellectual disability and related developmental disabilities. AAIDD has members in the United States and more than 50 other countries.
A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.
A group home, congregate living facility, care home, adult family home, etc., is a structured and supervised residence model that provides assisted living and medical care for those with complex health needs. Traditionally, the model has been used for children or young people who cannot live with their families or afford their own homes, people with chronic disabilities who may be adults or seniors, or people with dementia and related aged illnesses. Typically, there are no more than six residents, and there is at least one trained caregiver there 24 hours a day. In some early "model programs", a house manager, night manager, weekend activity coordinator, and four part-time skill teachers were reported. Originally, the term group home referred to homes of 8 to 16 individuals, which was a state-mandated size during deinstitutionalization. Residential nursing facilities, also included in this article, may be as large in 2015 as 100 individuals, which is no longer the case in fields such as intellectual and developmental disabilities. Depending on the severity of the condition requiring one to need to live in a group home, some clients are able to attend day programs and most clients are able to live normal lifestyles.
Best Buddies International is an American nonprofit 501(c)(3) organization. It consists of volunteers that create opportunities for people with intellectual and developmental disabilities (IDD). The program's main purpose is to allow volunteers to be paired up with a buddy with an intellectual and developmental disability and provide them with a friend or a mentor. Best Buddies is the world's largest organization dedicated to ending the social, physical and economic isolation of the 200 million people with IDD. It is an international movement that has spread to over 54 countries worldwide.
Learning disability, learning disorder, or learning difficulty is a condition in the brain that causes difficulties comprehending or processing information and can be caused by several different factors. Given the "difficulty learning in a typical manner", this does not exclude the ability to learn in a different manner. Therefore, some people can be more accurately described as having a "learning difference", thus avoiding any misconception of being disabled with a possible lack of an ability to learn and possible negative stereotyping. In the United Kingdom, the term "learning disability" generally refers to an intellectual disability, while conditions such as dyslexia and dyspraxia are usually referred to as "learning difficulties".
The Council on Quality and Leadership offers accreditation, training, certification, research, and consultation services to agencies.
Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment. Supported employment is considered to be one form of employment in which wages are expected, together with benefits from an employer in a competitive workplace, though some versions refer to disability agency paid employment. Companies such as Skilcraft in the United States are an example of "supported employment" which is defined in law for state and federal reimbursements.
Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation, is a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined by an IQ under 70, in addition to deficits in two or more adaptive behaviors that affect everyday, general living. Intellectual functions are defined under DSM-V as reasoning, problem‑solving, planning, abstract thinking, judgment, academic learning, and learning from instruction and experience, and practical understanding confirmed by both clinical assessment and standardized tests. Adaptive behavior is defined in terms of conceptual, social, and practical skills involving tasks performed by people in their everyday lives.
Research published from 2000 to 2020 illustrates increased prevalence rates of sexual violence against people with intellectual disabilities, compared to the general population.:61 The World Health Organization (WHO) funded a study which concluded that 15% of the adult population worldwide in 2012 had a disability, putting them at increased risk of physical, sexual, and intimate partner violence. Of that 15%, 6.1% or an estimated 7,008,716,704 adults worldwide had intellectual disability with 5.5% experiencing sexual violence. In another 2012 report, the WHO found that worldwide, children with intellectual disabilities experienced a 4.6 times greater risk of sexual violence than those without disability.
Dr. Tom Sannicandro is an American attorney. He is the founder of SpecialNeedsTrustsOnline.com, a non-profit website providing estate planning documents to families with children with special needs. Previously he served as director of the Massachusetts Association of Community Colleges.
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), formerly known as Intermediate Care Facilities for Mental Retardation (ICF/MR), is an American Medicaid-funded institutional long-term support and service (LTSS) for people with intellectual disabilities or related conditions. Section 1905(d) of the Social Security Act enacted benefits and made funding available for "institutions" for individuals with intellectual or related conditions. According to federal law 42 CFR § 440.150 the purpose of ICD/IIDs is to "furnish health or rehabilitative services to persons with Intellectual Disability or persons with related conditions."
Family support is the support of families with a member with a disability, which may include a child, an adult, or even the parent in the family. In the United States, family support includes "unpaid" or "informal" support by neighbors, families, and friends, "paid services" through specialist agencies providing an array of services termed "family support services", school or parent services for special needs such as respite care, specialized child care or peer companions, or cash subsidies, tax deductions or other financial subsidies. Family support has been extended to different population groups in the US and worldwide. Family support services are currently a "community services and funding" stream in New York and the US which has had variable "application" based on disability groups, administrating agencies, and even, regulatory and legislative intent.
The Utah HCBS waiver program is a state-run program that serves individuals in Utah with intellectual disabilities or related conditions (ID/RC). HCBS stands for Home and Community-Based Services.
As of 2017, approximately 1.4 million Americans live in a nursing home, two-thirds of whom rely on Medicaid to pay for their care. Residential nursing facilities receive Medicaid federal funding and approvals through a state health department. These facilities may be overseen by various types of state agency.
In previous years, students in the United States who have been diagnosed to have intellectual disabilities (ID) cannot have access or have difficulty having access to post-secondary education (PSE). One significant reason why these students have been marginalized from continuing their education is their being denied federal student aid. Many were disqualified due to the lack of having a high school diploma while others were not able to pass standardized tests which should indicate if their claim to secure aid is justified. With the legislation of the Higher Education Opportunity Act of 2008, students with ID can now qualify for student grants and work-study programs.
People with disabilities are at greater risk of contracting COVID-19 and have higher rates of mortality than non-disabled populations. This is especially true for people with intellectual and developmental disabilities, individuals who reside in care facilities, and women with disabilities. People with disabilities are at greater risk of experiencing mental health issues related to the pandemic, such as feelings of loneliness and isolation. They may be at greater risk of domestic violence and abuse during the pandemic. People with disabilities are more likely to experience unemployment as a result of the pandemic and may require changes to the types of accommodations they require for work. Children with disabilities are experiencing disruptions to their educational programming. Remote learning poses a host of challenges for children with disabilities, including disruptions to physical and occupational therapies and access to assistive technologies.