Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Developmental disability interventions have undergone a shift in the last 30 years from an institutional model to a community model. Deinstitutionalization of people with developmental disabilities has led to smaller, community-based living arrangements. In addition, consumer choice is now a key concept in intervention. New intervention techniques put the consumer in the role of central decision-maker determining what supports are needed and who will provide them. Despite this shift, there is a lack of research that examines the outcomes of these intervention concepts. It is widely believed that greater choice and smaller living arrangements improve the quality of life, yet empirical validation of this idea remains limited. This study examines whether choice and living arrangement have an influence on three quality of life indicators: rights, community inclusion, and opportunities for relationships.

Methods

Secondary data analysis of Washington State's 2002 National Core Indicators (NCI) consumer survey was conducted. The sample consisted of 220 adults who received developmental disability services and were able to respond to the survey instrument. The measures included residence, services used, choice (in services and daily living), rights (to privacy and self-advocacy opportunities), community inclusion, and opportunities for interpersonal relationships. Two structural equation models were constructed and tested using MPLUS 3.0. Model one assessed the influence of choice and living arrangement on the three measured indicators: rights, community inclusion, and opportunities for relationships. Model two assessed the influence of choice and living arrangement on a latent quality of life construct.

Results

In model one, significant paths were present from living arrangement to all three quality of life indicators: rights (-.33), community inclusion (-.16), and relationships (-.20). However, the only significant path from choice was to rights (.19). The model explained sixteen percent of the variance in rights, eight percent for community inclusion, and four percent for relationships. The model had a good fit (Χ²=78.92 (45), CFI=.95, RMSEA=.059, SRMR=.060). In model two, both living arrangement (-.48) and choice (.25) were significantly associated with quality of life. The model explained thirty percent of the variance in the latent quality of life variable (R²=.30) and had good fit indices (Χ²=80.36 (49), CFI=.95, RMSEA=.054, SRMR=.060).

Implications

The results of this study provide evidence for the hypothesized relationships between choice, living arrangement, and quality of life for people with developmental disabilities. First, the finding that living arrangement was strongly correlated to quality of life supports the trend in developmental disability intervention towards small group or individualized living arrangements. Second, the finding of a relationship between choice and rights supports the use of developmental disability interventions that seek to increase consumer choice. Third, the finding that all quality of life indicators loaded on to one factor supports the idea of a latent quality of life construct. The results suggest that social workers and professionals from other disciplines can influence quality of life by enhancing client choice and advocating for community-based living arrangements. Taken together, these results inform future directions in practice, policy, and research in work with an often neglected population.