Search results

The purpose of this paper is to examine the early stages of change and the way that stories can open up forms of collaborative dialogue and creative thinking among divergent stakeholders on known but “intractable” problems by enabling multiple voices to be heard in the co-construction of future possibilities for change. The empirical focus is on a project undertaken by two organizations located in Australia. The organizations – AAC, a large aged care provider and Southern Disability Services, a disability support service – collaborated with the researchers in identifying and re-characterizing the nature of the problem in the process of storying new pathways for tackling the transitioning needs of people with intellectual disabilities into aged care services.

An action research approach was used in conducting interviews in the case organizations to ascertain the key dimensions of the presenting problem and to identify change options, this was followed by an ethnographic study of a Pilot Project used to trial the provision of disability day service programmes within an aged care setting.

A key finding of the study centres on the importance of stories at the early stages of change in widening the arena of innovative opportunities, in facilitating collective acceptance of new ideas and in initiating action to resolve problems. The paper demonstrates how stories are used not only in retrospective sensemaking of existing problems but also in giving prospective sense to the possibilities for resolving protracted problems through innovative solutions that in turn facilitates a level of collective acceptance and commitment to opening up new pathways for change.

The paper focuses on problem characterization during the early stages of change and bring to the fore the often hidden notion of time in utilizing concepts from a range of literatures in examining temporality, stories and sensemaking in a context in which future possibilities are made sense of in the present through restorying experiences and events from the past. On a practical and policy front, the paper demonstrates the power of stories to mobilize commitment and action and presents material for rethinking change possibilities in the delivery of aged and disability care.

Barbara M. Altman, a Sociologist with a Ph.D. from the University of Maryland, is currently a Special Assistant on Disability Statistics at the National Center for Health Statistics and an Adjunct Associate Professor at the University of Maryland, College Park. Her previous position was Senior Research Fellow with the Agency for Healthcare Research and Quality. She is a past president of the Society for Disability Studies and served on the founding Board of Directors of that organization. Her disability research interests focus in three areas: operationalization of disability definitions/measures in survey data; access to, financing and utilization of health care services by persons with disabilities, particularly working age persons and women with disabilities; and disability among minority groups. She is the author of a number of articles and book chapters on disability topics, and has served as editor of special issues of Disability Studies Quarterly and Journal of Disability Policy Studies. She is co-editor of this series Research in Social Science and Disability.Deborah J. Anderson, Ph.D., has conducted policy research in the area of Aging and Developmental Disabilities at the University of Minnesota since 1985. Her studies have included analyses of the health status, health conditions and health-related limitations and needs of older adults with mental retardation living in a variety of residential settings as well as in their own homes. These studies have included a longitudinal study of a 10% sample of older adults living in residential facilities licensed by developmental disabilities agencies, the National Nursing Home Survey of 1985, the National Medical Expenditure Survey of 1987, and the National Health Interview Disability Supplement (NHIS-D) of 1994–1995. She has also studied careproviders of older adults with mental retardation, innovative programs serving aging adults with developmental disabilities/mental retardation, and state agencies’ preparation for serving adults with mental retardation as they aged. Most of this research has been conducted as part of the NIDRR-funded RRTC on Aging and Developmental Disabilities. Dr. Anderson is also an Associate Professor in the Department of Psychology at St. Olaf College in Northfield, MN.Lynda L. Anderson, M.A., M.P.H., is a Resource Manager at No Place like Home in Robbinsdale, Minnesota. Ms. Anderson earned a Master of Arts degree in Human Service Administration and a Master of Public Health degree in Community Health. Ms. Anderson is a doctoral candidate in Work, Community and Family Education at the University of Minnesota. She has more than eighteen years of experience working with people with disabilities as a Direct Support Professional, Program Director, and Researcher. She has participated in NHIS-D analysis activities for the last five years.Sharon N. Barnartt, Ph.D., is Professor of Sociology at Gallaudet University. She has co-authored two books: Deaf President Now: The 1988 Revolution at Gallaudet University (1995) and Contentious Politics in the Disability and Deaf Communities (2001). She has also presented papers and published widely in the areas of socio-economic status and disability/deafness, legal and disability policy issues, and social movements in the deaf and disability communities. She is a former president of the Society for Disability Studies, co-editor of Research in Social Science and Disability and on the editorial board of Journal of Disability Policy Studies.Phillip W. Beatty, M.A., is a Senior Research Associate at the National Rehabilitation Hospital Center for Health & Disability Research in Washington, DC. His recent research focuses on predictors of access to health services among adults with disabilities. Mr. Beatty is also conducting research to determine the ways in which functional outcomes information is being used by stakeholders in the medical rehabilitation industry.Edward Brann, M.D., M.P.H., is Acting Director of the Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. The division conducts a number of research and program activities for people with disabilities.Hong Chen, M.S., is an Economist in RTI International’s Division of Health Economics Research. His work focuses primarily on the analysis of large claims and survey databases, with an emphasis on diabetes prevention, substance abuse, and competitive bidding for durable medical equipment.Lisa J. Colpe, Ph.D., M.P.H., is a Clinical Epidemiologist Specializing in Survey Design and Research. At the time the work on this chapter was done, she was an Epidemiology Training Program Fellow in the Division of Health Interview Statistics, National Center for Health Statistics.Roger B. Davis, Sc.D., is Associate Professor of Medicine at Harvard Medical School and Associate Professor of Biostatistics at the Harvard School of Public Health. Dr. Davis has overseen the statistical design of numerous clinical trials, especially involving cancer and AIDS therapies. An expert in survival analysis, he also participates in health services research and clinical epidemiology studies with colleagues at Beth Israel Deaconess Medical Center, where he serves as Biostatistician in the Division of General Medicine and Primary Care.John Drabek, is an Economist in Office of Disability, Aging, and Long-Term Care Policy in the U.S. Department of Health and Human Services. He received his B.A. in Economics from Northwestern University, and his Ph.D. in Economics from the University of California, Santa Barbara. Prior to joining the federal government, he performed research at the University of Southern California, and at the University of California, Los Angeles.Laura J. Dunlap, M.A., is a Health Economist in RTI International’s Center for Interdisciplinary Substance Abuse Research. Since joining RTI in 1994, she has worked on studies analyzing the costs and benefits of substance abuse treatment, the effect of treatment services on post-treatment outcomes, and the costs and cost-effectiveness of public health and treatment interventions aimed at special populations such as drug users and low-income women.Holly J. Fedeyko is a former employee of the Disability and Health Branch, CDC in Atlanta, Georgia. While at the CDC she focused her efforts on Research in disability issues as related to questions from the National Health Interview Survey. She received her M.P.H. in Epidemiology and Environmental Health from Emory and her B.S. in Biology from McGill. She is currently employed as an analytical consultant for a private company and now resides in the San Francisco Bay area.Frances K. Goldscheider, University Professor and Professor of Sociology, began her Brown career in 1974. Since obtaining her Ph.D. in Demography from the University of Pennsylvania in 1971, Goldscheider has focused her research on census and survey data to address questions related to family structure and coresidential relationships, examining causes and consequences of change. Goldscheider pioneered research on the single-person household, and on home leaving and return to the nest of young adults, and has examined issues of labor force and family decisions of 20th century American women. She is an expert on family structure and relationships, fertility, parenthood, household economy, and marriage. Her intergenerational focus (on the living arrangements of young adults and the elderly) has expanded to include gender issues, particularly marriage and divorce, with a strong concern with the consequences of family structure for investments in childhood and young adulthood. Recent research interests include men’s roles in parenting and in the family.Scott D. Grosse, Ph.D., is a Health Economist at the National Center for Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. He conducts applied research on the costs associated with various childhood conditions and economic evaluations of screening programs and interventions intended to improve health and developmental outcomes in children.Gerry E. Hendershot, Ph.D., is a Consultant on Disability and Health Statistics. From 1985 to 2001, he held various positions on the staff of the National Health Interview Survey, including Assistant to the Director for Data Analysis and Dissemination. He had a lead role in promoting, designing, and analyzing the National Health Interview Survey on Disability. He is the author of many published statistical reports on disability and other health-related topics.Dennis P. Hogan, Professor of Sociology, joined the Population Studies and Training Center at Brown University in 1995. He received a Ph.D. in Sociology from the University of Wisconsin-Madison in 1976. He has taught at both the University of Chicago, where he acted as associate director of the Population Research Center, and Pennsylvania State University, where he served as director of the Population Research Institute. In 1997, Hogan was named to an endowed professorship as the Robert E. Turner Distinguished Professor of Population Studies. Some of his research interests include the interrelationships of the family lives of individuals and their social environments, the measurement of disability, family consequences of disability, and the transition to adulthood. Hogan’s current research focuses on child disability. He is the principal investigator on grants supporting this program from the National Institute for Child Health and Human Development, the National Center for Medical Rehabilitation Research, the Assistant Secretary for Planning and Evaluation, the Federal Interagency Forum on Child and Family Statistics Subcommittee on Disability and the Spencer Foundation.Ghada al Homsi, M.S., is an Economist in RTI International’s Center for Interdisciplinary Substance Abuse Research. Her work focuses on the analysis of large surveys and the design and maintenance of databases of program costs.Amanda A. Honeycutt, Ph.D., is an Economist in RTI International’s Division of Health Economics Research. Since joining RTI in 1998, she has led a number of studies on the cost-of-illness, the cost of intervention programs, and the cost-effectiveness of prevention and treatment interventions that focus primarily on diabetes, HIV/AIDS prevention, and children’s health, disability, and development.Peter C. Hunt, M.P.H., was an Association of Schools of Public Health Fellow in the Division of Health Interview Statistics, National Center for Health Statistics, at the time work on this chapter was done. He subsequently served as a Special Assistant to the Director of the National Institute of Disability and Rehabilitation Research. He is currently a Research Associate at the University of Pittsburgh Model Center on Spinal Cord Injury.Lisa I. Iezzoni, M.D., M.Sc., is Professor of Medicine at Harvard Medical School and Co-Director of Research in the Division of General Medicine and Primary Care, Department of Medicine, at Beth Israel Deaconess Medical Center in Boston. Her primary research interest is risk adjustment for assessing health care quality and improving the fairness of payments. A 1996 recipient of The Robert Wood Johnson Foundation Investigator Award in Health Policy Research, she also studies health policy issues relating to mobility impairments. Dr. Iezzoni is a member of the Institute of Medicine.Gwyn C. Jones, Ph.D., M.S.W., M.Ed., is a Senior Research Associate at the National Rehabilitation Hospital Center for Health & Disability Research in Washington, DC. She is a former ATPM/CDC Fellow and current grantee. Her research and publications have focused on health risks, chronic conditions, and use of preventive services among working-age adults with disabilities, prescription drug use among non-elderly adults with disabilities, and rural Medicaid managed care for adults with disabilities.Judith D. Kasper, Ph.D., is a Professor in the Department of Health Policy and Management, and a Senior Research Associate in the Center for Health Services Research, at The Johns Hopkins Bloomberg School of Public Health. Her research interests include health policy in long-term care, aging and disability, access to health care for vulnerable populations, and the development and application of data sources for health policy and health services research. Dr. Kasper holds a Ph.D. in sociology from the University of Chicago.K. Charlie Lakin, Ph.D., is the Director of the Research and Training Center on Community Living at the University of Minnesota. Mr. Lakin has had extensive experience in gathering, analyzing, and using statistics from many primary and secondary data sources with the products of this work included in more than 200 publications in developmental disabilities and related services. Mr. Lakin was a member of the six-person external technical advisory panel on the instrumentation for the Disability Supplement. Mr. Lakin serves as Associate Editor of Mental Retardation, and consulting editor of The Journal of the Association for Persons with Severe Handicaps (JASH), the Journal on Intellectual and Developmental Disability and Social Science and Disability.Sheryl A. Larson, Ph.D., is a Research Associate at the Research and Training Center on Community Living at the University of Minnesota. She earned her Ph.D. in Educational Psychology from the University of Minnesota. She has 20 years of experience in services to persons with DD as a residential counselor, behavior analyst, social worker, and program evaluator and has worked for the RTC for the last 14 years. Ms. Larson was the Co-Principal Investigator for a two-year NIDRR Field Initiated Project which used the National Health Interview Survey Disability Supplement to examine the characteristics and service needs of persons with intellectual or developmental disabilities. She directed a supplement to the Research and Training Center on Community Living’s core grant that funded an international user’s conference in June 2000 for researchers analyzing NHIS-D topics. She has co-authored several papers using NHIS-D data. Dr. Larson has also co-authored several books, book chapters, journal articles and technical reports on workforce development issues, residential services, and community integration for persons with developmental disabilities and is a consulting editor of Mental Retardation.Donald J. Lollar, Ed.D., Senior Research Scientist, Division for Human Development and Disability, National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention in Atlanta. His advanced degrees are from Indiana University, and his most recent writings include co-editing an Archives of Physical Medicine and Rehabilitation supplement on the Science of Disability Outcomes, and articles for the 2003 Annual Review of Public Health and 2002 Public Health Reports outlining public health strategies to improve the health and well-being of people with disabilities. He has spent the past seven years developing public health science and programs to improve the health of people with disabilities, prevent secondary conditions, and increase participation in society. He currently serves as the co-lead of the Healthy People 2010 workgroup on Disability and Secondary Conditions (Chap. 6 of HP 2010). Dr. Lollar began involvement with the WHO classification ICIDH in 1994 while still in private practice, assessing potential utility of ICIDH-2 for clinical records. He is currently a part of the team to adapt the ICF to improve its utility for children and youth.Pamela Loprest is a Labor Economist and Senior Research Associate at the Urban Institute. Her research focuses on low-wage labor markets and how government policies can help to reduce and remove barriers to work among disadvantaged populations. Dr. Loprest has a Ph.D. in Economics from the Massachusetts Institute of Technology and has been at the Urban Institute since 1991.Elaine Maag is a Research Associate in the Urban Institute’s Income and Benefits Policy Center. Her research focuses on policies affecting youth with disabilities and employment opportunities for adults. She also conducts research on how tax policy affects low-income families. Ms. Maag holds an M.S. in Public Policy from the University of Rochester.Jennifer M. Park is a Post-Doctoral Fellow at the Harvard Graduate School of Education. Her current research is funded by a grant she holds from the American Education Research Association to examine cognitive development among first grade youth with and without emotional impairment. Her dissertation explored cognitive growth among kindergarteners with and without perceptual impairment. Dr. Park holds a Ph.D. in Sociology from Brown University, where her research examined the diverse effects of child disability on family outcomes.Elizabeth K. Rasch, M.S., P.T., is an Associate Service Fellow at the National Center for Health Statistics, CDC, working in the area of disability statistics. She is a Ph.D. candidate at the University of Maryland, Department of Physical Therapy and Rehabilitation Science, with a concentration in Epidemiology. Her research interests include the health of persons with disabilities, factors that contribute to disability, as well as the use of and access to healthcare services by persons with disabilities. She has been actively involved in research since 1985 and has published articles and book chapters on topics related to disability and rehabilitation.Anne W. Riley, is an Associate Professor in the Department of Health Policy and Management, in the division of Health Services Research, at the Johns Hopkins Bloomberg School of Public Health. Dr. Riley has expertise in the assessment of mental health and health, especially of children and adolescents, methods development, and evaluation systems for monitoring the outcomes of care for youth.Diana E. Schendel, Ph.D., is a Lead Health Scientist at the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. She directs both intramural and extramural epidemiologic studies of reproductive and developmental outcomes, with a primary focus on cerebral palsy, autism, and other neurodevelopmental problems.Hilary Siebens, M.D., is Lecturer in the Department of Physical Medicine and Rehabilitation (PMR) at Harvard Medical School and Associate Director, PMR Service, at the Massachusetts General Hospital. She received clinical training in internal medicine, geriatrics, and PMR. Her publications address exercise among older adults, models of rehabilitation, and quality improvement initiatives.Lois M. Verbrugge, Ph.D., M.P.H., is Distinguished Senior Research Scientist in the Institute of Gerontology at the University of Michigan. She has contributed to disability theory and has conducted analyses of arthritis disability, gender differences in morbidity and mortality, and co-morbidity, using large-scale data sets. Her recent publications have emphasized the relative benefits of equipment and personal assistance for disability, the interleaving of aging and disability, and global indicators of disability. She was awarded the American Psychological Association Distinguished Contribution to Women’s Health Award in 1994.Whitney P. Witt, Ph.D., M.P.H., is an Assistant Professor of Medicine in the Division of General Internal Medicine and Center for Healthcare Studies at the Northwestern University, Feinberg School of Medicine. Dr. Witt’s prior work focuses predominately on people living with HIV/AIDS, including children and their families. Over the last five years, she has applied her experience in advocacy, policy, and research on vulnerable and high-cost, chronically ill populations to the field of maternal and child health services research. Dr. Witt’s research emphasizes the importance of family adaptation in ensuring the mental health of children with disabilities and for helping these children obtain access to mental health services. Most recently, her work has focused on the impact of maternal depression on familial health and mental health, preventive care practices, and use of health and mental healthcare services. She holds a Ph.D. in health services research and a M.P.H. from the Johns Hopkins Bloomberg School of Public Health and a B.A. in women’s studies and law from Hampshire College.Li-shou Yang, Ph.D., is Research Investigator in the Institute for Social Research at the University of Michigan. Trained in social demography, her research focuses on the family, the life course, and social change.

The National Disability Insurance Scheme (NDIS) is a new program for the provision of support to people with disabilities in Australia. The purpose of this paper is to explore the early implementation experience of this scheme, with a particular focus on the implications of this scheme for issues of care integration.

Semi-structured interviews were conducted with 26 policymakers in the Commonwealth government charged with the design and implementation of the NDIS.

The authors find somewhat of a lack of clarity concerning the boundaries of the NDIS and how it will work with a range of different services in the provision of seamless and consumer-directed care. Many of the same kinds of debates about interfaces with services were detected in this study as have been highlighted in relation to UK individual funding schemes. If the NDIS is truly to support individuals with disabilities to achieve choice and control, important work will need to be undertaken in to overcome organizational and institutional boundaries.

There is little empirical data relating to the implementation of the NDIS to date. This is the first study to explore boundary issues in relation to care integration.

According to The Ethics Centre (2018) ‘[T]he social license to operate (SLO) is made up of three components: legitimacy, credibility, and trust’. These three components serve to frame the relationship that has emerged and continues to evolve, its root arguably dating back to the Enlightenment and Post-industrial ages, between the worlds of capitalist commercial and industrial operations, and the liberal-democratic citizenry/consumers of society. The ‘SLO’, it will be shown, has historical grounding that indicate the SLO is a broader translatable concept not limited to the business realm. The SLO, the evidence will show, is a multifaceted concept not least, a unifying vehicle utilized for the purpose of acceptance, to advance normative concerns, and resistance, against questionable and harmful practices. Evidently, many domains of human services operate sub-optimally with less than favourable outcomes. In effect, this translates to structural injustices as characterized by poor understanding, insufficient standards of practice, ineffective safeguard, and governance institutions, perpetuated by entrenched practices, allowing the rise of mediocre service providers no less enabled by deficient regulation. Accordingly, the ethical focus of this paper is on the healthcare system, the evident and unnecessary deficiencies, and the failings of the central governance institutions involved. The underlying characteristics of what constitutes a SLO arguably, whether in name or not, have been engaged to expose, challenge, and repel, unethical conduct that gave rise to multiple health care-related Royal Commissions across Australia; predominantly, impacting the Disability, Aged Care, and Mental Health (DAM) sectors to name a few of recent times.

In the International Classification of Functioning, Disability and Health (ICF) 2001, the World Health Organization (WHO) defines disability as: ‘an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors)’, with environmental factors including assistance from other people, from equipment and from formal sources. WHO previously defined disability, in the context of health experience, as “any restriction or lack (resulting from impairment) of ability to perform an action in the manner or within the range considered normal for a human being” (World Health Organization, 1980, p. 28).

The purpose of this paper is to explore the potential value of applying spatial science and technology to the issue of care integration across what are the often fragmented domains of health and social care provision. The issue of focus for this purpose is population ageing because it challenges existing information and practice silos. Better integration, the author proposes, needs to adopt a geographic approach to deal with the challenges that population ageing present to health and social care as they currently function in many countries.

The approach utilised here explores the role that could be played by enhancing spatial perspectives in care integration. Spatial and temporal strategies need to be coordinated to produce systems of integrated care that are needed to meet the needs of growing numbers of older people.

The author’s premise is that, with some rare exceptions, geographies of care are needed to address important shifts in demography such as population ageing and their epidemiological consequences. The rising intersection between the ageing and disability concepts illustrates how the fluid nature of health and social care client groups will challenge existing systems and their presuppositions. Health and medical geography offer a theoretical and practical response to some of these emerging problems.

This is a brief conceptual piece in favour of integrating geographic concepts and methods in the context of changing demography and the social, economic and service implications of such changes. It is limited in scope and a more detailed explanation would be required for a proof of concept.

Practically we know that all human services vary across space as do both healthcare and related social services and supports. Issues of quality and safety are numerous in these policy domains generally, with aged care evidencing a growing number of problems and challenges. Being able to inquire on significant challenges in health and social care through a spatial lens has the potential to provide another, highly practical, kind of evidence in this field of work. This lens is, the author contends, very poorly integrated into either health or social care at present. However, doing so would have a variety of useful outcomes for monitoring and intervening on real problems in care integration. An example could be “frequent flyers” in emergency departments as has been done in Camden, New Jersey through patient mapping.

The author’s position in this paper is that the challenges we face in providing integrated care to ageing and increasingly disabled (including both physical and cognitive impairments) populations will only grow in the face of variable governmental responses and increasingly complex funding and service provider arrangements. Without a geographical perspective and the concepts and tools of spatial science the author does not see an adequate response emerging. The shift to community-based care for many groups, including the aged, means that location will become more important rather than less so. This is a societal concern of major proportions and the very concept of integrated care requires of us a geographical perspective.

This is a short but, the author believes, conceptually rich piece with a variety of potential practical implications for health and social care service provision. Issues of equity, quality, safety and even basic access can only grow as population ageing progresses and various forms of chronic disease and disability continue to grow. Knowing where the most affected people and their social and service connections are located will support better integration. And better integration may resolve some of the financial and related resource problems that are already evident but which can only continue to increase. In this context, the author suggests that the integrated care of the future needs to be geographically informed to be effective.

While ageing with an intellectual (learning) disability has been subject to increased research in recent years, there remains little knowledge regarding the daily practice issues that disability workers struggle most to support in this cohort. The purpose of this paper is to gain feedback directly from staff regarding the problems they experience in daily work, and to evaluate whether any changes to legislation or practice could potentially alleviate identified areas of concern.

A Delphi project was conducted over three rounds with participants from rural areas of New South Wales (NSW). The panel was composed of support workers who assist people ageing with a learning disability. Participants were asked their perceptions of the main practice issues facing them while they provide support.

The panel identified 29 issues that were considered problematic in the provision of support to people ageing with a learning disability. A thematic analysis indicated three main themes of access to services; time constraints; and funding.

The participants in this study were all disability workers employed by non-government organisations in rural NSW, and as such, many of the issues identified may be specific to this population cohort and geographic setting. Any generalisation of these results to other locations or populations must be considered within these limitations.

Identification of the issues facing disability staff may facilitate government, health care providers and disability organisations to proactively plan to address current and future problem areas. The consequent effect of improving practices can assist individuals to receive better support and lead to a corresponding improvement in their quality of life. The current implementation of the National Disability Insurance Scheme in Australia is an ideal opportunity for cross-sectoral collaboration to change practice to facilitate better support for a highly vulnerable group of the community.

People with intellectual disability are reported to encounter many negative life events during their increasingly long lives. In the absence of protective elements, these may cause toxic stress and trauma. Given the reported negative effects of such adverse events on their quality of life (QoL), the perspective of older people with intellectual disability themselves may be of relevance. The paper aims to discuss these issues.

The authors questioned nine participants with mild intellectual disability, aged 61–88 years old, in four 90-min focus group sessions and thematically analysed the data.

Many recent and bygone negative life events still weighed heavily on the participants. Negative interactions, experiences of loss, lack of control and awareness of one’s disability caused stress. Their emotional response contrasted with their contentment, compliance and resilience. Having (had) good relationships, having learnt coping skills, remaining active, talking about past experiences and feeling free of pain, safe, well supported, capable, respected and involved seemed to heighten resilience and protect participants from toxic stress.

Monitoring and preventing adverse (childhood) experiences, supporting active/emotional coping strategies, psychotherapy and life story work may facilitate coping with negative events and enhance QoL of elderly people with intellectual disability.

Elderly people with mild intellectual disability run a higher risk of experiencing (early) adverse events in life. They are very capable of talking about their experiences, QoL, and the support they need. Focus groups were a reliable method to capture their insights.

The purpose of this paper is to examine the relationship between aged care employees’ perceived job quality and intention to stay in current aged care facilities, mediated by work-life interference.

This paper uses the nationally representative employee–employer matched data from the 2012 National Aged Care Workforce Census and Survey in Australia. It applies the theoretical lens of the Job Characteristics Model and a mediation analytical model that controls for a rich set of employee, employer and regional characteristics.

This paper finds that higher perceived job quality positively correlates with greater intention to stay and that work-life interference mediates the relationship between perceived job quality and intention to stay.

This paper cannot make inference about causal relationship. Future studies on the aged care workforce should collect longitudinal data so that time-invariant unobservables can be eliminated in econometric modelling.

Efforts by the aged care sector to design quality jobs are likely to have significant positive correlation with the intention to stay, not only because employees are less likely to leave higher quality jobs per se, but also because higher quality jobs interfere less in the family lives of aged care workers, which itself is associated with greater intention to stay.

The results add to a small literature that has investigated how work-family variables can mediate between interventions that organisations put in place to improve work-life balance, and employee outcomes.

The contributions of qualitative research to the study of behavioral–emotional disabilities, mild intellectual disabilities, and learning disabilities (the three types of high-incidence disabilities) are relatively recent and far from abundant. This chapter discusses qualitative, or “naturalistic” research by briefly examining the methodology used in such inquiry, reviewing many of the available studies concerning those with high-incidence disabilities, and providing implications from the existing empirical literature. It is not recommended that qualitative research takes the place of quantitative research in special education, but well-designed and executed naturalistic studies can contribute additional knowledge that is worthwhile to the field.