Association of state-level and individual-level factors with choice making of individuals with intellectual and developmental disabilities.
A client’s state cost of living predicts how much choice they experience as strongly as their IQ or speech.
01Research in Context
What this study did
Houseworth et al. (2018) looked at how much choice adults with intellectual or developmental disabilities get in everyday life.
They used a big U.S. data set that mixes each person’s traits with facts about the state they live in.
The team asked: do things like state cost of living or how many people live on their own predict choice scores as strongly as IQ or talking ability?
What they found
People with milder ID, speech, and their own apartments scored higher on the choice scale.
Yet state facts mattered just as much: living where rents are high or where few people live independently pulled scores down.
In short, zip code and ability level shared the steering wheel.
How this fits with other research
Kleinert et al. (2007) first showed that adults with ID who get more daily choices feel more self-determined; James adds that those chances are shaped by state policy, not just staff style.
Hall et al. (2005) found IQ helps little once real money choices are given; James widens this idea by showing state cost of living can block those same real-life chances.
Cooper et al. (2011) saw neighborhood poverty hurt service access; James flips the lens to show state dollars also shrink everyday choices, linking empty wallets to empty options.
Why it matters
You can’t fix low choice by targeting only client skills. Push for agency policy that funds supported living in high-rent areas and track state-level housing data. One quick move: add “cost of living” to your advocacy slides this week.
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02At a glance
03Original abstract
BACKGROUND: State-level factors have not been examined in research on choice, despite findings of between-state differences. AIMS: To examine both individual and state-level factors associated with choice. METHODS AND PROCEDURES: We used multilevel modeling to explore two choice scales, support-related and everyday choice, based on the National Core Indicators (NCI) data from 2013-14. OUTCOMES AND RESULTS: At the individual level, milder ID, greater mobility, fewer problem behaviors, answering questions independently, communicating verbally, and living in a non-agency setting, particularly independent settings, were associated with more choice for both scales. State-level factors overall explained variance for both scales, but were more strongly associated with support-related choice. A higher proportion of people with IDD living independently within the state predicted more support-related choice. High cost of living within a state predicted less everyday choice. Higher proportion of people living with family and lower proportion being served within a state predicted more everyday choice. CONCLUSIONS AND IMPLICATIONS: These findings suggest further study of choice in relation to policies that: (1) increase independent living for individuals with IDD, and (2) assist individuals/families living in high cost states. State differences on important QOL outcomes are likely to be associated with economic and system-based factorsbeyond individual differences.
Research in developmental disabilities, 2018 · doi:10.1016/j.ridd.2018.08.008