Correlates of everyday choice and support-related choice for 8,892 randomly sampled adults with intellectual and developmental disabilities in 19 states.
Smaller or individual residential placements—and the state you live in—strongly predict how much everyday and support-related choice adults with IDD actually get.
01Research in Context
What this study did
The team pulled a random sample of almost 9,000 adults with intellectual or developmental disabilities from 19 US states. They looked at two kinds of choice: everyday choices like what to eat or wear, and support choices like picking a staff person or setting a schedule.
They compared people living in three places: large state institutions, small agency homes, and their own homes. They also checked if the state you live in changes how much choice you get.
What they found
Adults in their own homes or small agency homes got far more everyday and support choices than those stuck in big institutions. The state mattered too; some states gave more choice no matter where the person lived.
Size of the home was the strongest predictor. Smaller settings meant more voice in daily life.
How this fits with other research
Ferreri et al. (2011) asked the same adults a year earlier and found most had zero say in where they live. Renáta et al. now show that once housed, the setting size keeps shaping daily choices.
Mount et al. (2011) looked at Europeans and found smaller settings also bring higher health risks like obesity. Together the papers say: choice goes up in small homes, but health monitoring must go up too.
Leung et al. (2014) tracked moves for 20 years and found people who start in individualized placements move less later. The new data explain why: more choice early creates a stable, preferred life.
Why it matters
If you write ISP goals or place adults, fight for individual or small agency homes. Large institutions cut choice even when state rules look equal. Pair the placement with a plan that guards health and builds daytime activities so the gain in choice does not slip away.
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02At a glance
03Original abstract
This article examines everyday choices made by 8,892 adults with intellectual and developmental disabilities (IDD) and support-related choices made by 6,179 adults with IDD receiving services from 19 state developmental disabilities program agencies that participated in the 2008-2009 National Core Indicators Project. Controlling for physical and sensory impairment, age, behavioral support, communication, and state, people in residential settings with 16 or more people had less everyday choice than those in other living arrangements. People with mild and moderate IDD had more control over everyday choices when living in their own homes, whereas people with severe and profound IDD had more control when living in agency homes of 3 or fewer residents. For people of all levels of IDD, institutional settings of 16 or more residents offered the lowest levels of everyday choice. Controlling for the same covariates, individuals with all levels of IDD living in their own homes had significantly more support-related choices than those in any other residential arrangement. Controlling for individual and residential setting characteristics, the state in which sample members lived was notably predictive of support-related choice. Overall, the tested variables accounted for 44% of the variability in everyday choice and 31% in support-related choice.
Intellectual and developmental disabilities, 2012 · doi:10.1352/1934-9556-50.06.486