THE CLIENT STATUS OF MINNESOTA DEVELOPMENTAL ACHIEVEMENT CENTERS: 1980-1982
Contents
I. Introduction
II. Methodology
III. Results
Characteristics of Client Population
Age
Level of Functioning
Place of Residence
Client Movement
New Admissions
Readmission
Transfers
Deaths
Clients Ready for Work Placement
Waiting Lists
IV. Implications
V. References
VI. Appendix
I. INTRODUCTION
The issues creating the impetus for this statewide study of developmental achievement centers (DACS) are the same issues that generated similar reports for the past several years.
These issues are cost, purpose, and characteristics about the agencies and clients served.
Similar to previous studies, there is a pressing need for information since the combined federal, state, and local cutbacks have an effect on community-based programs such as DACS. In addition, the Community Social Services Act (CSSA) went into effect on January 1, 1980, thus terminating the existing Department of Public Welfare data base developed for DACS. The potential Use of Title XIX as one funding mechanism for DACS has created an intensified demand for information about clients, personnel, and services. This policy analysis paper is the third of three issues to present the results of a statewide study of all DACS in Minnesota. The first paper (Policy Analysis Series No. 6) focused on the financial status of DAC programs, the second report (Policy Analysis Series No. 7) presented information on program and personnel.
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A Department of Public Welfare report completed in 1978 provides historical information about DACS. Highlights from that report are presented as follows:
- Prior to 1961, few DACS existed in Minnesota (p. 22).
- In 1961, the Minnesota Legislature acted upon recommendations of the Interim Commission on the Problems of the Mentally Retarded, Handicapped and Gifted Children and funded a pilot project to develop nine DACS Extra Sessions Law of Minnesota for 1961, Chapter 93. ] (p. 22).
- In 1963, the Legislature appropriated funds for 14 additional centers under the Daytime Activity Center Act [Chapter 830 of the Session Law.] (p. 23).
- Title IVA and Title XX provided federal support to the state with minimal financial commitment of counties (p. 23).
- The Trainable Mentally Retarded Act of 1971 made the State Department of Education responsible for all school age children, who could reasonably expect to benefit socially, emotionally, or physically from their service. DACS shift focus to serving only preschoolers and adults (p. 23).
- In 1975, the Minnesota Legislature provided a special appropriation to pay for 100 percent of approved costs for transportation of DAC clients to and from DACS (p. 23).
- in 1976, Assistant Commissioner Mike Weber requested a study of DACS including characteristics of the population, movement of clients, administrative standards and practices as well as unmet needs (p. 24).
- In 1976, an internal DPW working paper Policy Alternatives for Daytime Activity Centers highlighted major problems including the "absence of a clear goal for DACS as well as inadequate definitions of services, lack of information on clients being served, impact of services and measures of program effectiveness" (p. 3).
- In 1977, the DAC Evaluation Project was funded to develop an instrument to evaluate DACS (p. 24).
- In 1978, DPW completed a comprehensive study of 104 DACS serving 4,221 participants at a total cost of $15 mill ion (p. 34).
A review of the literature on day program services revealed little information. National surveys of activity programs were undertaken in 1963, 1971, and 1979 (Cortazza, 1972; and Bellamy, Sheehan, Homer, & Boles, 1980). In 1963, there were 94 programs identified nationwide. By 1971, the number increased by 612 programs and tripled by 1979 to an estimated 1,989. The primary purpose of activity centers in 1971 was described by Cortazza (1972) as:
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The severely mentally retarded have a potential and are entitled as human beings in our society to have their potential developed to capacity. It is the responsibility of society to develop and make maximum use of their potential (p. 9).
The rapid deinstitutionalization during the 1970s as well as funding changes cited by Bellamy et al (?980) "drastically altered the scope, economics and role of ADPs." The 1980 report continued:
Today these programs represent a significant element of each state's adult service planning and have become critical in efforts to disperse residents of public institutions into community programs. Adaptive day programs frequently are viewed as providing the initial services for newly deinstitutionalized individuals [DHEW Report on Deinstitutionalization, 1978], and placement of individuals out of institutions frequently is contingent on availability of space in adaptive day programs (p. 309).
The summary of the Bellamy et al report was to call for greater coordination of policies and the development of practical service models that include greater opportunities for work and vocational outcomes (p. 321). Other literature on day programs includes technological
applications for severely retarded adults (Bellamy, Homer, and Inman, 1979), guidebooks
for establishing activity centers (Bergman, 1976), and specific training operations within centers (Salmon, 1975; Wehman, 1976; and DeMars, 1975).
The purpose of the current study of developmental achievement centers is to assess the financial, programmatic, and client status during 1980, 1981, and 1982. A three-year time period was selected because little information existed at a statewide level since January 1, 1980. The study was conducted as a joint effort of the Department of Public Welfare, the Minnesota Developmental Achievement Center Association, and the Minnesota Developmental Disabilities Program.
II. METHODOLOGY
The methodology for this study will be presented in abbreviated fashion. According to DPW, there were 108 DACS listed as licensed facilities. One facility is a satellite of the Glacial Ridge Training Center of Willmar State Hospital, one other facility receives no public money and refused to participate. None of the State Hospital DACS were included in the DPW list nor were they included in this study. Information about satellite DAC programs was collected from the respective central administrative offices. In order to get
100% participation, mail and telephone surveys were discarded in favor of on-site
interviews. Interview studies typically yield a higher response rate, greater accuracy, and higher reliability than other methods. All 106 DACS participated in the study.
The general areas of investigation were outlined in a working document prepared
by DPW and MNDACA. A joint meeting of representatives from DPW, DD,
and MNDACA was held on September 1, 1981, to discuss the purpose, method,
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timeline, procedures, and questionnaire areas. Suggested questions were generated
at that meeting. The Developmental Disabilities Program drafted the questionnaires with assistance from DPW staff. On September 11, 1981, the MNDACA Board of Directors gave its approval to the study. Revisions were made until September 15, when a briefing was held with three interviewers from DPW and five interviewers from DO. On September 29, 1981, interview materials were distributed to all the surveyors.
An interview packet contained:
1. an interviewer manual which outlined the purpose, selection of respondents, data
privacy, question-by-question instructions, and sampling instructions;
2. cover sheet with identification information about the DAC;
3. administrator questionnaire;
4. financial questionnaire;
5. individual client forms;
6. eligible client roster form; and
7. respondent determination sheet.
Interviewers were responsible for setting up appointments with the assigned DACS. Interviews began on September 30, 1981, and ended in December 1981.
Editing and coding of the protocols occurred during November and December 1981 by
staff of the Developmental Disabilities Program. Key to disc entry of the data was made by the Land Management Information Center of the Department of Energy, Planning and Development under contract with the Developmental Disabilities Program. Copies of the questionnaires are available from the Developmental Disabilities Program by written request.
III. RESULTS
Characteristics of Client Population
Age. Table 1 presents DAC enrollment totals for 1981 by age categories. These
figures include all persons who were enrolled in Minnesota's DAC programs at the
time of the survey-including homebound programs. The total enrollment for the state's 106 DAC programs is approximately 5,150. Over one-half of the clients (56.1% ; N = 2,892) are 21 to 50 years old; 73% (N = 3,764) are enrolled in adult programs. Seventeen (17) percent of all DAC clients are 50 years or older (N = 872). The school-age population is the smallest group (2.6%; N = 134).
It is difficult to analyze changes within the age structure of DAC populations during the past several years because previous surveys have used different age categories.
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The number of persons receiving DAC services has increased steadily over the past several years. There were 1,935 participants in 1972; by 1976 there were 3,679 DAC clients (Community Programs Division, 1976). Approximately 63 percent of the DAC clients in 1976 were 21 to 59 years old; about 22 percent were three to 21 years old.
Three and a half years ago, there were 4,221 persons receiving DAC services in
Minnesota (Mental Retardation Program Division, 1978). The school-age population
(ages 5 to 21) represented approximately 4.1 percent of all DAC clients. Participants who were 22 to 65 years old represented .about 68 percent of the state's DAC enrollment.
The proportion of clients enrolled in adult programs has been increasing:
1976: (persons 21 years and older) 67.7% of all DAC participants;
1978: (persons 22 years and older) 71.5% of all DAC participants;
1981: (persons 21 years and older) 73.0% of all DAC participants.
Level of Functioning. Information reported in the 1978 DPW study indicated that most DACS served the total range of mental retardation. However, 39 (38%) of the 104 centers reported that none of their clients were classified as profoundly retarded. Forty-five (45) centers reported that 26 to 75 percent of their clients were severely retarded; four DACS reported that more than 75 percent of their clients were severely mentally retarded.
Table 2 reports the level of functioning of DAC clients during 1981. The figures are presented by region and statewide totals, and by program: infant, pre-school,
school-age, adult. The statewide figures indicate that 2.9 percent of all DAC clients are not retarded (N = 149), 4.6 percent are borderline (N = 235), 13.9 percent are mildly retarded (N = 716), 30.4 percent are classified as being moderately retarded (N = 1,566), 28.2 percent are severely retarded (N = 1,455) and 9.5 percent are profoundly mentally retarded (N = 492). DACS reported that the level of functioning was unknown or undetermined for 541 individuals--primarily infants and preschoolers.
In addition serving persons with mental retardation, developmental achievement centers may be licensed under State statute and DPW rule to provide day programming to persons with cerebral palsy.
Table 2
Level of Client Functioning by Region and Statewide Total
(Minnesota DACS: 1981; 100% reporting)
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Place of Residence. DPW reported in 1976 (Community Programs Division) that one-half (49.9%) of the DAC clients lived in their natural home and one-third (34.2%) lived in Rule 34 (ICF-MR) facilities. Seven (7) percent were in foster homes.
Client living arrangements were similar in 1978 (Mental Retardation Program Division): 49.6 percent were living in their natural or adoptive homes; 34.6 percent were living in ICF-MR settings; 5.4 percent were living in foster homes.
Table 3 indicates the type of client residences during 1981. A higher percentage of clients now live in ICF-MR/group homes: 41.3 percent. DACs reported that 4.8 percent
(N = 2,362) lived in their natural or adoptive home and 4.5 percent (N = 231) were living in foster care homes.
Living arrangements for 1976 and 1978 are summarized below:
1976 DPW Report
Natural homes
Independent living
Apartment training program
Foster homes
Board and care
Rule 34 residence
Licensed SNF
Miscellaneous
(not reported)
1,597
42
2:;
43 1,096
165
10 481
3,679
49.9
1.3
7::
1.3 34.2
5.1
.3
--
1978 DPW Report
N
%
Natural homes 2,091 49.5 Independent living
.2
Semi-independent 1: .4 Foster home
233 5.5
ICF/G B&l. 356 8.4
ICF/MR 1,457 34.5
SNF 60 1.4
4,221
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Movement
Client Movement. One measure of the effectiveness of day program services is the degree of client movement. Lack of movement may, however, also indicate a shortage of resources in critical areas: employment opportunities (sheltered or competitive), residential options or other necessary community support services.
Client movement within Minnesota's DACS can be determined by examining four client statistical: new admissions, readmission, transfers and deaths. For this analysis the infants, preschoolers and school-age children have been combined. As a group they show greater movement than do adult clients. This higher level of movement should be expected, primarily because of the public school system's responsibilities under state and federal legislation to provide services to school-age children.
Statewide movement of DAC clients is summarized below:
Infant/Pre-school/
School age
Adult 1980 1981 1982
1980 1981 1982
943 912 774 555 613
489
(7i~) (9:!) (6~;) (3::) (3::) (2~[)
( 22) ( 18) ( 28) ( 12)
161 ( 19) ?54 267 301 257
The figures reported for infants, preschoolers and school-age children indicate greater movement than do the average daily attendance figures reported in Policy Analysis Series No. 6 (page 24). The difference may be attributable, in part, to reporting errors. The movement figures indicated here include homebound programs. Average daily attendance figures are for in-center programs only. Additionally, movement figures reflect
enrollment rather than attendance numbers. The same is true for movement and attendance figures for the adult DAC clients
Movement figures must be considered along with waiting list figures and the number of people waiting to go into other programs such as work activity and sheltered workshops. There is a need for movement in the system.
New admission - an individual entering an agency for the first time; a client moving from one program to another program within an agency was not a new admission.
Readmission - a client who entered, left the program and then re-entered the agency.
Transfer - a client who left the program due to "graduation," promotion to sheltered work,
return to a state hospital, entry into public school, retirement.
Deaths - clients who died during the time period indicated.
Parentheses indicate a negative value, i.e., movement out of DAC programs
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The Department of Public Welfare (1976) reported that 615 clients were discharged
from DACS in 1975. DPW estimated that the recidivism rate was 6.6 percent in 1975--40 clients returned to the DAC after discharge during that year.
The number of clients entering and leaving DAC programs is presented by region
and statewide totals in Table 4.
-5
Table 4*
Number of Clients Entering and Leaving Programs by Region and Statewide Total
The Department of Public Welfare (1976) reported that 615 persons were discharged from DAC programs in 1975. Twenty-three (23) were discharged to work activity; 103 individuals were discharged to sheltered workshops and 272 were transferred to schools.
DACS estimated in 1976 that approximately 87 percent of the adult clients could benefit from work activity and 50 percent could benefit from sheltered work. DACS also
indicated that about 7.2 percent (N = 244) of the adult population would be placed in a sheltered workshop if those openings were available.
DACS reported in 1978 that 192 clients who were not participating in work activity would be recommended for those programs if the services were available (Mental Retardation Program Division, 1978). Seventy-one (71) DACS also indicated that 370 clients were ready for placement in sheltered workshops. In 1978 there were approximately 2,300 adult DAC clients between the ages of 20 and 60 years.
According to the estimates of DAC administrators, there are 454 clients ready to move into work activity components (either within the center or in another agency), and 240 individuals ready to move into sheltered work situations.
DAC administrators stated a number of reasons why adult clients could not participate in work activity or be promoted to sheltered work. The reasons indicated in 1981 are similar to those reported in the 1976 DPW study and are summarized below:
availability of work activity/sheltered work slots is limited;
necessary community support services such as adequate residential living arrangements or transportation services are lacking or limited;
parents or clients are reluctant to make the changes (e.g., do not want to leave the community/home; work activity center or sheltered workshop is located too far away;
unwilling to participate);
client characteristics (e.g., level of functioning; lack of ability, skills or adequate production rate; emotional, social, or behavior problems; age);
clients are awaiting evaluation, referral or placement.
Table 5 presents the number of adult clients ready for work placements by regional and statewide totals.
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Table 5
Adult Clients Ready for Work Placements by Region and Statewide Total
(Minnesota DACS: 1981; 100% reporting)
The numbers presented here may be duplicated, i.e., individuals identified as
being ready for work placement inside an agency may also have been reported as being ready for work placement outside of an agency. The numbers reported ready for sheltered work are accurate.
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Waiting Lists
Five years ago, 24 of the 96 DACS (total II = 101) reported that they had waiting lists totaling 174 people (Community Programs Division, 1976). In 1978, DAC directors indicated that 144 persons were on waiting lists at 18 of the State's 104 centers (Mental Retardation Program Division, 1978).
Respondents to the 1981 survey reported that 449 persons were identified on waiting lists at 32 of Minnesota's 106 developmental achievement centers: 71 infants, 75 preschoolers, one school-age child and 302 adults. Two centers in the Saint Paul-Minneapolis area each reported having more than 100 people on their lists. DACS in Region Eleven account for over 85 percent of all people who are identified on waiting lists.
The reader is advised to use these numbers with caution. Every attempt has been made to eliminate duplicate names. In some cases adults on waiting lists may already be enrolled in a day program. They may be waiting to go into a work activity placement at another agency.
Table 6 presents current waiting lists by region and state, and by program.
IV. IMPLICATIONS
This paper presents an analysis of the general characteristics of the people currently enrolled in Minnesota's developmental achievement centers. The percentage of adult clients has increased since the enactment of state and federal legislation mandating public school programs for students with mental or physical handicaps. Coincidentally, the proportion of clients living in ICF-MR/group homes has risen. Client movement is an important
statistic. Slow or little movement may indicate a lack of necessary resources--in employment, transportation, residential arrangements or other support services. The number of people waiting to participate in DAC programs and the number of current DAC clients awaiting work placement are significant indicators of movement potential. There are currently 450 clients ready to move into work activity or sheltered work situations.
There are approximately 300 adults on DAC waiting lists for day program services and/or work activity placements. At the same time, statewide admission data indicate that DACS are admitting more people than they are demitting, transferring or "graduating."
Policy Analysis Series No. 9 will present more detailed information on the people enrolled in DAC programs. The paper will also summarize some of the results reported in Policy Analysis Series Numbers 6, 7 and 8, and will present some of the implications associated with the findings of this DAC study. Policy Analysis Series No. 9 will also summarize the changes which are likely to occur in DACS during the current year due to recent
budget changes.
449 is an Unduplicated count. The actual number reported by DACS was 483. Thirty-four people (30 adults, 4 preschoolers) were apparently identified on other lists or at other agencies. At least 40 people on waiting lists are enrolled in other DAC's; they are in need of work activity program services.
