This paper looks into the issue of mental disabilities. First, the general notion of severe disability is addressed. Then, specific examples of such disabilities are considered; namely, intellectual disability, traumatic brain injury, autism, and deaf-blindness. The definitions of these disorders are provided; their characteristics and causes are also explained. The paper is based on the data obtained from scholarly books and articles. It only provides a brief general review of the topic and does not go into detail. For a more in-depth study, further inquiries are recommended.
Introduction
Mental disabilities are highly adverse conditions that severely hinder or prevent people from participating in private, social, and professional life. These conditions often are inborn or develop at an early age, which means that a person suffering from them does not get a chance to become a full-fledged member of society. In our paper, we will look into the issue of mental impairments. First, we will look into the general notion of severe disability; then, we will consider more concrete examples, namely, intellectual disability, traumatic brain injury, autism, and deaf-blindness, addressing the definitions, characteristics, and causes of these conditions.
Severe disabilities
Severe mental disabilities are conditions that cause the inability to think, experience, or feel emotions properly, to an extent that results in functional impairment. Such conditions are characterized by difficulties that the people suffering from the experience while trying to establish and maintain relationships with others, execute tasks related to work, etc.; they find all this extremely hard or impossible to do (Perring, 2010).
The causes of severe mental disabilities include genetic diseases or abnormalities, anomalous brain development, head traumas, exposure to noxious substances, viral or bacterial agents. These disorders can also develop or be further aggravated by drug abuse. Severe mental disabilities often develop at an early age (e.g., the intellectual disability), but might also emerge in adult persons, especially if exacerbated by external factors (for instance, Alzheimer’s disease).
Intellectual disability (ID)
Intellectual disability, or intellectual developmental disorder, is a neurodevelopmental problem that is characterized by “significantly subnormal intellectual functioning in the presence of impairment in adaptive functioning” which exposes itself before a person reaches the age of 18 (Wilmshurst, 2012). ID is “a condition of subnormal intellectual functioning or arrested/incomplete development of the mind”; the development is defined as significant if the IQ of a patient is two standard deviations lesser than the norm (i.e. if the average IQ score=100, then the IQ≈70 signifies ID) (Wilmshurst, 2012). It is characterized by the low general ability to learn but is distinguished from specific disabilities such as dyslexia combined with a normal IQ (Wilmshurst, 2012).
ID can result from the damaged FMR1 gene (codes a protein vital for healthy brain growth); phenylketonuria (caused by two recessive genes coding inborn errors of metabolism); the influence of teratogens on the embryo; usage of hard drugs and alcohol by the mother; mother suffering from rubella during 3-8 weeks of pregnancy, a birth trauma, meningitis or encephalitis, brain injuries, significant malnutrition, exposure of children to lead or other toxins (Wilmshurst, 2012).
Traumatic brain injury (TBI)
TBI is defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force” (Ponsford, Sloan, & Snow, 2012, p. 1). TBIs are caused by an impact of the head against a blunt object or from its penetration by a sharp object; it often results from vehicle accidents (Ponsford et al., 2012). TBI causes highly adverse outcomes for the injured; it can lead to negative long-term results, such as poor sensory integrity, bad coordination, trouble with handling data, accomplishing tasks, and focusing attention (Silver, McAllister, & Yudofsky, 2011, p. 9). Alzheimer’s dementia, Parkinson’s disease, endocrine dysfunction, and dire social consequences are all related to TBI (Silver et al., 2011, p. 11).
Autism
Autism is a developmental disorder that influences the social and communication skills of those suffering from it. It can manifest in numerous ways; to diagnose an autism spectrum disorder (ASD), at least mild impairment in each of the following aspects of a person’s behavior must be present: 1) socialization, 2) communication, 3) limited interests and repeated behaviors (Rodriguez, 2011, p. 10).
Damaged social interaction and abnormal behaviors are common for autistic patients. They often have trouble perceiving the world; some external stimuli might be interpreted as too intensive ones, while there exists hyposensitivity towards others (Rodriguez, 2011, p. 18). Autistic behavior is often repetitive and self-harming; no specific behaviors are common, but such behaviors occur frequently (Bodfish, Symons, Parker, & Lewis, 2000).
ASDs are caused by a different pattern of brain growth. There is no localized brain abnormality; numerous differences from healthy brains are present (Rodriguez, 2011, p. 42). It is stated that autism is mainly caused by genetic disorders (Rodriguez, 2011, p. 13); Zoghbi and Bear (2012) stress that synaptic dysfunction might play a crucial role in it.
Deaf-blindness
Deaf-blindness is a severe condition, a combined sensory impairment, defined as the absence of hearing (or the lack of useful hearing) and sight (or the lack of useful sight). Deaf-blind people, in many cases, can be taught to speak, which is why the word “muteness” is not a part of the term (Dalby et al., 2009).
Deaf-blindness can be either congenital (inborn) or acquired (Dalby et al., 2009). Congenital deaf-blindness might be the result of various factors such as birth complications, premature birth, some diseases (e.g. rubella). Acquired deaf-blindness might come from injury, severe disease (such as meningitis), or be a result of aging.
Dalby et al. (2009) note that individuals who suffer from inborn deaf-blindness have a higher probability of developing cognitive disabilities, and find it more difficult to establish social contacts, as well as to be able to care for themselves; they are less likely to learn to use speech as a means of communication as well (p. 96).
On the whole, people who suffer from deaf-blindness have different abilities to care for themselves, communicating with others, etc., due to the differences in the level of sight and hearing impairments; the fact of the condition being inborn lowers these abilities. It means that the needs of people with innate deaf-blindness differ from those of people with acquired deaf-blindness (Dalby et al., 2009, p. 102).
Conclusion
As we have seen, mental disabilities are severe conditions that prevent people from having a full-fledged life by making them unable to feel emotions, think, or experience properly. They are often caused by genetic factors or serious diseases, as well as substance abuse or head injury. These conditions can be inborn (ID, autism, deaf-blindness) or acquired (TBI, deaf-blindness). People suffering from these disorders require special care and attention.
References
Bodfish, J. W., Symons, F. J., Parker, D. E., & Lewis, M. H. (2000). Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders, 30(3), 237-243. Web.
Dalby, D. M., Hirdes, J. P., Stolee, P., Strong, J. G., Poss, J., Tjam, E. Y.,…Ashworth, M. (2009). Characteristics of individuals with congenital and acquired deaf-blindness. Journal of Visual Impairment & Blindness, 103(2), 93-102. Web.
Perring, C. (2010). Mental illness. Web.
Ponsford, J., Sloan, S., & Snow, P. (2012). Traumatic brain injury: Rehabilitation for everyday adaptive living (2nd ed.). Hove, UK: Psychology Press.
Rodriguez, A. M. (2011). Autism spectrum disorders. Minneapolis, MN: Twenty-First Century Books.
Silver, J. M., McAllister, T. W., & Yudofsky, S. C. (2011). Textbook of traumatic brain injury. Arlington, VA: American Psychiatric Publishing.
Zoghbi, H. Y., & Bear, M. F. (2012). Synaptic dysfunction in neurodevelopmental disorders associated with autism and intellectual disabilities. Cold Spring Harbor Perspectives in Biology, 4(3). Web.
The targeted study seeks to explore caregivers’ perceptions of intellectually disabled persons and their impact on the quality of care. Current literature shows that many mentally disabled persons have been ignored in different healthcare delivery systems. The study will use focus groups and constant comparison analysis to come up with quality research findings. Such findings will be used to develop effective healthcare policy for supporting the needs of intellectually disabled persons. The proposed study will present new approaches and practices that can be used to support the health needs of many patients with mental disabilities.
Introduction
Background Information
Past studies have presented mixed views regarding the view of direct caregivers’ perception of people with intellectual disabilities and their impact on the level of medical care. These results have made it impossible for many medical professionals to propose better policies that can avail better care to mentally disabled persons. Many patients with mental disabilities have been discriminated in different healthcare settings (Thornicroft, Rose, & Kassam, 2007). Many healthcare policies have failed to transform the health outcomes of many individuals with mental disabilities.
Purpose Statement and Public Health Implications
That being the case, the proposed study seeks to explore the view of direct caregivers’ perception of people with intellectual disabilities. This knowledge will outline the impact of such perceptions on the level and quality of care provided to such persons. The ultimate goal is to propose evidence-based practices and approaches that can improve the health outcomes of every mentally-disabled patient (Thornicroft et al., 2007). This knowledge will result in better health practices that can address the health needs of these persons.
Rationale
Mentally disabled groups should receive equal healthcare and support. However, this has not been the case because of discrimination and negative perception among healthcare providers. Current literature does not offer conclusive analyses to explain the complexity, origin, and challenges associated with intellectual disability (Corrigan, 2004). The study will, therefore, outline the perceptions of healthcare providers and how they affect the quality of care available to such patients. A powerful qualitative research approach will be used in order to complete a successful study. The members involved in every focus group will outline the major gaps affecting the quality of care delivered to patients with mental disabilities.
Definition of terms
Intellectual disability: This is a disability known to affect a person’s adaptive behavior and intellectual functioning (Corrigan, 2004).
Health care policy: A specified model or action plan aimed at achieving specific healthcare goals.
Satisfaction: Ability to receive content and desirable health care.
Literature Review
Individuals with “intellectual disabilities are categorized as a vulnerable group when it comes to the issue of care” (Corrigan, 2004, p. 615). Such persons have poor health outcomes and lifestyles. Lin, Yen, Li, and Wu (2005) argue that the health needs of many people with mental disabilities are ignored by different societies and caregivers.
These people encounter a wide range of health challenges that require continued hospitalization. Lin et al. (2005) indicate that such people tend to die early and spend much time in healthcare institutions. This issue has encouraged more scholars to focus on the best strategies that can improve the health outcomes of these mentally disabled persons.
Patients with various mental problems encounter numerous barriers in getting appropriate health services (Corrigan, 2004). The individuals lack proper health delivery models. They also encounter numerous challenges whenever looking for better solutions to their health challenges. Many “disabled persons experience barriers in getting support for better lifestyle choices” (Lin et al., 2005, p. 231).
Many healthcare providers argue that they work hard to deliver quality care to patients with different mental disabilities. However, studies have indicated that such patients receive compromised or delayed healthcare services. The quality of care available to many people with mental disabilities remains questionable in many parts of the world. For very many years, individuals with various mental problems have been omitted from various healthcare agendas and campaigns (Corrigan, 2004). This fact explains why the problem of healthcare disparity continues to affect many societies. Different healthcare systems fail to embrace the power of evidence-based research in an attempt to support more persons with mental disabilities.
Medical professionals and theorists have been focusing on the best strategies to eliminate these health disparities. This is the case many caregivers have negative perceptions about mentally disabled individuals. Consequently, the malpractice has continued to affect the quality and level of care delivered to such patients (Lin et al., 2005). Better healthcare delivery models can be proposed in an attempt to improve the quality of care and health support available to these vulnerable groups.
Methodology
Proposed Research Methodology
A powerful qualitative approach will be used to undertake this study. During the study, a focus group will be used in order to get the most desirable results. The use of a focus group will ensure the relevant information regarding the perception of different healthcare providers is obtained. The focus group will include several caregivers, nurse practitioners (NPs), and medical professionals. The professionals will present quality views regarding the issue of mental disability and how it affects the quality of care available to the targeted patients (Lin et al., 2005).
The study approach will present meaningful insights and ideas that can be used to develop the most appropriate healthcare policy. The research objectives and goals presented below will be used to guide the study.
Research Goals/Objectives
The following research objectives will be used to conduct targeted interviews. The goals will also be used to come up with the best findings and discussions.
To examine the competencies and experiences of caregivers providing medical support to mentally incapacitated patients.
To propose a new policy capable of promoting the health outcomes of mentally disabled patients.
To explore the views of direct caregivers’ perception of people with intellectual disabilities and their impact on the level of care provided.
Research Questions
The questions presented below will be used to undertake and complete the study.
What issues and factors dictate the quality of care delivered to mentally disabled persons?
How do caregivers’ perceptions of people with intellectual disabilities affect the quality and level of care provided to them?
What new measures and policies can be promoted in order to safeguard the nature of care available to persons with intellectual disabilities?
Data Collection and Analysis
As mentioned earlier, several focus groups will be used in order to get quality information from more respondents. Every focus group will be expected to present the most desirable information and themes that can be used to come up with meaningful conclusions (Creswell, 2007). The themes will play a significant role in producing a powerful health care policy that can make a difference for many mentally disabled persons.
After collecting relevant information using these focus groups, a powerful qualitative data analysis technique will be used. The proposed technique is a constant comparison analysis (Onwuegbuzie, Dickinson, Leech, & Zoran, 2009). This model was “developed by Glaser and Strauss in 1978” (Onwuegbuzie et al., 2009, p. 11). This model has been used extensively to analyze data obtained using focus groups. The analytical technique requires the use of three major stages. These stages will be used in order to produce quality information.
The first stage is known as “open coding whereby the collected data from the focus groups is grouped into smaller units” (Onwuegbuzie et al., 2009, p. 12). A code or descriptor is used to identify each of the data units. The second stage will be “the axial coding whereby the descriptors will be grouped to form several categories” (Onwuegbuzie et al., 2009, p. 12). The third stage is usually known as selective coding.
During the third stage, several themes are obtained from the information presented by members of each focus group. The use of focus groups will ensure several themes are obtained during the study (Ulin, Robinson, & Tolley, 2005). The next step will be to examine if the gathered themes from different groups are similar or different. The use of several focus groups will make it easier for researchers to test the collected themes. Such themes will be used to understand how different caregivers perceive patients with intellectual disabilities.
Recruitment and Inclusion of Participants
Competent caregivers from diverse backgrounds will be requested to be part of the targeted focus groups. Caregivers from various mental health units and departments will be part of the study. This approach will make it easier for the study to produce meaningful discussions. Every individuals willing to be part of the study will be included in the focus groups. The individuals should also be willing to offer evidence-based data and information.
Policymakers, social workers, and mental health specialists will be encouraged to participate in the focus groups (Creswell, 2007). These strategies will ensure the study approach gathers quality information. As well, members of the community and mentally-disabled patients can be involved throughout the study process (Onwuegbuzie et al., 2009). Such groups will present meaningful insights that can be used to design the most desirable healthcare policy for mentally-disabled persons.
Ensuring Trustworthy of Data and Ethical Considerations
The other important consideration is to ensure quality data is obtained from the study. The focus groups will be composed of competent practitioners who are capable of providing quality information and data. The respondents will be encouraged to provide evidence-based ideas and information in order to increase the level of validity (Thornicroft et al., 2007). The focus groups will be characterized by scientifically-guided questions. The research approach will also be collaborative in nature. This strategy will increase the trustworthiness of the gathered data.
The consent of different participants will be sought before undertaking the study. Human subjects will be treated with dignity throughout the study process (Onwuegbuzie et al., 2009). The concept of reflexivity will be embraced in order to ensure the gathered information can be used to propose a new healthcare policy. The healthcare policy will also encourage more caregivers are ready to offer quality services. Additionally, the targeted mentally disabled patients will be able to receive quality health care.
Appendix
Questions for a Focus Group on Caregivers’ Perception of People with Intellectual Disabilities
Engagement Questions
What is the importance of delivering quality care to individuals with mental disabilities?
What is the role of a caregiver in delivery quality care?
Exploration Questions
What is your take about persons with mental disabilities?
What is your view regarding these patients?
What makes it impossible for these mentally disabled persons to get quality nursing care?
What structural, cultural, social, and economic factors hinder the care availed to them?
What positive measures can be undertaken to transform the care available to these groups?
What is the implication of poor care for persons with intellectual disabilities?
Exit Questions
What is the role of future caregivers towards improving the care of these patients?
How can multidisciplinary teams improve the health outcomes of these patients?
Reference List
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625.
Creswell, J. (2007). Qualitative inquiry and research design: choosing among five approaches. Thousand Oaks, CA: Sage.
Lin, J., Yen, C., Li, C., & Wu, J. (2005). Caregivers’ perceptions of accessibility, satisfaction, and policy priorities of health care for people with intellectual disabilities in Taiwan. Journal of Medical Science, 25(5), 229-236.
Onwuegbuzie, A., Dickinson, W., Leech, N., & Zoran, A. (2009). A qualitative framework for collecting and analyzing data in focus group research. International Journal of Qualitative Methods, 8(3), 1-21.
Thornicroft, G., Rose, D., & Kassam, A. (2007). Discrimination in health care against people with mental illness. International Review of Psychiatry, 19(2), 113-122.
Ulin, P., Robinson, E., & Tolley, E. (2005). Qualitative methods in public health: a field guide for applied research. San Francisco, CA: Jossey-Bass.
In fact, music therapy is essential for preventing students with ADHD from school failure, low self-esteem, and social rejection. Although music therapy is one of the related services under IDEA for supporting students with disabilities for meeting their individualized education program (IEP) goals, music therapy as a related service is associated with many challenges. Policy-makers should be inform that music would effectively enhance classroom behaviors and improve on-task behavior of students with ADHD. Combining music therapy with other interventions and/ or classroom instructions would improve classroom behaviors and to enhances on-task behavior of students with ADHD which result in creating more opportunities for learning.
Learning to follow classroom instructions and to spend appropriate time on-task are major goals for students’ social, personal, and educational development. However, students with ADHD have difficulties following classroom instructions, and they have additional barriers when it comes to on-task behavior. Together, the problems add up, becoming a significant barrier for academic achievement in children who have ADHD. ADHD is a neurobiological disorder that is affected by both genetic and environmental factors. In addition, as defined in the Diagnostic and Statistical Manual of Mental Disorders (2013), ADHD is a neurodevelopmental disorder characterized by disorganization, inattentive, impulsive, and overactive behaviors.
In addition, because few research studies have been completed on music therapy as a related service, future studies should be conducted to determine how students with ADHD perform with musical intervention. In order to inform policy-makers of the importance of music therapy as a related service, this paper discusses the effects of music on the brain form a neuroscientific perspective. In particular, this paper focuses on the effects of music therapy on the brain of students with ADHD which positively reflect on the academic performance of students with ADHD to notify policy-makers of the benefits from using music therapy as a related service. There is a need for a better understanding of how music therapy might influence the academic and behavioral development of students with ADHD. Moreover, this literature review is dedicated to reviewing obstacles associated with the eligibility for or access to related services in special education; in particular, challenges related to music therapy as a related service under IDEA for individuals with disabilities. Therefore, this paper highlights how the advocacy efforts made by advocacy groups or institutions such as the American Music Therapy Association (AMTA) has influenced the policies regarding music therapy as a related service under IDEA for students with disabilities.
In order to contribute to the literature, this review has the following research questions:
how the advocacy efforts made by advocacy groups or institutions such as the American Music Therapy Association (AMTA) has influenced the policies regarding music therapy as a related service under IDEA for students with disabilities.
From a neuroscientific perspective, how would music intervention improve classroom behaviors and academic outcomes of students with ADHD as a way to inform policy-makers of the importance of music therapy as a related service?
Review of Related Literature
Music Therapy as a Related Service
Congress established IDEA in 1975 which mandates public schools to provide an adequate education to students with disabilities (Siegel, 2011). The main purpose of IDEA is providing a Free Appropriate Public Education to students with special needs (FAPE). (IDEA) is the American law that ensures services to all individuals with disabilities, and it governs how states and public agencies provide eligible individuals who have disabilities with early intervention, special education and related services. IDEA consists of four parts, including, Part A states general provisions whereas, Part B relates directly to school age children (3-22 years of age). In addition, Part C is related to early intervention (0-3 years of age), and Part D relates to teachers preparation.
Under Part B of IDEA, individuals with disabilities may qualify for related services such as music therapy. The term “related services” is defined by IDEA in section 300.34(a) of Title 34, Code of Federal Regulations as Related services means transportation and such developmental, corrective, and other supportive services as are required to assist a child with a disability to benefit from special education, and includes speech-language pathology and audiology services, interpreting services, psychological services, physical and occupational therapy, recreation, including therapeutic recreation, early identification and assessment of disabilities in children, counseling services, including rehabilitation counseling, orientation and mobility services, and medical services for diagnostic or evaluation purposes. Related services also include school health services and school nurse services, social work services in schools, and parent counseling and training. (34 CFR 300.34(a)).
IDEA was not the only legislation piece that addressed the issue of music therapy. In 2001, the US Department of Education passed the No Child Left Behind (NCLB) Act to improve the effectiveness of education interventions (Sze, 2005). According to the given Act, schools should have ensured that all children, irrespective of their special educational needs, met annual educational objectives and demonstrated sound academic achievements (Sze, 2005). This state of affairs denoted that educators witnessed a significant challenge to deal with children with disabilities and make them achieve progress. Sze (2005) admits that music therapy was considered a useful tool to cope with the task above since it is an ancient method for healing, which “neutralizes negative feelings, increases stress tolerance level,” and others (p. 79). However, it is impossible to mention that the NCLB was explicitly designed to widen the use of music therapy. Instead, the Act stipulated the goals, and the phenomenon under consideration was chosen as a way to achieve them.
It can be obviously noted in the definition above that music therapy is not specifically included in the list of related services (Wilson, 2002), and this what creates the challenge and confusion about securing music therapy as a related service for students with disabilities in some states. Therefore, AMTA initiated an action advocating for a policy clarification for the public law related to music therapy as a related service, and this effort was recognized at the state level (Humpal, 2006).
One should also state that the NCLB was widely criticized for setting high goals and standards, which meant that a new legislation piece was necessary, and the ESSA appeared. President Barack Obama signed this regulation in 2015 to address and improve the nation’s education system (Sharp, 2016). Thus, the ESSA resulted in the fact that a significant part of education authority was shifted from federal governments to state ones, which allowed local agencies to address the existing challenges in a timely manner.
It is also necessary to mention that the ESSA contributed to the spread of music therapy. It is so because the regulation introduced the concept of specialized instructional support personnel (SISP), including music therapists and others (National Alliance of Specialized Instructional Support Personnel, n.d.). The legislation piece also made state and local agencies engage in timely consultation with SISP members (National Alliance of Specialized Instructional Support Personnel, n.d.). That is why it would be a violation of the ESSA if an eligible child does not have access to music therapy.
The American Music Therapy Association (AMTA)
The AMTA is one of the non-profit and professional associations that was established in 1950. Today, the AMTA consists of more than 8,000 music therapists and other members. The mission of the AMTA focuses on the development and improvement of using music as a therapy in many different settings such as special education, rehabilitation, and community; in addition, the AMTA’s mission is improving the public awareness of the benefits of music therapy. In addition, the AMTA is considered to be the pioneer in this type of therapy because the AMTA determines the educational and clinical training standards for music therapists. Thus, AMTA is committed for providing high quality and comprehensive information about the music therapy profession. In order to achieve this goal, AMTA and its seven regions hold a conference yearly (American Music Therapy Association www.musictherapy.org).
AMTA has been advocating for securing access to high quality music therapy services for individuals with disabilities. Unfortunately, in the past, it was difficult for providers, parents, and advocates to secure music therapy as a related service under Part B of IDEA for students with disabilities because of the confusion as music therapy is not specifically listed in the statutory list of examples of related services. As a result, the executive director of AMTA, Ms. Andrea Farbman, wrote a letter on behalf of the AMTA in April 5, 2000 to the Assistant Secretary Judith Heumann seeking for a letter of policy clarification from the Office of Special Education Programs (OSEP)regarding the provision of music therapy as a related service for students with disabilities (Humpal, Colwell, & American Music Therapy Association, 2006).
As a result of the advocacy made by the AMTA, the OSEP clarified the confusion about the requirements of music therapy as a related service under IDEA. In the policy clarification letter, the OSEP stated that the list of related services in the definition is not “exhaustive”. Although music therapy is not specifically listed as a related service, it may be considered as such under IDEA (Simpson, 2002). In addition, King & Coleman, (2000) mention that the Senate Report on Public Law-94-142 indicated that the related services listed in the definition is “not exhaustive and may include other developmental, corrective, or supportive services (such as artistic and cultural programs, and art, music, and dance therapy), if they are required to assist a child with a disability to benefit from special education”, and this will not change anything in the basic definition of related services or the Senate Report’s comments (IDEA Amendments of 1997, Part A, Section 602.22).
The above clarifications of the recognition of music therapy as a related service under IDEA aligns with the guidance provided in the Questions and Answers document on Individualized Education Programs (IEPs), Evaluations, and Reevaluations which was issued in June 2010 by the U.S. Department of Education (U.S. Department of Education, 2011). In 2006, the new, final regulations of the implementation of Part B of the Individuals with Disabilities Improvement Act of 2004 were released. The information from the Federal Register / Vol. 71, No. 156 / Monday, August 14, 2006 / Rules and Regulations, page 46569 that relates to music therapy in the final regulation indicates exactly the same clarification language that the list on related services is not exhaustive and may include other services. This new, final regulations of the Part B of IDEA were a result of the hundreds and thousands of comments were submitted requesting to add additional different services to the list of related services (U.S. Department of Education, 2011).
This advocacy efforts illustrate the misinterpretation of the defection of related services in some states; however, this obstacle remained in the state of New York. Unfortunately, clarification regarding the music therapy as a related service had never been provided by the New York State Education Department. This resulted in some school districts rejecting or discontinuing music therapy services because they stated that the state of New York has never approved music therapy as a related service. Therefore, in 2013, Elizabeth Schwartz, an AMTA member, initiated an advocacy action and requested a policy official clarification letter from the U.S. Department of Education to present it to the state. This resulted in obtaining an official letter that clarifies the recognition of music therapy as a related service under IDEA which can be used to secure this type of therapy for students with disabilities in the state of New York (American Music Therapy Association, 2013).
In addition to the pervious advocacy efforts made by the AMTA, the AMTA and the Certification Board for Music Therapists (CBMT) started a collaborative effort in 2005 for a State Recognition Operational Plan to move form state advocacy level to federal advocacy level. According to the Mid-Atlantic Region of the AMTA (n.d.), this legislation is of significance since it ensures that all individual states recognize the importance of music therapy to make this service more available to citizens. The State Recognition Operational Plan aims at reaching the outcome that state agencies will have music therapy as one of their recognized professions (MAR-AMTA, n.d.). It is necessary to implement a few specific steps to cope with the task above. These actions include identifying states that need urgent assistance, analyzing their data, offering legislative or regulatory actions, and others (MAR-AMTA, n.d.). One should also admit that the plan under consideration implies essential benefits. It refers to the fact that state recognition of music therapy will ensure that clients and patients are given high-quality service. Thus, the State Recognition Operational Plan has attempted to make the sphere of music therapy more official.
Another challenge related to music therapy is the misconceptions about music therapy and music education. Researchers and policymakers should clarify the misconceptions about music therapy and music education, and these discrepancies should be communicated to stakeholders such as parents and practitioners. The distinction between music therapy and music education is that music education focuses on teaching music in general such as teaching students how to use musical instruments or perform using voice or singing. However, music therapy focuses on using music to help students achieve physical, cognitive, emotional, and social goals (Smith, 2018). It refers to the fact that numerous activities, including singing, listening to music, creating it, and others, can help children with disabilities cope with various challenges. For example, they include socializing, expressing emotions, motivating learning, and many others (Smith, 2018). Consequently, the difference between the two areas manifests itself in the fact that music therapy is a wider concept that can lead to health benefits in addition to promoting learning performance and improving academic outcomes. Simultaneously, music education is a teaching practice that is performed to ensure that children master certain skills in the music domain.
In addition to the misconceptions about music therapy and music education, there is also misconceptions about music therapists and music teachers regarding to their roles. Thus, policy-makers should comment on the difference between these professionals to ensure that appropriate specialists provide the services under analysis. According to Smith (2018), music educators are individuals with teacher education, who are trained to utilize specific methods to make students master learning materials. These specialists teach children with and without disabilities to sing, play musical instruments, make music, and others (Smith, 2018). In particular, these professionals act as teachers of all the other school disciplines. On the contrary, “with degree in music therapy, you would instead use music as a therapeutic tool that helps clients through the emotional and physiological effects it produces.” Such professionals typically deal with special education needs students because therapy is necessary to assist individuals with health, economic, social, and other issues. According to the AMTA (2015), “music therapists develop music therapy treatment plans specific to the needs and strengths of the client who may be seen individually or in groups” (para. 5). Consequently, there is a fundamental difference between music therapists and music teachers.
In addition to the information above, it is reasonable to comment on music therapists’ preparation. It has already been mentioned that a degree in music therapy is needed. According to the AMTA (2015), a person requires at least a bachelor’s degree or its equivalent to start a career in the music therapy field. Cohen and Behrens (2002) admit that it is also reasonable to seek Doctoral and Master’s degrees to improve their professional skills, which can result in a longer and more successful professional path. Furthermore, a person should complete pre-internship and internship training at the AMTA-approved programs (AMTA, 2015). These two steps provide individuals with sufficient professional knowledge and allow them to gain the required skills. However, additional efforts are needed for a person to become a music therapist.
The information above refers to the fact that such professionals should have additional certification. The CBMT offers the Music Therapist – Board Certified (MT-BC) credential to ensure that all specialists follow national standards (AMTA, 2015). Thus, the given credential ensures that a music therapist has sufficient knowledge, abilities, and experience to provide their service to children. An individual should successfully complete an academic and clinical training program to be awarded the credential (AMTA, 2015). All these steps are necessary to ensure that music therapists can understand the special needs of children with disabilities and know how to address them.
Furthermore, it is worth considering that music therapists should meet specific expectations when it comes to their practice. Pizzi (2020) admits that the Code of Ethics regulates professional behaviors in the given sphere. According to the AMTA (2015), music therapy practice includes conducting a patient’s assessment, developing and implementing an individualized treatment plan, eliminating possible barriers between the therapist and the patient, and many others. This information supports Thompson’s (2020) claim that reflexivity plays a crucial role in music therapy practice. Finally, one should draw attention to the fact that this practice does not focus on training and educating children with disabilities. Thus, Ghetti (2011) admits the benefits of child life training, but the researcher indicates that this issue is not necessary to demonstrate advanced music therapy practice standards. This point has also highlighted the difference between musical therapists and teachers.
School districts violate IDEA’s obligations by failing to affirmatively provide students with disabilities with high quality access to all necessary related services that appropriately meet their needs. For instance, This policy clarification explicitly task schools to evaluate students with disabilities to determine whether they would qualify or related services such as music therapy based on the students’ needs. Then, provide them with high quality access.“When a school is aware of a student’s disability, or has reason to suspect a student has a disability, and the student needs or is believed to need special education or related services, it would be a violation of Section 504 if the school delays or denies the evaluation.”
In addition to seeking for the policy clarification in that letter, the executive director of AMTA requested another policy clarification regarding the standards for appropriate personnel who offer music therapy as one of the related services.
Music and ADHD
Prevalence and Indicators of ADHD
ADHD is one of the high prevalence disorders. ADHD was not included in the Diagnostic and Statistical Manual (American Psychiatric Association) until 1980 which results in a global increase in the prevalence of children with ADHD (Helle-Valle, Binder, Anderssen, and Stige, 2017). Among children in schools, ADHD is a popular reason for mental health referral (Walker and Gresham, 2014) as it appears in 5% of children (Gehricke et al., 2017). As a result of the high prevalence of ADHD, Walker and Gresham, (2014) state that there is at least one student with ADHD in each typical classroom, and boys are more likely to be diagnosed with ADHD than girls.
The prominent characteristics of ADHD are inattention, hyperactivity, and impulsivity. Nonetheless, Nowadays, technology and Neuroscience take us beyond what we ever thought as ADHD can be diagnosed through magnetic resonance imaging (MRI). It is interesting to mention that Gehricke et al.’ study (2017) was one of the first to investigate the structure and function of the brain of children and adults with ADHD and how it relates to a diagnose of ADHD. The study used Voxel-wise linear regression models to examine the MRI data collected for this study, and the findings indicate that increase white matter concentration and decrease grey matter concentration is associated with ADHD diagnosis in children and young adults. One of the best ways to predict ADHD diagnosis is to measure the white matter concentration in the brain, and MRI based data correctly predicted 83% of the ADHD diagnoses (Gehricke et al., 2017). Furthermore, study by Gehricke et al. (2017) corroborates that there is a stronger association between micro- and macrostructural changes and ADHD symptoms in childhood compared to ADHD symptoms in adults.
In addition to diagnosing ADHD through MRI, MRI also can indicate that the brain of students with ADHD functions differently from the brain of students without ADHD. Individuals with ADHD have smaller brain sizes compared to people who do not have ADHD (citation). Gehricke et al. (2017) present that individuals with ADHD have dysfunction in the superior longitudinal fasciculus (SLF) and in the cortico-limbic, and they have audio-visual, motivational, and emotional deficits. Moreover, Friedman and Rapoport, (2015) indicate that ADHD leads to volume reductions in the prefrontal cortex, parieto-temporal regions, basal ganglia, and cerebellum. Friedman and Rapoport, (2015) state that ADHD also leads to degradation in the person’s cognitive abilities; however, these deteriorations are not ubiquitous, and people with ADHD have different cognitive profiles. The nature of the disorder is complicated, and more research is needed to determine the exact mechanisms that cause cognitive degradation (Friedman and Rapoport, 2015).
Due to the brain differences, inattention, hyperactivity, and impulsivity are the symptoms of ADHD in the classroom. In addition, Barkley (2003), provides additional details about ADHD symptoms by stating that children with ADHD have difficulties with focusing on details, organizing tasks, and sustaining attention during various activities. Children who have ADHD may have problems with discipline, as they are not able to stay in one place and be occupied with one task for a long period of time, and they frequently cannot wait their turn or be patient to listen to a question or task description until the end (Barkey, 2003). Especially notable is the emphasis was made by Mautone et al., ( 2009) on the academic difficulties that students with ADHD encounter such as the inability to complete seatwork independently or inaccuracy of seatwork when it is completed. According to Mautone et al., (2009), disruptive classroom behaviors and lack of study skills are other effects of ADHD on students. Compared to their peers, students with ADHD show lower performance on tests (Mautone et al., 2009), and they fail to graduate due to the academic underachievement (Hedin et al., 2011). Based on the characteristics of students with ADHD, students would benefit from some types of interventions in the classroom such as music intervention.
Music intervention
The positive influence of music on people’s psychological state has been acknowledged, and certain attention has been paid to the impact music has on the learning of students with ADHD. Serrallach et al. (2016) found that the interhemispheric asynchronies in auditory cortices related to ADHD were less pronounced in students practicing musical instruments. Marcuzzi and Romero-Naranjo (2017) shed light on the central aspects to concentrate on when developing music interventions for students with ADHD. The researchers emphasize that rhythm is the basic element that proved to have a major impact on learners (Marcuzzi & Romero-Naranjo, 2017). Slater and Tate (2018) also found the positive role rhythm plays on the learning of students with ADHD. Neuroscientific research identified the role rhythm can play in decreasing timing deficits that are commonly found in children with ADHD (Slater & Tate, 2018). Dymnikowa (2017) examined the effectiveness of an intervention aimed at training working aural musical memory. The intervention improved the attention and overall performance of students diagnosed with ADHD.
The literature introduces evidence that music positively affects the brain of individuals with ADHD. According to Parker, (2020) playing and experiencing music can enhance brain plasticity and improve cognitive function. From a neuroscientific perspective, music in general has its benefits on the brain when listening to it or playing it. Playing music and listening to it can improve cognitive people intellectual functioning. Maloy and Peterson, (2014) emphasize what Parker, (2020) proposes by reporting that pleasurable music can be used to increase dopamine levels in the brain. Based on the general positive impact of music in the brain, it can be inferred that music in particular can improve the function of the brain of students with ADHD. Maloy and Peterson, (2014) state that using music as an external auditory stimulation with students who have ADHD could enhance memory performance. In addition, Parker, (2020) mentions that brain performance of students with ADHD increases by a specific level of auditory stimulation such as music. From this, it may be concluded that music intervention would improve the function of the brain of students with ADHD.
Music can be used as an effective external stimulation for enhancing on-task behavior of students with ADHD. Maloy and Peterson, (2014) and Parker, (2020) underline the use of music as an external stimulation to improve on-task behavior of students with ADHD; however, the study conducted by Parker (2020) is an extension to Maloy and Peterson’s study 2014). In order to address the gap in the literature Parker conducts a quantitative study to examine the effectiveness of listening to Baroque style music at a specific level “just above the threshold of hearing” in improving on task behavior of students with ADHD. Parker, (2020) compares students’ on-task behavior with intervention (listening to Baroque style music while performing a task) with their on-task behavior without intervention (not listening to music). Parker finds that listening to Baroque style music improves the duration of on-task behavior of students with ADHD; thus, he recommends applying music intervention in the classroom to enhance on-task behavior of students with ADHD (p.120). Parker’s study proves that music would regulate the prefrontal cortex and parietal cortex of the brain of students with ADHD. Therefore, it can be concluded that student with ADHD would benefit from music intervention in term of enhancing their attention span which in turns improve on-task behavior.
In addition, music can enhance the attention span of students with ADHD. Especially notable is the emphasis was made by Maloy and Peterson, (2014) on the academic benefits of an external stimulation such as music while working on a task for students with ADHD. They demonstrate that attention span of students with ADHD could be enhanced by music which positively reflects on performing tasks. To illustrate, students with ADHD have attention deficits, and this means the inability to maintain attention on tasks; thus, the enhancement in their attention span by using music could benefit them on spending more time on the tasks. Maloy and Peterson, (2014) investigate the effectiveness of music intervention as an external stimulation on task performance of children and adolescents who have ADHD, and they indicate that music intervention has minimal positive impacts in improving task performance of children and adolescents with ADHD.
Additional aspects other than attention and memory have gained momentum recently. Madjar et al. (2020) explores the effects a music intervention could have on the reading comprehension of elementary-school students with and without ADHD. It was found that music improved ADHD students’ reading comprehension while no such effects were observed with children without the disorder under study. The positive effects of music on children with mental disorders have been acknowledged, and the improvements in learning, memory, and emotional aspects were also researched (Hosseini & Hosseini, 2018). Hosseini and Hosseini (2018) also found that group interventions had more pronounced positive results compared to individual therapy.
Although quite substantial empirical data concerning the positive influence of music on children’s learning is available, the educational system only partially employs this kind of information to improve the quality of the services provided. Music has been a part of the educational paradigm, but educators tend to pay less attention to this aspect due to the scarcity of time and the need to meet established objectives. Hedemann and Frazier (2017) stated that diverse school-based interventions were introduced and proved to be effective. After-school programs have a positive impact on the development of children with special needs, including those diagnosed with ADHD (Hedemann & Frazier, 2017). However, the lack of resources and associated issues in rural schools and educational establishments located in low-income neighborhoods make the implementation of such programs hard, or even impossible. There is a limited number of policies enacted on a state or federal level, although governments try to improve inclusive incentives.
It is noteworthy that the neuroscientific approach is increasingly used when exploring the effects of music intervention on students with ADHD. Kasuya-Ueba (2019) implemented a review of novel techniques utilized in neuroscientific research of the effects of music on children with mental disorders such as ADHD or ASD. For instance, functional near-infrared spectroscopy proved to be an effective instrument to measure children’s attention. However, numerous gaps are still apparent and require detailed investigation. For instance, the long-term effects of music initiatives are still unclear. Qualitative data is also necessary to identify the motivation of educators and students with ADHD, as well as their perceptions regarding the design of interventions and their outcomes. Clearly, it is critical to assess the effectiveness of diverse interventions targeting students of different ages, so that appropriate policies could be introduced in the U.S. educational system.
Conclusion
Thus, this literature review highlights the effectiveness of music as an intervention for students with ADHD. In particular, this current paper reviews the related literature from a neuroscientific perspective to shed the light upon the effects of music intervention on the academic performance and behavioral development of students with ADHD. It is evident that music can enhance the brain of students with ADHD; therefore, music intervention can be used as an effective tool for improving academic and behavioral development of students with ADHD. For this reason, this paper proposes a policy for implementing music intervention individually or in groups within the classroom.
References
American Music Therapy Association. (2013). NYSED clarifies music therapy as a related service. Web.
Anna Helle-Valle, Per-Einar Binder, Norman Anderssen, & Brynjulf Stige. (2017). Is restlessness best understood as a process? Reflecting on four boys’ restlessness during music therapy in kindergarten. International Journal of Qualitative Studies on Health & Well-Being, 12(0). Web.
Barkley, R. A. (2003). Issues in the diagnosis of attention-deficit/hyperactivity disorder in children. Brain and Development, 25(2), 77-83.
Cohen, N. S., & Behrens, G. A. (2002). The relationship between type of degree and professional status in clinical music therapists. Journal of Music Therapy, 39(3), 188-208.
Diagnostic and statistical manual of mental disorders: DSM-5. (2013). American Psychiatric Association.
Dymnikowa, M. (2017). Hemispheric music processing and learning efficiency improvement in children with ADHD and healthy during working aural musical memory training at its optimal maturity age. Asian Journal of Humanities and Social Studies, 5(3), 175-196.
Friedman, L. A., & Rapoport, J. L. (2015). Brain development in ADHD. Current Opinion in Neurobiology, 30(1), 106-111.
Gehricke, J. G., Kruggel, F., Thampipop, T., Alejo, S. D., Tatos, E., Fallon, J., & Muftuler, L. T. (2017). The brain anatomy of attention-deficit/hyperactivity disorder in young adults – A magnetic resonance imaging study. PLoS ONE, 12(4), 1–22. Web.
Ghetti, C. M. (2011). Clinical practice of dual-certified music therapists/child life specialists: A phenomenological study. Journal of Music Therapy, 48(3), 317-345.
Hosseini, S. E., & Hosseini, S. A. (2018). Therapeutic effects of music: A review. Report of Health Care Journal, 4(4), 1-13.
Humpal, M. E., Colwell, C., & American Music Therapy Association. (2006). AMTA Monograph Series – Effective Clinical Practice in Music Therapy Early Childhood and School Age Educational Settings. American Music Therapy Association.
Jones, S. K. (2015). Teaching students with disabilities: A review of music education research as it relates to the Individuals with Disabilities Education Act. Update: Applications of Research in Music Education, 34(1), 13-23.
Smith, J. (2018). Hidden in plain sight: A music therapist and music educator in a public school district. International Journal of Music Education, 36(2), 182-196.
Sze, S. (2005). Empowering students with disabilities through music integration in the classroom: Music therapy on student. Proceedings of the Academy of Educational Leadership, 10(1), 79-84.
Thompson, G. A. (2020). A grounded theory of music therapists’ approach to goal processes within their clinical practice. The Arts in Psychotherapy, 70.
Walker, H. M, & Gresham, F. M. (2014). Handbook of evidence-based practices for emotional and behavioral disorders : applications in schools. New York: The Guilford Press.
Wilson, B. L. (2002). Models of music therapy interventions in school settings. 2nd ed. Silver Spring, Md.: American Music Therapy Association.
The 2009 United States census report showed that 20% of the population was comprised of disabled individuals (U.S. Census Bureau, 2011). Most of these individuals are old people above the age of 60. Florida is among the states that has a high number of retired individuals in the US. It has a population of 18,537,969. This paper focuses on the needs of elderly women with disabilities in Fort Lauderdale, Florida. The town has a population of 183,374 people. Of this, 35,223 are above the age of 60 years. 52.6% of these individuals are females. With the high number of women with disabilities and the high medical costs, it is necessary to develop a health initiative plan that will ensure that their needs are met.
Health Problems of Women with Disabilities
Disability is a health condition which impairs the physical and mental well being of an individual. It affects almost all the dimensions of the life of a person. Most of the individuals who are disabled depend on other people to perform their daily routines. This may be family members, friends or neighbors. This dependency makes the community to view them as a burden and in the long run they are neglected by the society.
In Fort Lauderdale, disabled women above the age of 60 years are experiencing these conditions making their lives to be difficult especially while considering the fact that most of them had been physically fit for most of their lives. These women have been diagnosed with conditions such as with Haemophilus Influenza (2%), Hepatitis B (6%), Hepatitis C (21%), Strep Pneumonia (4%). At the same time 26.6% of them suffer from chronic illness such as heart diseases, arthritis, kidney failure and cancer (Center for Disease Control, 2011).
The current economic crisis that the world is experiencing has made the cost of living to be expensive. The impact of this economic crisis can be felt in the healthcare industry. The cost of medical treatment and drugs has increased tremendously. Despite the economic crisis, the cost of medical care has also increased due to the rise in the number of lawsuits filed against the physicians of the state. There has also been a lot of malpractice by the physicians which has made the cost of insurance premiums to rise. All these factors have made the cost of medical care go up (Department of Health, 2002).
Most of the elderly women of Fort Lauderdale cannot meet their medical expenses. Getting good services from doctors has been difficult due to the high insurance premiums that have increased the cost of these services. Doctors therefore avoid offering their services to individuals of this group (Bryant, 2002). The social security administration should therefore come up with an initiative which will ensure that affordable health services are provided to elderly women with disabilities. This will ensure that they have a comfortable and healthy life at their old age.
Proposed Health Initiative
A health initiative programme should be put in place to address the health needs of elderly women who are disabled. This programme should ensure that the cost of medical services is affordable to the people of this age group. Currently, there is a supplementary security income (SSI) plan in Fort Lauderdale that provides a relatively cheap health plan for the elderly people in the region. However, this plan only considers a small portion of elderly women as most of them are not eligible for the plan due to their low incomes. This plan should therefore be amended to include even those women who live below the poverty level. According to the census results of 2009, 16% of the elderly women live below the poverty line. These women are not covered by the current SSI plan. The proposed amendment to the plan should therefore include this idea. The plan should also ensure that the prices of prescription drugs are reduced by the government. The United States government should impose price controls on these drugs since they are essential to sustain the lives of disabled women. Price ceilings should be put to ensure that their prices do not exceed a certain limit. With proper price controls in place, the elderly women will be able to afford the cost of prescription drugs. This will ensure that they have a stable health condition.
An initiative should also be put in place to create disability awareness to the public. The public should be educated about disabilities and how to live with disabled individuals. They should be taught how to deal with people with disabilities, accept such individuals and treat them as part of their society. This will make the disabled people in the community, especially the elderly women, be accepted by the community. They will therefore have a comfortable life where they can associate with everyone in the society.
Conclusion
Disability is a condition which impairs an individual either physically or mentally. This condition is serious especially on the older individuals of the community. The condition is even worse to elderly women due to the rise in costs of drugs and medical services. Initiatives which will reduce the prices of drugs and medical services and create public awareness on disability should be put in place. This will ensure that people with disabilities live a normal life just like the rest of the people in the community.
References
Bryant, J. (2002). Malpractice rates sicken hospitals. Atlanta: Business Chronicle, 2 (1), 2-4.
Center for Disease Control. Communicable Disease Surveillance Data 2011. Web.
Department of Health. (2002). Assessing the needs of elder floridians. Web.
U.S. Census Bureau. (2011). Population Finder. American Fact Finder. Web.
Drozd and Clinch (2016) make it quite clear that in spite of the inclusion philosophy that has been promoted in nursing over the past few decades, the needs of patients with learning disabilities have been ignored, at best, and misinterpreted, at worst. The portrayal of the issues that the target members of the population have when accessing healthcare services can be viewed as the most convincing and a very well put together element of the research. Thus, the authors specify the dents in the current nursing approach toward people with learning disabilities (PLD). Much to the authors’ credit, they identify the effects that the current framework has on every single aspect of the patients’ lives. In addition, various implications for the nursing facilities, including the legal ones, are detailed.
It could be argued that Drozd and Clinch (2016) could have used a better focus on the outcomes that the strategy proposed by them is going to have on the well-being of the patients, as well as on the functioning of the nursing facilities. Moreover, although the idea of using auxiliary services seems very sensible, the tools for making the change and transferring to a new quality level have not been identified.
Despite several problems in the overall design of the strategy that can be used to improve the nursing services for PLD, Drozd and Clinch (2016) make a very valid point by stressing the significance of a change in the focus of the services. Isolating the needs of the target audience and tending to them so that PLD could receive the necessary support is a necessity at present, as it will create prerequisites for designing new therapy approaches.
Serving as a link between the community and the patients with disabilities, disability liaison nurses (DLN) can be considered of crucial significance in the therapy process, research by Gates and Snooden (2013) states. The authors insist that the outcomes of their study point clearly to the need to introduce PLD to the services of DLN so that the learning process could occur at a faster pace and that the patients could become more active in their communication with their community members. To be more accurate, the liaison framework serves as the foil for the mental capacity processes to speed up; as a result, the related issues are resolved at a much faster pace. In addition, the forming of a liaison can be viewed as the prerequisite for implementing holistic care, which is crucial in the progress of PLD.
The fact that Gates and Sooden (2013) focus on the effects that a comparatively recent approach has on the patients, as well as delineate the ways, in which it helps address the current issues in PLD care, can be considered a significant advantage. The authors of the study make it quite evident that the access-related problems that PLD typically have when searching for professional help can be easily avoided as long as the support of a DLN is provided to the identified patients. Moreover, the array of domains that the researchers cover in their analysis, including the ones linked to mental health, prescribed medications, chronic illnesses, etc., is beyond impressive. Although the possible nurse burnout issue should have been addressed, the study can be deemed as quite impressive. Therefore, the paper can be viewed as an essential addition to the literature on the subject matter.
McArthur et al. (2015) focuse on the provision of the corresponding nursing services to the PLD of a rather specific kind. The authors talk about male representatives of the target population, mentioning the outcomes of the Getting It Right program and indicating that the access to information is the primary focus of Learning Disability Liaison Nurses (LDLN).
The significance of the study as a contribution to the understanding of the needs of people with disabilities cannot possibly be underrated since the study evaluates the effects of the most recent program and the latest approaches designed to meet the needs of PLD. For instance, the research findings emphasize the need for collaboration between the general health services and the facilities providing specialist learning disability assistance.
However, one must admit that the study has a very specific limitation. Going into detail, one should note that the sampling process might have been a touch biased since the selection of the participants was based on the referrals to the LDLNs and, therefore, could not be deemed as fully trustworthy. Nevertheless, the research can be viewed as a significant addition to the existing knowledge of PLD and their needs. The study served as the tool for getting a general idea about how the problem under analysis could be approached. For instance, the connection between the specific needs of PLD and their needs within the context of general nursing services has been identified. As a result, a better and a deeper insight on the characteristics of PLD and the factors that shape their development can be gained.
According to the authors of the study, the necessity for consistent communication is the key need of PLD, which is often dismissed by a range of nurses as the one that is not on the list of the crucial items to be considered. The results of the quantitative analysis of the questionnaire data show quite graphically that PLD need conversations to develop and train the necessary social and cognitive skills. For instance, they need to be talked to, they must ask questions and receive proper answers, they need someone to listen to so that they could learn the basics of active listening, etc.
The fact that Lewis et al. (2013) do not shy away from the economic aspect of the issue and make it quite transparent that the financial costs are going to be rather drastic can be considered among the key advantages of the article. While the aspect of communication as the mechanism for treating PLD is not new, the economic concerns are rarely brought up. Therefore, the focus on the subject matter can be considered a step forward in creating premises for an improvement of the services offered to PLD.
However, the range of approaches to be used as the means of treatment could be a bit wider. For instance, other strategies could be mentioned along with the description of the role-plays. Nevertheless, the study can be deemed as compelling and inspiring. It may serve as a foundation for an even greater analysis of the subject matter, thus opening a plethora of opportunities for a new therapeutic approach.
Reference List
Drozd, M., & Clinch, C. (2016). The experiences of orthopaedic and trauma nurses who have cared for adults with a learning disability. International Journal of Orthopaedics and Trauma Nursing, 22(1), 13-23. Web.
Gates, B., & Sooden, R. D. (2013). Experiences of the implementation of a learning disability nursing liaison service within an acute hospital setting: A service evaluation. British Journal of Learning Disabilities, 40(4), 318-327. Web.
Lewis, D., O’Boyle-Duggan, M., Chapman, J., Dee, P., Seiner, K.,& Gorman, S. (2013). Putting Words into Action’ project: Using role play in skills training. British Journal of Nursing, 22(11), 638-644. Web.
McArthur, J., Brown, M., McKechanie, A., Mack, S., Hayes, M., & Fletcher, J. (2015). Making reasonable and achievable adjustments: the contributions of learning disability liaison nurses in ‘Getting it right’ for people with learning disabilities receiving general hospitals care. Journal of Advanced Nursing, 71(7), 1552-1563. Web.
As a student aiming at becoming a Nurse Practitioner, I am currently focusing on the exploration of the options for managing the work of the nursing staff, as well as seeking the opportunities for improving their competencies and identifying the ways to enhance the efficacy of the nursing services provided. Therefore, I believe that the issue of management, in general, and communication along with the conflict-resolving strategies, in particular, are essential in enhancing the overall nursing services quality. Despite the recent technological and research-related breakthroughs and the following numerous discoveries that swept the realm of nursing, there are a lot of white spots that need to be filled. Focusing on the issues that need to be addressed and designing the framework that will help increase the quality standards in the designated area should be the key priority for Nurse Practitioners at present.
Literature Review and the Problem
An overview of the recent nursing studies has shown that the issue of tending to the needs of people with learning disabilities is currently among the primary concerns. Although the number of patients with the identified diagnosis is getting increasingly larger, the number of solutions concerning the services that a Nursing Practitioner can provide to the target audience is very small (Sheehan et al., 2016).
For the most part, the current studies point to the necessity for creating a safe environment for the identified type of patients (Beaver, 2014). Although an admittedly important goal, the identified approach does not imply that the patient is capable of acquiring the basic skills at a moderate pace and using them correspondingly. Instead, the current nursing approaches tend to create the environment, in which the patient does not feel the urge to evolve and, therefore, prefers to maintain a consistent lack of the proper abilities.
The fact that patients with learning disabilities are often underrated as learners should also be brought up (Keller, Fisher, Marks, & Hsieh, 2014). A recent study points to the fact that people with specific learning disabilities may show impressive skills in other domains and, in fact, be capable of acquiring information in a rather fast manner. However, nurses tend to overlook the identified specifics of the patients’ learning capacities, therefore, blocking their way to success in developing the necessary skills.
Differently put, the current framework of catering to the needs of people with learning disabilities requires a reconsideration as it is based on the erroneous premise that the target audience is incapable of acquiring basic learning skills and cannot possibly have any talents. Therefore, it is necessary to design the approach that will promote active engagement of people with learning disabilities into the process of information and skills acquisition.
Potential Innovation
In order to address the problem identified above, the concept of crossing networks could be brought up. By definition, the subject matter implies creating the communication platform on which people with learning disabilities, i.e., both intellectual and developmental ones, may converse and share their knowledge and experiences. It is expected that the framework of crossing networks will serve as the foundation for building the participants’ enthusiasm about the idea of communication and knowledge and skills acquisition. Moreover, the platform will create the breeding grounds for sparking the patients’ social engagement and encouraging them to device specific communication, negotiation, and conflict-solving strategies that will allow them to converse with others successfully.
Reference List
Beaver, M. A. (2014). Project GRANDD revisited: A community-based service learning experience for nurse practitioner students. International Journal of Child Health and Human Development, 7(3), 331-335.
Keller, T., Fisher, D., Marks, B., & Hsieh, K. (2014). Interventions to promote health: Crossing networks of intellectual and developmental disabilities and aging. Disability and Health Journal, 7(1), 24-32.
Sheehan,R., Gandesha, A., Hassiotis, A., Gallagher, P., Burnell, M., Jones, G.,… & Crawford, N. J. (2016). An audit of the quality of inpatient care for adults with learning disability in the UK. BMJ Open, 6(4), 1-7.
People with developmental disabilities face numerous barriers when dealing with physicians.
Poor communication.
Short visit durations.
Insufficient patient information.
Lack of patient proper education.
People with developmental disabilities are likely to face numerous barriers when accessing healthcare services, specifically from physicians. The barriers to the access of satisfactory healthcare services among such individuals fall within broad themes. According to McClintock et al. (2016), some of these themes include poor coordination among different care providers, short durations during physician visits, giving insufficient information to patients, and failure to educate patients thoroughly. When dealing with patients with developmental problems, physicians may contribute significantly to these barriers, with or without their knowledge. Therefore, it is important to highlight these problems for physicians to be aware and come up with ways of addressing them for improved patient outcomes and satisfaction.
Issues Faced by Individuals with Developmental Disabilities
Communication barriers:
Poor physician-patient communication;
Use of technical language by physicians;
Patients feel neglected or invisible to physicians;
Short visitation durations:
Patients do not stay long enough with physicians;
Lack of long and fruitful conversations;
Patients get inadequate information;
Non-compliance to treatment;
Patient education:
Lack of proper patient education;
Other barriers:
Lack of health insurance and finances;
Poor transportation;
Inaccessible facilities.
McClintock et al. (2015) argue that communication between patients with developmental disabilities and physicians is a common problem hindering the provision of quality care services. For instance, it may be difficult for physicians to communicate clearly with autistic patients (Dern & Sappok, 2016). Besides, physicians are known to use technical language, which might not be understood by patients with developmental disabilities, thus affecting the effectiveness of the communication. McClintock et al. (2018) argue that people with developmental problems are likely to communicate in ways that are different from what is used by those without the same health problems, and this aspect affects communication with healthcare providers. As such, some patients may feel neglected or invisible to physicians, thus affecting the quality of care provided and received, which ultimately leads to poor or negative outcomes.
People with developmental disabilities are likely to be in physicians’ office for a short time. McClintock et al. (2018) posit that healthcare providers may lack the requisite skills to engage such patients in long conversations. Therefore, these patients may spend brief periods with their physicians because long and fruitful conversations cannot be sustained. Consequently, the physician may fail to recognize some health conditions among such patients due to the lack of time to listen and learn from one another. This problem is linked to the barrier of patients receiving inadequate information from physicians. Roll (2018) found that when patients get insufficient information from care providers, they are likely to be non-compliant to directives, and this aspect leads to poor outcomes due to the affected quality of care.
In a study conducted by Selick, Durbin, Casson, Lee, and Lunsky (2018), healthcare providers noted that they face numerous challenges during patient education especially when dealing with people with developmental disabilities. Therefore, physicians are likely to face the same problems and fail to carry out the necessary patient education, thus affecting care outcomes negatively. Williamson, Contreras, Rodriguez, Smith, and Perkins (2017) argue that people with developmental disabilities face a myriad of problems, such as lack of health insurance coverage, insufficient finances, transportation, and inaccessible facilities. While physicians may be ready to serve such patients, their service delivery is hindered. These barriers ultimately affect the quality of care that physicians render to patients with developmental disabilities (Whittle, Fisher, Reppermund, Lenroot, & Trollor, 2018).
Needs, Competencies and Recommendations
Communication skills:
Physicians should be patient-centered;
patience;
Use of assistive technology;
Length of visitation duration:
Enough time allocation for patient visits;
Proper understanding of patient needs;
Training office staff members;
Patient education:
Proper patient education is needed;
Tailored patient education programs based on needs;
Emotional and physical support needed.
Physicians have a duty to provide quality care to all patients regardless of whether they have developmental disabilities or not. Therefore, some core competencies are needed to enable physicians to render their services competently. Concerning communication barriers, physicians should focus on patient-centered service delivery. As such, despite the efforts and time needed to communicate effectively with patients with developmental disabilities, physicians will be patient enough to ensure that the message is passed across and received by the recipient. Besides, physicians should encourage the use of assistive technology where possible. For instance, patients with hearing or speaking impairments may use technological devices to facilitate their communication with health care providers.
Concerning the length of time that patients have during their visits to care facilities, physicians should exercise patience to ensure that they give enough time for quality care services. Physicians should be competent enough to understand different patient needs. As such, physicians should discuss with patients and implement customized care plans to ensure compliance with treatment and positive outcomes. Besides, physicians should ensure that office staff members are trained on how to handle patients with different needs. For instance, when scheduling for visits, office telephone staff members should identify patients with special needs and allocate sufficient time with the physician. Physician-patient interaction should be healthy and fruitful at all times to facilitate appropriate care provision and positive outcomes.
On patient education, physicians should communicate in a way that allows patients to understand and synthesize information. For instance, if a patient has short attention spans, the physician should give the most important information immediately after their meeting has started. Patients could also be asked to give feedback to ensure that they have understood what has been said. In cases when dealing with individuals with vision problems, colored print or large fonts could be used to facilitate patient educations. Ultimately, physicians should be competent enough to offer the required emotional, physicals, and psychological support that patients need to overcome their health challenges. Family members and friends should be involved where necessary.
Questions to Other Presenters
Role of healthcare providers in access to care services.
Role of advocacy in promoting access to care services.
References
Dern, S., & Sappok, T. (2016). Barriers to healthcare for people on the autism spectrum. Advances in Autism, 2(1), 2-11.
McClintock, H. F., Barg, F. K., Katz, S. P., Stineman, M. G., Krueger, A., Colletti, P. M., … Bogner, H. R. (2015). Health care experiences and perceptions among people with and without disabilities. Disability and Health Journal, 9(1), 74-82.
McClintock, H. F., Kurichi, J. E., Barg, F. K., Krueger, A., Colletti, P. M., Wearing, K. A., & Bogner, H. R. (2018). Health care access and quality for persons with disability: Patient and provider recommendations. Disability and Health Journal, 11(3), 382-389.
Roll, A. E. (2018). Health promotion for people with intellectual disabilities – A concept analysis. Scandinavian Journal of Caring Sciences, 32(1), 422-429.
Selick, A., Durbin, J., Casson, I., Lee, J., & Lunsky, Y. (2018). Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: What do staff tell us? Health Promotion and Chronic Disease Prevention in Canada, 38(10), 349-357.
Whittle, E., Fisher, K., Reppermund, S., Lenroot, R., & Trollor, J. (2018). Barriers and enablers to accessing mental health services for people with intellectual disability: A scoping review. Journal of Mental Health Research in Intellectual Disabilities, 11(1), 69-102.
Williamson, H. J., Contreras, G. M., Rodriguez, E. S., Smith, J. M., & Perkins, E. A. (2017). Health care access for adults with intellectual and developmental disabilities: A scoping review. Occupation, Participation and Health, 37(4), 227-236.
In today’s progressive society, people with disabilities are fortunate enough to have the same quality of life as people without disabilities. In the “Challenge” tab, I saw a video showing various photos of people with disabilities (Iris Center, 2021). These pictures leave a positive impression, as people look happy and content with their lives. I think that these people are powerful and inspiring, as they prove to the world that it is possible to live life to the fullest with a disability. The perception of such people, particularly children, by those around them plays a significant role in shaping their personality and their success in life. For example, if people treat a child with a disability as incapable of doing anything independently, he will grow up to be inhibited and unlikely to succeed. If he is treated as equal, he will develop a good self-image and achieve a lot in life.
If I had children with disabilities in my class, I would do everything I could to ensure they do not feel left out or restricted. If I were making a film about a blind person, I would focus on their forms of perception of reality, such as hearing, and touch. I would want to show that even though they perceive the world in a slightly different way, they are still an independent and versatile person. I would like to avoid the stereotype that blind people cannot take care of themselves or that if a person loses their sight, they lose their happiness in life. I want to show that disability is not a sentence but an opportunity to start valuing your life even more.
Health care disparities affect numerous minorities in the United States, and one of them is people with intellectual and developmental disabilities. Such individuals face a variety of challenges in their lives, including problems with access to medical services.
People with intellectual disabilities often lack the capacity to act consciously in a complex environment. As a result, they become dependent on other people who must assist them in getting all essential medical procedures. In addition to health care disparities, such as poor access to care, including preventive one, and dependency, people with disabilities also face higher morbidity and lack of insurance (Robinson et al., 2012). Although people with developmental disabilities are eligible for Medicaid insurance, health care providers often limit the number of such patients.
In addition to biological factors contributing to health care disparities in people with disabilities, there are also non-biological ones. For instance, people with disabilities often experience a lack of financial resources because they are unable to work. As a result, they lack the ability to afford the services of healthcare specialists and have to rely on the help of relatives and friends. Medical social workers can address this factor by assisting people with disabilities in receiving social benefits and other types of public support. Another factor is public health policy, which is evident in the example with the Medicaid insurance mentioned above.
Although there are government initiatives, such as insurance coverage for people with disabilities, such policies are poorly enforced. Medical social workers can address the factor by helping the patient cope with the complex health system since it is one of their primary work functions (Ruth et al., 2019). Finally, social workers also can address the factor of poorly-trained home caregivers who often neglect the health issues of the population in question. Social workers can provide the knowledge and skills necessary to detect health problems in patients with disabilities early.
References
Robinson, L. M., Dauenhauer, J., Bishop, K. M., & Baxter, J. (2012). Growing health disparities for persons who are aging with intellectual and developmental disabilities: The social work linchpin. Journal of Gerontological Social Work, 55(2), 175–190. Web.
Ruth, B., Wachman, M., & Marshall, J. (2019). Public health social work. In S. Gehlert & T. Browne (Eds.), Handbook of health social work (3d ed.) (pp. 93–118). John Wiley & Sons.
Currently, civilized countries are trying to solve social problems associated with the growing number of people with disabilities based on a research approach, the use of material and technical means, and national and public programs. In addition, various technologies are being developed for people with disabilities to facilitate existence and make life more comfortable. Undoubtedly, there are multiple diseases and limitations that people suffer from, and therefore various technologies are being developed, for example, for the hearing impaired, blind, or unable to move. The most interesting recent developments are the technology of a motorized exoskeleton and a keyboard with laser pointer activation.
Motorized Exoskeleton Technology
Motorized Exoskeleton Technology allows people who are unable to move without the help of a wheelchair to walk independently again. The system works by activating sensors that record the position of the body and the tilt of the upper part (AccessiBe, 2019). This technology will also be able to help patients recover from severe injuries. This information will help the rehabilitation consultant to demonstrate that patients with a probability of recovery have a reliable device that will help them return to their previous life. As for patients who will no longer be able to move, the rehabilitation consultant will be able to give recommendations on how they will be able to provide themselves with the necessary movements.
Laser pointer-activated keyboard technology has been developed for patients who suffer from quadriplegia, which is also a form of paralysis. Patients with this disease cannot independently control the mouse when working with a computer, and therefore it is difficult for them to use a laptop (AccessiBe, 2020). This technology allows to control the computer without using hands since the keyboard works under the influence of a laser, which is installed on the patient’s head (AccessiBe, 2019). A rehabilitation consultant will be able to recommend this equipment to people who are acutely worried about the inability to use a computer and the Internet to ensure a comfortable life.
Conclusion
In conclusion, technology evolves and makes people’s lives easier and more comfortable. Especially convenience is necessary for people who suffer from various diseases and do not have the opportunity to live like healthy people. Technologies for people with disabilities also do not stand still and are regularly updated, allowing people suffering from any diseases to feel better and have approximately equal opportunities with ordinary people.
