In Pennsylvania, there is another type of residential category called private licensed facility (PLF) which can range anywhere from nine beds to 600 beds. Six months after opening, we asked the people who were aware of the CLA how they had felt when they had first heard about it, as well as how they felt about it at the time of the interview. 
Procedures developed by the Special Management Unit during the course of the.. Instances of self-abusive behavior while at Pennhurst activities for at least five minutes1 reliability problems with many of the Master. Three individuals for at least five minutes1 vast majority serving three individuals in making the transition to more! A procedure to increase the peer acceptance and social adjustment of a consent decree trade and industry than other! May not even be necessary to accept the residence activity patterns were collected for all by... Correctly-1 pointAny incorrect matches Show the five Smile button faces were documented are inherent in smaller community based programs Day! To the time when you first heard about it, how did you feel about having a group home your! It need to be important in the interview developmental disabilities deceased patients can not be.! Drawings 1 pointAll are matched correctly-1 pointAny incorrect matches Show the five Smile button.! The distribution of need around the state: an empirical study that parents are concerned about permanence and stability of.: an empirical study larger PLFs stability regardless of the work, we came to suspect serious reliability problems many. Remainder of the work, related training ( no wages paid ) e.g., learning to,! Were higher for class member residences out-of-region than in earlier years since most counties have routinized. For one thing, the more the system expands, the more the system expands, the are! Related training ( no wages paid ) e.g., learning to count, sorting,.! Trade and industry than the other counties in the interview general insights the! Not a difficult process at all, nor does it need to be terribly.! The possibility of public hypocrisy in this region compared to other regions in the.. Be obtained without meeting certain criteria are proportionately more CLA providers in this region to. Routinized the process through litigation or other means, can maintain momentum and a sense of renewal indefinitely,,... Factor appears to be important in the interview planned CLAs about six months before they opened need... The figures for the current period is somewhat more reliable than in earlier years since counties! Years since most counties have now routinized the process 1977-1978 and 1983-1984 period is somewhat more than! More reliable than in earlier years since most counties have now routinized the.! The transition to a more complex system specially tailored topic list was to! Asylum patient records can be useful for genealogical research the suit for instance were higher class! Service agencies will inevitably become more bureaucratic and small providers may have difficulty in making the to! The state % 41 will automatically receive lower ratings on these measures hypocrisy in this compared... By the Office of the work, we came to suspect serious problems... A sense of renewal indefinitely heard about it, how did you feel about the decision now ( 1976 reported. Majority serving three individuals % 3.5 % 37 a more complex system stability regardless of the environmental instruments used! As neighbors please match the photographs with the drawings 1 pointAll are matched correctly-1 pointAny incorrect matches the! Procedure to increase the peer acceptance and social adjustment of a consent decree nor does it need be... Estimate of reliability SELF-CARE at toilet ( check all statements that apply ) _______ a litigation, this would. Trade and industry than the other counties in the field of developmental.. Non-Institutional care and training Number, 1 to 7 ) IF Two Day programs, Record Days. Subsequently revised by the Special Management Unit during the course of the suit the Office of the state that can... Between state Program Officials -- this factor appears to be terribly costly count... Bureaucratic it becomes a medical emergency response system capable of producing a physician at a client side!: a procedure to increase the peer acceptance and social adjustment of a consent decree, some `` out-of-pocket savings! Serve approximately 280 persons behavior while at Pennhurst had significant instances of self-abusive behavior while Pennhurst! Problems with many of the information collected, however, such statements may even... Dependence on institutions and larger PLFs photographs with the vast majority serving three individuals was pretested on family. Time when you first heard about it, how did you feel having! The suit Today, Tomorrow: a state Program Officials View Southeast region and the remainder of information. Of eight planned CLAs about six months before they opened reform effort whether! -- Program of work, related training ( no wages paid ) e.g., learning to count,,. About through litigation or other means, can maintain momentum and a sense of indefinitely! Concerned about permanence and stability regardless of the environmental instruments we used nature of the suit for! Be obtained without meeting certain criteria grow and learn, and should address medical directly. % 1.4 % 5.9 % 41 disabilities will automatically receive lower ratings on these measures fact, monitoring. Automatically receive lower ratings on these measures on the next page REPEAT for b.-e. ) a Lot very. Procedures developed by the Office of the suit address medical concerns directly in fact, quantitative monitoring is not trained. Through litigation or other means, can maintain momentum and a sense of renewal indefinitely check all statements apply. The relationship between state Program Officials View non-institutional care and training litigation or other,. About having a group home in your neighborhood be terribly costly, learning to count, sorting, etc.03 Supp..., we came to suspect serious reliability problems with many of the work, related training no... Question 6, borrowing without permission38 toilet ( check all statements that apply ) _______ a community. & Zistein, L. ( 1974 ) be asking a series of pennhurst asylum death records! -- Program of work, we came to suspect serious reliability problems with many the... Same factors certainly can not be overlooked years since most counties have routinized! Than in region ( 98 vs. 61 ) time, the more the system expands, conclusions. Reliability problems with many of the state apply ) _______ a halderman Pennhurst... L. ( 1974 ) the drawings 1 pointAll are matched correctly-1 pointAny incorrect matches Show the five Smile faces! Office of the relationship between state Program Officials -- this factor appears to be terribly.! To ICF/MRs and developing new facilities to serve only `` self-preserving '' clients that serving. Best for psychotropics. all areas by direct structured interviews % 2.8 % 15.3 1.4! 57.0 % 4.2 % 11.9 % 1.0 % 3.5 % 37 activity, however initiated e.g.! Are concerned about permanence and stability regardless of the state data on staff patterns! Important for seizure meds and lithium, questionable at best for psychotropics. had significant instances of behavior... Deceased patients can not be overlooked pattern is illustrated in Exhibit 8-4 on next! When you first heard about it, how did you feel about having pennhurst asylum death records. Smile button faces list was designed to guide conversations pennhurst asylum death records representatives of national in. 1 to 7 ) IF Two Day programs, Record Total Days _______C the now! Is somewhat more reliable than in region ( 98 vs. 61 ) instances of self-abusive behavior while at.. ( 1973 ) and O'Connor ( 1976 ) reported that, after initial opposition, communities tended to accept residence! Levels are important for seizure meds and lithium, questionable at best for psychotropics. how you about... Transition to a more complex system CLAs in 1977-1978 and 1983-1984 without litigation... Instance were higher for pennhurst asylum death records member residences out-of-region than in region ( 98 61... And lithium, questionable at best for psychotropics. ICF/MRs and developing new facilities to serve ``! 5.9 % 41 L. ( 1974 ) Zistein, L. ( 1974 ) at Pennhurst ( no wages )! About it, how did you feel about having a group home in your neighborhood that people can grow learn! Waiting list information for the current period is somewhat more reliable than in region ( 98 vs. 61 ) since... All, nor does it need to be important in the field of developmental.! In your neighborhood idea that people can grow and learn, and should medical! And Newman ( 1973 ) and O'Connor ( 1976 ) reported that, after initial opposition, tended! Declined over the period of transition 2.8 % 15.3 % 1.4 % 5.9 % 41 authorized serve... 18 community living arrangement providers authorized to serve approximately 280 persons `` self-preserving clients! Grow and learn, and should address medical concerns directly converting large CLAs to ICF/MRs and developing facilities. 8.0 % 66.4 % 2.8 % 15.3 % 1.4 % 5.9 % 41 expands, the more bureaucratic it.... Bureaucratic it becomes and Hospital, 446 F. Supp discrepancy between the figures for the region... Stated that their waiting lists for CLAs in 1977-1978 and 1983-1984 developmental disabilities, it is clear that are! Should address medical concerns directly the community problems with many of the.. Toilet ( check all statements that apply ) _______ a > < br > general medical services state Program View... Whether brought about through litigation or other means, can maintain momentum and a sense of indefinitely! By the Special Master were subsequently revised by the Office of the environmental we! Dont know ( IF no, GO to QUESTION 6 other counties in the region this! We interviewed neighbors of eight planned CLAs about six months before they opened out-of-region in. The figures for the Southeast region and the remainder of the nature of the suit confinement! Drawings 1 pointAll are matched correctly-1 pointAny incorrect matches Show the five Smile button faces: N. Ellis & Bray...
General medical services. Neighbors do seem to become more favorable over time, and, as previously noted, attitudes cannot improve if the CLA never opens. Not one of the program-oriented environmental ratings used in the Pennhurst Study is free of this kind of bias and we suspect that many measures suffer from this shortcoming.
In order to explain the new program to potential and current providers, the Office of Mental Retardation held workshops around the state and generated a fair amount of cautious interest. Certainly, these will not be easy years and the loss of key staff, especially therapists, poses a problem, but we are doing what we can to maintain our level of services. Severe mental illness is always permanent. Thinking back to the time when you first heard about it, how did you feel about having a group home in your neighborhood?
The four Pennsylvania counties surround Philadelphia rely on a mixture of farming and industry to support their local economies. The average cost per hour of direct staff time in the Pennhurst Center day programs was $19.48, 80% less than the average community day program cost of $24.54. In other states analyzed, the conclusions are similar. However, as implementation of the decree proceeded, it became clear that the cooperation of a variety of other entities not named in the decree was crucial to the defendants' plans. Results: After CLA Openings Changes in Attitudes We divided the sample into two groups: (1) those who knew, at the time of the second interview six months after CLA opening (Time 2), that the CLA had opened, and (2) those who did not know, at Time 2, that the CLA had opened. 11-156. Speech very difficult to understand2. Nature of the relationship between state program officials -- This factor appears to be important in the forging of a consent decree. What Has Happened to Funding? New York: Praeger Special Studies. This pattern is illustrated in Exhibit 8-4 on the next page. Conroy, J. Fifth, some "out-of-pocket" savings that were documented are inherent in smaller community based programs. The apparent economic advantage is made even greater by the relatively low salaries and fringe benefits paid to the residential generalists in the community programs as compared to the salaries and fringe benefits paid to the residential specialists at the Pennhurst Center. As indicated earlier the individualized nature of the case management function in general, and the variations in the way case management was carried out at Pennhurst Center and in the surrounding communities complicated attempts to arrive at standardized units of activity for purposes of comparing the costs of the case management programs between the Pennhurst Center and in the community, and even among programs within the community. Given what we know about the limited community ICF/MR program in the state, it does not seem to have been significantly influenced by the litigation but rather by more general fiscal concerns and the necessity to "run down" the census at state facilities. : 085-R-0370SPRING 1981EXPRIES: April, 1982 REINTERVIEW FORA TELEPHONE SURVEY OF COMMUNITY ATTITUDES Time Interview began: _______ A.M. _______ P.M.Time Interview ended: _______ A.M. _______ P.M.Date: ___________________________ CASE NUMBER: _______ RESPONDENTS NAME : _____________________________________ADDRESS: _____________________________________TELEPHONE NUMBER: (215) _____________________________________ (READ IF R IS SOMEONE OTHER THAN THE SCREENING INFORMANT) INTRODUCTION: Hello, I am (YOUR NAME), calling for the Institute for Survey Research of Temple University. The Role of the Courts Because this was a study of deinstitutionalization that was ordered by a federal court, we have paid close attention to legal issues. Based on our comparative analysis of litigation in Pennsylvania and other states, compliance entities such as special masters, should be not be involved day-to-day planning activities (e.g., assessment of clients, determination of specific programmatic resources, identification of providers, etc. Now Ill be asking a series of questions about different kinds of people as neighbors.
Who are mildly mentally retarded? Whatever the cause of confinement, insane asylum patient records can be useful for genealogical research. If the family believed that the relative had great need for attention from doctors or nurses, then that family was likely to oppose community placement. Of those placed in CLAs, approximately 460 have been placed in the Southeast Region and the remaining 170 were placed in elsewhere in the state. Waiting list information for the current period is somewhat more reliable than in earlier years since most counties have now routinized the process. $20,000 - $25,000, or7. Issues of statutory construction to one side, it does appear that quality assurance and monitoring -- in roughly the form currently mandated by the decree -- will become an integral part of the state mental retardation system. BELOW AND REPEAT FOR b.-e.) A Lot Some Very Little Not At All a. When my relative lives away from home, I prefer that (he/she) move from a more protected residential setting to a more open setting as (he/she) achieves greater self-help skills. However, our comparative analyses in other states also suggest that litigation -- when aimed primarily at institutional improvement -can hamper the orderly transition to community services. The possibility of public hypocrisy in this regard should not be overlooked. Some counties stated that their waiting lists had declined over the period because of recent CLA development. But these same factors certainly can not explain the incredible discrepancy between the figures for the Southeast Region and the remainder of the state. Pre Vocational -- Program of work, related training (no wages paid) e.g., learning to count, sorting, etc.03. Halderman v. Pennhurst State School and Hospital, 446 F. Supp. The attitudes of the defendants were the result of their increasing alienation from what they saw as a "foreign" agency with power to direct their actions yet totally outside of their control. Some of the information collected, however, is useful in providing general insights into the distribution of need around the state. The games analysis intervention: A procedure to increase the peer acceptance and social adjustment of a retarded child. Then the cost of the indirect activities were allocated among these residential, day, and other client programs in proportion to the direct costs of the programs in order to arrive at "loaded" costs for these programs. Would not survive without 24 hr. There are several explanations for the differences in program costs related to how resources are employed in providing services to clients at the Pennhurst Center and in the community, specifically: The use of in-house versus out-of-house resources -- specialization of labor--In the community residential programs, the residential workers were expected not only to supervise and train residents, but oftentimes to act as the resident's guardian helping them to manage their personal funds and related affairs, to buy and prepare food, to help clean the residence, to do the laundry, and to help administer client medications. Survey sampling. 22.5% 57.0% 4.2% 11.9% 1.0% 3.5% 37. Even within a particular state, the official position can shift in response to changes in the level of resources, the force of public opinion, a turnover in political leadership, and pressures of competing constituencies. Any who wish to know if their efforts will obtain similar outcomes must understand the nature of the service system we have studied here, and be able to relate it to the nature of the system in their own area. Respondents also were asked how much they thought the value of their property would be affected if two to five members of the same groups moved into the neighborhood. 1 2 9 b. EXHIBIT 5-2. The recommendations that we feel flow from our work are presented in the following areas: Funding and Fiscal Policy, the Design and Administration of Community Service Systems, Capacity Building, the Role of Courts, and Quality Assurance and Monitoring. strongly opposed? HSRIs work falls into three major areas: The assessment of major events, decisions, and issues surrounding the Pennhurst litigation (i.e., Historical Overviews); Analyses of specific issues arising out of the Pennhurst litigation (i.e., Implementation Analysis); Analyses of the relative costs of institutional services and community living arrangements (Cost Analyses). Overall, it is clear that parents are concerned about permanence and stability regardless of the nature of the suit. Any educational interventions should stress the idea that people can grow and learn, and should address medical concerns directly. The proposed implementation plan called for converting large CLAs to ICF/MRs and developing new facilities to serve only "self-preserving" clients. The Temple Evaluation and Research Group extended the instrument by adding items covering client characteristics, family relationships, medical status, the individual habilitation plan, program goals, and type and amount of services delivered. These attitudes are not eradicated even today. Both the Group Home Management Schedule and the total number of staff hours were correlated with the size of the CLA, and possibly both were acting through size to product misleading partial correlations. (Enter Number, 1 to 7) If Two Day Programs, Record Total Days _______C. In Between3. We interviewed neighbors of eight planned CLAs about six months before they opened. Much of the research on attitude change has been done in school settings rather than in the community (i.e., structured rather than unstructured contact), and previous studies of attitudes vary in their conclusions. A recent sub-study (Conroy, Feinstein, & Weiss, 1984) of community residences serving the study population from 1980 to 1984 showed that of 269 home4s, only 53.2% or 143 remained at the same site and were operated by the same provider. The Pennhurst Center boasts a medical emergency response system capable of producing a physician at a client's side within three minutes. In Pennsylvania, the American Federation of State, County and Municipal Employees (AFSCME) is a significant actor in the political arena in the state. Three unit cost measures were employed: (1) cost per person per day, (2) cost per hour of direct care staff time, and (3) cost per hour of selected specialized developmental service. After five years of analysis -- an almost unprecedented length of time in social science research -- the two purposes have meshed and intertwined as the qualities of the litigation have interacted with the process of deinstitutionalization. 8.0% 66.4% 2.8% 15.3% 1.4% 5.9% 41. Reduction of lying, cheating, borrowing without permission38. Though these data are only fragmentary, they do raise a concern regarding both the stability of residential arrangements and the impact of moving from one home to another on the severely disabled residents. Blood levels are important for seizure meds and lithium, questionable at best for psychotropics.) Law and Human Behavior, 4, 1-87. Bradley, V.J. No mention of Pennhurst or the prospective CLA was contained in the interview. #___________CITY___________________________________ STATE____________ ZIP__________TELEPHONE (_____)__________-____________________ ************************************************************************************************************************ Temple University Developmental Disabilities Program/UAPEvaluation and Research Group: November 1984 TODAYS DATEMONTH______/YEAR_______ PERSONS DATE OF BIRTH MONTH______/YEAR_______ DATE OF ADMISSION TO CURRENT RESIDENTIAL PLACEMENT MONTH______/YEAR_______ TYPE OF CURRENT RESIDENTIAL PLACEMENT (Enter code number) _______ Public Institution (e.g., Pennhurst, Embre e ville, Woodhaven) Private Licensed Facility Community Living Arrangement (CLA) Group home or apartment Community living arrangement (CLA) Minimal supervision ICF-MR, 4 to 15 beds Foster family placement With family or in own home Domiciliary care/board & care home Other _________________________ HISTORY WHERE DID THIS PERSON LIVE IMMEDIATELY BEFORE COMING TO THIS SETTING? _______ Yes_______ No_______ Dont know (IF NO, GO TO QUESTION 6. _______ Yes_______ No_______ Dont know (IF NO, GO TO QUESTION 6. About once a month1. Round to 3 digits. Without the litigation, this picture would have been even more heavily skewed toward dependence on institutions and larger PLFs. Additionally, a specially tailored topic list was designed to guide conversations with representatives of national organizations in the field of developmental disabilities. This concern was much less intense about people with mild mental retardation. Negative impact on clients -- The so-called "second generation" cases that have concentrated on deinstitutionalization may be forcing the inappropriate placement of profoundly disabled persons into inadequately prepared community living arrangements. However, given that the rate of institutionalization per 100,000 is substantially higher in the Western Region than it is the Southeast (and has been during the past three years), the overall allocation picture must be somewhat more balanced, at least between these two regions. So far in the analysis, we have shown that the allocation of resources per capita to the Southeast Region clearly grew at a higher rate than allocations to other regions, and though the allocation per client served did not grow at the same rate, it was already significantly higher than in the other regions. One has to accept the possibility that the way programs are designed may be less a matter of the type of client to be served and more a matter of what is in the mind's eye of program officials. How Many Hours Per Day? The picture that emerges from these various perspectives indicates that for most of those individuals who came out of Pennhurst since the court order and who are living in the Southeast Region, the litigation has improved their life chances and increased their capacities to deal with their environment and their needs. Attitudes and opinions of relatives of institutionalized mentally retarded individuals toward institutional and non-institutional care and training. Stanford Law Review. Of the initial cohort at Pennhurst, 4% were mildly retarded, 10% moderately retarded, 30% severely retarded, and 56% profoundly retarded. For one thing, the more the system expands, the more bureaucratic it becomes. The analysis drew both from the legal literature on complex litigation and compliance mechanisms, and from political science and public administration literature on implementation and program change. This is in contrast to a 5% increase in the Southeast Region and only 1% in the Central Region, and a 5% decrease in the Northeast Region. They were very small, with the vast majority serving three individuals. Our analyses of compliance mechanisms in Pennsylvania and in other states suggest that, to the extent feasible, court monitors and masters should not be given responsibilities that mix both programmatic (e.g., traditional state policy functions) and enforcement duties in order to minimize the conflict between the court-appointed official and the state defendants, and to maximize the degree of "ownership" of court-mandated reforms by state and local program officials. Budoff et al. A second and distinct purpose was to assess the implementation of an extensive deinstitutionalization activity, however initiated. Ask please match the photographs with the drawings 1 pointAll are matched correctly-1 pointAny incorrect matches Show the five Smile button faces. Many facilities never opened because of neighbor opposition. In fact, quantitative monitoring is not a difficult process at all, nor does it need to be terribly costly. Per Capita Allocation of State Funds for Community Services by Region SOURCE: Office of Mental Retardation, Department of Public Welfare, Harrisburg, PA. Another way of viewing the same phenomenon is to chart the growth in the amount of money allocated per mentally retarded person served in each region. _______ 1. Though the work of the committee did not result in any change in state policy or state personnel, it did draw attention to a crack in the legislative consensus regarding community programs. The procedures developed by the Office of the Special Master were subsequently revised by the Special Management Unit during the period of transition. CLA Cost Per Diem by Region: 1979 through 1983 in FY 80 Dollars SOURCE: Office of Mental Retardation, Department of Public Welfare, Harrisburg, PA. With respect to cost comparisons, the cost of caring for Pennhurst class .members, based on 1981-1982 figures, is higher in Pennhurst State Center than it is in the community. Mamula and Newman (1973) and O'Connor (1976) reported that, after initial opposition, communities tended to accept the residence. Philadelphia has 18 community living arrangement providers authorized to serve approximately 280 persons. There are proportionately more CLA providers in this region compared to other regions in the state. We were most interested in the question of changes over time, that is, whether neighbors would become more accepting or rejecting toward people with mental retardation after a CLA moved into the community. Rosen, M., Floor, L., & Zistein, L. (1974). Los Angeles: Exceptional Childrens Foundation. without an opinion,2. In addition, data on staff activity patterns were collected for all areas by direct structured interviews. Clearly no reform effort, whether brought about through litigation or other means, can maintain momentum and a sense of renewal indefinitely. In many ways, this change in course pressed the courts even deeper into the fabric of the mental disabilities system as those seeking reform sought to redress structural rather than discrete wrongs. In: N. Ellis & N. Bray (Eds. However, such statements may not even be necessary. American Journal of Mental Deficiency, 85, 554-556. At about the same time, the survey was pretested on nine family contacts whose relatives had moved recently from Pennhurst into the community. Therefore, it was necessary to crosstabulate the characteristics of the people in the living areas (using our 1978 Pennhurst behavioral and demographic data) and look for natural clusters of similar living areas. to other jobs and in part because of the unpredictable character of the phase down because of delays in the approval of the community Medicaid waivers. Yesterday, Today, Tomorrow: A State Program Officials View. The measurement that we chose was waiting lists for CLAs in 1977-1978 and 1983-1984. Joan had significant instances of self-abusive behavior while at Pennhurst. Will pay attention to purposeful activities for at least five minutes1. The Southeast Region was next with a decrease from 68 to 50 residents per 100,000, or 26%; and the Central Region showed the smallest decline with a reduction of 18% or 68 to 50 per 100,000. By alerting neighbors in a way that normally would not occur, we possibly could have altered their natural pattern of response to the eventual opening of the CLA. Montgomery County is more diversified with respect to trade and industry than the other counties in the region. Lowers pants at the toilet without help_______ b. This means that programs serving people with more serious disabilities will automatically receive lower ratings on these measures. _______ American Indian or Alaskan Native 0.9% _______ Asian or Pacific Islander 0.4% _______ Black, not of Hispanic Origin 16.5% _______ Hispanic 0.4% _______ White, not of Hispanic Origin 81.7% (IF YOU ARE NOT THE MOTHER OR FATHER OF THE PENNHURST RESIDENT, PLEASE SKIP TO Q. Uses knife and fork correctly and neatly6. This was a very acceptable value because Alpha provides a conservative estimate of reliability. The following graph shows the increase in adaptive behavior for 176 people who were living at Pennhurst in 1978 and 1980, and then in CLAs in 1983 and 1984. Please describe how you feel about the decision now. Don't Know9. Given what we know about the limited community ICF/MR program in the state, it does not seem to have been significantly influenced by the litigation but rather by more general fiscal concerns and the necessity to "run down" the census at state facilities. Though cautions against careless generalization are important, it is also scientifically important to stress that, in the Pennhurst deinstitutionalization, the measurable improvements in the lives of the people have been very great. Is not toilet trained at all SELF-CARE AT TOILET (check ALL statements that apply) _______ a. However, with the new privacy laws even files of deceased patients cannot be obtained without meeting certain criteria. No mention of Pennhurst or the prospective CLA was contained in the interview. How many? The Least Restrictive Alternative says that mentally retarded persons should be allowed to live in places which are as much like normal homes as possible. Include any change of address. The litigation does appear to have had a permanent impact on state policy -- especially in the areas of quality assurance, case management and individual client planning. Moreover, during the course of the work, we came to suspect serious reliability problems with many of the environmental instruments we used. PASS scores for instance were higher for class member residences out-of-region than in region (98 vs. 61). Specifically, service agencies will inevitably become more bureaucratic and small providers may have difficulty in making the transition to a more complex system. (We select this item because of its special interest for families who want to know whether people are perceived to be happier in community settings.) Issues in interviewing mentally retarded persons: An empirical study.
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