Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice

Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice

Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice

Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice

Synopsis

One of the largest and most complex human services systems in Western nations has evolved to address the needs of people with developmental disabilities. In the U.S., for example, school budgets are stretched thin by legally mandated special education, and billions of Medicaid dollars annually are consumed by residential and professional services to this population. The temptation of a quick fix is strong. Many parents desperately seek the latest ideas and place pressure on program administrators, who often are not trained to think critically about the evidence base for intervention efforts. The problems of people with developmental disabilities have historically been targeted by a wide range of professionals who rely on clinical experience and intuition and do not submit their claims to the tests of scientific research. Professional entrepreneurs have energetically promoted their treatments to a public perhaps too trustful of those with credentials. Thus, families and their children are buffeted by reforms founded on belief and ideologically driven management. Services fluctuate with the currents of social movements and rapidly shifting philosophies of care as policymakers and providers strive for increased responsiveness and individualization. These forces affect not only where and how, but how well people are served. Too often, services are less effective than they could be, or worse, damaging to personal growth and quality of life. Many treatments are based on poorly understood or even disproven approaches. What approaches to early intervention, education, therapy, and remediation really help those with mental retardation and developmental disabilities improve their functioning and adaptation? And what approaches represent wastes of time, effort, and resources? This book brings together leading behavioral scientists and practitioners to focus light on the major controversies surrounding these questions. The authors review the origins, perpetuation, and resistance to scrutiny of questionable practices, and offer a clear rationale for appraising the quality of services. In an era of increasing accountability, no one with a professional stake in services to individuals with mental retardation and developmental disabilities can afford not to read this book.

Excerpt

Since approximately 1978, one of the largest and most complex, and costly, human services systems in the United States, indeed, in the world, has evolved to serve individuals with mental retardation and developmental disabilities. In the United States, this system, including child, family, and adult services, consumes billions of service dollars annually, at a level greatly disproportionate to the number of people with developmental disabilities served relative to the number of others served through other programs. The breadth and depth of the clinical field, and related research activities, attest to an extensive and now longstanding public policy commitment to the betterment of people with developmental disabilities in the United States and many other nations. At the same time, this field has certain essential features that are common to other human services and that challenge the fidelity and effectiveness of care at the individual, practitioner, provider agency, and local, state, and national service system levels. These features include shifting philosophical positions that often drive regulatory action and change where and how, but not how well, people with developmental disabilities are served; and a broad reliance on the least trained and experienced personnel as the primary agents of service. These features are perhaps inherent both in the nature of the work to be done, which relies on human agentry as a service delivery process, and on the constraints on resources that are determined first by public policy, and second by the costs of providing services in a manner that conforms to market standards in the general community. Manual labor is involved in much of the work that needs to be done on behalf of people with developmental disabilities, and this work is done in real time. There are fewer opportunities for teaching service recipients self-care skills and fewer educated consumers of services, and there is often a degree of antagonism toward professionals who incorrectly estimate the service needs or independence of people with developmental disabilities. There are also persisting tensions among those who advocate for services based on how much costly professional support is really needed. This is because some regard disability as merely a “state of mind” that requires only attitude change on the part of those without disabilities and view the . . .

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