Showing papers in "The Journal of The Association for Persons With Severe Handicaps in 2005"

Stress Levels and Adaptability in Parents of Toddlers with and without Autism Spectrum Disorders.

Abstract: The toddler years can be a particularly stressful time for all parents, however, parents of children with disabilities may experience additional sources of stress. Recent literature on early education for children with disabilities promotes inclusion with typical peers with increases in the availability of inclusive programs. However, little is known about early intervention inclusion programs and parental factors such as stress and adaptability. The current study expands the research for children with disabilities by investigating the associations of having a young child with an Autism Spectrum Disorder (ASD) on multiple dimensions of parental stress for mothers and fathers and how participation in an inclusive toddler program may be related to these stress levels. Results for this community sample are consistent with previous research indicating that that both mothers and fathers of children with ASD report significantly elevated levels of both child and parent related stress in comparison with parents of typically developing toddlers. Following their child's participation in the inclusion program, mothers of children with ASD report significant reductions in child-related stress but no reductions in the parent-related stress domain. No changes were seen with either child or parent domain for fathers. Lastly, a child's level of social skills was a significant predictor of childrelated maternal stress for children with autism. This pattern was not seen in fathers of these children. Implications for early intervention program modifications, such as increasing family support and incorporating adjunctive parent interventions for parents with elevated levels of stress are discussed.

Self-Determination and Individuals with Severe Disabilities: Re-examining Meanings and Misinterpretations.

Abstract: Although some progress has been made, the belief that students with severe cognitive and multiple disabilities will not or cannot become self-determined remains a barrier for many such students. Th...

Effects of Peer Support Interventions on Students' Access to the General Curriculum and Social Interactions.

Abstract: Peer support interventions are emerging as an effective alternative to traditional paraprofessional models for assisting students with moderate to severe disabilities to access the general curriculum. To contribute to the refinement of peer support interventions, we evaluated the impact of altering the number of participating peers on the social and academic outcomes of students with and without disabilities. Our findings indicated that changes in the configuration of peer support arrangements differentially affected student outcomes. Specifically, higher levels of social interaction and contact with the general curriculum were observed when students with disabilities worked with two peers relative to one peer. The additive benefits of a second peer provide guidance to educators concerning the implementation of peer support interventions in inclusive classrooms.

Increasing Social Interaction among Adolescents with Intellectual Disabilities and Their General Education Peers: Effective Interventions.

Abstract: Research indicates that peer interaction can have a substantial impact on the lives of adolescents with disabilities. However, social interaction among adolescents with intellectual disabilities and their general education peers typically occurs infrequently in secondary schools. This paper provides a critical analysis of twenty-six empirical interventions aimed at promoting social interaction among adolescents with intellectual disabilities and their general education peers in middle and high school settings. Findings are analyzed with regard to intervention components; student characteristics; interaction settings; measures of interaction; observation procedures; experimental designs; intervention components; and measures of generalization, social validity, and treatment integrity. Based upon findings from this literature, we present recommendations to guide future research and the development of effective social interaction interventions for adolescents with intellectual disabilities in middle and high...

Parent Practices in Facilitating Self-Determination Skills: The Influences of Culture, Socioeconomic Status, and Children's Special Education Status:

Abstract: This survey study investigated the influences of culture, socioeconomic status, and children's special education status on parents' engagement in fostering self-determination behaviors. Major findings included (a) children from Caucasian families were more involved in personal independence activities than Asian and African American children; (b) Asian and immigrant parents did not believe in exercising parental authority or emphasize family priorities as expected; and (c) parents with college degrees gave their children more opportunities to express their interests, make daily decisions that have important impacts on their life, and set personal goals than parents without college degrees. Similarly, parents of higher-income families were more likely to engage in practices that fostered their children's self-determination skills. Parents of students with disabilities, however, were less likely to engage in these practices. The implications of these findings are discussed.

A Review of Self-Determination Interventions with Individuals with Severe Disabilities

Abstract: A comprehensive review was conducted of intervention studies designed to teach component skills of self-determination to individuals with severe disabilities. Twenty-one articles were analyzed rega...

The Effectiveness of Contextually Supported Play Date Interactions between Children with Autism and Typically Developing Peers

Abstract: Difficulties with social interaction are characteristic of autism. This study presents data illustrating the use of motivational strategies in play dates to improve the quality of social interactions between children with autism and their typically developing peers. Specifically, a multiple baseline design across participants shows how a contextual support package implemented during play dates can promote reciprocal interactions and improve affect. These results support the use of intervention strategies that target the pivotal area of motivation and provide evidence for using play dates as a context for intervention. The findings are discussed in terms of promoting quality interactions and encouraging friendship development.

Paraprofessional Services for Students with Disabilities: A Legal Analysis of Issues.

Abstract: Concomitant with the increase in the number of paraprofessionals assisting students with disabilities is the emergence of legal issues pertaining to the need, selection, responsibilities, preparation, and supervision of those paraprofessionals. The purpose of this article is to provide a legal analysis of administrative and judicial decisions concerning these issues and to propose guidelines for ensuring appropriate paraprofessional involvement in the educational programs for students with disabilities.

Teachers' Perceptions of Alternate Assessments

Abstract: The purpose of this study was to examine teachers' perceptions of alternate assessments. A total of 983 teachers from five states participated in this study. The results suggest that teachers tended to agree that their students should be included in school accountability, but they did not agree with most items assessing the educational benefits of alternate assessments. Teachers reported that the most significant impact of alternate assessments is the increase in paperwork and demands on their time. In contrast, when teachers perceive alternate assessments counting in school accountability systems, more teachers report a positive impact for alternate assessments. Significant differences in positive impact of alternate assessment between testing approaches (i.e., portfolio, performance-based, checklist) were also found. Implications and recommendations are discussed

An Historical Perspective of Self-Determination in Special Education: Accomplishments and Challenges.

Abstract: Self-determination for people with severe disabilities first appears in the 1972 writing of Benget Nirje, where he came to the realization that they could and should have a role in their own choices (Shapiro, 1993). Nirje's writings called for a wide range of actions that would enable them to better control their lives and destinies, including choice and control over personal activities, education, independence, participation in decisions, and information upon which to make decisions and solve problems (Agran & Wehmeyer, 2003). Nirje equated self-determination with the respect and dignity to which all people are entitled. He identified making choices, asserting oneself, self-management, selfknowledge, decision making, self-advocacy, selfefficacy, self-regulation, autonomy, and independence (although often not using those terms) as the salient features of personal self-determination (Agran & Wehmeyer, 2003; Nirje, 1972).

The Impact of Siblings with Disabilities on Their Brothers and Sisters Pursuing a Career in Special Education.

Abstract: It is well known that growing up with a sibling who has a disability has both positive and negative impacts on the non-disabled sibling (Beckman, 2002; Fisman, Wolf, Ellison, & Freeman, 2000; Gans, 1997; McHugh, 2003). In fact, the concern for ameliorating the potential negative impacts on nondisabled siblings has been a major impetus for the development of sibling support groups and agencies serving families of children with disabilities for a number of years (Gallagher et al., 2000; Powell & Gallagher, 1993). This article reports on a project in which we explored this sibling experience from the perspective of those who chose to enter the field of special education. The current study involved interviews with 7 individuals who have chosen special education as a career in order to understand what may have contributed to this decision as well as how their experiences growing up with a brother or sister who has a disability influenced their work and their views of special education.

Effect of Continuous Improvement Training on Student Interaction and Engagement.

Abstract: This article describes a preliminary study investigating whether a specific awareness and training for six teacher-paraprofessional teams would have an effect on the inclusion of six students with ...

Deinstitutionalization in Two States: The Impact of Advocacy, Policy, and other Social Forces on Services for People with Developmental Disabilities

Abstract: This paper presents a comparative case study of diverse approaches to deinstitutionalization of developmental disabilities residential services in two Midwestern states. During the 1970s and 1980s,...

A Challenge to Self-Determination: Disagreement between the Vocational Choices Made by Individuals with Severe Disabilities and Their Caregivers.

Abstract: Individuals become self-determined when they are empowered to make choices that match their interests. But caregivers' perceptions of what they think individuals with severe disabilities like often direct vocational decision making. This choice by proxy denies individuals with disabilities an opportunity to become self-determined. We examined whether the vocational choices made by participants with severe cognitive disabilities matched the vocational choices caregivers made on their behalf. Eight participants with severe disabilities and 11 caregivers participated in this study. Caregivers ranked the top three settings, characteristics, and activities from a checklist of typical entry-level positions. By using the Choose and Take Action vocational assessment software, combined with watching or doing the job of their choice in the community, job seekers indicated their preferences. We compared job seekers' cumulative choices to those made by their caregivers. Results indicate that the choices made by indiv...

Informed Choice: The Catch-22 of Self-Determination.

Abstract: Self-determination has become an integral part of instruction and supports for individuals with severe disabilities (Agran, King-Sears, Wehmeyer, & Copeland, 2003; Martin & Marshall, 1995) as well as a key component of the Rehabilitation Act (Rogan, Novak, Mank, & Martin, 2002). An important component of selfdetermination has been choice. However, there is a potential ‘‘catch-22’’ regarding choice as a component of self-determination which needs further discussion in the literature. In general terms, catch-22 refers to a no-win situation. Wikipedia (http://en.wikipedia.org/wiki/Nowin-situation) describes a catch-22 as a no-win situation where a person has choices, but no choice leads to success and provides the ‘‘tongue-in-cheek’’ example of an executioner offering a condemned person the catch-22 choice of dying by being hanged, shot, or poisoned, where all choices lead to death. I am not suggesting that selfdetermination per se is a ‘‘no win’’ situation, but rather that self-determination can be used in ways so that it is in practice the antithesis of what it is intended to be. Choice-making is only one component associated with self-determination, and although it may arguably be the most frequently taught self-directed strategy, it is not necessarily the most important one. Choice has been defined as ‘‘the act of an individual’s selection of a preferred alternative from among several familiar options’’ (Shevin & Klein, 1984, p. 160). Choice requires alternatives. Informed choice has been defined as meaning that ‘‘useful information is provided in a clear and understandable manner about two or more reasonable options or the person has experience or the opportunity to gain experience to understand the benefit or risk of the options. If necessary, a person must be supported through education, role modeling and accommodation in order to have informed choice’’ (http://www.selfdetermination.com, November, 2005). The purpose of this article is to briefly articulate three issues relating to informed choice in self-determination: the necessary components of informed choice; lack of choices in systems; and the influence of communication ability. Necessary Components of Informed Choice What makes a choice ‘‘informed?’’ Is it based upon knowledge, options, experiences, and/or skills? Callahan and Mank (1998) state that true choice in employment depends on having preferences, information, options, and control. Since many people with severe disabilities have limited experiences in supported employment, residential, and/or community settings they may not be able to make a truly informed choice. An individual has to be aware of and have access to choices. If you only go bowling on Saturday mornings with 100 other people with severe disabilities through the Special Olympics then that may be your choice, but it is unlikely to be an informed one. For many people with severe disabilities, knowledge may not come through abstract lessons in a classroom, it may have to come through real experiences. That is, a picture of a job in a class setting is unlikely to provide enough information for the person to make an informed job choice, or engage in what has been described as lifestyle enhancement (Bambara, 2004; LohrmannO’Rourke, Browder,&Brown, 2000). Sincemany choices are activity based, it is necessary that the individual experience a variety of activities with appropriate supports in order to make choices (Newton, Ard, & Horner, 1993; Wilcox & Bellamy, 1987). These experiences should sample the range of activities that are available in the local community. It is not clear how many times an individual must access an activity in order to make an informed choice regarding that activity. However, as noted by Skinner (1971), for guidance to be effective, control must be exerted. Even to arrange opportunities is a form of control, even if it increases the likelihood that behavior (e.g., choicemaking) will be emitted. Some individuals may have made an informed choice but without provision of appropriate supports will be unable to access that choice. For instance, an individual may want to join an aerobics class but if they can not get to the class then that choice becomes meaningless. Thus, appropriate supports must be available for implementing the person’s choice. It is important to evaluate what skills are required for an informed choice. There are self-determination curricula available (Sale & Martin, 2004), but if a person hasn’t acquired necessary skills then are they making an informed choice? Just because an individual has been Address all correspondence and requests for reprints to Keith Storey, Touro University, College of Education, 1310 Johnson Lane, Vallejo, CA 94592. Email: kstorey@touro.edu Research & Practice for Persons with Severe Disabilities 2005, Vol. 30, No. 4, 232–234 copyright 2005 by TASH

Peer-Mediated Conversational Repair in Students with Moderate and Severe Disabilities.

Abstract: Conversation skills are critical to learning and the development of social relationships. Some students with severe disabilities have a difficult time conversing with their nondisabled classmates b...

Self-Determination by Individuals with Severe Disabilities: Limitations or Excuses?:

Abstract: The five manuscripts in this special issue provide a helpful discussion of the status of the professional disability field with regard to understanding and advancing self-determination, and they remind me of the numerous barriers that keep individuals with severe disabilities from opportunities to determine and act upon their lives. As a professional with disability who has devoted much of my career to this topic, I am not particularly satisfied about what we have accomplished. However, despite my cynicism and as detailed by the authors, progress has been achieved in key areas. For example, several interrelated theories of selfdetermination have been articulated. We have documented the restricted opportunities that many individuals with disabilities, especially those with severe disabilities, have in expressing self-determination. Instructional approaches have been identified to assist individuals to learn skills associated with the expression of self-determination. And there is growing validation of the association between self-determination and achievement of life outcomes valued by Western society. Mike Ward provides a comprehensive overview of the above achievements, many of which were spearheaded by key federal educational initiatives in selfdetermination over the past 15 years, as well as the key role of self-determination for increasing student success in general education. Ward and Wehmeyer highlight a recurring barrier facing students with severe disabilities; that is, too many professionals do not believe in their capacities for self-determination and fail to affirm or recognize their preferences. Ward shares his perspective that successful approaches include systematic instruction in self-determination and providing real choices and opportunities to practice skills, coupled with letting go of assumptions about what students can do. He reminds us that self-determination is owned by an individual; it is not a program, and strategies such as person-centered planning and brokering are just tools for enabling individuals to express self-determination. Ward highlights the dichotomy between selfdetermination and protection and challenges professionals, family members, and adult service systems to truly support persons with severe disabilities to have life options. As reflected by the title of his paper, “Inching Toward Self-Determination . . . ,” Jim Martin and his colleagues highlight the gradual progress that has been achieved in infusing self-determination opportunities within transition preparation, particularly for employment. He describes the evolution in transition preparation from placing students in any job to self-directed employment, as well as advancements in strategies for employment preference assessment. Martin also makes the familiar call for students with severe disabilities to have real opportunities for meaningful life choices. He challenges predominant approaches to career planning with individuals who have severe disabilities— observation and decision making by professionals and family members—by reporting findings from a smallscale study that documents widespread disagreement in vocational choice by individuals with severe disabilities and their “caregivers,” and promotes the use of technology as a medium for directly assessing student preferences. Dalun Zang discusses cultural perspectives on selfdetermination, reporting findings from another smallscale study comparing reports of self-determination– related behaviors and beliefs of parents of children with and without disabilities from different cultures and between first-generation immigrants and nonimmigrants. His findings are somewhat divergent from prior research and predominant cultural assumptions. For example, as might be expected, nonimmigrant parents and parents with higher levels of education and income reported that their children did more chores, dealt with salespeople, and made more important daily decisions than parents with less education reported for their children. Likewise, parents of students in special education generally reported allowing their children fewer opporAddress all correspondence and requests for reprints to Laurie E. Powers, PhD, Professor of Social Work and Social Research, Portland State University, P.O. Box 751, Portland, OR 97207. E-mail: powersl@pdx.edu. Research & Practice for Persons with Severe Disabilities copyright 2005 by 2005, Vol. 30, No. 3, 168–172 TASH

Introduction to Special Issue: Self-Determination Reexamined are People with Severe Disabilities Any More Self-Determined? Introduction to the Special Issue on Self-Determination: How Far Have We Come?:

Abstract: Eight years ago, in the spring 1998 issue of RPSD (then the Journal of the Association for Persons with Severe Handicaps), we coedited a special issue on selfdetermination and its relation to persons with severe disabilities. We started by defining self-determination and placing its contribution historically in the development of services and programs for individuals with substantial support needs. We also asked, “Is selfdetermination signaling a systems change?” Seven years later, in the fall of 2005, we don’t believe we need to provide the same background information or ask the same question. Self-determination as a concept has become both pervasive and universally accepted in the field of special education and adult services for people with disabilities. A systems change has occurred in that current federal education and rehabilitation legislation mandates that self-determination, as both a process (skills and support) and outcome (goals and performance), be included in a person’s daily programmatic activities. For example, the Individuals with Disabilities Education Act (IDEA) Amendments of 1997 and 2004 require that students’ interests and preferences be incorporated into their individualized education programs (IEPs) and transition services and activities. Students must be invited to their IEP meetings if their postsecondary goals are the purpose of the meeting. If a student cannot attend the meeting, steps must be taken to ensure that the student’s interests and preferences are considered. Furthermore, professional journals (e.g., Education and Training in Developmental Disabilities, Exceptional Children, RPSD) and introductory textbooks in special education, psychology, secondary transition, and rehabilitation have published empirical findings that support the relation between teaching self-determination skills (e.g., self-monitoring, choice making, goal setting) and improved outcomes for persons with disabilities. Additionally, there are a number of curricula and texts written by several authors in this issue that describe systematic procedures to teach students with cognitive and multiple disabilities how to set their own goals, regulate their own behavior, and advance their personal agendas. Nevertheless, despite the legislative mandates and professional literature that support self-determination as a growing movement in the severe disabilities field, a number of researchers suggest that self-determination is not a universal component of educational practice. Wehmeyer, Agran, and Hughes (2000) showed us that even though practitioners value self-determination as a skill for their students, they generally report that they Address all correspondence and requests for reprints to Martin Agran, Department of Special Education, University of Wyoming, McWhinnie 222, 1000 E. University Ave., Laramie, WY 82071. E-mail: magran@uwyo.edu Research & Practice for Persons with Severe Disabilities copyright 2005 by 2005, Vol. 30, No. 3, 105–107 TASH

On Persistent Pursuits of Self-Interest.

Abstract: From my vantage point, self-determination is characteristic of all us humans regardless of our capabilities, disabilities, or idiosyncrasies. It is evident when we act on our circumstances to get what we need or want and when we persist in those pursuits until situations change in the right direction for us. It is accurately represented by the phrase persistent pursuits of selfinterest, and by how we regulate our expectations, choices, and actions to engage those pursuits. And it is protected by policy, law, and the equal protection clause of the Fourteenth Amendment to the Constitution—and of course it is idealized by the Declaration of Independence claim, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness” [italics added] (Mithaug, 1996a). This is the perspective on self-determination I have advanced over the years (Mithaug, 1991, 1993, 1996a,b, 1998a,b, 2003), and I found it useful here in commenting on the articles in this issue. For example, the article by Martin, Woods, Sylvester, and Gardner (2005) led me to consider the possibility that choice opportunities are the only means of reversing the other-determined patterns of treatment that people with severe disabilities are forced to deal with daily. Ward’s (2005) claim that self-determination is all about the SELF and must be advanced by authentic choice opportunities made me rethink the definition of self-determination and its relationship to choice. Wehmeyer’s (2005) redefinition of self-determination prompted me to consider whether his new definition fully dealt with the control issue he sought to resolve. The Wood, Fowler, Uphold, and Test (2005) review of research interventions suggested to me that other areas of research may have been overlooked and that use of direct instruction to provoke choice making may be counterproductive over the long term. Finally, the study by Zhang (2005) broadened the scope of my comments substantially, focusing as it did on the cultural and socioeconomic determinants of self-determination in children and youths with disabilities. With this advance summary of my comments in mind, I offer the following additional thoughts on the issues of choice, the self, control, research interventions, and capacity versus opportunity that were raised by this timely set of articles on selfdetermination.

Book Review: Individualized Supports for Students with Problem Behavior: Designing Positive Behavior Plans

Abstract: Bambara and Kern have written their book on positive behavior support (PBS) for school-based professionals and for preservice professionals. Their effort is important because PBS is an effective evidence-based practice (e.g., Carr et al., 1999) and continues to be legally mandated in schools by the most recent reauthorization of the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA 2004; Yell, 2006). This combination creates a situation in which all professionals are educationally compelled to provide PBS, and school-based professionals are both educationally and legally compelled to provide PBS to students with problem behavior. Thus, there is a great need for a resource that makes the philosophical base, the conceptual base, and the technology of PBS accessible to new and practicing professionals. Before we review the book in some detail, we would like to begin by acknowledging that this is an excellent book and that, in our opinion, its main strength is that it is a remarkably cohesive text. Although Bambara and Kern are the main authors, there are also 21 additional contributing authors. Indeed, the contributing authors’ lineup reads like a “Who’s Who” list of special education. It is sometimes the case that books with a large number of contributing authors have individual chapters or sections that address a similar topic, but do not systematically and sequentially relate to each other. In this book, each chapter is logically and sequentially related to the other chapters. A contributing factor for this cohesiveness may be that either Bambara or Kern is single or co-author on 8 of the book’s 13 chapters. Moreover, the authors provide two case examples across chapters that illustrate the steps of developing a behavior support plan; this provides an even tighter connection of material in the book. The book is divided into three sections. The first five chapters provide practitioners with the philosophical and conceptual foundations of PBS. The next six chapters describe and illustrate the processes for designing and implementing PBS. The final two chapters address applications of PBS outside of school settings, and beyond individualized supports to schoolwide implementation of PBS. Overall, the book is comprehensive and characterized by technical accuracy. The first section of the book establishes a firm basis for the professionals to understand, appreciate, and benefit from the remainder of the book. In Chapter 1, Bambara defines PBS, describes its evolution, and firmly establishes the philosophical base of PBS. This type of chapter is crucial for professionals, especially those preservice professionals who have not been in the field long enough to have personally seen the movement away from punishment and toward skill development and supports. Bambara’s chapter is one of the best that we have read on the philosophy of PBS, and it provides a compelling case for why we ought to do it this way before moving on in the rest of the book to how we ought to do it. In Chapter 2, Dunlap and his colleagues describe the behavioral model and explain how it serves as the conceptual base of PBS. They also expand the traditional setting event–antecedent– behavior–consequence (SE-A-B-C) model to include quality of life and concomitant lifestyle issues. As always, Dunlap and his colleagues’ contribution is of the highest quality. In Chapter 3, Bambara provides a well-organized and helpful overview of the behavior support process. In Chapter 4, she, along with her colleagues Nonnemacher and Koger, describe the teaming process and relate it to PBS. This chapter is an especially good one and makes a substantial contribution on its own. One of the greatest challenges that new professionals may face when implementing PBS is getting all the relevant professionals to play on the same team, especially when professionals in applied settings may have such different backgrounds, perspectives, and philosophies. This chapter not only describes the team process but is also full of evidenced-based recommendations, examples, and illustrations that will facilitate the PBS process and foster improved outcomes. The first section concludes with Miltenberger’s chapter on measuring behavior change. Miltenberger describes methods for observing, recording, and graphing behaviors so that professionals have accurate and objective information about student behavior. This information is essential for a number of reasons, but perhaps most importantly it enables professionals to make good instructional decisions based on fact instead of making subjective decisions derived from speculation. The quality of this chapter is consistent with the overall high quality of this first section. The second section consists of six chapters that address developing individualized interventions by deResearch & Practice for Persons with Severe Disabilities copyright 2005 by 2005, Vol. 30, No. 3, 173–176 TASH

Book Review: Costs and Outcomes of Community Services for People with Intellectual Disabilities

Abstract: The authors of Costs and Outcomes of Community Services for People with Intellectual Disabilities address critical issues related to available home and community-based services and how to finance those services. This book serves as an informative resource that will appeal to a large readership, including advocates, service providers, administrators, researchers, and policymakers. In addition to providing information related to costs and outcomes of alternative community services, it offers insight into cost accounting models from different states and countries (e.g., England, Australia). One topic in particular, deinstitutionalization, has fallen under great debate and controversy over the past 100 years. In Chapter 1, Stancliffe and Lakin appropriately allude to this controversial topic as being less important today because our focus is more appropriately placed upon consumer-desired, community-related services and their outcomes, rather than “cost comparisons between institutional and community services” (p. 12). Throughout, Costs and Outcomes emphasizes that the outcomes and quality of life for individuals with intellectual disabilities must remain our primary focus. Eidelman, in his foreword, sets the stage for the book by recognizing that “we have tended to bundle deinstitutionalization and community service development as a single process when we should have acknowledged them as notably different processes and achievements” (p. XXI), a similar mistake often made when attempting to promote competitive employment by comparing sheltered employment and supported employment (Cimera & Rusch, 1999). In their examination of costs and outcomes related to community-focused alternatives, Stancliffe, Lakin, and contributing authors focus on factors that promote independence, autonomy, and quality of life. Throughout Cost and Outcomes, three themes emerge in relation to expenditures and outcomes including: (a) community service models, (b) person-centered models (e.g., individual budgeting), and (c) family care models. For example, Felce and Emerson (Chapter 3) point to difficulties in estimating the cost and benefits associated with alternative community care models, whereas Emerson and his colleagues (Chapter 7) conclude that quality-of-life outcomes that are associated with larger care models (e.g., a large group home) are inferior to outcomes associated with smaller care models (e.g., smaller group homes). Further, chapters on freedom from staff control (Chapter 9), being self-determined (Chapter 10), and supporting consumers in directing their resources (Chapter 11) are important springboards for discussion and exploration of how consumers can eventually assume greater responsibility for their desires and needs (person-centered models). Important family issues are also discussed in this valuable resource. Lewis and Johnson (Chapter 4) remind us that while the family provides the vast majority of care to persons with intellectual disabilities, existing public policies associated with family care discriminate against families with children with disabilities. For example, tax breaks are available for childcare for families with typically developing children that are not enjoyed by families with children with disabilities. The 20th century began with great hope for the “rehabilitation” of persons with intellectual disabilities, with the growth and support of a huge network of staterun institutions. Yet sadly the following 100 years witnessed inadequate health care, involuntary sterilizations, and acts of inhumanity. As we are embarking upon the 21st century, we are still influenced by institutional models that are not very promising and antiquated at best. Costs and Outcomes provides a vast amount of information related to new and emerging models available to individuals with intellectual disabilities. When considering variations on costs and outcomes that vary across models, the authors are firm in their conviction that the focus must be upon individuals assuming more direct control over their lives, family care models receiving more attention and support, and society promoting solutions to today’s problems with an eye toward the future, not the past.