PROTOCOL: Multifaceted interventions for supporting community participation among adults with disabilities: a systematic review

Abstract

The Fair Housing Amendments Act of 1988 allowed tenants to make reasonable modifications to their apartments at their own expense; the Americans with Disabilities Act of 1990 was designed to protect the civil rights of citizens with disabilities; the Olmstead v. L.C. Supreme Court decision (1999) allowed people to live in least restrictive environments; and the currently proposed Disability Integration Act (DIA), S. 2427 would create a civil right to home and community-based services and supports as an alternative to institutions. Multifaceted interventions - address two or more individual (changing something about the person, including enhancing skills/knowledge, changing behaviour, changing perceptions/attitudes) or environmental characteristics (changing something about the people, places, or things in the environments in which the person interacts) in different domains (e.g., social skills/inclusion, financial resources/management, physical health, mental health, employment, transportation, adult learning, health care) Disability – any physical or cognitive limitations, including multiple disabilities Community - settings that are integrated with people without disabilities in an environment where people without disabilities typically work, live, and recreate Community participation outcomes –are chosen by/desired by the individual with a disability, occur in the community (i.e., integrated with people without disabilities),and are reflective of (a) direct access to or participation in the community or (b) dimensions of community participation (i.e., outcomes for which there is a research base linking them to community participation). Direct access to or participation in the community Integrated competitive employment (i.e., employment in the community with non-disabled peers for minimum wage or higher) Continued learning (e.g., engaging in college or technical training – classes or diploma or certificate completion) Housing (e.g., independent living in a home of choice, usability of the home) Civic involvement (e.g., voting, volunteer work, advocacy, committees/leadership) Recreation (e.g., sports, art, music, community events) Navigating the community/accessing community (e.g., accessing public transportation) Dimension of community participation Increased self-determination (e.g., autonomy, decision-making, self-advocacy) Improved physical or mental health Improved general quality of life Increased family support/activities in the home (e.g., caregiving, supporting children/parenting, household chores/care) Social networking (e.g., friendships, relationships – boy/girlfriend or spouse, church) We recognize that the nature of the community participation outcomes defined is broad. Examples of multifaceted interventions resulting in community participation outcomes include the following: 1.A vocational services agency decides to implement customized employment services and social skills training in an effort to affect rates of obtaining and maintaining integrated competitive employment. 2.An independent living center implements an adaptive recreation program at the local community center along with transportation training in the community in an effort to affect the rate at which individuals with physical disabilities are accessing and navigating their community and engaging in recreational activities.