Deinstitutionalization: The Research Findings are Remarkably Consistent
As already mentioned, Larson & Lakin (1989 and 1991) undertook meta-analyses of all rigorous studies of deinstitutionalization’s impacts on independent functioning, and on family satisfaction. They are currently updating their 1989 analysis of studies on independent functioning. They found complete consistency in the literature. No researchers have yet found that people become more dependent when they move to the community. One report found no change, and all the others found significant improvement.
Similarly, no researchers have found families to be less satisfied with
community homes than with the institution, even though families tended to be
very satisfied with institutional care as long as their relatives were in
institutions. The following table
shows many, but not all, of the community placement processes that have been
scientifically studied, with a small description of what took place.
|
State |
Time
Period |
Notes |
|
Arizona |
1992-1997 |
Closed Ft. Stanton
1996, one left |
|
Arkansas |
1983-86 |
Slow depopulation
studied by Rosen (1985) |
|
California |
1993-1998 |
Coffelt settlement,
2400 movers, largest and fastest in history |
|
Connecticut |
1985-1994 |
Mansfield closed 1994 |
|
Louisiana |
1980-1998 |
Gary W. or “Texas
Children” lawsuit brought 600 back to LA, and then into community |
|
Maine |
1990 |
Pineland closed, only
one Center left |
|
Michigan |
1975-1995 |
Plymouth Center and
others closed during 20 year buildup of community capacity, led by
Macomb-Oakland Regional Center; only 250 people with mental retardation
still in institutions, largest state to be almost institution-free |
|
Minnesota |
1980-1998 |
Rapid downsizing of
all facilities, closure of some |
|
New Hampshire |
1992 |
Became first state to
have no citizen in a public institution |
|
New Jersey |
1988-1998 |
Johnstone closed 1991,
North Princeton closed 1997 |
|
New Mexico |
1996 |
Became
institution-free with closure of last public facility |
|
New York |
1994 |
Governor announced
goal of no institutions by 2000 (not currently keeping up with goal) |
|
North Carolina |
1991-1998 |
Thomas S. lawsuit
results in movement of nearly 1,000 people with dual diagnosis out of
Psychiatric Hospitals |
|
Oklahoma |
1988-1992 |
Hissom Memorial Center
closed under court order, but ahead of schedule, with the best outcomes
yet measured anywhere (Conroy, 1996) |
|
Pennsylvania |
1978-1987 |
Took
9 years to close Pennhurst, most closely studied closure of all time |
|
Rhode
Island |
1995 |
Became
institution-free after a long policy of community placement |
|
Vermont |
1996 |
Became
institution-free |
|
West Virginia |
1985-1998 |
Continual gradual
process of placement and closure |
The following table offers further evidence of the consistency of
findings across studies. As Larson
& Lakin (1989) found in their meta-analysis of all rigorous studies,
adaptive behavior (independent functioning) was found to increase in
deinstitutionalization studies. In
our own deinstitutionalization studies, we have found a pattern of increasing
independence according to how many years people have been out in the community.
|
State |
#
of Years |
Time-1 Average Adaptive Behavior Score |
Time-2 Average Adaptive Behavior Score |
Gain on 100 Point Scales |
|
Pennsylvania |
14
years |
39.8 |
50.2 |
10.4 |
|
New Hampshire |
8
years |
53.0 |
62.3 |
9.3 |
|
Louisiana |
7
years |
56.2 |
64.2 |
8.0 |
|
Oklahoma |
6
years |
41.3 |
47.4 |
6.2 |
|
Connecticut |
5
years |
49.5 |
54.0 |
4.5 |
|
California |
3
years |
44.7 |
46.7 |
2.0 |
|
North Carolina |
2
years |
52.7 |
54.8 |
2.2 |
|
Kansas |
1
year |
33.1 |
34.8 |
1.7 |
|
Indiana |
.5
year |
46.4 |
48.8 |
2.4 |
One of the primary goals of all services and supports for people with developmental disabilities is to permit and assist them to learn, grow, develop, and achieve the highest level of independence of which they are capable. The results in the table above provide compelling evidence that people grow, learn, and develop over long periods of time once they move out of institutions. The more the years of community living, generally the higher is the gain in independence. These outcomes are strong, favorable, and consistent with all published research literature.