Readthe paper and answer the following question. It can added in the first pararpah. How would you learn about physicians’ referral process for the waivers without talking to physicians or physicians’ groups? Could you find this information in a scholarly peer-reviewed article? I think finding scholarly sources with this information would be unlikely. So what information would you learn from articles and not people for an ARM?
Name: April Allen
Learner ID:2168216
Learner Email Address:
School: Capella University
Program/Specialization: DHS
Type of project (e.g., dissertation, capstone, etc.): Capstone
Quarter/Year of V8927completion:
Project topic
Evaluating the disparities that influence referral process of the Intellectual Disabled and Related
Disabilities Waiver (IDRD) by physicians.
Alignment to the Program of Study
The topic aims to evaluate physicians’ referral process for Intellectual Disabled and
Related Disabilities waivers by considering the disparities existing in the sector. The Intellectual
Disabled and Related Disabilities waiver (IDRD) is a waiver that is under the Medicaid Home
and Community Based waiver program (1915c). The waiver aims to serve individual people with
intellectual disabilities and related disabilities. According to the Department of Disabilities and
Special Needs (DDSN), “The services offered in the waiver are meant to prevent and/or delay
institutionalization. The IDRD waiver reflects the State’s commitment to offering viable
community options to institutional placement” (DDSN, 2020, pg. 4). Evaluating the need for the
problem can help raise awareness of why the program is vital. According to the Health
Management Association (HMA 2020), “ One 2017 national study found over 182,000 people
with ID/DD waiting for HCBS,* with five states reporting waitlists of over 10,000 people each
and 13 states reporting no ID/DD waitlists.
According to (Linfield et al., 2022), the USA Preventive Services Task Force advocates
that primary care physicians effectively make referrals for high-risk patients. Patients with
disabilities are supposed to be referred for critical care. The physicians are supposed to
apprehend massive integrated health care systems to help ensure that the referrals are made more
diverse to enhance better health outcomes. The physicians are supposed to make referrals for
patients experiencing disabilities for referrals as this will help in testing them more to ascertain
their improvement. The expected result is to understand the disparities influencing physiciansÂ’
2
referrals of intellectual disabilities and related disabilities and how the IDRD waiver has been
effective in the present instead of before when IDRD was not implemented.
Project Problem
Problem to be Addressed
The problem is the lack of referrals to the IDRD waiver by physicians and the extremely
long waitlist. The objective will be to address their knowledge of the program and requirements,
find ways to shorten the waitlist. According to (Fine & Asch, 2016), the stigmatization and
discrimination in society are due to a lack of patient education about their psychological
wellbeing. Intellectual stigmatized deemed shameful, a problem created in the home communitybased settings. The evaluation of the IDRD waiver seeks to ensure individuals have a
comprehensive home or community-based programs to meet their daily mental needs and by
ensuring that, we must evaluate the importance of the IDRD waiver program. According to
Liang et al. (2018), raising awareness in the community reduces stigma and increases the
continuity of treatment services and support from the community. The consent can be in different
forms based on the program’s criteria, for instance, rehabilitation, treatment care, availability of
medication, and other services (Riffle & Chen, 2020). Mental stigma has led to many individuals
suffering in silence as they lack the know-how of what is going on and where they can seek
treatment (Olfson, 2016). Thus, centers need trained professionals who can engage patients and
make them talk about their problems without reservation.
According to (Linfield et al., 2022), USA Preventive Services Task Force’s primary
concern is ensuring that people with disabilities are waived from an extended hospital stay
during minor visits. Patient Protection and Affordable Care regards that physicians should
3
develop patients centered medical homes. This will aid in better care for patients with special
needs and disabilities. Coordination among the physicians will help meet the patient’s needs
effectively. The care coordination activities allow physicians to share the information, which will
help in the identification of the best interventions in taking care of patients with disabilities and
special needs.
Gap
To better understand how disability affects oneÂ’s health, it is critical to collect data. Data
helps make global judgments on poverty alleviation, poverty reduction, and humanitarian
response. Programming, policy, and execution have all been radically altered by this innovation
(Barnes et al., 2014). The lack of information and research surrounding the referral process for
the IDRD is alarming. According to (Blaskowitz, Hernandez, & Scott 2019), many people,
especially parents, lack enough information about the referral process surrounding their disabled
children. Before a child or an adult with IDRD is referred, research and data have to be collected
about them and then analyzed to determine the type of disability or condition they have and
where they will receive the necessary support or help. Through an extensive search of research,
limited data and studies have been found on common intellectual disabilities, including PraderWilli Syndrome (PWS), Fetal Alcohol Syndrome, Fragile X Syndrome, and DownÂ’s Syndrome
(Friedman, 2019). According to (Tassé, Wagner, & Kim, 2020), certain IDRDs, including
Anosognosia, Psychopathy, and Sociopathy, do not have any visible symptoms. However,
research has also shown that they are perilous mental disorders that need to be addressed sooner
than later (Friedman, 2019). If not, they might become more severe disorders like schizophrenia,
bipolar disorders, and other extreme psychotic disorders. However, with little to almost no
4
research about the referral process of these IDRDs, it is hard for people to find the correct
approach to find the correct treatment. Most people suffering from these mental disorders have
grown with them since they were young. They did not find a way to address the issue because
they had little to no knowledge about the referral process for their disorders. Therefore, the
government needs to develop a way to ensure that more scientific research is conducted and
made available to the public (Lunsky & Modi, 2018). It will go a long way in addressing these
issues and helping people find an efficient way through the referral process.
According to (Linfield et al., 2022), the physicians should advocate for the IDRD waiver
program as it will help ensure there is a low level of discrimination and stigmatization of the
patients in society, which is a significant contributor to increased illness cases. Physicians
utilizing the IDRD waiver program can educate society, the patient, and the families to take care
of the patients effectively. This will help in maintaining better care for the patients. Patients can
share their needs and issues in more diverse healthcare settings (Linfield et al., 2022). The
physicians should undertake research regarding evidenced-based care to help educate the
patients. Hence this will help increase the number of referrals the patients with disabilities and
special needs will have to enhance their health outcomes.
Supporting Evidence
Primary Orientation
The early 1800s saw the emergence of intellectual and developmental disorders (IDD) as
a separate diagnosis category due to a shift in conceptualization. Persons with Intellectual and
Developmental Disabilities (IDD) were thought to be at risk of ending up in prison if they were
not educated at the time since their condition was attributed to “a failure of the will” (Alonso-
5
Sardón, Iglesias-de-Sena, Fernández-MartÃn, & Mirón-Canelo, 2019). In this way, IDD was first
diagnosed and pathologized. Institutions have been used to teach people with IDD who have a
“failure of will,” allowing them to become “useful” members of society.
As institutions grew, these spaces could no longer accommodate so many students.
Concurrently, the economic downturn prompted the hiring non-disabled people from the
community rather than educated people with intellectual disabilities (Friedman, 2019). As a
result, institutions moved from instructional schools to correctional facilities whose primary job
was to control individuals. Unlike educational institutions, institutional environments were
modeled after “lunatic” asylums and operated as medical care and therapy sites. The shift in
perspective viewed intellectual disability as a medical illness rather than an educational one.
The research aims to present evidence on the advantages of deinstitutionalizing persons
with intellectual disabilities. Children and teens with intellectual disabilities were
deinstitutionalized due to parental activity, discrimination popularity, and media reports on child
abuse. As a result, extensive changes were made to state-run facilities and health care standards.
IDRD advocates have also pushed for community-based alternatives to institutionalization,
which has led to deinstitutionalization (Alonso-Sardón et al., 2019). During that period, the
rights of people with disabilities have been strengthened, resulting in innovative programs like
the IDRD waiver program.
Efforts to Address the Problem
According to the Department of Health, Human Services, Washington, DC., Healthy
People 2010 (Group), & United States Government Printing Office (2020), healthcare workers
should get cultural competency training on IDRD. There are several ways to address physiciansÂ’
lack of knowledge and awareness of the IDRD waiver program and its services. Accreditation
6
criteria in every state should be established that openly acknowledge and accept intellectual
disability (Medicaid, 2022). Anecdotal information suggests that American medical schoolsÂ’
intellectual disability cultural competency education is inadequate. Consequently, medical
schoolsÂ’ national accreditation standards should oblige them to teach students about social issues
and the technical abilities required to help the poor and disadvantaged in society.
According to (Friedman, 2019), an evidenced-based, long-term curriculum that increases
interpersonal engagement with persons with intellectual and associated impairments while
simultaneously eliminating medical bias is essential for medical schools. Medical students need
mentorship, criticism, and assessment to help them identify prejudice and learn how to treat
persons with intellectual and associated impairments with dignity and respect. Physician
shortages for persons with intellectual impairments and associated disabilities may be alleviated
by providing additional training and specialization options for healthcare professionals who
desire to work in the healthcare field (Friedman, 2019). further argues that we can address the
issue by eliminating discrimination by implementing an evidence-based disability awareness
program.
Furthermore, we can address the problem by integrating perspectives from persons with
disabilities who face discrimination because of their race, gender, sexual orientation, or
socioeconomic status into research on how medical education affects attitudes about patient care.
Lack of knowledge in IDRD has led to most of these problems. According to (Simmons, 2014),
it is essential to invest in the proper training of all personnel involved in the IDRD process. It is
also vital to share information and spread awareness about IDRD.
Additionally, physicians need more research on the connection between medical training
and racism, ageism, sexism, and homophobia because of the scarcity of literature addressing how
7
intersectional identities worsen attitudes about healthcare (Orner, 2015). Adopt antidiscrimination legislation and require medical schools to take reasonable measures to provide
accessibility and opportunity for students and faculty with disabilities. Disabled people are
underrepresented in the medical business. According to (Riffel & Chen, 2020), making the
profession more accessible and inclusive may increase the recognition of intellectual disability
rights views. Investing in waiver referrals is also very important (Fine & Asch, 2015). For
example, we could invest in Medicaid referrals. According to (Medicaid, 2022), people who
ordinarily require long-term care in a hospital or nursing home can receive it in the community
with the assistance of Medicaid Waivers, which provide services to these individuals.
Along with personal and companion care services, authorized in-home health care
agencies that provide competent nursing care are another option for delivering these services. To
assist in expanding oneÂ’s company, they can receive referrals for home care or Medicaid waiver
programs. In addition, once they have obtained accreditation, they will be able to market these
services to obtain senior care leads specifically and leads for other services through their
advertising (Medicaid, 2022). Therefore, waiver referrals can go a long way in addressing the
problem.
Synthesis of the Evidence
Research has shown significant referral disparities, which have harmed individuals
diagnosed with IDRD. According to (Blaskowitz, Hernandez, & Scott, 2019), some of these
disparities include:
•
A long waiting list.
•
Improper documentation.
8
•
Referral errors.
•
Lack of communication among service workers.
•
Lack of follow-ups.
•
Insufficient referral analytic features.
•
Lack of proper training due to inadequate education: You might find someone working in
the referral system but does not have the proper knowledge to do proper documentation
or work with certain referral analytics features. Such people should undergo more
training or go back to school.
Long waiting lists negatively impact individuals diagnosed with IDRD. Long waiting lists
lengthen the time they could have gotten the necessary treatment for their condition. By waiting
extended periods, their conditions might worsen, bringing more complications that are expensive
to treat and life-threatening. Improper documentation usually occurs physicians miss important
information about a patientÂ’s condition. Missing essential symptoms means that the patient will
not be treated for what they are suffering from. It may lead to more harm than good. It may even
lead to further health complications. According to (Friedman, 2019), referral errors are another
disparity caused by inadequate and ineffective referral systems. These mistakes have the
potential to have life-threatening consequences for the patients involved. According to a study
published in 2018, medical errors have risen to become the third leading cause of death in the
United States, with an estimated 440,000 deaths occurring each year (Medicaid, 2022). It
includes individuals diagnosed with IDRD.
Lack of communication among service workers is another form of disparity experienced in
the referral process among IDRD individuals. Without proper communication among service
workers, it is hard to coordinate treatment and the transfer of patients from one place to another.
9
An IDRD patient may need specific treatment urgently, but it becomes hard for them to treat the
patient effectively without proper communication among service workers involved. The same
case applies to the lack of follow-ups after the referral appointment. Referrals are more
complicated when specialists cannot offer follow-up reports (Blaskowitz, Hernandez, & Scott,
2019). As a result of the delay, the patientÂ’s medical history is not updated immediately. Finally,
doing these operations manually increases the risk of misinterpretation or data loss, which can
significantly impact patient care in severe instances.
Furthermore, referral analyticsÂ’ insufficient features are another disparity that negatively
impacts individuals diagnosed with IDRD. According to (Orner, 2015), health systems must
keep track of an infinite number of referrals within and outside their networks. As a result, it
isnÂ’t easy to keep track of and monitor different types of referrals. Providers canÂ’t optimize their
process further if their referral management system lacks analytic tools to help them spot patterns
in specific referrals.
Besides, barriers to first-rate healthcare and the resulting inequities faced by people with
Intellectual Disability and Related Disabilities (IDRD) have been well-documented in extensive
studies. Health outcomes for people with IDRD are worse than those of the general population,
with elevated incidences of comorbidities, chronic conditions, preventable deaths, inadequacies
in mental health services, less access to health promotion and preventative care, cognitive
difficulties in communicating, recognizing, and understanding health problems that affect
adherence to treatment (Mpofu, Houck, Linden, & Fernandez, 2020).
Other obstacles include financial barriers, lack of incentives for healthcare providers to
ensure the health of people with IDRD, motility issues; social, societal, and attitudinal
misconceptions; and a shortage of formal training for healthcare providers resulting in an acute
10
shortage of experienced professionals. Increased awareness and knowledge of the IDRD waiver
program among physicians will result in increased perception of healthcare requirements among
people with IDRD, development of health promotion resources for people with IDRD, improved
quality of care among community healthcare providers, availability of integrated healthcare, and
the development of a healthcare delivery model suited to the requirements of people with IDRD
(Medicaid, 2022). As a result, identifying risk factors and causes of IDRD will be easier,
resulting in early measures to prevent these impairments.
An increased prevalence of coinciding mental health issues, such as hostility, is common in
people with intellectual impairments. Outpatient mental health services in the United States have
struggled since the 1960s deinstitutionalization movement to meet the needs of people with
intellectual disabilities and coinciding behavioral issues. In the United States, a lack of access to
community-based mental health services has resulted in an overreliance on hospital-based care
(Friedman, 2019). The ideal way to think of inpatient therapy in the context of mental health is to
think of it more as an intermediate step toward more comprehensive forms of treatment options.
The Olmstead Act of 1999 stated that patientsÂ’ constitutional rights were violated if they were
confined to a hospital environment when other treatment options were available in the
community
(Blaskowitz,
Hernandez,
&
Scott,
2019).
Reducing
the
number
of
institutionalizations is one of the primary objectives of the IDRD waiver program. As outlined in
the Olmstead Act and the American Council on Aging law, the UKÂ’s Transforming Care Agenda
asks for the speedy discharge of individuals with intellectual disabilities to the community if
appropriate outpatient support is available.
11
In (Blaskowitz et al. 2019) study, hospitalization was associated with schizophrenia-related
illnesses and mild ID. However, even after accounting for a wide range of variables such as age
ranges, the presence of an autism spectrum disorder diagnosis, gender differences in the home
environment, the severity of psychopathology, medication use across the board, and self-injury,
(Lunsky, and Modi, (2018) found that only psychiatric polypharmacy and aggression were
significant predictors of hospitalization. The discrepancy between these findings may be due to
differences between the countries analyzed. The study’s data came from a tertiary-care crisis
intervention program called START (Systemic, Therapeutic, Resources, Treatment), which aims
to reduce restrictive and expensive services like inpatient hospitalization by promoting and
supporting access to first-rate community-based healthcare. The START model was developed in
1988 by Dr. Joan B. Beasley and her colleagues in Northeast Massachusetts. The START
Resource Center is intended to provide assessment, crisis prevention, and stabilization in the
context of a safe, supportive therapeutic setting for individuals over the age of 21 who need these
services. The center is designed to use a positive, person-centered approach for these purposes.
According to four-year research on 89 START program participants, the program reduced
emergency services use while improving participant satisfaction (Lunsky & Modi, 2018). With
the following research, START hopes to learn more about how often their patients referred for
treatment used mental hospitalization services and what those services were associated with.
Using the Andersen model of healthcare consumption, researchers looked at eleven
predisposing, enabling, and necessary aspects to determine whether or not people use healthcare
(Lunsky & Modi, 2018). Preliminary studies suggested that a higher likelihood of
institutionalization was associated with higher caregiver ratings of aggressive behaviors, less
severe ID, male gender, younger age, the diagnosis and treatment for psychotic disorder, and an
12
increased number of mental health diagnoses. Referrals for the IDRD waiver and approval can
reduce the prevalence of these incidences and can help patients afford community-based medical
care. It will help reduce the overreliance on hospital-based care because they will be able to
afford the needed care (Barnes et al., 2014). These waivers will also give rights to healthcare
institutions to deliver IDRD care in a manner that differs from the stipulated procedures and
guidelines.
Purpose of the Project and Project Questions
Purpose of the Project
The project aims to determine the disparities that have resulted in referrals not being
completed and the outcomes for those diagnosed with IDRD. The research investigates the links
between a lack of knowledge, disability discrimination, and the institutionalization of persons
with intellectual and associated impairments.
Statement of Primary Question(s)
The projectÂ’s research questions are as follows:
1. How successful is the IDRD waiver program in preventing institutionalization?
2. Do physicians refer individuals to IDRD waiver due to a lack of knowledge of the program
and benefits?
Definition of Terms
Intellectual Disability
13
This term describes a person who has difficulties with cognitive abilities such as communication,
social interaction, or self-care. As a result, these restrictions may hinder a childÂ’s development
and learning.
Intellectual Disability and Related Disabilities Waiver
This waiver is part of the Medicaid Home and Community Based waiver program for the
intellectually disabled and those with related disabilities. Individuals with intellectual
impairments and other disabilities will benefit from this waiver.
Institutionalization
They are putting someone in a care facility (a place such as a hospital). Thanks to communitybased medical assistance, people with serious medical illnesses may be cared for in standard
community settings. People with IDRD who have a wide variety of medical requirements may be
supported in the community, despite the need for improvement in the community-based
healthcare system.
Disability Prejudice
Unreasonable and unfair opinions of people with disabilities are mainly formed without enough
knowledge. Professional ignorance and personal and social prejudice may lead to insufficient or
improper interventions and therapies for persons with IDRD or a lack of appropriate care.
If you are seeking Topic Endorsement in XX-V8926 – Doctoral Project Development – Topic
Approval, you only need to complete the sections above for approval.
Proposed Project Framework
14
The methodological approach is clearly defined and includes constructs, phenomena, variables,
and population.
Methodological Approach
Provide a description and explanation of the methodological approach. The methodological
approach must align to the topic, problem, supporting evidence, and data sources. Suggested
length 2-3 paragraphs.
Population and Sample (including site if necessary)
Describe the general target population (e.g., size, characteristics). Suggested length 1-2
paragraphs.
Constructs, Phenomena, Variables
Present evidence and explanation for the final choice of framework. Constructs, phenomena,
and/or variables must align to the topic, problem, gap, and project questions. Suggested length
2-3 paragraphs.
Proposed Data Sources
Instrumentation and data collection tools address project concepts; ethical threats and their
mitigation are detailed.
Measures or Artifacts to be Reviewed
15
Present a description of instrumentation or data collection tools. Measures or artifacts must
closely align with the methodological approach. Suggested length 3-4 paragraphs.
Detailed Procedures
Present a description of the participants’ or observers’ processes to complete the instruments.
Suggested length 3-4 paragraphs.
Validity/Reliability/Credibility/Dependability
Identify and present the potential threats to reliability and validity (quantitative techniques) or
trustworthiness (qualitative techniques). Include a proposed plan to mitigate the noted threats.
Suggested length 1-2 paragraphs.
Proposed Data Collection
Describe
sampling,
recruitment,
data
collection
procedures,
and
potential
ethical
considerations.
Sampling Strategy, Number of participants
Describe, explain, and justify the sampling strategy to be used. Suggested length 2-3 paragraphs.
Recruitment Procedures
16
Provide a recruitment process to identify, screen, and recruit participants as it aligns with the
methodological approach. Present the inclusion and exclusion criteria for participating in the
project. Suggested length 2-3 paragraphs.
Data Collection Process
Provide a logical step-by-step data collection process that aligns with the methodological
approach. Suggested length 3-4 paragraphs.
Ethical Considerations
Identify potential ethical issues and propose a plan to adhere to strict ethical standards. Include
details regarding privacy, confidentiality, and data security procedures and concerns. Suggested
length 1-2 paragraphs.
Proposed Data Analysis Plan
Articulate data analysis techniques appropriate to the project framework.
Present a plan to analyze and present data with techniques appropriate to the project,
framework, data sources, and sample size. Suggested length 3-4 paragraphs.
17
References
Alonso-Sardón, M., Iglesias-de-Sena, H., Fernández-MartÃn, L. C., & Mirón-Canelo, J. A.
(2019). Do Health and Social Support and Personal Autonomy Have an Influence on the
Health-Related Quality of Life of Individuals with Intellectual Disability? BMC Health
Services Research, 19(1), 1-10. https://doi.org/10.1186/s12913-018-3856-5
Blaskowitz, M. G., Hernandez, B., & Scott, P. W. (2019). Predictors of Emergency Room and
Hospital Utilization Among Adults with Intellectual and Developmental Disabilities
(IDD).
Intellectual
and
Developmental
Disabilities,
57(2),
127-145.
https://doi.org/10.1352/1934-9556-57.2.127
Barnes, C., Swain, J., French, S., & Thomas, C. (2014). Disability, disability studies, and the
academy. Disabling barriers–enabling environments, 17-23.
Department of Health, Human Services, Washington, DC., Healthy People 2010 (Group), &
United
States
Government
Printing
Office.
(2020). Healthy
people
2010:
Understanding and improving health. US Department of Health and Human Services.
Department of Disabilities and Special Needs. (2020). Application for a §1915(c) Home and
Community-Based Services Waiver.
18
Fine, M., & Asch, A. (2015). Disability beyond stigma: Social interaction, discrimination, and
activism. Journal of social issues, 44(1), 3-21.
Friedman, C. (2019). The Relationship Between Disability Prejudice and Institutionalization of
People
with
Intellectual
and
Developmental
Disabilities.
Intellectual
and
Developmental Disabilities, 57(4), 263-273. http://dx.doi.org/10.1352/1934-955657.4.263
Simmons, J. S. (2014). The evaluation of the use of perceived health status as a measure of care
coordination efficacy. Medical University of South Carolina-College of Health
Professions.
Liang, D., Mays, V. M., & Hwang, W. C. (2018). Integrated mental health services in China:
challenges and planning for the future. Health Policy and Planning, 33(1), 107-122.
https://doi.org/10.1093/heapol/czx137
Linfield, D., Rothberg, M., Pfoh, E., Noss, R., Cassard, L., & Powers, J. et al. (2022). Primary
care physician referral practices regarding BRCA1/2 genetic counseling in a major
health system. Breast Cancer Research And Treatment. https://doi.org/10.1007/s10549022-06523-5
Lunsky, Y., & Modi, M. (2018). Predictors of Psychotropic Polypharmacy Among Outpatients
with Psychiatric Disorders and Intellectual Disability. Psychiatric Services, 69(2), 242246. https://doi.org/10.1176/appi.ps.201700032
MACPAC.Gov. 2022. Medicaid Services for People with Intellectual and Developmental
Disabilities.
[online]
Available
at:
[Accessed 21 August 2022].
Medicaid, (2022). Intellectual Disabilities/Developmental Disabilities Waiver | Mississippi
Division of Medicaid. Medicaid.ms.gov. https://medicaid.ms.gov/programs/intellectualdisabilitiesdevelopmental-disabilities-waiver/
Mpofu, E., Houck, E., Linden, A., & Fernandez, C. (2020). Intellectual and Developmental
Disabilities Wellbeing. In Sustainable Community Health (pp. 461-497). Palgrave
Macmillan,
Cham.
https://www.un.org/development/desa/disabilities/about-
us/sustainable-development-goals-sdgs-and-disability.html
Olfson, M. (2016). Building the mental health workforce capacity needed to treat adults with
serious mental illnesses.
Health
Affairs,
35(6),
983-990.
https://doi.org/10.1377/hlthaff.2015.1619
Orner, B. (2015). Efficiency in the Enrollment Process for the South Carolina Intellectual
Disability and Related Disabilities Waiver Program. South Carolina State Documents
Depository. https://dc.statelibrary.sc.gov/handle/10827/19766
Riffel, T., & Chen, S. P. (2020). Exploring the knowledge, attitudes, and behavioral responses of
healthcare students towards mental illnesses—A qualitative study. International Journal
of
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17(1),
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https://doi.org/10.3390/ijerph17010025
Tassé, M. J., Wagner, J. B., & Kim, M. (2020). Using technology and remote support services to
promote independent living of adults with intellectual disability and related
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