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Alstt Mo. 3-7/0 PERCEPTIONS OF 37? AlStt Mo. 3-7/0 PERCEPTIONS OF CAREPROVIDERS CONCERNING THE NORMALIZATION/ DEVELOPMENTAL MODEL'S REPLACEMENT OF THE MEDICAL MODEL AS THE BASIS FOR PROVIDING EDUCATION AND TRAINING TO THE INSTITUTIONALIZED ADULT WITH DEVELOPMENTAL DISABILITIES DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Sharon Coutryer, B.A., M.S. Denton, Texas May, 1993 37? AlStt Mo. 3-7/0 PERCEPTIONS OF CAREPROVIDERS CONCERNING THE NORMALIZATION/ DEVELOPMENTAL MODEL'S REPLACEMENT OF THE MEDICAL MODEL AS THE BASIS FOR PROVIDING EDUCATION AND TRAINING TO THE INSTITUTIONALIZED ADULT WITH DEVELOPMENTAL DISABILITIES DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Sharon Coutryer, B.A., M.S. Denton, Texas May, 1993 (?WM Coutryer, Sharon M. Perceptions of Careproviders Concerning the Normalization/Developmental Model's Replacement of the Medical Model as the Basis for Providing Education and Training to the Institutionalized Adult With Developmental Disabilities. Doctor of Philosophy (Higher Education), May, 1993, 216 pp., 73 tables, 5 figures, bibliography, 110 titles. Previous research suggests that careproviders' attitudes and perceptions significantly influence the type and quality of services received by institutionalized adults with developmental disabilities (IADD). This study explored attitudes careproviders hold concerning training needs of the IADD and their service model orientation. It traced the history of training people with developmental disabilities and provided a brief review of the medical, developmental, and normalization models of service delivery. The conceptual framework upon which this study was based proposed that staff perceptions and orientation concerning service delivery to the IADD can be conceptually related to five factors in a research model. They were identified as: (a) careprovider's characteristics; (b) working environment; (c) previous careprovider experience; (d) developmental disability history within the careprovider's family; and (e) self-reporting of a service delivery orientation. This study examined only a portion of this model (factors a, b, and e). The response sample included 370 professionals and paraprofessionals, aged 17 to 72 years, who were employed at a large residential facility serving individuals with developmental disabilities in Denton, Texas. The respondents were predominantly female (76.5%), Caucasian (72.2%) with slightly less than 75% having more than a high school diploma. The instrument, a self-administered questionnaire, consisted of three parts; Careprovider's Service Model Orientation; Careprovider's Perception of Training Needs; and, Demographic Information. Data were analyzed through the use of regression, chi square, and analysis of variance tests. Findings revealed several significant relationships between: professional status and perceptions of training needs of the IADD; professional status and service model orientation; professional status and reported service model orientation; professional status and attitude toward the medical model; and, professional status and attitude toward the developmental model. Significant relationships were not found for four additional hypotheses that were included the study. ACKNOWLEDGEMENTS I wish to express my sincerest appreciation and gratitude to all who have assisted in the development of this work. I could not have asked for more encouragement, love and inspiration than I received from those I am about to mention. Firstly, sincere appreciation and gratitude are expressed to Dr. Ron Newsom, advisor and Chairperson of my dissertation committee, for his professional guidance, patience, and support. Special appreciation is also expressed to my Doctoral Committee members, Dr. Susan Eve, Dr. Jean Saul, and Dr. Eugenia Bodenhamer. Their academic assistance and recommendations have greatly contributed to the success of my study. Special thanks is expressed to Dr. Keith W. Turner, who is also a member of my Doctoral Committee, for his advice, extensive knowledge base, support and encouragement which will always be remembered. Secondly, I wish to express my sincere appreciation to Dr. Sigrid Glenn, Ms. Nancy Bridenthrall, and Dr. Joe Thurmon for their assistance in critiquing my questionnaire. Special appreciation is expressed to the Denton State School employees who spent time and effort in completing the instrument. Without their cooperation, this dissertation could not have been achieved. Gratefulness and appreciation are also expressed to John Delaney, my director/supervisor for his support, interest and flexibility. Thirdly, indebtedness and gratitude are extended to my parents, Mr. & Mrs. Gussie Coutryer; and to all members of my family for their patience, love, understanding, interest, encouragement, and inspiration. Finally, my special gratitude is expressed to my God children, Shelley Howard Myers, and Whitney Janice Eaddy, and their families for their reassuring support and encouragement. 111 TABLE OF CONTENTS Page ACKNOWLEDGMENTS iii LIST OF TABLES vi LIST OF FIGURES xi Chapter I. INTRODUCTION 1 Statement of the Problem Purposes of the Study Research Questions Hypotheses Definitions of Terms Assumptions and Limitations Delimitations of This Study Significance of the Study II. REVIEW OF LITERATURE 19 The History of Training People With Developmental Disabilities The Medical Model of Service Delivery Developmental Disabilities and Medical Diseases/ Illness The Developmental Model of Service Delivery The Normalization Conceptualization of Service Delivery The Concept of Deviancy/ Devaluation and the Normalization Principle Summary of the Literature History of Denton State School Denton State School's Utilization of the Normalization/ Developmental Model for Service Delivery III. DESIGN OF THE STUDY 53 Plan of the Study Conceptual Framework Paradigm Scope for Dissertation Population and Sample Protection of Human Subjects Procedure for Collection of Data IV Chapter Page Instrument Validation by Jury Panel Pilot Study IV. ANALYSIS OF DATA 69 Profile of the Respondents Careprovider's Service Model Orientation Careprovider's Perception of Training Needs Findings Hypotheses and Corresponding Statistical Analyses Summary V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS ... 142 Summary Results Conclusions Recommendations Chapter Summary APPENDICES 164 A. Target Population of Study B. Denton State School 1. Agency Mission, Values, and Goals 2. Client Services Division 3. Residential Services Department C. Questionnaire D. Factors Included in the Careprovider's Service Model Orientation Instrument E. Classification of Denton State School's Residential Homes by Level of Care F. Letter to Jury Panel G. Cover Letter for Pilot Sample H. Cover Letter for Total Sample REFERENCE LIST 206 LIST OF TABLES Tables Page 1. Distribution of Respondents by Gender 72 2. Distribution of Respondents by Age 72 3. Distribution of Respondents by Level of Education 73 4. Distribution of Respondents by Position 74 4a. Distribution of Respondents by Professional/ Paraprofessional Status 75 5. Distribution of Respondents by Marital Status 76 6. Distribution of Respondents by Ethnicity. ... 76 7. Distribution of Respondents by Tenure at Denton State School 77 8. Distribution of Respondents by Tenure at Denton State School in Their Current Position 78 9. Distribution of Respondents by Work Location 79 10. Distribution of Respondents by Level of Care Provided 80 11. Distribution of Respondents by Work Shift ... 80 12. Distribution of Respondents by Prior Work Experience With Individuals With Developmental Disabilities 81 13. Regression Analysis: Hypothesis 1 (Training Needs by Tenure) 89 13a. Regression Analysis: Hypothesis 1 - Disaggregated By Level of Care = Medically Fragile 89 vx Tables Page 13b. Regression Analysis: Hypothesis 1 - Disaggregated By Level of Care = VI 90 13c. Regression Analysis: Hypothesis 1 - Disaggregated By Level of Care = V. 90 13d. Regression Analysis: Hypothesis 1 - Disaggregated By Level of Care 91 14. Analysis of Variance: Hypothesis 2 (Training Needs by Professional Status) 92 14a. Analysis of Variance: Hypothesis 2 - Disaggregated By Level of Care = Medically Fragile 93 14b. Analysis of Variance: Hypothesis 2 - Disaggregated By Level of Care = VI 93 14c. Analysis of Variance: Hypothesis 2 - Disaggregated By Level of Care = V. 94 14d. Analysis of Variance: Hypothesis 2 - Disaggregated By Level of Care 94 15. Regression Analysis: Hypothesis 3 (Training Needs by Age) .... 95 15a. Regression Analysis: Hypothesis 3 - Disaggregated By Level of Care = Medically Fragile 96 15b. Regression Analysis: Hypothesis 3 - Disaggregated By Level of Care = VI 96 15c. Regression Analysis: Hypothesis 3 - Disaggregated By Level of Care = V. 97 15d. Regression Analysis: Hypothesis 3 - Disaggregated By Level of Care 97 16. Analysis of Variance: Hypothesis 4 (Service Model Orientation by Tenure) 99 16a. Analysis of Variance: Hypothesis 4 - Disaggregated By Level of Care = Medically Fragile 99 16b. Analysis of Variance: Hypothesis 4 - Disaggregated By Level of Care = VI 100 Vll Tables Page 16c. Analysis of Variance: Hypothesis 4 - Disaggregated By Level of Care = V 100 16d. Analysis of Variance: Hypothesis 4 - Disaggregated By Level of Care = I 101 17. Analysis of Variance: Hypothesis 5 (Service Model Orientation by Professional Status) 102 17a. Analysis
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