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A database was assembled from data collected on all people served by the Developmental Disabilities divisions of Nebraska, South Dakota, and Wyoming, including state institutions and state-funded programs (n=5,928). Information included provider expenditures associated with each individual, allocations made by individual reimbursement rates, services/supports received, funding sources, and individual characteristics as measured by the Inventory for Client and Agency Planning. Results from the analysis found institutions had the highest costs. Although Home and Community-Based Service recipients experienced lower levels of independence than people funded with state money, their costs were higher. South Dakota's people had the highest independence scores. This was attributed to their relatively high utilization of supervised apartments and supported living. Wyoming's costs and rates were higher than those for the other two states, presumably a result of the "Weston v. Wyoming" lawsuit. Supported employment was less expensive than community facility-based daytime programs but this finding was not consistently found in all states. South Dakota, which had a relatively higher utilization of supported employment, also had significantly higher supported employment costs. Evidence substantiated a diseconomy of scale function, as costs increased steadily with agency size. (Contains 23 references.) (CR)

The changes in what people with developmental disabilities wanted and got for living and daytime settings in South Dakota and Wyoming during 1988 were compared to what they wanted and received in 2000. Although the percentage of people in their desired setting rose, there were substantial changes in the types of settings recommended over the years. The numbers of people for whom large residential facilities were recommended generally declined. Conversely, the recommendations for supported employment and supported living rose sharply. The barriers to people getting social and leisure activities were also analyzed. Data from Nebraska were added to the analyses. The Home and Community-Based Services expansion of services reduced some of the social barriers to community integration and independence and increased positive social activities for many of the 7,034 people served in Nebraska, South Dakota, and Wyoming. South Dakota hit a high point in 1987, with 87 percent of its people getting the program they wanted, and is approaching that high with the current 83 percent rate. Wyoming reached a new all time high of 83-90 percent of its people getting the programs they wanted in 2000, while Nebraska's rate was 77-82 percent. (Contains 46 references.) (Author/CR)

This report investigated the financial expenditures of states for services for individuals with developmental disabilities and examined the factors that influenced the level of expenditure. Eight multiple-regression models are presented which explain 70 to 88 percent of the variation in states' total expenditures. In addition to the obvious relationships between spending for services for individuals with developmental disabilities and a state's total population and income, several additional factors were demonstrated to be important. Domestic migration was shown to have a significant negative relationship with spending; that is, states that are losing population have higher expenditures. History of litigation was also demonstrated to increase a state's spending. Providing supported living programs to a large number of people appears to have resulted in a substantial decrease in total spending. Increasing the numbers of people in any combination of ICF/MR and HCB waiver Medicaid services tended to increase spending. An alternative method of assessing fiscal effort is proposed and the concept of "alternative" services/supports of funding sources is questioned. Finally, a method for concurrently summarizing and displaying the effectiveness of delivering services and supports, and the cost-efficiency of providing those services/supports, is demonstrated. (Contains 25 references.) (CR)

This report describes the activities and outcomes of a pioneering Telehealth project in which clinical psychologists use state of the art satellite technology to consult with paraprofessionals who live and provide treatment settings to persons with the dual diagnosis of developmental disabilities and mental illnesses. The goal is to provide early intervention to individuals who have psychiatric and behavioral troubles before they escalate to the level of needing acute hospitalization. The project began with support for 56 people who had lived an average of 14 years in the Wyoming State Hospital. This 5-year project has been able to avoid psychiatric hospitalization for the 90 subjects in this project. This success has saved thousands of dollars and assured a quality, integrated life for individuals with severe disabilities by supporting them in their communities. The report concludes that compressed video technology provides an excellent venue at a reasonable cost in a rural state such as Wyoming, to get quality training to the worker in the field on subjects that are individualized and interactive. The program found that the technology provides a cost-, time-, and travel-effective way to bridge the gap of distance and inclement weather in the rural state. (Contains 17 references.) (CR)

This report describes the outcomes of a Wyoming program that provides host families for individuals with developmental disabilities. Host families work with certified Medicaid providers of home and community-based services for people with developmental disabilities and provide residential habilitation to an adult who is accepted as a member of their family. The first part of the report discusses findings from a study involving 13 adults with mental retardation who were in host families for 9 to 11 months. Results from the study indicate there was a positive change in the individuals when they lived with host families compared to the same individuals while they lived in an institution or at the beginning of their placement with a regional service provider. Incident reports of inappropriate behavior decreased significantly in eight individuals who had had maladaptive behaviors. All 13 individuals maintained or improved their health status, including 3 individuals who lost an average of 42 pounds. Two individuals have been able to slightly decrease psychotropic medications since their move to a host family. The second part of the report presents case studies of four participants who have lived in a host family and have made exceptional gains. (Contains 16 references.) (CR)