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Full-Text Articles in Disability Law

State Employment First Policies #3: Investing In Training And Technical Assistance To Build Capacity In Integrated Employment, Jennifer Bose, Jean Winsor, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston Oct 2018

State Employment First Policies #3: Investing In Training And Technical Assistance To Build Capacity In Integrated Employment, Jennifer Bose, Jean Winsor, Jaimie Ciulla Timmons, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

For more than a decade, many states have been developing policies that prioritize integrated employment as the first choice and preferred outcome for individuals with intellectual/developmental disabilities (IDD). Collectively, these actions have been united under the framework of Employment First, a commitment by states and state IDD agencies to the propositions that all individuals with IDD (a) are capable of performing work in typical integrated employment settings, (b) should receive as a matter of state policy employment-related services and supports as a priority over other facility-based and non-work day services, and (c) should be paid at minimum or prevailing wage …


The Essential Characteristics Of Successful Organizational Transformation: Findings From A Delphi Panel Of Experts, Oliver Lyons, Jaimie Ciulla Timmons, Allison Cohen Hall, Stephanie Leblois, Thinkwork! At The Institute For Community Inclusion At Umass Boston Oct 2018

The Essential Characteristics Of Successful Organizational Transformation: Findings From A Delphi Panel Of Experts, Oliver Lyons, Jaimie Ciulla Timmons, Allison Cohen Hall, Stephanie Leblois, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

BACKGROUND: Federal legislation has called for the phasing out of sheltered workshops and the transition to integrated employment, causing providers to struggle with how to adapt their model towards providing community integration services.


Research To Practice: State Employment First Policies: State Definitions, Goals And Values, Jennifer Bose, Jean Winsor, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2018

Research To Practice: State Employment First Policies: State Definitions, Goals And Values, Jennifer Bose, Jean Winsor, Thinkwork! At The Institute For Community Inclusion At Umass Boston

Research to Practice Series, Institute for Community Inclusion

This brief is the first in a series focusing on Employment First implementation as it relates to one of the seven elements within the High-Performing States in Integrated Employment model. It examines the background of circumstances under which Employment First efforts began in seven states, and introduces each state’s values, mission, and goals around increasing employment opportunities for people with disabilities. States may use the lessons in this brief to develop an Employment First policy, or to evolve existing efforts.


Rrtc On Advancing Employment For Individuals With Idd: State Of The Science Paper – State Level Strategy And Policy, Thinkwork! At The Institute For Community Inclusion At Umass Boston Aug 2017

Rrtc On Advancing Employment For Individuals With Idd: State Of The Science Paper – State Level Strategy And Policy, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

Since the introduction of supported employment in the Developmental Disabilities Act of 1984 and the Rehabilitation Act Amendments of 1986, there has been continued development and refinement of best practices in employment services and supports. Progress includes demonstration of creative outcomes for individuals with significant support needs, including customized jobs and self-employment, community rehabilitation providers that have shifted emphasis to integrated employment, and states that have made a substantial investment in Employment First policy and strategy. Despite these achievements, the promise of integrated employment has not been realized for many individuals with intellectual/developmental disabilities (IDD). The number of individuals supported …


Ten Elements Of Organizational Transformation: Strategies For Moving Towards Integrated Employment, Jaimie Ciulla Timmons, John Butterworth, Jonathan Lucus, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jul 2017

Ten Elements Of Organizational Transformation: Strategies For Moving Towards Integrated Employment, Jaimie Ciulla Timmons, John Butterworth, Jonathan Lucus, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This session will share ten key organizational characteristics necessary to strengthen competitive integrated employment outcomes. Get a first-hand look at the RRTC’s Organizational Transformation Toolkit and explore our Provider Employment Leadership Network, a yearlong facilitated Community of Practice of provider leaders in employment. In conjunction with The Arc of the United States, this PowerPoint offers ten essential elements necessary for successful organizational transformation, along with strategies for implementing each element.


Rrtc On Advancing Employment: Bringing Employment First To Scale, John Butterworth, Amie Lulinski, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jul 2017

Rrtc On Advancing Employment: Bringing Employment First To Scale, John Butterworth, Amie Lulinski, Thinkwork! At The Institute For Community Inclusion At Umass Boston

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In July 2017, ThinkWork conducted a State of the Science session the The Summer Leadership Institute hosted by The Arc of the United States.


State Of The Science Paper – Delivering The Most Effective Employment Supports: Organizational Design And Capacity Building, Brief Summary, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jul 2017

State Of The Science Paper – Delivering The Most Effective Employment Supports: Organizational Design And Capacity Building, Brief Summary, Thinkwork! At The Institute For Community Inclusion At Umass Boston

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This brief aims to share information learned from two studies: 1) interviews with employment consultants; and 2) a Delphi process to determine what characteristics are most critical for organizational transformation from facility-based to community-based integrated employment for people with IDD. The relationship between study findings will be explored and a relational model will be introduced.


Different States, Common Issues: Moving Mountains One Service At A Time., Suzzanne Freeze, Allison Hall, Stacy Collins, Duane Shumate, Cindy Thomas, Barbara Brent, Thinkwork! At The Institute For Community Inclusion At Umass Boston Mar 2017

Different States, Common Issues: Moving Mountains One Service At A Time., Suzzanne Freeze, Allison Hall, Stacy Collins, Duane Shumate, Cindy Thomas, Barbara Brent, Thinkwork! At The Institute For Community Inclusion At Umass Boston

ThinkWork! Publications

No abstract provided.


Rrtc On Advancing Employment: Bringing Employment First To Scale, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2017

Rrtc On Advancing Employment: Bringing Employment First To Scale, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

The RRTC on Advancing Employment for People with Intellectual and Developmental Disabilities, housed at the Institute for Community Inclusion at UMass Boston, is convening a State of the Science process in 2017. Towards that end, we are hosting a variety of listening sessions with multiple audiences to reflect the level of stakeholder engagement that has been a hallmark of the RRTC since our launch. In this listening session, we will focus on a “knowledge to action” agenda that grounds our research in issues important to the lives of individuals with disabilities and the systems and people that provide support. This …


Listen Up! Listening Session For The Rrtc On Advancing Employment, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2017

Listen Up! Listening Session For The Rrtc On Advancing Employment, Thinkwork! At The Institute For Community Inclusion At Umass Boston

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Slides from a conference listening session about the Rehabilitation Research and Training Center (RRTC) on Advancing Employment for Individuals with Intellectual and Developmental Disabilities.


From Sheltered Work To Competitive Integrated Employment: Lessons From The Field (Bringing Employment First To Scale, Issue No. 11), Amie Lulinski, Jaimie Ciulla Timmons, Stephane Leblois, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2017

From Sheltered Work To Competitive Integrated Employment: Lessons From The Field (Bringing Employment First To Scale, Issue No. 11), Amie Lulinski, Jaimie Ciulla Timmons, Stephane Leblois, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

Community providers across the nation are embracing the transformation from facility-based employment supports to competitive integrated employment. While many providers believe in inclusion and Employment First for the individuals they support, some struggle to make their vision a reality. The process of organizational transformation can seem daunting without an understanding of the full range of tactics and approaches available.

The Institute for Community Inclusion (ICI), in conjunction with The Arc of the United States, is conducting research to better understand the transformation process and to guide the development of tools and resources for providers seeking to transform their services. As …


Partnerships In Employment: State Self-Assessment Toolkit For Systems Change In The Transition Of Youth And Young Adults With Intellectual And Developmental Disabilities From High School, Cady Landa, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2017

Partnerships In Employment: State Self-Assessment Toolkit For Systems Change In The Transition Of Youth And Young Adults With Intellectual And Developmental Disabilities From High School, Cady Landa, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This self-assessment tool was developed for those who wish to embark on state-wide governmental systems change to improve high school transition and employment outcomes for youth and young adults with intellectual and developmental disabilities (IDD). Its purpose is to aid in the development of a work plan that is based on a review of the state policies, practices, and strategies that impact transition from school and opportunities for competitive integrated employment of youth and young adults with IDD.

This tool incorporates research identifying elements of state government that support high rates of participation in integrated employment (Hall et al., 2007), …


Statedata: The National Report On Employment Services And Outcomes, 2016, Jean Winsor, Jaimie Ciulla Timmons, John Butterworth, John Shepard, Cady Landa, Frank A. Smith, Daria Domin, Alberto Migliore, Jennifer Bose, Lydia Landim, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2016

Statedata: The National Report On Employment Services And Outcomes, 2016, Jean Winsor, Jaimie Ciulla Timmons, John Butterworth, John Shepard, Cady Landa, Frank A. Smith, Daria Domin, Alberto Migliore, Jennifer Bose, Lydia Landim, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This report provides statistics over 25 years from several national datasets that address the status of employment and economic self-sufficiency for individuals with intellectual and developmental disabilities. The authors use abbreviations for both intellectual disability (ID) and intellectual and developmental disabilities (IDD) in this report. This is because data sources vary in the specific target groups that can be described. Please refer to each chapter for the disability definition used in that chapter. We provide a comprehensive overview that describes national trends in employment for people with IDD, and the appendices provide individual state profiles with data from several sources. …


Statedata: The National Report On Employment Services And Outcomes, 2015, John Butterworth, Frank A. Smith, Jean Winsor, Jaimie Ciulla Timmons, Alberto Migliore, Daria Domin, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2015

Statedata: The National Report On Employment Services And Outcomes, 2015, John Butterworth, Frank A. Smith, Jean Winsor, Jaimie Ciulla Timmons, Alberto Migliore, Daria Domin, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This report provides statistics over 25 years from several national datasets that address the status of employment and economic self-sufficiency for individuals with intellectual and developmental disabilities. The authors use abbreviations for both intellectual disability (ID) and intellectual and developmental disabilities (IDD) in this report. We do this because data sources vary in the specific target groups that can be described.

We provide a comprehensive overview that describes national trends in employment for people with IDD, and the appendices provide individual state profiles with data from several sources. These include the ICI’s IDD Agency National Survey of Day and Employment …


Statedata: The National Report On Employment Services And Outcomes, 2014, John Butterworth, Jean Winsor, Frank A. Smith, Alberto Migliore, Daria Domin, Jaimie Ciulla Timmons, Allison Cohen Hall, Thinkwork! At The Institute For Community Inclusion At Umass Boston Jan 2014

Statedata: The National Report On Employment Services And Outcomes, 2014, John Butterworth, Jean Winsor, Frank A. Smith, Alberto Migliore, Daria Domin, Jaimie Ciulla Timmons, Allison Cohen Hall, Thinkwork! At The Institute For Community Inclusion At Umass Boston

All Institute for Community Inclusion Publications

This report provides statistics over 25 years from several national datasets that address the status of employment and economic self-sufficiency for individuals with intellectual and developmental disabilities. The authors use abbreviations for both intellectual disability (ID) and intellectual and developmental disabilities (IDD) in this report. We do this because data sources vary in the specific target groups that can be described.

We provide a comprehensive overview that describes national trends in employment for people with IDD, and the appendices provide individual state profiles with data from several sources. These include the ICI’s IDD Agency National Survey of Day and Employment …


Statedata: The National Report On Employment Services And Outcomes, 2013, John Butterworth, Frank A. Smith, Allison Cohen Hall, Alberto Migliore, Jean Winsor, Daria Domin Jan 2013

Statedata: The National Report On Employment Services And Outcomes, 2013, John Butterworth, Frank A. Smith, Allison Cohen Hall, Alberto Migliore, Jean Winsor, Daria Domin

All Institute for Community Inclusion Publications

This report provides statistics over 25 years from several existing national datasets that address the status of employment and economic self-sufficiency for individuals with intellectual and developmental disabilities. The authors use abbreviations for both intellectual disability (ID) and intellectual and developmental disabilities (IDD) in this report. We do this because data sources vary in the specific target groups that can be described.

We provide a comprehensive overview that describes national trends in employment for people with IDD, and the appendix provides individual state profiles with data from several sources. These include the ICI’s IDD Agency National Survey of Day and …


Partnerships In Employment: Benchmarking Toolkit, Jean Winsor, Alberto Migliore Jan 2013

Partnerships In Employment: Benchmarking Toolkit, Jean Winsor, Alberto Migliore

All Institute for Community Inclusion Publications

Policy shifts over the past 20 years have created an agenda that calls for a sustained commitment to integrated employment for individuals with disabilities. But despite these clear intentions, unemployment of individuals with disabilities continues to be a major public policy issue.

For people with intellectual and developmental disabilities (IDD), the disparity in labor market participation grows. Data suggest only 14.7% of individuals who receive supports from state IDD agencies work in either individual or group integrated employment, and 19% of individuals who receive day services from a state IDD agency participate in a service designed to support integrated employment …


Statedata: The National Report On Employment Services And Outcomes, 2012, John Butterworth, Allison Cohen Hall, Frank A. Smith, Alberto Migliore, Jean Winsor, Daria Domin, Jennifer Sulewski Jan 2013

Statedata: The National Report On Employment Services And Outcomes, 2012, John Butterworth, Allison Cohen Hall, Frank A. Smith, Alberto Migliore, Jean Winsor, Daria Domin, Jennifer Sulewski

All Institute for Community Inclusion Publications

This report provides statistics over 20 years from several existing national datasets that address the status of employment and economic self-sufficiency for individuals with intellectual and developmental disabilities. The authors use abbreviations for both intellectual disability (ID) and intellectual and developmental disabilities (IDD) in this report. We do this because data sources vary in the specific target groups that can be described.

We provide a comprehensive overview that describes national trends in employment for people with IDD, and the appendix provides individual state profiles with data from several sources. These include the ICI’s National Survey of State Intellectual and Developmental …


Data Note: State Intellectual And Developmental Disability Agencies' Funding For Employment Services, Jean E. Winsor, Frank A. Smith Jul 2011

Data Note: State Intellectual And Developmental Disability Agencies' Funding For Employment Services, Jean E. Winsor, Frank A. Smith

Data Note Series, Institute for Community Inclusion

Employment has been identified as a priority outcome in federal policy and state employment-first initiatives, and by individuals with IDD. Members of Self Advocates Becoming Empowered have issued a call to increase access to integrated employment and eliminate facility-based work (2009). In many states, the IDD agency and/or statewide advocacy coalitions have developed and implemented employment-first initiatives (State Employment Leadership Network, 2011). However, there is limited data available on the cost of integrated employment services compared to facility-based work services to guide the implementation of these initiatives.


Research To Practice: Collaboration Between State Intellectual And Developmental Disabilities Agencies And State Vocational Rehabilitation Agencies: Results Of A National Survey, Heike Boeltzig, Jean E. Winsor, Kelly Haines Apr 2011

Research To Practice: Collaboration Between State Intellectual And Developmental Disabilities Agencies And State Vocational Rehabilitation Agencies: Results Of A National Survey, Heike Boeltzig, Jean E. Winsor, Kelly Haines

Research to Practice Series, Institute for Community Inclusion

Do state intellectual and developmental disabilities (IDD) agencies collaborate with their vocational rehabilitation (VR) counterparts? If so, in what ways and how formalized are these collaborative efforts? This Research to Practice Brief provides answers to those and other questions.


Data Note: Examining Collaboration Between State Intellectual And Developmental Disabilities Agencies And State Vocational Rehabilitation Agencies, Kelly Haines, Heike Boeltzig, Jean E. Winsor Mar 2011

Data Note: Examining Collaboration Between State Intellectual And Developmental Disabilities Agencies And State Vocational Rehabilitation Agencies, Kelly Haines, Heike Boeltzig, Jean E. Winsor

Data Note Series, Institute for Community Inclusion

Since Fiscal Year 1988, the Institute for Community Inclusion has administered the National Survey of State Intellectual and Developmental Disabilities Agencies' Day and Employment Services. The FY 2009 survey included a module to assess the ways in which state intellectual and developmental disabilities (IDD) agencies collaborate with their state vocational rehabilitation (VR) agencies to support integrated employment outcomes for adults with IDD. A total of 40 agencies responded to the module. Their responses provide a broader understanding of the relationship between the two types of state agencies, and the ways in which they work together to provide integrated employment services.


Statedata: The National Report On Employment Services And Outcomes, John Butterworth, Allison Cohen Hall, Frank Smith, Alberto Migliore, Jean Winsor, Jaimie Ciulla Timmons, Daria Domin Jan 2011

Statedata: The National Report On Employment Services And Outcomes, John Butterworth, Allison Cohen Hall, Frank Smith, Alberto Migliore, Jean Winsor, Jaimie Ciulla Timmons, Daria Domin

All Institute for Community Inclusion Publications

Policy shifts over the past 20 years have created an agenda for sustained commitment to integrated employment for individuals with disabilities. But despite these clear intentions, unemployment of individuals with disabilities continues to be a major public policy issue. Labor force statistics for December 2010 indicate that 28 percent of working-age adults with disabilities are employed, compared with 70 percent of people without disabilities. Labor force data also indicate that workers with disabilities have experienced significantly higher levels of job loss and hardship during the recession of the late 2000s. For people with intellectual and developmental disabilities (IDD), the disparity …


Data Note: Tracking Employment And Day Support Participation And Outcomes In State Intellectual Disability And Developmental Disability Agencies, Samita Bhattarai, Jean E. Winsor Nov 2008

Data Note: Tracking Employment And Day Support Participation And Outcomes In State Intellectual Disability And Developmental Disability Agencies, Samita Bhattarai, Jean E. Winsor

Data Note Series, Institute for Community Inclusion

As a part of the FY2007 National Survey of Day and Employment Programs data was requested from state Intellectual Disabilities and Developmental Disabilities (ID/DD) agencies regarding the sources of information used to report the total number of individuals served in the following services categories: integrated employment, facility-based work, community-based non work, and facility-based non work. Data on sources is an important factor to note when comparing each state’s service outcomes over time. Collecting information on the source of the data can help to explain unexpected trends in state service distribution when the state has not implemented changes in policy or …


Data Note: Employment Rates In The General Population And Vr Rehabilitation Rates, Alberto Migliore Jul 2008

Data Note: Employment Rates In The General Population And Vr Rehabilitation Rates, Alberto Migliore

Data Note Series, Institute for Community Inclusion

The Vocational Rehabilitation (VR) program plays a critical role in assisting people with disabilities gaining integrated employment. In 2006, for instance, 48,876 people with intellectual or developmental disabilities (ID/DD) exited the VR program after receiving services, with 56% of those who received services finding jobs in integrated employment. This percentage, known as the VR Rehabilitation Rate, varied from 42% in Hawaii to 77% in Maryland, if excluding the figure in Oklahoma where the VR rehabilitation rate was 22%.


Data Note: State Mental Retardation And Developmental Disabilities Agencies Expenditures For Integrated Employment Services, Jean E. Winsor, Frank A. Smith, Brooke Dennee-Sommers Apr 2008

Data Note: State Mental Retardation And Developmental Disabilities Agencies Expenditures For Integrated Employment Services, Jean E. Winsor, Frank A. Smith, Brooke Dennee-Sommers

Data Note Series, Institute for Community Inclusion

In FY2004, the average expenditure per person for integrated employment as reported by state Mental Retardation and Developmental Disabilities (MR/DD) agencies was $6,251 (Table 1). This figure has increased steadily since the mid-1990s indicating that states have slowly begun allocating additional resources towards integrated employment. However, growth in expenditures is likely a result of changes in federal law as opposed to changes in the amount of state dollars available to fund integrated employment.


Data Note: Timeframe From Application To Closure In Integrated Employment For Vocational Rehabilitation Customers With Developmental Disabilities, Alberto Migliore, Frank A. Smith Jan 2008

Data Note: Timeframe From Application To Closure In Integrated Employment For Vocational Rehabilitation Customers With Developmental Disabilities, Alberto Migliore, Frank A. Smith

Data Note Series, Institute for Community Inclusion

Getting a job promptly after applying for vocational rehabilitation (VR) services is important for a successful career. Rapid placement boosts self-confidence and prevents applicants from losing work skills as a consequence of inactivity. Moreover, employers may prefer candidates whose work history shows limited gaps in employment.


Data Note: National Day And Employment Service Trends In Mr/Dd Agencies, Jean E. Winsor, John Butterworth Sep 2007

Data Note: National Day And Employment Service Trends In Mr/Dd Agencies, Jean E. Winsor, John Butterworth

Data Note Series, Institute for Community Inclusion

In FY2004, 22% of individuals receiving day supports from state mental retardation or developmental disability (MR/DD) agencies participated in integrated employment while 56.5% of individuals were supported in facility-based settings. While the data demonstrate a continued decrease in the percent of people served in facility-based settings (from 60% in 1999 to 57% in 2004), it also suggests a slight decrease in the percent served in integrated employment (from 25.5% in 1999 to 22% in 2004).


Community Rehabilitation Programs And Organizational Change: A Mentor Guide To Increase Customized Employment Outcomes, John Butterworth, Cecelia Gandolfo, W. Grant Revell, Katherine J. Inge Jan 2007

Community Rehabilitation Programs And Organizational Change: A Mentor Guide To Increase Customized Employment Outcomes, John Butterworth, Cecelia Gandolfo, W. Grant Revell, Katherine J. Inge

All Institute for Community Inclusion Publications

In 2002, the U.S. Department of Labor, Office of Disability Employment Policy (ODEP) announced the availability of funds to support a National Training Technical Assistance for Providers (T-TAP) project. The goal of the project was to assist community rehabilitation providers (CRPs) in facilitating integrated employment / customized employment outcomes for individuals served by these programs. Virginia Commonwealth University (VCU) in partnership with the Institute for Community Inclusion (ICI) at the University of Massachusetts Boston submitted a proposal and was awarded the cooperative agreement in October of 2002.

For the purpose of this Guide, customized employment is defined as a process …


Data Note: The Relationship Between Supported Employment Status And Minimum Wage For Vocational Rehabilitation Integrated Employment Closures In 2004, Frank A. Smith, Dana Scott Gilmore Dec 2006

Data Note: The Relationship Between Supported Employment Status And Minimum Wage For Vocational Rehabilitation Integrated Employment Closures In 2004, Frank A. Smith, Dana Scott Gilmore

Data Note Series, Institute for Community Inclusion

Some VR customers earn less than minimum wage despite being closed successfully, i.e., exiting Vocational Rehabilitation (VR) services into an integrated employment setting. Section 14(c) of the Fair Labor Standards Act allows employers to pay less than the minimum wage to a person whose disability impairs their capacity to be productive at a particular job. People in supported employment are more likely to have a disability that makes them eligible for Section 14(c) minimum wage exemption. How do wages for customers in supported employment compare to those earned by other customers?


Research To Practice: The National Survey Of Community Rehabilitation Providers, Fy2004-2005 Report 1: Employment Outcomes Of People With Developmental Disabilities In Integrated Employment, Heike Boeltzig, Dana Scott Gilmore, John Butterworth Jul 2006

Research To Practice: The National Survey Of Community Rehabilitation Providers, Fy2004-2005 Report 1: Employment Outcomes Of People With Developmental Disabilities In Integrated Employment, Heike Boeltzig, Dana Scott Gilmore, John Butterworth

Research to Practice Series, Institute for Community Inclusion

Where do people with mental retardation and developmental disabilities work? What are their hours, wages, and benefits? This brief covers partial results from a survey that gives a snapshot of the outcomes for recently employed people with developmental disabilities.