A Purpose in Life: Why Employment First Matters to Self-Advocates

Self-advocates with intellectual disabilities describe Employment First efforts in their states, and why those efforts are important. Self-Advocates Becoming Empowered asked leaders in the self-advocacy movement to describe the impact of Employment First in their states. The authors spoke with 21 peer leaders across the country and asked, “What does Employment First mean?

APSE Employment First Statement

These authors worked together to write a statement about what Employment First means and why it’s important. Here is an excerpt from the statement. All people with disabilities should have opportunities to work. Public dollars should be used to pay for supports for people to work in the community. People with disabilities, their families, and their allies believe that: All people should have opportunities for real jobs with real wages. It will get us out of poverty. We will be more independent. We will feel more included. All people, with and without disabilities, can work in jobs together earning minimum wage or higher. Like everyone else, people with disabilities should have access to supports that they need to work successfully. All people, no matter what disability they have, have the right to work a job they choose that matches their skills and interests. Public policies must support people with disabilities having real jobs. Money for services should be spent on people having jobs in the community. Just calling your state an Employment First state is not enough. “Employment First” is when everyone who wants a job, has a job

An ethic of connectedness: enacting moral school leadership through people and programs

As educators, we grapple with a myriad of dilemmas and often have difficulty resolving issues that relate to curriculum and instruction, funding, facilities and supervision, to name a few. Depending on the leader(s), a variety of ethics come in to play when making decisions. The ethic of connectedness refers to community building and welfare as central to moral thought and practice (Bradley, 2007). Responsibility to community building and welfare begins in the schools and must be an acculturated practice within the schools so future generations possess the knowledge, skills and dispositions that ensure a connectedness to their society (Marzano et al., 2005; Barth 2006; Collinson et al., 2006). This article will explore the importance of an ethic of connectedness to effective school leadership and the experience of a Pennsylvania school district in nurturing and building a connectedness within the school community.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Managing diabetes in people with dementia: a realist review

Background: Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. Objectives: To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. Design: Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. Participants: Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. Data sources: The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). Results: We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. Limitations: There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. Conclusions: This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes