The Healthy People 2010 is a national initiative to establish goals and specific objective with regard to health in the United States. The development and monitoring of Healthy People 2010 goals and objectives is led by the Centers for Disease Control and Prevention (CDC). The overarching goals of Healthy People 2010 are: “1) increasing the quantity and quality of life for Americans, and 2) eliminating the disparities in health among us” (CDC, 2001, p. 1). Unlike the earlier Healthy People 2000 objectives, Healthy People 2010 established disability as a specific focus of national objectives. Among the specific national objectives reported in Chapter 6: Disability and Secondary Conditions (CDC, 2001) was Objective 6.7b: “Reduce to zero the number of children aged 17 years and younger living in congregate care facilities” (p. 89). Congregate care facilities were defined as: “settings in which children or adults with disabilities live in a group of 4 or more people with disabilities, in order to receive needed supports and services” (CDC, 2001, p. 89).
In an effort to establish the mid-decade status of Objective 6.7b, in June of 2005 state developmental disabilities program agencies were requested to report the numbers of children (0–14 years), youth (15–18), and young adults (18–21 years) with intellectual and developmental disabilities (ID/DD) in “out-of-home residential placements.” Out-of-home residential placements were defined as individuals receiving residential supports who are not living with parents or other relatives. Figure 1 presents a summary of changing patterns in out-of-home residential placements of children and youth with developmental disabilities at approximately decade intervals since 1977. It shows the substantial decrease in children (0–14 years) and youth (15– 21 years) placed out-of-home along with the substantial increase in the number of individuals of all ages receiving residential services. Between June 1977 and June 2005, children and youth with ID/ DD in out-of-home placements decreased from an estimated 90,942 (36.7% of all persons in residential settings) to an estimated 26,395 (6.2% of all persons in residential settings). These changes were the product of important assistance to families of children with ID/DD, including Supplemental Security Income for children with substantial disabilities (1974), the entitlement to an appropriate education for children with disabilities (1976), Medicaid Home and Community-Based Services (1981), state family support programs, and other reflections of the principles of permanency planning that were recognized in the Healthy People 2010 report (CDC, 2001, p. 93). It must, however, also be noted that the reduction in out-of-home placements of children and youth with ID/DD appears to have slowed substantially, if not ended. In 1997, there were an estimated 26,028 persons with ID/ DD 21 years or younger receiving out-of-home residential supports (.98 per 1000 persons 21 and younger in the general population). In 2005 there were an estimated 26,395 persons 21 years and younger receiving residential supports (about .90 per 1000 persons 21 years and younger). Along with the modest decrease in the number of out-of-home placements indexed for this population, there was also a decrease in the proportion of persons 21 years and younger among all persons receiving out of home residential services for person with ID/DD (from 7.6% in 1997 to 6.2% in 2005). The trend toward decreasing numbers of children 14 years and younger continued between 1997 and 2005 (from an estimated 10,243 to 7,926), but was offset by an increase in the number of youth between 15 and 21 years in out-of-home settings.
Table 1 summarizes statistics reported by states relevant to the national objective of eliminating congregate care for children and youth. Comparative statistics are also provided for 1997. Table 1 also presents the results of the state survey related specifically to individuals 18 years and younger in out-of-home settings generally and in congregate care settings (i.e., places in which 4 or more people with disabilities were living and receiving residential supports). In 2005 it was estimated, based on the reports of 46 states, that there were 16,421 children and youth 18 years or younger in out-of home placements for persons with ID/DD, and, based on the reports of 37 states, that an estimated 8,356 (50.9%) of these individuals were living in congregate care settings. It appears that (a) great progress has been made in the past three decades in reducing out-of-home placements of children and youth with ID/DD; (b) this progress has been substantially slowed or halted, depending on the measure selected, in recent years; and (c) the nation has considerable distance to go in accomplishing the national Objective 6.7b of Health People 2010.
Centers for Disease Control and Prevention. (2001). Healthy People 2010 Chapter 6: Disability and secondary conditions. Atlanta: Author at http://health.gov/healthy people
Lakin, K. C., Anderson, L., & Prouty, R. (1998). Children and youth receiving residential services for persons with developmental disabilities outside their family homes: Trends from 1977 to 1997. Policy Research Brief, 9(1), whole issue. Minneapolis: University of Minnesota, Research and Training Center on Community Living.
Prouty, R., Smith, G., & Lakin, K. C. (Eds.). (2005). Residential services for persons with developmental disabilities: Status and trends through 2004. Minneapolis, MN: University of Minnesota, Research and training Center on Community Living.
Data collection was supported in part by the Administration on Developmental Disabilities and the Centers for Disease Control and Prevention (U.S. Department of Health and Human Services) and the National Institute on Disability and Rehabilitation Research (U.S. Department of Education).