A Comparative Study of the United States, Korean and Japan on CIL

Services that Improve Community Participation for People with

Disabilities:

Glen W. White, Craig Ravesloot,Chiaki Gonda, KyungMee KimShoji Nakanishi, Ahn Ji Hwan

Jeff Gordon and the Consumer Empowered Team

Acknowledgements Consumer Empowered Team

Jason Beloungy, Independent Living Resources, La Crosse, WI Michael H. Blatchford, ASSIST! to Independence, Tuba City, AZ

(deceased) Peggy Cosner and Tom Elmore, Heart of Central Texas ILC, Belton,

TX Ann Ford, Illinois Network for Centers for Independent Living,

Springfield Rahnee Patrick, Access Living, Chicago, IL Virginia Harris and Julie Harrell, BAIN, Inc. Center for Independent

Living, Bainbridge, GA Roger Frischenmeyer, Prairie Independent Living Resource Center

(PILR), Hutchinson, KS

National Institute on Disability and Rehabilitation Research (grant # H133B060018)

Overview Best practice competition CIL Services Instrument

construction CIL Survey translation and

testing CIL Data Collection Results Lessons Learned

Best Practices Solicited applications

NCIL and APRIL members Propose best practices

that increase community participation

Eight programs selected; 4 each at NCIL & APRIL Conferences

Provided content and direction for survey

Instrument Construction Best practices Consumer

Empowered team 704 report variables International

Classification of Function

100 randomly selected CIL websites

Survey Example:

Content CategoriesCategory Number of

Items1. Advocacy 102. Housing 63. Independent Living Skills 94. Information/ Referral 85. Peer Support 66. Transportation 67. Employment 78. Recreation 49. Assistive technology 410. Mental Health 311. Healthcare 212. Nursing Home Emancipation 213. CIL Process Dimension 14

Data Collection (in USA study)

Randomly selected 90 CILs

65 CILs agree to participate

Surveys returned by 61 CILs

Completed by 420 CIL staff members

Developing Comparison Process of USA CIL data with

Korea and Japan Initially worked with Chiaki Gonda and

KyungMee Kim

We contacted and then worked with top IL leaders in Korea and Japan (Ji Hwan Ahn and Shoji Nakanishi) to get their buy-in and agreement to assist with recruiting CILs

To maintain consistency, the US survey was translated into Korean and Japanese as close to possible to the original

Developing Comparison Process of USA CIL data with Korea and Japan

(con’t) The surveys were then placed into on-

line survey format and pilot tested with several consumers in Korea and in Japan

Korean and Japanese text and grammar were corrected where necessary and the actual web based survey was de-bugged as necessary

Survey went ‘live’ and CIL staff were recruited by Mr. Hwan and Mr. Nakanishi

Developing Comparison Process of USA CIL data with Korea and Japan

(con’t) The international data were collected

during late spring-early summer 2012

USA – 450 CILs – randomly selected 90 – received data 420 staff from 65 CILs

Korea – 120 CILs – received data from 175 staff from 54 CILs

Japan – 121+ CILs – received data from 288 staff from 65 CILs

CIL staff Top 5 items by order of importance

USA-Korea-Japan

CIL Staff Top 5 Importance Ratings USA-CILs %

1. Provides services in a way that empowers consumers to make their own choices.

97

2. Advises consumers about benefits they are eligible for (e.g., Medicaid, SS, housing).

97

3. Provides services in a way that encourages consumers to advocate for their own rights.

97

4. Works for the rights of people with all types of disabilities/chronic health concerns (e.g., sensory, mental health).

96

5. Uses partnerships with other agencies in the community to help consumers meet IL needs (e.g., transportation providers, housing authority).

96

CIL Staff Top 5 Importance Ratings Korea-CILs %

1. Provides personal assistant services management training.

97

2. Helps people with disabilities find the types and amounts of personal assistive services they need.

91

3. Provides competent, confidential and respectful peer counseling services.

91

4. Gives services to help integrate consumers into the community once emancipated from nursing home.

91

5. Provides services in a way that encourages consumers to advocate for their own rights.

89

CIL Staff Top 5 Importance Ratings Japan-CILs %

1. Provides services in a way that empowers consumers to make their own choices.

97

2. Gives services to help integrate consumers into the community once emancipated from nursing home.

96

3. Provides nursing home emancipation services. 96

4. Works for the rights of people with all types of disabilities/chronic health concerns (e.g., sensory, mental health).

96

5. Helps with decision and policy-making regarding other community services for consumers.

95

Content CategoriesCategory Number of

Items1. Advocacy 102. Housing 63. Independent Living Skills 94. Information/ Referral 85. Peer Support 66. Transportation 67. Employment 78. Recreation 49. Assistive technology 410. Mental Health 311.Healthcare 212. Nursing Home Emancipation 213. CIL Process Dimension 14

Category USA Korea Japan1. CIL Process Dimension 5 1 22. Nursing Home Emancipation 1 2 23. Peer Support - 3 24. Transportation - - -5. Housing - - 16. Advocacy 2 2 27. Employment - - -8. Mental Health - - -9. Assistive Technology - - -10. Independent Living Skills - 1 -11. Information/ Referral 2 1 112. Healthcare - - -13. Recreation - - -

USA-Korea-Japan Top 10 Importance by Category

Category USA Korea Japan1. CIL Process Dimension 7 6 32. Nursing Home Emancipation 2 2 23. Peer Support 2 5 44. Transportation 1 - 15. Housing 1 - 26. Advocacy 4 3 67. Employment - - -8. Mental Health - - -9. Assistive Technology - - -10. Independent Living Skills 0 2 111. Information/ Referral 3 2 112. Healthcare - - -13. Recreation - - -

USA-Korea-Japan Top 20 Importance by Category

Category USA Korea Japan1. CIL Process Dimension 5/7 1/6 2/32. Nursing Home Emancipation 1/2 2/2 2/23. Peer Support 0/2 3/5 2/44. Transportation 0/1 - 1/15. Housing 0/1 - 0/26. Advocacy 2/4 2/3 2/67. Employment - - -8. Mental Health - - -9. Assistive Technology - - -10. Independent Living Skills 0 1/2 1/111. Information/ Referral 2/3 1/2 1/112. Healthcare - - -13. Recreation - - -

USA-Korea-Japan Top 10/20 Importance by Category

Core Services Comparison US and Japan

USA Japan*

Info. and Referral Personal Assistance Services

Peer Counseling Peer Counseling

Advocacy ----Info. and Referral

IL Skills Training ----IL Skills Training

Deinstitutionalization ----Advocacy

* Korean CILs were originally developed with Japan’s structure

Comparison of CIL Service Strengths and Weaknesses

StrengthItem that has both high importance and high satisfaction

WeaknessItem that has high importance, but has low satisfaction

USA Top 5 StrengthsAdvises consumers about benefits 90%Provides services to empower consumer choice 87%Has services that encourage personal consumer advocacy 86%Makes referrals to other disability support service providers 85%Partners with other community agencies to meet IL needs 85%

USA Top 5 WeaknessesWorks with worship sites so interested consumers can participate 29%Gives info on accessible medical services 27%Gives education/computer skills workshops 27%Newsletter & website info on accessible community resources 26%Helps increase access to medical services 26%

Korea Top 5 StrengthsProvides PAS Management trg. 92%Helps consumers find the PAS they need 91%Gives competent and respectful peer counseling 91%Helps integrate emancipated consumers into the community 91%Provides services to empower consumer choice 89%

Korea Top 5 WeaknessesPromotes positive disability portrayal 34%Helps PWD transition to employment and community living 22%Advocates for all PWD rights & Chron/Con 21%Helps PWD have equal opportunity in applying for jobs 20%Offers home access mod. Programs 17%

Japan Top 5 StrengthsProvides services to empower consumer choice 97%Helps integrate emancipated consumers into the community 96%Gives nursing home eman-cipation services 96%Advocates for policies about community services that affect consumers 95%Helps consumers find accessible and affordable housing 95%

Japan Top 5 WeaknessesPromotes positive disability portrayal 40%Helps involve PWD in the legislative process 35%Uses grassroots advocacy to increase community accessibility 30%Works with local businesses to increase accessibility 28%Gives regular self-advocacy training 28%

Category USA Korea Japan1. CIL Process Dimension 5 2 22. Nursing Home Emancipation 2 23. Peer Support 2 14. Transportation 1 - -5. Housing - 26. Advocacy 1 2 27. Employment - -8. Mental Health - -9. Assistive Technology - -10. Independent Living Skills 1 -11. Information/ Referral 3 1 112. Healthcare - -13. Recreation - -

USA-Korea-Japan Top 10 Strengths by Category

Category USA Korea Japan1. CIL Process Dimension 1 - -2. Nursing Home Emancipation - -3. Peer Support 1 24. Transportation - 25. Housing 1 2 -6. Advocacy 1 3 57. Employment 1 2 -8. Mental Health 1 - -9. Assistive Technology 1 - -10. Independent Living Skills 1 1 111. Information/ Referral - -12. Healthcare 2 1 -13. Recreation 1 - -

USA-Korea-Japan Top 10 Weaknesses by Category

Lessons learned All three countries have somewhat

similar response patterns US-Korea-Japan all viewed the following

content categories as less important compared to other categories: Employment Mental health Assistive technology Health care Recreation

Lessons learned (con’t)

While Korea and Japan have emphasized personal assistive services and peer counseling, they also note value in the process dimensions and how the services are delivered, which reflects core philosophy..

In the top 20 items of importance Japan and Korea CIL staff agreed on the importance of at least one item in each of the 5 US core service areas.

Lessons learned (con’t)

There were no specific item categories for PAS

Korea and Japan selected PAS-related items ILS-6 “Provides PAS management training” and I&R-1 “Helps people with disabilities find the types and amounts of PAS they need” Both rated in the top 20.

US did select I&R-1 in its top 10.

Korea and Japan CILs indicated at least twice the importance of peer support vs US CILs

Top Impt

.

USA Korea Japan

10 0 3 220 2 5 4

Limitations The original survey was based on US CIL

experience and history with services and may not reflect all the types or descriptions of CIL services offered in Korea and Japan.

These findings should be interpreted through a cultural, economic and political lens. The intent of this study is not to determine whether one country offers better CIL services than another, but to examine our commonalities.

Next Steps We will be conducting a deeper analyses

of these data to determine any other key relationships in the way CIL staff view their services across each of the three countries.

This study will be presented and discussed with the leaders of KOIL and JIL to determine further lessons learned.

Next Steps This study will be presented a the Asian

Pacific Network on Independent Living in Incheon, Korea this October.

We plan on writing reports and papers on this study for US, Korean and Japanese audiences.

This study will be presented outside Seoul Korea in late October 2012

Questions and Answers

Contact InformationGlen W. White, PhDRTC/IL, University of Kansas1000 SunnysideAve., Room 4089Lawrence, KS 66045785-864-4095Glen@ku.edu

http://rtcil.orghttp://www.rtcil.org/micl

Craig Ravesloot, PhDRTC/Rural, University of

Montana52 Corbin HallMissoula, MT 59812406-243-2992Craig.Ravesloot@umontana.edu

http://mtdh.ruralinstitute.umt.edu/http://rtc.ruralinstitute.umt.edu/health/

RuH.htm