View in EDS HTML Full Text PDF Full Text

Association of COVID-19-Related Restrictions with Changes in Functional Skills of Adults with Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization

Saved in:
Bibliographic Details
Title: Association of COVID-19-Related Restrictions with Changes in Functional Skills of Adults with Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization
Language: English
Authors: Ben David, Nophar (ORCID 0000-0002-9487-116X), Lotan, Meir, Moran, Daniel Sender
Source: Research and Practice for Persons with Severe Disabilities. Jun 2023 48(2):79-91.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 13
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Descriptors: Foreign Countries, Intellectual Disability, Adults, COVID-19, Pandemics, Day Programs, Daily Living Skills, Environmental Influences, Social Services, Change
Geographic Terms: Israel
DOI: 10.1177/15407969231173929
ISSN: 1540-7969
2169-2408
Abstract: Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1380844
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwF61FMwQpzGVQy-OsZBK2xMAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDM2BQeTvWIE9axK-NAIBEICBm5fObqFdbqamLUU30HbsH4c4LrUhA2bs6oGG0TJD_AwH8zqWKeJgOaO-YUREkN4q4-i5W91NFnYaD5pg8ZCC374EO_4_K4gFAk7a8tekK41oi9jAm0j3nt4CnBMJv7fnH8TIseOMA6IgFH3GtWUWIRqsQny5Z-iGLMiX8A5tDrYgCeySaZGiVQsylukGZTUlY6zuoVo24q0ABCLd
Text:
  Availability: 1
  Value: <anid>AN0164157795;myx01jun.23;2023Jun09.06:52;v2.2.500</anid> <title id="AN0164157795-1">Association of COVID-19-Related Restrictions With Changes in Functional Skills of Adults With Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization </title> <p>Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.</p> <p>Keywords: functional change; environmental change; severe intellectual disability; informal assessment; COVID-19</p> <p>Intellectual disability (ID) is an umbrella term for a group of disorders that are usually present at birth and negatively affect the trajectory of an individual's physical, intellectual, and/or emotional development ([<reflink idref="bib18" id="ref1">18</reflink>]). About 2% of the total world population has been diagnosed with ID, and it is currently assumed by the World Health Organization (WHO) and other significant organizations to be a dynamic phenomenon. This assumption derives from the understanding that the functional abilities of an individual with ID can improve or deteriorate throughout their lifespan owing to health factors as well as external influencers, that is, personally customized programs and accessibility to health care services, as well as appropriate therapeutic support ([<reflink idref="bib13" id="ref2">13</reflink>]).</p> <p>While this assumption is well documented in childhood research and thus, children receive more adequate intensive personalized health care services ([<reflink idref="bib6" id="ref3">6</reflink>]), there is not enough evidence-based research regarding the benefits of such programs during adulthood, especially for those with severe/profound (S/P) ID ([<reflink idref="bib1" id="ref4">1</reflink>]; [<reflink idref="bib24" id="ref5">24</reflink>]). Severe neurological, communicative, physical, medical, and behavioral functioning challenges are typical for adults with ID (e.g., [<reflink idref="bib4" id="ref6">4</reflink>]; [<reflink idref="bib10" id="ref7">10</reflink>]; [<reflink idref="bib13" id="ref8">13</reflink>]), who may need different levels of assistance in their daily routines ([<reflink idref="bib15" id="ref9">15</reflink>]). Therefore, this group requires regular reassessment and continuous adaptation of suggested therapeutic interventions that may be much more challenging at the S/P levels ([<reflink idref="bib10" id="ref10">10</reflink>]; [<reflink idref="bib27" id="ref11">27</reflink>]).</p> <p>According to the regulations of the Disabilities Administration of the [<reflink idref="bib18" id="ref12">18</reflink>], individuals with ID are required to undergo a functional assessment every 3 months and a complete assessment every 3 years. However, in the absence of appropriate screening tools, fulfilling this requirement is not possible ([<reflink idref="bib5" id="ref13">5</reflink>]).</p> <p>Coronavirus disease 2019 (COVID-19), declared by the WHO as a pandemic on March 11, 2020, added an external challenge for people with ID ([<reflink idref="bib7" id="ref14">7</reflink>]; [<reflink idref="bib22" id="ref15">22</reflink>]). The presence of ID was found to be the strongest independent risk factor for COVID-19 infection. However, beyond the direct risk of COVID-19, the pandemic hampered the ability of individuals with ID to receive the health care and daily support they typically received ([<reflink idref="bib12" id="ref16">12</reflink>]).</p> <p>As a public health crisis, the COVID-19 pandemic caused long-term disruption in the support systems of people with ID across the globe ([<reflink idref="bib2" id="ref17">2</reflink>]; [<reflink idref="bib8" id="ref18">8</reflink>]; [<reflink idref="bib26" id="ref19">26</reflink>]). Government mandates, often changing overnight, reduced all social contact, thereby affecting the health and well-being of neurotypical individuals as well as those with ID. Owing to a sweeping reduction of daily support and health services for those with ID ([<reflink idref="bib9" id="ref20">9</reflink>]), there has been an observed decrease in competencies and social integration and an increase in challenging behaviors, mental problems, and other comorbidities ([<reflink idref="bib7" id="ref21">7</reflink>]; [<reflink idref="bib14" id="ref22">14</reflink>]; [<reflink idref="bib23" id="ref23">23</reflink>]). This added an extra burden on a system that was already stretched thin ([<reflink idref="bib8" id="ref24">8</reflink>]; [<reflink idref="bib11" id="ref25">11</reflink>]; [<reflink idref="bib26" id="ref26">26</reflink>]).</p> <p>In Israel, as in other countries, adults with ID and their direct service providers experienced disruptions because of COVID-19. For example, at Amichai, a non-profit organization that operates day centers for adults with ID, only those who lived with their families (mostly those with S/P diagnoses) could regularly visit throughout this period, whereas those who lived in group homes (those with moderate and mild [M/M] ID) could visit only sporadically and were exposed to significant changes regarding their previous routines and personnel. Consequently, the regular schedule and teams changed daily for those who lived in group homes, whereas those who lived with their families mostly maintained their schedules and even received extra professional treatment from the para-professional teams who were allowed to work only within the day center.</p> <p>Throughout 2021, only 6.6% of the total number of adults with ID known to the [<reflink idref="bib18" id="ref27">18</reflink>] underwent a full reassessment, which is required by law once every three years. This represents a 40% drop compared with previous years and is attributed to accessibility issues related to the pandemic (<emph>An official response to a request regarding budgetary expenses by the IMWSS</emph>, sent by the authors (Aug 2021), reply sent by E-mail, Nov 2021). The need for such a reassessment in a familiar and accessible environment is well documented ([<reflink idref="bib16" id="ref28">16</reflink>]; [<reflink idref="bib25" id="ref29">25</reflink>]). The services of inexperienced and stressed providers, a result of personnel changes brought on by COVID-19 restrictions, complicated the situation ([<reflink idref="bib11" id="ref30">11</reflink>]).</p> <p>Owing to such changes caused by COVID-19, a rare opportunity presented itself where we could investigate the assumption that adults with ID, especially those with S/P disabilities, can improve their functional abilities through intensive comprehensive developmental and therapeutic programs. Thus, we hypothesized that the functional scores of different groups of participants (S/PID who continued to receive day services and those with M/M) would differ owing to the great environmental changes of COVID-19.</p> <p>To this end, during 18 months of the pandemic (September 2020–February 2022) at three points of time, we used the Functional Screening Tool for adults with ID (FST-ID), found to have high psychometric values ([<reflink idref="bib5" id="ref31">5</reflink>]), to map the environmental and functional changes experienced by individuals with three different levels of ID.</p> <hd id="AN0164157795-2">Aims</hd> <p>This study aims to describe the environmental changes that occurred during the COVID-19 pandemic and the association of these changes with the functional abilities of adults within three groups, seniors with M/M, non-senior adults with M/M, and non-senior adults with S/P ID visiting day centers.</p> <hd id="AN0164157795-3">Method</hd> <p>This study included the voluntary involvement of direct service providers and multidisciplinary staff. No research activity directly involved adults with ID. All participants (direct care providers and multidisciplinary staff) and formal guardians of the involved individuals with ID signed informed consent forms.</p> <hd id="AN0164157795-4">Participants</hd> <p>This study was based on a convenience sample of direct service providers (<emph>n</emph> = 37), most of whom were around the age of 19, engaged in one year of volunteering. Eight of whom were men (21.6%). The rater ages ranged from 19 to 55 years (<emph>M</emph> = 26.73, standard deviation [<emph>SD</emph>] ± 12.13). Owing to the COVID-19 outbreak, there was significant turnover among service providers. Therefore, 22 service providers knew the service recipients for only 2 to 3 months, and the rest (15 service providers or 40.5%) knew them for more than 3 months.</p> <p>The sample also included the professional team, a total of eight participants, one of whom was a male (12.5%). Their professions were as follows: two physiotherapists, one speech therapist, one behavior modifier, one occupational therapist, one social worker, and two art therapists. The raters' ages ranged from 23 to 57 years (<emph>M</emph> = 44.13, <emph>SD</emph> ± 10.34), and the length of their acquaintance with the service recipients was as follows: two (25%) less than 6 months, one (12.5%) more than 6 months, and five (62.5%) more than 5 years.</p> <p>The adults with ID were enrolled at the day centers of Amichai a non-profit organization during the three sampling times. Of the 76 adults, 29 (38.2%) were women and were diagnosed with all levels of ID: mild (<emph>n</emph> = 31; 41%), moderate (<emph>n</emph> = 29; 38%), and S/P (<emph>n</emph> = 16; 21%). Their ages ranged from 21 to 71 years (<emph>M</emph> = 37.63, <emph>SD</emph> ± 14.61). This was according to the official up-to-date diagnosis (Diagnostic Committees of the Israeli Ministry of Welfare and Social Services), as extracted from their personal files. Most (63; 82.9%) were not engaged in any type of work (owing to their cognitive and emotional limitations), with a few (13; 17.1%) enrolled in protected employment services.</p> <p>All adults with S/P ID (16; 100%) lived with their families, whereas most adults with moderate (22 out of 29, 76%) and mild (24 out of 31, 77%) ID lived in various community residential programs. Most presented with other comorbidities apart from ID, usually with more than one diagnosis, such as gastrointestinal problems (34; 45%), cerebral palsy (20; 26%), epilepsy (19; 25%), challenging behaviors (16; 21%), vision impairments (19; 25%), and autism (nine; 12%). A total of 50 of 76 (65.8%) were diagnosed with COVID-19 during the 18 months of the research period.</p> <p>Those who were not physically at the day centers during the sampling owing to the associations of COVID-19 restrictions, were excluded from this study.</p> <p>The ages of the 76 adults according to type of day center are presented in Table 1.</p> <p>Graph</p> <p>Table 1 Age of 76 Care Receivers According to Type of Day Center.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="center">Type of day center</th><th align="center">Mean</th><th align="center"><italic>N</italic></th><th align="center"><italic>SD</italic></th><th align="center">Minimum</th><th align="center">Maximum</th></tr></thead><tbody><tr><td>Senior citizens' employment day center</td><td>60.32</td><td>19</td><td>7.66</td><td>46</td><td>71</td></tr><tr><td>Therapeutic day center</td><td>30.29</td><td>42</td><td>6.26</td><td>21</td><td>51</td></tr><tr><td>Supported employment day center</td><td>29.47</td><td>15</td><td>4.59</td><td>23</td><td>38</td></tr><tr><td>Total</td><td>37.63</td><td>76</td><td>14.61</td><td>21</td><td>71</td></tr></tbody></table> </ephtml> </p> <hd id="AN0164157795-5">Research Setting</hd> <p>Amichai, a non-profit organization, operates day centers that adapt to the different needs and abilities of adults with ID. This includes a therapeutic center for S/P and M/M groups, a supported employment center for the younger M/M group, and a senior citizens' employment center for the older M/M group</p> <p>Before the pandemic, 76 adults with ID aged 21 years and above were enrolled in the day centers. These adults (the entire S/P group and some from the M/M group) either lived with their families and with foreign workers employed by the families aiding those individuals with disabilities or at various community group apartments (the M/M group) with paid caregivers. During regular circumstances, the day centers are open 5 days a week and offer professional therapy services according to personally customized programs, mostly at the therapeutic center.</p> <p>A "regular" treatment protocol for all those enrolled in the therapeutic day center for adults with M/M and S/P disability includes different individual and group sessions. All of these aim to improve residents' functional abilities according to the following three functional clusters:</p> <p></p> <ulist> <item> Communication (by a speech therapist; ST):</item> <p></p> <item> (a) Weekly "meetings" for communication were held within a group constellation. During these meetings, the ST presented clinical tools and insights to the direct care providers.</item> <p></p> <item> (b) Each care provider was instructed on appropriate communication enhancement techniques, and their implementation in everyday situations was followed up by the ST. These techniques were regularly adapted based on staff availability and care-recipients' abilities.</item> <p></p> <item> (c) Observations were made during mealtimes, and the direct care team received training according to the needs of the service recipients.</item> <p></p> <item> (d) Hearing rehabilitation: The direct caregivers were trained on the maintenance of existing devices and the referral for tests and follow-up of those identified by the communication clinician.</item> <p></p> <item> Physical therapy (by a physical therapist; PT):</item> <p></p> <item> (a) Individual PT sessions were available to most of the S/P group and some of the M/M group according to their needs. The direct care providers accompanied the care receivers during these treatments and received insights into and clinical advice on proper care tailored to each care recipient's abilities and their team's availability.</item> <p></p> <item> (b) PT weekly group meetings were held within a group constellation. During these meetings, the PT presented clinical tools regarding handling and provided insights supporting further daily care to the direct care providers.</item> <p></p> <item> (c) Each care provider was instructed on proper handling enhancement techniques and their implementation in everyday situations. These instructions were followed up by the PT and regularly updated to meet staff availability and care recipients' abilities.</item> <p></p> <item> Art therapy (by art therapists; AT):</item> <p></p> <item> (a) Weekly group meetings were conducted by the AT and focused on art products such as creating ceramic bowls.</item> <p></p> <item> (b) Each care provider was instructed on the proper techniques to advance the care receiver's functional abilities. These instructions were followed up by the AT and regularly updated based on staff availability and care recipients' abilities.</item> </ulist> <hd id="AN0164157795-6">The Two Other Day Centers</hd> <p>These centers serve only M/M individuals. One center is for older adults, and the other for younger individuals (see the section on demographic characteristics). A "regular" treatment protocol for all those enrolled in the other day centers includes making different products, such as small flowerpots and art products, with some assistance from their direct care providers. All the created products are then sold in different marketplaces.</p> <hd id="AN0164157795-7">Changes Due to COVID-19</hd> <p>During the first few months of the pandemic, only the therapeutic center remained open for individuals who lived with their families. All other service receivers stayed isolated within their group homes (the M/M group). Gradually, all centers reopened; however, once a service provider or recipient tested positive for COVID-19, they were immediately sent into quarantine isolation; recipients were accompanied by care providers. This of course caused endless routine changes, especially for adults with ID who lived in group homes. It was far less disruptive for those who lived with their families (as these individuals continued to come to the therapeutic day center as they had done before COVID-19). The professional team was allowed to work only at the therapeutic center.</p> <p>During COVID-19, the two other day centers were closed at the beginning and gradually reopened, but with a separation between groups according to the housing framework in which they resided, to prevent infection. Once one of them tested positive for COVID-19, the whole group was sent back to isolation in their apartments until everyone tested negative. Therefore, even when those centers were reopened, for several days during the research period, the participants were not present.</p> <p>Hence, the S/P group received almost all the professional therapy hours, which in normal circumstances are usually divided between the S/P and M/M groups (twice the services compared with the number of hours pre-COVID). For example, during COVID-19, a weekly group meeting by the ST via Zoom was held for those residing in group homes (M/M group). Meanwhile, daily small group meetings and individual therapies by the professional team members were held for those living with their families (S/P group). During COVID-19, there were twice the number of sessions of individual or small-group therapies conducted by the PT, AT and music and animal-assisted therapists for those who came to the therapeutic center. Some counseling sessions for the isolated teams at the group homes on feeding, listening, physiotherapy exercising, and making some art products were mostly held via Zoom, and visits at the group homes were rare to avoid the risk of infection.</p> <p>Meanwhile, the other two types of day centers—one for the older M/M group and the other for the younger M/M group—were closed at the beginning and opened gradually. The M/M group were confined to their apartments without visitation and almost no professional therapies, and their daily routines were significantly impaired. Furthermore, these individuals were repeatedly exposed to COVID-19, as they were in frequent contact with others in their living space.</p> <hd id="AN0164157795-8">Tools</hd> <p>The FST-ID contains information divided into three functional clusters, following the <emph>International Classification of Functioning, Disability and Health</emph> ([<reflink idref="bib28" id="ref32">28</reflink>]) concept and as suggested by others ([<reflink idref="bib4" id="ref33">4</reflink>], 2022b; <emph>Conceptual, Activities of Daily Living, Social</emph>, and <emph>General Adaptive Composite</emph> [GAC]; see Appendix). These components are obtained from the summary of the three cluster scores mentioned above. The answers for each item in the three functional clusters range from 0 to 4, and the total score of the scale ranges from 0 = profound disability to 68 = no disability. In addition, this scale contains two items: "environmental changes" and "using assistive devices" as well as an option to add the rater's subjective comments, as suggested by the WHO ([<reflink idref="bib5" id="ref34">5</reflink>]).</p> <p>The construction and validation processes of this tool are described in detail elsewhere ([<reflink idref="bib5" id="ref35">5</reflink>]). Criterion validity included high positive correlations between the FST-ID and Adaptive Behavior Assessment System—Second Edition ABAS-II (gold standard) and between the severity of ID and GAC (score of the FST-ID [<emph>r</emph> = 0.78, <emph>p</emph> <.001]). High internal consistency was achieved for the FST-ID (Cronbach's α: 0.96–0.98; α: 0.62–0.96, respectively). Intra- and inter-rater reliability were also very high (α = 0.99–0.79). The cutoff point between M/M ID was 50.4 (sensitivity: 87%, specificity: 86%, <emph>p</emph> <.001), and that between moderate and S/P ID was 29.4 (sensitivity: 96%, specificity: 94%, <emph>p</emph> <.00; [<reflink idref="bib5" id="ref36">5</reflink>]).</p> <hd id="AN0164157795-9">Procedures</hd> <p>During 18 months of the COVID-19 outbreak (September 2020 until February 2022), the FST-ID was filled out by direct service providers via phone for 76 adults with ID who visited the day centers, at three points of time: beginning, middle, and end of that period.</p> <p>The <emph>functional score</emph> was defined by calculating the mean FST-ID GAC score received by all the service providers who answered for each of the adults with ID, at each point of the sampling time.</p> <hd id="AN0164157795-10">Results</hd> <p></p> <hd id="AN0164157795-11">Environmental Changes During COVID-19</hd> <p>All 76 adults with ID experienced environmental changes during the study period. The highest level of change occurred at the beginning of the year, a little less in the middle, and a minimal amount by the end of the year (Figure 1).</p> <p>Graph: Figure 1. Environmental Changes for 76 Adults With ID.</p> <p>At the beginning of the pandemic, because of the governmental closure policy, there was a need to change the schedule, and direct care providers were replaced several times. For instance, because all regular professional groups at the therapeutic day center were not available for those being isolated in the group homes, the direct care providers had to develop new schedules. These included waking up later at 9:00 AM and finishing breakfast at 10:30 a.m. instead of the usual 9:30 a.m. and performing one activity via Zoom, such as communication groups with the other apartments led by the speech and language pathologist, followed by cooking together or a daily walk around the group home. Those who came to the therapeutic day center received approximately twice the usual amount of personal physiotherapy, art therapy, and small communication group engagement (as detailed in the "Research Setting" section).</p> <hd id="AN0164157795-12">Functional Changes During COVID-19 for 76 Adults With ID</hd> <p>During the pandemic, the mean functional score (GAC) for all 76 individuals slightly decreased (Wald chi-square = 6.21, <emph>df</emph> = 2, <emph>p</emph> <.05).</p> <p>For a better understanding of the interactions between <emph>time</emph> and various factors (disability level, age, gender, COVID-19, day care, and type of residence) regarding the functional score, we used a generalized estimating equations test. Time had no significant interaction with <emph>age, gender</emph>, or <emph>COVID-19</emph>.</p> <p>There was a significant interaction between <emph>time and type of day care</emph> regarding the functional score (Wald chi-square = 27.14, <emph>df</emph> = 4, <emph>p</emph> <.001). The post hoc analysis showed that only adults who visited the senior day centers showed a significant functional decrease (Wald chi-square = 110.84, <emph>df</emph> = 2, <emph>p</emph> <.001). The others did not show any significant change (Figure 2).</p> <p>Graph: Figure 2 Functional Scores According to Type of Day Center During COVID-19. Note. GAC = general adaptive composite.</p> <p>There was also a significant interaction between <emph>time and type of residence</emph> regarding the functional score (Wald chi-square = 9.37, <emph>df</emph> = 2, <emph>p</emph> <.01). The post hoc analysis showed that adults who lived with their families in their homes did not present any significant functional change (Wald chi-square = 5.51, <emph>df</emph> = 2, <emph>p</emph> =.06), whereas those who lived in group homes showed a significant decrease in functioning (Wald chi-square = 22.18, <emph>df</emph> = 2, <emph>p</emph> <.001).</p> <p>The interaction between <emph>disability level</emph> and <emph>time</emph> was significant (Wald chi-square = 11.491, <emph>df</emph> = 4, <emph>p</emph> <.05). The post hoc analysis showed that adults with S/P ID presented a statistically significant functional improvement (Wald chi-square = 6.04, <emph>df</emph> = 2, <emph>p</emph> <.05), whereas those with moderate ID presented a nonsignificant decrease (Wald chi-square = 3.37, <emph>df</emph> = 2, <emph>p</emph> =.185); adults with Mild ID presented a statistically significant decrease in functional scores (Wald chi-square = 10.55, <emph>df</emph> = 2, <emph>p</emph> <.001) during 18 months of the pandemic. Figure 3 shows the change in the functional scores for the whole S/P group (<emph>n</emph> = 16), compared with the moderate (<emph>n</emph> = 29) and mild (<emph>n</emph> = 31) groups, at the three points of time.</p> <p>Graph: Figure 3. Functional Scores for Three Groups of ID During COVID-19. Note. GAC = general adaptive composite.</p> <hd id="AN0164157795-13">Discussion</hd> <p>This study describes the environmental changes that occurred during the COVID-19 pandemic and their associations with functional skill changes among adults with different levels of ID. It also describes the ability of the FST-ID to detect such minimal functional changes and be used as an ongoing clinical assessment tool. Before the pandemic, the adults in this study visited day centers and lived either in their family's homes or various community group homes, with support from family members or paid service providers ([<reflink idref="bib18" id="ref37">18</reflink>]). The daily program of constructed routines and activities established a stable framework constantly supporting their well-being; any change in these routines would have been sensitively communicated to them before implementation ([<reflink idref="bib7" id="ref38">7</reflink>]; [<reflink idref="bib19" id="ref39">19</reflink>]).</p> <p>During the first months of the pandemic, owing to repeated lockdowns, those routines and habits dramatically changed: only 1 day center, the therapeutic center, was open and continued to provide services to adults with ID who lived with their families, all of whom were individuals diagnosed with S/P ID. Most (77%) individuals diagnosed with M/M ID remained in group homes. Gradually, all day centers were reopened, and all service receivers were allowed to resume their pre-COVID-19 routines. However, this period was characterized by constant and unexpected changes, as individuals testing positive for COVID-19 or exposed to another person found positive were promptly isolated. This happened more often to adults with M/M ID than to those with S/P ID. To reduce infections, the professional team worked only in the therapeutic center (both during the period in which only adults with S/P ID received therapy and afterward). Consequently, the S/P group gained about twice as many professional therapeutic hours compared with pre-COVID-19 days and presented statistically significant functional improvement. Hence, the pandemic provided the opportunity to add more evidence to the hypothesis that individuals with ID can experience significant functional improvement by adding therapeutic hours, even for those with S/P disabilities, if effective and appropriate intervention is implemented ([<reflink idref="bib20" id="ref40">20</reflink>]; [<reflink idref="bib21" id="ref41">21</reflink>]).</p> <p>In contrast, during this time, direct service providers and their clients with ID faced new challenges such as experiencing limited access to professional health care, problems in creating meaningful activities, and dealing with continued quarantine measures, all leading to reduced socialization experiences ([<reflink idref="bib8" id="ref42">8</reflink>]; [<reflink idref="bib17" id="ref43">17</reflink>]). Moreover, this period was characterized by several personnel changes, including regular unexpected reductions in the number of care providers owing to exposure to COVID-19. Shortages and sudden unexpected changes resulted in work overload and fatigue experienced by the direct service providers. Moreover, as reported by others, inexperienced direct service providers were left alone with no professional supervision at the group homes where the adults with M/M ID lived ([<reflink idref="bib8" id="ref44">8</reflink>]; [<reflink idref="bib26" id="ref45">26</reflink>]).</p> <p>During these times, the FST-ID was used to collect online data from the direct service providers. As expected, all 76 adults with ID experienced environmental changes, mainly due to direct service providers' constant turnover and disruptions to routine. These interactions suggest that the functioning of all the individuals changed during the research period because of many environmental and individual factors. Those changes occurred mostly at the beginning of the year (September 2020), when routines were severely damaged, quarantines were initiated, and there were no clear guidelines on how to handle such a complex situation. Gradually, the environmental changes became milder. Finally, by the end of the sampling period (February 2022), the environmental changes were minor.</p> <p>The two most interesting associations are the functional improvement in the S/P group as opposed to the M/M, which deteriorated, and the fact that the seniors' day center was affected the most.</p> <p>A possible explanation for the first association is that while maintaining a regular schedule for the S/P group by their direct personal service provision at home, and gaining double therapeutic hours, compared with the pre-COVID-19 time, the M/M group experienced major changes in schedule, service providers, place of stay, and social isolation, all of which caused functional deterioration.</p> <p>The second effect is that the most affected group consisted of those individuals with M/M who used to visit the senior day centers. All personal and environmental factors affected them: rapid aging accompanied by typical aging-related comorbidities in individuals with ID, living in group homes, testing positive for COVID-19, and the senior day centers closing at the first stages of the pandemic. This suggests the need for decision-makers to consider these factors when developing health plans in the future.</p> <p>Our current findings for the service recipients at the M/M ID levels suggest that a decline in their functional abilities supports similar global reports of the associations of COVID-19 with ID ([<reflink idref="bib8" id="ref46">8</reflink>]; [<reflink idref="bib14" id="ref47">14</reflink>]; [<reflink idref="bib17" id="ref48">17</reflink>]). Individuals with ID often adhere to routines and gain confidence as a result; hence, they need to be properly prepared for changes. As witnessed globally, individuals with ID were not appropriately prepared for the repeated quarantines, reduced availability of professional teams, and other disruptions to routine ([<reflink idref="bib7" id="ref49">7</reflink>]; [<reflink idref="bib8" id="ref50">8</reflink>]; [<reflink idref="bib9" id="ref51">9</reflink>]; [<reflink idref="bib14" id="ref52">14</reflink>]; [<reflink idref="bib26" id="ref53">26</reflink>]).</p> <p>Our in-depth inquiry revealed that since most of those diagnosed at the M/M levels (around 77%) lived in various community homes with paid service providers, they were most exposed to such environmental changes, which caused behavioral and physical deteriorations. Our findings suggest that most of the reported exacerbations gradually and sometimes spontaneously improved toward the end of that period owing to the reopening of all centers, the return to previous routines, and new adjustments to the professional telehealth support system.</p> <p>The functional improvement in the S/P group is notable in this study. These positive changes may be explained by how members of this group lived in their family homes and were constantly supported by one paid service provider owing to their need for full functional assistance. This routine of one-on-one care did not critically change during the repeated lockdowns. Furthermore, the therapeutic day center remained open for these adults, almost throughout the entire duration of the pandemic; hence, they were able to experience approximately twice as many individual therapeutic professional hours of intervention compared with the pre-COVID-19 period. The professional teams were not allowed to enter the group homes as a precaution to avoid spreading infection; thus, they spent all their time in the therapeutic day center with a small group of service recipients.</p> <hd id="AN0164157795-14">Conclusion</hd> <p>The main finding of this study, which is the dynamic nature of adults with ID (expressed by functional changes in the association with environmental changes), adds evidence-based support to the notion that when adults with ID are supported more intensely, as with the group of individuals with S/P ID, their functionality can improve. Our findings are also supported by studies showing that similar improvements can be achieved even with limited budgets at unconventional times by adopting intensive, creative, and personally customized programs ([<reflink idref="bib3" id="ref54">3</reflink>]; [<reflink idref="bib20" id="ref55">20</reflink>]; [<reflink idref="bib21" id="ref56">21</reflink>]).</p> <p>Our main findings suggest that during the 18 months of COVID-19, adults diagnosed with M/M levels of ID, especially those who visits day centers for seniors (who experienced major changes in their daily routine), were more negatively affected compared with those with S/P levels of ID, who experienced significant improvement probably owing to fewer changes in their daily routine and more intensive professional therapy hours compared with pre-pandemic times.</p> <p>To comprehensively understand each factor, examining how it influences a larger sample with repetition of measures for a longer period, during regular times as well by using the FST-ID and interviewing the service providers, is needed.</p> <hd id="AN0164157795-15">Novelty of the Study</hd> <p>The COVID-19 pandemic presented a rare opportunity where the changes in daily routine and services of adults with ID and their associations with functionality could be observed, thus making this study novel especially for the S/P ID group.</p> <hd id="AN0164157795-16">Relevance and Contribution of the Study</hd> <p>The rare circumstances surrounding this study make it entirely relevant as the world continues to grapple with the aftermath of COVID-19 and its impact on the health and well-being of all people. This study investigated how COVID-19 impacted adults at all levels of ID.</p> <hd id="AN0164157795-17">Limitations of the Study</hd> <p>The current study was carried out on a relatively small number of adults with ID: 76 individuals across three groups of ID. We would like to emphasize that all our results should be considered with additional caution owing to the small sample size and relatively short period of sampling. In addition, while there was general congruence among the groups by level of ID and participants' residential and treatment experiences, it was not absolute. A larger and more carefully controlled samples might facilitate a better understanding of related changes in functional abilities. Finally, as the study was conducted during the pandemic, this topic should be further explored in regular conditions.</p> <hd id="AN0164157795-18">Appendix</hd> <p> <bold> <emph>Name of service recipient</emph> </bold> <emph>__________________________</emph> </p> <p>Date: ___ Completed by: _____ How long have you been working with the service recipient? ___</p> <p>Each rectangle contains items that describe functional behavior. Circle the item that is most suitable for the service recipient in your opinion.</p> <p>Graph</p> <p></p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left" colspan="2">Communications and Academics (CON)</th></tr></thead><tbody><tr><td> Communications: communicates well with everyone (4), communicates reasonably well with some people (3), maintains limited communications with few people (2), rarely communicates with the human environment (1), does not seem to communicate (0).</td><td>Score</td></tr><tr><td> Language and speech: fluent and coherent (4), short but clearly understandable sentences (3), most speech is not clear (2), single words, many unclear (1), does not seem to speak at all (0).</td><td /></tr><tr><td> Writing (by hand or with the assistance of a switch, a spelling board, etc.): complete, entire stories (4), writes sentences (3), writes words (2), copies few words or letters (1), does not write (0).</td><td /></tr><tr><td> Comprehension: understands everything (4), understands daily/related issues (3), understands most instructions (2), understands few/basic instructions (1), does not understand instructions (0).</td><td /></tr><tr><td> Reading: reads short stories (4), reads short sentences (3), reads at least 5 words (2), identifies letters (1), not able to read (0).</td><td /></tr><tr><td colspan="2">Practical activities of daily living (ADL) and self-care</td></tr><tr><td> Mobility: walks, sits, and lies down independently (4), is mostly independent but uses walker or wheelchair (3), needs mild supervision in transitions (2), needs extensive support in transitions (1), needs complete support in all ADL (0).</td><td /></tr><tr><td> Falls: Walks independently without any falls in the past year (4), lost their balance last year but did not fall (3), fell several times this year (2), fell several times this week (1), needs constant support/supervision to prevent falls (0).</td><td /></tr><tr><td> Daily activities (preparing a beverage, organizing a desk or classroom, throwing out the garbage, putting things back in their place): completely independent (4), needs mild supervision and verbal direction during ADL (3), need physical assistance in a small number of activities (2), needs assistance in most activities (1), needs full support to perform these activities at all (0).</td><td /></tr><tr><td> Leisure activities (draws, flips pages through a newspaper, strings beads, plants a plant): completely independent (4), needs only supervision and light verbal direction (3), needs a little physical and mostly verbal support (2), needs extensive physical & verbal support to participate (1), is unable to perform these activities at all (0).</td><td /></tr><tr><td> Eating and drinking: independent (4), needs food to be cut (3), needs mild assistance and/or mostly independent with special cutlery (2), needs to be fed completely (1), enteral feeding only (0).</td><td /></tr><tr><td> Food consistency: ordinary (4), cut into small pieces (3), chopped (2), blended (1), food blended and beverage with thickening agent (0).</td><td /></tr><tr><td> Mealtime behavior: ordinary (4), mild supervision only (3), custom eating environment and group supervision (2), staff member provides personal supervision due to challenges (1), does not eat in the setting (0)</td><td /></tr><tr><td> Toileting: completely independent (4), independent but needs verbal reminders (3), needs assistance only in wiping or during menstrual period (2); partial control of urination or soiling (may alert caregiver) (1), no control at all/wears diapers continuously (0).</td><td /></tr><tr><td> Dressing: completely independent (4), needs mild assistance (mostly verbal) (3), needs moderate assistance (with shoelaces, buttons, and zippers) (2), mostly not independent (1), does not dress independently (0).</td><td /></tr><tr><td> Self-care and hygiene (washes hands, awareness of deodorant, menstrual products, bad breath, etc.): independent (4), needs mild assistance/reminders (3), needs moderate assistance (2), does almost everything with assistance (1), full support (0).</td><td /></tr><tr><td colspan="2">Social and emotional (SOC)</td></tr><tr><td> Participation in activities: full (4), generally participates (3), sometimes participates (2), rarely participates (1), does not participate in any activity (0).</td><td /></tr><tr><td> Challenging behavior (shouts, spits, pinches, pushes, hits, undresses, insults): regular behavior (4) rarely (3), sometimes (2), most of the time (1), all the time (0).</td><td /></tr><tr><td>Total score for all clusters (GAC)</td><td /></tr><tr><td colspan="2">Use of assistive devices</td></tr><tr><td> Use of assistive device: wheelchair, walker, crutches, helmet, custom/medical shoes, support belt, braces, corset, communications device, glasses, hearing aid, false teeth, custom cutlery, other.</td><td /></tr><tr><td colspan="2">Environmental changes</td></tr><tr><td> Did any of the following occur recently: Change in staff, change in family, change in class/place of residence/isolation, change in schedule, change in medication. Other (specify): _____________.</td><td /></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> ADL = activities of daily living; GAC = general adaptive composite.</p> <p>The authors thank all the direct service providers at Amichai and Mr. Guy Ben-David for all their support. The authors thank Editage (<ulink href="http://www.editage.com">www.editage.com</ulink>) for English language editing.</p> <ref id="AN0164157795-19"> <title> References </title> <blist> <bibl id="bib1" idref="ref4" type="bt">1</bibl> <bibtext> Baker-Ericzén M. J., ElShamy R., Kammes R. R. (2022). Current status of evidence-based practices to enhance employment outcomes for transition age youth and adults on the autism spectrum. Current Psychiatry Reports, 24, 161–170. https://doi.org/10.1007/s11920-022-01327-2</bibtext> </blist> <blist> <bibl id="bib2" idref="ref17" type="bt">2</bibl> <bibtext> Baksh R. A., Strydom A., Pape S. E., Chan L. F., Gulliford M. C. (2022). Susceptibility to COVID-19 diagnosis in people with Down syndrome compared to the general population: Matched-cohort study using primary care electronic records in the UK. Journal of General Internal Medicine, 37(8), 2009–2015. https://doi.org/10.1007/s11606-022-07420-9</bibtext> </blist> <blist> <bibl id="bib3" idref="ref54" type="bt">3</bibl> <bibtext> Beadle-Brown J., Beecham J., Leigh J., Whelton R., Richardson L. (2021). Outcomes and costs of skilled support for people with severe or profound intellectual disability and complex needs. Journal of Applied Research in Intellectual Disabilities, 34(1), 42–54. https://doi.org/10.1111/jar.12782</bibtext> </blist> <blist> <bibl id="bib4" idref="ref6" type="bt">4</bibl> <bibtext> Ben David N., Lotan M., Moran D. S. (2022a). Building a new screening tool to detect changes in the functional status of adults with intellectual and developmental disabilities (IDD). Is there a real need? Dash Bareshet, 41, 56–67. https://doi.org/10.1111/jar.13004</bibtext> </blist> <blist> <bibl id="bib5" idref="ref13" type="bt">5</bibl> <bibtext> Ben David N., Lotan M., Moran D. S. (2022b). Development and validation of a functional screening tool for adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 35(6), 1281–1296. https://doi.org/10.1111/jar.13004</bibtext> </blist> <blist> <bibl id="bib6" idref="ref3" type="bt">6</bibl> <bibtext> Cogswell M. E., Coil E., Tian L. H., Tinker S. C., Ryerson A. B., Maenner M. J., Rice C. E., Peacock G. (2022). Health needs and use of services among children with developmental disabilities—United States, 2014–2018. MMWR. Morbidity and Mortality Weekly Report, 71(12), 453–458. https://doi.org/10.15585/mmwr.mm7112a3</bibtext> </blist> <blist> <bibl id="bib7" idref="ref14" type="bt">7</bibl> <bibtext> Courtenay K., Perera B. (2020). COVID-19 and people with intellectual disability: Impacts of a pandemic. Irish Journal of Psychological Medicine, 37(3), 231–236. https://doi.org/10.1017/ipm.2020.45.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref18" type="bt">8</bibl> <bibtext> Desroches M. L., Fisher K., Ailey S., Stych J., McMillan S., Horan P., Marsden D., Trip H., Wilson N. (2022). Supporting the needs of people with intellectual and developmental disabilities 1 year into the COVID-19 pandemic: An international, mixed methods study of nurses' perspectives. Journal of Policy and Practice in Intellectual Disabilities, 19(1), 48–63. https://doi.org/10.1111/jppi.12411</bibtext> </blist> <blist> <bibl id="bib9" idref="ref20" type="bt">9</bibl> <bibtext> Dimitriou D., Esposito G. (2022). Management and support of individuals with developmental disabilities during the COVID-19 pandemic. Research in Developmental Disabilities, 125, Article 104228. https://doi.org/10.1016/j.ridd.2022.104228</bibtext> </blist> <blist> <bibtext> Doyle A., O'Sullivan M., Craig S., McConkey R. (2021). People with intellectual disability in Ireland are still dying young. Journal of Applied Research in Intellectual Disabilities, 34(4), 1057–1065. https://doi.org/10.1111/jar.12853</bibtext> </blist> <blist> <bibtext> El Tahir M., Elhusein B., Elamin H., Rustom H., Reagu S., Bedhiaf H.,.. Alabdulla M. (2022). Stress levels and coping strategies of families of adults with intellectual disability and challenging behaviours during the COVID-19 pandemic in Qatar. Journal of Intellectual Disabilities, 17446295211062381.</bibtext> </blist> <blist> <bibtext> Gleason J., Ross W., Fossi A., Blonsky H., Tobias J., Stephens M. (2021). The devastating impact of COVID-19 on individuals with intellectual disabilities in the United States. New England Journal of Medicine Catalyst, 2(2), 1–12. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0051</bibtext> </blist> <blist> <bibtext> Hanley E., Martin A. M., Dalton C., Lehane E. (2022). Communication partners experiences of communicating with adults with severe/profound intellectual disability through augmentative and alternative communication: A mixed methods systematic review. Journal of Intellectual Disabilities, 17446295221115914.</bibtext> </blist> <blist> <bibtext> Hartley S. L., Fleming V., Piro-Gambetti B., Cohen A., Ances B. M., Yassa M. A., Brickman A. M., Handen B. L., Head E., Mapstone M., Christian B. T., Lott I. T., Doran E., Zaman S., Krinsky-McHale S., Schmitt F. A., Hom C., Schupf N. (2022). Impact of the COVID 19 pandemic on daily life, mood, and behavior of adults with Down syndrome. Disability and Health Journal, 15(3), Article 101278. https://doi.org/10.1016/j.dhjo.2022.101278</bibtext> </blist> <blist> <bibtext> Hilgenkamp T. I., van der Schans C. P., van der Putten A. A., Waninge A. (2022). Development of a Dutch training/education program for a healthy lifestyle of people with intellectual disability. Intellectual and Developmental Disabilities, 60(2), 163–177. https://doi.org/10.1352/1934-9556-60.2.163</bibtext> </blist> <blist> <bibtext> Hom C. L., Walsh D., Fernandez G., Tournay A., Touchette P., Lott I. T. (2021). Cognitive assessment using the Rapid Assessment for Developmental Disabilities (RADD-2). Journal of Intellectual Disability Research, 65(9), 831–848.</bibtext> </blist> <blist> <bibtext> Howkins J., Hassiotis A., Bradley E., Levitas A., Sappok T., Sinai A., Thakur A., Shankar R. (2022). International clinician perspectives on pandemic-associated stress in supporting people with intellectual and developmental disabilities. BJPsych Open, 8(3), e84.</bibtext> </blist> <blist> <bibtext> Israeli Ministry of Welfare and Social Services. (2021). Rights of individuals with intellectual disability and their family. Assessment of Intellectual Disability and Determination of Treatment. [ משרד הרווחה והבטחון החברתי-אנשים עם מוגבלותהתפתחותית]. https://<ulink href="http://www.molsa.gov.il/Populations/Disabilities/MentalRetardation/IntellectualDisabilities/Pages/AboutIntellectualDisabilities.aspx">www.molsa.gov.il/Populations/Disabilities/MentalRetardation/IntellectualDisabilities/Pages/AboutIntellectualDisabilities.aspx</ulink></bibtext> </blist> <blist> <bibtext> Kaya A., Cavkaytar A. (2022). Development of a daily living education program for individuals with intellectual disabilities under protective care. Rehabilitation Research, Policy, and Education, 35(4), 280–297.</bibtext> </blist> <blist> <bibtext> Lotan M., Downs J., Elefant C. (2021). A pilot study delivering physiotherapy support for Rett syndrome using a telehealth framework suitable for COVID-19 lockdown. Developmental Neurorehabilitation, 24(6), 429–434.</bibtext> </blist> <blist> <bibtext> Lotan M., Ippolito E., Favetta M., Romano A. (2021). Skype supervised, individualized, home-based rehabilitation programs for individuals with Rett syndrome and their families–Parental satisfaction and point of view. Frontiers in Psychology, 12, Article 3995.</bibtext> </blist> <blist> <bibtext> Rebillat A. S., Hiance-Delahaye A., Falquero S., Radice G., Sacco S. (2021). The French translation of the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities is a sensitive tool for screening for dementia in people with Down syndrome. Research in Developmental Disabilities, 118, Article 104068.</bibtext> </blist> <blist> <bibtext> Parchomiuk M. (2021). Care and rehabilitation institutions for people with intellectual disabilities during the COVID-19 pandemic: Polish experiences. International Social Work. 00208728211060471.</bibtext> </blist> <blist> <bibtext> Singer G. H., Agran M., Spooner F. (2017). Evidence-based and values-based practices for people with severe disabilities. Research and Practice for Persons with Severe Disabilities, 42(1), 62–72. https://doi.org/10.1177/1540796916684877</bibtext> </blist> <blist> <bibtext> Stavropoulos K. K. M., Bolourian Y., Blacher J. (2022). A scoping review of telehealth diagnosis of autism spectrum disorder. PLOS ONE, 17(2), Article e0263062. https://doi.org/10.1371/journal.pone.0263062</bibtext> </blist> <blist> <bibtext> Thakur A., Pereira C., Hardy J., Bobbette N., Sockalingam S., Lunsky Y. (2021). Virtual education program to support providers caring for people with intellectual and developmental disabilities during the COVID-19 pandemic: Rapid development and evaluation study. JMIR Mental Health, 8(10), 1–11. https://mental.jmir.org/2021/10/28933</bibtext> </blist> <blist> <bibtext> Wessels M. D., Paap M. C., Van der Putten A. A. (2022). Validity of an instrument that assesses functional abilities in people with profound intellectual and multiple disabilities: Look what I can do!. Journal of Intellectual & Developmental Disability, 46(3), 250–260.</bibtext> </blist> <blist> <bibtext> World Health Organization. (2002). ICF beginner's guide: Towards a common language for functioning, disability and health. https://<ulink href="http://www.who.int/publications/m/item/icf-beginner-s-guide-towards-a-common-language-for-functioning-disability-and-health">www.who.int/publications/m/item/icf-beginner-s-guide-towards-a-common-language-for-functioning-disability-and-health</ulink></bibtext> </blist> </ref> <ref id="AN0164157795-20"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported in part by the Shalem Foundation for the development of services for people with developmental and intellectual disabilities in local authorities, Israel (grant number:890-277-2020; Year: 2021).</bibtext> </blist> <blist> <bibtext> The study was conducted following approval of Ariel University's IRB (AU-HEA-ML-20200610).</bibtext> </blist> <blist> <bibtext> The provided funding source was not involved in the study design; collection, analysis, and interpretation of data; writing of the report; and decision to submit the article for publication.</bibtext> </blist> <blist> <bibtext> Nophar Ben David</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0002-9487-116X</bibtext> </blist> <blist> <bibtext> Editor-in-Charge: Jenny R. Root</bibtext> </blist> </ref> <aug> <p>By Nophar Ben David; Meir Lotan and Daniel Sender Moran</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib18" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib13" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib24" firstref="ref5"></nolink> <nolink nlid="nl4" bibid="bib10" firstref="ref7"></nolink> <nolink nlid="nl5" bibid="bib15" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib22" firstref="ref15"></nolink> <nolink nlid="nl8" bibid="bib12" firstref="ref16"></nolink> <nolink nlid="nl9" bibid="bib26" firstref="ref19"></nolink> <nolink nlid="nl10" bibid="bib14" firstref="ref22"></nolink> <nolink nlid="nl11" bibid="bib23" firstref="ref23"></nolink> <nolink nlid="nl12" bibid="bib11" firstref="ref25"></nolink> <nolink nlid="nl13" bibid="bib16" firstref="ref28"></nolink> <nolink nlid="nl14" bibid="bib25" firstref="ref29"></nolink> <nolink nlid="nl15" bibid="bib28" firstref="ref32"></nolink> <nolink nlid="nl16" bibid="bib19" firstref="ref39"></nolink> <nolink nlid="nl17" bibid="bib20" firstref="ref40"></nolink> <nolink nlid="nl18" bibid="bib21" firstref="ref41"></nolink> <nolink nlid="nl19" bibid="bib17" firstref="ref43"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1380844
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Association of COVID-19-Related Restrictions with Changes in Functional Skills of Adults with Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ben+David%2C+Nophar%22">Ben David, Nophar</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-9487-116X">0000-0002-9487-116X</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lotan%2C+Meir%22">Lotan, Meir</searchLink><br /><searchLink fieldCode="AR" term="%22Moran%2C+Daniel+Sender%22">Moran, Daniel Sender</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Research+and+Practice+for+Persons+with+Severe+Disabilities%22"><i>Research and Practice for Persons with Severe Disabilities</i></searchLink>. Jun 2023 48(2):79-91.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Pandemics%22">Pandemics</searchLink><br /><searchLink fieldCode="DE" term="%22Day+Programs%22">Day Programs</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Services%22">Social Services</searchLink><br /><searchLink fieldCode="DE" term="%22Change%22">Change</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Israel%22">Israel</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/15407969231173929
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1540-7969<br />2169-2408
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Intellectual disability (ID) is assumed to be a dynamic phenomenon influenced by personal and environmental factors. During the 18 months of the coronavirus disease (COVID-19) pandemic, most day centers remained open for adults with ID who lived with their families (most of them with severe/profound [S/P] ID) but were closed to those who lived in group homes (with moderate and mild ID). Owing to the fewer participants in day centers, adults with S/P ID received more hours of therapy than before the pandemic. Using a functional screening tool, functional and environmental changes were mapped and discussed in team meetings. As expected, the pandemic caused environmental and personnel changes that affected all groups. The moderate (n = 29) and mild (n = 31) groups deteriorated over the 18 months of the study, especially the senior ones. However, the functional state of the S/P group (n = 16) improved. These results support the understanding that ID is truly dynamic throughout the lifespan. Functional improvements for S/P ID can occur during adulthood with intense and individually adapted interventions.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1380844
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1380844
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/15407969231173929
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 79
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
        Type: general
      – SubjectFull: Day Programs
        Type: general
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Environmental Influences
        Type: general
      – SubjectFull: Social Services
        Type: general
      – SubjectFull: Change
        Type: general
      – SubjectFull: Israel
        Type: general
    Titles:
      – TitleFull: Association of COVID-19-Related Restrictions with Changes in Functional Skills of Adults with Intellectual Disabilities in Day Programs of an Israeli Non-Profit Organization
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ben David, Nophar
      – PersonEntity:
          Name:
            NameFull: Lotan, Meir
      – PersonEntity:
          Name:
            NameFull: Moran, Daniel Sender
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 06
              Type: published
              Y: 2023
          Identifiers:
            – Type: issn-print
              Value: 1540-7969
            – Type: issn-electronic
              Value: 2169-2408
          Numbering:
            – Type: volume
              Value: 48
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Research and Practice for Persons with Severe Disabilities
              Type: main
ResultId 1