Article 12 of the Convention for the Rights of Persons with Disabilities recognizes all persons with disabilities as having legal capacity in all areas of life. However, in adherence to the Israeli Legal Capacity and Guardianship Law (1962), many persons with intellectual disability (ID) or mental illness (MI) have these rights revoked because of the appointment of a guardian. Little is known about these persons' perceptions about guardianship and supported decision making (SDM). Using focus groups, we examined the perceptions of persons with ID, persons with MI, and parents regarding guardianship and SDM. Most participants expressed their desire to adopt a model of SDM in their daily decision making, though differences were found among the groups. Persons with MI emphasized their right to be independent in decisions regarding their lives, and parents of these persons aspired to support their children to reach independence, except in times of crisis. Persons with ID also desired more independence, but they were uncertain if this would be possible for them. Some individuals with ID preferred that decisions regarding their lives be made on their behalf. Parents of persons with ID felt that it was critical for them to serve as guardians of their children. Recommendations are provided on how to promote the legal capacity of individuals with disabilities.

This book examines how intellectual disability is affected by stigma and how this stigma has developed. Around two per cent of the world’s population have an intellectual disability but their low visibility in many places bears witness to their continuing exclusion from society. This prejudice has an impact on the family of those with an intellectual disability as well as the individual themselves and affects the well-being and life chances of all those involved. This book provides a framework for tackling intellectual disability stigma in institutional processes, media representations and other, less overt, settings. It also highlights the anti-stigma interventions which are already in place and the central role that self-advocacy must play.

Negative attitudes and discrimination remain everyday realities for many individuals with intellectual disabilities. This chapter provides an overview of interventions aimed at reducing intellectual disability stigmaand encouraging more positive perceptions and interactions. Based on a multilevel model of stigma change interventions, this chapter provides an overview of interventions aimed at the intrapersonal, familial, widerinterpersonal, and structural levels to reduce stigma. The quality of the evidence on the range of interventions is considered and found to be rather thin on the whole. Priorities for research and intervention are identified.

Adequate measurement tools are mandatory in order to enable researchers to examine the extent and severity of stigma and develop effective stigma change interventions. However, the theoretical foundations and methodological frameworks in this field are underdeveloped. This chapter highlights the main theoretical and methodological challenges facing this field, and presents a summary of leading scales. Finally, recommendations for further scale development are provided.

Background Research in the field of family quality of life (FQOL) emphasises the importance of attainable support resources for families of children with developmental disability (DD). In this study we explored FQOL by examining some of its specific domains and expanded upon them. The 2 main aims were to examine differences in FQOL according to the degree of religiosity among Israeli Jewish families and to investigate the contribution of family, social, and governmental service support, as well as religion and spirituality to FQOL. Method Parents from 170 Jewish families of children with DD aged 3 to 14 years completed a self-administered questionnaire, which included the Family Quality of Life Survey – 2006 and instruments measuring family support, social support, support from governmental services, and support through religion and spirituality. Results Religious families reported a higher FQOL in comparison with secular families. No differences were found, however, between religious and secular families regarding familial, social, and service supports. Familial support and religious and spiritual support were found to contribute to the FQOL of religious families, whereas social support contributed to the FQOL of secular families. Conclusion These findings help clarify which supporting factors predict the FQOL for families living in Israel. Suitable support resources should be offered to families raising children with DD in order to enhance their FQOL.

Background Research supports the importance of sports for people with intellectual disability (ID); however, the unique experience of the Special Olympics (SO) World Games has rarely been examined. The aim of this study was to examine how the SO World Games have affected athletes with ID, their parents and siblings, and the relations between their family members.Method Twenty-three semistructured interviews were conducted with athletes, parents, and siblings within 9 families upon their return from the World Games held in Athens in 2011. Data were analysed using thematic analysis.Results Four themes were found. The first theme dealt with the World Games role in developing the athletes self-identity. The second theme related to the World Games positive impact on their family's quality of life. The third theme related to the World Games positive impact on siblings, and the fourth theme related to the importance of participation in the World Games in improving community awareness and inclusion for the 3 groups: athletes, parents, and siblings.ConclusionsThe results are discussed and practical implications are highlighted, including the need to increase knowledge and awareness of the SO.

Background: Studies have shown that beyond public and self stigma, stigma can also impact family members. Only scant research has examined the internalised aspects of stigma, known as affiliate stigma, among family caregivers of individuals with disabilities. This study examined affiliate stigma among family caregivers of individuals with developmental disabilities via a comparison between caregivers of individuals with intellectual disabilities (ID), autism spectrum disorders (ASD) and physical disabilities (PD) in Israel. Methods: Family caregivers (n=171) of individuals with developmental disabilities, mainly ID (22.4%), ASD (32.9%) and PD (27.1%), completed a self-report structured questionnaire including the Affiliate Stigma Scale and background variables. Results: Results supported a one-factor structure for the Affiliate Stigma Scale. Overall, affiliate stigma was relatively low in this sample, but was found to be higher among caregivers of individuals with ASD when compared with caregivers of individuals with ID or PD. Conclusion: Findings from this study point to the importance of supporting caregivers of individuals with ASD to decrease their feelings of stigma. It is also important to further develop scales measuring affiliate stigma in order to capture the multi-dimensional nature of the concept.

Using a multidimensional perspective, we examined and compared kindergarten children's attitudes toward children with a physical disability, a hearing impairment, or no disability. Attitude scales, based on picture cards, were administered face-to-face to 106 kindergarten children in Israel. Each reported their attitudes toward each of three target children. More positive attitudes were reported toward a child without a disability as compared with a child with a physical disability or a child with a hearing impairment. More negative cognitions were reported toward the child with a hearing impairment compared with the child with a physical disability. Furthermore, moderate correlations were found between the three attitude components. The findings call for the provision of knowledge regarding disabilities, especially those disabilities that are less clearly understood by young children, as well as opportunities for contact between children with and without disabilities.

Stigma may have detrimental effects on the rights of individuals with disabilities. This study examined the association between stigma and the perception of rights of people with intellectual disabilities and people with physical disabilities. Telephone interviews using vignette methodology were conducted with a nationally representative sample of 605 adults. Items included stereotypes, prejudice, behavioral reactions and the perception of rights of these individuals. More negative stereotypes, greater social distance and greater withdrawal behaviors were found toward people with intellectual disabilities as compared to people with physical disabilities. Lower support of rights was found toward people with intellectual disabilities as compared to people with physical disabilities. Lower degree of acceptance and higher perception of dangerousness were associated with greater social distance, which was related to lower perception of rights. Programs should aim at decreasing social distance to improve support to exercise rights, especially among people with intellectual disabilities.

Background: Stigma may negatively impact individuals with intellectual disabilities (ID). However, most studies in the field have been based on the use of direct measurement methods for assessing stigma. This study examined public stigma towards individuals with ID within a representative sample of the Israeli public by comparing direct versus indirect questioning. Methods: Vignette methodology was utilised with two questionnaire versions. In the direct questionnaire (n=306), the participants were asked how they would think, feel and behave if a man with ID asked them a question in a public place. In the indirect questionnaire (n=301), the participants were asked to report how a hypothetical 'other man' would think, feel and behave in the same situation. Results: Higher levels of stigma were reported among participants that answered the indirect questionnaire version. Furthermore, among those participants that answered the indirect questionnaire version, subjective knowledge of ID was a less important correlate of stigma than for those participants that answered the direct questionnaire. Conclusion: Several explanations are suggested for the finding that indirect questioning elicits more negative stigmatic attitudes. Among others, indirect questioning may be a more appropriate methodology for eliciting immediate beliefs. Furthermore, the results call for implementing a comprehensive, multi-level programme to change stigma.

Studies in the area of intellectual disability (ID) stigma are few and atheoretical. This study examined the adequacy of the conceptual framework of stigma from the mental illness field regarding ID. Telephone interviews were conducted with a nationally representative sample of 304 adults in Israel. Participants were read a vignette describing a man with ID and answered items related to cognitive, emotional, and behavioral reactions. Behavioral dimensions included: Withdrawal, Social distance, and Helping behaviors. The stigma process leading to Withdrawal was drawn through Negative affect, whereas the process to Social distance was drawn through Calm affect. One unique aspect of the stigma process in ID is the importance of Calm affect, which helped reduce Social distance.

אחת הבעיות השכיחות בהתמודדות עם שיטיון (דמנציה) היא בעיית הניידות מחוץ לבית. כיום יכולים אנשים עם דמנציה להיעזר בטכנולוגיות תומכות, כגון טכנולוגיות מתקדמות של איתור על ידי מערכת איכון לוויינית. העמדות כלפי השמוש בטכנולוגיות כאלה אינן חד-משמעיות, והשימוש בהן בקרב אנשים עם דמנציה מעלה לבטים אתיים. היעדר קונצנזוס אתי בנוגע לשימוש במערכת איכון לוויינית למעקב אחר אנשים שחולים בדמנציה מעלה את הצורך בקביעת קווים מנחים ומדיניות ברורה יותר בנושא. מסקנות המחקר הנוכחי: ההחלטות אם, מתי וכיצד להשתמש במערכת איכון לוויינית למעקב אחר אנשים עם דמנציה צריכות להתקבל לאחר מתן האבחנה, בשיתוף האדם החולה בדמנציה, בני משפחתו ואנשי מקצוע מטפלים, ובמסגרת פגישה פורמלית ומובנית שנערכת על ידי צוות מקצועי. (מתוך המאמר)

עובדים סוציאליים ממלאים תפקיד של מנהלי טיפול עבור אנשים שיש להם אבחנה כפולה של מוגבלות שכלית ומחלה פסיכיאטרית. הסקר שלפנינו בחן את תפיסת הידע והעמדות של עובדים סוציאליים והכשרתם לטיפול באוכלוסייה זו בנוסף לתפיסותיהם לגבי טיבו של השירות הפסיכיאטרי ששירותי בריאות הנפש מספקים כיום לאוכלוסייה זו. עובדים סוציאליים מלשכות לשירותים חברתיים או ממסגרות דיור קהילתי לאנשים עם מוגבלות שכלית מילאו שאלונים למילוי עצמי. נמצא כי העובדים הסוציאליים מהלשכות דיווחו על רמת ידע נמוכה יותר בתחום אבחנה כפולה לעומת עמיתיהם ממסגרות הדיור. עובדים סוציאליים משתי קבוצות המחקר דיווחו על קשיים בשימוש בשירותי בריאות הנפש, ובהם ידע מוגבל של הפסיכיאטרים בתחום אבחנה כפולה וכן דעות קדומות ומחסור במיומנויות תקשורת המתאימות לעבודה עם אוכלוסייה זו. ממצאי הסקר מרמזים על אי הלימה בין שירותי בריאות הנפש ובין צורכיהם של אנשים המתמודדים עם אבחנה כפולה. חשוב להרחיב את הכשרתם של עובדים סוציאליים ושל פסיכיאטריים בנושא האבחנה הכפולה ולשפר את הנגישות של שירותי בריאות הנפש לאוכלוסייה המדוברת. (מתוך המאמר)

For years, people with intellectual disabilities (ID) have been among the least socially accepted groups of society (Thomas, 2000). Furthermore, whereas studies in the field of mental illness stigma are abundant, the literature on ID stigma is relatively scarce. The goal of this chapter is to focus on aspects of stigma that are unique to individuals with ID. To begin, we briefly trace the history of change in the terms used to describe this condition. Next, we highlight key developments that have a bearing on enhancing the societal status of people with ID. We show how the negative impact of stigma on people with ID still prevails in society within different areas of life, despite the change in terminology and enactment of important laws. Finally, we describe efforts that should be used to bring about real stigma change for people with ID.

Background: It is well established that people with intellectual disabilities are at higher risk of developing mental illnesses. This study aimed to assess the need for a specialized service for people (children and adults) with intellectual disabilities and mental health problems living in Israel. Methods: Our research question was: is there a need for a specialist mental health service for people with intellectual disabilities living in Israel and, if so, what type of service would be most appropriate? We conducted a qualitative study using semi-structured interviews with 14 major stakeholders to identify key themes in response to our research question. The data were coded and themes were identified. Results: Participants were generally not satisfied with current mental health care for people with intellectual disabilities and there was a general agreement that services are in need of improvement. We identified three major themes from the data. These were: current services, future services, and ways to facilitate change. Conclusion: We hope that our findings will be instrumental in shaping the ongoing debate about the best form of delivery of services to this population in Israel. Specifically, we suggest the development of a more specialized system, with the formation of multidisciplinary regional assessment and treatment units in parallel with improved relevant training for all mental health workers and the possibility of referral to specialized teams in more complex cases.

Objective: The cochlear implant has revolutionized functioning with severe-to-profound sensori-neural loss. A deaf child implanted at an early age with good habilitation may have good language abilities and function well in daily life. As the implanted child grows up, managing in the world of hearing people may become more complex. During adolescence, the teenager copes with many issues, including identity, socialization with the peer group, and managing in the school setting. These issues may be even more challenging for the adolescents using a cochlear implant. This study was designed to shed light on how adolescents with cochlear implants experience coping with the issues mentioned. Method: Twelve teenagers (14-18 years old), fairly similar to the entire adolescent implanted population at the center at which the study was conducted, participated in the study. They had been unilaterally or bilaterally implanted at differing ages. The participants filled out a questionnaire dealing with their functioning in the educational setting, their social preferences and functioning, and their identity as hearing or deaf. The results were analyzed using the principles of thematic analysis. Results: At school, some reported better achievements than others but they all expressed some difficulty functioning in class mainly in situations involving several speakers. From a social point of view, some reported a preference for association with normal hearing peers, whereas others favored hard-of-hearing friends, and one had no preference. Of those who touched on the topic of self-identity, one referred to herself as deaf, eight defined themselves as hard-of-hearing, and two consider themselves hearing. Conclusions: From the responses of these teenagers, it is clear that adolescents with cochlear implants are a heterogeneous group. Parents and teachers should be aware that adolescents with implants, even when successful academically, may experience difficulties in the classroom setting. Most of the participants in this study learning in a mainstream setting, preferred social relationships with hearing peers (to hard of hearing/deaf). The responses of these adolescents with cochlear implants support the conjecture that they have both a hearing identity and a deaf identity, which may be expressed at varying intensities depending on the situation at the time.

Background: The Convention on the Rights of Persons with Disabilities enshrines the right of people with intellectual disability to optimal mental health services. However, the literature suggests that psychiatrists' ability to meet such a standard is questionable. Psychiatrists' self-assessment regarding their training, knowledge and skills in working with this population was examined, as well as the availability of continuous education resources. Methods: A questionnaire was completed by 256 psychiatrists working within the public sector in Israel. Results: Training in the field was very low; average level of self-perceived knowledge and skills was found to be slightly below the midpoint of the scale, while actual knowledge, as assessed through a case vignette, was found to be low for all psychiatrists, in particular for general psychiatrists. Discussion: Results point to an urgent need to increase the level of knowledge and skills of psychiatrists and improve the level of services offered to people with intellectual disabilities and mental health problems. Various options for achieving this are presented.