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.

Background Psychiatrists are responsible for providing proper care for people with intellectual disability who have psychiatric disorders. This study examined psychiatrists' perceptions of their own training, knowledge and therapeutic skills, as well as their attitudes towards this population. Methods Questionnaires were distributed to 679 psychiatrists working within the public sector in Israel. Results Completed questionnaires were returned from 256 psychiatrists (38% response rate). Most (90%) participants reported having had limited training in the diagnosis and treatment of people with intellectual disabilities, while between 34% and 72% reported having inadequate knowledge in specific areas. Conclusion The findings of limited training and self-perceived inadequate knowledge are at least partially explained by the service model, wherein people with intellectual disabilities are cared for by general mental health services. The identified inadequacies could be overcome through the implementation of a model in which specially trained psychiatrists are deployed within generic services.

Purpose: Individuals with intellectual disabilities (ID) and individuals with mental illness are consistently found to be among the most socially excluded populations and continue to face substantial health, housing, and employment disparities due to stigma. Although this has spurred extensive research efforts and theoretical advancements in the study of stigma toward mental illness, the stigma of ID has received only limited attention. In this article we explore the application of mental illness stigma research for ID. Design: We carefully reviewed the existing research on mental illness stigma as a foundation for a parallel summary of the empirical literature on attitudes and stigma related to ID. Results: Based on our review, there has not been a systematic approach to the study of stigma toward ID. However, multilevel conceptual models of stigma have received much attention in the mental illness literature. These models have been used to inform targeted interventions and have application to the study of the stigma process for individuals with ID. Nonetheless, there are indeed key differences between-as well as substantial variability within-the ID and mental illness populations that must be considered. Conclusions: Stigma is an issue of social justice impacting the lives of individuals with ID, yet there remains virtually no systematic framework applied to the understanding of the stigma process for this group. Future research can draw on the stigma models developed in the mental illness literature to guide more rigorous research efforts and ultimately the development of effective, multilevel stigma-change strategies for ID.

Studies have shown that stigmatization is linked to lower quality of life; however, only scant research has examined the association between family caregivers' internalization of stigma (affiliate stigma) and their subjective quality of life (subjective well-being, SWB). Furthermore, studies have rarely examined this association via comparison between caregivers of individuals with different developmental disabilities in addition to examining the influence of psychosocial protective factors. These were the aims of the current study. Family caregivers ( N= 176) of individuals with autism spectrum disorders (ASD), intellectual disabilities (ID), and physical disabilities (PD) completed a self-report structured questionnaire including scales measuring SWB, affiliate stigma, burden, positive meaning in caregiving, social support and self-esteem. Results showed that SWB of family caregivers was below the average normative level and especially low for caregivers of individuals with ASD. The strongest predictors of SWB were caregivers' self-esteem, social support, positive meaning in caregiving, and affiliate stigma. Furthermore, an interaction was found between affiliate stigma and diagnosis, showing that among caregivers of individuals with ASD, greater levels of stigma were associated with lower ratings of SWB, whereas such an association was not found among caregivers of individuals with ID or PD. Findings from this study point to the importance of supporting caregivers across the life-span in order to decrease stigma, improve social support and self-esteem and improve SWB. Further, findings point to the need to respond differentially to the various developmental disabilities.

Background: Out-of-home mobility refers to the realization of trips outside the home, by foot or by other means of transportation. Although out-of-home mobility is important for the well-being of older people with cognitive impairment, its importance for their caregivers is not clear. This study aims to clarify the relationship between caregiving burden and out-of-home mobility of care-recipients using Global Positioning Systems (GPS) technology. Methods: Seventy-six dyads (care-recipients and caregivers) were recruited from a psychogeriatric center, where they underwent cognitive assessment, followed by psychosocial interviews at home. Care-recipients received GPS tracking kits to carry for a period of four weeks, whenever they left home. Mobility data and diagnostic and psychosocial data were examined in relation to caregiver burden. Results: The strongest predictors of burden were care-recipients lower cognitive status and more time spent walking out-of-home. An interaction was found between cognitive status and time spent walking in relation to caregiver burden. The relationship between walking and burden was stronger among caregivers of carerecipients with dementia than caregivers of care-recipients with no cognitive impairment or mild cognitive impairment. Care-recipients behavioral and emotional states were also positively related to caregiver burden. Conclusions: The findings stress the importance of maintaining older persons out-of-home mobility during cognitive decline.

Background: Problems with out-of-home mobility are among the more common behavioral disturbances in dementia. Today people with dementia can be aided by easily accessible assistive technologies, such as tracking devices using Global Positioning Systems (GPS). Attitudes toward these technologies are still inconclusive and their use with people with dementia raises ethical concerns. The lack of ethical consensus on the use of GPS for people with dementia underlines the need for clearer policies and practical guidelines. Methods: Here we summarize qualitative and quantitative findings from a larger research project on the ethical aspects of using GPS for tracking people with dementia. Results: The findings are formulated in a list of recommendations for policy-makers as well as for professional and family caregivers. Among other points, the recommendations indicate that the preferences and best interests of the people with dementia should be central to the difficult decisions required in dementia care. Further, no-one should be coerced into using tracking technology and, where possible, people with dementia must be involved in the decision-making and their consent sought. Conclusions: The decision whether, when and how to use GPS for tracking people with dementia should be made at the time of diagnosis jointly by the person with dementia, his/her family and professional caregivers. This decision should be made in formal structured meetings facilitated by a professional team.

To achieve the basic human right of autonomy, individuals, including those with intellectual disabilities (ID), must be able to practice decision-making, that is, to make their own decisions and communicate these decisions to others. In support of autonomous decision-making, Article 12 of the United Nations Convention on the Rights of People with Disabilities (CRPD) stresses the right of individuals with disabilities to legal capacity on an equal basis with others.1Supported decision-making approaches may aid individuals with ID in achieving this right. The question remains whether the enactment of the CRPD indeed is translated into opportunities for autonomous and supported decision-making among individuals with ID. In order to examine this question, a systematic review of bibliographic databases since 2008, when the CRPD came into force, was conducted in order to map the current state of decision-making among individuals with ID, and to identify areas in need of improvement. Twenty-seven manuscripts were reviewed, most focusing on decision-making within the fields of residential settings, health care, and sexuality-related decisions. This review showed that difficulties in decision-making in the area of ID remain during the early years after the CRPD entered into effect. These difficulties are related to the individuals with ID themselves, to their caregivers, and to the service system. No working models on supported decision-making for this population were found. The discussion highlights the importance of developing decision-making skills among people with ID, allowing them opportunities for decision-making, training professionals in supported decision-making, and fostering the philosophy of person-centered planning.

Providing holistic care to individuals with the dual diagnosis (DD) of intellectual disability and mental illness is a challenging task that requires the work of various health care specialists. The aim of the current study was to examine the intentions of students from various fields to work with individuals with DD. A questionnaire was completed by 512 social work, occupational therapy, speech and language therapy, special education, and nursing students in Israel to measure students' attitudes toward working with individuals with DD, as well as their perceptions of subjective norms, controllability, and self-efficacy. Structural equation modeling showed that the students' intentions to work with individuals with DD were predicted by their attitudes and perceptions of subjective norms. Controllability was found to negatively affect their behavioral intentions. Furthermore, social work and nursing students were found to have the lowest behavioral intentions. Given the lack of education in the field of DD and the prevailing stigmatic attitudes toward this population, university programs should focus on increasing knowledge, promoting positive contact, and reducing the fear attached to working with people with DD. 2012 National Association of Social Workers2012