An individual with Mr. Foster’s disabilities may be eligible for a variety of services and supports, including special education and related services through age 21. If he had been enrolled in special education, a transition plan to prepare him for adult living may have been developed and implemented. He might also be eligible for state developmental disabilities services, Supplemental Security Income (SSI), and Medicaid for health care. Even if he is connected to services, he may not have housing supports. The fact that his family situation appears to be unstable makes it more likely that he is not connected to services and supports. Living in poverty has likely impacted on his current status. Children and adults with intellectual disabilities are more likely than those without disabilities to live in poverty. This association is multifaceted. Costs associated with needed services and supports (health and others) can increase the chance of becoming poor and decrease the ability to escape from poverty. Having a disability increases exclusion from the workforce, exacerbating poverty.
Because individuals with ASD may have challenges with social interactions, they may be less comfortable living with other people and less likely to avail themselves of available social services. The noise and number of people in congregate living situations may be challenging for a person with ASD. Although there is little data available on the prevalence of ASD in the adult homeless population, it is believed that a large number of undiagnosed individuals with ASD are homeless.
Below-average intellectual functioning has been identified as a risk factor for homelessness and as a predisposing factor for vulnerability among homeless individuals. Most homeless adults with ID attribute their homelessness to substance abuse, mental health problems, and fractured relations with family1.
Integrated community-based housing would be the optimal housing option for Mr. Foster. Adults with ASD and other disabilities experience better quality of life and life outcomes when they live in community settings with access to needed services and supports. The Olmstead Decision, issued by the Supreme Court in 1999, requires that services offered to people with ID be offered in the most integrated setting, but implementation is not complete. A policy brief by the Autistic Self Advocacy Network (ASAN), Integrated Housing for People with Intellectual and Developmental Disabilities: Know the Facts (http://autisticadvocacy.org/wp-content/uploads/2014/09/Integrated-Housing-Fact-Sheet.pdf), summarizes what is known and recommended concerning integrated housing2.
- Emerson, E. (2007). Poverty and people with intellectual disabilities. Developmental Disabilities Research Reviews, 13(2), 107-113.
- Mercier, C., & Picard, S. (2011). Intellectual disability and homelessness. Journal of Intellectual Disability Research, 55(4), 441-449.
- Crane, S. & Ne’eman, S. (2014, September). Integrated Housing for People with Intellectual and Developmental Disabilities: Know the Facts. Retrieved from Autistic Self Advocacy Network
What could be barriers or challenges to providing care for Mr. Foster in the emergency department setting? How could these challenges be overcome?