Learning Disabilities



1. Identify the research as: narrative, ethnographic, grounded theory, case study, or phenomenology

2. Write the reference list entry for the article followed by a three-paragraph annotation that includes:

A. A summary that:

EXAMPLE: Identifies the topic, research methodology, theoretical basis or the research, and conclusions from the research

Identifies the topic, research methodology, qualitative research design, theoretical basis or the research, conclusions from the research, research question, contribution to the literature, and limitations of the research. I’m curious as to why you have not discussed these requirements so if you would like to share that information with me I would appreciate it.

this is a good effort and description of the study but you are missing key elements of the assignment: the research design, the theoretical basis of the research, and the research question. I’m curious as to why you have not discussed these requirements so if you would like to share that information with me I would appreciate it.

B. An analysis that:

Identifies the research question

Critiques and explains the article as an original contribution to the body of knowledge

Critiques and explains the theoretical framework as adequate and/or appropriate

States the study limitations

Critiques the conclusions in the context of the results

C. An application as illustrated in this example

The example annotation below includes the citation, a summary in the first paragraph, the critique/analysis in the second paragraph, and the application in the third paragraph.
J Appl Res Intellect Disabil. 2019;32:159–171. wileyonlinelibrary.com/journal/jar  |  159

Published for the British Institute of Learning Disabilities

© 2018 John Wiley & Sons Ltd


The purpose of this study was to explore parent perceptions of the value they receive through their state’s home- and community- based services waiver programme for their child/youth with autism. The study is increasingly important as the prevalence of autism con- tinues to rise (Baio et al., 2018; Rice et al., 2010). Further, the le- gal- (Olmstead v. L.C., 1999) and evidence- based expectation that children with disabilities are best served while living with their fami- lies in their home communities has led to a need to identify effective and efficient models of care and specific services that result in opti- mal outcomes for both child and family.

For many families, raising a child with autism creates a complex set of challenges arising from the diverse range of symptom severity, comorbid conditions such as intellectual disability (Salomone et al.,

2018) and in general the pervasive impact of autism on the child’s com- munication, behavioural and social needs (Karst & Van Hecke, 2012). Families of children with autism experience more stress than families of either typically developing children or children with other disabili- ties (Estes et al., 2013; Hayes & Watson, 2013; Lai, Goh, Oei, & Sung, 2015). Parents of children with ASD are more than twice as likely to file claims for treatment for depression than other parents, based on an analysis of a large national claims database (Cohrs & Leslie, 2017). Such stress often begins prior to the child’s diagnosis and persists through adulthood, as many adults with autism continue to live in their parental home (Howlin & Asgharian, 1999; Howlin, Goode, Hutton, & Rutter, 2004; Seltzer et al., 2003; Woodman, Smith, Greenberg, & Mailick, 2015). In fact, families of children with autism tend to experience poorer family quality of life (FQoL) than families of typically develop- ing children (Fenton, Hood, Holder, May, & Mouradian, 2003; Khanna

Received: 20 December 2017  |  Revised: 17 July 2018  |  Accepted: 25 July 2018 DOI: 10.1111/jar.12518


Family perceptions of the impacts of a home and community based services autism waiver: Making family life possible

Karen Goldrich Eskow1  | Jean Ann Summers2

The findings/opinions of this manuscript are not necessarily the views of MSDE. The contents of this manuscript were developed under a grant from the Department of Health and Human Services, National Institute on Disability, Independent Living, and Rehabilitation Research, NIDILRR—grant number: 90IF0023. However, these contents do not necessarily represent the policy of the Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

1College of Liberal Arts, Towson University, Towson, Maryland 2Research & Training Center on Independent Living, Life Span Institute, University of Kansas, Lawrence, Kansas

Correspondence Karen G. Eskow, College of Liberal Arts, Towson University, 8000 York Road, Towson, MD 21252. Email: keskow@towson.edu

Funding information National Institute on Disability, Independent Living, and Rehabilitation Research, NIDILRR, Grant/Award Number: 90IF0023

Abstract Background: An important mechanism that provides support and services for fami- lies with a child/youth with autism spectrum disorder is the home- and community- based services (HCBS) Waiver authorized by Section 1915(c) of the Social Security Act or Medicaid. Methods: This study used qualitative research methods to explore parent perspec- tives about the impact of HCBS Waiver services on the child/youth with autism and their family. In- depth interviews focused on aspects of the programme they valued, identification of barriers and general issues they experienced. Results: Results of the qualitative study indicated that improved outcomes could be explained by providers of services who were well- trained, flexible and allowed par- ents’ opportunities for choice regarding provision of services to meet child/youth and family needs. Conclusion: The findings of this study provide guideposts for further research about factors that contribute to satisfaction of families receiving waiver services for quality of life and child progress.


160  |     Published for the British Institute of Learning Disabilities


et al., 2011; Lee, Harrington, Louie, & Newschaffer, 2008; Mugno, Ruta, D’Arrigo, & Mazzone, 2007; Simonoff et al., 2008; Sivberg, 2002; Tint & Weiss, 2016; Vasilopoulou & Nisbet, 2016). Families with greater social supports, adaptive coping strategies and children with milder autism- related symptoms and behaviours tend to experience better FQoL or reduced stress (Baghdadli, Pry, Michelon, & Rattaz, 2014; Benson, 2012; Benson & Karlof, 2009; Boehm, Carter, & Taylor, 2015; Eskow, Chasson, & Summers, 2015; Eskow, Pineles, & Summers, 2011; Lu et al., 2018; Pozo, Sarria, & Brioso, 2014).

Families of children with autism also experience significant eco- nomic burdens associated with raising their child with autism (Ouyang et al., 2014; Parish, Thomas, Williams, & Crossman, 2015). Some of the burden comes from costs directly related to services for the child with autism, which tend to be higher than typical health costs as well as costs for other developmental disorders (Barrett et al., 2015). In addition, mothers of children with autism in particular are less likely to be employed and when they are employed are likely to earn less money than mothers of typically developing children (Cidav, Marcus, & Mandell, 2014). Recent research suggests that parents of children with autism are motivated to continue employment, but face signifi- cant barriers including a lack of childcare and rigid work environments (Hill, Jones, Lang, Yarker, & Patterson, 2014; Houser, McCarthy, Lawer, & Mandell, 2014; Matthews, Booth, Taylor, & Martin, 2011; Stoner & Stoner, 2014). Unemployment then becomes another threat to paren- tal well- being, as parents struggle to meet their own needs as well as those of their child with autism (Stoner & Stoner, 2014). A variety of circumstances, such as those noted above, contribute to families of children with autism who report challenges associated with accessing and maintaining services for their child (Searing, Graham, & Grainger, 2015; Vohra, Madhavan, Sambamoorthi, & St Peter, 2014). These chal- lenges are exacerbated for minority and low- income families (Meadan, Halle, & Ebata, 2010). Not surprisingly, given these findings, par- ents have selected interventions based on the availability of funding (Shepherd, Csako, Landon, Goedeke, & Ty, 2018).

As a result, practitioners and policymakers have long recog- nized the need to provide comprehensive supports for families of children with disabilities including autism. An important mech- anism to provide resources for family supports and services are home- and community- based services (HCBS) Waivers authorized by Section 1915(c) of the Social Security Act or Medicaid (Centers for Medicare and Medicaid Services, 2017). These funds were origi- nally earmarked to provide hospital, nursing home and other institu- tional care for people with a variety of disabilities (e.g., frail elderly, physical disabilities or developmental disabilities, including autism). However, states may apply for waivers to enable them to use these funds to support community living options, a trend which acceler- ated following the Supreme Court ruling in Olmstead (Olmstead v. LC., 1999) that established the right of citizens with disabilities to live and participate in the community. Families of children with au- tism may benefit from waivers intended for services for intellectual and developmental disabilities. Further, 11 states currently have or have received waivers specifically targeted to families of children with autism (Friedman, 2017; Miller, Merryman, Eskow, & Chasson,

2016). The types of services provided by the waiver programmes vary state to state, ultimately reflecting a multimillion- dollar invest- ment nationwide (Braddock, 2013; Eskow et…