International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 DOI: 10.18357/ijcyfs94201818647 A SYSTEMATIC APPROACH TO ENHANCING THE PERSONAL WELL-BEING OF CHILDREN AND ADOLESCENTS R. L Schalock, J. van Loon, and R. Mostert Abstract: This article describes a systematic approach to enhancing the personal well-being of children and adolescents with intellectual or closely related developmental disabilities. The article incorporates international trends in disability-related policies and practices and proposes a quality of life framework for implementing the approach, which consists of input, throughput, output, and outcome components. Guidelines for implementing the approach are presented, along with an example of its use. Keywords: children, adolescents, quality of life, personal well-being, systematic approach Robert L. Schalock PhD (the corresponding author) is Professor Emeritus at Hastings College, PO Box 285, Chewelah, Washington 99109, USA. Email: rschalock@ultraplix.com Jos van Loon PhD is an Adjunct Research Professor in the Department of Special Needs Education, University of Ghent, Henri Dunantlaan 2, B-9000 Ghent, Belgium. Email: vanLoon.jos@gmail.com Remco Mostert BA is a Master Trainer at the Arduin Foundation in The Netherlands and is an Instructor in the Faculty of Education, Health and Social Work, University College, University of Ghent, Geraard de Duivelstraat 5, 9000 Ghent, Belgium. Email: remcomosteret@gmail.com mailto:rschalock@ultraplix.com mailto:remcomosteret@gmail.com International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 189 Children and adolescents with an intellectual or closely related developmental disability (IDD) and their families face a number of challenges related to acceptance, placement, educational opportunities, and experiencing a life of quality. Despite significant changes over the last few decades in policies and practices regarding these individuals, many still experience segregated environments and fewer opportunities for personal development, participation in regular environments, and involvement with peers who are non-disabled. The purpose of this article is to address these ongoing challenges by integrating recent international changes regarding disability policies and practices into a systematic approach that policy makers and educators can use to enhance the well-being of children and adolescents with IDD. This article is divided into four sections. In the first, we identify five recent international changes that are currently influencing disability policies and practices. We incorporate these changes into our systematic approach to enhancing the personal well-being of children and adolescents. In the second section, we provide an overview of the quality of life (QOL) concept and the rationale for using this concept as an underlying principle and framework for the systematic approach. In the third section, we describe the four components of the approach and include implementation guidelines for each component. In the final section, we present an example of the approach. Throughout the article we focus primarily on the educational system and the education reform movement, while realizing that children and adolescents with IDD live and interact in multiple environments that involve home living, community living, leisure, and recreation. Although we do not address these other environments in detail, we believe that the systematic approach we describe here is applicable to these other environments. International Changes Influencing Current Disability Policy and Practices Recent changes in several areas affect current disability-related policies and practices. These changes, international in scope, influence how services and supports are provided to children and adolescents with IDD. The areas in which relevant changes are seen include professional attitudes to disability, increased knowledge about disability, disability policy, the supports paradigm, and the education reform movement. In Table 1, we summarize the potential influences of trends in each area on enhancing the personal well-being of children and adolescents with IDD. A listing of relevant references is also provided. International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 190 Table 1 International Trends Influencing Services and Supports to Children and Adolescents Area of Change Potential Influences Relevant References Professional attitudes to disability  Person-referenced policies and practices (e.g., self-determination and empowerment)  System-referenced policies and practices (e.g., universal human and legal rights; equal and inclusive education) Claes, Vandenbussche, & Lombardi (2016); Shogren & Turnbull (2014); Turnbull & Stowe (2014); United Nations (2006); Verdugo, Navas, Gomez, & Schalock (2012) Increased knowledge about disability  Multifactorial approach to etiology  The socioecological model of disability  Demonstration that with opportunity development and appropriate supports over time, the life functioning of persons with disability will generally improve Nussbaum (2011); Schalock & Keith (2016); Thompson, Schalock, Agosta, Teninty, & Fortune (2014); Wehmeyer (2013) Integrated approach to disability policy  Special education goals encompass equal opportunity, full participation, independent living, and economic self-sufficiency  Post-graduation measurable outcomes relate to education status, employment status, and independent living status Shogren, Luckasson, & Schalock (2015; 2017); Test et al. (2009); Turnbull & Stowe (2014) Supports paradigm  Any person-environment mismatch that results in needed supports can be addressed through the judicious use of individualized supports rather than focusing on “fixing the person”  The focus of supports should be on bridging the gap between “what is” and “what can be”  Children and adolescents should be approached on the basis of the type and intensity of their support needs Luckasson & Schalock (2015); Mpofu (2016); Shogren, Wehmeyer, Schalock, & Thompson (2017); Stancliffe, Arnold, & Riches (2016); Thompson et al. (2014) Education reform movement  The centrality of communities of equality, respect, and social support  Creation of inclusive educational environments whose structure is to provide opportunities and support people; whose function is to enhance participation, involvement, and development; and whose culture is reflected in respect for the student, student centeredness, and a commitment to enhance the student’s personal well-being  Strength-based models of disability  Capacity and potential of students  Contextualized strategies that address the requirements of specific contexts and situations  Relevance of the QOL concept as an integrating framework in both special education and inclusive education Bogdan & Taylor (1989); Bryant, Smith, & Bryant (2007); Danforth & Naraian (2015); Noddings (1995); Nussbaum (2011); Pazey, Schalock, Schaller, & Burkett (2016); Shogren et al. (2015; 2017); Vaughan, Bos, & Schumm (2010); Wehmeyer (2013); Yell (2012) International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 191 An Overview of the Quality of Life Concept and its Relevance The conceptualization and measurement of the QOL of children and adolescents with IDD has historically been approached from three perspectives: health-related, social indicators, and subjective well-being (Wallender & Koot, 2015). Over the last three decades, the present article’s authors have been involved in the conceptualization, measurement, and application of the QOL concept across age and diagnostic groups. In this work we have used a definition of individual QOL that encompasses these three historical approaches: Quality of life is a multidimensional phenomenon composed of core domains that constitute personal well-being. These domains are influenced by personal characteristics and environmental factors. One’s quality of life is the product of these factors and can be impacted positively through quality enhancement strategies that encompass developing personal talents, maximizing personal involvement, providing individualized supports, and facilitating personal growth opportunities (Schalock, Verdugo, Gomez, & Reinders, 2016, p. 2). The QOL conceptual model used in this article includes eight core domains: personal development, self-determination, interpersonal relations, social inclusion, rights, emotional well- being, physical well-being, and material well-being. Each domain has associated culturally sensitive indicators — the behaviors and conditions that give an indication of the person’s well- being, and provide the items for assessing domain-referenced outcomes (Gomez & Verdugo, 2016; Schalock et al., 2016). The rationale for using a QOL framework as an underlying principle and framework in implementing the systematic approach described in this article is that a QOL framework: (a) integrates the five trends summarized in Table 1 through its emphasis on fundamental principles related to equity, inclusion, empowerment, and self-determination; (b) incorporates a holistic, positive approach to individuals based on positive psychology and strengths-based models of growth and development; (c) provides a framework for person-centered planning; (d) allows one to evaluate the impact of various individual and environmental variables on personal outcomes: (e) reflects the individualized nature of personal well-being; (f) aligns thought and action through a “quality of life language of thought and action” whose basic concepts include human and legal rights, equity, inclusion, empowerment, and self-determination; whose relationships involve interactions, social networks, community participation, valued roles, and positive experiences; and whose spatial concepts reflect inclusion, active participation, and being in and of the community; and (g) has an extensive literature base regarding its conceptualization, measurement, and application (Bigby & Beadle-Brown, 2014; Bigby, Knox, Beadle-Brown, & Bould, 2014; Brown, Hatton, & Emerson, 2015; Claes, Van Hove, van Loon, Vandevelde, & Schalock, 2009; Pazey et al., 2016; Reinders & Schalock, 2014; Schalock & Keith, 2016; Wehmeyer, 2013). Because of its strengths and applicability, the QOL concept is increasingly being used as a universal indicator of International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 192 success whenever we intend to advance the well-being of children and adolescents through interventions, programs, and policy (Schippers, Zuna, & Brown, 2015; Wallender & Koot, 2015). Components of a Systematic Approach To Enhancing Personal Well-Being This section describes the four components of the proposed systematic approach, and includes implementation guidelines for each component. As the reader will find, the input component focuses on what we refer to as outcome drivers, the throughput component on practices, the output component on characteristics of inclusive education environments, and the outcome component on the assessment of QOL domain indicators. Input Traditionally, inputs regarding education and rehabilitation programs have been viewed as resources related to fiscal and social capital, time, expertise, and technology. While these types of resources are critical, three other factors act as inputs that drive valued outcomes: foundational principles, the alignment of policy and measurable outcomes, and the pattern and intensity of the individual’s assessed support needs. Foundational principles. Articles contained in the United Nations Convention on the Rights of Persons with Disability (UNCRPD; United Nations, 2006) provide a basis for those principles that drive valued outcomes for children and adolescents with IDD. These involve human rights and fundamental freedoms (Article 7), inclusive and equal education (Article 24), participation (Article 30), and freedom of expression (Article 21). These four Articles are consistent with the core QOL principles of inclusion, equity, empowerment, and self- determination. Alignment of policy goals and desired outcomes. This alignment can serve as a framework that enables policy makers, education providers, and support teams to begin with the end in mind and ask, “What needs to be in place for the desired outcomes to occur?” One constructive way to operationalize this alignment is to match QOL indicators (i.e., desired outcomes) with core QOL domains. This alignment is shown in Table 2. The exemplary indicators listed are from the KidsLife Scale (Gomez et al., 2016) and the Personal Outcomes Scale for Children and Adolescents (Claes, van Loon, Schalock, & Mosteret, 2015). Table 2 Alignment of Quality of Life Domains and Domain Indicators Quality of Life Domain Exemplary Quality of Life Indicators Personal development Demonstrates self-help skills and has opportunities to learn and grow Self-determination Makes decisions, sets personal goals, expresses personal feelings Interpersonal relations Has close friends, interacts socially, is part of family interactions Social inclusion Participates in family and community activities, receives assistance and help from others International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 193 Quality of Life Domain Exemplary Quality of Life Indicators Rights Treated the same way as his or her peers, has a pet if he or she wants one Emotional well-being Feels safe and secure, home and school environments are predictable, expresses satisfaction, contentment, and happiness Physical well-being Participates in physical activities, eats healthy food, uses supportive technology if needed (e.g., glasses, braces, wheelchair) Material well-being Has enough money to buy personal possessions, has own physical space Pattern and intensity of support needs. The extensive work done with the Supports Intensity Scale for Children (Thompson et al., 2016) has helped us to achieve a better understanding of the support needs of children and adolescents. Table 3 provides an overview of support need categories and specific support need areas assessed on this scale. Table 3 Overview of Support Needs of Children and Adolescents with IDD Support Need Category Exemplary Support Need Areas Exceptional medical needs Respiratory care, feeding assistance, skin care Exceptional behavioral needs Externally-directed destructiveness, internally-directed destructiveness Home life activities Eating, dressing, toileting Community and neighborhood activities Moving around the neighborhood, community participation, using public services School participation activities Being included in general education classrooms, participation in activities in common school areas School learning activities Learning academic skills, completing academic tasks Health and safety activities Maintaining physical fitness, emotional well- being, health and wellness Social activities Maintaining positive relationships with others, respecting the rights of others Advocacy activities Making personal choices and decisions When studying Table 3 it is important to note that the pattern of needed supports for children and adolescents with IDD is not unlike that of children without a disability, with the possible exception of those related to exceptional medical and behavioral conditions. The intensity of those support needs will vary, however, depending on the individual’s impairment and level of functioning. International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 194 Implementation Guidelines: Input  Develop school-related policies based on foundational principles embedded in the UNCRPD and the QOL concept.  Align policies and practices to measurable outcomes.  Assess the pattern and intensity of support needs. Throughput The throughput component focuses on educational and support practices that encompass education reform foundational priorities, the provision of individualized supports, and the characteristics of an inclusive education environment. Education reform foundational priorities. The education reform movement is based on a number of foundational priorities that include communities of equality, respect, and social support; strengths-based models of disability that build on the student’s capacities and potential; contextualized strategies that result from a contextual analysis that identifies those factors that hinder change and those that facilitate change; and the need to develop 21st-century skill sets. These foundational priorities influence both the provision of individualized supports and the characteristics of an inclusive education environment. Provision of individualized supports. The provision of individualized supports involves the planned and integrated use of support strategies and resources composing a system of supports. Elements of such a system include natural supports, technology, prosthetics, education across the life span, reasonable accommodation, dignity and respect, personal strengths and assets, and professional services. Specific examples of these support strategies are found in Lombardi, Chiu, Schalock, and Claes (2017) and Schalock and Luckasson (2014). A system of supports model focusing on the provision of individualized supports provides the structure to increase opportunities and enhance performance elements that are interdependent and cumulative. The provision of individualized supports is facilitated by a support team that: (a) is composed of the student, one or more family members, teachers and teacher aides, a supports coordinator, and relevant professionals; (b) is characterized by being involved, informed, organized, accountable, and empowered; and (c) incorporates a quality improvement process that involves evaluation and adjustment to maximize the positive impact of support strategies on valued personal outcomes (Schalock & Verdugo, 2012). Characteristics of an inclusive education environment. An inclusive education environment is built on those education reform foundational priorities just described, and provides a system of individualized supports. Furthermore, it is characterized by its structure, function, and culture. Specifically, its structure is a regular education classroom that provides opportunities and supports students through assistive technology, modified curricula and teaching methods, and International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 195 other elements of a system of supports. Its function is to enhance participation, involvement, and development by mediating access to education and community resources, facilitating everyday participation in regular education activities and relationships, supporting opportunities for self- determination, and allowing students to build social capital. Its culture is based on respect for the student, student centeredness, and a commitment to enhance the student’s personal well-being. This culture should embed strong leadership, shared responsibility, teamwork, and openness to ideas and change (Bryant et al., 2007; Danforth & Naraian, 2015). Implementation Guidelines: Throughput  Base educational practices on education reform foundational priorities.  Recognize that supports can be administered by everyone who interacts with the child or adolescent. This includes family members, teachers, friends, and professionals.  Use a “user-friendly” plan such as a one-page Individual Supports Plan or an Education Plan-at-a-Glance that lists the specific support strategies provided and who is responsible for their implementation (including the individual and his or her family, and the teachers and support staff).  Develop the supports or education plan using a QOL framework in which specific support strategies are provided to enhance each QOL domain.  Use the characteristics of the inclusive education environment for strategic planning, organization transformation, and output evaluation. Output The output component of the systematic approach focuses on the product of an inclusive education environment in which interventions, services, and supports are provided to enhance the individual’s participation, involvement, and development — and thereby enhance personal well- being. The evaluation of the output component of the proposed systematic approach involves assessing the status of three characteristics of an inclusive education environment using the following measurable status indicators:  Structure: The degree to which the classroom provides opportunities and supports students through assistive technology, modified curricula and teaching methods, and other elements of a system of supports.  Function: The degree to which the classroom enhances participation, involvement, and development through mediating access to education and community resources, facilitating everyday participation in regular education activities and relationships, supporting opportunities for self-determination, and allowing students to build social capital. International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 196  Culture: The degree to which the classroom reflects respect for the student, student centeredness, and a commitment to enhancing the student’s personal well-being. At this time, inclusive education environments are a reality in some jurisdictions, a short- or long-term goal in others, and only a dream in still others. The authors recognize the reality of this continuum, but also feel that the goal is a worthy one. The value-base is there, the education and reform movement and outcomes-driven policy formulation have begun, and the characteristics of such an environment are becoming clearer. Thus, readers of this article might consider the following implementation guidelines as they strive to implement inclusive education environments whose output would be evaluated in terms of measurable results from the status indicators in the three areas of structure, function, and culture. Implementation Guidelines: Output  Conduct a contextual analysis of the current environment and determine the factors that facilitate change and those that hinder change. Examples for inclusive education can be found in Shogren, Schalock, and Luckasson (2018) and Verdugo, Jenaro, Calvo, and Navas (2017).  Analyze the current environment in terms of its structure, function, and culture. The analysis should be based on operational definitions of these three characteristics of the inclusive environment: (a) structure: to provide opportunities and support people; (b) function: to enhance participation, involvement, and development; and (c) culture: to create environments that enhance personal well-being.  Use the results of this analysis to determine significant discrepancies between the listed characteristics and current practices.  Use strategic planning and organization transformation strategies to reduce the discrepancies. Examples are presented in Reinders and Schalock (2014) and Schalock and Verdugo (2012). Outcome One of the fundamental changes associated with the education reform movement is the evaluation of personal outcomes that reflect the personal well-being of children and adolescents with IDD. Outcomes evaluation is based on the need to demonstrate a program’s effectiveness and requires the alignment of policy goals with measurable outcomes. Outcomes evaluation is defined as assessing changes and benefits that follow as a result of some activity, intervention, or service (Gomez & Verdugo, 2016). Outcome information obtained from reliable and valid assessments can be used for multiple purposes including monitoring and reporting, quality improvement, and research (Schalock et al., in press). The advantage of using a QOL framework for outcomes International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 197 evaluation is that its multidimensionality represents a whole-life approach to outcomes measurement, and thereby results in a more comprehensive approach to status evaluation, quality improvement, and research (Pazey et al., 2016; Reinders & Schalock, 2014; Schalock & Keith, 2016). The outcome component of the proposed systematic approach operationalizes a whole-life approach through the standardized assessment of culturally sensitive indicators associated with each of the eight QOL domains. (A listing of these domains and exemplary indicators was presented in Table 2.) Each of these indicators is assessed on a 3 to 6 point scale such as: (a) yes, depends, no; (b) yes, more or less, no; (c) frequently, sometimes, seldom or never; (d) very safe, somewhat safe, not safe; (e) very good, okay, not good; or (f) always, sometimes, seldom or never. Depending on the person’s age, each indicator is scored based on either the person’s input (“self- report”) or the input of a family member or teacher (“report of others”). Depending on the instrument, domain scores can be reported as raw, transformed, or percentile scores. QOL scores can be used for multiple purposes. For example, an individual profile summarizing QOL domain scores provides information to the student and the student’s family that reflects a holistic picture of the person across the eight QOL domains. The profile can also be used to form a dialog with the student or family about personal goals and desired outcomes, and about implementing support strategies to enhance them. Raw or transformed scores can be used as dependent variables in research studies to determine the specific predictors of successful educational practices, effective support strategies, or characteristics of the inclusive environment. At the aggregate level, QOL domain and total scores can be used for monitoring and reporting, establishing quality improvement strategies, and conducting research. In the following section, we present an example of a whole-life approach to assessment using a standardized QOL assessment instrument. The example reflects the following guidelines. Implementation Guidelines: Outcome  Align policies and practices with measurable outcomes.  Use a whole-life approach to assess those outcomes.  Use an assessment instrument that is based on a well-formulated and validated conceptual model, uses culturally sensitive indicators, employs a standardized scoring metric, has good psychometric properties, and has standardized administrative procedures (Claes et al., 2009; Gomez & Verdugo, 2016).  Use outcome measures for multiple purposes. International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 198 Applying the Systematic Approach The example presented in this section incorporates the four components — input, throughput, output, and outcome — of the proposed systematic approach to enhancing an individual’s personal well-being. These four components and associated processes are shown graphically in the logic model presented in Figure 1. The advantages of using a logic model to organize the systematic approach is that a logic model articulates the operative relations among policies, practices, and outcomes; aligns the operative relations among input, throughput, output, and outcome; and enables all stakeholders to understand what must be done to achieve the desired goals and associated outcomes (Schalock & Verdugo, 2012). Figure 1. A systematic approach to enhancing the personal well-being of children and adolescents. Input Anna, a 9-year-old girl with Down syndrome, lives at home with her parents, brother, and two sisters with whom she frequently plays. Anna is strong-willed. She has a visual impairment and moderate to mild intellectual disability. Anna is very sensitive to sensory stimuli. She goes to a regular school, and is in a regular classroom supported by a support worker from Arduin, a community-based program in Zealand, The Netherlands, that provides services for people with IDD. Values Personal Goals Policy Goals Profile and Intensity of Support Needs Policy makers and services/support providers creating environments that provide opportunities for participation, involvement, and development Support teams providing individualized supports within those environments Adjust Evaluate Inclusive environments in which supports are provided to children and adolescents to enhance their participation, involvement, and development Quality of life- related changes or benefits to children and adolescents from the throughputs and outputs THROUGHPUT OUTPUT OUTCOME Resources INPUT International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 199 Anna’s support needs are measured using the Supports Intensity Scale – Children’s Version (SIS-C; Thompson et al., 2016). The SIS-C was completed by her mother and a support worker who has known Anna for four years. As indicated in the SIS-C information summarized in Table 4, Anna has moderate to high support needs across the nine support need categories. Table 4 Summary of Anna’s Support Needs Support Need Category Standard Score (range=1–16) Home life activities 8 Community and neighborhood activities 10 School participation activities 10 School learning activities 11 Health and safety activities 10 Social activities 10 Advocacy activities 11 Exceptional medical and behavioral needs* 4 *Anna has no exceptional medical support needs other than some support for irritable bowel syndrome. In reference to exceptional behavioral support needs, she needs some support for maintaining mental health treatments at school, and extensive support for her sensitivity to stimuli. Throughput Education reform foundational priorities. According to the Wet Passend Onderwijs [Appropriate Education Act] adopted in the Netherlands in October 2012, there should be a place in a regular school for every child to fit the child’s competencies. To make this possible for Anna, there is a partnership between regular and special schools. Arduin provides the extra support needed for Anna to participate in a regular school. Provision of individualized supports. Individualized supports are provided through a support worker who implements an individual support plan (ISP) that is developed by Anna’s parents, her personal director (i.e., case manager), and her support worker. The ISP aligns Anna’s goals and assessed support needs with specific support strategies. Table 5 summarizes the parameters of Anna’s ISP. Characteristics of the inclusive environment. The supports a child such as Anna gets in a regular classroom are based on the child’s education plan and ISP. The composition of the support team is dependent on the child and family’s personal goals and the child’s assessed support needs. In Anna’s case, the support team is composed of the remedial teacher, the support worker, her parents, the personal director, a psychologist (provided by Arduin), and a speech therapist. Anna also gets support at home. Anna’s parents want as normal a life for their daughter as possible. International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 200 Table 5 Parameters of Anna’s Individualized Support Plan Support Need Category Objective Specific Support Strategies Exceptional behavioral needs Reduce sensitivity to stimuli Use the relaxation strategy to calm Anna, using a special vest if necessary to give her a sense of control. Provide a daily schedule to increase predictability and control. Home life activities Keep self occupied during unstructured time at home Provide an iPad; invite Anna to participate in an activity; assist her in riding her tricycle Community and neighborhood activities Increase compliance with basic community standards, rules, and laws Encourage and facilitate contact with other people; advocate for Anna in important matters; prevent conflicts with others through redirection School participation activities Increase participation in common school activities (e.g., playground, hallways, cafeteria) Structure Anna’s day through supervised participation in common school activities School learning activities Increase completion of academic tasks, including time, quality, neatness, and organizational skills Support participation in classroom activities; use a validated teaching method such as Leespraat en Rekenlijn [Reading Talk and Calculating]; provide an incentive program for completing academic tasks Health and safety activities Maintain physical fitness Involve in physical activity and recess programs; provide close supervision while on her daily walks; provide very close supervision in crossing streets Social activities Increase communicating with others in social situations Involve in peer groups; supervise and provide active feedback when participating in social activities Advocacy activities Increase choice and decision making Provide choices for Anna; assist in making a decision by pointing out the results of the choice made; reinforce decision making Output The output component focuses on the product of the inclusive environment. In Anna’s case, the output is evaluated on the basis of: (a) maintaining placement in the inclusive environment with individualized supports; (b) maintaining the partnership among the family, school, and Arduin; and (c) Anna’s increased community participation and expanded social capital. Outcome The Personal Outcomes Scale for Children (POS-C; Claes, van Loon, Schalock, & Mostert, 2015) was used to measure Anna’s QOL. As the POS-C prescribes for a child below the International Journal of Child, Youth and Family Studies (2018) 9(4): 188–205 201 age of 12, the Report of Others version of the Scale was used. The respondents were Anna’s mother and her support worker. Domain scores on the POS-C can range from 6 to 18. Anna’s domain scores were as follows: Personal Development (12), Self-Determination (16), Interpersonal Relations (15), Social Inclusion (15), Rights (16), Emotional Well-Being (18), Physical Well- Being (15), and Material Well-Being (16). As reflected in these domain scores, Anna’s assessed QOL using the POS-C is quite high, with needed attention given to Personal Development. Summary and Conclusion This is a time of change regarding policies and practices focusing on children and adolescents with IDD. These changes are influenced by ideological changes, increased knowledge about disability, an integrated approach to disability policy, the supports paradigm, and the education reform movement (see Table 1). The changes in these five areas provide the rationale, content, and framework for the proposed systematic approach to enhancing the personal well-being of children and adolescents. Four components of a logic model are used to operationalize the systematic approach. The input component is based on foundational principles, the alignment of policy goals and measurable outcomes, and the assessment of the pattern and intensity of the individual’s support needs. The throughput component is based on educational reform foundational priorities, the provision of individualized supports, and the characteristics of an inclusive education environment. The output component focuses on the products of an inclusive education environment and is evaluated on the basis of the environment’s structure, function, and culture. The outcome component focuses on the evaluation of personal and valued outcomes related to the QOL domains of personal development, self-determination, social inclusion, interpersonal relations, rights, emotional well-being, physical well-being, and material well-being. Although Anna provides just one example of using the systematic approach to work with a student with a disability who is being supported in a regular classroom, her example highlights the changes that will enhance other children’s personal well-being. 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