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Although many adults with intellectual or developmental disabilities live with members of their own family, since the late 1960s community-based services have emerged as the dominant public model for supporting individuals with intellectual or developmental disabilities. Chief among the options now available in each state is a network of group homes and supported living arrangements. Prouty and colleagues (2005) estimated that 420,202 adults with developmental disabilities live in 148,520 of these arrangements nationwide.

In the process of deinstitutionalization and the building of a system of community supports, policy makers emphasized residential and employment options. Health, on the other hand, tended to be equated with medical care; and the responsibility for managing the overall health of this population was assigned to medical providers. As a result, little systematic work that integrates efforts to encourage healthy lifestyles has been found. Frey and colleagues (2001) conducted a literature review to identify intervention programs targeting the top 20 secondary conditions found in a series of studies of this population. Of the more than 2,000 studies that they reviewed, only 25 met the minimum criteria of prevention and empirical evaluation.

Researchers, policy makers, and service providers have developed a wide range of empirically derived programs for the general population; but these efforts typically exclude or ignore the needs of people with disabilities. The Surgeon General of the United States thus called for a significant and systematic effort to address the health and wellness needs of people with intellectual or developmental disabilities (U.S. Surgeon General, 2002). This paper outlines one model for conducting research in this area and briefly summarizes the relevant findings from one series of studies. This approach involves contextually appropriate research based on a surveillance model for a targeted population.

CONCEPTUAL FRAMEWORK OF SECONDARY CONDITIONS

Secondary conditions have been defined as any condition to which a person with a primary diagnosis is more susceptible and may include medical, physical, emotional, family, or community problems (Lollar, 2001). From the perspective of tertiary prevention, it is important to diagnose and treat secondary conditions to limit their impact on an individual. Alternatively, the impact of secondary conditions might be managed. Figure O-1 outlines a conceptual model for understanding secondary conditions. In this model, physiological, environmental, and behavioral risk and protective factors are seen as influencing limitations due to secondary conditions. For example, a change in living arrangements to a less restrictive arrangement may increase limitations due to isolation. Alternatively, the change



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