We examined whether an internet use promotion intervention influences low-income older adults' communication modes, internet use, and social networks using existing data collected for an intervention. Participants living in public senior housing facilities in the United States (n = 77) completed surveys before and after a 12-week computer and internet training. The six-item Lubben Social Network Scale (LSNS-6) was used to measure the extent of older adults' social networks. The primary mode of communication shifted from more traditional means to internet-based communications (p < .0005 in a Fisher's exact test). The frequency of internet use significantly increased (p < .00005 in a one-sided Sign test). Overall, the LSNS-6 score increased by 4.1 points (p < .00005 in a Welch's t-test). The LSNS-6 score increase was significantly larger among African Americans than Whites, controlling for gender (p < .05 in negative binomial regression). Moderate (p < .005) and frequent internet users (p < .05) had higher LSNS-6 scores than rare internet users at posttest when gender and race were controlled for in linear regression. Comparatively more improvement in the extent of social networks among African Americans suggests greater benefits of such interventions for population groups of disadvantaged backgrounds. Larger social networks among moderate and frequent internet users than rare users suggest positive impacts of internet communications on social networks.

Accessible summary• Palliative care is a holistic model of care that lessens suffering and improves quality of life for individuals who are very sick.• As people with intellectual and developmental disabilities (PWIDD) get very sick, direct care workers (DCWs) are more likely to provide palliative care.• Researchers need to know more about what palliative care training DCWs need.• One hundred and forty-nine (149) DCWs filled out surveys about their palliative care training needs. • The research showed that DCWs need more training in certain areas, such as cultural competence, effective communication, post-death logistics and legal matters. Abstract Background: Direct care workers (DCWs) caring for people with intellectual and developmental disabilities (PWIDD) provide palliative care, but research indicates DCWs are ill-equipped to do so. This study aimed to assess DCWs' palliative care experience and training and their perceived training needs. Materials and Methods: Staff trained as DCWs (n = 149) in organisations that serve PWIDD were surveyed in suburban and rural areas of a U.S. Midwestern state. Descriptive statistics were run, including t tests, analysis of variance, Scheffe's tests for pairwise comparison, Pearson's correlation, Fisher's exact tests and chi-square tests.Results: Participants reported limited experience in legal matters, yet had substantial experience in assisting PWIDD with pain, distress and bereavement. Training was inadequate but desired for cultural competence, effective communication, post-death logistics and legal matters. Rural DCWs reported less palliative care experience and training than suburban counterparts. Conclusions: The results demonstrate the need for specific types of palliative care training among DCWs caring for PWIDD and that such training should be prioritised in rural agencies. Future research can explore ways to maximise training effectiveness. K E Y W O R D S direct care workers, intellectual and developmental disabilities, needs assessment, palliative care, training How to cite this article: Gray JA, Kim J. Palliative care needs of direct care workers caring for people with intellectual and developmental disabilities. Br J Learn Disabil. 2020;48:69-77.

Objective: To learn about the challenges, policies, and needed resources to serve people with intellectual disability and protect staff during the COVID-19 pandemic. From the perspective of intellectual disability service providers. Methods: We conducted in-depth qualitative interviews with 16 intellectual disability organization administrators throughout Illinois, USA from November 2020 through February 2021. We coded and analyzed the data using thematic analysis. Results: Three major themes emerged: (1) COVID-19 caused considerable challenges to people with intellectual disability and staff and service providers, (2) intellectual disability organizations reinvented service provisions in response to COVID-19 challenges, and (3) the interrelatedness of intellectual disability organizations, public policies, and community entities became evident. Conclusions: Exhibiting responsiveness to needs and developing innovative solutions were strategies championed by intellectual disability organizations during the pandemic. Fostering collaboration with community entities may assist these organizations in navigating pandemic challenges and developing resilient infrastructure for future environmental threats.

Objectives The objectives of this study were to evaluate the psychometric properties of a palliative care self-efficacy instrument developed for intellectual and developmental disability (IDD) staff using Rasch analysis and assess the change in palliative care self-efficacy between 2 time points using Rasch analysis of stacked data. Methods Staff from 4 nonprofit IDD services organizations in a US Midwestern state (n = 98) answered 11 questions with Likert-style responses at baseline and 1-month follow-up post training. Rasch analysis was performed to examine rating scale structure, unidimensionality, local independence, overall model fit, person and item reliability and separation, targeting, individual item and personal fit, differential item functioning (DIF), and change in palliative care self-efficacy between 2 time points. Results The rating scale structure improved when 5 response categories were collapsed to 3. With the revised 3 response categories, the instrument demonstrated good psychometric properties. Principal components analysis of Rasch residuals supported the assumption of unidimensionality. Model fit statistics indicated an excellent fit of the data to the Rasch model. The instrument demonstrated good person and item reliability and separation. Gender-related DIF was found in 1 item, and work tenure–related DIF in 3 items. Overall palliative care self-efficacy improved between 2 time points. Significance of results Rasch analysis allowed for a more thorough examination of this palliative care self-efficacy instrument than classical test theory and provided information on rating scale structure, targeting, DIF, and individual persons and items. These recommendations can improve this instrument for research and practical contexts.

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