Contents

Accommodating Students with Disabilities Training to be Health Providers

Association on Higher Education and Disability (AHEAD) - An international, multicultural organization of professionals committed to full participation in higher education for persons with disabilities. Address the need and concern for upgrading the quality of services and support available to persons with disabilities in higher education. 

Health Sciences Faculty Education Project - Tools for faculty to help effectively teach their increasingly diverse student population, particularly students with disabilities. Faculty members playan important role in providing for our country's health care system: To produce highly trained and qualified professionals in each of the health science disciplines. The Health Science Faculty Education Project assists faculty to provide the most effective instruction for each student's unique needs and strengths.

 

Health Care

Health, Wellness and Aging with Disability - Information on, and links to, health, wellness and aging with disability, including cerebral palsy, conferences, developmental disabilities, exercise, health information online, managed care, polio, spinal cord injury, and women's issues.

Health Care Stories Videos - These free, downloadable short videos illustrate, as no policy paper can, the obstacles and barriers that still stand in the way of getting appropriate health care for many people with disabilities.

Access - Communication

A six-page document that presents questions and answers for healthcare providers about auxiliary aids and services such as Sign Language Interpreter services, captioning, and other methods for making aural communication accessible.

 

 

 

 

“Why It’s Important to Use an Interpreter” 
“Rights and Responsibilities” 
"How to Get Interpreter Services” 

 

 

 

 

 

 

 

 

http://www.jointcommission.org/PatientSafety/HLC/video_improving_pt_provider_comm.htm

The Joint Commission and the U.S. Department of Health & Human Services (HHS) Office for Civil Rights worked together to support language access in health care organizations with the video Improving Patient-Provider Communication: Joint Commission Standards and Federal Laws. The video highlights what the Joint Commission standards require as well as Federal civil rights laws with respect to patients who are deaf or hard of hearing, or have limited English proficiency.  A list of resources and tools that health care organizations can use to build effective language access programs accompany the video.

 

Hearing

www.hearinglossweb.com/Issues/Access/Medical/delc.htm

 

Vision

Persons who are blind or have low vision face special challenges in obtaining care that is safe, effective, timely, and patient centered. To explore perceptions of care and recommendations for improvements, authors conducted 8 interviews with experts and 2 focus groups with 19 persons, all of whom are blind or have low vision. Interviewees perceived that they confront special barriers to care because of being blind or having low vision. Barriers fell into 4 broad categories: basic respect, including concerns about physicians thinking they cannot participate fully in their own care; communication barriers, including difficulties interacting with physicians and office staff; physical access barriers, including difficulties getting to and around physicians' offices; and information barriers, including receiving written materials in inaccessible formats (eg, not in Braille, large print, or audiotape). Using common courtesy and individualized communication techniques, physicians and office staff could improve health care experiences of blind and low-vision patients.

This study provides qualitative support for the view that visually impaired people in the United States may, as a group, be systematically excluded from receiving high quality diabetes care and education. Equal access to diabetes care and education for visually impaired people requires increased accessibility of diabetes care and education programs, and increased professional and public awareness that the diabetes programs are accessible. Some specific recommendations are to make all patient education materials available in low-vision/nonvisual formats and to teach all diabetes education professionals how to work effectively with visually impaired people.

Access: Medical Equipment

 

 

 

A short text document that provides suggested questions and information concerning accommodations women with disabilities might require when scheduling a mammography appointment. Giving the caller the opportunity to alert staff to her specific needs prior to her appointment will help her feel less anxious and more welcomed by the facility.

Access: Physical

 

Americans with Disabilities Act (ADA)

Federal Disabled Access Tax Credits

A web based resource that explains how small businesses, including healthcare providers can take advantage of two Federal tax incentives available and help cover costs of making access improvements and providing accommodations such as Sign Language Interpreters for customers/patients with disabilities.

The "Disabled Access Tax Credit" (Title 26, Internal Revenue Code, Section 44), is a tax credit for access expenditures that are incurred in order to comply with the ADA. This enables an eligible small business to elect a nonrefundable tax credit equal to half of the expenditures for eligible accommodations that are above $250. The maximum credit a business can elect for any tax year is $5,000 for eligible expenditures of $10,250 or more. 

California Disabled Access Tax Credits

Similar to the federal tax credit, except that under California law, allowable expenditures cannot exceed $250, unlike federal law, which has a maximum of $10,250.

(See Access section for more information related to the ADA and architectural and communication accessibility, and information about accessible medical equipment.)

 

Coordination and Working with the Community

 

 

 

 

 

Customer Service

Etiquette Tips for Interacting with People with Disabilities

 

 

 

 

 



 

 

The web-based Preservice Health Training (PHT) Modules were designed to improve students' and practicing clinicians' comfort level and knowledge related to working with patients who have developmental disabilities. A total of seven modules have been developed in the series, including two medical modules, two nurse practitioner/physician assistant modules, two dental modules, and one interdisciplinary women’s health module. The modules were produced in response to the continuing disparity in access to quality healthcare experienced by this patient population. As students work through each case, they make decisions about how to conduct the examination, as well as answer specific questions related to developing a treatment plan.

 

This Internet-based recorded slide program assists women's health care clinicians with office skills to assist with their care of women with physical, developmental or sensory disabilities and includes specific information for reproductive health care. 

The updated program includes specific information about accommodating patients with physical, sensory, and intellectual and developmental disabilities; disability culture; ADA requirements and incentives; disability facts; and access and office solutions. The programs also provides a clinical overview of a wide variety of issues related to the care of women with disabilities such as the GYN exam, aging and osteoporosis, contraception, pregnancy and parenting, and menopause. It also provides extensive resources on topics including Federal and national resources, sexuality, women’s health examination, breast health, contraception, advocacy and etiquette, and ADA and barrier removal.

 

Curriculum and video offers health care providers an introduction to issues affecting the quality of care for patients with mobility, vision, hearing and communication disabilities. It does not address people with cognitive or intellectual disabilities. Curriculum materials offer a case-based training exercises to put knowledge into practice.

Education Resources

Approaches to Training Healthcare Providers on Working with Patients with Disabilities 
Last accessed 11.4.12

Webinar co-sponsored by AUCD's Health and Disability Special Interest Group (SIG) and the Alliance for Disability in Health Care Education. 10/12
- Describes approaches to "making the case" for training providers
- Discusses methods of designing training programs for providers
- Discusses steps for implementing provider trainings at various institutions (medical schools, medical societies, etc.)
- Describes elements of successful training programs
 
PRESENTERS:
Susan M. Havercamp, PhD, The Ohio State University Nisonger Center, UCEDD
Kenneth Robey, PhD, Matheny Institute for Research in Developmental Disabilities, Alliance for Disability in Health Care Education, Inc., UMDNJ-New Jersey Medical School
Suzanne C. Smeltzer, RN, EdD, FAAN, Center for Nursing Research, Villanova University College of Nursing

 

"A Training Program for Medical Professionals about Improving the Quality of Care for People with Disability and Chronic Illness" (Resource Paper) - Developed by the World Institute on Disability & Center for Health Care Strategies, Kaiser Permanente Foundation, & California Healthcare Foundation, March, 2005, 20 p.

Manual accompanying a training program for medical professionals, including training goals, suggestions for trainers about disability issues, a workshop facilitator's guide with training format options, and a 22 minute video "Access to Medical Care: Adults with Physical Disabilities." The training program uses the video to prompt discussion, engage in case studies, facilitate small group exercises, explain on-line resources, and an evaluation of the training by those who take it. Formats are designed for one, two or three hour workshops. Excellent outline for a brief exposure to disability issues in health care.

 

The Barrier Free Healthcare Initiative (TBFHI) is spearheaded by advocates, non-profit organizations, legal service providers, and lawyers whose goal is to eliminate the physical and programmatic barriers that people with disabilities face in obtaining healthcare. BFHI aims to develop and support legal advocacy and policy initiatives designed to eliminate these barriers in hospitals and other settings where medical care is provided. Last accessed 12.28.12

 

Health and Health Care Disparities

 

The summit explored ways in which health care professionals and health care facilities can overcome barriers to the best possible care for women with disabilities. It featured promising effective programs and new paradigms for approaching the health of women with disabilities that have helped improve access and, ultimately, quality of care including projects that focus on educating health care professionals.

In a national telephone survey of 1,505 non–elderly adults with permanent physical and or mental disabilities, this study identified the healthcare experiences of non–elderly adults across a broad array of disability types and sources of health insurance.

This article presents the results of a series of focus groups with people with disabilities, in which researchers took a cross-disability, lifespan perspective of disability. Consumers were asked about a broad set of barriers, such as problems with communication, transportation, and insurance, as well as about barriers related to physical accessibility. Authors used the Institute of Medicine's framework to categorize barriers as either structural, financial, or personal/cultural. Results suggest that individuals with disabilities experience multiple barriers to obtaining health care and that these barriers are more pronounced for some types of health care than others. In addition, regardless of disability type, consumers consistently spoke about similar barriers. The results underscore the importance of taking a broad perspective when making policy decisions and the need for continued change and improvement in this area.

In 2006, 37 million adults in the United States had trouble hearing (ranging from a little trouble to being deaf), representing a substantial increase since 2000 when 31.5 million U.S. adults reported trouble hearing. Self-reported trouble hearing is a measure of hearing loss that is defined as "the total or partial inability to hear sound in one or both ears." The National Healthy People Objectives for 2010 include goals to reduce prevalence of hearing loss as well as goals to eliminate health disparities among persons with disabilities. Accommodations are needed for adults who do not hear well to ensure equal access to health services. Services mandated by the Americans with Disabilities Act have improved access for this group of Americans, but disparities in access to health care and health information remain. The goal of this report is to highlight disparities in health status and health risk behaviors of interest to the health community working to meet the needs of adults with hearing loss. Based on a nationally representative sample of U.S. adults, this report describes selected sociodemographic characteristics, health status and conditions, and health risk behavior characteristics of adults who were deaf or had a lot of trouble hearing and adults who had a little trouble hearing compared with adults with good hearing.

This report presents a national Blueprint to improve the health of persons with intellectual and developmental disabilities (IDD) (formerly known as mental retardation). The Blueprint identifies problems and solutions proposed by the community of people with IDD and those who care about their health. It consists of multiple action steps that were developed by work groups at the Surgeon General's National Conference on Health Disparities and Mental Retardation, December 5-6, 2001, in Washington, DC. The action steps are organized under six broad goals that emerged from Conference discussions and analysis of work group recommendations.

 

Health promotion interventions for adults who are visually impaired have received little attention. This article reports what is currently known about the health, overweight and obesity, and levels of physical activity reported by these adults. Conclusions about the need for health promotion activities based on this information are provided, and suggestions for implementing these activities or interventions are offered.

This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services.

Researchers used 2 large government databases to identify women who were receiving disability benefits when localized breast cancer was diagnosed. They then compared women with disabilities who received mastectomy and breast-conserving surgery with those without disabilities who underwent these surgeries. They also compared the women's survival from the time of diagnosis on the basis of disability and type of treatment. Women with disabilities were less likely than those without disabilities to be treated with breast-conserving surgery. Women with disabilities also did not survive as long after breast cancer was diagnosed. The shorter survival was not explained by the difference in treatment.

This study examined the health care of a national sample of 8,721 disabled and 45,522 non–disabled women living in the United States.  Findings indicate that despite having similar potential access to healthcare, women with disabilities experience worse health care and worse preventive care than non–disabled women.

Long Term Care

"Health Care Organization and Incentives Under Emerging Models of Elderly Health Care" - Dept. of Health Administration and Policy [no date], 10 p. David R. Graber, Ph.D., M.P.H. and Anne Osborne Kilpatrick, D.P.A. Medical University of South Carolina, 171 Ashley Ave., Charleston, SC 29425

Brief article describing existing models of elderly health care that receive capitated payments, including:  

The potential significance of these programs for providing financial incentives, comprehensiveness of health care, volume of institutional services, and primary care orientation is analyzed. The three programs are compared with each other in terms of organizational issues, health care issues, and financial systems. A two-page reference list is included at the article's end.

"The Olmstead Decision and Long-Term Care in California: Lessons on Services, Access, and Costs from Colorado, Washington, and Wisconsin" - California Health Care Foundation, December, 2003, 46 p.
Eliot Z. Fishman, Ph.D., Bruce C. Vladeck, Ph.D., Ann-Gel S. Palermo, M.P.H., and Margaret H. Davis, M.H.S.

In response to the 1999 Supreme Court decision in Olmstead v. L.C., this comprehensive report details positive programs in California which support the court's findings and goes into more depth about the glaring problems in the state. These problems are:  

Ultimately the authors recommend that the state could address these problems by redirecting resources currently spent on institutional care or by drawing federal Medicaid funds more effectively. The narrative includes information about Olmstead, the policy context in California, descriptions of programs for various disability groups; comparison of California's program to similar ones in Colorado, Washington, and Wisconsin. Includes helpful graphs, charts, appendices, and endnotes. Recommendations for policy-makers and advocates are written in detail.

"Understanding Medi-Cal: Long-Term Care" - Medi-Cal Policy Institute, Lucy Streett, M.P.H., September, 2001, 35 p.

This guide presents information about Medi-Cal's long-term care programs. Statistical data - annual unduplicated counts (or average monthly estimates) of participants in California's complex system - are included. Well laid-out with graphs, charts and pictures, the guide answers the following questions:  

Especially helpful are the on-line resources and glossary of words used at the end of the guide.

Medi-Cal Managed Care for Seniors and People with Disabilities

"Adults with Disabilities in Medi-Cal Managed Care: Conference Summary" - Medi-Cal Policy Institute, June, 2003, 20 p. Prepared by Health Systems Research, Inc.

This is a summary of conference proceedings based on discussions in February, 2003. The purpose of the conference was to discuss the possibility of moving more people with disabilities into the California managed care system. Findings from the Medi-Cal Policy Institute were shared and discussed. Participants included policymakers, program administrators, health plan representatives, provider organization representatives, consumer advocates, and researchers. Topics covered in the conference summary:  

Appendices included the publications shared and mentioned above, agenda for the conference, and list of participants.

"Faces of Medicaid" - Kaiser Commission on Medicaid and the Uninsured, April, 2004, 12 p.

Pictorial descriptions of various recipients of federal Medicaid-funded programs and health services, this brochure puts a human face on what it means to be a Medicaid beneficiary. Three primary groups, with examples from different states across the U.S., are:  

Helpful handout to introduce Medicaid program to general public.

"It Takes More than Ramps to Solve the Crisis of Health Care for People with Disabilities" - Rehabilitation Institute of Chicago, September, 2004, 76 p. Judy Panko Reis, M.A., M.S., Mary Lou Breslin, M.A., Lisa I. Iezzoni, M.D., M.Sc., and Kristi L. Kirschner, M.D.

Attempting to challenge the general health care system of the U.S., this study provides information, resources and recommendations for integrating people with disabilities into our health care systems. Topics include:  

Resource information is included in the appendices, along with examples of accessible examination tables, mammography projects, clinical services for women with disabilities, research and training centers, clinics, legal and advocacy services, and references. Tables include population by age, gender, and disability, race and disability, and instances of discrimination. Excellent publication for all involved in health care policy-making and decision-making.

"Making Tough Choices: Adults with Disabilities Prioritize their Medi-Cal Options" - California Healthcare Foundation, December, 2004, 38 p. Marjorie Ginsburg and Kathy Glasmire, Sacramento Healthcare Decisions, Inc.

Using a computerized tool and interactive group process called CHAT (Choosing Healthplans All Together), 12 separate groups in urban, suburban and rural settings designed their Medi-Cal benefits by making choices from 14 categories of service. Participants (131 total) were given a limited budget and had to prioritize services most vital. This paper is a full report of the process, the types of participants and their disabilities, and its findings:  

"Medi-Cal Beneficiaries with Disabilities: Comparing Managed Care with Fee-for-Service Systems" - California HealthCare Foundation Issue Brief, August, 2005, 12 p.  Lisa Chimento, Moira Forbes, and Any Sander, The Lewin Group; June Isaacson Kailes, Brenda Premo, and Curtis Richards, The Center for Disability Issues and Health Professions, Western University for the Health Sciences; and Chris Perrone, California HealthCare Foundation

Brief paper synthesizes recent research about the experiences of non-elderly beneficiaries with disabilities in managed care and fee-for-service systems in California and other states. The purpose of this review is to help policymakers understand and evaluate options for changing service and payment systems under Medi-Cal. Key findings:  

Makes recommendations to strengthen the Medi-Cal program's performance, measurements, public reporting, reimbursement systems, and coordination across programs.

Tables and graphs enhance the narrative.

"Serving Persons with Disabilities in Medicare Managed Care: Assuring Continuity Quality and Cost Effectiveness" - Technical Assistance Conference of the Health Resources and Services Administration and Centers for Medicare and Medicaid Services, April 17, 2002, 22 p.

Highlights of proceedings of a national conference on Medicaid funded managed care programs for people with disabilities held in Los Angeles. Most speakers listed are representatives of health care plans and medical institutions. Topics covered:  

The goal of this conference was to learn how to provide quality, comprehensive services to people with disabilities in a Medicaid managed care environment. Appendices of handouts and slides are included.

"Understanding the Health Care Needs of People with Disabilities: Findings from a 2003 Survey" - Kaiser Family Foundation, December, 2003, 27 p. Kristina Hanson, Tricia Neuman, and Molly Voris

This report details the results of a national telephone survey of 1,505 non-elderly adults (18-64) with permanent physical and/or mental disabilities, including a detailed description of survey methods and results. The goal was to describe health care experiences across a broad array of disability types and sources of health insurance, specifically those receiving SSI or SSDI income and those not receiving payment from either of those two programs. Key findings were that people with disabilities are at "significant socio-economic and health-related disadvantages when compared to the non-elderly U.S. population as a whole." Numerous tables and graphs detail the numeric findings of this large survey. Conclusions and policy implications included recommendations for both improved health care systems and strengthened funding coverage for those without insurance or who are under-insured.  

"Adults with Disabilities in Medi-Cal Managed Care: Health Plan Practices and Perspectives" - Medi-Cal Policy Institute, prepared by Jackie Rudich Nolan, September, 2003, 34 p.

Written for California policymakers and other stakeholders to provide insights and information relevant to expansion of managed care programs for non-elderly Medi-Cal beneficiaries with disabilities in response to budget deficits in the state. It is based on a survey of health plans currently providing managed care services to members with disabilities in Medi-Cal. Findings include:  

Discussed are barriers and challenges; promising practices; and favorable conclusions about using managed care for people with disabilities.

"Adults with Disabilities in Medi-Cal Managed Care: Lessons from Other States" - Medi-Cal Policy Institute, prepared by Center for Health Care Strategies, September, 2003, 48 p. Nikki Highsmith, M.P.A., and Stephen Somers, Ph.D.

Examines how well managed care programs for people with chronic illnesses and disabilities served people in other states: Massachusetts, New Jersey, Oregon and Pennsylvania. Interviews were conducted with senior state Medicaid officials, health plan executives, and leaders from consumer organizations. Also mentioned in the report are the experiences of other states the authors knew had developed programs in this area. Key findings are:  

"The California Working Disabled Program: Lessons Learned, Looking Ahead" - Medi-Cal Policy Institute, California HealthCare Foundation, April, 2003, 83 p. Joanne Jee and Joel Menges, The Lewin Group

Based upon the relatively new "Californians Working Disabled Medi-Cal Buy-In Program (CWD)," this study examines the factors affecting enrollment in the program and to estimate enrollment and cost impacts of potential program changes. Enrollment as of June 2002 was 652 people, far lower than state officials had anticipated. Two analyses were conducted: a quality review of stakeholders' experience with the program; and a gathering (by survey, telephone, teleconference, interview) of the experiences of the CWD enrollees, those eligible but not enrolled, and county eligibility workers to gain insight and suggestions for improvement. Chapters cover:  

Themes emerging from this feedback include: increase program outreach to potential users; improve eligibility worker knowledge; improve program attractiveness; and eliminate barriers to employment for people with disabilities. Authors also recommend that:  

  1. raise the income limit to 450% of FPL
  2. eliminate asset level restrictions
  3. combination of the two options above.

 

Policies, Procedures, and Resources

A two-page, easy-to-use check sheet that patients can complete either independently or with assistance that identify and record accommodations they require in a health care setting. This document can be retained in the patient’s file for ease of reference or added to on-line, digital patient records.

A 12-page document for primary care practitioners that is designed either to stand alone as a new chapter that can be inserted into a three ring binder or added to a digital file of existing policies and procedures.  Suggested policies set forth the basic position of the practice on key issues while procedures describe specific tasks required to implement the policies, including managing the delivery of care, and they also specify who is responsible for accomplishing specific tasks.

Who Are People with Disabilities? 

Explores the historic meanings and definitions of disability including those of the Americans with Disabilities Act, the Social Security Administration, and the American Medical Association, and notes that the Institute of Medicine recommends adopting the conceptual framework set forth by the World Health Organization in the International Classification of Impairments, Disabilities, and Handicaps.

http://www.who.int/classifications/icf/en/

The International Classification of Functioning, Disability and Health, known more commonly as ICF, is a framework for measuring health and disability at both individual and population levels. The ICF takes into account the social aspects of disability and does not interpret disability only as a “medical” or ”biological” dysfunction.

History of Disability and the Health Professions

A Brief History of Blind Physicians  

 

Improving and Protecting Your Health
(Consumer Focus) 

 

Prescription Drugs and Assistance Programs  

Prescription Drug Patient Assistance Programs Finder 

familyvillage.wisc.edu 

Medication Assistance Programs - provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.

Medwatch - Medical product safety information from the U.S. Government Food and Drug Administration.

The Medical Letter for Drugs and Therapeutics

The MEDLINEplus Drug Link 

The University of Miami's School of Medicine, Louis Calder Memorial Library - Internet Listings for Pharmacology and Toxicology

The Medicine Program - For a $5 processing fee for each medication requested, The Medicine Program site will assist the patient in the enrollment process. Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.

U.S. Food and Drug Administration - Center for Drug Evaluation and Research.

U.S. Food and Drug Administration Consumer Information - From the FDA's Center for Drug Evaluation and Research.

Profiles of People with Disabilities in the Health Professions

"Barriers Fall for Disabled Medical Students" - November, 2003 NY Times article about Jeffrey Lawler, 4th year Western University of Health Sciences medical student and other health care providers with disabilities. - Note: this is a PDF file.

Blind Physicians In Current Practice - "There is a common misperception that we have to be all things to all people, and that anyone who falls short of perfection is somehow incomplete." - Dr. Yarnell

Center on Self-Determination Stories of exemplary health science professionals with diverse abilities who are practicing as nurses, doctors, dentists and dental hygienists.

Deaf Professor Creates Web Site to Help Deaf Children Communicate By Bianca P. Floyd

Disability Leads Student To Medical School - Like all medical students, he faces numerous challenges which will put all his abilities to the test in coming years. For Jeff, however, there are additional obstacles to overcome.

Disabled Students Encouraged to Pursue Science Careers.

For doctors with disabilities, overcoming obstacles is part of the job. By Julie G. Madorsky, MD, and Barry Corbet

Margaret Stineman, M.D. by June Isaacson Kailes, Disability Policy Consultant and Susan Madison, consultant.

Michael Ain - "Aiming High," by Melissa Hendricks - John Hopkins Magazine, April 1999 - In the rough and rugged world of orthopedic surgery, Dr. Michael Ain stands out. Ain has a form of dwarfism called achondroplasia.

Thomas E. Strax, M.D., Doctor, Physiatrist, Administrator, Executive Dr. Tom Strax comes from a long line of physicians, including his father and beloved cousin who served as a key mentor throughout his education. With athetoid cerebral palsy, becoming a doctor was not a "piece of cake," but it seems that Tom had many cards stacked in his favor, not the least of which was his singular desire.