Educational programs Women with Disabilities. Why This Curriculum? 54 million Americans live with...

educational programs

Women with

Disabilities

Why This Curriculum?

54 million Americans live with disabilities

28.6 million are women (21.3% of all females)

An Urgent Healthcare Problem:

Source: U. S. Census Bureau. Disability Status: 2000: Census 2000 Brief. 2003.

Disability Trends in Women

From 1990-19941:

<18 years 33% (4.2% to 5.6%)

18-44 years 16% (8.8% to 10.3%)

From 1982-19962:

65 years 26.8% (26.9 million to 34.1 million)

1LaPlante, M.P, and H.S. Kaye, eds.Trends in Disability and Their Causes: Proceedings of the Fourth National Disability Statistics and Policy Forum. 1998.

2U.S. Department of Health & Human Services. Healthy People 2010. 2001.


Overweight

Physically inactive

Overstressed

Women With Disabilities Are More Likely to be

Source: U.S. Department of Health & Human Services. Healthy People 2010. 2001.


Pain

Depression

Anxiety

Sleep problems

Days of low vitality

Women with Disabilities Report More

Source:CDC. Morbidity and Mortality Weekly Report 47, no. 7 (1998):134-140.


Given preventive healthcare services (e.g., Pap test, breast exam, mammogram)1

Screened for tobacco and alcohol use2

Asked about sexual activity and need for contraception2

Women With Disabilities Are Less Likely to Be

1U.S. Department of Health & Human Services. Healthy People 2010. 2001.


All people with disabilities are in poor health Public health policy should focus only on preventing

disabling conditions Standard definitions of disability and people with

disabilities are not needed Environment plays no role in the disabling process

Major Misconceptions

Source: U.S. Department of Health & Human Services. Healthy People 2010. 2001.

Leading “Hidden” Causes of Disabilities in Women

Arthritis

Obesity

Chronic health conditions

Aging

Arthritis and Disabilities

Leading cause of disability in U.S.1

38% of people with arthritis restrict their daily activities2

By 2030, 67 million Americans will have arthritis3

1CDC. Morbidity and Mortality Weekly Report 50, no. 7 (1999):120-125.2CDC. Morbidity and Mortality Weekly Report 55, no. 40 (2006):1089-1092.3Hootman, J.M., and C.G. Helmick. Arthritis and Rheumatism 54, no. 1 (2006):226-229.

Obesity and Disabilities

Obese people are 2-4 times more likely to limit their daily activities1

17% of children and 32% of adults in U.S. are obese2

1Sturm, Roland, et al. Health Affairs 23, no. 2 (2004):199-205. 2Ogden, Cynthia I., et al. Journal of the American Medical Association 295, no. 13 (2006):1549-1555.

What Is a Disability?

Occurring at a personal level and is definedas any restriction or lack of ability (fromimpairment) to perform an activity in themanner or within the range considerednormal for a human being

World Health Organization. International Classification of Functioning, Disability and Health: ICF. 2001.

Disability Models

Medical Model

Individual problem

Directly caused by disease

Social Model

Does not reside in individual

Created by a non-accommodating environment

International Classification of Functioning, Disability and Health (ICF)*

*World Health Organization. International Classification of Functioning, Disability and Health: ICF. 2001.

A Person’s Functioning and Disability Is aDynamic Interaction Between

Health Conditions (diseases, disorders,

injuries, traumas, etc.)

Contextual Factors (environmental and personal)


Part 1: Functioning and Disability

Part 2: Contextual Factors

Components Body Functions and

Structures

Activities and Participation

Environmental Factors

Personal Factors

* World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization, 2001.

ICF Definitions

Body functionsPhysiological functions of body systems (including psychological functions)

Body structuresAnatomical parts of the body, such as organs, limbs and their components

ActivityExecution of a task or action by an individual

ParticipationInvolvement in a life situation

Source: World Health Organization. International Classification of Functioning, Disability and Health: ICF. 2001.

ICF Definitions

Environmental factorsThe physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person’s functioning.

Personal factors(Not classified)





Components Body Functions and Structures



Personal Factors

Domains Body functions;Body structures

Life areas (tasks, actions)

External influences on functioning and disability

Internal influences on functioning and disability

Constructs Change in body functions (physiological)

Change in body structures (anatomical)

Capacity: Executing tasks in a standard environment

Performance: Executing tasks in the current environment

Facilitating or hindering impact of features of the physical, social, and attitudinal world

Impact of attributes of the person


Activities and Participation (ICF)

Learning and Applying Knowledge

General Tasks and Demands

Communication

Mobility

Self Care

Domestic Life

Interpersonal Interactions and Relationships

Major Life Areas

Community, Social and Civic Life


Environmental Factors (ICF)

Products and Technology

Natural Environment and Human-Made Changes to Environment

Support and Relationships

Attitudes

Services, Systems and Policies





Components Body Functions and

Structures



Personal Factors

Positive Aspect

Functional and structural integrity

Activities; Participation

Facilitators Not applicable

Functioning

Negative Aspect

Impairment Activity limitation;

Participation restriction

Barriers/hindrances

Not applicable

Disability


ICF Definitions

Activity limitationsDifficulties an individual may have in executing activities

Participation restrictionsProblems an individual may experience in involvement in life situations


Who Will You Be Seeing?

46%have more than one disability



60% of disabled men are employed

51% of disabled women are employed



16.2%

10.7%

20.3%21.7% 21.8%

14.3%

21.9%

9.1%

18.0%19.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

White Black NativeAmerican

Asian Hispanic

Females Males

Source: Jans, L., & Stoddard, S. (1999). Chartbook on Women and Disability in the United States. An InfoUse Report. Washington, D.C.: U.S. National Institute on Disability and Rehabilitation Research.

Document source? I put it in the notes section.

Document source? I put it in the notes section.


Main Condition Causing Limitation

Number (in 1000s) %

Main Condition Causing Limitation

Number (In 1000s) %

All conditions 19.950 100.0 All conditions 17,783 100.0

1. Spine or back conditions 3,059 15.3 1. Spine or back conditions 2,829 15.9

2. Arthritis & allied disorders 2,660 13.3 2. Heart diseases 2,028 11.4

3. Heart diseases 1,943 9.7 3. Orthopedic impairment of lower extremity

1,086 6.1

4. Asthma 1,051 5.3 4. Arthritis & allied disorders

1,038 5.8

5. Orthopedic impairment of lower extremity

833 4.2 5. Asthma 964 5.4

6. Mental disorders 668 3.3 6. Learning disability & mental retardation

881 5.0

7. Diabetes 665 3.3 7. Mental disorders 825 4.68

8. Learning disability & mental retardation

507 2.5 8. Diabetes 524 2.9

Females Males

Source? I inserted in the note section.

Source? I inserted in the note section.


50% of women with activity limitations are currently married

64% of women with no activity limitations are currently married

44% of women with severe activity limitations are married

Source: Jans, L., and S. Stoddard. Chartbook on Women and Disability in the United States. 1999.

Major U.S. Disability Systems

Worker’s Compensation

Social Security

Disability Insurance

Federal Employees’ Compensation

Longshore and Harbor Workers’ Compensation Program

Railroad Workers and Seamen

Black Lung Benefits

Veteran’s Disability Programs

Source: Katz RT, Rondinelli RD. Major U.S. disability systems graphically compared. Phys Med Rehabil Clin N Am. 2001;12:499-505.

Disability Classifications

Age A Person Is Disabled if He/She Has…

5 Years …a sensory, physical, mental or self-care disability

16 Years …difficulty going outside the home

16-64 Years …an employment disability


Specific Disabilities

Age Specific Disability% of Total Population

≥ 5 years Sensory disability involving sight or hearing 3.6%

≥ 5 years Condition limiting basic physical activities, such as walking, climbing stairs, reaching, lifting or carrying

8.2%

≥ 5 years Physical, mental or emotional condition causing difficulty in learning, remembering or concentrating

4.8%

≥ 5 years Physical, mental or emotional condition causing difficulty in dressing, bathing or getting around the home

2.6%

≥ 16 years Condition that makes it difficult to go outside the home to shop or visit a doctor

8.6%

≥ 16 years Condition that affects ability to work at a job or business

11.9%


Percent of Males and Females in U.S. Population That Meet Disability Classifications

Age Males Females

5-15 Years 7% 4%

16-64 Years 20% 18%

≥65 Years 40% 43%


Questions for Healthcare Providers

Do you know how to safely assist with a transfer for a patient with mobility limitations?

Do you know how to use an alphabet board?

Would you know how to effectively use an interpreter?

Can you identify secondary conditions and define autonomic dysreflexia?

Is your practice accessible to women living with disabilities?

Do you have financial concerns regarding patients who require longer time to receive medical services?

Defining an Individual Woman’s Disability

Ask what accommodations she needs

Don’t assume she’s in poor health

Determine if her emotional distress is linked to environmental barriers

Discussion

Social Context

Discuss the societal stigmas and barriers related to gender and disability.

Identify healthcare providers’ biases and stereotyping of women with disabilities.

Discuss the impact of these stigmas, barriers and biases on health care and health outcomes for women with disabilities.

Discussion

Quality of Life

Discuss why healthcare providers need to understand that patients decide their own quality of life.

Discuss the difference between self-determination and independence.

Discussion

Cultural Competency

Discuss the impact of membership in concurrent cultural groups (ethnic, class, gender, sexual orientation) on the care offered and provided to women with disabilities.

Discuss the impact of membership in concurrent cultural groups on healthcare outcomes.

Discussion

Collaborative Care

Describe the importance of education for both healthcare providers and patients in maximizing informed choices.

Discuss the importance of healthcare providers and patients in partnering together.

Discussion

Professional Etiquette

Describe the principles of professional etiquette in interacting with women with disabilities

Summary: What’s Needed

Diverse, compassionate healthcare providers

Individualized, whole-person care

Accessible medical facilities

Best evidence-based practices

Empowerment of both patient and provider through knowledge

Learning Modules

Future ModulesHealth Care Provider Learning Modules Health and Wellness Reproductive Health Maximizing independence Associated medical conditions/Secondary Conditions Ethical and legal issues Making user-friendly practice changes (for all users-patients AND clinicians)

Patient Educational Outreach Modules: Reproductive Health Health and Wellness Maximizing independence Associated medical conditions/Secondary Conditions Ethical and legal issues Resources

Current modulesHealth Care Provider Learning Modules Introduction Communication

Bibliography

American Medical Association. Guides to the Evaluation of Permanent Impairment, 5th ed. Chicago: American Medical Association, 2001.

Centers for Disease Control and Prevention (CDC). “Health-related Quality of Life and Activity Limitation—Eight States, 1995.” Morbidity and Mortality Weekly Report 47, no. 7 (1998):134-140.

Centers for Disease Control and Prevention (CDC). “Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation—United States, 2003-2005.” Morbidity and Mortality Weekly Report 55, no. 40 (2006):1089-1092.

Centers for Disease Control and Prevention (CDC). “Prevalence of Disabilities and Associated Health Conditions Among Adults—United States, 1999.” Morbidity and Mortality Weekly Report 50, no. 7 (1999):120-125.

Hootman, J.M., and C.G. Helmick. “Projections of US Prevalence of Arthritis and Associated Activity Limitations. Arthritis and Rheumatism 54, no. 1 (2006):226-229.

Jans, L., and S. Stoddard. Chartbook on Women and Disability in the United States. An InfoUse Report. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research, 1999.

Bibliography

Mokdad, Ali H., Earl S. Ford, Barbara A. Bowman, William H. Dietz, Frank Vinicor, Virginia S. Bales, and James S. Marks. “Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors, 2001.” Journal of the American Medical Association 289, no.1 (2003):76-79.

Ogden, Cynthia I., Margaret D. Carroll, Lester R. Curtin, Margaret A. McDowell, Carolyn J. Tabak, and Katherine M. Flegal. Prevalence of Overweight and Obesity in the United States, 1999-2004.” Journal of the American Medical Association 295, no. 13 (2006):1549-1555.

Sturm, Roland, Jeanne S. Ringle, and Tatiana Andreyeva. “Increasing Obesity Rates and Disability Trends.” Health Affairs 23, no. 2 (2004):199-205.

U.S. Census Bureau. Disability Status: 2000: Census 2000 Brief, by Judith Waldrop and Sharon M. Stern. Washington, DC: Government Printing Office, 2003.

U.S. Department of Health & Human Services. Healthy People 2010. Washington, DC: U.S. Government Printing Office, 2001.

Zola, Irving K. "Disability Statistics, What We Count and What It Tells Us: A Personal and Political Analysis." Journal of Disability Policy Studies 4, no. 2 (1993): 9-39.

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