Introduction to Disabilities and Disability-Competent Care · Introduction to Disabilities and...

https://www.ResourcesForIntegratedCare.com

Wednesday February 8th, 2017

Introduction to Disabilities and Disability-Competent Care

DCC Pillars Webinar Series

https://www.ResourcesForIntegratedCare.com2

Download content here

Type questions here


Introductions

Christopher Duff Disability Practice and Policy Consultant

3


Disability-Competent Care Webinar Series Overview

The Lewin Group, under contract with the CMS Medicare-Medicaid Coordination Office, partnered with Christopher Duff and other disability practice experts to create the Disability-Competent Care Webinar Series. This is the first session of the seven-part series.

Each session will be interactive, with 40 minutes of presenter-led discussion, followed by a 20 minute presenter/participant question and answer session

Video replay and slide presentation are available after each session at:

https://www.ResourcesForIntegratedCare.com/

4

https://www.resourcesforintegratedcare.com/


DCC Pillars Webinar Series

1. Understanding the DCC Model

2. Participant Engagement

3. Access

4. Primary Care

5. Care Coordination

6. Long Term Services and Supports

7. Behavioral Health

5


Agenda

1. Defining disability Understanding people with disabilities Focusing on function and barriers to care Disability types Demographics and health disparities

2. Disability-Competent Care (DCC) What is DCC? The DCC model Applying DCC

6


DEFINING DISABILITY

Disability is the complex interaction between a person with an impairment or limitation and his or her environment.

7


Knowing Those You Are Serving

Persons living with disabilities are a diverse group varying in different characteristics including, but not limited to: age; gender; gender identity; race; ethnicity; socioeconomic status; sexual orientation; and type of functional limitation.

Disability-Competent Care requires that providers of health care understand their consumers:

Experience of being disabled

Disability itself (clinically)

Functional limitations due to the disability

8


Focus on Function Limitation

Functional status identifies the impact of the disability whereas a diagnosis identifies the cause or source of an individuals disability.

Functional limitations impact a persons ability to perform activities of daily living (ADLs) or instrumental activities of daily living (IADLs)

ADLs include self-care tasks (e.g., feeding, bathing, and dressing)

IADLs include tasks that enable an individual to live independently in a community (e.g., using a telephone or communication device, homemaking, shopping, and managing finances)

Medical diagnoses and clinical response may not identify if a person has limitations as a result of the disability or the ability to compensate for those limitations

9


Disability Types

Common clinical categories of disability include: Physical (e.g., spinal cord injury, multiple sclerosis); Intellectual or Developmental (ID / DD) (e.g., autism, cerebral palsy); Sensory (e.g., vision, hearing); and Behavioral (e.g., schizophrenia, major depression, chemical

dependency)

Acquiring a disability Persons born with (congenital) or who acquire a disability in early life Persons who acquire a disability later in life

Individuals rarely fit into one category and there is often overlap as individuals may have multiple categories of disability.

10


Age Related Disabilities

As we age, most everyone experiences some decline in function and independence

Examples include: Loss of hearing acuity Decline of vision Memory or other cognitive capabilities Increased anxiety or depression due to loss of independence

While these are not commonly viewed as disabilities, and generally occur in an elderly population, they are certainly experienced as functional limitations

11


Visible vs. Invisible Disabilities

Visible: Disabilities that are readily evident to an observer Examples include individuals with:

Paralysis

Wheelchair users

Invisible: Disabilities that are not as readily evident Examples include individuals with:

Hearing or vision loss

Diabetes

Arthritis

12


Demographics of Individuals with Long-Term Disabilities

Fourteen percent1 of adults in the U.S. live with a disabling condition resulting in a complex activity limitation.

These individuals are: More likely to live in poverty and experience hardships

Disproportionately represented in racial and ethnic minority groups

Growing in numbers as the population ages

13

Source: Health, United States 2015, table 42 http://www.cdc.gov/nchs/data/hus/hus15.pdf#042


Health Disparities

People with disabilities are more likely to: Experience worse outcomes and are less likely to receive the

recommended care1

Experience difficulties or delays in receiving the necessary health care

Not have had recommended health screening tests (e.g., breast cancer, colorectal cancer and diabetes)2

Not receive comprehensive preventive care (e.g., BMI assessment, medication adherence and annual flu vaccine)

Not have had an annual dental visit

Limited knowledge and access to sexual health information

Have high blood pressure

14

Sources: 1) Office of the Assistant Secretary for Planning and Evaluation, Report to Congress: Social Risk Factors and Performance under Medicares Value Based Purchasing Programs, December 20162) Healthy People 2020 website http://www.healthypeople.gov/2020/topicsobjectives2020/nationalsnapshot.aspx?topicId=9


Social Factors

Payers, including Medicare and Medicaid, are moving from traditional fee-for-service payment toward models that reward value over volume.

Disability status and dual eligibility for Medicare and Medicaid are often associated with poorer performance on measures that are linked to payment in value-based purchasing programs.

On many measures of focus (e.g., cancer screenings, vaccinations, diabetes management), the clinical interventions are straightforward but communications and service delivery for people with disabilities stretch the disability competence of most providers.

For some providers, improving outcomes for people with disabilities will have a direct impact on revenue.

Source: National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for social risk factors in Medicare Payment, Washington, DC: The National Academies Press. doi: 10.1722

15


Disability-Related Biases

It is important to be aware of disability-related beliefs, biases, prejudices, stereotypes, and fears, and understand: Where they come from

How they can affect your ability to work effectively with people with disabilities

How to address them, so they dont interfere with your ability to provide effective care

Disability-related biases can often inhibit listening to and learning from the participant. This may also result in adverse health outcomes.

16


First Person Story

Jim LeBrecht was born with Spina Bifida. He grew up outside of New York City and went to college in Southern California. Jim moved to the east bay of Northern California to take a job with the Berkeley Repertory Theater as a sound engineer. He has recently opened his own business serving the film industry.

17

Double Click

http://dredf.org/healthcare-stories/2012/06/24/carol-gill-and-larry-voss/


Current Challenges in Health Care Delivery

Care is commonly: Reactive & proscriptive

Fragmented (provided by multiple specialists without primary care coordination)

Inaccessible

Standardized / uniform

Resulting in: Avoidable costs, both human and financial

Misaligned incentives, leading to increasing costs

Ineffective or nonexistent primary care

18


DISABILITY-COMPETENT CARE (DCC)

A model of care designed to treat the individual, not just his or her diagnosis or condition.

19


What is DCC?

Disability-Competent Care is: A participant-centered model, delivered by an interdisciplinary care

team (IDT) that focuses on achieving and supporting maximum function.

Intended to maintain health, wellness, and life in the community as the participant chooses.

A model that recognizes and treats each individual as a whole person, not a diagnosis or condition.

Structured to respond to the participants physical and clinical needs while considering his or her emotional, social, intellectual, and spiritual needs.

20


A Shift in Attitude: Medical Model vs. DCC Model

21

Context Medical (Traditional) ModelDCC (Person-Centered)

ModelDefinition of Problem Physical or mental impairment

Dependency; attitudes and environments need fixing

Locus of Problem The individual The environment

Solution to the Problem

Fix the person through professional intervention

Barrier removalConsumer control over options and services

Perception of Person with a Disability

Individual is a patient or client Individual is consumer, participant, user of the service

Who Controls Professional Consumer or participant


First Person Story

Karen Schneiderman was also born with Spina Bifida. She went to college on the West Coast and returned to Boston where she works as the Director of Advocacy at the Boston Center for Independent Living.

22

Double Click

http://dredf.org/healthcare-stories/2014/02/05/barriers%E2%80%8E-solutions/


Development of the DCC Model of Care

23

The DCC model of care evolved from a few pioneering programs initiated in the late 1990s Pioneering programs revised their model over the next decade

Components of the revised model and approach were adopted more broadly by health plans and health systems

The model has evolved into well-known and recognized best practices

The DCC Self-Assessment Tool was introduced in 2013, by a small group of the pioneering organizations, with input from subject matter experts and field tested by several health plans. Currently it is being revised to reflect the experience of the last several

years, and the further evolution of practices

You can access the current version of the Tool online at:




The DCC Model

The DCC Model is comprised of three core values and imbedded in seven pillars of disability competency.

24

Core Values

1. Participant-centered Participants choices, preferences, and goals provide

a foundation for his or her individualized plan of care.

2. Respect for participant choice and dignity of risk Inherent in participant-centered planning of care

goals and needs is the concept of the dignity of risk, which honors and respects the participants choices even if they are inconsistent with healthcare recommendations.

3. Elimination of medical and institutional bias Medical and institutional bias often impedes

providers from addressing the whole individual, including his or her unique abilities, limitations, and preferences for social and community participation.


The DCC Model (continued)The DCC Model is comprised of seven pillars of disability competency.

25

Par

ticip

ant

Eng

agem

ent

Acc

ess

Und

erst

andi

ng th

e D

CC

Mod

el

Car

e C

oord

inat

ion

Prim

ary

Car

e

Long

-Ter

m S

ervi

ces

and

Sup

ports

Beh

avio

ral H

ealth

A model of care designed to treat the whole person, beyond the diagnosis or condition

Disability-Competent Care


DCC Practice Model Component: Introduction to Disability-Competent Care and Disabilities

1. Implementing DCC requires an understanding of disabilities and understanding persons with disabilities Understand the population you are serving Focus on functional limitations Understand how to effectively communicate Define disabilities Identify and address barriers to accessing care

26


DCC Practice Model Component: Participant Engagement

2. Participant Engagement is a key element of providing disability-competent care as the model revolves around person-centered care Build trust with participants Develop a plan to address the participants needs and wants Understand how to effectively communicate Leverage an interdisciplinary care team

27


DCC Practice Model Component: Access

3. Participants must have sufficient access to health care services. This involves developing competency to address barriers in several key areas: Attitude Physical Equipment Communication Service Programmatic

28


DCC Practice Model Component:Primary Care

4. Responsive Primary Care is the practice of providing timely access to care and services in a variety of settings Enhanced primary care with home-based episodic care capacity 24/7 access Partner with the interdisciplinary care team Focus on early intervention Inpatient care management, transition planning, and follow-up Accessible physical facilities and adaptive equipment Flexible scheduling

29


DCC Practice Model Component: Care Coordination

5. Relational Care Coordination is a practice that recognizes the recipient is the primary source of defining care goals and needs Informed decision-making Team-based care Comprehensive, timely assessment and reassessment Personalize plans of care Manage transitions with clear communication and accountability

30


DCC Practice Model Components:Long-Term Services and Supports

6. Flexibility in providing long-term services and supports that enable participants to continue residing in their community Ensure participant choice Participant-directed personal care services Equipment purchasing, fitting, seating, training, and maintenance

clinics Enhance participant independence via medically or functionally

necessary equipment and technology Allow flexibility to use alternatives to traditional home-based supports

31


DCC Practice Model Component: Behavioral Health

7. Disability-competent care involves identifying and addressing behavioral health needs as an integral receive appropriate and coordinated care Behavioral health includes mental health and substance abuse Recognize mental health issues and understanding their impact on

functional capacity Understand the difference between chemical dependence and

substance abuse Implement recovery learning

32


CONCLUSION

Understanding the DCC model and the disabilities experienced by your population is the first of seven pillars in achieving disability

competency.

33


Key Takeaways

The DCC Model is designed to treat the individual, not just a diagnosis or condition. This model is participant-centered, respects the dignity of risk, and eliminates medical and institutional bias.

To effectively implement the DCC Model, providers must be familiar with the different types of disabilities and understand the population being served.

Becoming proficient in understanding the experiences of individuals with disabilities, and the barriers they commonly experience is the first of seven pillars needed to successfully implement the DCC Model.

34


AUDIENCE QUESTIONS & DISCUSSION

35


Send Us Your Feedback

Help us diversify our series content and address current Disability-Competent Care training needs your input is essential!

Please contact us with your suggestions [email protected]

What Wed Like from You: How best to target future Disability-Competent Care webinars to

health care providers and plans involved in all levels of the health care delivery process

Feedback on these topics as well as ideas for other topics to explore in webinars and additional resources related to Disability-Competent Care

36

mailto:[email protected]


Disability-Competent Care Self-Assessment Tool

Disability-Competent Care Self-Assessment Tool available online at: https://www.ResourcesForIntegratedCare.com/

37



Next Webinar

Disability-Competent Care Webinar Series

Disability-Competent Participant Engagement

Wednesday February 15th, 20172:00-3:00PM EST

38


Thank You for Attending!

For more information contact:

[email protected]

Kerry Branick at [email protected]

Gretchen Nye at [email protected]

Christopher Duff at [email protected]

Further information, including webinar resources, are available at:

https://www.resourcesforintegratedcare.com

39

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.resourcesforintegratedcare.com/

Wednesday February 8th, 2017Introduction to Disabilities and Disability-Competent CareDCC Pillars Webinar SeriesIntroductionsDisability-Competent Care Webinar Series OverviewDCC Pillars Webinar SeriesAgendaDefining disabilityKnowing Those You Are ServingFocus on Function LimitationDisability TypesAge Related DisabilitiesVisible vs. Invisible DisabilitiesDemographics of Individuals with Long-Term DisabilitiesHealth DisparitiesSocial FactorsDisability-Related BiasesFirst Person StoryCurrent Challenges in Health Care DeliveryDisability-Competent Care (DCC)What is DCC?A Shift in Attitude: Medical Model vs. DCC ModelFirst Person StoryDevelopment of the DCC Model of CareThe DCC ModelThe DCC Model (continued)DCC Practice Model Component: Introduction to Disability-Competent Care and DisabilitiesDCC Practice Model Component: Participant EngagementDCC Practice Model Component: AccessDCC Practice Model Component: Primary CareDCC Practice Model Component: Care CoordinationDCC Practice Model Components: Long-Term Services and SupportsDCC Practice Model Component: Behavioral HealthConclusionKey TakeawaysAudience questions & discussionSend Us Your FeedbackDisability-Competent Care Self-Assessment ToolNext WebinarThank You for Attending!

Introduction to Disabilities and Disability-Competent Care · Introduction to Disabilities and...

Documents

Transcript of Introduction to Disabilities and Disability-Competent Care · Introduction to Disabilities and...