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Health & Disabilities

Addressing Disability in Local Public Health, Part 1

Funded by the Centers for Disease Control and Prevention

May 5, 2008

Health & Disabilities

Addressing Disability in Local Public Health, Part 1

Noelle Wiggins, MSPH

Manager, Community Capacitation Center

Multnomah County, OR

Barbara Garcia, MS, Ed.

Council Coordinator, Family Health Services Division

Alameda County Health Department, CA

Laura Morris, MPH

Community Health Coordinator

Central Connecticut Health District, CT

Alameda County Alameda County

Public Health DepartmentPublic Health Department

Developmental Disabilities Developmental Disabilities

Planning and Advisory CouncilPlanning and Advisory Council

Diabetes Prevention and Nutritional Diabetes Prevention and Nutritional Education ProgramEducation Program

NACCHO PRESENTATIONNACCHO PRESENTATION

Addressing Disabilities in Addressing Disabilities in

Local Public Health, Part 1Local Public Health, Part 1

May 5, 2008May 5, 2008

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Mission StatementMission Statement

The mission of the Developmental Disabilities Council is to advocate for the rights of people with developmental disabilities to be assisted in the fullest development of their mental, physical, and spiritual potentials, and the right to community living in the least restrictive environment.

History of the ACDDCHistory of the ACDDC

�� ACDDC began in 1960sACDDC began in 1960s

�� Started from a groundswell of parentsStarted from a groundswell of parents

�� Continues to be a forum for discussion and Continues to be a forum for discussion and advocacy on critical issues concerning the advocacy on critical issues concerning the welfare of people with developmental disabilities welfare of people with developmental disabilities and their familiesand their families

�� Council has a 30 member Board of Directors and Council has a 30 member Board of Directors and 800+ general members in community including 800+ general members in community including consumers, family members, providers and consumers, family members, providers and other interested members of the public.other interested members of the public.

ACDDC PurposesACDDC Purposes

�� Coordinate and plan for services Coordinate and plan for services

�� Identify gaps in servicesIdentify gaps in services

�� Provide a forum for discussion and Provide a forum for discussion and

advocacy on critical issuesadvocacy on critical issues

�� Advise and educate the communityAdvise and educate the community

�� Encourage efforts toward preventionEncourage efforts toward prevention

�� Assist and advises the Area BoardAssist and advises the Area Board

�� Advise Board of SupervisorsAdvise Board of Supervisors

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Collaborating with Our Partners for Collaborating with Our Partners for

Systems Health Care ChangeSystems Health Care Change

�� FamiliesFamilies

�� RCEB & designated RCEB & designated

agenciesagencies

�� Area Board 5Area Board 5

�� Contra Costa DDCContra Costa DDC

�� Adult Service Adult Service

Providers Providers

�� Other County Other County DepartmentsDepartments

�� Long Term CareLong Term Care

�� In Home SupportIn Home Support

�� Hospitals/Special Hospitals/Special Clinics/HMOsClinics/HMOs

�� LegislatorsLegislators

�� Generic ServicesGeneric Services

Unique State Entitlement:Unique State Entitlement:

CaliforniaCalifornia’’s Title 17s Title 17

�� Lanterman Act signed into legislation in 1969 Lanterman Act signed into legislation in 1969

entitles all persons meeting the eligibility entitles all persons meeting the eligibility

diagnosis of a developmental disability will be diagnosis of a developmental disability will be

served by Regional Centers throughout their served by Regional Centers throughout their

lifetime for services and supports to live and lifetime for services and supports to live and

thrive in their own communities.thrive in their own communities.

�� RC of the East Bay serves over 13,000 children RC of the East Bay serves over 13,000 children

and adults in Alameda County.and adults in Alameda County.

Social, cultural, environmental and Social, cultural, environmental and

developmental factors that result in developmental factors that result in

health disparities for persons with health disparities for persons with

intellectual disabilitiesintellectual disabilities

�� Limited access to health careLimited access to health care

�� Sedentary lifestyleSedentary lifestyle

�� Nutritional challengesNutritional challenges

�� Medical interactionsMedical interactions

�� Limited incomeLimited income

�� Patterns of agingPatterns of aging

�� Increased life expectancyIncreased life expectancy

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Previous ACDDC Previous ACDDC -- NACCHO projectNACCHO project

�� Adaptive Diabetes ProgramAdaptive Diabetes Program

�� OutcomesOutcomes……

aaAdapted Public Health curriculums to meet Adapted Public Health curriculums to meet

the needs of persons with developmental the needs of persons with developmental

disabilities & their caredisabilities & their care--providersproviders

aaIdentified 150 consumers with diabetes Identified 150 consumers with diabetes

aaTrained 45 consumers and 141 care providers Trained 45 consumers and 141 care providers

(including family members, case managers (including family members, case managers

and direct service staff)and direct service staff)

Diabetes & YouDiabetes & You

�� Our CurriculumOur Curriculum

�� What is diabetes?What is diabetes?

�� How to prevent it?How to prevent it?

�� Healthy eating, Healthy eating,

meal planning, meal planning,

snackssnacks

�� Guide to eating outGuide to eating out

�� Physical activities Physical activities

for you.for you.

Sustainable EffortsSustainable Efforts

�� AC Diabetes Program hired nutritionist used by AC Diabetes Program hired nutritionist used by

NACCHO project to specialize their staff for 20 NACCHO project to specialize their staff for 20

hrs./wk. hrs./wk.

�� State funded Regional Center used nutritionist State funded Regional Center used nutritionist

for their own trainings and also for their own trainings and also vendorizedvendorized her her

to conduct 1:1 nutritional consultation with to conduct 1:1 nutritional consultation with

consumersconsumers

�� Nutritionist also trained separate Nutrition Nutritionist also trained separate Nutrition

program on the nutritional issues of persons program on the nutritional issues of persons

with developmental disabilitieswith developmental disabilities

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Continuing ConcernsContinuing Concerns

�� Obesity and other prevalent social, Obesity and other prevalent social, environmental, cultural, developmental environmental, cultural, developmental and behavioral concerns observed in first and behavioral concerns observed in first project indicated that there were many project indicated that there were many consumers who would still be at risk for consumers who would still be at risk for diabetesdiabetes

�� More staff awareness was needed. More staff awareness was needed. Program accomplishments were widely Program accomplishments were widely acclaimed and more providers requested acclaimed and more providers requested training.training.

Other ConcernsOther Concerns

�� Adult consumers Adult consumers

and young adults and young adults

tend to rely heavily tend to rely heavily

on fast food on fast food

venues and need venues and need

to be able to make to be able to make

healthy choices in healthy choices in

those settingsthose settings

�� PicturePicture

New NACCHO ProjectNew NACCHO Project

DPNEP ObjectivesDPNEP Objectives

�� To actively participate in the Peer To actively participate in the Peer Assistance Network by sharing informationAssistance Network by sharing information

�� To actively participate in the NACCHO To actively participate in the NACCHO Demonstration Work Group MeetingDemonstration Work Group Meeting

�� To conduct activities to attempt to To conduct activities to attempt to mitigate the impact of Diabetes and mitigate the impact of Diabetes and promote its prevention among individuals promote its prevention among individuals with developmental disabilities residing in with developmental disabilities residing in Alameda CountyAlameda County

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DPNEP ACTIVITESDPNEP ACTIVITES

Modify existing Adaptive Diabetes Modify existing Adaptive Diabetes

curriculum to address diabetes preventioncurriculum to address diabetes prevention

By May 1, 2008 trained 71 consumersBy May 1, 2008 trained 71 consumers

�� Most were consumers who live independently Most were consumers who live independently

or were participants in day programsor were participants in day programs

By May 1, 2008 trained 73 staff/parentsBy May 1, 2008 trained 73 staff/parents

�� Included residential and day program staff, Included residential and day program staff,

ILS instructors, case managers & teachersILS instructors, case managers & teachers

Other OutcomesOther Outcomes

�� Pre/Post test for direct care staff Pre/Post test for direct care staff –– 100 % 100 % improvement in awareness of 20 essential improvement in awareness of 20 essential issues regarding diabetes and the issues regarding diabetes and the prevention of diabetesprevention of diabetes

�� Hands on activities for consumers Hands on activities for consumers indicated their ability to make healthier indicated their ability to make healthier choices in their eating habits and other choices in their eating habits and other healthy lifestyle changes.healthy lifestyle changes.

�� Compounded the overall effect of nutrition Compounded the overall effect of nutrition awareness training by training both awareness training by training both consumers and care providersconsumers and care providers

Other Training PropsOther Training Props

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Internship ProgramInternship Program

�� Offered an Internship to a Holistic Health Offered an Internship to a Holistic Health

graduate student from nearby JFK graduate student from nearby JFK

UniversityUniversity

�� With consultation from nutritionist and With consultation from nutritionist and

others, she designed a others, she designed a Fast and Easy Fast and Easy Pocket Guide to Eating Fast Food! Pocket Guide to Eating Fast Food!

�� She also hopes to get some classroom She also hopes to get some classroom

experience with guidance from Nutritionistexperience with guidance from Nutritionist

Fast and Easy Pocket GuideFast and Easy Pocket Guide

OtherOther

�� Plans to meet with Jefferson County (WA) Plans to meet with Jefferson County (WA)

Health Department to share projectHealth Department to share project

�� Trained WIC (Women, Infants and Trained WIC (Women, Infants and

Children Program) Staff regarding Children Program) Staff regarding

nutritional concerns of children and nutritional concerns of children and

women with disabilitieswomen with disabilities

�� Providing monthly newsletter on diabetes Providing monthly newsletter on diabetes

and other nutritional updates to and other nutritional updates to

consumers living independentlyconsumers living independently

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Developmental Disabilities Developmental Disabilities

Planning and Advisory CouncilPlanning and Advisory Council

�� Family Health Services Division Family Health Services Division

�� Council Coordinator Council Coordinator –– Barbara Garcia, MS, Ed. Barbara Garcia, MS, Ed. barbara.garcia@acgov.orgbarbara.garcia@acgov.org

�� Rajinder Singh, MS RD Rajinder Singh, MS RD –– Project Coordinator, Project Coordinator, NutritionistNutritionist

Alameda County Public Health Dept. Alameda County Public Health Dept. www.acphd.orgwww.acphd.org

1000 Broadway, Suite 500, Oakland, CA 946071000 Broadway, Suite 500, Oakland, CA 94607

(510) 267(510) 267--3261 FAX (510) 2733261 FAX (510) 273--3892 3892 ddcinfo@co.alameda.ca.usddcinfo@co.alameda.ca.us

ABLE TO BE HEALTHYABLE TO BE HEALTHY

Presented byPresented by

Laura J. Morris, MPHLaura J. Morris, MPH

Community Health CoordinatorCommunity Health Coordinator

Central Connecticut Health DistrictCentral Connecticut Health District

ABLE TO BE HEALTHYABLE TO BE HEALTHY

�� About CCHDAbout CCHD

�� Phase I Phase I –– Advisory CommitteeAdvisory Committee

�� Phase II Phase II –– Assess BarriersAssess Barriers

�� Phase III Phase III –– Facility AssessmentFacility Assessment

�� Phase IV Phase IV –– Able to be Healthy GuideAble to be Healthy Guide

�� Lessons LearnedLessons Learned

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Central CT Health DistrictCentral CT Health District

State of Connecticut

Central CT Health District TownsCentral CT Health District Towns

$53,289$53,28993.2% Caucasian93.2% Caucasian

4.2% Hispanic/Latino4.2% Hispanic/Latino

2.1% Black/African 2.1% Black/African AmericanAmerican

26,27626,276

SuburbanSuburbanWethersfieldWethersfield

$60,247$60,24790.2% Caucasian90.2% Caucasian

4% Asian4% Asian

3.4% Black/African 3.4% Black/African AmericanAmerican

17,966 17,966

Suburban/Suburban/

RuralRural

Rocky HillRocky Hill

$57,188$57,18892% Caucasian92% Caucasian

3.7% Hispanic/Latino3.7% Hispanic/Latino

2.8% Asian2.8% Asian

29,30629,306

SuburbanSuburbanNewingtonNewington

$63,068$63,06897% Caucasian97% Caucasian18,26618,266

Suburban/RuraSuburban/Rurall

BerlinBerlin

Median Household Median Household IncomeIncome

% Ethnicity% EthnicityPopulationPopulation

Source: 2000 U.S. Census Data

Disability Statistics in the CCHDDisability Statistics in the CCHD

31.1%31.1%17.8%17.8%WethersfieldWethersfield

35.7%35.7%15.2%15.2%Rocky HillRocky Hill

33.3%33.3%14.1%14.1%NewingtonNewington

41.5%41.5%19%19%BerlinBerlin

% of individuals % of individuals 65 and older 65 and older with disabilitywith disability

% of individuals % of individuals 21 and older 21 and older with disabilitywith disability

Source: 2000 U.S. Census Data

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Advisory CommitteeAdvisory Committee

�� An Advisory Committee developed An Advisory Committee developed

�� Representatives from each of the four Representatives from each of the four towns in the Central CT Health Districttowns in the Central CT Health District

�� One member from each town had a One member from each town had a physical or sensory impairmentphysical or sensory impairment

BARRIERS SURVEYBARRIERS SURVEY

�� Conducted a survey of individuals with Conducted a survey of individuals with disabilities on their perceived barriers they disabilities on their perceived barriers they experience with regard to health promotion experience with regard to health promotion and disease preventionand disease prevention

�� Mailings, personMailings, person--toto--person, phone calls, person, phone calls, websitewebsite

�� Survey was modeled after the University of Survey was modeled after the University of MontanaMontana’’s Rural Institutes Rural Institute’’s s ““Disability and Disability and Health Perceived Barriers QuestionnaireHealth Perceived Barriers Questionnaire””

BARRIERS SURVEYBARRIERS SURVEY

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BARRIER SURVEY RESULTSBARRIER SURVEY RESULTS

�� 43% of respondents indicated that it would take too long 43% of respondents indicated that it would take too long to get to an eventto get to an event

�� 36% of respondents indicated that they have trouble 36% of respondents indicated that they have trouble hearing what people sayhearing what people say

�� 29% of respondents indicated that inclement weather is 29% of respondents indicated that inclement weather is somewhat of a problemsomewhat of a problem

�� 29% of respondents indicated that not having assistive 29% of respondents indicated that not having assistive equipment was problemequipment was problem

�� 29% of respondents indicated that their neighborhood 29% of respondents indicated that their neighborhood has too few curb cutshas too few curb cuts

�� 29% of respondents indicated that they tire easily29% of respondents indicated that they tire easily�� 28% of respondents indicated that they do not have 28% of respondents indicated that they do not have

accessible transportationaccessible transportation

BARRIERS SURVEY RESULTSBARRIERS SURVEY RESULTS

�� 21% of respondents indicated that their 21% of respondents indicated that their disability limits them to muchdisability limits them to much

�� 21% of respondents indicated that not 21% of respondents indicated that not having someone to help them is a big having someone to help them is a big problemproblem

�� 14% of respondents indicated that they 14% of respondents indicated that they have pain when they do too muchhave pain when they do too much

FITNESS FACILITY FITNESS FACILITY ASSESSMENTSASSESSMENTS

�� Assess local area fitness facilities for ways Assess local area fitness facilities for ways to remove barriersto remove barriers

�� Assessment was modeled using North Assessment was modeled using North Carolina Office on Disability and HealthCarolina Office on Disability and Health’’s s ““Removing Barriers to Health Clubs and Removing Barriers to Health Clubs and Fitness FacilitiesFitness Facilities””

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FITNESS FACILITYFITNESS FACILITYASSESSMENTASSESSMENT

�� Parking and EntranceParking and Entrance•• Van AccessibleVan Accessible•• Easy Front Entrance ParkingEasy Front Entrance Parking•• Smooth TransitionSmooth Transition•• Easy Passenger Load ZonesEasy Passenger Load Zones•• Power Door OpenersPower Door Openers•• Wide DoorsWide Doors

�� Interior AccessInterior Access•• National Telephone Relay SystemNational Telephone Relay System•• TTY TelephoneTTY Telephone•• Wide corridorsWide corridors•• 5 feet diameter turn space5 feet diameter turn space•• Braille SignsBraille Signs•• Low CountersLow Counters

�� ShowersShowers•• 3 x 3 transfer shower3 x 3 transfer shower•• No Curb ShowerNo Curb Shower•• Shower Seat Fold UpShower Seat Fold Up•• Faucets AccessibleFaucets Accessible•• HandrailHandrail

�� BathroomsBathrooms•• 3636”” Wide StallWide Stall•• Enlarged Standard StallEnlarged Standard Stall•• Lavatory 34Lavatory 34”” above groundabove ground•• Lever faucet handlesLever faucet handles•• Mirror 40Mirror 40”” above groundabove ground•• Soap dispenser accessibleSoap dispenser accessible

FITNESSFITNESS FACILITIY FACILITIY ASSESSMENTASSESSMENT

�� WeightsWeights•• Moveable SeatsMoveable Seats•• Accessible RouteAccessible Route•• Turning SpaceTurning Space•• Pins Within ReachPins Within Reach•• Adjustable Seat HeightAdjustable Seat Height•• Turning Space in RouteTurning Space in Route

�� Cardio EquipmentCardio Equipment•• Standing and Sitting EquipmentStanding and Sitting Equipment•• Turning SpaceTurning Space•• Accessible RoutesAccessible Routes•• 6060”” Diameter Turning SpaceDiameter Turning Space•• Clear Floor Space to Leave Clear Floor Space to Leave

WalkersWalkers

�� PoolsPools•• Sloped EntrySloped Entry•• Entry Stairs/HandrailsEntry Stairs/Handrails•• Pool LiftPool Lift•• Clear Floor SpaceClear Floor Space•• Seat 18Seat 18”” min. submergedmin. submerged•• Lift Independent OperationLift Independent Operation•• Transfer WallTransfer Wall•• Wheelchair ParkingWheelchair Parking•• Transfer Wall SystemTransfer Wall System•• Clear Floor SpaceClear Floor Space

FACILITY ASSESSMENTFACILITY ASSESSMENTKEY FINDINGSKEY FINDINGS

�� 17 Fitness Facilities Assessed17 Fitness Facilities Assessed�� 5 use National Telephone Relay Systems5 use National Telephone Relay Systems�� 5 have TTY available5 have TTY available�� 10 10 –– No power doorsNo power doors�� 10 10 –– No Van accessibleNo Van accessible�� 9 do not have Braille on signs9 do not have Braille on signs�� 8 do not have low counters8 do not have low counters�� 5 do not have 365 do not have 36”” wide stalls in bathroomswide stalls in bathrooms�� 6 do not have 3 x 3 transfer shower, no curb shower, 6 do not have 3 x 3 transfer shower, no curb shower,

no accessible faucets in bathroomsno accessible faucets in bathrooms�� 12 do not have shower seat fold up in bathrooms12 do not have shower seat fold up in bathrooms�� 12 do not have handrails in bathroom12 do not have handrails in bathroom

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FITNESS ASSESSMENT FITNESS ASSESSMENT KEY FINDINGSKEY FINDINGS

�� Only one facility has a pool which has a sloped Only one facility has a pool which has a sloped entry and handrails only entry and handrails only

�� 16 had standing and sitting cardio equipment, 16 had standing and sitting cardio equipment, turning space, accessible routes, clear floor turning space, accessible routes, clear floor space to leave walkers, 60space to leave walkers, 60”” diameter turning diameter turning spacespace

�� 15 had moveable sets, accessible routes, 15 had moveable sets, accessible routes, turning space, pins within reach, adjustable seat turning space, pins within reach, adjustable seat height and turning space in routes for strength height and turning space in routes for strength trainingtraining

ABLE TO BE HEALTY GUIDEABLE TO BE HEALTY GUIDE

�� Develop, design and distribute Develop, design and distribute Guide to residents of Berlin, Newington, Guide to residents of Berlin, Newington, Rocky Hill and WethersfieldRocky Hill and Wethersfield

�� Guide includes Guide includes �� National, State and Local Fitness resourceNational, State and Local Fitness resource�� Adaptive Resource LitAdaptive Resource Lit�� Healthy recipes and shopping listsHealthy recipes and shopping lists�� Ways to reduce secondary health conditionsWays to reduce secondary health conditions

�� Focus Groups to review GuideFocus Groups to review Guide

ABLE TO BE HEALTHY GUIDEABLE TO BE HEALTHY GUIDE

Able to Be Healthy Guide Able to Be Healthy Guide

Central CT Health District website: Central CT Health District website:

http://http://www.ccthd.orgwww.ccthd.org//

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Lessons LearnedLessons Learned�� Lack of transportation to Advisory Committee Meetings Lack of transportation to Advisory Committee Meetings ––

no transportation between townsno transportation between towns�� Community Health Workers Community Health Workers –– Hire local disabled Hire local disabled

individuals to work on project individuals to work on project –– transportation issuestransportation issues�� Focus Groups were held at different living facilities in Focus Groups were held at different living facilities in

CCHD due to transportation issuesCCHD due to transportation issues�� Transportation provided for specific spots only and Transportation provided for specific spots only and

medical appointments in certain townsmedical appointments in certain towns�� Transportation will be provided to certain area fitness Transportation will be provided to certain area fitness

facilitiesfacilities�� However, monthly cost for membership is expensive and However, monthly cost for membership is expensive and

most do not offer sliding scale feesmost do not offer sliding scale fees

Thank YouThank You

Laura J. Morris, MPHLaura J. Morris, MPHCommunity Health CoordinatorCommunity Health Coordinator

Central Connecticut Health DistrictCentral Connecticut Health District505 Silas Deane Highway505 Silas Deane HighwayWethersfield, CT 06109Wethersfield, CT 06109

860860--665665--85718571lmorris@newingtonct.govlmorris@newingtonct.gov

www.ccthd.orgwww.ccthd.org

Question and Answer Period

� Web: Type your question into the box in the lower

right corner of the window and click on the “Send”

button right below the box.

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Thank you!

Archived webcast materials will be available at

http://webcasts.naccho.org