AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE ANY REAL OR - - PowerPoint PPT Presentation

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AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE ANY REAL OR - - PowerPoint PPT Presentation

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AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE ANY REAL OR APPARENT CONFLICT RELATED TO THE CONTENT OF THEIR PRESENTATION THIS SPEAKER HAS NO DISCLOSURE TO MAKE AMA The University of Mississippi School of Medicine is accredited by the

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AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE ANY REAL OR APPARENT CONFLICT RELATED TO THE CONTENT OF THEIR PRESENTATION

THIS SPEAKER HAS NO DISCLOSURE TO MAKE

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AMA The University of Mississippi School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The University of Mississippi School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Mississippi Medical Center Division of Continuing Health Professional Education will award a maximum of 1.0 contact hour(s) to all participants who complete this activity. Pharmacy ACPE The University of Mississippi School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This seminar has been approved for 1 contact hours (0.1 CEU) by the University of Mississippi School of Pharmacy, Division of Pharmacy Professional Development. ACPE number: 0032-9999-15-053-L01-P

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Disability Inclusion: Getting to Know & Interact with People with Disabilities

Mina Li, MD., PhD., MS., CSM Institute for Disability Studies The University of Southern Mississippi May 16, 2017

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Institute for Disability Studies (IDS)

  • Mississippi’s University Centers

for Excellence in Developmental Disabilities, Research, Education and Service. (UCEDD)

  • One of the national network of

67 UCEDDs—provides preservice preparation, education, community services, research, and information dissemination.

  • Core funding agency—AIDD, US

DHH

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Objectives

  • Define Disability and Disability Inclusion
  • Overview Mississippi Health Disparity—

Disability Statistics

  • Summarize the guideline of interacting

with People with Disabilities—Disability Etiquette

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How long can an average person concentrate?

  • A. ~5 Minutes
  • B. ~15 Minutes
  • C. ~30 Minutes
  • D. ~50 Minutes
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Disability Definition

  • The ADA defines a person with a disability

as a person who has a physical or mental impairment that substantially limits one or more major life activities.

  • Different definitions (Dictionary, Social

Security Administration, CDC, WHO...)

  • Another View of Disability

“Disability is a universal experience that affects nearly everyone without exception at sometime in their lives.”

Kirschner, K. & Curry, R. (2009). Educating health care professionals to care for patients with Disabilities. JAMA, 302(12), 1334-1335

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Prevalence of Disability in MS

12.5% 16.2% 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% US MS US Census Bureau, 2015 BRFSS, 2014 22.5% 30.7% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% US MS

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0.8% 5.3% 10.2% 36.3% 0.7% 6.1% 15.0% 45.1% Under 5 Years 5~17 Years 18~64 Years 65 Years & Over 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

2014 US Census Bureau

US-MS Disability Age Distribution

US MS

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Disability Types among MS Adults

(BRFSS 2014)

22.5 % 30.7 % Any Disability US Mississippi 13.1% 10.8% 6.6% 4.7% 3.6% 18.2% 16.2% 9.6% 7.6% 5.0% US Mississippi

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Characteristics of Disabilities

Disabilities vary in...

Severity Type Visibility

Mild Physical disability Not at all visible to

  • thers

Moderate Sensory disability Visible to informed

  • thers

Severe Psychiatric mental Health disability Visible to all Very Severe Cognitive/intellectual disability Communication disability

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Challenges/Disadvantages for People with Disabilities

  • Difficulty obtaining health care and

preventive screening

  • Higher incidence of health disparities than

those without disabilities

  • Increased risk of secondary conditions
  • Negative experience with health care

providers

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MS Disability and Health Disparity— Health Risks & Behaviors

26.3% 41.3% 35.7% 61.9% 43.5% 32.3% 19.4% 48.8%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% 55.0% 60.0% 65.0%

Physical Activity Obesity Smoking Attempting to Quit Smoking PWD PWOD

Source: CDC BRFSS 2014

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MS Disability and Health Disparity— Prevention and Screenings

54.3% 61.5% 55.6% 76.0% 68.4% 44.2% 31.5% 75.7% 76.2% 62.0% 86.7% 72.9% 62.8% 36.8%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Clinical Breast Exam Mammogram Colorectal Cancer Scr Pap Test Routine Check-Up Dentist Visit Flu Vaccine

PWD PWOD

Source: CDC BRFSS 2014

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MS Disability and Health Disparity— Barriers and Costs of Health Care

37.9% 74.1% 12.7% 82.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Could not See a Doctor Due to Cost Have Health Care Coverage

PWD PWOD

Source: CDC BRFSS 2014

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MS Disability and Health Disparity— General Health Conditions

44.1% 45.4% 10.8% 51.0% 53.1% 40.9% 18.4% 9.7% 5.1% 32.4% 31.9% 64.9%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

Fallen Fair or Poor Health Heart Disease High Blood Pressure High Cholesterol Gets 7-9 Hr. Sleep

PWD PWOD

Source: CDC BRFSS 2014

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MS Disability and Health Disparity— Chronic Conditions

48.2% 14.9% 9.8% 17.4% 17.2% 8.9% 17.3% 4.3% 4.4% 2.7% 9.4% 2.3%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

Arthritis Asthma Cancer (excluding sk cancer) COPD Diabetes Stroke

PWD PWOD

Source: CDC BRFSS 2014

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MS Disability and Health Disparity— Mental and Emotional Health

43.7% 35.3% 11.0% 6.2%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%

Depression >14 mentally unhealthy days (in the past 30 days) PWD PWOD

Source: CDC BRFSS 2014

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Disability Inclusion

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Importance of disability inclusion

  • Disabilities, impairments, and chronic

health conditions are a natural part of being human.

  • The disability community is the world’s

most inclusive minority community.

  • Disability is the most equal opportunity

minority: anyone can join at any time, and with time, most people will. –Edward

Roberts (1939-1995)

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Interact with People with Disabilities Basic

Use appropriate and respectful language

  • The difference between the right word and

the almost right word is the difference between lighting and the lightning bug.

—Mark Twain

  • Use Person First language

Puts the person BEFORE the disability, and describes what a person has.

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Some Example of Accepted Terms

Appropriate Inappropriate

Person with a disability, people with disabilities Impaired, crippled, handicap, the disabled... Person with a physical disability, person with no arms Lame, defective, defect, deformed, invalid, infirmed... Person who is Deaf, person who is hard of hearing Hearing impaired, deaf and dumb... Person who is blind, person who has low vision Visually handicapped, visually impaired... Person with a speech disability, communication disability, person who stutters Speech impaired, halted, dumb, mute... Person who uses a wheelchair, a wheelchair user, walks with crutches Confined/bound to a wheelchair, physically impaired... Person who has a stroke Person who is a victim of a stroke (or sufferer) Person with mental health condition, person with a psychiatric disability Mentally retarded, feeble minded, moron, imbecile, crazy, freak, maniac, lunatic, psycho... Person of short stature, little person Deformed, dwarf, midget...

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Interact with People with Disabilities (1) People with Physical/Mobility Disabilities

  • Offer assistance before providing

assistance

  • Sit down at an eye level position

whenever possible

  • Do not push, lean on, or hold onto a

person’s wheelchair [Wheelchair User]

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Interact with People with Disabilities (1) People with Communication/Speech Disabilities

  • Do not make assumptions based on facial

expressions or vocal inflections

  • Take time and listen
  • Ask for clarification
  • Solicit and provide feedback
  • Talk the way as you would to others
  • Ask how best to communicate (preference)
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Interact with People with Disabilities (4) People Who Are Deaf or Hard of Hearing

  • Tap shoulder or arm to gain attention
  • Make direct eye contact and use

natural facial expressions and gestures

  • Face the person instead of the [sign

language] interpreter

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Interact with People with Disabilities (3) People with Visual Disabilities

  • Identify yourself and anyone else present
  • Guide a person by offering the use of your

elbow, walking normally

  • Use normal tone of voice. Notify the person

when leaving

  • Do NOT pet or talk to service animal without

the permission

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Interact with People with Disabilities (2) People with

Intellectual/Developmental Disabilities

  • Consider them are legally competent. They

can often sign documents, vote, consent to medical care and sign contracts

  • Use simple, clear sentences
  • Be patient
  • Don’t use baby talk
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Interact with People with Disabilities (2) People with

Mental/Psychiatric Disabilities

  • It is a hidden disability
  • Stress can affect the person’s ability to

function

  • They have varying personalities
  • Don’t assume they are violent
  • They can demonstrate good judgment
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Healthcare Providers Tend to...

Underestimate

  • The abilities of patients with disabilities.
  • The quality of life of patients with disabilities.
  • The patient’s capacity to contribute to their
  • wn care.
  • The extent and importance of the patient’s

expertise in own condition.

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Interact with Patients with Disabilities (1) Establish Respectful Communication

  • Speak directly to the patient
  • Use ordinary and age appropriate

language

  • Ask the patient for communication

preference

  • Using simple words, clear directions
  • Don’t interrupt. Don’t guess
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Interact with Patients with Disabilities (2) Respect Patient Privacy and Autonomy

  • Provide written materials
  • Ensure facility accessibility
  • Ask the best way for physical

assistance

  • Ask for consent before touching or

pulling

  • Don’t handle patients’ mobility device
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Interact with Patients with Disabilities (3) Respect Disability Identity & Culture

  • Respect a patient’s choice
  • Introduce your patients to disability

support groups

  • Don’t use negative words
  • Don’t fall into the trap of “golden rule

thinking.”

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Disability Etiquette

Top 5 Things to Consider

  • Use “Person First” language
  • Talk directly to the person
  • Ask before you help
  • Be sensitive about physical contact
  • Don’t make assumptions
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What should I do?

  • Shake hand?
  • Offer declined?
  • Patronize, praise?
  • Oops!?
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References/Resources

  • CDC. Disability and Health Data System (DHDS)

https://dhds.cdc.gov/profiles

  • DHS. A Guide to Interacting with People Who Have Disabilities.

https://www.dhs.gov/sites/default/files/publications/guide- interacting-with-people-who-have-disabilties_09-26-13.pdf

  • John Fuller, Ed.D. DVA. Office of Diversity and Inclusion. Leading

Diversity Disability Etiquette People First Language. https://www.diversity.va.gov/training/files/disability-first.ppt

  • TN Disability Pathfinder. Disability Etiquette & People First

Language. https://cme.mc.vanderbilt.edu/sites/default/files/TennesseeDi sabilityPathfinder- DisabilityEtiquettePeopleFirstLanguage%2812811%29.pdf

  • UOW. RRTC. Disability Stigma and Your Patients.

http://agerrtc.washington.edu/info/factsheets/stigma

  • United Spinal Association. Disability Etiquette Handbook.

https://www.unitedspinal.org/disability-etiquette/