Strategic Plan 2006-2010 Executive Summary
This report represents the collaborative endeavor of: The Montana Disability and Health (MTDH) Program, a partnership between the Chronic Disease Prevention and Health Promotion Bureau of the Montana Department of Public Health and Human Services (MDPHHS) and the University of Montana Rural Institute (UMRI): Center for Excellence in Disability Education, Research, and Service. The MTDH Program is responsible for developing and implementing programs and services designed to prevent secondary conditions, promote health, and reduce health disparities existing between Montanans with and without disabilities. The MTDH Program is funded by the National Center on Birth Defects and Developmental Disabilities, Disability and Health Centers for Disease Control and Prevention (CDC).
The following individuals were responsible for writing this strategic plan:
Marilyn Carlin, MA, Independent Consultant
Judy Garrity, BA, Independent Consultant
Meg Ann Traci, PhD, Project Director, MTDH Program, University of Montana
The following individuals provided conceptual input for the strategic plan:
Members of the Disability and Health Advisory Board as listed in Appendix A
Staff of the UMRI (listed in alphabetical order):
Donna Bainbridge, PT, EdD, ATC
Barbara Cowan, BA
Kathy Humphries, PhD
Erica Parker, BA
Craig Ravesloot, PhD
Tom Seekins, PhD
Diana Spas, MSEd
Meg Ann Traci, PhD
Lynda Zschaechner, BA
The following MDPHHS Managers reviewed this strategic plan:
James Driggers, Chief, Community Services Bureau, Senior and Long-Term Care Division
Todd Harwell, Chief, Chronic Disease and Health Promotion Bureau, Public Health and Safety Division
Joe Mathews, Administrator, Disability Services Division
The following UMRI staff reviewed this strategic plan:
Diana Spas, MSEd
The Montana Disability and Health Program is the result of a cooperative agreement between the:
1. Centers for Disease Control and Prevention (CDC); and
2. Chronic Disease Prevention and Health Promotion Bureau (CDHPB) in partnership with The University of Montana Rural Institute (UMRI): Center for Excellence in Disability Education, Research, and Service.
To begin the strategic planning process, a meeting of Advisory Board members, disability advisors, and DPHHS and University of Montana Rural Institute staff was held on November 19, 2004. At this meeting, participants formulated a vision, developed a mission statement, and identified several goals for the MTDH program. They also discussed seeking the input and participation of the individuals and groups most likely to have a vested interest and/or be involved in providing resources and/or implementing the plan. Accordingly, the MTDH Advisory Board identified a number of key stakeholders including service providers, state and federal agencies, consumers, businesses, and statewide associations/organizations. This master list of key stakeholders was then used to compile a list of individual informants who were contacted in February and March of 2005. In total, 56 key stakeholders representing a balance among academic, government, public health, non-profit, business and advocacy organizations were interviewed. A number of the interviewees function in leadership roles within their businesses or organizations. Forty-seven informants were agency/organization representatives and nine were consumers.
In addition to the key stakeholders, attempts were made to garner support for and enthusiasm about the plan from a number of individuals and organizations as well as the general public. On October 25, 2005, a draft of the plan was mailed to 64 individuals and emailed to 174 others. The plan was also posted on the MTDH website where a total of 136 visitors opened the pdf file as a download in the two weeks of the comment period, ending on November 7. Thus, a total of 374 individuals were exposed to the plan (assuming that each “visit” to the website was unduplicated).
Comments were received from 19 individuals, or 5.1% of those who had access to the draft plan. Suggestions that required only minor adjustments were integrated into the plan. More substantive suggestions were referred to the Advisory Board for discussion and consensus.
“This Call to Action is a call to caring. Every life has value and every person has promise. The reality is that for too long we provided lesser care to people with disabilities. Today, we must redouble our efforts so that people with disabilities achieve full access to disease prevention and health promotion services.”
U.S. Surgeon General Richard H. Carmona, M.D., M.P.H, FACS. First-ever Surgeon General’s Call to Action on Disability Released July 26, 2005 on the 15th anniversary of the Americans with Disabilities Act.
THE BIG PICTURE
It is estimated that nearly 54 million people in the U.S. (about 20% of the civilian, non-institutionalized population over the age of 5 years) have a disability. “Disability” is a term that covers a broad array of conditions and diseases. It refers generally to a limitation in physical or mental function caused by one or more health conditions. In 2003, one in five non-institutionalized adult Montanans reported that they had experienced activity limitations and/or perceived themselves to be a person with a disability.
Disability is not synonymous with poor health. Contrary to what was once a generally accepted notion regarding disability and health, having a disability does not preclude being in good health. In fact, most people with disabilities have the potential to lead healthy and productive lives. Moving away from using a disabling condition as a health status indicator has sparked an increased interest in promoting the health and wellness of people with disabilities. Key to this concern is an awareness that individuals with disabilities may be at increased risk for a number of preventable health problems, referred to as secondary conditions. Secondary conditions are those health circumstances that may be experienced by individuals after they experience a primary (or first) disability. Such conditions range from medical complications to problems of psychosocial adjustment and to environmental and quality of life issues. Research suggests that people with disabilities annually experience on average 14 secondary conditions that limit their health and independence.
Secondary conditions may significantly restrict activities, require extensive care, and cost a substantial amount. On average, the medical expenditures of people with disabilities are more than four times those of people without disabilities. Consequently, health promotion and wellness activities are particularly important for people experiencing a disability in order to prevent health complications and further disabling conditions.
Among the concerns specific to people with disabilities, health disparities rank as one of the highest. Health disparities are differences in health status among distinct segments of the population including differences that occur by gender, race, or ethnicity, education or income, disability, and geographic location. People with disabilities face substantial structural, economic, environmental, and personal barriers to participating in disability-related health promotion activities. Consequently, they are often at increased risk of developing secondary conditions.
ACCESS TO HEALTH CARE IN MONTANA
The prevalence of disability in Montana as measured by U.S. Census data estimates that there are 145,732 Montanans aged 21 years and over with disabilities living independently in their communities.
Montana has a large land mass and a relatively sparse population. Many of Montana’s 56 counties are categorized as Health Professional Shortage Areas and Frontier Counties with fewer than six people per square mile. Montana has 62 licensed hospitals; 59 are classified as rural by the Healthcare Financing Administration. The state has seven licensed outpatient facilities and 25 Rural Health Clinics. There are 181 physicians per 100,000 and a total of 468 registered physical therapists. In 2002, seven of Montana’s 56 counties had no dental professionals, 11 had no dentist, and 19 had no dental hygienist.
The lack of health care providers knowledgeable about disability is consistently reported as one of the most significant problems experienced by people with disabilities and rehabilitation providers. Such gaps in services and supports place many people with disabilities at risk, increase the cost of services, and reduce quality of life.
MONTANA ADULTS WITH DISABILITIES
A 2005 report entitled Assessing Disability and Secondary Health Conditions of Montana Adults provides information about Montana adults with disability from the 2001 and 2003 Montana Behavioral Risk Factor Surveillance System (BRFSS) surveys. The health indicators highlighted in this report were selected because they were:
Healthy People 2010 Leading Health Indicators closely related to disability and secondary health conditions;
Primary conditions known to be associated with activity limitation in adults;
Socio-demographic and health status indicators that describe the experience of Montana adults with disability.
Montana adults with disability compared positively to those without disability in attaining certain Healthy People 2010 Objectives, as designated by the Centers for Disease Control and Prevention (CDC). Adults with disability were more likely to have:
A usual primary health care provider
Regular blood cholesterol screening
Immunizations against influenza and pneumococcal disease (specifically adults with disability over 65)
A lower overall prevalence of binge drinking
Conversely, Montana adults with disability reported significant health gaps and disparities in the attainment of other Healthy People 2010 objectives. In summary, adults with disability in Montana were more likely than adults without disability to:
Have chronic joint symptoms and arthritis
Report clinically diagnosed diabetes
Have high blood pressure or blood cholesterol
Report clinically diagnosed cardiovascular disease
Sustain fall-related injuries
Report no leisure-time physical activity
Report moderate physical activity levels below recommendations
Report not being able to see a doctor when needed because of cost
MONTANA DISABILITY AND HEALTH (MTDH) PROGRAM TARGET POPULATION
The MTDH program has chosen to focus its attention on:
1. Adults with disabilities related to mobility impairments; and
2. Adults with intellectual/developmental disabilities (I/DD) living in supported living arrangements operated under contract with state agencies.
These are areas of clear need and in which the MTDH Program has demonstrated advanced capacity. Strategies and interventions specifically targeting these populations have been designed at the University of Montana Rural Institute. Moreover, established networks with existing capacity for building collaborations and for delivering education and interventions already exist to serve these target groups.
The vision, mission, and long-term outcome goals are based on the history and forward momentum of the national disability and health movement as well as the recognized expertise of the University of Montana Rural Institute (UMRI) to provide leadership for this effort.
The Montana Disability and Health (MTDH) Program Advisory Board envisions a state where people with disabilities are healthy and have the same opportunities to participate in community as people without disabilities—a place where people with disabilities go where they want to go; do what they want to do; have their individual needs met; are accepted in their communities; and are treated equally with others. This vision for Montana includes:
An increased awareness that preventing secondary health conditions (such as pain, depression, obesity, oral health problems, diabetes, and injuries such as pressure sores) is an important component of quality of life for people with disabilities in Montana.
Strong alliances among people with disabilities, the MTDH Program and other agencies and organizations.
No health care disparities.
Resources and efforts to promote healthy lifestyles.
Integration of people with disabilities in all physical, social and economic aspects of Montana.
Public awareness of success stories about people with disabilities living healthy lives.
The mission of the Montana Disability and Health Program is to reduce secondary conditions and improve the health of people with disabilities.
LONG-TERM OUTCOME GOALS
The long-term outcome goals of the Montana Disability and Health Program are to: (1) Help individuals with disabilities live longer, with improved quality of life years; and (2) Eliminate health disparities experienced by people with disabilities.
Three major divisions of the Montana Department of Public Health and Human Services (MDPHHS) have partnered to attain the long term outcome goal for this state plan: Public Health and Safety Division; Disability Services Division; and the Senior and Long-Term Care Division (SLTCD). All three divisions are represented on the Advisory Board as well as the Core Management Team of the MTDH Program.
INTERMEDIATE OUTCOME GOAL ONE: BUILD CAPACITY
In a short period of time, the MTDH Program, in partnership with the MDPHHS, has made significant strides in building program capacity by:
Providing surveillance of disability and health in Montana
Initiating strategic partnerships
Providing technical assistance to communities
Providing education and health promotion programs
Training health professionals
Facilitating access to services
Short-term Outcome Goal 1A
By 2007, the MDPHHS will improve the availability, accessibility, and utilization of data related to the health status and health behaviors of people with disabilities.
Short-term Outcome Goal 1B
By 2010, the MTDH Program will increase the awareness and knowledge of at least three new state and community agencies or programs about the MTDH Program, this state plan, and related publications in ways that lead to collaborations on three new activities.
Short-term Outcome Goal 1C
By 2007, the MTDH program will work with its partners to develop funding for ongoing implementation of this strategic plan. Opportunities to expand the program will also be identified and incorporated into the plan as funding is secured.
INTERMEDIATE OUTCOME GOAL TWO: SUPPORT DIRECT SERVICES AND PROGRAMS
Health promotion for people with disabilities can reduce the incidence and severity of secondary conditions that further limit their participation in society. Increasing the availability of direct services and programs designed specifically for this target group has been shown to improve health, prevent secondary conditions, and create greater consumer participation in health promotion activities.
The University of Montana Rural Institute: A Center for Excellence in Disability Education, Research, and Service has designed specific programs to fit the needs and strengths of people with disabilities—Living Well with a Disability (LWD), MENU AIDDS, and Have Healthy Teeth. These programs are effective in improving participant health and well being and are slated for expansion over the next five years.
Short-term Outcome Goal 2A
By 2007, the MDPHHS Developmental Disabilities Program will:
1) Coordinate training of at least 50% of group home managers on programs to improve the nutrition of adults living in group homes; and
2) Evaluate changes in group home food systems and nutrition of residents with support from the MTDH Program.
Short-term Outcome Goal 2B
By 2007, the MTDH Program will develop and implement a business model for Living Well with a Disability (LWD) that increases external funding for program implementation from 0% to 30% of total program costs without decreasing program effects on secondary conditions, symptom days and healthcare costs. Montana Home and Community-Based Services and Vocational Rehabilitation will establish procedures for reimbursing Centers for Independent Living to provide the Living Well with a Disability Workshop to their consumers.
Short-term Outcome Goal 2C
By 2007, the MTDH Program will increase the awareness and knowledge of Montana People First chapters in Helena, Missoula, Great Falls, and Billings of peer-support strategies for improving the health of its members by introducing programs such as the oral health program, Have Healthy Teeth, that lead to routine tooth brushing and the reduction of oral health risk indicators such as plaque, gingivitis, and presence of debris.
INTERMEDIATE OUTCOME GOAL THREE: IMPROVE ACCESS TO GENERIC SERVICES
Fundamental to the right of public access granted by passage of the ADA in 1990, is the responsibility to increase the general public’s knowledge and awareness of the needs of people with disabilities. Programs and services offered to the general public must also be made available to people with disabilities. In order to achieve the goal of full access for all people, professionals, service providers, and others in positions of influence must be educated about: (1) the needs of people with disabilities; and (2) how to recognize and eliminate potential barriers. This increase in knowledge and awareness requires increased dialogue and cooperation between health and disability educators and those who are best positioned to reinforce a shift in the disability paradigm from that of disability as a
medical problem to that of an issue involving accessibility, accommodations, and equity.
Short-term Outcome Goal 3A
By 2007, the MTDH Program will address the need for improving student training about the needs of people with disabilities. This objective will be accomplished by increasing the awareness and knowledge of preventive health care training and universal design curricula among the following groups: The University of Montana (UM) Board of Regents; Administrators of UM allied health programs; and Montana State University (MSU) allied health and architectural programs.
Short-term Outcome Goal 3B
By 2007, the MTDH Program will increase knowledge and awareness of health disparities and secondary conditions experienced by people with disabilities in Montana by providing health education information and materials to members of: the Montana Health Association; Montana Association of Independent Disability Service Providers; Centers for Independent Living (CILs); and Parents, Let’s Unite for Kids (PLUK).
Short-term Outcome Goal 3C
By 2007, the MTDH Program will increase knowledge and awareness of effective strategies for preventing secondary conditions and improving the health of people with disabilities to at least 800 professionals and service providers. This goal will be accomplished through: conference presentations; newsletter and newspaper articles; targeted e-mail distribution and postal mailings; and posting information on the MTDH Program website.
Short-term Outcome Goal 3D
By 2010, the MTDH Program in partnership with the MDPHHS Diabetes Advisory Coalition will increase by 10% the number of people with disabilities and diabetes who receive diabetes education as measured by the BRFSS.
Short-term Outcome Goal 3E
By 2007, the MTDH Program, in partnership with the Montana Department of Transportation, and Montana Department of Fish, Wildlife and Parks, will increase the awareness and knowledge of Montana public health professionals of the information needs of Montanans with low vision and blindness and other people with disabilities. This will be accomplished by providing accessible formats and/or sensitivity and inclusion education for five state health promotion campaigns and/or data collection activities.
Short-term Outcome Goal 3F
By 2010, the MTDH Program in partnership with the University of Montana and the Information Technology Services Division of the Montana Department of Administration will ensure that all information on web pages associated with programs in the Chronic Disease Prevention and Health Promotion Bureau are accessible to people with disabilities in accordance with state and federal law.
Short-term Outcome Goal 3G
By 2010, the MTDH Program in collaboration with the Montana Developmental Disabilities Program (DDP) and the Montana Tobacco Prevention Program will increase the knowledge and awareness of service providers regarding the effects of second-hand smoke and strategies for reducing second-hand smoke exposure. Consumers of DDP services and supports also will have an increased awareness of the effects of second-hand smoke as well as programs available to support smoking cessation.
Short-term Outcome Goal 3H
By 2007, the MTDH Accessibility Advisors, in collaboration with Montana People First chapters and the Montana Council on Developmental Disabilities, will raise awareness of the need for specific accessibility improvements among Community Health Center administrators and boards in six Montana communities—Butte, Billings, Helena, Great Falls, Miles City and Missoula.
INTERMEDIATE OUTCOME GOAL FOUR: IMPROVE ACCESS TO COMMUNITY ENVIRONMENTS
Access to civic life is a fundamental part of American society. Research shows that people with disabilities often have more problems accessing social and recreational activities, employment, and health care than people without disabilities. Within the new disability and health paradigm, disability is considered a medical-social-environmental issue involving accessibility, accommodations, and equity. Environmental factors such as physical barriers, knowledge, attitude and belief barriers, as well as geographic and economic barriers—not personal impairments—are viewed as the primary obstacles contributing to health disparities existing between people with and without disabilities.
Full access includes an environment that presents opportunities for inclusion and personal choice by integrating people in all social and economic aspects of life. Improving access for people with disabilities to community environments—to health care, public buildings, businesses, education, recreation, and private living spaces—enables participation in everyday commercial, economic, and social activities.
In 1990, Congress passed the ADA, which prohibits discrimination on the basis of disability by public accommodations and requires places of public accommodation and commercial facilities to be designed, constructed, and altered in compliance with the accessibility standards established within the law. Passage of the ADA compliance standards and requirements has significantly improved public accessibility for people with disabilities. However, the ADA has no authority over private residences. Movement toward full integration, without barriers—attitudinal or otherwise—is the key component in achieving the ideal community for people with disabilities.
Short-term Outcome Goal 4A
By 2007, the MTDH Program Advisory Council will disseminate findings from accessibility assessments in five Montana communities. This information will increase the awareness of city councils, city planners, and people with disabilities about existing environmental barriers that limit people with disabilities’ participation in social activities, health care, and health promotion activities.
Short-term Outcome Goal 4B
By 2010, the MTDH Program (in partnership with the UMRI, Montana Centers for Independent Living, the Senior and Long-Term Care Division of the MDPHHS, the Montana chapter of AARP, the Montana Department of Labor and Industry (DOLI), and the Montana Legislature) will increase awareness and knowledge of Montana legislators, the MSU school of architecture, the Montana Home Builders Association, Montana Realtors, and Montana public health officials about visitability in Montana with recommendations for supports that would increase the proportion of visitable homes in the state.
INTERMEDIATE OUTCOME GOAL FIVE: INTEGRATE DISABILITY AND HEALTH AGENDA
Short-term Outcome Goal 5A
By 2010, the MTDH Program in partnership with the Senior and Long-Term Care Division and the Disability Services Division will provide education to professionals, service providers and persons moving to the community from institutional settings about: (1) strategies to prevent secondary conditions; and (2) health resources available in Montana’s communities.
Short-term Outcome Goal 5B
By 2007, the MTDH Program will increase the knowledge and awareness of disability and health issues on key MDPHHS advisory groups and integrate disability and health issues into the MDPHHS planning documents. This will be accomplished by increasing from six to ten the number of MDPHHS standing advisory boards that have Disability Advisors as members.
Short-term Outcome Goal 5C
By 2010, the MTDH Program will partner with at least three other state agencies to:
(1) Include appropriate objectives addressing the health and wellness of people with disabilities in long-range plans; and
(2) Address the health and wellness needs of people with disabilities by explicitly integrating them as a population to be served.
This Executive Summary was produced by the Montana Disability and Health Program and supported through a cooperative agreement with the Centers for Disease Control and Prevention (CDC): MTDH Cooperative Agreement Number U59/CCU824602.
1000 copies of this public document were published at an estimated cost of $1.44 per copy, for a total cost of $1,440.00, which includes $1,440.00 for printing and $.00 for distribution.
The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the funding source.
For a copy of the full report, contact:
Meg Ann Traci, Project Director
University of Montana Rural Institute
52 Corbin Hall
University of Montana
Missoula, Montana 59812-7056