Glen W. White

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Emproverment—the process by which people gain some control over valued events, outcomes, and resources—is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior hange with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

Living Well With a Disability Health Promotion Intervention: Improved Health Status for Consumers and Lower Costs for Health Care Policymakers

Objective: Investigate effectiveness of a health promotion intervention for adults with mobility impairments. Study Design: Interrupted time series, staggered baseline quasi-experimental with random assignment to treatment start date. Setting: 9 Centers for Independent Living in 8 states. Participants: Adults with mobility impairments living independently (N 188). Intervention: Living Well With a Disability: Facilitated group health promotion (16 hr over 8 weeks). Main Outcomes Measures: Secondary conditions, symptom days, health care utilization. Results: Reductions in limitation from secondary conditions, symptom days, and health care utilization over the intervention period. Effects on secondary conditions maintained for 12 months. Overall cost savings of

Disaster Preparedness and Response for Persons With Mobility Impairments Results From the University of Kansas Nobody Left Behind Study

807 per person (total for sample

Guidelines and Criteria for the Implementation of Community-Based Health Promotion Programs for Individuals with Disabilities:

151,716) projected from reductions in health care utilization of study sample. Conclusions: Health promotion interventions can increase quality of life while helping to control health care costs.

Consumer Perspective Narrative Analysis of a Disaster Preparedness and Emergency Response Survey From Persons With Mobility Impairments

The objective of this study was to assess the impact of a major disaster on county-level preparedness for persons with mobility disabilities. The authors surveyed 30 randomly selected Federal Emergency Management Agency (FEMA) disaster sites between 1998 and 2003 to determine disability surveillance capacity, the extent to which the disaster experience influenced changes in policies and practices, whether persons with disabilities were involved in the planning process, what factors appeared to drive the planning process, and whether current policies and procedures could be “best practices.” They found that people with disabilities were poorly represented in emergency planning; federal training on the needs of people with disabilities appeared useful, although only 27% of emergency managers reported completing the training; 20% of emergency managers reported having disability guidelines in place; and county-level surveillance systems were ineffective. Sixty-six percent of counties had no intention of modifying their guidelines to accommodate the needs of persons with mobility impairments, citing limitations from (a) costs, (b) limited staffing, (c) lack of awareness, (d) other security demands, and (e) broader responsiveness to all “special needs individuals.” The authors suggest that improved training, awareness, and surveillance are needed so communities can better respond to the needs of persons with disabilities before, during, and after local disasters. Possible techniques include developing improved technology assistance, providing environmental modifications to improve access for persons with disabilities during disasters, and ensuring far greater participation of persons with disabilities in all phases of the disaster planning and response process.

Moving from Independence to Interdependence: A Conceptual Model for Better Understanding Community Participation of Centers for Independent Living Consumers

Health promotion programs for people with disabilities are in the early stages of development. This critical review utilizes a credentialed expert panel to develop a set of guidelines for community-based health promotion programs for individuals with disabilities. The procedures include a review of background material, systematic literature review with drafted guidelines consisting of operational, participation and accessibility recommendations. The role that those with disabilities can play is addressed and includes program planning, implementation and evaluation, physical and programmatic accessibility of programs, and importance of evidence-based practices.

Consumers as Collaborators in Research and Action

The purpose of this qualitative study is to gain a better understanding of disaster preparedness for and the difficulties faced by persons with mobility impairments to guide future research and policy development. From an online Internet survey, 56 persons with mobility impairments who have experienced a catastrophic event described what was helpful for survival, what difficulties were experienced during and after the event, lessons learned, and future directions for emergency management. From a consumer perspective, it was found that both general and disability-related disaster preparedness efforts were useful for the survival, independence, health, and safety of persons with mobility impairments. It was also found that coworkers, family, friends, neighbors, and strangers often formed spontaneous networks during and after disasters that provided needed assistance. Difficulties surfaced when there was a lack of community and workplace evacuation plans, someone was left behind during an evacuation, there was no accessible sheltering or temporary housing, and infrastructure broke down (power, public transportation, and elevators). Persons with mobility impairments encouraged their peers to develop individual preparedness plans and to be active in community-based disaster planning. Emergency management was asked to address the needs of persons with disabilities and to include them in emergency management.

Accessibility of Fitness Facilities for Persons with Physical Disabilities Using Wheelchairs

This article provides a brief historical review of disability and personal and environmental limitations to community participation. Attention is given to policies that have limited consumer choice and to the pushback from disability rights advocates. These advocates eventually started the independent living movement as a reaction to the medical model that identifies disability as a personal defect rather than an environmental limitation. The authors discuss the basic philosophy and core services of independent living, and they present a conceptual model for helping centers for independent living (CIL) consumers more fully participate in the community. This model describes a continuum from independence to interdependence approaches to providing CIL services. Finally, the authors describe current research to determine the effectiveness of these two approaches to increasing consumer community participation.

Emergency Response Training Practices for People With Disabilities: Analysis of Some Current Practices and Recommendations for Future Training Programs

SUMMARY This paper discusses the role of consumers as collaborators in disability research conducted in the community. A comprehensive model of participatory action research is described and illustrated with research and training projects conducted in a collaborative arrangement between researchers and a Consumer Empowered Team. The paper describes how adherence to the model could be conducted in actual research and training settings and produce outcomes valued by the consumers at whom the interventions were targeted. The advantages and caveats to using the consumer as collaborator approach are discussed.

Participatory action research designs in applied disability and rehabilitation science: protecting against threats to social validity.

This study was conducted to evaluate the accessibility of fitness facilities in Topeka, Kansas, using the Americans with Disabilities Act Accessibility Guidelines (ADAAG). ADAAG identifies the specifics of architectural accessibility mandated by Title III of the Americans with Disabilities Act of 1990 (ADA). Eight facilities were evaluated using an 83-item checklist adapted from Figoni et al. (1998). Most facilities had at least one barrier in each area surveyed. Only one facility was close to meeting the accessibility standards in the areas of restrooms and access to exercise equipment. Noncompliance with ADAAG can create significant barriers for wheelchair users and limit engagement in physical activity. Research increasingly shows the importance of physical activity for this population in preventing secondary conditions, such as deconditioning and depression.