Jean P. Hall

Narrowing the Breach: Can Disability Culture and Full Educational Inclusion Be Reconciled?

Because of the long history of exclusion of people with disabilities, total inclusion in the educational environment has many outspoken proponents. People and organizations favoring inclusion, however, are overlooking the value of the disability culture that is fostered when children with disabilities have the opportunity to associate with and learn alongside other individuals who share similar identities and life experiences. The history of the disability rights movement clearly illustrates that major changes do not occur unless people with disabilities band together to address shared injustices (e.g., Shapiro, 1993). The phenomenon of a disability culture has been convincingly demonstrated by many researchers and writers, and its importance to the development and self-esteem of students with disabilities is discussed. Although the current special education system has many negative aspects, changes to the existing system rather than a movement to full inclusion will be more effective in supporting disability culture and, ultimately, the needs of children with disabilities.

Discrepancy among Behavioral Risk Factor Surveillance System, Social Security, and functional disability measurement

Section 4302 requires the development of federal standards for the measurement of disability status in order to monitor health disparities and quality of care among this population. These new data will contribute to policy, research, and funding decisions. Therefore, the validity and reliability of disability measurement instruments are important to all those who will use these data. Of particular concern is the construct validity for measures of disability. Several authors (1, 2, 3, 4) have noted discrepancies in prevalence estimates that can occur when different survey methodologies or different measures of disability are used. A variety of federal agencies currently report differing disability prevalence rates. For example, the Census Bureau, through its American Community Survey (ACS), reports 15% of American adults 18 years and older have disabilities (5), while the Centers for Disease Control and Prevention (CDC), through the Behavioral Risk Factor Surveillance System (BRFSS), place disability prevalence for adults 18 and older at 20% (6). Public health officials typically use BRFSS data to identify emerging health problems, establish and track health objectives, develop and evaluate public health policies and programs, and examine health disparities among people with disabilities (1, 7, 8). All US states and territories collect BRFSS data, making it the largest telephone health survey in the world (9). Despite the wide usage of BRFSS disability questions, the Social Security Administration (SSA) definition of disability sets the standard for accessing federal disability benefits. The SSA definition is stricter, including only those individuals with severe disabilities (10). Because the BRFSS asks respondents if they are limited in any activity while the SSA looks only at work limitations, one might expect the BRFSS to capture more people, including those with SSA-determined disabilities. Indeed, the prevalence of people ages 18 to 64 receiving SSA disability benefits is only about 6%, a population reasonably expected to be included within the larger BRFSS figure (9). We examine here the construct validity of BRFSS disability items using a sample of adults who met the more stringent SSA definition of disability. We compare responses of this sample to the BRFSS questions to responses to a seven-part functional question. Finally, we discuss our findings, which suggest limitations in using the BRFSS for measuring disability prevalence, and implications for the new federal standards for the measurement of disability status.

Does High-Risk Pool Coverage Meet the Needs of People at Risk for Disability?

State high-risk insurance pools serve people denied coverage because of pre-existing conditions. With benefit plans modeled on the individual market, these pools generally require higher out-of-pocket expenditures and provide fewer benefits than employer-sponsored plans, while their beneficiaries have very intensive needs. We profile 416 working adults enrolled in a state high-risk pool and document their health conditions and health care utilization. High-risk pool and federal employee benefits are compared to assess insurance structure and implications for health and disability outcomes.

Health Care Access Affects Attitudes About Health Outcomes and Decisions to Apply for Social Security Disability Benefits

This article reports on qualitative findings from a mixed methods study that explored the efficacy of providing enhanced health benefits and services to people with chronic health conditions to reduce their application rates to federal disability programs. Comparing an intervention and control group, the study found that those who received enhanced benefits had reduced health decline. To explore reasons for this reduction, authors conducted focus groups with a sample of participants from both groups. Four themes emerged: (a) Due to the effects of their conditions, most participants believed their health would worsen over time; (b) Intervention group members said their health deterioration would be slowed or prevented, while control group members worried about more rapid decline and the future; (c) Intervention group members related their beliefs about continued health to their ability to access care; (d) Control group members were more likely than intervention group members to indicate they applied or were interested in applying for social security disability benefits. These themes suggest that people who believe they have access to quality health care feel their health can and will improve over time. If health care reform leads to the availability of more comprehensive coverage for people with potentially disabling conditions, growth in federal disability programs may slow.

Oral Health Needs and Experiences of Medicaid Enrollees With Serious Mental Illness

INTRODUCTION Chronic dental diseases are among the most prevalent chronic conditions in the U.S., despite being largely preventable. Individuals with mental illness experience multiple risk factors for poor oral health and need targeted intervention. This study investigated experiences of Kansas Medicaid enrollees with serious mental illness in accessing dental services, examined their oral health risk factors, and identified oral health needs and outcomes. METHODS Survey data were collected from October 2016 through February 2017 from 186 individuals in Kansas with serious mental illness enrolled in Medicaid. Data were analyzed quantitatively (descriptive and bivariate statistics) and qualitatively (for major themes). RESULTS Despite Medicaid coverage of dental cleanings, 60.2% of respondents had not seen a dentist in the last 12 months. Reasons included out-of-pocket costs, lack of perceived need, uncertainty about coverage, difficulty accessing providers, fear of the dentist, and transportation issues. High rates of comorbid physical health conditions, including diabetes and cardiovascular disease, and current or former tobacco use were also observed. CONCLUSIONS Medicaid dental benefits that cover only dental cleanings and low levels of oral health knowledge create barriers to utilizing needed preventive dental care. Lack of perceived need for preventive dental services and lack of contact with dentists necessitates the development of targeted oral health promotion efforts that speak to the specific needs of this group and are disseminated in locations of frequent contact. The Medicaid population with serious mental illness would be an ideal group to target for the integration of chronic oral, physical, and mental health prevention services and control.