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Disability Inclusion:Getting to Know & Interact with

People with Disabilities

Mina Li, MD., PhD., MS., CSMInstitute for Disability Studies

The University of Southern MississippiMay 16, 2017

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

Objectives

• Define Disability and Disability Inclusion

• Overview Mississippi Health Disparity—Disability Statistics

• Summarize the guideline of interacting with People with Disabilities—Disability Etiquette

How long can an average person concentrate?

A. ~5 Minutes

B. ~15 Minutes

C. ~30 Minutes

D. ~50 Minutes

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

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

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

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

Characteristics of Disabilities

Disabilities vary in...

Severity Type Visibility

Mild Physical disabilityNot at all visible to

others

Moderate Sensory disabilityVisible to informed

others

SeverePsychiatric mental Health

disabilityVisible to all

Very SevereCognitive/intellectual

disability

Communication disability

Challenges/Disadvantagesfor 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

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 QuitSmoking

PWD PWOD

Source: CDC BRFSS 2014

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 BreastExam

Mammogram ColorectalCancer Scr

Pap Test RoutineCheck-Up

Dentist Visit Flu Vaccine

PWD PWODSource: CDC BRFSS 2014

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


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 PoorHealth

Heart Disease High BloodPressure

HighCholesterol

Gets 7-9 Hr.Sleep

PWD PWOD Source: CDC BRFSS 2014

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

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 past30 days)


Disability Inclusion

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)

Interact with People with DisabilitiesBasic

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.

Some Example of Accepted TermsAppropriate 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 stuttersSpeech 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...

Interact with People with Disabilities (1)

People withPhysical/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]


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)


People Who AreDeaf 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


People withVisual 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


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


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

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 own care.

• The extent and importance of the patient’s expertise in own condition.

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


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


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.”

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

What should I do?

• Shake hand?

• Offer declined?

• Patronize, praise?

• Oops!?

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/TennesseeDisabilityPathfinder-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/

https://dhds.cdc.gov/profiles

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

https://www.diversity.va.gov/training/files/disability-first.ppt

https://cme.mc.vanderbilt.edu/sites/default/files/TennesseeDisabilityPathfinder-DisabilityEtiquettePeopleFirstLanguage(12811).pdf

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

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

Documents

AS MANDATED BY ACCME SPEAKERS ARE ASKED TO DISCLOSE … · Interact with People with Disabilities Basic Use appropriate and respectful language •The difference between the right