Under competitive application for Program Announcement 02007, the Disability and Health Team awarded funds to 16 states.

Public Health Outcome:Improved health of state residents with disabilities

Program Period: Program period began in 2002 and will continue 3-5 years.

State Awardees: In the spring of 2002, the Disability and Health team administered 16 competitive awards to implement effective state-level health promotion and wellness programs for people with disabilities.

Program Descriptions: Level I states are mentoring other states as well as implementing community-based health promotion programs targeting people with disabilities. Level 1a states are implementing community-based health promotion programs targeting people with disabilities. Level II states are including people with disabilities in their state's broad public health agenda, as well as planning health promotion interventions. Level III states are developing state health department infrastructure and developing a strategic plan for their disability and health program.

Core competencies. All 16 awardees have agreed to:

*Utilize the expertise of the 6 mentoring states -- Iowa, New Mexico, New York, North Carolina, South Carolina, and Washington.
*Develop and utilize a consumer-driven advisory board and a strategic plan for the Disability and Health program.
*Work closely with state Healthy People coordinators to integrate people with disabilities into their state's public health agenda.
*Coordinate with the state Behavioral Risk Factor Surveillance team to assess risk behaviors and health status by age, gender, and ethnicity.
*Coordinate with other health department divisions to include people with disabilities in health promotion activities and to make clinical preventive services ADA accessible.
*Collaborate with universities, centers of excellence, centers for independent living, advocacy organizations, vocational rehabilitation and senior or elderly services to facilitate health promotion efforts targeting people with disabilities.
*Inform the public about employment, independent living, access, transportation, physical activity, assistive technology, peer support and other state initiatives to improving the health of people with disabilities e.g. statewide annual conferences.
*Coordinate with the American Association on Disability and Health to (1) identify state staff training needs; (2) establish public health programs to promote the health of people with disabilities; (3) fortify and operate state disability and health programs; and (4) formalize collaborative relationships with national disability organizations.

Project: University of Arkansas for Medical Sciences North Little Rock "Partners for Inclusive Communities"

Project Director: Mark Swanson, MD, MPH

The State of Arkansas Department of Health (DOH) has designated the University of Arkansas for Medical Sciences, University Center for Developmental Disabilities, known as "Partners for Inclusive Communities," a funded project of the Administration on Developmental Disabilities, which now refers to its "University Affiliated Programs" (UAP) as "University Centers of Excellence in Developmental Disabilities Education, Research and Service" or "UCEs"), to operate the prospectively re-funded Arkansas Disability and Health Program. The Arkansas Department of Health would play a substantial, active role in this proposed State Implementation Project.

Accomplishments in the last four years have been directed by a 15-member Secondary Conditions Grant Consumer Advisory Board, composed of consumers and professionals working with programs that focus on disability issues. About half of the Board members are people with disabilities.

The Office of Disabilities Prevention, Arkansas Department of Health, spearheaded development of the Arkansas Strategic Plan for Disabilities Prevention in 1996 to identify key disability prevention activities. The Strategic Plan, published in 1997 by the Arkansas Department of Health and since updated by the State Capacity Project and the Consumer Advisory Board, continues to be used to develop, implement and monitor statewide activities related to health and disabilities. This document concentrates on two major activities:

*Development of state capacity to reduce the incidence and severity of primary and secondary disabilities, and
*Development, maintenance, and promotion of a coordinated statewide approach to prevent secondary conditions in Arkansans with disabilities.

This document, along with Healthy People 2010 and the DOH's conduct of the Behavioral Risk Factor Surveillance System (BRFSS), continues to represent the foundation for state program planning and development for people with disability; including their access to preventive health services in state health agency delivery systems.

Project: California Department of Health Services

Project Director: Roger B. Trent, Ph.D.

The project is located in the California Department of Health Services (CDHS), Office of Prevention Services, Division of Chronic Disease and Injury Control. The named project entity, the Office on Disability and Health (ODH), is addressing secondary conditions among people with existing disabilities, particularly focusing on women with disabilities and expanding the state's epidemiologic capacity to measure the prevalence of activity limitation within the state's population of more than 34 million people.

The ODH will conduct surveillance on disability prevalence by incorporating CDC's Disability Module within the state's Behavioral Risk Factor Surveillance System (BRFSS) and its California Women's Health Survey. The project will also explore ways to integrate disability-related questions into its California Health Interview Survey (52,000 respondents).

The ODH will implement a health promotion project for women, with statewide applicability that will be initially demonstrated at the local level. A local Independent Living Center, Community Resources for Independent Living, nominated by the proposed project partner known as California Foundation of Independent Living Centers, will be the lead agency at the local level in the East Bay region of the San Francisco Bay Area to provide:

*community collaboration;
*outreach and training for health care providers;
*self-efficacy and advocacy training for women; and
*assistance to encourage access (making appointments, referrals for transportation, etc.).

In addition, the proposed Living Healthy project would have two state level partners: the CDHS Office of Women's Health, and the state Department of Rehabilitation, the latter of which has indicated its commitment to replicate the local intervention statewide. Disability advocates and representatives from disability service organizations have expressed strong commitment to the proposed project and are assisting in framing both the concept and the goals contained in the ODH work plan.

Project: Iowa Department of Public Health

Project Manager: Roger Chapman

The Iowa project will partner with the University of Iowa to implement intervention and health promotion strategies that address disability issues identified in the state plan and a multi-year prospective cohort study of Iowa residents. Advice and guidance will be provided by three advisory bodies.

The University of Iowa will replicate the Living Well with a Disability curriculum in three Centers of Independent Living, including a refresher component, and test its effectiveness. A rural model is proposed in the second year of the grant cycle. In collaboration with the Healthy and Ready to Work project, the adolescent version of the Living Well program is also proposed.

The project will also develop and disseminate a disaster preparedness plan for people with disabilities. Resource cards to assist with sexual assault medical examinations will be developed and distributed. A statewide disability and health conference will be planned and conducted in Year Two. The project will monitor the time-line for the disability plan. The project will facilitate an ADA accessibility assessment of a large number of health department programs throughout the state and provide technical assistance to assist with transition plans.

The epidemiology component will be conducted by the Prevention of Secondary Conditions research unit in the Department of Epidemiology at the University of Iowa College of Public Health. It will focus on employment and occurrence of secondary conditions among people with mobility disability. Data from the Behavioral Risk Factor Surveillance System (BRFSS) will help define disability demographics, and linkages with other modules will be used to focus intervention strategies.

Project: University of Illinois at Chicago

Project Director: James H. Rimmer, PhD

The research on health promotion involving children and adults with developmental disabilities shows a clear pattern of poor health promotion practices in this population. The earlier work of key researchers noted that individuals residing in less restrictive community settings (e.g., within the family) had a significantly higher rate of obesity and low physical activity participation compared to individuals residing in highly structured settings (e.g., institutions). Based on these and other reports, overweight/obesity, poor nutrition, and low physical fitness are major problems among people with developmental disabilities residing in community settings. These secondary conditions have a substantial negative impact on quality of life and must be targeted in future intervention research.

The focus of the proposed project in close collaboration with the Illinois Department of Public Health is to develop the infrastructure for a statewide surveillance system that tracks the health status of adults with developmental disabilities. The surveillance data will help guide future health promotion intervention research addressing the secondary conditions of overweight and obesity, low physical fitness and poor nutritional status in people with developmental disabilities. Specifically, the statewide surveillance system will monitor the following measurable characteristics of disability over the life course of individuals with developmental disabilities:

I. Functional limitations and functional status;
II. Specific secondary conditions resulting from a developmental disability;
III. Quality of life among people with developmental disabilities and their families; and
IV. State-specific data that would support program development and evaluation of interventions at the state level.

Project: Massachusetts Department of Public Health

Project Director: Cheryl Bushnell

The mission of the Office on Health and Disability (ODH) of the Massachusetts Department of Public Health (DPH) is to promote the health and well being of people with disabilities and chronic conditions in Massachusetts. Since 1997, ODH has been a focal point in state government for leadership for addressing the public health needs and concerns of people with disabilities in Massachusetts including addressing accessibility and priority attention to ADA issues. The project's effectiveness is enhanced by the fact that half the members of the advisory council and the ODH staff have disabilities.

People with disabilities in Massachusetts have many urgent health needs. The published ODH strategic plan and the project work plan are products of collaboration between the advisory council and health agency staff. In collaboration, the project outlines four goals to address these key issues:

*Assure access to and inclusion of people with disabilities in health promotion activities or in targeted programs as needed;
*Ensure availability and use of data to determine prevalence of disabilities, identify health and related needs of individuals with disabilities, and plan and evaluate services;
*Improve access to and quality of health care for people with disabilities; and
*Build a health and disability constituency that fosters disability awareness and collaboration to promote health and well-being.

Through selected multi-level interventions in Massachusetts, the ODH will pursue the Healthy People 2010 goal: "Promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the United States.

Project: University of Montana

Project Director: Tom Seekins, Ph.D.

This proposal is an application for funding to create the Montana Disability and Health Program, Living Well under the Big Sky. After extensive discussions, the Director of the Montana Department of Public Health and Human Services and the directors of the two most relevant Divisions of the State Health Department have assigned the responsibility for initiating and overseeing the program to their university partner, the Rural Institute on Disabilities at the University of Montana.

The new state project will focus on both health behavior and environmental supports for adults with mobility impairments and developmental disabilities. For those with mobility impairments, the project will initiate a program of training, service, and supports including a replication of the Living Well with a Disability curriculum. Later, the project will implement a community-activated health planning forum related to community organization and coalition building that focuses on disability issues and independent living.

For adults with developmental disabilities, the project will conduct nutrition/environment/oral health assessments within group homes, supported living, and semi-independent living arrangements. This will include the establishment of practice guidelines designed to manage supported living including statewide training on approach, implementation, and program evaluation processes.

Project: North Carolina Department of Health and Human Services

Program Manager: Marcia Roth

The North Carolina Office on Disability and Health (NCODH) has been in an effective partnership with the Women's and Children's Health Section, Division of Public Health and the Frank Porter Graham Child Development Center at the University of North Carolina at Chapel Hill. The NCODH is charged with directing and coordinating programs that address health promotion, environmental access to programs and services, and the prevention of secondary conditions among people with disabilities. This is accomplished through an integrated program of intervention, evaluation, and technical assistance. Major activities have and will center on:

I. Population-based surveillance to monitor the health status of people with disabilities;
II. Developing health promotion materials for consumers and providers;
III. Strengthening state agency and consumer/community collaborations;
IV. Piloting state and community interventions and health communication activities;
V. Enhance integration with state physical activity initiatives and training and technical assistance to recreation providers, health service providers, and consumers;
VI. Expand community education interventions for women and providers in the areas of health promotion, cancer screening, preventive care, and violence;
VII. Continue population-based surveillance to better measure disability, health status, health risks and preventive care practices of people with disabilities; and
VIII. Promote increased access of health care environments using universal design and ADA.

The project has developed a series of initiatives around access to health care, including a publication, Removing Barriers to Health Care: A Guide for Health Care Professional. Over 6000 copies of this document has been distributed in 37 states. The project has also developed a publication, Depression and Disability and a series of publications and activities around physical fitness specific to the state of North Carolina for people with disabilities.

Training programs have been developed for physical fitness providers and consumers. In that regard, the project has formed a broad partnership base with state agencies and advisory groups to develop curricula, provide access to resources, and conduct train-the-trainer events for fitness providers, recreation directors, and consumers.

Project: New Jersey Department of Human Services Division of Disability Services

Project Director: William Ditto

The New Jersey Capacity Building for Disability and Health Program will be based in the Department of Human Services, Division of Disability Services (DDS), as designated by the Department of Health and Senior Services. The DDS serves as the focal point for cross-disability services in New Jersey.

The first year of the New Jersey Disability and Health Program will concentrate on the establishment of a core unit for health promotion and prevention of secondary conditions within the DDS. Working in partnership with the Department of Health and Senior Services, the Disability and Health Program will be responsible for establishing and orienting a cross-disability, consumer-driven Disability and Health Advisory Board. The Advisory Board will be active participants in the development of a Statewide Strategic Plan for Healthy Promotion and Prevention of Secondary Conditions.

In addition, Disability and Health Program staff will work with the Department of Health and Senior Services, Center for Health Statistics to determine what data may be available to use to determine the current health status of people with disabilities, e.g., hospital utilization data. Staff will also work with the Center for Health Statistics personnel to determine/resolve barriers to adding a unit to the Behavioral Risk Factor Surveillance System to focus on the health status of people with disabilities.

Beginning in the first year and continuing through the second, the Disability and Health Program initiatives will be implemented in collaboration with two university partners. This includes; 1) Rutgers University Center for State Health Policy which will conduct focus groups of women with disabilities to identify more thoroughly barriers to health care or prevention of secondary conditions; and 2) the partnership with the Elizabeth Boggs Center on Developmental Disabilities, New Jersey's Center for Excellence in Developmental Disabilities.

Project: New Mexico Department of Health

Project Manager: Nancy Pieters

The Office of Disability and Health (ODH) of the New Mexico Department of Health works in collaboration with its university-based partner, the Center for Development and Disability in the University of New Mexico's School of Medicine to build and sustain a strong and innovative program of health promotion, research, and capacity-building. It will include:

*Implementation of two proven health promotion interventions that have been pilot-tested in the state, The Take Charge Challenge and Living Well with a Disability, with three targeted populations: Centers for Independent Living, seniors, and youth 14 to 21 years of age;
*Innovative dissemination of training packages for these interventions, including web-based courses;
*Continued collection, analysis and dissemination of disability data from the Behavioral Risk Factor Surveillance System (BRFSS) through a series of policy briefing papers and technical assistance workshops;
*Collection, analysis and dissemination of existing disability data through creation of a database merging disability data from administrative data sets in state agencies in cooperation with the New Mexico Developmental Disabilities Planning Council; and
*Capacity-building efforts within and outside New Mexico to ensure that the health promotion interventions, BRFSS data and data from existing administrative data sets are used by community-based organizations within the state, other CDC-funded state projects, and other programs across the nation both during and after the grant period.The activities described in this proposal have been developed with the active cooperation and advice of members of the New Mexico Disability and Health Advisory Council, and are consistent with and fulfill the New Mexico State Plan for Promoting the Health of People with Disabilities, which focuses on access, health promotion, disability data, physical activity/nutrition and women's health.

Project: New York State Department of Health

Project Manager: Ms. Fran Stevens

The New York State Department of Health (DHP), in partnership with its established advisory group, uses its well-established State Strategic Plan to select and implement statewide and community interventions for health promotion for this population. As such, the DHP is prepared to offer technical assistance to state programs in a variety of areas. The target population for this program is adults with mobility impairments. Chief strengths of the New York program are the longevity of its key staff members, strength in epidemiology and surveillance, documented progress in implementing community interventions, and a public health system approach to a shared information and communication systems.

Based on State Strategic Plan objectives, and with the advice of its disability workgroup and community partners, DHP major activities have included:

I. Completion of the peer training program "Living Well with a Disability" in community agencies;
II. Linkage of major data sets to shed light on potential preventable secondary health conditions among people with mobility impairments;
III. Longitudinal analysis of the Behavioral Risk Factor Surveillance System (BRFSS) quality of life/disability modules;
IV. Regional trainings with YMCAs to adapt fitness programming for people with disabilities;
V. Successful partnership with the Cancer Services Program to increase access to cervical cancer screening and mammography for women with disabilities;
VI. Publication and dissemination of multiple pamphlets on disability and health issues;
VII. The conduct of annual Disability Awareness Week; and progress in incorporating the needs of people with disabilities in other public health programs and interventions.

Project: Oregon Department of Human Services

Co-Project Directors: Grant Higginson, MD, MPH, Charles Drum, Ph.D., J.D.

The State of Oregon Department of Human Services, Division of Public Health Services core activities include:

*Personal Power: Responding to Abuse, Neglect, and Exploitation. This intervention provides knowledge, skills, and resources to people with disabilities, their family members, and other advocates about abuse, neglect, and exploitation.
*Healthy Lifestyles, a workshop for people with disabilities to develop confidence and skills to stay on a journey toward a healthy and happy life. Some of the topics covered include social health, physical activity, emotional health, preventing illness, setting goals and objectives, and identify personal values.
*The Community Engagement Initiative, a community-level intervention that explores the social and behavioral determinants of health. Specifically, this intervention is interested in understanding the lived experiences of people with disabilities and how these experiences influence healthful behavior.
*OODH staff are involved in teaching two graduate courses through OHSU's Department of Public Health and Preventative Medicine's Masters of Public Health Program that provide perspectives on the role of public health as related to disability: 1) Disability and Public Health and 2) Disability and Epidemiology.

Project: Rhode Island Department of Health

Project Director: David Hamel

The Rhode Island Disability and Health Program (DHP), has emphasized the principle of access to health care and related services, for people with disabilities. In recent years, this has been the guiding principle to promote health and wellness and prevention of secondary disabilities for individuals with disabilities in the state. Throughout its history, the DHP has worked to integrate disabilities into the fabric of public health and into the mainstream of health services of the Rhode Island disability community at large. As such, the DHP has conducted ongoing disability surveillance systems, effected significant influence on disability programs and state policy, targeted interventions benefitting people with communication impairments, and implemented education programs for primary health providers and support staff serving people with disabilities.

For the project period ahead, the DHP proposes to address:

*assistive technology interventions targeting people of all ages with communication impairments;
*education/training of support staff and primary health care providers who serve consumers with communication impairments; and
*education/training of support staff and primary care providers who serve people with communication impairments, as well as other disabilities.

In addition, the DHP will continue to provide ongoing disability surveillance for the state which is critical for program planning and policy development and refinement. The project will use the national BRFSS (Behavioral Risk Factor Surveillance System) and the Rhode Island Health Interview Survey as the data basis for long-range planning for the health and wellness of people with disabilities in the state. Strategic planning efforts will be based on objectives promulgated via Healthy People 2010 as adapted in Healthy Rhode Islanders 2010, with special emphasis on access needs for people with disabilities to achieve stated health objectives.

Project: University of South Carolina

Project Director: Suzanne W. McDermott, Ph.D.

The South Carolina project has a strong state health agency and university partnership focused on disability issues, most notably the prevention of secondary conditions. The committed partners in the process are from the Department of Disabilities and Special Needs at the University of South Carolina School of Medicine and the South Carolina Department of Health and Environmental Control; who together formed the Interagency Office of Disability and Health (IODH). In addition, the project works with numerous advocacy groups, individuals with disabilities and representatives from other state agencies and organizations on the well established advisory council, the South Carolina Developmental Disabilities Council.

During the new five year project period, the IODH will continue to focus on:

*Health promotion (healthy eating, exercise and stress management);
*Enhancing recreation and sports opportunities;
*Providing technical assistance to health facilities and sports clubs and gyms on ADA compliance; and
*Surveillance of disability issues related to prevalence, employment, and onset of secondary conditions.

The proposed activities reflect a continuation as well as an expansion of the long-established state disability and health program. The partners have incorporated a data-based approach with state and community collaboration and continuous evaluation. The primary emphasis will be on the promotion of health for people with disabilities and the prevention of secondary conditions.

Specifically, the project will work with county and city-based recreation providers, private doctors' offices, gyms and health clubs, and a wide range of community groups. During the next five years, the project expects to increase the visibility of disability wellness activities in secondary conditions surveillance and prevention in state health agency programs, and in the community at large.

Project: Virginia Department of Health

Project Director: Ramona D. Schaeffer

The purpose of the Virginia Department of Health (VDH) project is to develop the infrastructure and build the capacity necessary to implement a comprehensive program to optimize the health status of people with disabilities, particularly from secondary conditions. With the state's public health agency preparing to commit to this area of endeavor, the overall plan can be understood in terms of the core functions of public health.

Assessment: As a newly funded state project, there are specific research questions to be addressed in order to inform program development. Accordingly, VDH will collaborate with its university partners and sister health and human services agencies to establish and implement those agendas.

Policy Development: VDH, as the lead agency, will undertake an internal review of existing policies and assess the need for revisions and new policy development to address the provisions of the Americans with Disabilities Act as applied to current programs and services. In collaboration with external partners - including the state Medicaid agency, the Department of Rehabilitative Services, and the Virginia Association of Health Plans - the project staff will consider the impact of reimbursement and eligibility policies on access to and utilization of primary care for people with disabilities.

Assurance: VDH will take a number of actions to assure that the health promotion needs of this population are addressed, including incorporating the relevant Healthy People 2010 objectives as they relate to disability and secondary conditions into the State Health Plan. The new project will also direct dedicated staff and programming to continually support inclusion of this population and its special needs in existing programs and services.

Project: Vermont Department of Aging and Disabilities

Project Director: Joan K. Senecal

The Vermont Department of Aging and Disabilities (DA&D) is a new state project proposing to implement a statewide, collaborative project to prevent secondary conditions and promote health for Vermonters with disabilities. The target population will be adolescents and adults.

State collaborators and partners in the Vermont Disability and Health Promotion Project are DA&D, the Vermont Department of Health, the Vermont Department of Developmental and Mental Health Services, and the Office of Vermont Health Access (Medicaid). Other collaborators and partners include the Vermont Center for Independent Living, the University of Vermont, the Vermont Program for Quality in Health Care, and the Vermont Area Health Education Centers. The Project will utilize the resources of Vermont non-profits and disability organizations, and Massachusetts-based ADA technical assistance.

The goals of the Vermont Disability and Health Promotion Project are to prevent secondary conditions for people with disabilities through health promotion, decrease the health disparities between people with and without disabilities, and ensure that public health disease prevention and health promotion programs are accessible to people across age and disability.

The major first year objectives are to:

*Gather and analyze information on the prevalence of risk factors and secondary conditions for Vermonters with disabilities across age and disability;
*Identify gaps in information regarding risk factors and secondary conditions for Vermonters with disabilities across age and disability and develop steps to address them;
*Identify gaps in primary care provider knowledge, skills and practice and steps to address them;
*Identify barriers and gaps to and in health promotion programs and steps to address them, including ADA compliance; and
*Outline and develop the State Plan for Health Promotion for People with Disabilities.

Project: Washington State Department of Health

Project Director: Debra Lochner Doyle

The Washington State Department of Health functions with partners operating as contractual partners at the University of Washington School of Public Health and Community Medicine's Center for Disability Policy and Research (CDPR), and in local health jurisdictions in Spokane County, Jefferson County, and Grays Harbor County. The project was designed to be a national model because of its public-private-academic sector partnerships, in addition to its unique orientation toward public health measurement of disability at the county level and inculcating "environmental" disability interventions at that local level.

The philosophical and structural orientation exhibited by this project focuses on changing the environments in which disabled Washingtonians live and work, rather than on changing characteristics within those disabled individuals themselves. This would be accomplished by involving people with disabilities, service providers and community partners in interventions to improve community accessibility through the reduction of environmental and social barriers, assuring program access, and raising community awareness of disability.

At the state level, emphasis is placed on assessment and policy development activities. Through these activities, awareness of disability issues and health promotion for people with disabilities throughout the state is achieved. A Washington State Plan for Disability and Health has been developed and includes additional activities such as:

*advocacy within the state health agency
*participating in state level interagency committees
*disseminating disability data
*building partnerships with other organizations concerned about disability issues.

The University of Washington CDPR contributes to state-level activities by collecting and analyzing population-based disability data, developing measures of secondary conditions, and supporting program evaluation.

© 2003