A Healthier Future for West Virginia - Healthy People 2010

6 - Disability and Secondary Conditions

Objectives | References

Background

According to the Americans with Disabilities Act of 1990, a person is considered as having a "disability" if he or she meets at least one of the following criteria: (1) He or she has a physical or cognitive impairment that substantially limits one or more major life activities; (2) he or she has a record of such an impairment, and/or (3) he or she is regarded as having such an impairment.

In spite of recent federal legislative initiatives and funded programs, there remains a discrepancy in the quality of life between persons with disabilities and their non-disabled peers in the areas of self-care, independent living, social skills, self-determination, education, health and safety, employment, and leisure. Programs that serve persons with disabilities vary from state to state with respect to the extent and quality of services provided. This is due, in part, to the geographic and demographic make-up of each state, unemployment rate, and tax base within the individual state. For example, states that are largely rural, like West Virginia, are less likely to have an accessible system of transportation; persons with low incidence disabilities may be widely scattered, making it difficult to provide services; persons with disabilities are less likely to secure employment when they must compete with non-disabled peers for a small pool of jobs; and the wealth of individual state and local governments determines the amount of state funding available to initiate or sustain programs serving individuals with disabilities. The elimination of such barriers is crucial to improving the quality of life for all individuals with disabilities.

The U.S. Census of 1990 reports that 35% of West Virginians are identified as having a disability. Of those, 19% are rated as severe. Approximately 3% of this population have difficulty with self-care, a major quality of life area. Survey research conducted by Keith and Stewart in 1992 found that approximately one-third of West Virginia households included a person with an identified disability. Of the adults who responded to this survey, one in five reported requiring professional care for their disability. Primary disabilities with concomitant chronic health problems and physical limitations occur within the aging population of West Virginia. Additionally, poverty, low educational levels, lack of prenatal care, and teenage pregnancies may contribute to high incidences of disability among infants born in the state.

One of the most important quality of life issues influencing a person's emotional, social, and financial well-being is their employment status. Not just having a job, but having a job that complements one's work personality, is critical to a feeling of satisfaction with one's state in life. Holland theorized that an individual's occupational choice is a reflection of one's personality. For example, a person with an artistic-type personality would be happiest in a work environment that allowed them full expression of their talent. Where jobs are scarce, people with disabilities are often steered into available jobs versus jobs that suit their individual work personality type. If job satisfaction is directly linked to the closeness of fit between work personality type and work environment, then dissatisfaction with one's job could lead to poor performance and failure to retain employment. In West Virginia, employment options for people with disabilities are often limited to sheltered workshops or part-time, low-paying jobs. Yet, supported employment options and a move to competitive employment may offer a wider range of career choices for people with disabilities.

As employment fosters the mental, social, and financial well-being of adults, educational placement opportunities with non-disabled peers have been shown to build social skills, produce long-term employment options, and promote mental health and self-esteem for school-age children with disabilities. Statistics provided by the West Virginia Department of Education (WVDOE) indicate that, in fiscal year 1999, 20% of students receiving special education services participated in full-time regular classroom placements and 60% were in part- time regular education services. This corresponds to similar numbers nationwide. Both the state traumatic brain injury and spinal cord injury model plans call for promoting participation in regular educational programs. A statewide commitment to making rural schools more accessible and the WV Office of Special Education's strategic improvement plan will impact the number of children participating in regular education.

Survey research has identified a variety of barriers to the health and well-being of people with disabilities in West Virginia. These include (a) physical barriers that prevent access to work, education, recreation, and community participation; (b) informational barriers in rural communities that limit the amount of health care and other information for people with disabilities; (c) transportation barriers that limit access to health care and social interaction; (d) lack of access to assistive technologies and specialized curricula that would promote independence at work, home, and school; and (e) governmental policies that limit health care services and supports.

The U.S. Department of Health and Human Services has designated areas in 40 West Virginia counties as all/part Health Professional Shortage Areas and 50 counties as all/part Medically Under served Areas. This severely impacts people with disabilities because of their special health care needs. A recent survey conducted by the West Virginia University Affiliated Center for Developmental Disabilities (UACDD) questioned clients of WV Children with Special Health Care Needs and found that 57% of children with seizure disorders, 50% with myelomeningocele, 48% with orthopedic issues, and 25% with cardiac problems were in need of feeding and nutrition intervention.

Mental Health: A Report of the Surgeon General, 1999 stresses that mental health is a critical public health problem. Annually, approximately 40 million Americans are reported as having some type of mental illness. Based on figures published in the Federal Register, approximately 2.6% (35,099) of the adult population and 13% (54,847) of the child population of West Virginia experience serious mental illness or emotional disturbance. Treatment for such disorders is often dependent on the individual's financial status. As Dr. David Satcher, United States Surgeon General, notes, "…formidable financial barriers block off needed mental health care from too many people regardless of whether one has health insurance with inadequate mental health benefits, or is one of the 44 million Americans who lack any insurance."

Leisure, respite, and recreational activities are known to improve satisfaction with life, increase the number of health days, and promote personal and emotional support. According to both the traumatic brain and spinal cord injury surveys conducted in 1998 and 1999, the lack of recreational and leisure opportunities for people with disabilities limits their ability to integrate successfully in their communities and ease pressures associated with disability. Specific needs are indicated in the areas of family and emotional support systems enhanced by leisure and recreational opportunity.

The Objectives

OBJECTIVE 6.1. (Developmental) Include a comparable core set of items to identify people with disabilities in data sets used for Healthy People 2010. People with disabilities should be part of the overall collection of data. (Baseline data available in 2001)

Data Sources: West Virginia Developmental Disabilities Council (DDC); UACDD; Office of Behavioral Health Services; Traumatic Brain Injury (TBI) Registry

The last statewide collection of information regarding the incidence and prevalence of disability in West Virginia was conducted by Lindberg and Putnam in 1979. Several small sample surveys have subsequently assessed the needs of people with developmental and other disabilities. These surveys provide some information for the current objectives but, as indicated in the national Healthy People 2010 draft, "the elements…that explicitly call for improvement for people with disabilities are limited by the availability of data with which to set targets." As with national data, approaches to include a demographic-like variable identifying people with disabilities is yet to emerge in West Virginia. The addition of disability questions to ongoing data assessments would more successfully include the same type of health care status information for people with disabilities as information available regarding the general public.

FLAGSHIP OBJECTIVE
OBJECTIVE 6.2. (Developmental) Increase employment rates among people with disabilities to reflect equal percentages of employment opportunities for people who want to work both with and without disabilities. (Baseline data available in 2000)

Data Sources: West Virginia Division of Rehabilitation Services (WVDRS), Spinal Cord Injury Survey; Job Accommodations Network; DDC

Employment promotes the inclusion of people with disabilities in the mainstream of adult life, identifies them as valuable contributors to their community, and enhances their self-esteem. However, according to national data, the unemployment rate is 70% among adults with severe disabilities. In a recent survey of people with spinal cord injury in West Virginia, of the 70% of adults employed prior to injury, only 24% remained employed after their injury. Furthermore, according to the 1990 census, only 21% of West Virginians with disabilities between the ages of 21 to 64 are employed. Data from a National Organization on Disability (NOD)/Harris Survey of Americans with Disabilities reports that " (a) only three in 10 working-age (18-64) people are employed full or part-time, compared to eight in 10 working-age people without disabilities (32% versus 81%); (b) two out of three unemployed people with disabilities would prefer to be working; and (c) fully 56% of people with disabilities who say they are able to work are working today, compared to 46% in 1986."

There are major disincentives to employment for people with disabilities. These include the fear of losing Medicaid or other health care benefits and the need for accommodations at the work place. The total number of persons (working and nonworking) with a work disability within West Virginia is 143,379. According to a March 2000 the Social Security Administration report, West Virginia has 1,954 working recipients. This represents 3% of all WV SSI-disabled recipients. New work incentives at the national level should have a positive impact on eliminating these barriers over the next 10 years. The Job Accommodations Network confirms that accommodations needed for employment supports are generally low-cost and low-tech.

OBJECTIVE 6.3. Increase to 87% the proportion of children with disabilities included in regular education programs with appropriate supports. (Baseline: 82% in 1999)

Data Source: WVDOE, Exceptional Students in West Virginia's County School Districts: Selected Child Count and Financial Data

As reported in fiscal year 1999, currently 80% of school-age children in West Virginia are being served through a combination of full- or part-time participation in regular education classrooms.

OBJECTIVE 6.4. (Developmental) Ensure that environmental factors are identified as barriers to participation at home, work, and in the community by equal proportions of people with and without disabilities. These factors include:
6.4a. Access to buildings (Baseline data available in 2000);
6.4b. Access to information, communications, devices, and technology (Baseline data available in 2000);
6.4c. Transportation (Baseline data available in 2000); and
6.4d. Governmental policies (Baseline data available in 2000)

Data Sources: West Virginia Assistive Technology System (WVATS); WVDRS, Spinal Cord Injury Survey; DDC; WV's Americans with Disabilities Act Office

OBJECTIVE 6.5. (Developmental) Increase the number of service providers offering appropriate health care with special emphasis on dental, nutritional, and mental health care needs. (Baseline data available in 2003)

Data Sources: U.S. Department of Health and Human Resources, Bureau of Health Professions; West Virginia Bureau for Public Health (WVBPH), Office of Maternal, Child & Family Health, Children's Dentistry Services

Although children with disabilities can receive dental care through Children with Special Health Care Needs, adults with disabilities have few or no supports for dental services. Recently a new program, Donated Dental Services, has offered a limited number of West Virginians with disabilities the opportunity for dental care.

OBJECTIVE 6.6. (Developmental) Increase the accessibility of leisure and recreational opportunities for people with disabilities. (Baseline data available in 2002)

Data Sources: WVATS; TBI; WVDRS, Spinal Cord Injury Survey

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

West Virginia offers a number of agencies that provide services to people with disabilities as the cornerstone of their mission. Their missions are consistent with meeting the previous six objectives. These include, but are not limited to:

Developmental Disabilities Council
University Affiliated Center for Developmental Disabilities:
Parent Network Specialists
State Program for TBI/SCI
Maternal and Child Health/LEAD Grant
Rural Education for Appalachian Community Health (REACH) Grant
West Virginia Assistive Technology System (WVATS)
West Virginia Advisory Council for the Education of Exceptional Children
W.G. Klingberg Center for Child Development
West Virginia Department of Education
West Virginia Division of Rehabilitation Services
West Virginia Office of Behavioral Health Services

Work Group Members

Mary Ellen Zeppuhar, EdD, Work Group Co-Leader, Assistant Director for Education and Community Support, UACDD, Robert C. Byrd Health Sciences Center, West Virginia University (WVU)
Sherry Wood-Shuman, EdD, Work Group Co-Leader, Senior Deputy Director, UACDD, Robert C. Byrd Health Sciences Center, WVU
Colleen Anderson, Parent Network Specialist, UACDD, Robert C. Byrd Health Sciences Center, WVU
Chet Johnson, MD, Director, Klingberg Child Development Center, School of Medicine, Department of Pediatrics, WVU
Frank Kirkland, BS, Director, Division of Developmental Disabilities, Office of Behavioral Health Services, WVBPH
G. Thomas Minshall, MAT, MA, Program Development Specialist, West Virginia Division of Rehabilitation Services
Samuel K. Mullett, TBI/SCI Rehabilitation Fund Board Member. Consumer who has experienced a traumatic brain injury.
Mary Nunn, MA, Assistant Director, Office of Special Education, WVDOE
Jeff Werner, MS, RD, LD, Program Manager, REACH, UACDD, Robert C. Byrd Health Sciences Center, WVU
Steve Wiseman, MS, Executive Director, West Virginia Developmental Disabilities Council

References/Resources

Americans with Disabilities Act. 1990.

Dawis R and Loftquist L. A Psychological
Theory of Work Adjustment. Minneapolis, MN: University of Minnesota Press, 1984.

"Health Professional Shortage Areas." Rural Partnership Newsletter 3.5 (Spring 1997): 8.

Keith B and Steward J. An Assessment of Disability among West Virginians and Households in West Virginia. Morgantown, WV: WVU, West Virginia Survey Research Center, 1992.

Lindberg D and Putnam J. The
Developmentally Disabled of West Virginia: A Profile of the Substantially Handicapped Who Are Not in Institutions. Elkins, WV: Report of the West Virginia DD Needs Survey Project, Davis and Elkins College, 1979.

McQuain S, ed. Exceptional Students in
West Virginia's County School Districts: Selected Child Count and Financial Data. Charleston, WV: West Virginia Department of Education, 1999.

National Organization on Disability. Survey Report. 2000.

Spokane AR et al., eds. Career Choice
and Development. 3rd ed. San Francisco, CA: Jossey-Bass, 1996.

Taylor S et al., eds. Quality of Life:
Perspectives and Issues. Washington, DC: American Association on Mental Retardation, 1990.

For More Information

University Affiliated Center for Developmental Disabilities
955 Hartman Run Road, Research Park
Morgantown, WV 26505
Phone: (304) 293-4692; Fax:(304) 293-7294

This page was last updated June 13, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov