Core

1. Health Promotion, Community Participation

Steps to Your Health (STYH) is a community based health promotion and wellness program designed for adults with intellectual disabilities. The goal is to develop healthy behaviors and improve health status through physical activity, a healthy diet, stress reduction and health maintenance. The ten week intervention consists of pre and post assessments and small group interactive lessons presented over eight weekly 90 minute sessions.

The short term expected outcomes include establishing strategies for optimum health, increasing health knowledge, and implementing healthy behaviors. The long range outcomes are improved health and wellness, including increased stamina, energy and strength, and prevention of additional or secondary health problems.

Lesson topics for STYH include nutrition, exercise, stress management, cognitive restructuring, communication styles, complications of obesity, behavior management, and relapse prevention. Participants are offered two home visits related to nutrition and exercise. The nutrition visit is a trip to the grocery store accompanied by an instructor. The exercise visit focuses on developing an individualized exercise program, selecting activities and an activity schedule. Several manuals have been developed to help facilitate the program. There is a workbook for participants and a curriculum guide for the health educator. An exercise guide and a cookbook are included in both the participant’s and facilitator’s manual.

IODH staff facilitate regional and county level train the trainer workshops several times each year and upon requests as well as provide technical assistance to trainers implementing the program. A number of Disability and Special Needs (DSN) Boards throughout the state are currently implementing the program.

Community Health Ambassador Team (CHAT) is a new initiative to recruit and establish CHAT members.  This project began as an outgrowth of discussions between our Project Director, Suzanne McDermott, and members and staff of our Advisory Council (the Developmental Disabilities (DD) Council) and the Department of Health and Environmental Control (DHEC).  In the initial phase of this endeavor associates of Partners in Policymaking (PIP), Organizing Partners to Improve and Maximize Advocacy (OPTIMA), Individuals Motivating People to Achieve Change in South Carolina (IMPACT SC) and members of the DD Council who are self-advocates or parents will be our primary partners. 

The mission of the CHAT initiative is to help self-advocates (and family members of self-advocates) recognize the need to become more active participants in decisions affecting their personal health and to empower CHAT members to assume a leadership role in promoting healthier behaviors.  Advocates are trained to use their influence to advocate for and help implement policies and programs that can improve their individual health as well as the health of their local community. 

We recently had a day-long CHAT Recruitment Workshop and three additional regional workshops will be held in the upcoming months.  Self-advocates and parents of children with disabilities will be identified to serve on local DHEC Advisory Boards or Task Forces of interest and to participate in local community health programs and initiatives.  SC IODH will provide linkages for specific opportunities for participation in local communities based upon CHAT member’s interests and needs.  Two to three months after each CHAT Recruitment Workshop, follow-up meetings will be held in each region of the state to give CHAT members an opportunity to share successes and discuss possible solutions to obstacles encountered. 

Please contact Marlo Thomas-Koger for questions or additional information.

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2. Health Promotion/Marketing and Communication

The goal of this component is to increase the communication and marketing of existing public health and wellness programs so they show and tell people with disabilities they are welcome to participate.

IODH and several DHEC Divisions implement the Disability and Health Outreach Initiative to increase representation of people with disabilities in marketing material and to include people with disabilities in marketing procedures.  Photo shoots have been held to include people with disabilities in stock photos that can be utilized throughout DHEC. Accessibility is being incorporated into the pandemic flu materials and marketed to people with disabilities through the DHEC Office of Public Health Preparedness.  DHEC has integrated some of the photos of people with disabilities throughout their flu home page.  You can also see additional photos included on the subsections for group and residentials settings, individual/family and caregiver, high risk groups and business/employer.  The All-Health Team of DHEC is looking for youth who are making a positive impact on the health of thier community.  SCIODH has worked with the All-Health Team to encourage all applicants to include children with disabilities in their projects.  We are so pleased to see the latest television ad for the newest All-Health All Star "Wii Are All Fit Project".  DHEC Office of Public Health Social Work has incorporated a lecture “Working with Clients with Disabilities” given by IODH staff into their annual Lunch and Learn series.

Presentations and seminars are given to fitness and recreation staff as well as people with disabilities regarding accessibility to such sites. We collaborate with and utilize the following agencies for information dissemination: DDSN Head and Spinal Cord Injury Division, DDSN Autism Division, DDSN Mental Retardation Division, SC Spinal Cord Injury Association, SC Traumatic Brain Injury Association and the SC Developmental Disabilities Council.

IODH continues to promote Splash Bash, a recreational opportunity for people with phyiscal disabilities.

Please contact Catherine Leigh Graham for questions or additional information.

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3. Emergency Preparedness

IODH Staff collaborates with the SC Emergency Management Division’s Emergency Planning Committee for People with Functional Needs. IODH Rehabilitation Engineer chairs the working group. The goals of this core activity are ensuring that disaster preparation in SC includes plans for evacuation, shelter and recovery of people with disabilities and the accommodation will be made by first responders and disaster workers as well as ensuring that people with disabilities are involved in the preparation and response and will be informed of their responsibilities and the available resources.

We continue to work with lead emergency response agencies to ensure that their standard operating procedures include preparedness and response items related to people with disabilities. We assist in the planning and present at the annual FEMA G197 course on Emergency Planning for Special Needs Populations. We are working with the American Red Cross, Department of Education and our partners to address shelter accessibility. An accessible emergency shelter video was produced to include the needs of those with disabilities. This video will be played on a loop at all shelters once they are opened. Staff collaborates with the annual SC Hurricane Conference to have an educational session(s) that is applicable to people with disabilities.

We are also working closely with the DHEC Office of Public Health Preparedness regarding preparedness, communication, response and quarantine for people with disabilities.

We are participating "The Great Central US Shake Out:  The Largest Earthquake Drill in South Carolina History" on February 7th at 10:15am.  This 1 minute drill will test people's preparedness in the Drop, Cover and Hold On drill for 1 minute.  We are disseminating the information to multiple disability organizations along with specific information on how to safely complete the drill if you have a disability.



Resources:

(click your choice resource to view)

• Emergency Planning for Citizens with Special Needs – Hurricane
• Emergency Shelter Accessible Intake Video
• Emergency Planning for Citizens with Special Needs – Earthquake
• 2007 Hurricane Workshop Agenda
• Preparedness for Pandemic Flu

 

Please contact Catherine Leigh Graham for questions or additional information.

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4. Livable Communities/Universal Design

IODH staff facilitates access to primary care physician offices, increasing access to fitness and recreation facilities and working with community planning agencies and officials to improve accessibility and ensure we have livable communities.

One goal of this component is to increase the number of medical practices that are ADA compliant so there will be fewer barriers for people with disabilities. The IODH Rehabilitation Engineer conducts free site assessments to public and private health care providers. Reports are generated with suggested modifications for facilities. Eligible facilities can apply for grant monies to make the suggested accessibility modification. Grant monies have been secured through and insurance provider (SC Blue Cross/Blue Shield) and the SC Developmental Disabilities Council via the Office of Rural Health. In addition, low interest loans are offered to providers through the Office of Rural Health. This is in partnership with the American Cancer Society and The Best Chance Network.

A second goal is to increase the accessibility of fitness centers, gyms, parks and recreation areas throughout the state. IODH staff conducts accessibility trainings which cover both structural and programmatic issues with staff. Staff provides technical assistance via phone and email to additional facilities to increase accessibility.

We are working closely with our Richland County Councils Complete Streets Project to ensure accessibility throughout the community development.

Please contact Catherine Leigh Graham for questions or additional information.

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5. Training for Professionals and Paraprofessionals

The goal of this component is to assure medical students at the University of South Carolina have the knowledge and tools to screen, diagnose and treat the whole person with a disability with dignity (Surgeon General’s Call to Action).

This is accomplished through a lecture in the second year of medical school, followed by a seminar, with interactive components, during the third year Family Medicine clerkship. The 90-minute session is presented to all third year medical students during the 6-week FM clerkship. It includes scenarios that focus on disability as a demographic characteristic, medical condition, and secondary considerations in typical primary care visits while emphasizing the many issues that are not different from the average population. We concentrate on PWDs with mobility impairments (i.e. spinal cord injury (SCI)) and those with cognitive impairment (CI). Examples of content in the SCI section are physical complications due to lack of consistent weight bearing and/or damage to the spinal cord; physical access issues associated with the use of a mobility device, such as a wheelchair; and clinical considerations including pressure ulcers, osteoporosis, autonomic dysreflexia, bladder and bowel issues, joint pain, weight management, sexuality issues and blood clots. Examples of content in the CI section are typical characteristics of a person with CI including concrete thinking, short attention spans, and limited ability to generalize; and the risk of prevalent medical conditions such as dementia and seizures. The class instructors, a Rehabilitation Engineer with an SCI and a Family Medicine Professor with a daughter that has a cognitive impairment, have extensive professional and personal experience with disabilities and the healthcare field.

The medical students are all tested at the end of their Family Medicine rotation using Standardized Patients (SP), with and without disabilities, on the Objective Structured Clinical Exam (OSCE). Some students see an SP with a spinal cord injury, others see an SP with a cognitive impairment and a caregiver, and a third group sees an SP without a disability for the final OSCE scenarios that replicate typical FM visits. This allows us to evaluate the effectiveness of the curriculum. SCIODH staff collaborated with Dr. Nancy Richeson in Medical Education at USC - School of Medicine and Dr. Rachel Brown in Family Medicine to modify typical exam scenarios to accommodate issues necessary for Standardized Patients (SP's) with disabilities.  Dr. Richeson, who trains all SP's for USC - School of Medicine, assists with training of our Standardized Patients with disabilities to ensure their performance and feedback to the students is equal to other SP's throughout the medical school.  For additional information see a short (3 minute) or long (8 minute) video of the OSCE program on the CDC website or the SCDDSN Prevention and Wellness committee newsletter.

IODH Rehabilitation Engineer participates in the Alliance for Disablity in Healthcare Education group which is focused on healthcare professional education relating to people with disabilities. The group has members nationwide encompassing medical, nursing and dental schools disability curriculum and experiences. The Alliance has presented a collaborative poster, Disability-related experiences in health care curricula, at the AAMC's Northeast Group on Education Affairs in Hershey, PA in May of 2009 and a Chair's Forum presenation "Access to Medical Care and the ADA:  Educating Health Professionals as a Force for Culture Change" at APHA in Denver, CO in November 2010.  The Alliance co-authored 3 papers published in Academic Medicine in 2011 (see articles section). 

Please contact Catherine Leigh Graham for questions or additional information.

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6. Disability Surveillance

The South Carolina Disability Surveillance System coordinates data collection from existing data sources and the BRFSS. The major functions for the surveillance program are to provide estimates of disabilities with respect to time, place, and person level and to evaluate the impact of targeted health promotion programs. The population under surveillance is the general population of South Carolina. The identification of individuals with disability is accomplished through use of the BRFSS, Medicaid, and administrative data.

We monitor the BRFSS questions for health service utilization and access to preventive services for individuals with and without disabilities and will use the disability surveillance data to report annual trends in incidence, prevalence and severity of disability. Our secondary emphasis is surveillance of employment for South Carolinians with cognitive disabilities in collaboration with SC DDSN. Finally, we focus on the administrative data to evaluate interventions sponsored by the IODH.

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The Behavioral Risk Factor Surveillance System (BRFSS) Data Set

The BRFSS is the state-based surveillance system and SC DHEC has conducted the survey continuously since its initiation here in 1984. It primarily provides information on risk behaviors among the adult component of the population. The SC BRFSS data have served as the backbone of our surveillance activity and we have conducted special studies to analyze the interplay of disability and many of the health promotion and disease prevention activities, as well as health services utilization. BRFSS results have been used in a variety of ways in SC to support and evaluate disability surveillance and prevention practices and to meet DHEC and CDC priorities. For the IODH these data are a fundamental component of our surveillance strategy and will be used for targeting and evaluating health promotion programs.

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Surveillance of Employment for People with Disabilities in South Carolina

In addition to the traditional health status surveillance activities, the SC IODH has conducted employment surveillance since 1995. This is because employment is one of the top three stated goals for adults with disabilities and unemployment rates are extremely high. Based on a thorough literature review about employment for people with disabilities we determined there was insufficient data about the subset of individuals with cognitive limitations on a longitudinal basis. We use a combination of active and passive reporting to obtain the numerator (individuals with a job) and the denominator (individuals served by DDSN who have some potential for employment).

In summary, the surveillance component requires interagency collaborations. Experienced personnel who are familiar with the data elements and formats handle data maintenance and analysis. Annual reports compiled from the analyses are distributed to the Advisory Council.

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Employment Publications

• Howarth, E, Mann, J, Zhou, H, McDermott, S, Butkus, S. What Predicts Re-employment after Job Loss for Individuals with Mental Retardation? Journal of Vocational Rehabilitation, 24.3, 2006, 183-189.
• Pierce, K., McDermott, S. Butkus, S. Predictors of Job Tenure for New Hires with Mental Retardation, Research in Developmental Disabilities, 24 (5), 2003, 369-380.
• Moran, R., McDermott, S., Butkus, S. “Getting, Sustaining, and Losing a Job for Individuals with Mental Retardation” Journal of Vocational Rehabilitation, 16 (3,4), 2002, 237-244.
• Gray, B. McDermott, S., Butkus, S. “Effect of Job Coaches on Employment Likelihood for Individuals with Mental Retardation” Journal of Vocational Rehabilitation 14, 2000, 5-11.
• McDermott, S. Martin, M., Butkus, S. “What Individual, Provider, and Community Characteristics Predict Employment of Individuals with Mental Retardation?” American Journal on Mental Retardation, 37(4), 1999, 346-355.

 

Please contact Suzanne McDermott for questions or additional information.

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Module D

Staff collaborates with the Council of Governments in several locations throughout the state. In the central region of the state, staff participates in the Bike and Pedestrian Committee to ensure the pedestrian pathways for physical activity and community access are accessible to those with disabilities. IODH Rehabilitation engineer has participated in one town’s 10 year master plan to incorporate accessibility and aging in place issues.

Staff works with community and advocacy groups to replicate and continue support for a free transportation program “Wheels” for elderly and people with disabilities. This program provides transportation to everyday activities (grocery store, movie, theater, and medical appointments) that facilitate people staying in their own homes and decrease the need for relocation. The program was replicated for the first time in 2007 in a downtown area of the capital city and again in 2009 in the northeast section of the capital city.

Staff continues to work with the SC Department of Transportation on their ADA Transition Plan to ensure that all DOT owned roads, street, sidewalks and other public rights of way areas are accessible to people with disabilities.  IODH staff, along with SCDOT staff is implementing a 3 hour sidewalks/streets and crossings seminar that will be taught multiple times statewide to DOT planners and engineers.

IODH Rehabilitation engineer provides course instruction on “Universal Design and Public Rights of Way” and “ADA and Buildings”. Courses are given to local and state building code officials, planners and fire marshals. Both of these courses have been approved for 1.5 ceu’s through Labor, Licensing and Regulation.

IODH Rehabilitation Engineer is a Board member of the Office of School Facilities Planning Committee and works to ensure that newly constructed/renovated schools comply with the ADA.  Accessibility of schools is not only critical to the educational offering for students with disabilities but also critical as schools in SC are often used as hurrican emergency shelters which benefit the whole community when they are accessible.

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Module F

Our Module F activities involve a collaboration with the South Carolina Office of Research and Statistics (ORS) to develop a Disability Cube for South Carolina. ORS is a central setting that houses state data and links persons across multiple service providers. Through a series of agreements, state agencies and organizations entrust their data systems with the ORS while retaining control of their own data at all times. The philosophy for the data warehouse is: “It is the entire human experience that influences health and social well-being and should therefore be captured in an integrated data system.” The ORS developed a series of algorithms using various combinations of personal identifiers to create its own unique identifier, enabling statistical staff to “link across” multiple providers and settings while protecting confidentiality of the client. The current data warehouse includes information from: (1) health services, (2) social services, (3) mental health, (4) disabilities, (5) alcohol and drug abuse programs, (6) education, (7) criminal justice, (8) elderly services, (9) housing, (10) public safety, (11) registries, etc Information on hospitalizations, emergency room utilization, outpatient or ambulatory surgeries, office visits, home health, and nursing centers.

The Disability Cube, currently under development, will include linkages to a broad range of agencies and outcomes, including the Department of Disabilities and Special Needs (DDSN), the Department of Education, the Department of Health and Environmental Control (DHEC), the Department of Elder Services and Assessments and the Department of Social Services. With the Disability Cube, a user will be able to ascertain whether, for example, people with disabilities are more likely to be victims of reported abuse and neglect – and whether certain disabilities appear to convey greater risk than others. Similarly, a user could assess school dropout rates for children with and without a disability. Such information can be used by policy makers for policy development, and by agency staff for program evaluation purposes.

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