academic planning for health professionals centered on persons with intellectual disabilities

Special Olympics Florida

Presentation for Future Health Professionals Centered on Persons with Intellectual & DevelopmentalDisabilities (IDD)

Figure 1. Physical Therapy Train-Train-Trainer Session


Outline

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Background

Objectives

Methods

Conclusion

Recommendations

Discussion

Pictures from Healthy Community Screenings and Intervention Programs


AbstractPreparing future health professionals academically to provide effective healthcare and multi-disciplinary services to individuals with intellectual or developmental disabilities (IDD) seems to be missing from many university curricula. Existing curricula for these professionals lack information to the needs of the IDD population. It is critical that aspiring health professionals recognize the challenges that come with providing healthcare and services to the IDD population. It is necessary that the preparation of addressing these individuals into their areas of practice, that is, to provide care, develop intervention programs, and educational presentations based on the myriads of health issues found in this population. Experiential learning with a qualified mentor prepares individuals who may not have had prior experiences in serving this population. This presentation explores the current issues relating to the knowledge deficiencies of future health professional to serve the IDD population. Reviews of recent literature confirmed this proposition.

Keywords: health professionals, healthcare education, disabilities, academic planning.


Objectives

• Prepare health students to become more aware of the developmental health issues faced by adults with intellectual disabilities.

• Equip students to provide effective health education, interventions, and multi-disciplinary services centered around the IDD population.

• Fill the knowledge gaps in order to help prepare future health practitioners to promote inclusion of this population into their fields of practice.

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Background

• The area of intellectual disabilities has often been described as the Cinderella discipline of medicine, (Prasher & Janicki, 2003).

• Nearly 200 million in the world live with some form of intellectual or developmental disability (IDD), and the prevalence is on the rise (World Health Organization [WHO], 2011).

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• Individuals with IDD experience poorer health than the general population (Krahn, Hammond, & Turner, 2006).

• Yet, health students from various health disciplines, are entering their fields ill prepared to teach, and provide services this population as personally experienced.

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Discussion

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Figure 2. Public Health and Nutrition Training Session


Health Students Entering their Fields Unprepared to Serve the IDD Population

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In a recent SO research study, the following individuals responded that graduates were “not competent” to treat people with IDD :

• 52 percent of medical school deans

• 53 percent of dental school deans

• 56 percent of students • 32 percent of medical residency

program directors (Special Olympics [SO], 2005).

Figure 3. Health Education Training Session


The reasons given for this startling deficiency were that:

• 81 percent of medical school deans and 50 percent of dental school deans say that clinical training regarding individuals with intellectual disabilities is not a high priority.

• 81 percent of medical school students say they are not getting any clinical training regarding individuals with intellectual disabilities and two-thirds (66 percent) are not receiving enough classroom instruction (SO, 2005).

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Curricula Differences


Overflow of Health Inequalities

The disparity between the general population and people with IDD is a result of:

• Genetic factors

• Social circumstances

• Environmental conditions

• Inadequate knowledge of health promotion

• Inadequate medical care access(Krahn, Hammond, & Turner, 2006)

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• Epilepsy, behavioral/mental problems, fractures, skin conditions, poor oral health, and respiratory disorders are repeatedly documented in IDD population

• There is a greater risk of inadequate attention to potentially life threatening conditions as there has been a rise in group living situations

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• People with IDD experience lower rates of preventative care and health promotion practices

• People with IDD have inadequate access to quality health care service (Krahn, Hammond, & Turner, 2006)

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Obesity Issues

• 39.3% of women and 27.8% of men with IDD are overweight or obese vs. 25.1% of women and 25.7% of men in general population

• Mean BMI of women with IDD (28.8) was significantly higher than the mean BMI for men with IDD (26.7)

• Women with IDD more likely to be obese than men with IDD

• Down syndrome was associated with increased

risk of overweight and obesity (Melville et al., 2008)13


• As the severity of the intellectual disability increased, the risk of overweight and obesity decreased

• Very low physical activity levels, lack of a balanced diet, inaccessible clinical services for weight management contribute to the increasing obesity rates

• Developing obesity early in adulthood increases risk for obesity related diseases (CVD, diabetes, cancer)(Melville et al., 2008)

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Social and Relationship Challenges

• All individuals with IDD valued being in an intimate relationship which fulfilled their needs, having a positive impact on mental health and well-being

• People with IDD often feel that control and choice are constrained by others (mainly caregivers)

• Main difference in experiences and psychology of sexual expression in IDD vs. general population is the strong impact that others have on their relationships

(Rushbrooke, Murray, Townsend, 2014). 15


Health Risks & Behaviors

Indicator (year)Adults with disabilities

Adults without disabilities

Disparity

Binge drank in the past 30 days (2012)

21.2% 18.1% 3.1

Always use a seatbelt (2012) 82.7% 85.8% -3.2

Ate fruit 1 or more times per day (2011)

55.8% 62.8% -7.0

Ate vegetables 1 or more times per day (2011)

75.3% 77.9% -2.5

Obese based on body mass index (2012)

36.1% 22.0% 14.1

At risk for HIV (age 18-64) (2012) 8.1% 6.7% 1.4

Sufficient aerobic physical activity (2011)

42.3% 57.1% -14.8

Meets both aerobic and muscle strengthening physical activity guidelines (2011)

15.0% 24.6% -9.6

Currently smoke cigarettes (2012) 28.7% 15.9% 12.8

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Table 1. Health risks and behaviors by disability status

Source: Disability & Health Data Systems


Health Conditions

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Indicator (year) Adults with disabilities

Adults without disabilities Disparity

Ever had a hysterectomy (2012) 26.0% 17.0% 9.0

Fair or poor self-rated health (2012) 48.4% 9.6% 38.9

Have heart disease (2012) 14.8% 4.1% 10.7

Ever had high blood pressure (2011) 43.7% 25.6% 18.1

Ever had high cholesterol (age 20+) (2011) 46.8% 33.9% 12.9

Ever had asthma (2012) 23.5% 10.1% 13.4

Ever had cancer (excluding skin cancer) (2012) 8.9% 5.0% 3.9

Ever had prostate cancer (age 40+) (2010) 5.5% 4.9% 0.6

Ever had skin cancer (2012) 7.8% 6.6% 1.2

Have chronic obstructive pulmonary disease (COPD) (2012) 17.7% 3.3% 14.4

Have diabetes (2012) 19.1% 6.8% 12.3

Have kidney disease (2012) 7.0% 1.9% 5.1

Ever had a stroke (2012) 7.0% 1.4% 5.6

Table 2. Health conditions by disability status



Prevention & Screenings

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Indicator (year) Adults with disabilities

Adults without

disabilities Disparity

Clinical breast exam in the past 2 years (age 40+) (2012)

64.2% 75.8% -11.6 0.000

Mammogram in the past 2 years (age 50-74) (2012) 73.5% 78.7% -5.2 0.062

Pap test in the past 3 years (age 21-65) (2012) 72.3% 82.3% -9.9 0.006

Up-to-date with colorectal cancer screening (age 50-75) (2012)

63.2% 65.7% -2.5 0.338

Routine check-up in the past year (2012) 72.3% 66.8% 5.5 0.036

Teeth cleaned in the past year (2010) 51.4% 66.8% -15.4 NA

Visited a dentist in the past year (2012) 49.1% 62.4% -13.4 0.000

Table 3. Prevention and screenings by disability status



Prevention & Screenings (FL vs. CA)

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Indicator (year) Florida California

Clinical breast exam in the past 2 years (age 40+) (2012)

Adults with Disability 64.2% 72.6%

Adults without

Disability 75.8% 75.8%

Mammogram in the past 2 years (age 50-74) (2012)


Adults without


Pap test in the past 3 years (age 21-65) (2012)


Adults without


Up-to-date with colorectal cancer screening (age 50-75) (2012)


Adults without


Cholesterol check in the past 5 years (age 20+) (2011)


Adults without


Routine check-up in the past year (2012)


Adults without


Table 4. Prevention and screenings by disability status



Conclusion

• Virtually in all health areas, people with IDD face poorer health outcomes

• They lack access to quality healthcare and prevention screenings/programs

• The myriad of health and wellness related issues that plagues them are on the rise

• Many health providers and future health professionals are not equipped to provide multi-discipline services to this population

• Ensuring inclusion of this population at the various

mentioned areas is essential.20


Recommendations

Preparing Health Professionals to Provide Care to Individuals with Disabilities:

• Increased didactic and clinical preparation of health school graduates regarding the care

of individuals with special health needs

• Develop appropriate curricula/ modules that provides opportunities to cater this population (Holder et. al, 2005)

• Facilitate internships, clinical rotations and volunteer with opportunities with facilities that serves the IDD population.

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Figure 3. Nutrition & Dietetics Students


Examples

• The “IDD Centered Course” that was designed to expose health students to methodologies that will help them become well versed of the issues faced by children/adults with IDD, and provide guidance of how to provide meaningful health education and multi-disciplinary services to that population.

• Formal affiliation agreements with community based organizations that serve the IDD population

• Internship opportunities, learning activities and clinical

rotations with those organizations

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Recommendations

Health Inequalities:

• Reduce the occurrence and impact of associated, comorbid, and secondary conditions

• Empower caregivers and family members to meet the health needs of persons with IDD

• Promote healthy behaviors in people with IDD

• Ensure equitable access to quality healthcare (Krahn & Fox, 2013)

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• Develop new strategies to properly sample and identify people with IDD across all ages

• Improve our ability to tailor public health interventions around the specific needs of disability populations

• Include persons with disabilities into the mainstream services where possible, give a cross-disabilities approach where necessary, and give a condition-specific approach where essential(Krahn & Fox, 2013)2

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Examples

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January 16, 2014 November 17, 2014

Rebecca Batura

Height 4'9 Height 4’9

Weight 185 Weight 170

BMI 40 BMI 36.8

Special Olympics Florida Wellness program for persons with IDD which includes:

• Evidence-based learning curricula/intervention

• Physical activity, health education and nutrition counseling

• Meal planning utilizing “My Plate” food guides

• Individualized meal plans for those requiring dietary modification due to chronic diseases

• Meal preparation demonstrations and recipes

• Inclusion of staff, family members with healthy choices


Recommendations

Social and Relationship Challenges:

• Caregivers should assist in providing opportunities for social contact/education about relationships

• Services should consider alternative avenues to address the unmet needs: increasing social networks & social activities

• Support should be provided on an individual basis

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• Since each person with IDD has different needs, support should be provided on an individual basis

• Increasing exposure of different types of relationships through education, increasing social networks and friends (Rushbrooke, Murray, Townsend, 2014)

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Figure 5. Social Wellness Program at Special Olympics FL


Recommendations

Obesity issues:

• Changes in policy/training should include: sensitive management of impact that caregivers have on relationships, emotional impact & physical expression of relationships

• Need early identification of obesity & related diseases in childhood and adolescence (Rushbrooke, Murray, & Townsend, 2014)

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• Effective weight management interventions/clinical services are needed to diminish health disparities

• Need for future research to focus on reasons for increased obesity prevalence in IDD population

(Melville et al., 2008)

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Figure 6. Health Promotion Intervention Program at Special Olympics FL


References

Centers for Disease Control and Prevention. Disability and Health Data System. (2012). Retrieved from http://dhds.cdc.gov.

Corbin, S., Holder, M., & Engstrom, K. (2005). Changing attitudes, changing the world: the health and health care of people with intellectual disabilities. Washington, DC: Special Olympics International.

Holder, M., Waldman, H. B., & Hood, H. (2009). Preparing health professionals to provide care to individuals with disabilities. Int J Oral Sci, 1(2), 66-71.

Krahn, G. L., & Fox, M. H. (2014). Health disparities of adults with intellectual disabilities: what do we know? What do we do?. Journal of Applied Research in Intellectual Disabilities, 27(5), 431-446.

Krahn, G. L., Hammond, L., & Turner, A. (2006). A cascade of disparities: health and health care access for people with intellectual disabilities. Mental retardation and developmental disabilities research reviews, 12(1), 70-82.

Melville, C. A., Cooper, S. A., Morrison, J., Allan, L., Smiley, E., & Williamson, A. (2008). The prevalence and determinants of obesity in adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 21(5), 425-437.

Rushbrooke, E., Murray, C., & Townsend, S. (2014). The experiences of intimate relationships by people with intellectual disabilities: a qualitative study. Journal of Applied Research in Intellectual Disabilities, 27(6), 531-541.

World Health Organization. (2011). World report on disability. Geneva, Switzerland: Author. Retrieved from http://www.who.int/disabilities/world_report/2011/accessible_en.pdf

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