community engagement: from health care to community living · community engagement: from health...
TRANSCRIPT
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Community Engagement:
From Health Care to Community Living
Charles E. Drum, MPA, JD, PhD Institute on Disability, University of New Hampshire/UCED Danielle Bailey, MPH Oregon Health & Science University
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Presentation Objectives
Describe a method to reduce barriers to accessing different environments called community engagement or CE
Describe the CE implementation process and research study
CE role play Describe new CE Project
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Acknowledgments
Funded by the RTC MICL and NIDRR (Grant H133B060018)
Do not represent the official position of NIDRR
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Community Engagement
The process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations, on common issues affecting their well-being.
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Theoretical Foundation to CE
Hahn’s theory on the institutional creation of disability (social attitudes, environment, public policy)(Hahn, 1985)
Social Model of Disability
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Theoretical Foundation
Source: Drum, Krahn, & Bersani, 2009
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Purpose of Community Engagement
Help PWDs and families identify local barriers and facilitators to accessing different environments; and
Encourage local responses to the identified barriers
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Types of Barriers Addressed by CE
Access to: Education, Employment, Health Care, Housing, Public Places, Recreation, and Transportation
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Recent Implementation of Community Engagement
In the last five years, CE has focused on access to health care…
Why?
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Health Status of People With and Without Disabilities*
24
61
32 30 27
9
19
10
10
20
30
40
50
60
70
Perc
ent
Excellent/VeryGood
Good Fair Poor
Health Status
Disability
No Disability
*Rounded Percentages Source: Drum, et al, 2008
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Providers Gather MORE Information On:
Pain Depression Stress Work/hobbies
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Providers Gather LESS Information On:
Smoking Blood pressure Cholesterol Mammograms Colorectal exams Sexual activity
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Other Risks
PWDs are more likely to: Smoke Be overweight or obese Have unmet health care needs PWDs are less likely to: Get preventive services Engage in physical activity
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Step 1. Town Hall Meeting Step 2. Community Infrastructure Meeting
Step 3. Resource Mobilization
Step 4. Follow Up
CE Methodology
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Step 1: CE Town Hall Meeting
Local Community Partner assists with: Recruitment Registration Co-Facilitation People with Disabilities & families: Identify HC assets
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Step 1: CE Town Hall Meeting
People with disabilities and families: Identify HC barriers in:
Facility Access & Services Communication & Attitudes
Prioritize the barriers Discuss possible solutions ID representatives for next phase
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Step 2: Infrastructure Meeting
HC providers, local govt. & agencies, & Town Hall reps: Overview of disability Review assets identified
during town hall meeting Validate / Modify
barriers presented in power point
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Step 3: Resource Mobilization
Commitments are obtained from community representatives to address barriers: Facilitated discussion of potential
solutions, including solutions identified during Town Hall meeting
Community Infrastructure Workbook
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Step 4: Follow-Up
Changes in the community are documented: Local liaison designed to record
decisions and steps taken to resolve access barriers
OHSU serves as ongoing resource
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CE Evaluation Project
Basic Study Purpose: To determine whether the use of
community engagement techniques increases access to health care among people with disabilities
Funded by the RTC MICL and NIDRR
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CE Research Design
A multisite embedded case comparison of matched communities in Oregon, Missouri, and Kansas
Embedded case studies are studies where different levels or sources of data are collected
Pre- Post Data at the individual, environmental, and organizational level
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Research Measures
Community Participation and Perceived Receptivity Survey (CPPRS)- Measures participation, accessibility, and perception of treatment Disability Rights Attitude Scale (DRAS)- Assesses attitudes toward rights under the ADA
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Research Measures
Outpatient Health Care Usability Profile (OHCUP)- Measure the usability of specific healthcare facilities, based on the ADAAGs Action Logs - records of decisions and
steps taken to resolve access barriers Case Reports
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Oregon CE Sites*
*Additional sites in Kansas & Missouri Not Reported
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Facility Access and Services Prioritized Barriers
Built environment: 47% Accessible parking: 25% Signage: 10% Communication aids: 10% Access to provider: 7% Paperwork: 7%
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Transportation Prioritized Barriers
Bus stops and routes: 52% Planning requirements: 16% Lack of awareness of options: 7% Cost: 11%
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Provider Attitudes & Communication Prioritized Barriers
Quality of physician/provider care and communication: 45%
Lack of disability awareness: 30% Poor customer service: 20% Lack of communication aids: 5%
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Corvallis- Prioritized Barriers
Transportation: Dial-a-bus short staffed City bus service limited Facility Access & Services: Accessibility of hospital parking Hospital curb ramps Parking lot signage
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Corvallis - Prioritized Barriers
Provider Attitudes & Communication: Lack of education among HC providers
re disability issues Doctors who do not communicate with
care providers or directly w/ PWDs Lack of quality MH services
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Progress to Date- Corvallis
Hospital improved parking, more spaces, drop-off point, signage
The para-transit bus system added 7 volunteers to address call volume
3 new bus routes added to increase access to hospital services
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Progress to Date- Corvallis
The Arc of Benton County and OSU held a forum to discuss physical activity and recreation
The Arc of Benton County has coordinated letter writing efforts to the editor of the local paper
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Progress to Date- Prioritized Barriers
Corvallis: 7/9 Pendleton: 6/9 Newburg: 5/10 Medford: 5/10
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Town Hall Meeting Your role: Town Hall meeting
attendee HC Assets Barriers:
Transportation Facility Access & Services Communication & Attitudes
CE Role Play- Now, it’s your turn!
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The Future of CE CE Knowledge Translation Research
Project Funded by the new RRTC on Community
Living How much TA is needed to implement
CE? 3 matched sites in Montana, Mississippi,
and New Hampshire