People Living with Disabilities Health Equity, Health Disparities, and Health Literacy: Proceedings of a Workshop (2018) / Chapter Skim
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5 Exploring Models and Best Practices
5 Exploring Models and Best Practices
Pages 53-72
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From page 53... ...
Toyin Ajayi, chief medical officer at Commonwealth Care Alliance,2 described her organization's program for integrating care for low-income elders and individuals with disabilities. Finally, Kathleen Bishop, director of program development in the Division of Person-Centered Supports at the New York State Office for People with Developmental Disabilities,3 discussed New York's innovative service model for crisis prevention and response for people with intellectual and developmental disabilities.
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From page 54... ...
The Centers for Medicare & Medicaid Services, for example, has an equity plan for improving quality in Medicare,4 which includes priority items relating to people living with disabilities. The White House has a webpage focused on disabilities,5 as well as the President's Committee for People with Intellectual Disabilities,6 which is overseen by the Administration for Community Living in the U.S.
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From page 55... ...
The prevalence of financial barriers was a surprise, she said, given the high rates of participation in public insurance programs such as Medicare and Medicaid, Nehus noted. The next step was to conduct an access review of the state's health care systems, but convincing health care facilities to allow them to do an access review was a hard sell, said Nehus.
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From page 56... ...
UNIVERSAL PRECAUTIONS9 To provide some insights on the intersection of health disparities and disabilities from the health literacy perspective, Paasche-Orlow discussed the principle of universal precautions. Health literacy universal precautions, he explained, are the steps practices can take when they assume that all patients may have difficulty comprehending health information and accessing health services.
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From page 57... ...
In his opinion, they can serve as a critical step forward and serve as a key for how a health literacy mindset can be a driver for health equity. Universal precautions, he explained, come from a synergy of a mentality about patient safety and one of empowerment to drive health equity.
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From page 58... ...
In summary, Paasche-Orlow said that universal precautions are an ethos, and to attain the goals of health care, it is necessary to go beyond the basic process of diagnosis and recommending treatments. The basic system taught in medical school takes a biophysical approach to health care, one that emphasizes the importance of making the right diagnosis and treatment recommendations.
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From page 59... ...
"That is not the case; health promotion programs do work," said Marks. Development of the HealthMatters program began in 1998 through a 5-year university-based exercise and health education clinical trial funded by the National Institute on Disability, Independent Living, and Rehabilitation Research–funded Rehabilitation Research and Training Center on Developmental Disabilities.
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From page 60... ...
, found that adults with intellectual and developmental disabilities had better perceived health behaviors, increased exercise self-efficacy and knowledge of nutrition and activity, improved cholesterol and blood glucose levels, and increased fitness and flexibility, and they benefited from better social and environmental supports for their exercise and nutritional needs. The trainthe-trainer model, which engaged direct care workers supporting people with disabilities, did a much better job and produced results that were more sustainable.
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From page 61... ...
HealthMatters4Kids, to help parents, teachers, and providers rec ognize the importance of teaching children about exercise and nutrition in order to prevent diabetes and chronic conditions COMMONWEALTH CARE ALLIANCE: INTEGRATED CARE FOR LOW-INCOME ELDERS AND INDIVIDUALS WITH DISABILITIES12 Commonwealth Care Alliance, explained Toyin Ajayi, serves a population of dual-eligible individuals comprising low-income seniors and low- income adults ages 21 to 64 with disabilities, severe persistent mental illness, or multiple chronic illnesses or functional and cognitive limitations. Racial and ethnic minority groups are overrepresented in this population and experince significant disparities in accessing needed health care services e and in life expectancy, particularly for the subset of this population with s evere persistent mental illness, said Ajayi.
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From page 62... ...
One program is a senior care options program that functions as a dual-eligible Medicare Advantage special needs plan and has some 7,000 members across Massachusetts. This program receives a fixed amount of dollars per month from Medicare and Medicaid to provide all of these individuals' needs, including physical acute and outpatient care, behavioral health care, and long-term supports and services such as home health care, personal care attendants, chores, food, and nonmedical transportation.
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From page 63... ...
Commonwealth Care Alliance delivers care through what it calls primary care redesign, which aims to improve the quality of primary care delivered to people with complex medical, behavioral health, and social needs. As a single-payer source, the organization has the perspective and ability to align incentives, Ajayi explained, which enables her and her colleagues to provide coordinated care and build a network to provide care for each beneficiary.
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From page 64... ...
Two crisis stabilization facilities to provide alternatives to inpatient psychiatric hospitalization were also created. Commonwealth Care Alliance has also developed a community paramedicine program that sends paramedics to clients' homes to treat them for acute illnesses and avoid trips to the emergency department.
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From page 65... ...
She also singled out the need for policy solutions to decrease barriers to interdisciplinary communication and collaboration, while continuing to safeguard patient privacy. THE NEW YORK STATE INITIATIVE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES: AN INNOVATIVE SERVICE MODEL FOR CRISIS PREVENTION AND RESPONSE13 As the payment systems associated with Medicaid begin shifting from models that rely on institutions and high-intensity settings to models of support for people that are much more community based, New York has been working to develop a new type of safety net for people with intellectual and developmental disabilities who find themselves in a behavioral health crisis, explained Katherine Bishop.
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From page 66... ...
New York's response to this situation was to look at evidence-based or evidence-informed models that would create a consistent statewide capacity for effective crisis prevention and response, incorporate evidence-informed treatment approaches, and monitor outcomes at an individual and systems level using consistent data reporting systems. New York's Office for People with Developmental Disabilities researched and chose the University of New Hampshire (UNH)
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From page 67... ...
Previous speakers had noted the importance of looking at the biopsychosocial elements of a model, and START coordinators, said Bishop, dig into the specific nature of what might be driving the events that bring a person to crisis so that an effective crisis plan can be developed to diminish those crises. The model includes in-home therapeutic supports for people ages 6 years and older to provide special training in the home environment specific to an individual's behavioral health needs.
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From page 68... ...
large part because her parents had someone to call who was knowledgeable and trained to understand the behavioral health elements of her support. Over time, the need for those calls fell sharply too.
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From page 69... ...
Another participant asked Ajayi how her program assesses people for the services they need, whom the program hires as personal care attendants, and what level of need the program addresses. Ajayi replied that assessments are carried out by long-term services and support coordinators employed by partner agencies.
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From page 70... ...
Marks replied that peer-to-peer learning was developed after 10 years of experience with HealthMatters and based on what she and her colleagues had learned in working with and getting feedback from their clients with intellectual and developmental disabilities. In particular, Harris was surprised by how much health education was not happening on the health care provider side.
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From page 71... ...
the primary care provider is invested in ensuring that a person not only gets his or her prescription filled, but also takes the medication and benefits from it, (2) the hospital that discharges a patient is invested in ensuring that the patient does not return to the hospital with some preventable condition, and (3)
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From page 72... ...
Marks replied that she has been thinking about who owns the data, and she believes it belongs to the person with a disability, in the case of her program. "The data should have meaning to them and the services that they get," she said.
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