Health promotion for people with disabilities: development and evaluation of the Living Well with a Disability program.

People with disabilities can benefit from health promotion opportunities to reduce the incidence and severity of secondary conditions that further limit their participation in society. This paper describes participatory action research (PAR) methods we used to develop, implement and evaluate the Living Well with a Disability program. Community-based agencies that provide information and referral services to people with disabilities (independent living centers funded under Title VII, Rehabilitation Act) recruited a convenience sample of 246 people with mobility impairments to participate in a randomly assigned, wait-list control health promotion intervention study. Paper-and-pencil outcome measures included the secondary conditions surveillance instrument, unhealthy days and health care utilization. Logistic regression on outcomes controlling for demographic variables and pre-test measures indicated reductions in all three outcome variables. People with mobility impairments who participated in the Living Well with a Disability program reported less limitation from secondary conditions, fewer unhealthy days and less health care utilization. PAR methods are particularly important to design useful interventions for this population.

Prevention of secondary health conditions in adults with developmental disabilities: a review of the literature.

PURPOSE: To compile empirical findings regarding prevention strategies for secondary conditions experienced by adults with developmental disabilities. METHOD: The PsycLit and PubMed databases were searched for articles addressing the 20 most pervasive secondary conditions and the prevention of secondary conditions in general. RESULTS: Of more than 2000 articles examined, 25 met criteria for inclusion. None could be categorized as a primary approach to prevention, 19 involved secondary and six involved tertiary approaches. The majority included between one and ten participants. Nine studies involved the administration of treatment, three providing certain experiences, two chart review, and 11 a training approach. Injuries due to self-abuse, communication problems, dental hygiene problems, and problems with memory, persistence and mobility were addressed. CONCLUSION: Little is known regarding the prevention of secondary conditions within this population. The authors stress the necessity to focus research efforts on greater understanding of the linkage between disability, rehabilitation and public health models.

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Empowerment--the process by which people gain some control over valued events, outcomes, and resources--is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior change with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

Empowering people with physical disabilities through advocacy skills training.

Members of an advocacy organization for people with physical disabilities were trained to identify and report issues at group meetings. In addition, two consecutive chairpersons were trained to conduct action-oriented meetings. Measures of group members' activities outside meetings and related outcomes on identified issues were also collected. Results indicated increases in the number of disability-related issues reported by trained members and consistent improvements in chairperson performance following training. Retrospective interviews and permanent records showed that advocacy activities, as well as the outcomes of members' actions, increased after training. These findings and their implications for the empowerment of people with disabilities are discussed.

Experimental evaluation of public policy: the case of state legislation for child passenger safety.

Observations of children in automobiles were made in seven states before and after implementation of legislation requiring use of child passenger safety devices. Increases in safe seating for children covered by state laws and children under 1 year old were observed in three of the five states implementing legislation during this study. Decreases in safe seating for these age groups were observed in two states, however. Increases in safe seating for children from 1 to 5 years old were observed in four of these five states. Although methodological limitations require cautious interpretation, these data suggest the impact child safety seat laws may have on compliance. Implications of this research for policies on child passenger safety and the importance of exploiting naturally occurring public experiments are discussed.

Behavior analysis and public policy.

The Task Force on Public Policy was created to examine ways for behavior analysts to be more functional citizen scientists in the policymaking arena. This report informs readers about the contexts and processes of policymaking; and it outlines issues regarding the roles of behavior analysts in crating policy-relevant conceptual analyses, generating research data, and communicating policy-relevant information. We also discuss a possible role for the professional association in enhancing analysis, research, and advocacy on policies relevant to the public interest.

Effects of a poverty-clients' agenda on resource allocations by community decision makers.

A coalition of human service agencies in one city used the Concerns Report Method of Basic Needs and Vital Services to obtain information on the concerns of their poverty clients. Results were disseminated to local decision makers of the United Way agency, city commission, and county commission during their annual budget deliberations. Two standard accounting methods were used to compare budget allocations to agencies serving low-income people before and after dissemination of the Concerns Report, to other items in the three budgets, and to allocations to similar agencies in a second city. Allocations to agencies serving those most in need in the experimental community grew 17% faster than the total budget, increased 3.96% in share of total budget, and gained 22% over other allocations following dissemination of the Concerns Report.

Public policymaking and research information.

The public policymaking process presents behavior analysts with opportunities to shape public policy and influence decisions that affect the evolution of communities. Although the scientist-advocate's role in public policymaking has received increased attention, little attention has been given to behavioral analyses of the policymaking context. This paper describes the stages of policymaking, including agenda formation, policy adoption, policy implementation, and policy review. It also analyzes seven types of research information important in agenda formation and policy adoption-information about the dimensions of an issue, number of people affected, relative standing of an issue, interests of those involved, controlling variables, program alternatives, and program acceptability. Methods for communicating research information to policymakers are discussed.

Enhancing leadership skills for community self-help organizations through behavioral instruction.

Group members with skills to lead effective meetings are valuable resources of any community organization. The effects of a behaviorally based textbook and training procedures designed to teach members of community self-help groups to chair effective meetings were analyzed. Measures were collected during regularly scheduled meetings on chairperson performance, member participation, and the closure of discussion topics. The results showed that the use of specified chairperson activities increased after training for each of two chairperson trainees. Further, outcome data suggest that more decisions were made. These findings suggest that the chairperson training procedures may enhance the leadership and decision-making resources of community self-help groups.

Creating and using social technologies for community empowerment.

Powerlessness appears to be associated consistently with widespread problems of living. Recently, enhancing community empowerment has been suggested as an important emphasis for human service professionals. This manuscript illustrates a role for human service professionals in creating and using social technologies to facilitate empowerment . Seven case studies are presented that represent seven frequently cited goals of empowerment efforts. Finally, the ethics of the empowerment strategy are analyzed and other implications of designing and using empowerment technologies are considered.