[ REPORT] June 2014 Strategies for Successfully Including People with Disabilities in Health Department Programs, Plans, and Services About NACCHO’s Health people may develop a disability at any point in their lifetime. According to the most recent U.S. Census estimates, one in and Disability Program five Americans lives with at least one disability; more people The National Association of County and City Health Officials will develop a disability as the “baby-boomer” population (NACCHO), with support from the National Center on Birth ages.1,2 NACCHO works with local and state health departments Defects and Developmental Disabilities (NCBDD) at the to help prevent secondary conditions that people with Centers for Disease Control and Prevention (CDC) and The disabilities may experience (e.g., obesity, high blood pressure, Arc of the United States (The Arc), promotes the inclusion cardiovascular disease, negative outcomes after a disaster/ and engagement of people with disabilities in planning, emergency). More information about the health of people implementing, and evaluating public health programs, products, with disabilities is available at http://www.cdc.gov/ncbddd/ and services. NACCHO’s Health and Disability Program provides disabilityandhealth/ and http://www.cdc.gov/ncbddd/. local health departments (LHDs) with practical strategies and recommendations, including tools and materials developed by peers and relevant information from partner organizations. The program (1) informs and educates LHDs about health and Health Inequities of disability activities and resources; (2) supports a peer assistance network; and (3) develops and shares model practices related People with Disabilities to health-promotion activities for people with disabilities. People with disabilities experience inequities In 2013, NACCHO conducted key informant interviews in their health status when compared to with LHDs on the topic of inclusion for people with members of the general population. Here are disabilities to better understand the capacity for inclusion some examples of these health inequities: among LHDs. NACCHO found that LHDs were interested in • Adults with disabilities are 58 percent more likely including people with disabilities but did not always have to be obese than their peers without disabilities;3 the tools, resources, or knowledge needed to begin. • Children and adolescents with disabilities This guide highlights specific strategies and tools to help are 38 percent more likely to be obese both local and state health departments include people with than their peers without disabilities;3 disabilities in public health programming and planning efforts. • People with disabilities smoke at significantly higher rates (25.4%) than those without disabilities (17.3%);4 • Women with disabilities are less likely to receive Background on Health and Disability mammograms than those without disabilities;5 and People may experience many types of disabilities, including • People with disabilities are less likely to difficulties with hearing, seeing, moving, thinking, learning, be included in emergency preparedness and communicating. A disability may not always be obvious planning than people without disabilities.6 based on a person’s appearance because not all disabilities are visible. Disabilities that people experience may be temporary (e.g., broken leg) or lifelong (e.g., Down syndrome), and The Importance of Including People with • NACCHO’s Model Practices Program (http://www.naccho. org/topics/modelpractices/) and Health and Disability Toolkit Disabilities in All Public Health Activities (http://www.naccho.org/toolbox/) contain resources and Including people with disabilities in public health activities examples to help develop inclusive programs and plans. is a goal set forth in Healthy People 2020 and is consistent • With respect to emergency preparedness, not including with NCBDDD’s mission to identify and reduce disparities in people with disabilities in planning efforts can have legal health experienced by people with disabilities. When health ramifications. Learn more about lawsuits and emergency departments apply for accreditation, write grants, and develop preparedness planning for people with disabilities at programs/plans, they should consider people with disabilities http://eweb.naccho.org/prd/?na566pdf and http:// as a health inequity population, similar to low-income www.naccho.org/topics/hpdp/healthdisa/eplearncomm. communities and communities of color, because all of these cfm. In addition, the Communication, Medical Needs, populations experience similar disparities in their health outcomes Independence, Supervision and Transportation [C-MIST] when compared to members of the general population. framework helps planners include people with disabilities in emergency preparedness plans. Visit http://www.freetobe. The following resources can help health departments ca/resources/pdf/c-mistforemergencyplanning.pdf. include people with disabilities in health promotion • The National Center on Health, Physical Activity and programming and emergency preparedness planning: Disability provides guidelines for including people with • NACCHO’s Health and Disability e-newsletter includes disabilities in health promotion programming efforts. Visit the latest news affecting the health of people with http://bit.ly/1me3Jr7. disabilities, provides tools, and offers information about upcoming conferences and webinars. E-mail [email protected] to subscribe. Checklist to Use when Creating Programs, Products, or Services Does my agency… Involve people with disabilities in planning? Ask people with disabilities about the accommodations needed to make programs accessible to them? Ask for feedback from people with disabilities to learn how to improve programs and services? Budget to accommodate people with disabilities? Raise awareness about the importance of including people with disabilities in public health efforts? Use data to understand the health needs of people with disabilities? Collect appropriate demographic data that includes people with disabilities? Partner with local/national organizations that work with people with disabilities? Complete inclusive emergency preparedness exercises/drills with community partners? Subscribe to NACCHO’s Health and Disability e-newsletter to get the latest news and tools for including people with disabilities? [2] Strategies for Successfully Including People with Disabilities in Health Department Programs, Plans, and Services Inclusion Strategies for Specific Disability Subgroups HEALTH PROMOTION DISABILITY EMERGENCY PREPAREDNESS EXAMPLES PROGRAMMING SUBGROUP PLANNING CONSIDERATIONS CONSIDERATIONS Sensory • Deafness/hard • Use Braille materials • Ensure that emergency of hearing • Use large print materials communications are simultaneously • Blindness/ • Use American Sign available in American Sign Language, difficulty seeing Language interpreters Braille, and large print • Use real-time captioning Physical • People who use • Hold programs in facilities that • Ensure emergency response equipment (e.g., comply with the Americans with units such as fire/police have wheelchairs, canes) Disabilities Act (ADA) and use the needed equipment to assist for mobility universal design (e.g., ramps for people with physical disabilities • People who wheelchairs and bathrooms) • Have shelters and points of dispensing have temporary that are ADA-compliant (e.g., ramps impairments such for wheelchairs and bathrooms) as broken limbs Cognitive • People who have • Use visual images to communicate • Work with direct support difficulties learning program content organizations serving people with or remembering • Adapt program content to a fourth- cognitive disabilities to develop • People who have or fifth-grade reading level emergency preparedness plans for developmental (see http://bit.ly/1jibufn) their consumers disabilities such • Provide staffing/volunteers to assist as autism, Down with program implementation syndrome, or • Include caregivers in programming intellectual disability All • People with a • Be aware of transportation • Recommend use of a buddy system Disabilities primary disability barriers/provide transportation where people in the community are (e.g., sensory, • Hold programs at locations easily responsible for checking on people physical, cognitive) accessible by public transportation with disabilities in an emergency that leaves them • Hold programs at convenient times • Use social media to provide vulnerable to • Allow extra time for people to arrive instructions/updates developing a and to implement the program during emergencies preventable • Ensure websites are Section • Partner with organizations/ secondary condition agencies that provide services (e.g., obesity, heart 508-compliant (see http:// www.hhs.gov/web/508/) to people with disabilities to disease, negative identify and locate people with • Ask program participants outcomes after a disabilities in an emergency disaster) with disabilities about specific accommodations relevant to • Ensure that emergency response their being able to participate workers/public health workers fully in the program receive training about working/ communicating with people with • Train staff on working with disabilities in emergencies people with disabilities Strategies for Successfully Including People with Disabilities in Health Department Programs, Plans, and Services [3 ] Strategies for Successful Inclusion of People with Disabilities Internal