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PubMed2002

Dead end jobs or a path to economic well being? The consequences of non-standard work among people with disabilities.

How do non-standard jobs affect the economic well-being of workers with disabilities, and what happens when non-standard workers use disability lawsuits to challenge discrimination and improve their economic opportunities? This study uses data from the Current Population Survey, the Survey of Income and Program Participation, and a Lexis search of legal cases to help answer these questions. Temporary employment, independent contracting, and part-time employment are almost twice as likely among workers with disabilities as among those without disabilities. Non-standard workers with disabilities receive lower pay and fewer benefits due both to the types of job they hold, and disability gaps within job types, which contribute to their high poverty rates. They would continue to have high poverty rates even if these pay gaps were eliminated, however, because they work fewer hours than non-standard workers without disabilities and are concentrated in lower-paying occupations. In attempting to improve their opportunities through disability lawsuits, non-standard workers prevail in only a small minority of cases. Several policy implications of the lawsuits and survey data are discussed.

Persons with Disabilities↗

PubMed2005

Diversity in context: how organizational culture shapes reactions to workers with disabilities and others who are demographically different.

Successfully integrating workers with disabilities into their organizations is both a challenge and an opportunity facing managers today. Despite laws and business practices prohibiting discrimination against those with disabilities, people with disabilities are consistently underutilized in organizations. This article applies theories of demographic diversity in organizations to assert that a richer understanding of organizational cultures and their implications for workers with disabilities may shed light on the question of how and why workers with disabilities may be excluded from mainstream work experiences and career progression. The article briefly reviews business arguments that support integration of workers with disabilities into organizations based on their contribution to the overall diversity within the organization, and reviews complications in the research on diversity to date that leave important questions of the potential gains or detriments from increasing this diversity unanswered. The article then goes on to introduce organizational culture as an underinvestigated but likely potent tool in explaining how and when workers who are demographically different, in general, and with disabilities, specifically, may be successfully integrated into an organization's work force. The article introduces three types of organizational culture: culture of differentiation, culture of unity, and culture of integration. Each is explained in terms of its content and its implications for managing diversity. A discussion of the implications of culture as a primary tool for managing the integration of workers with disabilities concludes the paper.

Attitude↗

PubMed2005

Disabilities and impairments: strategies for workplace integration.

This article argues that disabilities are, within many of the U.S. debates, best understood as certain kinds of impairment affecting a person's capabilities to perform socially defined roles and functions within specific environments. We also argue that it is not the impairments per se that lead to claims about what we ought to do or ought not do for people with disabilities. Rather, it is only within the context of capabilities being linked to the concept of freedom--almost universally valued in the current U.S. socio-political environment--that disability issues take on an ethical tenor. Additionally, we link the notion of disability to that of social capital. In particular, we argue that any social organization that discriminates against people with disabilities by attenuating their opportunities within that environment also decreases the social cohesion that exists within that organization. Such corporate climates promote organizational structures and processes that fail to optimize facilitation of the mutual benefits of the members. Finally, we discuss three different kinds of accommodation strategy: assistive technologies, systemic personal change, and universal design. We suggest a case-based (casuistic) approach to problems caused by disabilities. Using methods from both philosophy and public policy, we then build policies for accommodations incrementally, based on an application of those methods to the cases, and resulting in a more nuanced process enabling the creation of policies that take account of the experiences of both disabled and non-disabled people.

Persons with Disabilities↗

PubMed2003

A new approach to the qualitative evaluation of functional disability in dementia.

BACKGROUND: Dementia patients suffer from the progressive deterioration of cognitive and functional abilities. Instrumental disabilities usually appear in the earlier stages of the disease while basic disabilities appear in the more advanced stages. In order to differentiate between mild, moderate and severe patients both instrumental and basic functional disabilities should be taken into account simultaneously. OBJECTIVES: The objective of this study was to find a new method for classifying dementia patients based on their disabilities by using a basic and an instrumental Activities of Daily Living (ADL) scale. METHODS: Functional disability was assessed in a Belgian cohort of dementia patients using the Katz and Lawton Instrumental Activities of Daily Living (IADL) scales. A k-means derived clustering method allocated patients to disability clusters according to their Katz and Lawton scores. In order to validate the classification, we compared socio-demographic, clinical and costs parameters between the groups. RESULTS: The clustering method allocated patients between three clusters: dependent, non-dependent with instrumental functional disability (ND-IFD) and non-dependent. Dependence, as defined by these clusters, significantly correlates with age, residential setting, MMSE, patient's quality of life and costs. CONCLUSION: This new classification of patients suffering from dementia will provide better understanding of functional disabilities and will complement the evaluation of disease severity based on cognitive function.

Activities of Daily Living↗

PubMed1995

Adaptation of maximal aerobic and anaerobic tests for disabled swimmers.

The purpose of the present study was to submit disabled swimmers to two maximal swimming tests, and by comparing the physiological and performance responses of disabled and normal swimmers to determine if these adapted tests can be used to design training programmes for this particular class of swimmer. Two groups of disabled (n = 8 and 6) and two groups of normal competitive swimmers (n = 9 and 13) were respectively submitted to a functional maximal aerobic power test (FMAPT) and a maximal anaerobic lactic test (MANLT). For the disabled, the FMAPT included a slower initial speed and a slower increase in swimming speeds. In the maximal aerobic test, exercise duration, peak heart rate, and the maximal speed relative to the respective best time of a 100-m race [55.5 (SD 3.9) compared to 56.5 (SD 2.8)%] were not significantly different between the disabled and normal swimmers. Peak lactate concentration was, however, higher in the disabled swimmers [10.8 (SD 3.5) compared to 6.8 (SD 1.6)mmol.l-1]. In the MNALT, peak lactate concentration [14.3 (SD 4) compared to 16.8 (SD 1.9)mmol.l-1], and the maximal speed relative to the respective best time in a 100-m race [99.1 (SD 3.2) compared to 98.3 (SD 2.5)%] were not significantly different between the disabled and normal swimmers. These results would seem to indicate that functional maximal aerobic and anaerobic field tests could be used to evaluate and design training programmes for disabled competitive swimmers.

Adaptation, Physiological↗

PubMed2005

Ten-year change in disability prevalence and related factors in two generations of French elderly community dwellers: data from the PAQUID study.

BACKGROUND AND AIMS: Some studies have reported a decline in disability prevalence in older people, but few data were available for Europe, especially for France. Our aim was to study the 10-year evolution of disability prevalence in elderly community dwellers and related factors. METHODS: Two generations of subjects aged 75 to 84, participants in the PAQUID (Personnes Agées QUID) cohort were compared. The first generation included 1496 subjects (born between 1903 and 1912) and the second 910 subjects (born between 1913 and 1922). Three domains of disability were assessed: mobility, Activities of Daily Living (ADL) and Instrumental ADL (IADL). Logistic regressions were used to explain the effect of generation on disability, controlling for sociodemographic characteristics, impairment, life-style, medical care, and social support. RESULTS: The percentage of subjects fully independent increased from 13.5 to 23.3% (p < 0.001). A large decline in disability prevalence independent of the controlled factors was observed for mobility in both genders [Odds Ratio for the second generation (OR(G2)) = 0.48, 95% CI 0.38-0.60]. When adjusting for age and education, the risk of IADL disability was significantly lower in women in the second generation (ORG2 0.61, 95% CI 0.49-0.77), and the generation effect was strengthened when adjusting for the other covariates, but unchanged in men (ORG2 1.09, 95% CI 0.81-1.48). There was no significant change for ADL. CONCLUSIONS: A significant decline in disability prevalence was observed over 10 years, which was not explained by the selected covariates. These aggregate changes differed by gender, education, and the domain of disability considered.

Activities of Daily Living↗

PubMed2005

Association of cognitive status with functional limitation and disability in older adults.

BACKGROUND AND AIMS: Although cognitive status is known to be associated with physical function in older people, the role it plays in the disability process is not well established. This study aimed at determining whether cognitive ability predicts functional limitations, as well as disability, and whether it is associated with the rate of change in physical functions. METHODS: A community-based longitudinal study was conducted, involving 977 older persons aged 65 and older living in an urban community. Physical functions were assessed by tests scoring functional limitations (upper and lower body) and disability (activities of daily living). Cognitive function was evaluated using the Mini-Mental State Examination. Linear regression analyses with generalized estimating equations modeled the two physical function scores separately, as functions of cognitive status and time, in a one-year follow-up, controlling for sociodemographic and health-related characteristics. RESULTS: Cognitive status independently predicted functional limitations as well as disability in older people. In addition, the strength of the association of cognitive status with physical functions increased over time, as revealed by the significant interaction between cognitive ability and time. Cognitive status influenced the rate of change in disability scores, more among women and in those aged 75 or older. The relationship was unaffected by baseline physical functional status, but was significant only among those with no cognitive impairment at baseline. CONCLUSIONS: Cognitive status appears to be a useful indicator of the disablement process in older people. It may play an important role in the development of disability, implying that strategies for early intervention to prevent the progression of disability may need to take cognitive functions into account. The increasing strength of the relationship between cognitive and physical functions over time further attests to its value in monitoring functional change.

Activities of Daily Living↗

PubMed2002

Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, Axis I mental disorders and physical conditions with disability and health consultations.

BACKGROUND: The aims of this study were threefold. First, to ascertain whether personality disorder (PD) was a significant predictor of disability (as measured in a variety of ways) over and above that contributed by Axis I mental disorders and physical conditions. Second, whether the number of PD diagnoses given to an individual resulted in increasing severity of disability, and third, whether PD was a significant predictor of health and mental health consultations with GPs, psychiatrists, and psychologists, respectively, over the last 12 months. METHOD: Data were obtained from the National Survey of Mental Health and Wellbeing, conducted between May and August 1997. A stratified random sample of households was generated, from which all those aged 18 and over were considered potential interviewees. There were 10,641 respondents to the survey, and this represented a response rate of 78 %. Each interviewee was asked questions indexing specific ICD-10 PD criteria. RESULTS: Five measures of disability were examined. It was found that PD was a significant predictor of disability once Axis I and physical conditions were taken into account for four of the five disability measures. For three of the dichotomously-scored disability measures, odds ratios ranged from 1.88 to 6.32 for PD, whilst for the dimensionally-scored Mental Summary Subscale of the SF-12, a beta weight of -0.17 was recorded for PD. As regards number of PDs having a quasi-linear relationship to disability, there was some indication of this on the SF-12 Mental Summary Subscale and the two role functioning measures, and less so on the other two measures. As regards mental consultations, PD was a predictor of visits to GPs, psychiatrists and psychologists, over and above Axis I disorders and physical conditions. CONCLUSION: The study reports findings from a nationwide survey conducted within Australia and as such the data are less influenced by the selection and setting bias inherent in other germane studies. However, it does support previous findings that PD is a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions.

Australia↗

PubMed2004

Back pain, disability, and radiographic vertebral fracture in European women: a prospective study.

Vertebral fractures are associated with back pain and disability. There are, however, few prospective data looking at back pain and disability following identification of radiographic vertebral fracture. The aim of this analysis was to determine the impact of radiographically identified vertebral fracture on the subsequent occurrence of back pain and disability. Women aged 50 years and over were recruited from population registers in 18 European centers for participation in the European Prospective Osteoporosis Study. Participants completed an interviewer-administered questionnaire which included questions about back pain in the past year and various activities of daily living, and they had lateral spine radiographs performed. Participants in these centers were followed prospectively and had repeat spine radiographs performed a mean of 3.7 years later. In addition they completed a questionnaire with the same baseline questions concerning back pain and activities of daily living. The presence of prevalent and incident vertebral fracture was defined using established morphometric criteria. The data were analyzed using logistic regression with back pain or disability (present or absent) at follow-up as the outcome variable with adjustment made for the baseline value of the variable. The study included 2,260 women, mean age 62.2 years. The mean time between baseline and follow-up survey was 5.0 years. Two hundred and forty participants had prevalent fractures at the baseline survey, and 85 developed incident fractures during follow-up. After adjustment for age, center, and the baseline level of disability, compared with those without baseline prevalent fracture, those with a prevalent fracture (odds ratio [OR] = 1.4; 95% confidence interval [CI] 1.0 to 2.0) or an incident fracture (OR = 1.7; 95% CI, 0.9 to 3.2) were more likely to report disability at follow-up, though the confidence intervals embraced unity. Those with both a prevalent and incident fracture, however, were significantly more likely to report disability at follow-up (OR = 3.1; 95% CI, 1.4 to 7.0). After adjustment for age, center, and frequency of back pain at baseline, compared with those without baseline vertebral fracture, those with a prevalent fracture were no more likely to report back pain at follow-up (OR = 1.2; 95% CI, 0.8 to 1.7). There was a small increased risk among those with a preexisting fracture who had sustained an incident fracture during follow-up (OR = 1.6; 95% CI, 0.6 to 4.1) though the confidence intervals embraced unity. In conclusion, although there was no significant increase in the level of back pain an average of 5 years following identification of radiographic vertebral fracture, women who suffered a further fracture during follow-up experienced substantial levels of disability with impairment in key physical functions of independent living.

Activities of Daily Living↗

PubMed2003

[Promotion and maintenance of independence in older people with intellectual disability-results of an intervention study].

Results of gerontological research have seldom been used for the development of new concepts for housing, promotion and supply in people with intellectual disability. However, recent findings from international studies support the assumption that capability to learn and plasticity are also apparent in people with intellectual disability. The present study was designed as an empirical test of this assumption. As a theoretical starting point we describe competence as a comprehensive construct which integrates aspects of independence, self-responsibility, self-determination and experienced meaning of life. Moreover, the construct of competence refers to the impact of the physical, social, and infrastructural environment on the aforementioned aspects. We hypothesised that independent living in older people with intellectual disability could be enhanced by a more differentiated perception of respective potentials by the members of the institutional staff. An intervention program for caregivers was developed to initiate an examination of their own behaviour in daily interaction with intellectually disabled residents, particularly in terms of a possible support of dependent and ignorance of independent behaviour. We expected that unmasking contingencies between behaviour of care-givers and dependency in intellectual disabled residents should lead to increases in residents' independent behaviour and everyday competence. 40 intellectually disabled residents and 40 staff members participated in the present study. Videotapes were used to assess behaviour of staff members and residents in daily care and support. Moreover, a questionnaire was developed for further assessment of independence and everyday competence in intellectually disabled residents. Effects of the developed intervention program were tested with a pre-post-control group-design. Results show highly significant increases in residents' independence and everyday competence. Therefore, our hypothesis that independent living in older people with intellectual disability could be enhanced by a more differentiated perception of existing potentials by the members of the institutional staff received strong support.

Activities of Daily Living↗

PubMed1985

Disabilities caused by road traffic accidents and their relation to severity scores.

The disabilities incurred by 2502 road accident patients admitted in three separate years to an Accident Hospital have been analysed. There were about equal numbers of disabled among pedestrians, motorcyclists and vehicle occupants. This corresponds to the high relative frequency and severity of injuries among motorcyclists. Most of the serious disabilities were caused by head or lower limb injuries. Different severities of disability were not closely correlated with Abbreviated Injury Scale (AIS), (ISS) or (PI) scores or with treatment periods but useful threshold values are described which separate groups with high and low rates of disability. For given severities of injury, disabilities were less severe among young casualties. Comparisons with other studies show rather wide variations in estimates of the incidence of slight disabilities. There is fair agreement with the present findings that serious disabilities occur in about 3% of inpatient hospital cases or in about 1% of total casualties.

Accidents, Traffic↗

PubMed1985

Memory for verbal and nonverbal stimuli in learning disability subgroups: analysis by selective reminding.

Memory for verbal and nonverbal stimuli was evaluated using selective reminding procedures in normal achieving children and four groups of disabled learners: (1) reading-spelling disabled (R-S); (2) reading-spelling-arithmetic disabled (R-S-A); (3) spelling-arithmetic disabled (S-A); and (4) arithmetic disabled (A). Each child received two analogous free-list memory tasks, one for verbal material (animal names) and the other for nonverbal material (random dot patterns). These tasks were administered using selective reminding procedures that permit separation of storage and retrieval aspects of memory by reminding children only of those words not recalled on previous trials. Results revealed that relative to controls, the A and S-A children had significantly lower storage and retrieval scores on the nonverbal task, but did not differ on the verbal task; the R-S children differed only on retrieval scores from the verbal task; and the R-S-A children on retrieval scores on the verbal task and storage and retrieval scores on the nonverbal task. Thus, results indicate that the memory performance of disabled learners varies according to (1) the type of learning problem (arithmetic vs reading), (2) the nature of the stimuli (verbal vs nonverbal), and (3) the aspect of memory being assessed (storage vs retrieval). This study provides external validation for the classification of disabled learners according to patterns of academic achievement, demonstrating a useful procedure for dealing with the intrasubject variability characteristic of disabled learners.

Achievement↗

PubMed1993

Depressive symptoms and measures of disability: a prospective study.

OBJECTIVE: The purpose of this study was to test the hypothesis that decreases in severity of depressive symptoms in patients with chronic tinnitus would correlate with reductions in measures of functional disability. METHOD: This study describes the correlations between several measures of functional disability and Hamilton depression scores in two groups of patients with major depression and depressive symptoms (D-NOS) who were patients enrolled in a 12-week placebo-controlled, double-blind trial of nortriptyline. These patients had chronic severe tinnitus which was associated in most patients with high frequency hearing loss. The effect of whether affective symptoms improved and the patient's initial depression status (major depression versus depressive symptoms) are examined in order to increase understanding about the correlations between depressive symptoms and functional disability. RESULTS: Most measures of functional disability decreased synchronously with Hamilton Depression Scale scores in both patients with major depression and those with subclinical depressive symptoms. Patients whose depression improved had a significantly greater change in each disability measure than patients whose depression did not improve. This significant decrease in functional disability was seen in 11 of 13 scales in the improved D-NOS group, versus only 3 of the 13 scales in the unimproved D-NOS group; 9 of 13 scales of functional disability significantly decreased in the improved major depression group, versus 3 of 13 scales in the unimproved major depression group. CONCLUSIONS: The results suggest that there was a significant correlation between improvement in both major depression and depression-NOS symptoms, and decreases in measures of functional disability in an aging population with a chronic medical illness.

Adaptation, Psychological↗

PubMed1992

Judgements by health professionals of personal characteristics of people with a visible physical disability.

Discussion within rehabilitation literature suggests that visible disability is a cue which influences impressions that others form of a person. These impressions extend to include personality and social characteristics that have no necessary relationship with the disability. Evidence of such "spread" of judgement has emerged in studies with health professionals and raises concern for the quality and appropriateness of their interactions with clients with disabilities. This article incorporates the feature of disability within the wider context of implicit personality theory by exploring its effects on impression formation in conjunction with the effects of gender and manner of behaviour. A sample of 636 trainee and practising health professionals made Semantic Differential ratings of a job applicant observed in a videotaped interview. Twelve parallel videos were produced in which disability (use of a wheelchair), gender, and manner of behaviour (shy-neutral-brash) of the applicant were varied. Analyses of variance revealed significant main effects for each independent variable. Interaction effects were limited. Further study of Semantic Differential ratings indicated that respondents devalued the disabled applicants, with presence of wheelchair influencing judgments about social and psychological adjustment and about general competence and capability. Reasons posited for these findings include the nature of health professional-client relationship and occupation-related experiences. A disability awareness package is described which is aimed at health professionals and service providers and which is designed to address negative attitudes by providing accurate information and personal contact with people with disabilities.

Adaptation, Psychological↗

PubMed1988

The epidemiology of medical care utilization by severely-disabled independently-living adults.

A prospective study of the medical care utilization experience of 205 severely-disabled independently-living adults in Eastern Massachusetts shows that there was a mean of 0.83 +/- 1.26 hospital admissions, 9.9 +/- 22.7 hospital days, 1.5 +/- 2.31 emergency room (ER) visits, and 26.88 +/- 44.4 outpatient contacts per person per year. Among those hospitalized, the mean experience was 16.2 +/- 27.1 days per person per year; mean length-of-stay was 9.3 +/- 14.7 days per admission. Regression analysis indicates that those with spinal cord injuries as major disabling conditions were significantly more likely to be hospitalized. So were those with lower self-assessments of health, higher levels of depressions, and more baseline ER visits. Self-assessment of health is a significant predictor of hospital days for the total cohort (including those with no admissions); so are age at onset of disability (greater age; higher risk), and bed disability days in the month before the baseline survey (more disability days; higher risk). Among those hospitalized, the total number of days hospitalized is significantly related to both age at onset of disability (later onset; more days) and baseline days hospitalized (greater number; more days). Lengths-of-stay are significantly related to two factors; age and age at onset of disability (in both cases, greater age associated with longer stays). Prior ER visits are a significant predictor of subsequent ER visits (more baseline; more subsequent); so are respondents' reported satisfaction with their participation in their medical care (lower reported satisfaction; more ER visits), organizational affiliations, and frequencies of contacts with friends or relatives. Higher levels of social interaction (i.e. organizational affiliation and more frequent social contacts) were associated with more ER visits. Prior contacts with physicians, nurse-practitioners, or physician-assistants was the most powerful predictor of subsequent outpatient contacts (more baseline; more subsequent). There were also significant relationships between subsequent contacts and respondents' assessments of their health relative to others with similar disabilities (relatively worse health; more contacts), age (greater age; more contacts), and baseline ER visits (more visits; more contacts).

Activities of Daily Living↗

PubMed1993

Musculoskeletal disorders as determinants of disability in Finns aged 30 years or more.

The relationship between disability and various musculoskeletal disorders was investigated in 7217 men and women representative of the Finnish population aged 30 years or more. They participated in the Mini-Finland Health Survey and were first screened by interview and questionnaire about limitations in daily activities. The outcome variables were reduced working capacity, an occasional need for assistance in daily activities, and a regular need for assistance in daily activities. In a two-phase medical examination, all cases fulfilling predetermined diagnostic criteria of musculoskeletal, cardiovascular, respiratory and mental disorders and diabetes were recorded independently. In multivariate logistic regression analyses, inflammatory arthritis was the strongest determinant of all forms of disability. Osteoarthritis, especially in the hip, was a strong determinant of both occasional and regular need for assistance, and chronic low back pain was a strong determinant of reduced working capacity and occasional need for assistance among those aged 30-64 years. Other musculoskeletal disorders also determined the prevalence disability, but these relationships were reduced by taking comorbidity into account. A low level of education and a low (less than 20 kg/m2) or very high (at least 35 kg/m2) body mass index represented independent determinants of all forms of disability, and a history of physically strenuous work an independent determinant of reduced working capacity, when disabling illness was adjusted for. The proportion of all forms of disability attributable to musculoskeletal disorders, in models including, age, sex, other disabling illness and significant non-medical determinants of disability, was close to 20%. The disorders with the highest community impact were chronic low back pain among those aged 30-64, osteoarthritis of the hips and knees and inflammatory arthritis.

Adult↗

PubMed2006

Disability in patients with degenerative lumbar spinal stenosis.

OBJECTIVE: To determine factors associated with disability in patients with degenerative lumbar spinal stenosis. DESIGN: One-group cross-sectional study. SETTING: University hospital. PARTICIPANTS: One hundred eight patients with degenerative lumbar spinal stenosis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Oswestry Disability Index and 4 categories of factors, including patient demographics (age, sex, number of comorbidities, medications), symptom-related factors (intensity, location, onset duration, neurogenic claudication), body structure and function as described in the International Classification of Functioning, Disability and Health model (muscle strength, vibration sense, spine flexibility), and stenotic condition (type and number of spinal segments involved). RESULTS: Patients with symptoms in both back and leg reported greater disability than those with symptoms only in the leg or back (P=.008). Greater disability correlated significantly with greater symptom intensity (r=.385, P<.001) and higher vibration threshold (r=.236, P=.014). While controlling the variance in patient demographics in the regression analysis, vibration sense and symptom location each added 10% of the variance in disability, and symptom intensity and strength each added 5%, with a total of 44% variance explained (P=.044). CONCLUSIONS: Symptom intensity and location, vibration sense, and muscle strength were identified as significant factors and, together with patient demographics, accounted for 44% of the variance explained in disability. Further investigations are needed to determine if causal relationships exist between these factors and disability.

Age Distribution↗

PubMed2006

Approaches to child protection case management for cases involving people with disabilities.

OBJECTIVES: This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. METHOD: Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. RESULTS: Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. CONCLUSION: While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.

Case Management↗