'Not seeing people as capable': Disability professionals' mis/understandings of ableism

BACKGROUND

Knowledge about how disability professionals understand ableism may provide insight into the production of inequalities. The aim of this study was to examine how disability professionals understand ableism.

METHODS

We asked 347 disability professionals, all of whom worked with people with intellectual and developmental disabilities, among other populations, to define ableism and then analysed those definitions using content analysis.

RESULTS

The themes about how participants understood ableism were: discrimination; differential treatment; individualization; norms and othering; ableist language; microaggressions; and systems and environments. It was also not uncommon for participants to say ableist things, and express misconceptions in their definitions. This included these themes: avoiding disability; using ableist language; framing disability as in/ability; centring people without disabilities; ignoring invisible disabilities; believing only people without disabilities have bias; and believing ableism does not exist.

CONCLUSIONS

Knowing disability professionals' understandings of ableism is necessary to intervene biased attitudes and reduce ableism.

Developing Client Self-Advocacy in Occupational Therapy: Are We Practicing What We Preach?

Background

Developing client self-advocacy is in occupational therapy's (OT) scope of practice; however, there is limited understanding of if, or how, occupational therapists learn about self-advocacy interventions as well as implement self-advocacy into clinical practice.

Objective

This study sought to identify if and how therapists learn about self-advocacy intervention approaches and identify if and how therapists implement self-advocacy into their work with clients.

Method

A survey was distributed via email to academic and professional listservs in the United States, and data were collected using REDCap survey software. Descriptive statistics were analyzed data using REDCap/SPSS. Comparative statistics, Kruskal-Wallis's tests, Chi-square tests for independence, and Pearson's correlation tests analyzed differences across groups of respondents.

Results

Practicing and licensed occupational therapists (n = 138) across the United States completed the survey. Findings indicate a majority (59.5%) of occupational therapists not learning strategies for addressing or developing client self-advocacy. Of significance, 21.7% of participants had never been exposed to concepts of client self-advocacy in academic or clinical education. Practitioners who did address self-advocacy did so indirectly through teaching-related skills (76.6%).

Conclusion

Many clients of OT will need self-advocacy skills in order to address issues of exclusion and discrimination that prohibit full participation in society. Occupational therapists must prioritize incorporating client self-advocacy into curricula and clinical practice.

People with Disabilities' Access to Medical Care During the COVID-19 Pandemic

Delaying and forgoing medical care intensifies the health disparities and unmet needs people with disabilities already face. While many people with disabilities were at high risk for COVID-19, less is known about their access to medical care during the pandemic. This study explored people with disabilities' access to medical care during the COVID-19 pandemic. We analyzed United States Census Bureau COVID-19 Household Pulse Survey data from the second year of the pandemic (April-July 2021) from people with (n = 38,512) and without (n = 296,260) disabilities. During the second year of the pandemic, 30.8% of people with disabilities delayed getting medical care and 28.9% forwent needed care. People with disabilities were also significantly more likely to delay and forgo medical care than people without disabilities. Attention must be drawn to the unmet needs of people with disabilities and efforts must be made to expand their access to health care.

Early Career Occupational Therapists' Experiences during the COVID-19 Pandemic

Occupational therapists entering the clinical workforce during the COVID-19 pandemic experienced levels of uncertainty and stress. This study's aim was to explore the clinical experiences and concerns of early-career occupational therapists entering the workforce during the COVID-19 pandemic (n = 27). We administered an open-ended online survey and analyzed the data using inductive thematic analysis. Resulting themes included: safety, exposure, and transmission; implementation and enforcement of safety protocols; quality of care; and impact of the pandemic on overall health highlighting the issues that need to be addressed to be more prepared for future practice in an evolving environment.

Telehealth Use By Persons with Disabilities During the COVID-19 Pandemic

Telehealth use rapidly expanded during the COVID-19 pandemic. Understanding if, and how, people from disabilities used telehealth during the pandemic is vital to assuring this evolving and increasingly common form of health care is equitably developed and delivered to avoid reproducing the health disparities people with disabilities already face. Our aim was to explore the use of telehealth among people with disabilities during the pandemic. We conducted a weighted secondary analysis of United States Census Bureau data (April-July 2021) from 38,512 (unweighted) people with disabilities. Our findings revealed 39.8% of people with disabilities used telehealth during the second year of the pandemic, ranging from 34.5% of people with hearing disabilities to 43.3% of people with mobility disabilities. There were also differences in telehealth use based on sociodemographics. Telehealth promises to open doors to more equitable health care access for many people with disabilities, but only if access barriers are removed.

Explicit and implicit disability attitudes of occupational and physical therapy assistants

BACKGROUND

Reduction of explicit and implicit bias in healthcare providers is a critical issue faced by our society in moving toward more equitable and culturally appropriate health and rehabilitation care. Because resources for OT and PT services are limited and shortages in these professions exist, direct care provision by occupational and physical therapist assistants (OTA/PTA) is on the rise and valued in comprehensive rehabilitation practice. It is important to consider attitudes and biases of OTA/PTA, as they are directly involved in provision of rehabilitation services for people with disabilities.

OBJECTIVE

This study examined the explicit and implicit disability attitudes of a large cross-section of OTA/PTA.

METHODS

Secondary data analysis was completed using data from 6113 OTA/PTA from the Project Implicit Disability Attitudes Implicit Association Test. Implicit attitudes were calculated and OTA/PTA explicit and implicit disability attitudes were compared. Results were further categorized using an adapted version of Son Hing et al.'s two-dimensional model of prejudice.

RESULTS

Findings revealed the majority of OTA/PTA reported having no explicit preference for people with disabilities or nondisabled people. However, the majority of OTA/PTA were aversive ableists, indicating low explicit and high implicit bias.

CONCLUSIONS

Though explicit bias is lower in OTA/PTA, implicit bias is strong, indicating that people with disabilities face bias that may influence clinical interactions, and may be reproduced in professional education, practice, and policy. Concrete action must be taken to recognize and address disability bias to reduce health disparities in people with disabilities.

Anti-Fat Biases of Occupational and Physical Therapy Assistants

Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.

Impact of Occupational Therapy Education on Students' Disability Attitudes: A Longitudinal Study

IMPORTANCE

Discrimination based on disability-ableism-is pervasive and affects the opportunities of people with disabilities to fully engage in society.

OBJECTIVE

The aim of this study was to explore the impact of occupational therapy graduate education on students' explicit and implicit disability attitudes throughout their graduate education.

DESIGN

Longitudinal observational study, measuring occupational therapy students' attitudes on an annual basis.

SETTING

Three Midwestern graduate occupational therapy programs.

PARTICIPANTS

Occupational therapy students (N = 67). Outcomes and Measures: Participants completed the Symbolic Ableism Scale (to measure their explicit disability attitudes) and the Disability Attitude Implicit Association Test (to measure their implicit disability attitudes) on an annual basis, from when they entered their occupational therapy program to when they graduated.

RESULTS

The students' explicit attitudes decreased (i.e., became more favorable) throughout their education; however, their implicit attitudes did not change. In fact, most students (68%) were implicitly ableist at graduation.

CONCLUSIONS AND RELEVANCE

Occupational therapy education programs have an important role to play in terms of intervening with students' beliefs and preconceived assumptions about disability. Our finding suggests that occupational therapy programs may fail to intervene with students' ableist attitudes. What This Article Adds: Little longitudinal research has examined how students' implicit disability bias may be affected by their academic experience. Our findings about ableism among occupational therapy students should open the door for further dialogue on the existence of ableism in program content, its potential impact on future client interactions, and the development of approaches to address it.

Recognizing Inequity: A Critical Step of Health Literacy for People With Disability

IMPORTANCE

Receiving accommodations may require a person with physical disability (PWPD) to recognize and address disparate care when it occurs.

OBJECTIVE

To explore whether PWPDs recognize disparate health care and how their experiences contribute to the development of strategies to access care.

DESIGN

In this qualitative study, we used grounded theory methods to explore perceptions of PWPDs regarding access to health care. Ten PWPDs participated in three semistructured focus group interviews. The analysis used multiple phases of analysis and methods to ensure rigor.

SETTING

Focus groups were held at an urban university campus.

PARTICIPANTS

Four male and six female English speakers who identified as a PWPD in need of a mobility aid and who attended a primary health care visit in the past year.

RESULTS

Seven thematic categories emerged, representing a continuum of stages for recognizing health care as disparate and strategies to receiving equitable health care for PWPDs: (1) unrecognized experiences of normalization of disability discrimination (NODD), with a subtheme of medicalization; (2) knowing what you need; (3) noticing differences; (4) emerging understanding; (5) learning to take personal action; (6) NODD is systemic; and (7) taking control.

CONCLUSIONS AND RELEVANCE

The findings of this study can be used on micro, meso, and macro levels to work toward equitable health care access and outcomes for clients. What This Article Adds: Occupational therapy practitioners can use these findings to understand the health literacy demands of PWPDs in efforts to access equitable health care and, when necessary, educate clients on their potential need for accommodation, rights to care, and development of strategies for requesting accommodations.

Support for the Americans With Disabilities Act Among Nondisabled People

The Americans with Disabilities Act (ADA) opened the doors to access and enhanced the civil rights of people with disabilities. However, a lack of accessibility to all segments of society continues throughout the United States and is frequently described by people with disabilities as a leading cause for limited participation. Beliefs and attitudes regarding disability can affect critical decisions regarding inclusion and people with disabilities’ civil rights. Therefore, the purpose of this study was to explore support and opposition to the ADA among nondisabled people. We had the following research questions: (a) What is the relationship between disability prejudice and support for the ADA? and (b) When controlling for disability prejudice, what other factors lead people to support the ADA? To do so, we examined secondary data from approximately 13,000 participants from all 50 states and the District of Columbia. Findings from this study revealed that people who oppose the ADA are significantly more prejudiced toward people with disabilities than people who support the ADA. Understanding and becoming aware of attitudes and prejudice toward persons with disabilities can be a first step toward dispelling such beliefs and possibly a priori step to achieving the intent and spirit of the ADA.

ScreenABLE: Breast Cancer Screening among Women with Disabilities from Community Identified Challenges to Community-Based Programs

BACKGROUND

Women with disabilities are an unrecognized cancer disparities population who experience well-documented barriers to breast cancer screening. There is a critical need for targeted, community-directed programing to address these disparities.

OBJECTIVES

To describe the trajectory of a long-term community-academic partnership aimed at understanding and addressing breast cancer screening disparities among women with disabilities.

METHODS

Phase 1 was a thematic qualitative focus group study (n = 40) with women with physical disabilities to understand their breast cancer screening experiences. Phase 2 was the application of an equity-focused knowledge translation (KT) process that brought together breast cancer survivors with disabilities and graduate applied health students in KT collaboratives to create innovative, evidence-informed knowledge products. Phase 3 included the development of community-based programming.

RESULTS

In phase 1, women with disabilities identified provider and patient barriers to breast cancer screening, including a lack of provider knowledge and respect for individuals with disabilities, lack of accessibility, the history of stigma and mistreatment within the health care setting, and treatment fatigue. In phase 2, KT collaboratives created the short film "ScreenABLE" to educate providers and community members about physical and attitudinal barriers to cancer screening. In phase 3, community, academic, and clinical partners collaborated to create ScreenABLE Saturday, a wellness fair and free accessible mammograms, for women with disabilities with programming developed to directly address cancer screening barriers identified from the phase 1 research.

CONCLUSIONS

Long-term sustained partnerships between academic, disability, and clinical partners are needed to address the complex issues that perpetuate breast cancer screening disparities among women with disabilities.

Scholarly Reflections on the State of the Profession’s Embrace of Disability Studies

Date Presented 03/28/20

A 2005 special issue of the American Journal of OT was dedicated to the growing influence of disability studies on the profession. Authors from this journal reflected upon how shifting perspectives of disability might inform future research and intervention design. This study sought out these authors to explore their current perspectives on disability studies within the profession using thematic analysis to understand if or how suggestions and recommendations from the 2005 manuscript have been attended to.

Primary Author and Speaker: Laura VanPuymbrouck

Additional Authors and Speakers: Alisa Sheth, Jenna Heffron, Jacqueline Kish, Lisa Mahaffey

Contributing Authors: Danbi Lee

Interventions to Promote and Support Development of Client Self-Advocacy: A Narrative Review of the Literature

Date Presented 03/27/20

This narrative review examined the evidence within the scope of OT practice addressing client development of self-advocacy, synthesizing the content of effective OT interventions addressing client development of self-advocacy to identify common features vital to successful outcomes. Additionally, this study aims to determine the quality of available empirical evidence of OT interventions designed to promote and support client self-advocacy.

Primary Author and Speaker: Laura VanPuymbrouck

Additional Authors and Speakers: Abraham Kim, Kimberly Lieberman, Theresa Guzaldo, Erin Thrasher

Relationships Between OT Students’ Understandings of Disability and Disability Attitudes

Date Presented 03/28/20

This presentation describes the findings of a study exploring incoming OT graduate students’ understandings of disability and their implicit (unconscious) and explicit (conscious) attitudes toward it. The presentation will explore how students’ attitudes toward disability may be influenced by curriculum design, with discussion of strategies educators might incorporate to support or challenge their conceptual underpinnings of disability and its causes.

Primary Author and Speaker: Laura VanPuymbrouck

Contributing Authors: Carli Friedman

Explicit and implicit disability attitudes of healthcare providers

PURPOSE/OBJECTIVE

Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes.

RESULTS

While on average, provider's explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability).

CONCLUSIONS/IMPLICATIONS

This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Our Peers-Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries With Physical Disabilities

People with disabilities (PWD) are a health disparities population who experience well-documented physical, structural, attitudinal, and financial barriers to health care. The disability rights community is deeply engaged in advocacy to promote health care justice for all PWD. As the community continues to work toward systems change, there is a critical need for community-directed interventions that ensure individuals with disabilities are able to access the health care services they need and are entitled to. Peer health navigator (PHN) programs have been shown to help people from diverse underserved communities break down barriers to health care. The PHN model has not been systematically adapted to meet the needs of PWD. In this article, we describe the collaborative process of developing Our Peers—Empowerment and Navigational Supports (OP-ENS), an evidence-informed PHN intervention for Medicaid beneficiaries with physical disabilities in Chicago, IL, USA. Our Peers—Empowerment and Navigational Supports is a 12-month community-based PHN intervention that pairs Medicaid beneficiaries with physical disabilities (peers) with disability PHNs who use a structured recursive process of barrier identification and asset mapping, goal setting, and action planning to help peers meet their health care needs. Our Peers—Empowerment and Navigational Supports was developed by a collaborative team that included disability rights leaders, representatives from a Medicaid managed care organization, and academic disability health care justice researchers. We highlight both the conceptual and empirical evidence that informed OP-ENS as well as the lessons learned that can assist future developers.

Relationships between occupational therapy students' understandings of disability and disability attitudes

Background: Entering occupational therapy (OT) students have established beliefs, informed by sociocultural backgrounds. Understanding how students define and understand disability, and the relationships these understandings have to disability bias, can guide curriculum design decisions to integrate meso and macro level perspectives of disability into clinical reasoning.Aim/Objective: This study's aim was to explore incoming occupational therapy students' (n = 67) understandings of disability and their attitudes towards it.Material and method: An online survey was used to collect data on students' attitudes and definitions of disability. Mixed research methods were used to analyze students' definitions of disability (content analysis) in relation to disability attitudes (Disability Attitudes Implicit Association Test).Results/Finding: Findings reveal students enter curriculums with vast differences in understandings of people with disabilities and these may provide a basis for and contribute to differences in attitudes of disability.Conclusions: OT students have established beliefs of disability as individualized or more socially constructed and these influence disability biases.Significance: Students' education has considerable influence in shaping attitudes and ways of interacting with people with disability. Understanding students' assumptions as they enter a program is a first step to evaluate how curriculum design may influence development of student clinical reasoning strategies.

“The Bigger Picture”: Occupational Therapy Practitioners’ Perspectives on Disability Studies

OBJECTIVE. This qualitative study explored occupational therapy practitioners’ perspectives about integrating principles from the field of disability studies (DS) into clinical education and practice.

METHODS. After a conference presentation about DS, three simultaneous focus groups were conducted with 27 occupational therapy practitioners. A constant comparative, grounded-theory approach was used to identify themes across groups.

RESULTS. Identified themes included convergences and divergences between the profession of occupational therapy and the field of disability studies, influence of perspectives of disability on service delivery, clinician navigation of systemic barriers, and incorporation of DS-aligned intervention strategies into practice.

CONCLUSION. Despite points of alignment, occupational therapy has not fully addressed DS critiques. Practitioners recognized professional, systemic, and societal barriers and the need for more educational experiences, resources, and professional reflexivity and dialogue to inform the integration of DS concepts into practice.

The relationship between disability prejudice and medicaid home and community-based services spending

BACKGROUND

Medicaid is one of the most important health care safety nets for people with disabilities in the United States. Yet, from the beginning Medicaid only covered long-term services and supports (LTSS) through institutional care. In 1981 changes to Medicaid allowed states to provide home and community-based services (HCBS) instead so people with disabilities could receive LTSS in their own homes or in the community. As a result of these changes, there has been a significant decline in institutionalization of people with disabilities in favor of HCBS in the United States. However, the priority of HCBS can be impacted by ideas about community living and disability attitudes, among others. How these attitudes may trickle down to impact Medicaid funding decisions is unknown.

OBJECTIVE

The aim of this study was to examine the relationship between HCBS and disability prejudice in the United States.

METHODS

We used secondary data about state LTSS expenditures from across the nation in fiscal year (FY) 2015, as well as disability prejudice data (Disability Attitudes Implicit Association Test) from 325,000 people residing in all 50 states and the District of Columbia.

RESULTS

Findings revealed regardless of the state size or wealth, states with more disability prejudice direct less of their LTSS funding towards HCBS.

CONCLUSIONS

Biases and prejudice in disability policy decision-making are obstacles to equality of opportunity and full participation in society, as promised by civil rights.

Health Care Survival Skills: An Occupational Therapist–Disability Peer Led Intervention—Feasibility, Acceptability, and Preliminary Outcomes

Date Presented 4/21/2018

We describe the development, feasibility, acceptability, and preliminary findings of an occupational therapist–disability peer led intervention—Health Care Survival Skills—designed to help people with physical disabilities engage in the occupation of negotiating the health care system.

Primary Author and Speaker: Susan Magasi

Additional Authors and Speakers: Laura VanPuymbrouck

Contributing Authors: Sharon Lamp

Community-Based Services for People With Brain Injury: A National Analysis

Purpose:

Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.

Method:

This study examined how states utilized waivers to provide for people with BI.

Results:

Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.

Conclusions:

Of those waivers for people with BI, there were vast differences across states and services.

Occupational Therapy in Medicaid Home and Community-Based Services Waivers

OBJECTIVE

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015.

METHOD

Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization.

RESULTS

In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates.

CONCLUSION

Comparisons across states strengthen the profession's ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs.

Screen-ABLE: A Mixed-Methods Study on Breast and Cervical Cancer Screening Disparities Among Women With Disabilities

Date Presented 4/17/2015

In this mixed-methods study, we identified disparities in breast and cervical cancer among women with disabilities, along with modifiable barriers to screening. By understanding and addressing these barriers, occupational therapy practitioners can be change agents at the provider and client levels.

Research Platform