Missouri Disability and Health Collaborative George Gotto, UMKC-IHD Karen Wallace, DHSS Christy Miller, UMKC-IHD Missouri Council for Activity & Nutrition January 18, 2018

Adults with Intellectual and Developmental Disabilities… Engage in low levels of physical activity (Stanish, Temple, & Frey, 2006) Eat unhealthy diets (Draheim et al., 2007) Have high levels of obesity and related chronic disease (Sutherland, Couch, & Iacono, 2002) The trend in the United States is moving toward adults with mild IDD living in smaller, less supervised settings (Rimmer & Yamaki, 2006; Stancliffe, et al., 2011) People with IDD who live in less restrictive settings are more likely to be obese than those who live in more supervised settings (Rimmer et al., 1993, 1994; Lewis et al., 2002; Melville, et al., 2007; Rimmer & Yamaki 2006; Anderson, 2013 Stancliffe, et al., 2011) Missouri Council for Activity & Nutrition January 18, 2018

Missouri Disability and Health Collaborative The overall goal is “to support individuals with intellectual disabilities to be included in and have access to the full range of evidence-based physical activity and nutrition programs provided through public health programs within Missouri.” Reduce health disparities for people with intellectual disabilities (ID) within Missouri public health programs. Build internal state capacity and disability and public health partnerships. Support the implementation of a needs assessment which will assess gaps in access to Missouri public health programs by individuals with ID Adapt and implement evidence-based physical activity and nutrition programs. Enhance state level surveillance and monitoring related to health status of individuals with ID. Improve dissemination of materials and messaging related to nutrition and exercise promotion for people with ID. Missouri Council for Activity & Nutrition January 18, 2018

Statewide Needs Assessment Phase 1: Comprehensive literature review on health and wellness supports for people with ID. The comprehensive literature review identified common barriers to promoting nutrition and exercise programs for people with ID, with special attention given to methods for overcoming barriers to participation. Phase 2: Community-based systems modeling. The purpose of the system-modeling sessions was to gain insight into the conceptual and causal relationships community members attribute to policies and practices that impact participation of individuals with ID in public health nutrition and physical activity programs. This process included adults with ID, family members, and public health professionals. Phase 3: Community Health Inclusion Index Organizational Assessment. Lastly, the assessment team used the Community Health Inclusion Index (CHII) Organizational Assessment to collect data from county and municipal public health organizations that receive funding from/participate in Bureau of Community Health and Wellness public health programs. Missouri Council for Activity & Nutrition January 18, 2018

Phase I: Comprehensive Literature Review What barriers and facilitators affect the decisions that people with ID make about participating in fitness and nutrition programs in their community? What characteristics are shared by interventions/strategies that have been most effective in increasing the participation of people with ID in community fitness and nutrition activities? Missouri Council for Activity & Nutrition January 18, 2018

Flow Chart of the Article Selection Process Missouri Council for Activity & Nutrition January 18, 2018

Literature Review Highlights Themes: The articles provided evidence for what works to make community programs accessible and inclusive for people with ID. Some of the most important themes were: Support from family, peer mentors, and staff Social support, enjoyment, and rewards Accessibility of health promotion materials and programs Self-efficacy (believing in your own ability to do something) Attitudes about disability Staff and volunteer training Cost Transportation Perception of risk (people with ID or their support people worry about safety) What works: A few of the articles describe successful programs and strategies. These include volunteer or peer mentoring, goal setting, combined exercise and health education programs, including people with ID in the development of programs, and exposing community program staff to new ideas and attitudes about ID. Missouri Council for Activity & Nutrition January 18, 2018

Phase 2: Community-Based Systems Modeling Purpose: Gain insight into the conceptual and causal relationships community members attribute to policies and practices that impact participation of individuals with ID in public health nutrition and physical activity programs. Sessions occurred in six regions of the state Adults with ID (n=25) Family members (n=8) Disability support and public health professionals (n=41) Missouri Council for Activity & Nutrition January 18, 2018

Path Diagram for Accessible Community Fitness & Nutrition Programs Missouri Council for Activity & Nutrition January 18, 2018

Missouri Council for Activity & Nutrition January 18, 2018 Phase 3: Community Health Inclusion Index (CHII) Organizational Assessment Survey Purpose: To collect information about inclusive healthy living resources in a community. The survey asks questions across five topic areas: Healthy eating programs and policies; Physical activity programs and policies; Staff training and incentives; Healthcare; and Inclusion attitudes. Missouri Council for Activity & Nutrition January 18, 2018

Missouri Council for Activity & Nutrition January 18, 2018 Survey Participants 56 local public health agencies 44 (79%) healthcare sites 8 (14%) “worksites” 4 (7%) community institution/organizations The majority of participating professionals (40) identified themselves as supervisors, with two HR Coordinators, two Communication Liaisons, and 20 who selected “other.” Missouri Council for Activity & Nutrition January 18, 2018

CHII Organizational Assessment Highlights 56% of public health agencies have at least one policy that programs should be inclusive 39% offer some disability awareness training for staff and 70% offer at least some accommodations for people with disabilities 75% [42] are part of a wellness coalition but only seven of these include someone representing the disability perspective and only eight set goals related to the needs of people with disabilities 90% of agencies say their leadership supports enhanced inclusion 43% of agencies reported that disability inclusion was a strong or very strong concern, and 34% said it was a moderate concern Missouri Council for Activity & Nutrition January 18, 2018

2017 Needs Assessment Key Findings Missouri Council for Activity & Nutrition January 18, 2018

Missouri Council for Activity & Nutrition January 18, 2018 Next Steps Increase public health physical activity and nutrition strategies adapted to be inclusive of people with ID Increase utilization of adapted programs/strategies Train personal care assistants, service providers and family members on physical activity and nutrition Add questions related to ID to existing surveillance systems Missouri Council for Activity & Nutrition January 18, 2018

Missouri Council for Activity & Nutrition January 18, 2018 Next Steps Offer training on working people with disabilities for public health staff and partners Convene stakeholders from local public health and disability programs to encourage connections Missouri Council for Activity & Nutrition January 18, 2018