1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 31 Special Needs Populations

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Define terms related to disability. 2. Discuss implications of developmental disability, physical disability, or chronic illness. 3. Identify the conditions that may contribute to disability. 4. Discuss the effects of being disabled on the individual, the family, and the community. 5. Describe the implications of being disabled for selected (low-income) populations.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 6. Discuss selected issues for those who are disabled (abuse, health promotion). 7. Discuss the objectives of Healthy People 2020 as they relate to disability. 8. Examine the nurse’s role in caring for people who are disabled.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Understanding Disabilities Models of Disability Disability Defined Census Determination of Disability Social Security Disability Americans with Disabilities Act Functional Disability Additional Definitions

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Models of Disability  Medical model of disability  Places emphasis on the disabled person and the need to modify the course of illness to give the disabled person a “normal” life  Social model of disability  Emphasis is placed on systemic barriers as well as societal attitudes and stigmas that contribute to the perception that those with limitations or physical illnesses are disabled.

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Disability Defined (Webster’s Dictionary)  The condition of being disabled  Inability to pursue an occupation because of a physical or mental impairment  A program providing support to one affected by a disability  Lack of legal qualification to do something or a disqualification, restriction, or disadvantage

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Census Determination of Disability  2010 census definition changed to improve response rate and more reliable information  Six specific subpopulations of disability were identified:  Employment disability  Sensory disability  Mental disability  Physical disability  Self-care disability  Go-outside-the-home disability  Work disability

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Top 10 Causes of Disability in the United States 1. Arthritis or rheumatism 2. Back or spine problems 3. Heart trouble 4. Mental or emotional problem 5. Lung or respiratory problem 6. Diabetes 7. Deafness or hearing problem 8. Stiffness or deformity of limbs/extremities 9. Blindness or vision problems 10. Stroke

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Social Security Disability  Defines disability as “the inability to engage in any substantial, gainful activity by reason of a medically determinable physical or mental impairment, which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.”

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Americans with Disabilities Act  The term disability means, with respect to an individual,  A physical or mental impairment that substantially limits one or more of the major life activities of such an individual  A record of such an impairment  Being regarded as having such an impairment

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Functional Disability  Occurs when individuals experience difficulty performing basic activities of daily living because of their disability  Examples of difficulty with:  Standing  Walking  Climbing  Grasping  Reading

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Additional Definitions  Dual diagnosis  Children with special health care needs  Developmental disability  Chronic disease

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Scope of the Problem Number of Disabled Americans Number of Disabled Worldwide Burden of Chronic Disease Additional Causes of Disability Childhood Disability Mental Illness

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Number of Disabled Americans  12.1% or 36 million noninstitutionalized men, women, and children reported a disability in 2008.  19% or 54.4 million of all United States residents (includes institutionalized) reported a disability in 2008.  One in 5 United States residents has a disability.  Two in 7 United States families report having a family member with a disability.

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Number of Disabled Worldwide  Approximately 650 million people worldwide have some type of disability.  Number is increasing annually  Chronic diseases  Injuries  Automobile crashes  Violence  Aging population

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Burden of Chronic Disease  Chronic diseases contribute significantly to the development of disability.  Nearly 50% of the adult population in 2005 had at least one chronic illness.  About ¼ of people with chronic conditions have one or more daily activity limitations.  Arthritis is the most common cause of disability.

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Additional Causes of Disability  Genetic disorders  Acute and chronic illnesses  Violence  Tobacco use  Lack of access to health care  Failure to eat correctly  Failure to exercise regularly  Failure to manage stress effectively

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Childhood Disability  13.9% of children in the United States have special needs.  Developmental, behavioral, or emotional in nature  21.8% of households with children have at least one child with a special health need.  Special health care needs require a variety of care needs, including prescription medications, specialized therapies, and medical equipment.  Special health care needs increase with age.

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Mental Illness  Often overlooked source of disability  Annually, 57.5 million Americans over 18 years of age have a diagnosable mental disorder  Major depressive disorder is leading cause of disability in the United States for people 15 to 44 years of age  Multiple diagnoses and dual diagnosis increase the severity of disability and functional impairment.

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Effects of Disabilities Effects on the Individual Effects on the Family Effects on the Community

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Effects on the Individual  Related health problems (e.g., nutrition, oral health, hygiene, limited activity/stamina)  Self-concept/self-esteem  Life expectancy and risk for infection and secondary injury  Developmental tasks; change in role expectations

22. 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Effects on the Family  Stress on family unit  Need for use of external resources to help family meet role expectations  Options limited in use of any discretionary income  Social stigma

23. 23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Effects on the Community  Need/demand to reallocate resources  Discomfort or fear from lack of knowledge of disability  Need to comply with legislation  Services provided by health department, health care providers  Need for other services beyond medical diagnosis (e.g., transportation)

24. 24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Low-Income Populations  Individuals who often experience poverty:  Physically compromised  Single parents and their children  The aged  The unemployed  Members of racial and ethnic minorities  Less likely to have the resources to provide for their own special needs

25. 25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Selected Issues  Abuse  Disable persons more likely to experience some form of abuse during their lifetime  Care-related abuse is most common Neglect Cruel physical care  Disabled children at higher risk for abuse (Figure 31-4)  Health promotion

26. 26 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Healthy People 2020 Objectives  Many of the objectives address concerns regarding increasing health promotion and wellness activities for individuals with disabilities.  Greater emphasis on increasing access to services, which can increase independence and foster community living

27. 27 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Role of the Nurse  Provider of hands-on care  Educator  Advocate  Referral agent  Coordinator  Collaborator  Change agent

28. 28 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Legislation  A Guide to Disability Rights Law (2006) U.S. Department of Justice  Rehabilitation Act of 1973  Individuals with Disabilities Education Act of 1975  Civil Rights of Institutionalized Persons Act of 1980  Voting Accessibility for the Elderly and the Handicapped Act of 1984  Fair Housing Act of 1988  American with Disabilities Act of 1990  National Voter Registration Act of 1993

29. 29 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Rights Under IDEA  Free and appropriate public education  Appropriate evaluation/assessment  Individual Education Plan (IEP)  Education in the least restrictive environment  Parent and student participation in decision making  Early intervention services for children and their families