1. DISABILITY AND PUBLIC POLICY IN THE UNITED STATES Katherine D. Seelman, Ph.D. Associate Dean and Professor School of Health and Rehabilitation Science University of Pittsburgh, USA www.shrs.pitt.edwww.shrs.pitt.ed Kds31@pitt.edu www.shrs.pitt.ed Chinese Conference on Rehabilitation Medicine Beijing, PRC October 22-26, 2001

2. Greetings from the Faculty and Students University of Pittsburgh School of Health and Rehabilitation Science to Chinese Colleagues Chinese Society of Rehabilitation Medicine and Engineering

3. Purpose of Presentation Identify stages in the development of Disability Policy in the United States in the 20 th Century Identify stages in the development of Disability Policy in the United States in the 20 th Century Introduce national government rehabilitation and disability agencies Introduce national government rehabilitation and disability agencies Explain the role of interest groups Explain the role of interest groups

4. Stages in U.S. Disability Policy Stage I: Income and Health Benefits Policies Stage I: Income and Health Benefits Policies Stage II: Education and Work Services Policy and Stage II: Education and Work Services Policy and Stage II-III: Research and Accessibility Policy Stage II-III: Research and Accessibility Policy Stage IV: Civil Rights/Human Rights Policy Stage IV: Civil Rights/Human Rights Policy

5. Stage I: National and State Disability Income Benefits Policy Types of Programs: Programs for those injured at work or veterans Programs that pay benefits to persons who are disabled and poor General Disability Programs that that pay benefits to those who are enrolled in/insured by the program

6. Stage I: Income Benefits Legislation Social Security Act, 1935, benefits to retirees and blind people. Social Security Act, 1935, benefits to retirees and blind people. Social Security Disability Insurance, 1956, benefits for people who could show they were disabled and who had paid into the system. Social Security Disability Insurance, 1956, benefits for people who could show they were disabled and who had paid into the system. Supplemental Security Income, 1974, benefits for disabled, blind and aged people who are poor. Supplemental Security Income, 1974, benefits for disabled, blind and aged people who are poor.

7. Stage I: Health Benefits Policy Overall authority for health care is divided between the private sector and federal, state and local governments. Overall authority for health care is divided between the private sector and federal, state and local governments. Health care insurance is provided mainly by employers Health care insurance is provided mainly by employers Public insurance through Medicare or Medicaid Public insurance through Medicare or Medicaid

8. Stage I: Health Legislation-- Medicaid Social Security Act, 1965, Medicaid Social Security Act, 1965, Medicaid –Sets up a partnership between different levels of government –Aims at improving access and quality of health care for the poor.

9. Stage I: Health Legislation— Medicaid (continued) –Mandatory benefits include hospital and physician services, screening and treatment of children for various sicknesses and impairments. –Optional benefits have been used to assist disabled with assistive technology and home aides

10. Stage I: Health Legislation-- Medicare (continued) Social Security Act, 1965, Medicare Social Security Act, 1965, Medicare –Beneficiaries: » those over 65 years old, »those disabled and receiving Social Security cash benefits » those suffering from end-stage renal disease

11. Stage I: Health Legislation— Medicare (continued) Medicare Structure Medicare Structure –Part A: Hospital Insurance covers hospital expenses for specified periods –Part B: Voluntary, benefits covers a wide range of physician and outpatient services, surgical procedures, ambulance services; very limited long term care coverage

12. Stage II: Beyond Income and Health Policy to Community Integration and Research: Education Policy Education Policy Employment and Work Policy Employment and Work Policy Research Research Accessibility Accessibility

13. Stage II: Education and Work Policy and Legislation Individuals with Disabilities Education Act, 1975, requires participating states to furnish all children with disabilities a free, appropriate public education in the least restrictive setting. Individuals with Disabilities Education Act, 1975, requires participating states to furnish all children with disabilities a free, appropriate public education in the least restrictive setting. Rehabilitation Act, 1973, federal support for training and placing people with physical and mental disabilities into employment. Rehabilitation Act, 1973, federal support for training and placing people with physical and mental disabilities into employment.

14. Stage II: Governmental Support for Rehabilitation and Disability Research U.S. National Institute on Disability and Rehabilitation Research: http://www.ed.gov/offices/OSERS/NIDRR U.S. National Institute on Disability and Rehabilitation Research: http://www.ed.gov/offices/OSERS/NIDRR http://www.ed.gov/offices/OSERS/NIDRR U.S. Department of Veteran’s Affairs: http://www.vard.org/cent/centers.htm U.S. Department of Veteran’s Affairs: http://www.vard.org/cent/centers.htm http://www.vard.org/cent/centers.htm

15. Stage II: Governmental Support for Rehabilitation and Disability Research (continued) National Science Foundation: National Science Foundation: http:// www.nsf.gov http:// www.nsf.govwww.nsf.gov National Center for Medical Rehabilitation Research (National Institutes of Health): National Center for Medical Rehabilitation Research (National Institutes of Health): http://www.nichd.nih.gov http://www.nichd.nih.govhttp://www.nichd.nih.gov

16. Stage II: National Government Support for Rehabilitation and Disability Research Other agencies: Other agencies: –Access Board –Office of Disability, Aging and Long Term Care –Social Security Administration –U.S. Department of Housing and Urban Development –U.S. Department of Transportation

17. Stage II: National Institute on Disability and Rehabilitation Research (NIDRR) Mission Research to support re-integration into society Research to support re-integration into society New Paradigm of Disability: Disability is a relationship between impairment and the environment New Paradigm of Disability: Disability is a relationship between impairment and the environment

18. Stage II: NIDRR Long Range Plan: Research Elements Employment Outcomes Employment Outcomes Health and Function Health and Function Technology for Access and Function Technology for Access and Function Independent Living and Community Integration Independent Living and Community Integration Information Dissemination Information Dissemination Associated Areas: Disability Statistics, outcome measures, international Associated Areas: Disability Statistics, outcome measures, international

19. Stage II: NIDRR Programs Rehabilitation Research Training Centers Rehabilitation Research Training Centers Rehabilitation Engineering Research Centers Rehabilitation Engineering Research Centers Model Systems in Spinal Cord, Traumatic Brain Injury and Burn Rehabilitation Model Systems in Spinal Cord, Traumatic Brain Injury and Burn Rehabilitation

20. Stage II: NIDRR Programs (continued) Advanced Rehabilitation Training Projects Advanced Rehabilitation Training Projects Americans with Disabilities Act Technical Assistance Americans with Disabilities Act Technical Assistance Assistive Technology Act Assistive Technology Act

21. Stage II: NIDRR Research Structure Centers of Excellence Model Centers of Excellence Model Competitive grants process Competitive grants process IRB IRB Peer Review Peer Review Program Review Program Review

22. Stage II: NIDRR Organization Budget FYI 2001: $138 million Budget FYI 2001: $138 million Staff: 40 Staff: 40 Government cooperation: Interagency Committee on Disability Research Government cooperation: Interagency Committee on Disability Research

23. Stage II-Stage III: Accessibility Built Environment Built Environment Information Technology and Telecommunications Information Technology and Telecommunications Transportation Transportation Consumer Products Consumer Products

24. Stage II-Stage III: Accessibility Policy and Legislation Architectural Barriers Act, 1968: access to the built environment for wheelchair users and others Architectural Barriers Act, 1968: access to the built environment for wheelchair users and others Hearing Aid Compatibility Act of 1988, for hard of hearing access to telephone Hearing Aid Compatibility Act of 1988, for hard of hearing access to telephone Telecommunications Accessibility Enhancement Act, 1988 for deaf access to telephone Telecommunications Accessibility Enhancement Act, 1988 for deaf access to telephone

25. Stage II- Stage III: Accessibility Policy and Legislation Technology-Related Assistance for Individuals with Disabilities Act 1988 (Assistive Technology Act, 1998) Technology-Related Assistance for Individuals with Disabilities Act 1988 (Assistive Technology Act, 1998) – to integrate assistive technology into lives of disabilities, at home, at school, at work and in the community – to support technical assistance, training, finance and information dissemination

26. Stage II—Stage III: Accessibility Policy and Legislation Section 508 of the Rehabilitation Act, 1998, requires national government agencies to have their electronic and information technology accessible, including all electronic devices such as computers, xerox machines, telephones Section 508 of the Rehabilitation Act, 1998, requires national government agencies to have their electronic and information technology accessible, including all electronic devices such as computers, xerox machines, telephones

27. Stage II—Stage III: Accessibility Policy and Legislation Television Decoder Circuitry Act, 1990, universal design in televisions for closed captioning use by deaf and hard of hearing people and all people in noisy places Television Decoder Circuitry Act, 1990, universal design in televisions for closed captioning use by deaf and hard of hearing people and all people in noisy places Telecommunications Act of 1996, main national law for regulating communications, requires equipment access Telecommunications Act of 1996, main national law for regulating communications, requires equipment access

28. Stage III: Civil Rights and Full Citizenship Americans with Disabilities Act, 1990 Americans with Disabilities Act, 1990 –Purpose: “Clear and comprehensive mandate for the elimination of discrimination against individuals with disabilities”

29. Stage III: Americans with Disabilities Act Definition of disability: Definition of disability: –Physical or mental impairment that substantially limits one or more of the major life activities –A record of such an impairment –Being regarded as having such an impairment

30. Stage III: Americans with Disabilities Act Overview Overview –Title I: Employment: bans discrimination against qualified individual with a disability because of disability in employment –Title II: Public Services: bans exclusion from participation or benefits of services, programs or activities of a public entity such as public transportation and public meetings

31. Stage III: Americans with Disabilities Act (continued) Overview Overview –Title III-Public Accommodations and Services Operated by Private Entities: bans discrimination on the basis of disability by any person who owns or operates a place of public accommodation such as hotels, restaurants, health care providers –Title IV-Telecommunications; ensures that relay services are available to the extent possible for deaf and speech-impaired individuals

32. Conclusions Stages from Welfare to Citizenship Stages from Welfare to Citizenship Interventions and resources of the national government Interventions and resources of the national government Type of interest groups Type of interest groups –Stage I: Medicine and Social Work –Stage II: Educators, Counseling, Engineers, Architecture, Medicine, Consumers –Stage III: Consumer Advocates