Confronting Multiple Confronting Multiple Oppressions:Oppressions:

Examining the Needs of People Examining the Needs of People with Disabilities who are of with Disabilities who are of Hispanic / Latino descentHispanic / Latino descent

Kimberly Taylor, Joel Irizarry &Kimberly Taylor, Joel Irizarry &

Kris Balfanz-VertizKris Balfanz-Vertiz

Schwab Rehabilitation HospitalSchwab Rehabilitation Hospital

Chicago, ILChicago, IL

Funded by Hollister, Inc.Funded by Hollister, Inc.

Study SettingStudy Setting

Schwab Rehabilitation HospitalSchwab Rehabilitation Hospital

Extended Services DepartmentExtended Services Department

Centro de Vida IndependienteCentro de Vida Independiente

PWD are among the poorest & most stigmatized people in the world

Hispanic population is the fastest Hispanic population is the fastest growing minority group in the U.S.growing minority group in the U.S.

24.0% of working-age Hispanics have 24.0% of working-age Hispanics have a disability; compare to 18.6% in a disability; compare to 18.6% in CaucasiansCaucasians

Health disparities are seen in many Health disparities are seen in many areas including vaccinations, areas including vaccinations, insurance coverage, some types of insurance coverage, some types of cancer, HIV, hepatitis, diabetes, & TB.cancer, HIV, hepatitis, diabetes, & TB.

Neither health nor social services Neither health nor social services have increased at same rate as need.have increased at same rate as need.

Employment is associated with Employment is associated with increased life satisfaction and Quality increased life satisfaction and Quality of Life (QOL) scores.of Life (QOL) scores.

Schwab’s Needs Schwab’s Needs AssessmentAssessment

Surveys (Phase 1)Surveys (Phase 1) Interviews (Phase 2)Interviews (Phase 2) 71 participants71 participants 31 phone, 40 F2F31 phone, 40 F2F Outpatient clinic, Outpatient clinic,

outpatient therapy, outpatient therapy, Extended ServicesExtended Services

6 interviewers, 4 6 interviewers, 4 were bilingualwere bilingual

87% conducted in 87% conducted in English; 13% English; 13% SpanishSpanish

20 participants20 participants All were face-to-All were face-to-

faceface Phase 1 (12 Phase 1 (12

people), Extended people), Extended Services, Services, community partnerscommunity partners

6 interviewers, all 6 interviewers, all conversationally conversationally bilingual – 3 fluentbilingual – 3 fluent

80% in English; 20% 80% in English; 20% in Spanishin Spanish

Primary Domains StudiedPrimary Domains Studied

DemographicsDemographics EmploymentEmployment EducationEducation HousingHousing Benefits & Social ServicesBenefits & Social Services TransportationTransportation Health & MedicalHealth & Medical

DemographicsDemographics

SurveysSurveys InterviewsInterviews

ParticipaParticipant Sexnt Sex

82% male82% male

18% female18% female80% male80% male

20% female20% female

ParticipaParticipant Agent Age

Median age: 37Median age: 37

(18-84)(18-84)Median age: 29Median age: 29

(20-47)(20-47)

ParticipaParticipant nt

EthnicityEthnicity

69% Mexican69% Mexican

24% Puerto Rican24% Puerto Rican

7% Ecuadorian7% Ecuadorian

55% Mexican55% Mexican

35% Puerto 35% Puerto RicanRican

15% Guatemalan15% Guatemalan

DemographicsDemographics

SurveysSurveys InterviewsInterviews

Marital Marital statusstatus

32% Married32% Married

49% Single 49% Single (never (never been married)been married)

16% separated, 16% separated, divorced or divorced or widowedwidowed

3% other3% other

15% Married15% Married

70% Single 70% Single (never (never been married)been married)

15% separated, 15% separated, divorced or divorced or widowedwidowed

ChildrenChildren 61% have 61% have childrenchildren

15% have 15% have childrenchildren

DemographicsDemographics

SurveysSurveys InterviewsInterviews

Born in Born in the the

U.S.?U.S.?

48% born in the 48% born in the U.S.U.S.

(includes 9% born (includes 9% born inin

Puerto Rico)Puerto Rico)

65% born in the 65% born in the U.S.U.S.

(includes 10% born (includes 10% born inin

Puerto Rico)Puerto Rico)

If not If not born in born in

the the U.S., U.S., then then

where?where?

92% Mexico92% Mexico

3% Ecuador3% Ecuador

5% missing5% missing

71% Mexico71% Mexico

29% Guatemala29% Guatemala

DemographicsDemographicsSurveysSurveys InterviewsInterviews

If not born If not born in the U.S., in the U.S., how long how long

have have participants participants been here?been here?

Median: 21 yearsMedian: 21 years

(“Just arrived” to (“Just arrived” to

65 years)65 years)

Median: 13.5 yearsMedian: 13.5 years

(3 – 28 years)(3 – 28 years)

If not born If not born here, what here, what is residency is residency

or or immigration immigration

status?status?

38% Legal 38% Legal residentresident

32% Naturalized 32% Naturalized citizencitizen

19% 19% UndocumenUndocumented residentted resident

5% visa5% visa

5% unknown5% unknown

13% Legal resident13% Legal resident

13% Naturalized 13% Naturalized citizencitizen

63% Undocumented 63% Undocumented residentresident

13% unknown13% unknown

DemographicsDemographicsSurveysSurveys InterviewsInterviews

What is your What is your disability?disability?

36% SCI36% SCI

16% Stroke16% Stroke

12% Mobility12% Mobility

8% BI8% BI

6% Amputee6% Amputee

27% other27% other

80% SCI80% SCI

5% Mobility5% Mobility

5% Hard of 5% Hard of hearinghearing

5% Polio5% Polio

5% Spinal Bifida5% Spinal Bifida

Acquired or Acquired or congenital?congenital?

If acquired, If acquired, when?when?

97% were acquired.97% were acquired.

Median: 5 years Median: 5 years ago.ago.

(3 mos. – 30 years)(3 mos. – 30 years)

90% were 90% were acquired.acquired.

Median: 6 years Median: 6 years ago.ago.

(1 – 36 years)(1 – 36 years)

How did participant acquire disability?

Survey

43%

29%

21%

7% 0%

GSW

MVA

Stroke

Disease

Fall

Interview

77%

11%

0%

6% 6%

Demographics (Survey)Demographics (Survey)

Language – Language – SpeakSpeak

English: English:

57% fluent, 34% some, 9% 57% fluent, 34% some, 9% nonenone

Spanish: Spanish:

87% fluent, 10% some, 3% 87% fluent, 10% some, 3% nonenone

Language – Language – Read and WriteRead and Write

English:English:

54% fluent, 19% some, 27% 54% fluent, 19% some, 27% nonenone

Spanish:Spanish:

66% fluent, 19% some, 15% 66% fluent, 19% some, 15% nonenone

BilingualismBilingualism - 29% are fluent speakers of - 29% are fluent speakers of both Spanish & English.both Spanish & English.

- 88% speak at least “some” of - 88% speak at least “some” of the language in which they are the language in which they are not fluent.not fluent.

ResultsResults::Employment & Employment &

EducationEducation

Employment: Pre/Post Injury(Survey)

10% 14%

85%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Prior to Injury Since injury

Part-time Full-time

Employment (Survey)Employment (Survey)

For those who are working, what is the best For those who are working, what is the best part of having a job and/or working?part of having a job and/or working?

29% Getting a paycheck; supporting 29% Getting a paycheck; supporting family and/or myselffamily and/or myself

29% Helping others29% Helping others

14% Meeting new people14% Meeting new people

Employment (Interview)Employment (Interview)

Of the 8 interviewees who currently Of the 8 interviewees who currently have a job, 7 stated that they got the have a job, 7 stated that they got the interview because of contacts at a interview because of contacts at a rehab hospital.rehab hospital.

3 stated that having a disability was 3 stated that having a disability was an advantage for their job, because an advantage for their job, because they work at a rehab hospital or as a they work at a rehab hospital or as a medical supply vendor.medical supply vendor.

Employment (Interview)Employment (Interview)

Why are you not working?Why are you not working?

25% said they were discriminated against, 25% said they were discriminated against, because employers think they cannot work, because employers think they cannot work, due to having a disabiitydue to having a disabiity

25% said it was because of their legal status.25% said it was because of their legal status.

17% said it was because they have a 17% said it was because they have a pressure sore that needs to heal first.pressure sore that needs to heal first.

Employment (Survey)Employment (Survey)

How important is it How important is it to you to find to you to find employment?employment?

67% Very important67% Very important

16% Important16% Important

12% Neutral12% Neutral

6% Unimportant6% Unimportant

Are you satisfied Are you satisfied with your ability to with your ability to find employment?find employment?

9% Very Satisfied9% Very Satisfied

15% Satisfied15% Satisfied

21% Neutral21% Neutral

40% Dissatisfied40% Dissatisfied

16% Very 16% Very dissatisfieddissatisfied

Employment (Survey)Employment (Survey)

Top 5 Obstacles to Working

– Health Status / Disability (56%)– Lack of Job Opportunities (34%)– Transportation (30%)– Lack of Knowledge about Opportunities

(30%)– Inability to leave house independently,

due to inaccessibility (16%)

Education (Survey)Education (Survey)

45% of participants dropped out 45% of participants dropped out before entering the 9before entering the 9thth grade. grade.

37% graduated high school.37% graduated high school. 18% have some post-secondary 18% have some post-secondary

education.education. 5% graduated college.5% graduated college.

Education (Survey)

19%

72%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Attending School Want to Attend School

Education (Interview)

What is the best part of attending school?

40%

40%

20%

Likes learning

Social interaction

Furthering my education

Top 5 Obstacles to Top 5 Obstacles to Education & Employment Education & Employment

(Survey)(Survey)EmploymentEmployment

Health status / disability Health status / disability (56%)(56%)

Lack of job opportunities Lack of job opportunities (34%)(34%)

Transportation (30%)Transportation (30%) Lack of knowledge Lack of knowledge

about opportunities about opportunities (30%)(30%)

Inability to leave house Inability to leave house independently, due to independently, due to inaccessibility (16%)inaccessibility (16%)

EducationEducation

Health status / disability Health status / disability (37%)(37%)

Transportation (27%)Transportation (27%) Lack of knowledge Lack of knowledge

about opportunities about opportunities (25%)(25%)

Inability to leave house Inability to leave house independently, due to independently, due to inaccessibility (16%)inaccessibility (16%)

Family obligations Family obligations (15%)(15%)

Housing (survey)Housing (survey)

How long lived in How long lived in your your neighborhood?neighborhood?

Average 9 years (range: Average 9 years (range: 3 months to 53 years)3 months to 53 years)

Rent/ownRent/own 61% Rent61% Rent

39% Own39% Own

Is your name on Is your name on the the lease/mortgage?lease/mortgage?

53% Yes53% Yes

47% No47% No

Who lives with Who lives with participant?participant?

86% Family86% Family

2% Friends2% Friends

10% Live alone10% Live alone

2% Residential care -2% Residential care -OtherOther

Housing (survey)Housing (survey)

Enter and move Enter and move around in: around in:

Bedroom?Bedroom?

Kitchen?Kitchen?

Bathroom?Bathroom?

Living room?Living room?

93% Yes 7% No93% Yes 7% No

93% Yes 7% No93% Yes 7% No

73% Yes 27% No73% Yes 27% No

94% Yes 6% No94% Yes 6% No

Can participant Can participant enter & exit home enter & exit home

alone?alone?71% Yes 29% No71% Yes 29% No

Social Services (Survey)Social Services (Survey)

Are you entitled to Are you entitled to ANY financial ANY financial benefits?benefits?

41% Yes41% Yes

23% No23% No

36% “I don’t know” 36% “I don’t know” or no responseor no response

If yes, receiving If yes, receiving them?them?

75% Yes75% Yes

25% No25% No

If yes, where get If yes, where get information on information on financial benefits? financial benefits? (Top 3)(Top 3)

27% Family or 27% Family or FriendsFriends

27% Hospital27% Hospital

12% Social security 12% Social security officeoffice

Social Services (Survey)Social Services (Survey)

ServiceService Are you Are you eligible?eligible?

Do you use it?Do you use it?

YesYes NoNo ?? YesYes NoNo ??

Public Aid/TANFPublic Aid/TANF 46%46% 27%27% 27%27% 38%38% 57%57% 6%6%

Link CardLink Card 3636 3939 2626 2424 7474 11

DRSDRS 1414 2121 6464 77 8282 1111

SSISSI 4242 3131 2727 3838 5555 55

SSDISSDI 3333 3434 3333 2424 6464 1111

Section 8 Section 8 housinghousing

66 4141 5353 11 8181 1717

IDPA/MedicaidIDPA/Medicaid 4444 2323 3333 4040 6060 --

Worker’s compWorker’s comp 55 6363 3232 33 8484 1313

Social Services: DRS Social Services: DRS (interview)(interview)

65% of 65% of intervieweinterviewe

es had es had spoken to spoken to

DRS & DRS & 60% had 60% had opened opened cases.cases.

Services ReceivedServices Received IntervieweeIntervieweess

Homemaker onlyHomemaker only 00Education onlyEducation only 66Vocation onlyVocation only 11Homemaker & Homemaker & EducationEducation

11

Homemaker & vocationHomemaker & vocation 11Homemaker, education Homemaker, education & vocation& vocation

11

Social Services: DRS Social Services: DRS (interview)(interview)

CommentsComments:: One person who only spoke Spanish at the time One person who only spoke Spanish at the time

of his DRS interview was interviewed in English.of his DRS interview was interviewed in English. Everyone who has been to a DRS office says it Everyone who has been to a DRS office says it

was accessible.was accessible. Of those who gave a judgment of their Of those who gave a judgment of their

experience:experience:– 38% said good overall38% said good overall– 31% said okay31% said okay– 31% said it was bad31% said it was bad

23% stated staff was rude or ignored them.23% stated staff was rude or ignored them. 38% stated that, at least with some staff, it takes 38% stated that, at least with some staff, it takes

too long to get services.too long to get services.

Transportation (Survey)Average Number of Days per Week Participants Leave Home

8%

31%

20%

41%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0 1-2 3-4 5-7

Number of days per week

Transportation (Interview)

Reasons for Leaving Home

0

5

10

15

20

25

30

0-2 days out ofhouse

3-4 days out ofhouse

5-7 days out ofhouse

Family outings

Church

Volunteering

School

Errands & obligations

Looking for work

Work

Recreation / social

Doctor / Hospital

Transportation (Survey)

How satisfied are you with your ability to leave home?

18%

30%

14%

27%

11%

Very satisf ied

Satisf ied

Neutral

Dissatisf ied

Very dissatisf ied

Transportation (Survey)Transportation (Survey)Source of Source of transportation…transportation…

How get to…How get to…

StoreStore DoctoDoctorr

Family & Family & FriendsFriends

WorWorkk

DriveDrive 25%25% 27%27% 25%25% 16%16%

Family or friendsFamily or friends 30%30% 38%38% 38%38% 4%4%

Public trans – Public trans – main linesmain lines

7%7% 11%11% 6%6% 3%3%

Public trans – Public trans – CDT CDT

-- 11%11% 4%4% 4%4%

MedicarMedicar -- 4%4% -- --

Walk/rollWalk/roll 18%18% 4%4% 4%4% 1%1%

I don’t go thereI don’t go there 20%20% 3%3% 23%23% 72%72%

Transportation (Interview)

Satisfaction with Transportation Choices

0

5

10

15

20

25

CTA Paratransit

Very satisfied Somewhat satisfied Neutral Dissatisfied Don't use

Medical (Survey)Medical (Survey)

Currently have a Currently have a regular doctor?regular doctor?

79% Yes79% Yes

21% No21% No

Seen doctor in Seen doctor in last 12 months?last 12 months?

86% Yes86% Yes

14% No14% No

Have insurance?Have insurance? 80% Yes80% Yes

20% No20% No

If yes, type of If yes, type of insurance?insurance?

57% Public aid57% Public aid

34% Medicare34% Medicare

14% Private insurance 14% Private insurance through employmentthrough employment

Medical (Survey)Medical (Survey)

YesYes NoNo

Do you see a Do you see a dentist dentist regularly?regularly?

31%31% 69%69%

Do you have Do you have see an eye see an eye doctor doctor regularly?regularly?

38%38% 62%62%

Medical (survey)Medical (survey)How pay for How pay for prescriptions?prescriptions?

Note: 69% take Note: 69% take medication or medication or perform a medical perform a medical procedure daily. procedure daily.

52% Insurance partial 52% Insurance partial coverage coverage

27% Insurance full 27% Insurance full coveragecoverage

22% Out of pocket22% Out of pocket

What do you do What do you do if you need to if you need to see a doctor?see a doctor?

47% Call my doctor47% Call my doctor

32% Go to emergency 32% Go to emergency roomroom

9% Call my family9% Call my family

10% Other or nothing10% Other or nothing

Medical (interview)Medical (interview)

80% of interviewees stated that they had 80% of interviewees stated that they had experienced health care issues that were experienced health care issues that were obstacles to other parts of their life.obstacles to other parts of their life.

25% had UTIs. (“You can continue with 25% had UTIs. (“You can continue with your life.)your life.)

20% had pressure sores. (“I couldn’t leave 20% had pressure sores. (“I couldn’t leave home;” “I had to withdraw from school.”)home;” “I had to withdraw from school.”)

Other issues included broken limbs (“It’s Other issues included broken limbs (“It’s hard to get around in a manual chair with hard to get around in a manual chair with a broken arm”); obesity due to lack of a broken arm”); obesity due to lack of exercise, and difficulty breathing.exercise, and difficulty breathing.

SummarySummary

Many of these issues complicate other Many of these issues complicate other ones:ones:

Inaccessible homeInaccessible home: can’t go to work or : can’t go to work or schoolschool

UnemployedUnemployed: limited insurance & : limited insurance & finances to take care of healthfinances to take care of health

Health issuesHealth issues: can’t leave home to : can’t leave home to access social services to gain new access social services to gain new transportation options, learn about transportation options, learn about benefits, or attend schoolbenefits, or attend school

Now what???Now what???Why do you choose to use certain services?Why do you choose to use certain services?

(interview)(interview)

ComfortComfort – Building is accessible & I feel socially – Building is accessible & I feel socially accepted there.accepted there.

LocationLocation - It’s conveniently located somewhere - It’s conveniently located somewhere where I need to go for other reasons (e.g., school, where I need to go for other reasons (e.g., school, hospital).hospital).

QualityQuality - The services are good; I get what I need. - The services are good; I get what I need.

CostCost - It’s free. - It’s free.

What can we do to make your What can we do to make your disability / healthcare status disability / healthcare status

less of an obstacle?less of an obstacle?

Educate people on how to take care of their bodies.Educate people on how to take care of their bodies. Help people get into home schoolingHelp people get into home schooling Show people examples of successful living for PWDShow people examples of successful living for PWD Find resources for people who are undocumentedFind resources for people who are undocumented Provide transportationProvide transportation Provide mentoring servicesProvide mentoring services Train people on new life skillsTrain people on new life skills Provide recreational areasProvide recreational areas

(interview)(interview)

How can we share info?How can we share info?Workshops at hospital

Newsletter

Fliers or brochures

Hospital case managers / receive info as inpatients

Peer mentors

Doctors

Letters to homes

Outpatient clinic

"Just keep telling people"

e-mail

Advertise services in newspaper

How can we share info?How can we share info?Create a resource guide

Make sure info is in Spanish

Set up a system so that Ext. Services staff sees each patient before discharge

Go to churches

Video / DVD showing what transportation is available to people with different disabilities

Outpatient therapy

Conferences

In-services for hospital staff

Radio show

QUESTIONS???QUESTIONS???

DiscussionDiscussion

How could your program better How could your program better meet the needs of Hispanic meet the needs of Hispanic individuals with disabilities? individuals with disabilities?

How does what you’ve seen How does what you’ve seen here today impact your daily here today impact your daily work?work?

For more information, please contact: For more information, please contact: Kimberly TaylorKimberly Taylor Manager of Program Development, Manager of Program Development,

Evaluation & Research Evaluation & Research 773-522-2010, ext. 5176773-522-2010, ext. 5176 taykim@sinai.orgtaykim@sinai.org

Joel IrizarryJoel Irizarry Disability Resource CoordinatorDisability Resource Coordinator 773-522-5863773-522-5863 irij@sinai.orgirij@sinai.org