https://www.ResourcesForIntegratedCare.com
Wednesday February 8th, 2017
Introduction to Disabilities and Disability-Competent Care
DCC Pillars Webinar Series
https://www.ResourcesForIntegratedCare.com2
Download content here
Type questions here
https://www.ResourcesForIntegratedCare.com
Introductions
Christopher Duff Disability Practice and Policy Consultant
3
https://www.ResourcesForIntegratedCare.com
Disability-Competent Care Webinar Series Overview
The Lewin Group, under contract with the CMS Medicare-Medicaid Coordination Office, partnered with Christopher Duff and other disability practice experts to create the Disability-Competent Care Webinar Series. This is the first session of the seven-part series.
Each session will be interactive, with 40 minutes of presenter-led discussion, followed by a 20 minute presenter/participant question and answer session
Video replay and slide presentation are available after each session at:
https://www.ResourcesForIntegratedCare.com/
4
https://www.resourcesforintegratedcare.com/
https://www.ResourcesForIntegratedCare.com
DCC Pillars Webinar Series
1. Understanding the DCC Model
2. Participant Engagement
3. Access
4. Primary Care
5. Care Coordination
6. Long Term Services and Supports
7. Behavioral Health
5
https://www.ResourcesForIntegratedCare.com
Agenda
1. Defining disability Understanding people with disabilities Focusing on function and barriers to care Disability types Demographics and health disparities
2. Disability-Competent Care (DCC) What is DCC? The DCC model Applying DCC
6
https://www.ResourcesForIntegratedCare.com
DEFINING DISABILITY
Disability is the complex interaction between a person with an impairment or limitation and his or her environment.
7
https://www.ResourcesForIntegratedCare.com
Knowing Those You Are Serving
Persons living with disabilities are a diverse group varying in different characteristics including, but not limited to: age; gender; gender identity; race; ethnicity; socioeconomic status; sexual orientation; and type of functional limitation.
Disability-Competent Care requires that providers of health care understand their consumers:
Experience of being disabled
Disability itself (clinically)
Functional limitations due to the disability
8
https://www.ResourcesForIntegratedCare.com
Focus on Function Limitation
Functional status identifies the impact of the disability whereas a diagnosis identifies the cause or source of an individuals disability.
Functional limitations impact a persons ability to perform activities of daily living (ADLs) or instrumental activities of daily living (IADLs)
ADLs include self-care tasks (e.g., feeding, bathing, and dressing)
IADLs include tasks that enable an individual to live independently in a community (e.g., using a telephone or communication device, homemaking, shopping, and managing finances)
Medical diagnoses and clinical response may not identify if a person has limitations as a result of the disability or the ability to compensate for those limitations
9
https://www.ResourcesForIntegratedCare.com
Disability Types
Common clinical categories of disability include: Physical (e.g., spinal cord injury, multiple sclerosis); Intellectual or Developmental (ID / DD) (e.g., autism, cerebral palsy); Sensory (e.g., vision, hearing); and Behavioral (e.g., schizophrenia, major depression, chemical
dependency)
Acquiring a disability Persons born with (congenital) or who acquire a disability in early life Persons who acquire a disability later in life
Individuals rarely fit into one category and there is often overlap as individuals may have multiple categories of disability.
10
https://www.ResourcesForIntegratedCare.com
Age Related Disabilities
As we age, most everyone experiences some decline in function and independence
Examples include: Loss of hearing acuity Decline of vision Memory or other cognitive capabilities Increased anxiety or depression due to loss of independence
While these are not commonly viewed as disabilities, and generally occur in an elderly population, they are certainly experienced as functional limitations
11
https://www.ResourcesForIntegratedCare.com
Visible vs. Invisible Disabilities
Visible: Disabilities that are readily evident to an observer Examples include individuals with:
Paralysis
Wheelchair users
Invisible: Disabilities that are not as readily evident Examples include individuals with:
Hearing or vision loss
Diabetes
Arthritis
12
https://www.ResourcesForIntegratedCare.com
Demographics of Individuals with Long-Term Disabilities
Fourteen percent1 of adults in the U.S. live with a disabling condition resulting in a complex activity limitation.
These individuals are: More likely to live in poverty and experience hardships
Disproportionately represented in racial and ethnic minority groups
Growing in numbers as the population ages
13
Source: Health, United States 2015, table 42 http://www.cdc.gov/nchs/data/hus/hus15.pdf#042
https://www.ResourcesForIntegratedCare.com
Health Disparities
People with disabilities are more likely to: Experience worse outcomes and are less likely to receive the
recommended care1
Experience difficulties or delays in receiving the necessary health care
Not have had recommended health screening tests (e.g., breast cancer, colorectal cancer and diabetes)2
Not receive comprehensive preventive care (e.g., BMI assessment, medication adherence and annual flu vaccine)
Not have had an annual dental visit
Limited knowledge and access to sexual health information
Have high blood pressure
14
Sources: 1) Office of the Assistant Secretary for Planning and Evaluation, Report to Congress: Social Risk Factors and Performance under Medicares Value Based Purchasing Programs, December 20162) Healthy People 2020 website http://www.healthypeople.gov/2020/topicsobjectives2020/nationalsnapshot.aspx?topicId=9
https://www.ResourcesForIntegratedCare.com
Social Factors
Payers, including Medicare and Medicaid, are moving from traditional fee-for-service payment toward models that reward value over volume.
Disability status and dual eligibility for Medicare and Medicaid are often associated with poorer performance on measures that are linked to payment in value-based purchasing programs.
On many measures of focus (e.g., cancer screenings, vaccinations, diabetes management), the clinical interventions are straightforward but communications and service delivery for people with disabilities stretch the disability competence of most providers.
For some providers, improving outcomes for people with disabilities will have a direct impact on revenue.
Source: National Academies of Sciences, Engineering, and Medicine. 2017. Accounting for social risk factors in Medicare Payment, Washington, DC: The National Academies Press. doi: 10.1722
15
https://www.ResourcesForIntegratedCare.com
Disability-Related Biases
It is important to be aware of disability-related beliefs, biases, prejudices, stereotypes, and fears, and understand: Where they come from
How they can affect your ability to work effectively with people with disabilities
How to address them, so they dont interfere with your ability to provide effective care
Disability-related biases can often inhibit listening to and learning from the participant. This may also result in adverse health outcomes.
16
https://www.ResourcesForIntegratedCare.com
First Person Story
Jim LeBrecht was born with Spina Bifida. He grew up outside of New York City and went to college in Southern California. Jim moved to the east bay of Northern California to take a job with the Berkeley Repertory Theater as a sound engineer. He has recently opened his own business serving the film industry.
17
Double Click
http://dredf.org/healthcare-stories/2012/06/24/carol-gill-and-larry-voss/
https://www.ResourcesForIntegratedCare.com
Current Challenges in Health Care Delivery
Care is commonly: Reactive & proscriptive
Fragmented (provided by multiple specialists without primary care coordination)
Inaccessible
Standardized / uniform
Resulting in: Avoidable costs, both human and financial
Misaligned incentives, leading to increasing costs
Ineffective or nonexistent primary care
18
https://www.ResourcesForIntegratedCare.com
DISABILITY-COMPETENT CARE (DCC)
A model of care designed to treat the individual, not just his or her diagnosis or condition.
19
https://www.ResourcesForIntegratedCare.com
What is DCC?
Disability-Competent Care is: A participant-centered model, delivered by an interdisciplinary care
team (IDT) that focuses on achieving and supporting maximum function.
Intended to maintain health, wellness, and life in the community as the participant chooses.
A model that recognizes and treats each individual as a whole person, not a diagnosis or condition.
Structured to respond to the participants physical and clinical needs while considering his or her emotional, social, intellectual, and spiritual needs.
20
https://www.ResourcesForIntegratedCare.com
A Shift in Attitude: Medical Model vs. DCC Model
21
Context Medical (Traditional) ModelDCC (Person-Centered)
ModelDefinition of Problem Physical or mental impairment
Dependency; attitudes and environments need fixing
Locus of Problem The individual The environment
Solution to the Problem
Fix the person through professional intervention
Barrier removalConsumer control over options and services
Perception of Person with a Disability
Individual is a patient or client Individual is consumer, participant, user of the service
Who Controls Professional Consumer or participant
https://www.ResourcesForIntegratedCare.com
First Person Story
Karen Schneiderman was also born with Spina Bifida. She went to college on the West Coast and returned to Boston where she works as the Director of Advocacy at the Boston Center for Independent Living.
22
Double Click
http://dredf.org/healthcare-stories/2014/02/05/barriers%E2%80%8E-solutions/
https://www.ResourcesForIntegratedCare.com
Development of the DCC Model of Care
23
The DCC model of care evolved from a few pioneering programs initiated in the late 1990s Pioneering programs revised their model over the next decade
Components of the revised model and approach were adopted more broadly by health plans and health systems
The model has evolved into well-known and recognized best practices
The DCC Self-Assessment Tool was introduced in 2013, by a small group of the pioneering organizations, with input from subject matter experts and field tested by several health plans. Currently it is being revised to reflect the experience of the last several
years, and the further evolution of practices
You can access the current version of the Tool online at:
https://www.ResourcesForIntegratedCare.com
https://www.resourcesforintegratedcare.com/
https://www.ResourcesForIntegratedCare.com
The DCC Model
The DCC Model is comprised of three core values and imbedded in seven pillars of disability competency.
24
Core Values
1. Participant-centered Participants choices, preferences, and goals provide
a foundation for his or her individualized plan of care.
2. Respect for participant choice and dignity of risk Inherent in participant-centered planning of care
goals and needs is the concept of the dignity of risk, which honors and respects the participants choices even if they are inconsistent with healthcare recommendations.
3. Elimination of medical and institutional bias Medical and institutional bias often impedes
providers from addressing the whole individual, including his or her unique abilities, limitations, and preferences for social and community participation.
https://www.ResourcesForIntegratedCare.com
The DCC Model (continued)The DCC Model is comprised of seven pillars of disability competency.
25
Par
ticip
ant
Eng
agem
ent
Acc
ess
Und
erst
andi
ng th
e D
CC
Mod
el
Car
e C
oord
inat
ion
Prim
ary
Car
e
Long
-Ter
m S
ervi
ces
and
Sup
ports
Beh
avio
ral H
ealth
A model of care designed to treat the whole person, beyond the diagnosis or condition
Disability-Competent Care
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component: Introduction to Disability-Competent Care and Disabilities
1. Implementing DCC requires an understanding of disabilities and understanding persons with disabilities Understand the population you are serving Focus on functional limitations Understand how to effectively communicate Define disabilities Identify and address barriers to accessing care
26
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component: Participant Engagement
2. Participant Engagement is a key element of providing disability-competent care as the model revolves around person-centered care Build trust with participants Develop a plan to address the participants needs and wants Understand how to effectively communicate Leverage an interdisciplinary care team
27
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component: Access
3. Participants must have sufficient access to health care services. This involves developing competency to address barriers in several key areas: Attitude Physical Equipment Communication Service Programmatic
28
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component:Primary Care
4. Responsive Primary Care is the practice of providing timely access to care and services in a variety of settings Enhanced primary care with home-based episodic care capacity 24/7 access Partner with the interdisciplinary care team Focus on early intervention Inpatient care management, transition planning, and follow-up Accessible physical facilities and adaptive equipment Flexible scheduling
29
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component: Care Coordination
5. Relational Care Coordination is a practice that recognizes the recipient is the primary source of defining care goals and needs Informed decision-making Team-based care Comprehensive, timely assessment and reassessment Personalize plans of care Manage transitions with clear communication and accountability
30
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Components:Long-Term Services and Supports
6. Flexibility in providing long-term services and supports that enable participants to continue residing in their community Ensure participant choice Participant-directed personal care services Equipment purchasing, fitting, seating, training, and maintenance
clinics Enhance participant independence via medically or functionally
necessary equipment and technology Allow flexibility to use alternatives to traditional home-based supports
31
https://www.ResourcesForIntegratedCare.com
DCC Practice Model Component: Behavioral Health
7. Disability-competent care involves identifying and addressing behavioral health needs as an integral receive appropriate and coordinated care Behavioral health includes mental health and substance abuse Recognize mental health issues and understanding their impact on
functional capacity Understand the difference between chemical dependence and
substance abuse Implement recovery learning
32
https://www.ResourcesForIntegratedCare.com
CONCLUSION
Understanding the DCC model and the disabilities experienced by your population is the first of seven pillars in achieving disability
competency.
33
https://www.ResourcesForIntegratedCare.com
Key Takeaways
The DCC Model is designed to treat the individual, not just a diagnosis or condition. This model is participant-centered, respects the dignity of risk, and eliminates medical and institutional bias.
To effectively implement the DCC Model, providers must be familiar with the different types of disabilities and understand the population being served.
Becoming proficient in understanding the experiences of individuals with disabilities, and the barriers they commonly experience is the first of seven pillars needed to successfully implement the DCC Model.
34
https://www.ResourcesForIntegratedCare.com
AUDIENCE QUESTIONS & DISCUSSION
35
https://www.ResourcesForIntegratedCare.com
Send Us Your Feedback
Help us diversify our series content and address current Disability-Competent Care training needs your input is essential!
Please contact us with your suggestions [email protected]
What Wed Like from You: How best to target future Disability-Competent Care webinars to
health care providers and plans involved in all levels of the health care delivery process
Feedback on these topics as well as ideas for other topics to explore in webinars and additional resources related to Disability-Competent Care
36
mailto:[email protected]
https://www.ResourcesForIntegratedCare.com
Disability-Competent Care Self-Assessment Tool
Disability-Competent Care Self-Assessment Tool available online at: https://www.ResourcesForIntegratedCare.com/
37
https://www.resourcesforintegratedcare.com/
https://www.ResourcesForIntegratedCare.com
Next Webinar
Disability-Competent Care Webinar Series
Disability-Competent Participant Engagement
Wednesday February 15th, 20172:00-3:00PM EST
38
https://www.ResourcesForIntegratedCare.com
Thank You for Attending!
For more information contact:
Kerry Branick at [email protected]
Gretchen Nye at [email protected]
Christopher Duff at [email protected]
Further information, including webinar resources, are available at:
https://www.resourcesforintegratedcare.com
39
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.resourcesforintegratedcare.com/
Wednesday February 8th, 2017Introduction to Disabilities and Disability-Competent CareDCC Pillars Webinar SeriesIntroductionsDisability-Competent Care Webinar Series OverviewDCC Pillars Webinar SeriesAgendaDefining disabilityKnowing Those You Are ServingFocus on Function LimitationDisability TypesAge Related DisabilitiesVisible vs. Invisible DisabilitiesDemographics of Individuals with Long-Term DisabilitiesHealth DisparitiesSocial FactorsDisability-Related BiasesFirst Person StoryCurrent Challenges in Health Care DeliveryDisability-Competent Care (DCC)What is DCC?A Shift in Attitude: Medical Model vs. DCC ModelFirst Person StoryDevelopment of the DCC Model of CareThe DCC ModelThe DCC Model (continued)DCC Practice Model Component: Introduction to Disability-Competent Care and DisabilitiesDCC Practice Model Component: Participant EngagementDCC Practice Model Component: AccessDCC Practice Model Component: Primary CareDCC Practice Model Component: Care CoordinationDCC Practice Model Components: Long-Term Services and SupportsDCC Practice Model Component: Behavioral HealthConclusionKey TakeawaysAudience questions & discussionSend Us Your FeedbackDisability-Competent Care Self-Assessment ToolNext WebinarThank You for Attending!