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Disability in America: Toward a National Agenda for Prevention
integrated. Obviously, the mix of services is contingent upon levels of available public, private, and personal resources. Nonetheless, the effectiveness of each element within a particular set of services is enhanced if the elements are comprehensive, well coordinated, and integrated from the perspective of the client.
In general, the prevention of secondary conditions in people with disabling conditions requires a comprehensive approach that includes at least the following components: (1) organization and delivery of services; (2) availability of appropriate assistive technologies, as well as adequate training in the use of these technologies; (3) adoption of health-promoting behaviors; (4) education; and (5) consideration of environmental factors. The following sections discuss these components as they relate to the development of effective intervention strategies for the prevention of secondary conditions.
Organization and Delivery of Services
Preceding chapters have discussed the incongruity that characterizes the current patchwork of public and private health care and social services for people with disabling conditions. Services are compartmentalized and poorly coordinated, whereas the needs of people with disabling conditions are overlapping and long term. Even if the full spectrum of needed services are available, it is unlikely that services will be well integrated and easily accessible. More than half of the respondents in a 1986 survey of Americans with disabling conditions said it was "somewhat hard," "very hard," or "almost impossible" to identify available services (Louis Harris and Associates, 1986).
Because of the service system's fragmented organization and its emphasis on acute conditions, many people with disabling conditions are underserved and little attention is focused on prevention. One consequence is the occurrence of avoidable secondary conditions that worsen a disabling condition and increase the need for services.
Observers of the U.S. health care system often note that form follows funding. That is, funding policies directly determine the makeup of available services. Current funding policies, however, do not reflect the needs of people with disabling conditions; therefore, available services often do not provide the appropriate types and levels of care. Programs for income maintenance, rehabilitation, health care, and independent living are governed by their own separate policies rather than by an encompassing, unified disability policy.
Funding for health care and social services should follow client needs. But the needs of people with disabling conditions are diverse, and their requirements for services are equally diverse. Although a range of services should be available, not every person with a disabling condition will require all of these services. Thus funding of the health care and social service