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RECOMMENDATIONS
Pages 14-39

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From page 14... ... Increasing attention to and understanding of the broad range of issues related to disability in this country recently resulted in the Americans with Disabilities Act signed into law by President Bush on July 26, 1990. That same impetus, amplified by the desire for accessible, affordable quality health care for all, led to the committee's finding that there is an urgent need for a well-organized, coordinated national disability prevention program. Read the entire page →
From page 15... ... Educate health professionals, people with disability, family members, and personal attendants in disability prevention and preventing the development of secondary conditions. Read the entire page →
From page 16... ... Leadership of the National Disability Prevention Program The congressionally mandated role of the National Council on Disability (NCD) is to provide advice and make recommendations to the President and to Congress with respect to disability policy. Read the entire page →
From page 17... ... . In assuming the lead responsibility for implementing the national agenda for the prevention of disability over the life course, the NDPP should coordinate activities with other relevant agencies, emphasizing comprehensive surveillance, applied research, professional and public education, and preventive intervention with balanced attention to developmental disabilities, injuries, chronic diseases, and secondary conditions. Read the entire page →
From page 18... ... Thus a national disability prevention program will be centrally dependent on public attitudes toward people with disabilities and on the way community activities are organized, which includes access to housing, public transportation, and the workplace. Equally important is the reduction of prejudice and discrimination toward people with disabilities. Read the entire page →
From page 19... ... The interagency council should have a permanent staff and issue public reports to the Secretary of Health and Human Services, Congress, and the National Council on Disability. The members of the interagency council should be high-level administrators drawn from the major agencies involved in the various aspects of disability, which include the following: Centers for Disease Control; Health Care Financing Administration; Alcohol, Drug Abuse, and Mental Health Administration; National Institute for Disability and Rehabilitation Research; Health Resources and Services Administration (HRSA) Read the entire page →
From page 20... ... RECOMMENDATION 6: Develop a conceptual framework and standard measures of disability The CDC, which is responsible for surveillance of the nation's health, should design and implement a process for the development and review of conceptual frameworks, classifications, and measures of disability with respect to their utility for surveillance. This effort should involve components of the private sector that collect disability data, as well as federal agencies including the National Institutes of Health; Alcohol, Drug Abuse, and Mental Health Administration; National Council on Disability; Office of Human Development Services (a component of the Department of Health and Human Services) Read the entire page →
From page 21... ... A National Disability Surveillance System Despite its significance as a public health and social issue, disability has received little attention from epidemiologists and statisticians; consequently, surveillance of disabling conditions is inadequate in many ways. When disability is a focus of attention, surveillance is more often concerned with counting the number of people affected than with investigating its causes and secondary conditions. Read the entire page →
From page 22... ... specific developmental disabilities, injuries, and diseases that cause functional limitations and disability; and (3) secondary conditions resulting from the primary disability. Read the entire page →
From page 23... ... Core questions on mental disorders and other disabling conditions should be added to the survey to estimate the magnitude of these conditions in the general population and the extent to which they contribute to disability. RECOMMENDATION 9: Conduct a comprehensive longitudinal survey of disability A longitudinal survey is needed to collect data on the incidence and prevalence of functional limitation and disability (for the states and other geographic areas where feasible) Read the entire page →
From page 24... ... Coordinated Research Program RECOMMENDATION 11: Develop a comprehensive research program A coordinated, balanced program of research on the prevention of disability associated with developmental disabilities, injury, chronic disease, and secondary conditions should be an essential component of the National Disability Prevention Program. Emphasis should be placed on identifying biological, behavioral, and environmental (physical and social) Read the entire page →
From page 25... ... The research should emphasize the prevention of secondary conditions, improved functional status, and improved quality of life. In addition, because rapid changes are occurring for people with disabling conditions in terms of health services, public attitudes, and opportunities for social participation, cohort studies are needed to assess the effects of these changes over the life course. Read the entire page →
From page 26... ... RECOMMENDATION 14: Expand research on preventive and therapeutic interventions Research on the costs, effectiveness, and outcomes of preventive and therapeutic interventions should be expanded. The expanded research program should also include acute care services, rehabilitative and habilitative services and technologies, and longitudinal programs of care and interventions to prevent secondary conditions. Read the entire page →
From page 27... ... adequate preventive and long-term medical care, rehabilitation, and assistive technologies. These factors demonstrably contribute to the incidence, prevalence, and severity of primary and secondary disabling conditions and, tragically, avoidable disability. Read the entire page →
From page 28... ... Many aspects of the proposal could have favorable effects on the cost of health care (e.g., prenatal care should lower expenditures for intensive care of newborns and subsequent disabling conditions) Read the entire page →
From page 29... ... absence of local coordinating mechanisms. RECOMMENDATION 17: Develop new health service delivery strategies for people with disabilities New health service delivery strategies should be developed that will facilitate access to services and meet the primary health care, health education, and health promotion needs of people with disabling conditions. Read the entire page →
From page 30... ... the cost-effectiveness of assistive technologies that will enable people with disabling conditions to pursue health promotion strategies that would not otherwise be accessible to them. Building Capacity A network of services that include information and instruction regarding personal care and assistance in finding a job is an important aspect of a National Disability Prevention Program. Read the entire page →
From page 31... ... Furthermore, in its 1985 report, Preventing Low Birthweight, the IOM showed conclusively that, for each dollar spent on providing prenatal care to lowincome, poorly educated women, total expenditures for direct medical care of their low-birthweight infants were reduced by more than $3 during the first year of life. RECOMMENDATION 22: Provide effective family planning and prenatal services Educational efforts should be undertaken to provide women in highrisk groups with the opportunity to learn the importance of family planning services and prenatal care. Read the entire page →
From page 32... ... For example, many secondary conditions are preventable, but health professionals often are not familiar with the intervention strategies that can be used, and many provide inappropriate care as a result. Education of Professionals The committee notes that the field of physical medicine and rehabilitation is one of only a few medical specialties with a shortage of physicians. Read the entire page →
From page 33... ... In addition, such curricula should address physiatric principles and practices appropriate to the identification of potentially disabling conditions of acute illness and injury. Appropriate interventions, including consultation and collaboration with mental health and allied health professionals, social workers, and educational specialists, and the application of effective clinical protocols should also be included. Read the entire page →
From page 34... ... Independent living centers are also effective advocates for attitudinal and architectural changes in society that would improve accessibility, stimulate social interaction and productivity, and facilitate an active, quality lifestyle. RECOMMENDATION 27: Provide more training opportunities for family members and personal attendants of people with disabling conditions Persons with disabilities, their families, personal attendants, and advocates should have access to information and training relative to disability prevention with particular emphasis on the prevention of secondary Read the entire page →
From page 35... ... Box 2 presents a list of the committee's recommendations for a national agenda for the prevention of disability. Read the entire page →
From page 36... ... 36 DISABILITY IN AMERICA BOX 2 LIST OF RECOMMENDATIONS A NATIONAL AGENDA FOR THE PREVENTION OF DISABILITY ORGANIZATION AND COORDINATION Develop leadership of National Disability Prevention Program at CDC Develop an enhanced role for the private sector Establish a national advisory committee Establish a federal interagency council Critically assess progress periodically SURVEILLANCE Develop a conceptual framework and standard measures of disability Develop a national disability surveillance system Revise the National Health Interview Survey Conduct a comprehensive longitudinal survey of disability Develop disability indexes RESEARCH Develop a comprehensive research program Emphasize longitudinal research Conduct research on socioeconomic and psychosocial disadvantage Expand research on preventive and therapeutic interventions Upgrade training for research on disability prevention ACCESS TO CARE AND PREVENTIVE SERVICES Provide comprehensive health services to all mothers and children Develop new health service delivery strategies for people with disabilities Develop new health promotion models for people with disabilities Foster local capacity building and demonstration projects Continue effective prevention programs Provide comprehensive vocational services Provide effective family planning and prenatal services PROFESSIONAL AND PUBLIC EDUCATION Upgrade medical education and training of physicians Upgrade the training of allied professionals Establish a program of grants for education and training Provide more public education on the prevention of disability Provide more training opportunities for family members and personal attendants of people with disabling conditions Read the entire page →

From page 14...

... Increasing attention to and understanding of the broad range of issues related to disability in this country recently resulted in the Americans with Disabilities Act signed into law by President Bush on July 26, 1990. That same impetus, amplified by the desire for accessible, affordable quality health care for all, led to the committee's finding that there is an urgent need for a well-organized, coordinated national disability prevention program.

RECOMMENDATIONS Pages 14-39

RECOMMENDATIONS
Pages 14-39