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Editor's note: This article is adapted from the address Dr. Caballero delivered as the recipient of the American Diabetes Association's Outstanding Educator in Diabetes Award for 2023. He delivered the address in June 2023 during the Association's 83rd Scientific Sessions in San Diego, CA. A webcast of this speech is available for viewing on the DiabetesPro website (https://events.diabetes.org/live/25/page/186). [ABSTRACT FROM AUTHOR]

According to the Centers for Disease Control and Prevention, over 61 million Americans have a disability, which translates to about 26 percent of the national population. The most common types of disability are physical (13.7 percent), or those that impact mobility, and intellectual (10.8 percent), or those related to cognitive processing. The Bureau of Justice Statistics has reported that 32 percent of people in state prisons and 40 percent of people in county jails have at least one disability, rates that demonstrate alarming disproportionality. Yet the history of the disability rights movement, the impact of the Americans with Disabilities Act for people with disabilities who are involved with the criminal justice system, and the implications of disability justice and critical disability theory for the field of social work are not well understood. The purpose of this article is to review these under-recognized topics and offer recommendations for addressing this neglected area of social work education, research, policy, and practice. [ABSTRACT FROM AUTHOR]

The author suggests further consideration on the relationship between the Americans with Disabilities Act (ADA), supported decision-making and medical aid in dying. She addresses legal requirements for participation of healthcare providers in medical aid in dying. She discusses the prohibition of discrimination against people with disabilities, as well as equal access to medical services, effective communication for people with disabilities and reasonable modifications in healthcare under ADA.

This Article explores the connections between disability and health justice in service of further tethering the two theories and practices. The author contends that disability should shift from marker of health inequity alone to critical demographic in the analytical and practical application of health justice. This theoretical move creates a more robust understanding of the harms of health injustice, its complexities, and, remedially, reveals underexplored legal and policy pathways to promote health justice. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities. Method: Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities. Results: Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities. Conclusion: To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities. [ABSTRACT FROM AUTHOR]

For almost fifty years, federal civil rights laws such as Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, and Section 1557 and other provisions of the 2010 Patient Protection and Affordable Care Act have prohibited discrimination against Americans with disabilities, including in health care. Despite these laws, disabled Americans continue to experience disparities in health and health care, from preventive care to home and community-based services. In its 2022 Health Equity Framework for People with Disabilities, the National Council on Disability highlighted some of these disparities and recommended remedies. To explore these concerns, this article examines disability inequities and potential solutions within six areas. It concludes by recommending the ratification of the 2006 United Nations Convention on the Rights of Persons with Disabilities to reinvigorate US efforts to maximize the health and dignity of disabled Americans and support their full participation in the community. [ABSTRACT FROM AUTHOR]

Much research centers on correctional programming and successful reintegration; however, little work explores how incarcerated people with disabilities (IPWDs) perceive accessibility and accommodations in such programs. Given that this population has a higher recidivism rate than others, it is important to better understand unique problems faced by IPWDs. The sample was drawn from a local reentry program in Virginia. Utilizing qualitative methods, data were collected through a focus group interview and in-depth interviews. Three themes identified from these data were the lack of attention to programs, barriers to medical services, and dissatisfaction with correctional staff. Implications for correctional facilities are presented as well as suggestions for future research. [ABSTRACT FROM AUTHOR]

The article discusses a telephone survey of outpatient physicians in the U.S. to determine the extent to which they understand their legal obligations to patients under the American With Disabilities Act (ADA). Topics covered include their understanding of their responsibility in ensuring the provision of equitable care to patients with disability, their perceived risk of ADA lawsuits, and the associations among physician characteristics, their knowledge of ADA, and perceived lawsuit risk.

Rehabilitation psychology is based on foundational principles that can guide us toward health equity among disabled and nondisabled communities. We summarize the literature on disparities in the disability community and underscore the urgency to address underlying inequities to eliminate disparities. We include examples of population-level interventions that promote equity in the disability community. We conclude with a call for a broader mission for rehabilitation psychologists based on the field's foundational principles, and outline emerging opportunities to widen our impact and advance equity. Our foundational principles, built on systems theory, call on rehabilitation psychologist to work at macrosystemic levels. As rehabilitation psychologists, we need to widen our focus from the micro (individual) to the macro (population) level. We need to bring the respect, dignity, and collaborative spirit that inspire our work with individuals to the broader community by advocating for structures and policies that promote equity for disabled persons. Impact and Implications: This article underscores the existing health disparities, and influence of inequities, among people with disabilities and chronic health conditions; informs readers about the inherent social justice nature of rehabilitation psychology's foundational principles, which can guide the field in promoting equity among individuals with disabilities and chronic conditions; and recommends that we, as rehabilitation psychologists, broaden our focus from the micro (individual) to the macro (population) level by joining our approaches with the field of public health to promote equity among a wider group of disabled persons. [ABSTRACT FROM AUTHOR]

Objectives. To explore the effect of the Affordable Care Act (ACA) on disparities in access to health care based on disability status, as well as age, income, race, and ethnicity. Methods. In this study, I used logistic regression to analyze nationally representative data from 128 000 respondents to the US National Health Interview Survey from 2008 to 2010 and 2015 to 2017. Outcome variables were uninsurance over the previous 12 months, delayed or forgone health care for reasons of cost, and having a regular provider at a doctor's office or health clinic. Results. Over the period when the ACA was implemented, large existing disparities in access to health care were reduced for people with certain types of disabilities, young adults aged 19 to 25 years, and low-income families. Conclusions. The ACA improved overall access to health care and reduced some disparities, but substantial disparities persist. Disability status remains associated with much greater risk of delayed or forgone care, and mental health disability is associated with greater likelihood of uninsurance. Public Health Implications. The ACA partially achieved its goals and must not be weakened or rolled back. Further policy efforts are needed to address the remaining disparities. [ABSTRACT FROM AUTHOR]

The article provides an update on the mental health parity in the U.S. codified by the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), as of June 2006. Topics covered include the findings of the 2019 Milliman's report on the status of mental health parity based on insurance, the violations of parity law revolving around MHPAEA guidelines and the impact of the COVID-19 pandemic on parity.

United States' courts have played a limited, yet key, role in shaping health equity in three areas of law: racial discrimination, disability discrimination, and constitutional rights. Executive and administrative action has been much more instrumental than judicial decisions in advancing racial equality in health care. Courts have been reluctant to intervene on racial justice because overt discrimination has largely disappeared, and the Supreme Court has interpreted civil rights laws in a fashion that restricts judicial authority to address more subtle or diffused forms of disparate impact. In contrast, courts have been more active in limiting disability discrimination by expanding the conditions that are considered disabling and by articulating and applying the operative concepts "reasonable accommodation" and "other qualified" in the context of both treatment and insurance coverage decisions. Finally, regarding constitutional rights, courts have had limited opportunity to intervene because, outside of specially protected arenas such as reproduction, constitutional law gives government wide discretion to define health and safety goals and methods. Thus, courts have had only a limited role in shaping health equity in the United States. It remains to be seen whether this will change under the Affordable Care Act or whatever health reform measure might replace it. [ABSTRACT FROM AUTHOR]

Patients receiving care for the management of end stage renal disease require transport to nephrology practice settings and treatment centers for hemodialysis and peritoneal dialysis. This type of transportation, defined as non-emergency medical transportation, has long presented a challenge for patients, families, and healthcare providers. This article explores the current and projected statistics and trends for chronic kidney disease, transportation challenges faced by patients and nephrology healthcare providers, and examples of successful transportation services and programs. Implications for practice with a focus placed on the importance of an interprofessional approach are described. [ABSTRACT FROM AUTHOR]

Access to the Internet is increasingly critical for health information retrieval, access to certain government benefits and services, connectivity to friends and family members, and an array of commercial and social services that directly affect health. Yet older adults, particularly those with disabilities, are at risk of being left behind in this growing age- and disability-based digital divide. The Americans with Disabilities Act (ADA) was designed to guarantee older adults and persons with disabilities equal access to employment, retail, and other places of public accommodation. Yet older Internet users sometimes face challenges when they try to access the Internet because of disabilities associated with age. Current legal interpretations of the ADA, however, do not consider the Internet to be an entity covered by law. In this article, we examine the current state of Internet accessibility protection in the United States through the lens of the ADA, sections 504 and 508 of the Rehabilitation Act, state laws and industry guidelines. We then compare U.S. rules to those of OECD (Organisation for Economic Co-Operation and Development) countries, notably in the European Union, Canada, Japan, Australia, and the Nordic countries. Our policy recommendations follow from our analyses of these laws and guidelines, and we conclude that the biggest challenge in bridging the age- and disability-based digital divide is the need to extend accessibility requirements to private, not just governmental, entities and organizations. [ABSTRACT FROM AUTHOR]

The Americans with Disabilities Act (ADA) requires full and equal access to healthcare services and facilities, yet studies indicate individuals with mobility disabilities receive less than thorough care as a result of ADA noncompliance. The objective of our pilot study was to assess ADA compliance within a convenience sample of healthcare clinics affiliated with a statewide healthcare network. Site assessments based on the ADA Accessibility Guidelines for Buildings and Facilities were performed at 30 primary care and specialty care clinics. Clinical managers completed a questionnaire on standard practices for examining and treating patients whose primary means of mobility is a wheelchair. We found a majority of restrooms (83%) and examination rooms (93%) were noncompliant with one or more ADA requirements. Seventy percent of clinical managers reported not owning a heightadjustable examination table or wheelchair accessible weight scale. Furthermore, patients were examined in their wheelchairs (70%-87%), asked to bring someone to assist with transfers (30%), or referred elsewhere due to an inaccessible clinic (6%). These methods of accommodation are not compliant with the ADA. We recommend clinics conduct ADA selfassessments and provide training for clinical staff on the ADA and requirements for accommodating individuals with mobility disabilities. [ABSTRACT FROM AUTHOR]

Students with disabilities are a growing population in higher education (National Center for Education Statistics, 2009). Providing accommodations for students with disabilities can raise ethical and social justice questions and pose challenges for social work faculty, administrators, and field instructors. Social work educators must balance the legal mandates for nondiscrimination and reasonable accommodation against ethical obligations around protection of clients and preparation for practice. This article presents case examples in the context of legal analysis to help social work educators make difficult decisions about student academic performance. [ABSTRACT FROM PUBLISHER]

We argue for the existence of a state constitutional legal right to language. Our purpose here is to develop a legal framework for protecting the civil rights of the deaf child, with the ultimate goal of calling for legislation that requires all levels of government to fund programs for deaf children and their families to learn a fully accessible language: a sign language. [ABSTRACT FROM AUTHOR]

Stigma against mental illness is a complex construct with affective, cognitive, and behavioral components. Beyond its symbolic value, federal law can only directly address one component of stigma: discrimination. This article reviews three landmark antidiscrimination laws that expanded protections over time for individuals with mental illness. Despite these legislative advances, protections are still not uniform for all subpopulations with mental illness. Furthermore, multiple components of stigma (e.g., prejudice) are beyond the reach of legislation, as demonstrated by the phenomenon of label avoidance; individuals may not seek protection from discrimination because of fear of the stigma that may ensue after disclosing their mental illness. To yield the greatest improvements, antidiscrimination laws must be coupled with anti-stigma programs that directly address other components of stigma. [ABSTRACT FROM AUTHOR]

The article presents a guideline on the management of dental patients with special health care needs (SHCNs) from the American Academy of Pediatric Dentistry (AAPD). According to the guideline, which was revised in 2012, people with disabilities may have compromised immune systems or lack the capability to take responsibility for preventative care. Topics include health care access for patients with SHCNs, dental insurance, pediatric dentistry, and behavioral guidance techniques. The article emphasizes the importance of communication and consultation with parents and other care providers. The Americans with Disabilities Act is mentioned.

Meeting the "special needs" of at-risk populations affected by disasters is of the utmost importance. In the United States, there are 54 million people who fit into the special needs category who are defined as handicapped, disabled, vulnerable, challenged, or having special needs. The paramount importance for the special needs population is maintaining human dignity throughout the disaster management cycle. Government agencies, nongovernmental organizations, and advocacy organizations have all worked together to attempt to address and ensure that the needs of all individuals are addressed throughout the disaster cycle. Each provider and emergency responder should be familiar with the Americans with Disabilities Act requirements, but this alone does not begin to address the needs of children, the elderly, or other individuals and their special needs. There are multiple theoretical frameworks that may be useful, but the most human approach may be to consider needs based on Maslow's hierarchy of needs. [ABSTRACT FROM AUTHOR]

Transition from pediatric to adult medical care and the significant psychosocial considerations impacting this developmental process are a primary focus in health care today. Social workers are often the informal brokers of this complex and nuanced process and are uniquely trained to complete biopsychosocial assessments to understand the needs of patients and families and address psychosocial factors. Their extensive knowledge of resources and systems, along with their sophisticated understanding of the relationship issues, family dynamics, cultural implications, and basic person-in-context approach allow for unique collaboration with the health care team, family, and community supports to develop successful transition plans and programs. [ABSTRACT FROM AUTHOR]

In 1982, the first Medicaid Home and Community-based Services (HCBS) waiver program was initiated in Oregon State. At that time, policy makers and practitioners were eager to develop in-home options as alternatives to nursing home care for older people. In 2012, many advocates aspired that HCBS become the dominant more of long-term care (or long-term supportive services) and nursing home care be the much rarer alternative. This article introduces this topic, describes the major vehicles to reduce reliance on nursing homes, and distinguishes between two major approaches-preventing admissions to nursing homes (sometimes called diversion) or helping nursing home residents return to the community (sometimes called transitions). The article also gives an overview of the content of the Spring 2012 issue of Generations, narrative that takes stock of progress made in HCBS for elders and the challenges that exist now and in the future. [ABSTRACT FROM AUTHOR]

The funding of assistive technology (AT) in the United States falls within a complex web of traditional and non-traditional funding sources that often create challenging barriers for individuals with disabilities. This article outlines the founding policies that drive the federal and state funding of AT across insurance, education, rehabilitation sectors and beyond. A presentation of specific medical and non-medical funding options is discussed addressing eligibility, types of AT covered and general program characteristics. I conclude with recommendations for the pursuit of AT funding in light of these policies and options. [ABSTRACT FROM AUTHOR]

The article discusses a report by LI Iezzoni et al on the results of a qualitative study that examined prenatal experiences of 22 mothers-to-be with mobility disabilities. Most of the women felt disrespected by their physicians and healthcare system leaving them less likely to report changes in their health or new medical concerns thus risking poorer maternal-fetal health and pregnancy outcomes. It cites suggested alternative approaches such as requiring access for patients with disabilities.

The article studies a comparison of healthcare access for older adults with disabilities to older adults without disabilities, and the effect of policies to healthcare access. Results revealed that older adults with disabilities exhibit disparities in healthcare access as compared to older adults with no disabilities. Also, it was found that implementations of legislation such as the Americans with Disabilities Act of 1990 (ADA) and Medicare had no significant impact on accessibility.

The article presents an editorial that discusses structural conditions that negatively affect the access to health care services for people with disabilities. Effects of structural barriers on patient safety, quality of care, and health care worker safety are discussed. Legal and policy contexts of ensuring physical accessibility of people with disabilities to health care facilities are examined, including the enactment of the Americans with Disabilities Act. The authors make recommendations for structural health care access, including those based on the environment of care, equipment recommendations, and staff training.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and on-site risk management audits, and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other health care professionals so "clinician" is used to indicate all treatment team members. [ABSTRACT FROM AUTHOR]