ACADEMIC PLANNING FOR HEALTH PROFESSIONALS CENTERED ON PERSONS WITH INTELLECTUAL DISABILITIES

Special Olympics Florida
Presentation for Future Health
Professionals Centered on
Persons with Intellectual &
Developmental
Disabilities (IDD)
Figure 1. Physical Therapy Train-Train-Trainer Session

Outline
2
Background
Objectives
Methods
Conclusion
Recommendations
Discussion
Pictures from Healthy Community Screenings
and Intervention Programs

Abstract
Preparing future health professionals academically to provide effective
healthcare and multi-disciplinary services to individuals with intellectual or
developmental disabilities (IDD) seems to be missing from many university
curricula. Existing curricula for these professionals lack information to the needs
of the IDD population. It is critical that aspiring health professionals recognize
the challenges that come with providing healthcare and services to the IDD
population. It is necessary that the preparation of addressing these individuals
into their areas of practice, that is, to provide care, develop intervention
programs, and educational presentations based on the myriads of health issues
found in this population. Experiential learning with a qualified mentor prepares
individuals who may not have had prior experiences in serving this population.
This presentation explores the current issues relating to the knowledge
deficiencies of future health professional to serve the IDD population. Reviews of
recent literature confirmed this proposition.
Keywords: health professionals, healthcare education, disabilities, academic planning.

Objectives
• Prepare health students to become more aware of the
developmental health issues faced by adults with
intellectual disabilities.
• Equip students to provide effective health education,
interventions, and multi-disciplinary services centered
around the IDD population.
• Fill the knowledge gaps in order to help prepare future
health practitioners to promote inclusion of this
population into their fields of practice.
4

Background
• The area of intellectual disabilities has often been
described as the Cinderella discipline of medicine,
(Prasher & Janicki, 2003).
• Nearly 200 million in the world live with some form of
intellectual or developmental disability (IDD), and the
prevalence is on the rise (World Health Organization [WHO], 2011).
5

• Individuals with IDD experience poorer health than the
general population (Krahn, Hammond, & Turner, 2006).
• Yet, health students from various health disciplines, are
entering their fields ill prepared to teach, and provide
services this population as personally experienced.
6

Discussion
7
Figure 2. Public Health and Nutrition Training Session

Health Students Entering
their Fields Unprepared
to Serve the IDD Population
8
In a recent SO research study, the
following individuals responded that
graduates were “not competent” to
treat people with IDD :
• 52 percent of medical school deans
• 53 percent of dental school deans
• 56 percent of students
• 32 percent of medical residency
program directors
(Special Olympics [SO], 2005).
Figure 3. Health Education Training Session

The reasons given for this startling deficiency were that:
• 81 percent of medical school deans and 50 percent of
dental school deans say that clinical training regarding
individuals with intellectual disabilities is not a high
priority.
• 81 percent of medical school students say they are not
getting any clinical training regarding individuals with
intellectual disabilities and two-thirds (66 percent) are
not receiving enough classroom instruction (SO, 2005).
9
Curricula Differences

Overflow of Health
Inequalities
The disparity between the general population and people
with IDD is a result of:
• Genetic factors
• Social circumstances
• Environmental conditions
• Inadequate knowledge of health promotion
• Inadequate medical care access
(Krahn, Hammond, & Turner, 2006)
10

• Epilepsy, behavioral/mental problems, fractures, skin
conditions, poor oral health, and respiratory disorders
are repeatedly documented in IDD population
• There is a greater risk of inadequate attention to
potentially life threatening conditions as there has
been a rise in group living situations
11

• People with IDD experience lower rates of preventative
care and health promotion practices
• People with IDD have inadequate access to quality
health care service (Krahn, Hammond, & Turner, 2006)
12

Obesity Issues
• 39.3% of women and 27.8% of men with IDD are
overweight or obese vs. 25.1% of women and 25.7% of
men in general population
• Mean BMI of women with IDD (28.8) was significantly
higher than the mean BMI for men with IDD (26.7)
• Women with IDD more likely to be obese than men with
IDD
• Down syndrome was associated with increased risk of
overweight and obesity (Melville et al., 2008)
13

• As the severity of the intellectual disability increased,
the risk of overweight and obesity decreased
• Very low physical activity levels, lack of a balanced
diet, inaccessible clinical services for weight
management contribute to the increasing obesity rates
• Developing obesity early in adulthood increases risk for
obesity related diseases (CVD, diabetes, cancer)
(Melville et al., 2008)
14

Social and Relationship
Challenges
• All individuals with IDD valued being in an intimate
relationship which fulfilled their needs, having a positive
impact on mental health and well-being
• People with IDD often feel that control and choice are
constrained by others (mainly caregivers)
• Main difference in experiences and psychology of sexual
expression in IDD vs. general population is the strong
impact that others have on their relationships
(Rushbrooke, Murray, Townsend, 2014).
15

Health Risks & Behaviors
Indicator (year)
Adults with
disabilities
Adults without
disabilities
Disparity
Binge drank in the past 30 days (2012) 21.2% 18.1% 3.1
Always use a seatbelt (2012) 82.7% 85.8% -3.2
Ate fruit 1 or more times per day (2011) 55.8% 62.8% -7.0
Ate vegetables 1 or more times per day
(2011)
75.3% 77.9% -2.5
Obese based on body mass index (2012) 36.1% 22.0% 14.1
At risk for HIV (age 18-64) (2012) 8.1% 6.7% 1.4
Sufficient aerobic physical activity
(2011)
42.3% 57.1% -14.8
Meets both aerobic and muscle
strengthening physical activity
guidelines (2011)
15.0% 24.6% -9.6
Currently smoke cigarettes (2012) 28.7% 15.9% 12.8
16
Table 1. Health risks and behaviors by disability status
Source: Disability & Health Data Systems

Health Conditions
17
Indicator (year)
Adults with
disabilities
Adults without
disabilities
Disparity
Ever had a hysterectomy (2012) 26.0% 17.0% 9.0
Fair or poor self-rated health
(2012)
48.4% 9.6% 38.9
Have heart disease (2012) 14.8% 4.1% 10.7
Ever had high blood pressure
(2011)
43.7% 25.6% 18.1
Ever had high cholesterol (age 20+)
(2011)
46.8% 33.9% 12.9
Ever had asthma (2012) 23.5% 10.1% 13.4
Ever had cancer (excluding skin cancer)
(2012)
8.9% 5.0% 3.9
Ever had prostate cancer (age 40+)
(2010)
5.5% 4.9% 0.6
Ever had skin cancer (2012) 7.8% 6.6% 1.2
Have chronic obstructive pulmonary
disease (COPD) (2012)
17.7% 3.3% 14.4
Have diabetes (2012) 19.1% 6.8% 12.3
Have kidney disease (2012) 7.0% 1.9% 5.1
Ever had a stroke (2012) 7.0% 1.4% 5.6
Table 2. Health conditions by disability status

Prevention & Screenings
18
Indicator (year)
Adults with
disabilities
Adults
without
disabilities
Disparity
Clinical breast exam in the
past 2 years (age 40+)
(2012)
64.2% 75.8% -11.6 0.000
Mammogram in the past 2
years (age 50-74) (2012)
73.5% 78.7% -5.2 0.062
Pap test in the past 3 years
(age 21-65) (2012)
72.3% 82.3% -9.9 0.006
Up-to-date with colorectal
cancer screening (age 50-75)
(2012)
63.2% 65.7% -2.5 0.338
Routine check-up in the past
year (2012)
72.3% 66.8% 5.5 0.036
Teeth cleaned in the past
year (2010)
51.4% 66.8% -15.4 NA
Visited a dentist in the past
year (2012)
49.1% 62.4% -13.4 0.000
Table 3. Prevention and screenings by disability status

Prevention & Screenings (FL vs. CA)
19
Indicator (year) Florida California
Clinical breast exam in the past 2
years (age 40+) (2012)
Adults with
Disability
64.2% 72.6%
Adults
without
Disability
75.8% 75.8%
Mammogram in the past 2 years
(age 50-74) (2012)
Adults with
Disability
73.5% 79.8%
Adults
without
Disability
78.7% 84.1%
Pap test in the past 3 years (age
21-65) (2012)
Adults with
Disability
72.3% 82.8%
Adults
without
Disability
82.3% 86.4%
Up-to-date with colorectal cancer
screening (age 50-75) (2012)
Adults with
Disability
63.2% 64.1%
Adults
without
Disability
65.7% 65.3%
Cholesterol check in the past 5
years (age 20+) (2011)
Adults with
Disability
79.8% 82.2%
Adults
without
Disability
77.2% 75.9%
Routine check-up in the past year
(2012)
Adults with
Disability
72.3% 63.5%
Adults
without
Disability
66.8% 62.4%
Table 4. Prevention and screenings by disability status

Conclusion
• Virtually in all health areas, people with IDD face
poorer health outcomes
• They lack access to quality healthcare and prevention
screenings/programs
• The myriad of health and wellness related issues that
plagues them are on the rise
• Many health providers and future health professionals
are not equipped to provide multi-discipline services to
this population
• Ensuring inclusion of this population at the various
mentioned areas is essential.
20

Recommendations
Preparing Health Professionals to Provide Care
to Individuals with Disabilities:
• Increased didactic and clinical preparation of health
school graduates regarding the care
of individuals with special health needs
• Develop appropriate curricula/
modules that provides opportunities
to cater this population (Holder et. al, 2005)
• Facilitate internships, clinical rotations
and volunteer with opportunities with
facilities that serves the IDD population.
21
Figure 3. Nutrition & Dietetics Students

Examples
• The “IDD Centered Course” that was designed to
expose health students to methodologies that will help
them become well versed of the issues faced by
children/adults with IDD, and provide guidance of how
to provide meaningful health education and multi-
disciplinary services to that population.
• Formal affiliation agreements with community based
organizations that serve the IDD population
• Internship opportunities, learning activities and clinical
rotations with those organizations
22

Recommendations
Health Inequalities:
• Reduce the occurrence and impact of associated,
comorbid, and secondary conditions
• Empower caregivers and family members to meet the
health needs of persons with IDD
• Promote healthy behaviors in people with IDD
• Ensure equitable access to quality healthcare
(Krahn & Fox, 2013)
23

• Develop new strategies to properly sample and identify
people with IDD across all ages
• Improve our ability to tailor public health interventions
around the specific needs of disability populations
• Include persons with disabilities into the mainstream
services where possible, give a cross-disabilities
approach where necessary, and give a condition-
specific approach where essential
(Krahn & Fox, 2013)
24

Examples
25
January 16, 2014 November 17, 2014
Rebecca
Batura
Height 4'9 Height 4’9
Weight 185 Weight 170
BMI 40 BMI 36.8
Wellness program for persons
with IDD which includes:
• Evidence-based learning curricula/intervention
• Physical activity, health education and nutrition
counseling
• Meal planning utilizing “My Plate” food guides
• Individualized meal plans for those requiring
dietary modification due to chronic diseases
• Meal preparation demonstrations and recipes
• Inclusion of staff, family members with healthy
choices

Recommendations
Social and Relationship Challenges:
• Caregivers should assist in providing opportunities for
social contact/education about relationships
• Services should consider alternative avenues to address
the unmet needs: increasing social networks & social
activities
• Support should be provided on an individual basis
26

• Since each person with IDD has different needs,
support should be provided on an individual basis
• Increasing exposure of different types of relationships
through education, increasing social networks and
friends (Rushbrooke, Murray, Townsend, 2014)
27
Figure 5. Social Wellness Program at Special Olympics FL

Recommendations
Obesity issues:
• Changes in policy/training should include: sensitive
management of impact that caregivers have on
relationships, emotional impact & physical expression of
relationships
• Need early identification of obesity & related diseases in
childhood and adolescence (Rushbrooke, Murray, & Townsend, 2014)
28

• Effective weight management interventions/clinical
services are needed to diminish health disparities
• Need for future research to focus on reasons for
increased obesity prevalence in IDD population
(Melville et al., 2008)
29
Figure 6. Health Promotion Intervention
Program at Special Olympics FL

References
Centers for Disease Control and Prevention. Disability and Health Data System. (2012). Retrieved from
http://dhds.cdc.gov.
Corbin, S., Holder, M., & Engstrom, K. (2005). Changing attitudes, changing the world: the health and health
care of people with intellectual disabilities. Washington, DC: Special Olympics International.
Holder, M., Waldman, H. B., & Hood, H. (2009). Preparing health professionals to provide care to individuals
with disabilities. Int J Oral Sci, 1(2), 66-71.
Krahn, G. L., & Fox, M. H. (2014). Health disparities of adults with intellectual disabilities: what do we know?
What do we do?. Journal of Applied Research in Intellectual Disabilities, 27(5), 431-446.
Krahn, G. L., Hammond, L., & Turner, A. (2006). A cascade of disparities: health and health care access for
people with intellectual disabilities. Mental retardation and developmental disabilities research reviews,
12(1), 70-82.
Melville, C. A., Cooper, S. A., Morrison, J., Allan, L., Smiley, E., & Williamson, A. (2008). The prevalence and
determinants of obesity in adults with intellectual disabilities. Journal of Applied Research in Intellectual
Disabilities, 21(5), 425-437.
Rushbrooke, E., Murray, C., & Townsend, S. (2014). The experiences of intimate relationships by people with
intellectual disabilities: a qualitative study. Journal of Applied Research in Intellectual Disabilities, 27(6),
531-541.
World Health Organization. (2011). World report on disability. Geneva, Switzerland: Author. Retrieved from
http://www.who.int/disabilities/world_report/2011/accessible_en.pdf
30

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