Living Well with a Disability Improves Health and Saves Money

Darren Larson (right) and Michael O’Neil

“Living Well with a Disability has been a great experience. The 10-week program allows individuals with disabilities to create a healthy lifestyle plan, unique to their desires and strengths, to overcome every day and ongoing challenges, and to reach meaningful life goals. It is awesome!”
~Darren Larson, LWD Facilitator

Public Health Issue

People with disabilities compose about 20% of the U.S. population but account for nearly half of all medical expenditures. A combination of medical, rehabilitation, and community advancements have increased the life expectancy of people with disabilities. A challenge for public health is to ensure these added years are quality life years. The Living Well with a Disability (LWD) evidence-based CDC-sponsored health promotion program meets this challenge by reducing the effects of health problems and associated medical expenses for people with physical disabilities or mobility impairments.1

Program Overview    

A national study funded by Centers for Disease Control and Prevention's  (CDC) Disability and Health Program indicated that a state would save approximately $81,000 to $240,000 above the cost of the LWD program when implemented with 240 participants each year. The Research and Training Center on Disability in Rural Communities (RTC:Rural), in partnership with MTDH, provides the organizational and facilitator training and technical assistance to Centers for Independent Living and other community agencies that implement LWD workshops. LWD teaches skills to manage health, solve problems, communicate with service providers, avoid frustration and depression, increase physical activity and nutrition, and maintain healthy lifestyle practices.

Making a Difference

From February 1995 to April, 2016, RTC:Rural staff trained 1,159 LWD facilitators in 46 states, who served more than 9,272 adults with disabilities. The vast majority of trained facilitators were located in 16 of the 18 states with *CDC Disability and Health programs (http://www.cdc.gov/ncbddd/disabilityandhealth/index.html).  Since 2002, 735 LWD facilitators in current and previous CDC Disability and Health funded states reached over 5,880 workshop participants, whose symptom-free days are estimated at having increased by 69,972 days. The estimated net benefit to healthcare payers is between $5.5 and $9.4 million

Shaping Tomrrow

Contact your state Department of Public Health and Human Services to discuss LWD as a possible Medicaid reimbursable service through the Home and Community Based Services (HCBS) Waiver programs.

1Ravesloot C, Seekins T, Traci M, et al. Living Well with a Disability, a Self-Management Program. MMWR Suppl 2016; 65place_Holder_For_Early_Release:61–67. DOI:  http://dx.doi.org/10.15585/mmwr.su6501a10

Contact Information: Montana Disability and Health Program; Tracy Boehm, MPH; 52 Corbin Hall, Missoula, MT 59812; (406) 243-5741; This email address is being protected from spambots. You need JavaScript enabled to view it.;  www.livingandworkingwell.org.

MTDH is a State Disability & Health Grantee of the Disability and Health Branch, Division of Human Development & Disability, National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. MTDH is a partnership of the Montana DPHHS and the University of Montana Rural Institute for Inclusive communities. More information is available at: http://mtdh.ruralinstitute.umt.edu    

© 2016 RTC: Rural. Opinions expressed are the author’s and do not necessarily reflect those of the funding agency.

Improving Individuals’ Nutritional Health with Menu-AIDDS

At Eastern Montana Industries, group home manager Steve Amick used the MENU-AIDDs program to improve dietary offerings, but he did not stop there. He increased resident involvement in the menu planning by researching traditional native vegetables with several American Indian residents. They put several varieties of squash on the menu and learned new recipes together. This is a culturally competent increase in vegetable consumption—a winning solution.

Public Health Issue

Adults with intellectual or developmental disabilities (I/DD) are at increased risk for nutrition related chronic diseases and secondary conditions such as overweight, obesity, diabetes, cardiovascular disease, gastrointestinal dysfunction and nutritional deficiencies. Staffing issues and planning for multiple individual cultural and special dietary needs present challenges to maintaining food systems within to this population’s living situations that align with the American Dietary Guidelines.

Program Overview    

MENU-AIDDs was developed using community-based participatory research methods to ensure its acceptability and usability by group homes and individuals with disabilities. The program uses an ecological approach to health promotion, which means that it takes into consideration the many influences on nutritional choices and behavior. MENU-AIDDs’ dietary recommendations follow the Dietary Guidelines for Americans and the MyPlate food guidance system. It is not a therapeutic diet and does not need a doctor’s order to implement. MENU-AIDDs has been evaluated in an 8- and 16-week pilot trial and a 6-month public health dissemination (effectiveness trial) in Montana.

Making a Difference

To date, more than 160 community-based group homes for adults with IDD in Montana, New York, North Carolina, and Oregon have been trained to implement MENU-AIDDs. Training evaluations indicate that 99% of managers trained agreed that they were well prepared and confident to implement the program; 96% agreed the day of training was worth their time and effort, and 96% agreed that they were prepared to teach the concepts and procedures to their staff.

Because managers, staff, and residents now make the weekly home menus, the food systems have become more responsive to cultural food habits and resident preferences, grocery store sales and seasonal foods, residents’ special dietary needs, and their staff capacity. Significant improvements were found in homes that used MENU-AIDDs: healthfulness of planned menus dietary intake of individuals who lived there body weight of people who were overweight or obese and of people who were underweight gastrointestinal function.

Shaping Tomorrow

MTDH plans to partner with I/DD services providers, who are already using MENU-AIDDs successfully, to use the program as a base for introducing the Diabetes Prevention Program to adults with IDD. Such a linkage would likely allow evidence-based diabetes prevention programming to this population who are at increased risk for the chronic, expensive condition.
For more nutrition materials and information, visit the MTDH website at http://mtdh.ruralinstitute.umt.edu/Contact

Information: Montana Disability and Health Program; Meg Traci, PhD; 52 Corbin Hall, Missoula, MT 59812; (406) 243-4956; This email address is being protected from spambots. You need JavaScript enabled to view it.

MTDH is a State Disability & Health Grantee of the Disability and Health Branch, Division of Human Development & Disability, National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. MTDH is a partnership of the Montana DPHHS and the University of Montana Rural Institute for Inclusive communities. More information is available at: http://mtdh.ruralinstitute.umt.edu    

© 2016 RTC: Rural. Opinions expressed are the author’s and do not necessarily reflect those of the funding agency.

Marty Blair and Jason Billehus were part of a Montana disability delegation to the 2016 Disability Policy Seminar earlier this week. They participated in a number of meetings and seminars focused on improving policies and programs for people with disabilities. They met with the Montana Congressional delegation and their staff: Senators Tester, Daines and Representative Zinke.

“In older American towns, like Glendive, it’s important to realize that accessibility is needed and can continually be improved for a whole and healthy community.”
~ Kathie Bach, Glendive resident & MTDH Disability Advisor since 2003.

Public Health Issue

People with disabilities compose about 20% of the U.S. population but often are left out of community planning efforts. As communities organize to ‘…build active community initiatives’, persons with disabilities have significant roles in realizing a healthy community for all its members regardless of ability.

Program Overview    

The Montana Disability and Health (MTDH) Program recruits, trains and supports Disability Advisors who provide technical assistance and infuse disability inclusion and wellness goals in public health planning at state and local levels. The Montana Nutrition and Physical Activity (NAPA) Program’s Building Active Communities Initiative (BACI) is a project of the Montana Department of Public Health and Human Services in cooperation with Montana State University’s Office of Rural Health. With in-depth, interactive training, mentoring and ongoing technical assistance, NAPA’s Building Active Communities Initiative supports community-led approaches to develop active and healthy communities. MTDH Disability Advisors are involved in BACI planning and implementation in communities across Montana and are supported with data and resources (e.g., Montana BACI Disabilities Resources & Information, available at: http://www.umt.edu/sell/cps/baci/Disabilities%20Resources%20.php ).

Making a Difference

Active community policy resolutions have been adopted in eleven Montana towns to date. Examples of inclusive planning language in those policies include “accessible streets”, “safe and accessible routes”, “meet the needs of all users and abilities”, and “universal access to transit systems”. Community BACI Teams reported that a Disability Advisor testimony directed them to be more thoughtful about the inclusion of community members with disabilities in active communities work.

Dawson County is a rural county with a population nearly doubling the state rate in the past few years due to the oil boom in eastern Montana and North Dakota. In 2013, Dawson County sent a multi-sector leadership team representing the county and the city of Glendive to the first Montana BACI Action Institute. Soon after attending the Action Institute the Building Active Glendive (BAG) coalition was formed and currently has close to a dozen community leaders including the Mayor of Glendive, a county commissioner, the health department, Rotarians, planners and engineers as well as active community volunteers. Dawson County adopted a Complete Streets Policy in October 2014 that received national recognition, a third ranking among all complete streets policies passed nationwide in 2014. The City unanimously passed the “Safe and Accessible Streets” Policy for the City of Glendive in April 2015.

Contact Information: Meg Traci, PhD; 52 Corbin Hall, Missoula, MT 59812; (406) 243-4356; This email address is being protected from spambots. You need JavaScript enabled to view it.

MTDH is a State Disability & Health Grantee of the Disability and Health Branch, Division of Human Development & Disability, National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention. MTDH is a partnership of the Montana DPHHS and the University of Montana Rural Institute for Inclusive communities. More information is available at: http://mtdh.ruralinstitute.umt.edu    

© 2016 RTC: Rural. Opinions expressed are the author’s and do not necessarily reflect those of the funding agency.

July 15, 2016 - 10AM at McCormick Park, Missoula, MT

The AMCHP meeting in DC last week was outstanding. Marty Blair, Director of the Rural Institute, attended the meeting and met some wonderful new people and connected with several Montana colleagues. Tarra Thomas, chair of the Montana Council on Developmental Disabilities was there and he had an opportunity to visit with AUCD staff, Ben and Shannon. He also had lunch with several Montana Title 5 staff. There was certainly no shortage of good ideas and talked about future collaborations.

Andrew Myers and Lillie Greiman were at a conference the last week of March and presented a couple posters on some of the research we have been working on (funded through the RTC: Rural and the RTC on Community Living in Kansas). The conference was the Association of American Geographers Conference in San Francisco and our posters were titled: The Geography of Home for People with Disabilities & Person-Environment Fit in Rural Communities: Toward and Ecology of Disability

You can learn about the Geography of Home Research at https://www.facebook.com/RTCILKansas/

The director of the Rural Institute for Inclusive Communities, Marty Blair, presented on the March 22 panel with Cecilia Feely at the inaugural State Policy Summit: Innovations in Adult Programming, sponsored by the Autism Services, Education, Resources, & Training Collaborative (ASERT) in Philadelphia, PA.

The primary goal of the summit is to gather experts from across the United States to share successes in establishing, maintaining and evolving programs, policies, service philosophies and models within systems for adults with autism spectrum disorder (ASD), intellectual disabilities (ID), other developmental disabilities (DD), and mental health diagnoses (MH).

During this webinar, the presenters will describe assistive technology (AT), both high- and low-tech, to help young adults with disabilities succeed at school and at work. Ideas for funding will also be shared. 

Tuesday, April 12, 2016 • 1:00 PM - 2:30 PM MDT

Register on the Transition & Employment Projects newsletter.

The newest Impact issue from the Institute on Community Integration & Research and Training Center on Community Living highlights the work people in Montana are doing to support wellness for adults with intellectual and developmental disabilities. Connie Lewis, Rural Institute employee, and community partner Andrea Dahl, from Summit Independent Living Center in Missoula, are featured for their leadership and participation in 14 Weeks to a Healthier You, a fitness and nutrition program developed by the National Center on Health, Physical Activity and Disability (NCHPAD). Supported by the Montana Disability and Health Program at the Rural Institute, the 14 Weeks program addresses the need for health promotion and wellness opportunities for people with disabilities in Montana.

The Institute for Community Inclusion’s announcement of the new issue states:
“Wellness is a rapidly growing area of focus for Americans. But for people with intellectual and developmental disabilities, access to wellness activities and programs can be limited. How can we open up participation? Find out in the just-released free publication, Impact: Feature Issue on Supporting Wellness for Adults with Intellectual and Developmental Disabilities.