Development of an eHealth Group Weight Management Intervention for People with Spinal Cord Injury
Rosemay B. Hughes
The purpose of this study is to reduce the prevalence of obesity in people with SCI by helping them learn to better self-manage their weight through healthy lifestyle change. Our goal is to use a community-based participatory and multidisciplinary approach to develop and pilot test a weight management intervention that responds to the unique needs of women and men with SCI, builds on the team's prior weight management research on women with mobility impairments, including SCI, and is delivered primarily online. We will 1) partner with a community advisory board and expert consultants in SCI health and medical management, nutrition, and physical activity, to adapt and expand an existing weight management program to meet the specific needs of men and women with SCI; and 2) pilot test the adapted intervention in a sample of overweight and obese persons with SCI to determine feasibility, identify areas for further modification, and evaluate changes in weight, waist circumference and other outcomes to obtain preliminary estimates of effect sizes for a subsequent full-scale trial. We will use a randomized controlled pre-post-test design to pilot test the intervention among 40 men and women with SCI, and will use a mixed models approach to analyze the repeated measures design. We hypothesize that participants randomly assigned to the 28-week eHealth weight management program will experience greater reductions in weight and waist circumference and greater improvements in other outcomes (diet, physical activity, self-efficacy for diet and activity, nutrition knowledge, and barriers to exercise) from pre- to post-intervention compared to participants assigned to the control condition. The proposed program addresses a critical need of people living with SCI and has the potential to exert a sustained and powerful influence on policy change and the health and well-being of people with SCI.
Partnering with People with Disabilities to Address Interpersonal Violence
The Partnering with People with Intellectual Disabilities to Address Interpersonal Violence study is the first randomized, controlled evaluation of a group prevention program designed for men and women with intellectual disabilities. Constituting a coherent and sustained approach to research on violence in the context of disability, this project uses a Community Based Participatory Research approach to test the efficacy of the group program compared to a control condition among 192 adults with ID. The study is being implemented by 12 centers for independent living across the nation. We hypothesize that participants in the group program will report greater improvements than participants in the comparison group on measures of knowledge of health relationships, knowledge of abuse and safety, knowledge of warning signs, safety and communication skills, safety self-efficacy, and social network at the immediate posttest and the three-month follow-up. In the first year, researchers and community partners have partnered to adapt the researchers' existing empirically-based program to meet the unique language, content, and process needs of people with intellectual disabilities. Qualitative and quantitative methodologies will be used to conduct formative and summative evaluations. The intervention will offer a prevention program designed specifically for people with intellectual disabilities who often lack access to community-based violence prevention programs. We anticipate that the program, if determined to be efficacious, will be of interest and benefit to both domestic violence and disability service providers. Dr. Rosemary Hughes is the principal investigator of this study.
Risks and Protective Factors for Unintended Pregnancy in Women with Disabilities
The study addresses four goals of Healthy People 2020: to improve pregnancy planning and spacing, and prevent unintended pregnancy; to improve access to comprehensive, quality health care services, to promote the health and well-being of people with disabilities, and to improve the health and well-being of women, infants, children, and families. To contribute to the attainment of these goals, the proposed study will leverage existing data, using the first population-based data from the National Survey on Family Growth that uses six disability status questions required by the Affordable Care Act, and will integrate qualitative data designed to improve the understanding of the role of context, risk, and protective factors for unintended pregnancy among women with disabilities.
Virtual Reality Weight Management - with Baylor University
The prevalence of obesity in women with mobility impairments is nearly double that of women without disabilities, yet this significant health disparity has received little attention. Women who have difficulty walking or engaging in vigorous physical activity due to disabling conditions report critical health and environmental barriers to maintaining a healthy weight. We have developed and now are pilot testing the first evidence-based weight management intervention for women with mobility impairments. This intervention responds to the unique needs and expressed concerns of women with mobility impairments, builds on prior weight management research conducted on adults in general, and is delivered using virtual reality on the Internet. This study will result in a virtual reality weight management intervention with preliminary evidence of efficacy for women with mobility impairments, a significantly underserved population. The University of Montana Rural Institute is collaborating on this project at the invitation of Baylor College of Medicine's Center for Research on Women with Disabilities in Houston. Dr. Rosemary Hughes is the project director for the UM site.
Montana Children and Youth with Special Health Care Needs - Concerns Report Method
We are conducting a program assessment with our partners at the DPHHS Children’s Special Health Services (CSHS). We will be working closely with Rachel Donahoe, caregivers for CYSHCN (Children and Youth with Special Health Care Needs), healthcare providers for CYSHCN and adults with special health care needs with experience with CSHS as children. This work will extend the current work of colleagues, Dr. Tom Seekins and Dr. Craig Ravesloot, on patient centered outcomes in Montana, to CYSHCN. The program assessment will be statewide and use a community participatory approach. The outcome of this assessment will shape the future goals and strategies of Children’s Special Health Services
Participation Interference Patterns: Investigating Impact of Pain and Environment
Craig Ravesloot, Tannis Hargrove
The Participation Interference Patterns investigates the Relative Impact of Pain and Environmental Barriers on Participation. Touch screen devices were used for participation research data collection about pain, its consequences over time, and its relationship to access barriers and community participation. This study examined the impact of pain and environmental barriers on community participation. The study includes a population-based random sample with mobility and sensory impairments in a longitudinal, population-based study of community participation. The study has three goals: (1) increase understanding of how personal factors like pain interact with environmental barriers like physical accessibility to influence community participation in adults with mobility and sensory impairments living in the community, (2) establish methods that rehabilitation researchers and practitioners can use to better evaluate the dynamic interplay of personal and environmental factors on participation outcomes, and (3) publish results that rehabilitation scientists and practitioners can put into practice or make use of to guide future interventions.
Rural Options After Discharge
Residents of rural and frontier counties experience significant disparities in health care access and outcomes when compared to their urban counterparts. The organization of health care delivery contributes significantly to these disparities. For rural residents with multiple chronic conditions, transitioning along the continuum of care, between systems of treatment and support, and between dispersed locations present significant challenges. One critical challenge involves hospitalization for treatment because it requires travel to locations at a significant distance from home and disrupts personal and family routines. The transition back home is also problematic because discharge planning does not adequately account for limited access to care in rural areas. Indeed, discharge planning has been recently described as a “black hole;” fragmented and uncoordinated, and contributing to poor outcomes and patient dissatisfaction. The SPECIFIC AIM of this research is to ascertain rural patients’ actual experience of the discharge planning process and to involve patients and rural providers in designing and testing a contextually appropriate rural options discharge model (ROADMAP) that improves patient outcomes and reduces re-hospitalizations.
Objectives include: 1) Ascertain actual patient experiences in the rural discharge process. 2) Use patient-defined standards and performance requirements to create a framework for rural transitions. 3) Design the ROADMAP model to fit the emerging health services context. 4) Test the ROADMAP’s efficacy in enhancing patient defined outcomes. 5) Design the components for rapid diffusion.
Potential diffusion and beneficial impact: The emerging emphasis on outcome-based reimbursement sets the occasion for rapid diffusion of a rural transitions planning model. Incorporating the patient perspective into the design increases the likelihood that critical functions will be addressed and outcomes will improve. Similarly, rural provider input increases the likelihood of adoption by designing it to fit within the emerging reimbursement model. Assuming that half of the discharges to rural communities benefit from this process, we estimate that a comprehensive rural ROADMAP could save as much as $ 2 billion annually. By basing the ROADMAP on established standards, we build on evidence based practice to design a program that is inexpensive and superior to standard practice.
The Pre-ETS Technical Assistance Center supports Vocational Rehabilitation and school staff to provide quality pre-employment transition services to students with disabilities. We facilitate system change by researching and sharing innovative ideas, providing technical assistance, and helping to forge collaborations focused on competitive integrated employment
TTEAM: Training Teachers to Assure Achievement and Membership Admin and Participant Support
Training Teachers to Ensure Achievement and Membership (TTEAM) is a federally funded personnel preparation grant in the area of low incidence disabilities. The project provides tuition support for graduate students to gain a master’s degree in Curriculum and Instruction with an emphasis on the needs of students with low incidence disabilities. Course funding supports the delivery of six courses focused on this area of specialization.
Wheels Across Montana
Wheels Across Montana is a grant-funded health promotion project, made possible by the Christopher and Dana Reeve Foundation, to promote physical activity, physical and mental health and quality of life for Montanans living with a variety of disabilities. Through the selection, purchase and distribution of adaptive bikes and trikes in 4 key areas of Montana, and working with select community partners to assure creative outreach and all-inclusive recreational programs, we will increase physical activity and social interaction. Program sites will include Fort Peck Tribes, Billings, Dillon and Missoula. In each region, one medical center/provider is partnered with a recreation program provider to assure that people with disabilities are aware of the program and able to access the recreational equipment that is best suited for their needs. A statewide advisory group of adults living with disabilities is assisting in selection of equipment and program delivery.
Providing recreational assistive technology closer to home for rural-dwelling Montanans who are aging and living with disability enables greater social engagement in physical activities (PA). Regular PA and social engagement results in prevention of secondary conditions and/or improved management of chronic diseases; and reductions in depression, cognitive function, falls, mobility limitations and/or social isolation. Experience shows that improved functional independence and enhanced social engagement through PA contributes to improved health, financial stability and improved life satisfaction.
Funded by a Quality of Life High Impact Innovative Assistive Technology grant from the Christopher & Dana Reeve Foundation.
PEPNet 2.0 (PN2)'s mission is to improve postsecondary outcomes for individuals who are deaf or hard of hearing, including those with co-occurring disabilities. PN2 provides resources to individuals who are deaf or hard of hearing (D/HH), and the educators, schools, agencies and professionals who work with them. Our goal, and the focus of our resources, is to increase the educational, career, and lifetime choices available to individuals who are D/HH. PN2 offers consultation, training, professional development, technical assistance and other resources to our stakeholders-individuals and institutions including, but not limited to: Two- and four-year colleges and universities, High School Staff, Vocational and technical training programs, Community rehabilitation programs, Adult basic education programs, Continuing education programs, Students, and Parents. We provide resources in three broad categories: Personnel Development (PD), Technical Assistance (TA), and Technology and Media (TM). Our Research and Evidence Synthesis Center (RES) provides research and analysis, and the PN2 Leadership Team (LT) provides guidance and administrative oversight. PN2's national effort is in conjunction with the U.S. Department of Education's Office of Special Education Programs' Technical Assistance & Dissemination (TA & D) network, of which PN2 is an integral part. The TA&D Network supports federal projects that provide information and technical assistance to states, schools at the local level, educational professionals and families that have been impacted with disability. The network offers expertise in the areas of autism, disproportional representation, dispute resolution, learning disabilities, parenting children with special needs, positive behaviour support, and transition. PEPNet 2.0 is funded by the Research to Practice Division, Office of Special Education Programs and the US Department of Education via Grant Award #H326D110003. Funding is provided from October 1, 2011 to September 30, 2016.
Montana Adaptive Equipment Program
The Montana Adaptive Equipment Program (MAEP) provides positioning, seating, mobility, recreation and some ADL equipment to Montanans living with qualifying developmental disabilities. This grant-funded program may be able to loan adaptive equipment (AE) to children, teens and adults who have a qualifying developmental disability (see eligibility form) and are unable to acquire the AE by other means or need to trial equipment prior to purchase. Our clinical coordinator is available to assist families, therapists, and family support specialists in selecting the best equipment to meet each person’s specific needs.
Program participants must be eligible for services through the Developmental Disabilities Program, Department of Public Health and Human Services. The State of Montana’s definition of a developmental disability (DD) is:
“Developmental disabilities” means disabilities attributable to intellectual disability, cerebral palsy, epilepsy, autism, or any other neurologically disabling condition closely related to intellectual disability and requiring treatment similar to that required by intellectually disabled individuals if the disability originated before the person attained age 18, has continued or can be expected to continue indefinitely, and results in the person having a substantial disability.”
Evidence of DD disability is required prior to the loan of MAEP equipment. This verification can be acquired through the Family Support Specialist or the primary care physician working with the client. We are not permitted to accept forms signed by family members, therapists, or school personnel.
MAEP will work directly with consumers, their families, occupational and physical therapists, case managers, durable medical equipment suppliers around the state to ensure provision of the most appropriate adaptive equipment. MAEP also provides a list of many of the equipment vendors who provide services to individuals with disabilities within Montana.
MAEP is only able to serve clients with qualifying DD. Some donated adaptive equipment has been added to the MATP inventory which is available to all Montana residents with disabilities. This limited inventory should increase as we receive donations. (http://montech.ruralinstitute.umt.edu/)
Child Care plus+
There is a need to build the capacity of existing early childhood professional development systems to enhance the ability of instructors/trainers and educators to promote and support inclusion in early childhood programs in their local communities. When early childhood trainers and educators are skilled in teaching inclusion strategies and embedding them in existing courses and training events, child care providers and other early childhood professionals who participate in their training are going to learn the knowledge, skills, and attitudes they must have to provide effective inclusive programs.
Overall goals and objectives
The Child Care plus+ mission is to share knowledge, foster skills, and encourage attitudes that promote inclusion as a core component of excellence in early childhood. To accomplish this mission, we: strive to expand child care options for children with disabilities and their families provide training and technical assistance for child care providers and other early childhood professionals (including specialists in early intervention and special education) seek to improve the quality of the child care experience for all children
Child Care plus+ products, resources, and training on inclusion are filled with practical and evidence-based strategies for individualizing for young children in group settings. Child Care plus+ approaches inclusion in the most inclusive way—by focusing on best practices in early childhood care and education. Rather than providing specialized information that applies only to children with disabilities, every resource supplies information on—and strategies for—improving the quality of early childhood programs so that the strengths, interests, and needs of every child are represented in the every-day-little-kid-activities and routines that are part of program.
As the number of programs who use inclusive practices (family partnerships, individualizing for each child, developmentally appropriate practice, etc.) increases, child care options for families of young children with disabilities are systematically expanded. Just as inclusion happens one child at a time, programs prepared to include young children with disabilities are developed one teacher/caregiver at a time. As the number of trainers/educators able to provide the basics of inclusion practice increases, the number of providers willing and able to include each and every child grows exponentially.
Responsive Education for All Learners OR REAL: Low Incidence Support Strand
Project REAL (Responsive Education for All Learners) is Montana’s State Personnel Development Grant, funded by the U. S. Department of Education. The subcontract awarded to the Rural Institute is focused on the goal of increasing access to the general education curriculum for students with low incidence disabilities who, for purposes of statewide assessment, are described as the 1% population. In order for this group of students to receive instruction that is aligned with the Montana Common Core Standards (MCCS), special educators need to be introduced to the new and rapidly changing perspective about academic instruction and its relevance for students who traditionally participate in a more functional/life skills curriculum. The low incidence initiative of Project REAL is focused on disseminating information about changing perspectives and providing an opportunity for teachers to be introduced to a new set of instructional resources designed to help them design and implement standards-aligned instruction. This is occurring through information dissemination, targeted training opportunities, and support to teachers who are attempting to implement these new practices.
EnvisionIT is an online curriculum to help prepare students for transition to post-school opportunities. In Montana, limited education resources are focused on providing effective standards-aligned education tools that promote literacy and enable our youth to engage in activities that result in college and career readiness skills. The use of effective tools is particularly important for the approximately 7,000 secondary-aged (grades 7-12) students with disabilities served in Montana’s public schools. Our goals are to: (a) build and implement an “Awareness to Adoption” plan with LEA special education directors, secondary school counselors and LEA superintendents/ associates, and the Montana Digital Academy; (b) implement the EnvisionIT curriculum in Montana secondary schools for a three year period, following a prescribed sampling and research design; and, (c) scale-up and sustain the use of the EnvisionIT curriculum, incorporating it as a credit-generating course for Montana’s secondary students. -- As a result of our efforts, we anticipate the following outcomes: (a) by 2017, over 150 students and 15 education staff who serve them will be trained in the use of this high quality transition-focused resource; and, (b) EnvisionIT resources will be available to Montana schools as a for-credit curriculum option to support college and career readiness courses.
MENU-AIDDS: Nutrition Intervention for Weight and GI Dysfunction in Disability A.
Specific Aims and Hypotheses: Many adults with intellectual or developmental disabilities (IDD) live in community-based supported arrangements. In these settings, paraprofessionals with little or no training in nutrition or dietary planning directly supervise the households dietary intake. Further, they often lack support for creating and managing a food system that offers healthy choices. There is a need for an evidence-based approach to menu and dietary planning for this population. As direct care staff change shifts and/or new staff begin work, it is critical to the health of individuals living in a group home that their food systems are maintained through established policies and consistent procedures. The primary aim of this behavioral trial is to assess the efficacy of a household-level nutrition intervention (T) versus a control condition (C) on weight status at 6 months among adults with intellectual or developmental disabilities (IDD) residing in community-based group homes. This study will use a group randomized design with two conditions (T and C). Over six months, participants in T will receive MENU-AIDDs (Materials supporting Education and Nutrition in Adults with Intellectual or Developmental Disabilities), and participants in C will receive their regular food service. Randomization will occur at the level of group home. Twenty-two group homes (11 per condition) will participate, for a total of 132 study participants. The study will test the following hypotheses -- Primary hypothesis: At 6 months from randomization, adults with IDD receiving MENU-AIDDs (T) will have significantly lower Normal Weight Deviation Scores (defined as the absolute value of the deviation from the range of normal BMI) than adults with IDD receiving regular food service (C). Secondary hypotheses: 1. At 6 months, adults with IDD in T will have significantly lower Overall Gastrointestinal Symptom Scores (a sum of seven individual symptoms scores) than adults with IDD receiving regular food service (C); 2. At 6 months, adults with IDD in T will have significantly higher Healthy Eating Index scores from menus (HEIM) than adults with IDD in C; 3. At 6 months, adults with IDD in T will have significantly higher Healthy Eating Index scores from Food Frequency Questionnaire (HEIDI) than adults with IDD in C.
Field Test of Internet-Based Safer and Stronger Program for Women with Disabilities
Portland State University holds the primary grant and the work by the University of Montana on the project is funded via subcontract and involves a randomized, controlled trial to test the efficacy of the internet-based Safer and Stronger Program (SSP) with 390 women with diverse disabilities to be recruited by centers for independent living in Montana, Arkansas, and Arizona. The single-session SSP provides information about interpersonal violence, risk factors, and safety-promoting strategies while integrating survivor stories and affirming narration. It is expected that results from this study will have significant policy implications for the safety and well-being of women with disabilities and Deaf women.
Motivating Smokers with Mobility Impairments to Quit Smoking
A contract (3 of 5 years) with The Miriam Hospital/Brown University in Rhode Island. We are developing an innovative DVD-based smoking cessation intervention for people with significant mobility limitations. The aim of this project is to use community based participatory research to develop and produce a theory-based DVD for smoking cessation that is tailored for smokers with mobility impairments, and test the efficacy in a randomized clinical trial. -- Principal Investigator: Belinda Borrelli, PhD -- Co-Investigators: Beth Bock, PhD; Rosemary Hughes, PhD and Tom Lasater, PhD -- Funding Agency: National Cancer Institute -- Dates: 2009 - 2014
Developing a Community Health Index for People with Disabilities
Meg Ann Traci
This is a CDC regrant through the University of Illinois.
Montana Disability and Health Program and Sales and Service
Meg Ann Traci
The MISSION of the Montana Disability and Health Program, Living Well Under the Big Sky, is to promote the health and independence of Montanans with disabilities. During the next two years, our GOAL is to maintain and expand our capacity to conduct the six core activities of: (1) maintaining and expanding partnerships, (2) developing and implementing statewide strategic planning, (3) implementing, evaluating, and expanding prescribed public health surveillance; (4) serving as a disability and health technical assistance resource, (5) providing technical assistance to Montana's communities, and (6) preventing secondary conditions and promoting the health of Montanans with disabilities. Specific objectives include: 1. Maintain strong partnership between UMRI and MDPHHS and develop partnerships with other state and community agencies. 2. Maintain and develop Advisory Board capacity. 3. Maintain and expand broad Disability and Health Network 4. Complete and implement a statewide strategic plan for disability and health. 5. Continue to assess and monitor the health status and health behaviors of Montanans with disabilities. 6. Improve the capacity of professionals and service providers to conduct health education and promotion for people with disabilities by serving as a technical assistance resource and focal point for the prevention of secondary conditions in Montana. 7. Improve the capacity of persons with disabilities, professionals and service providers to prevent secondary conditions in Montana communities by providing health education information and materials that are timely, relevant, and accessible. 8. Plan, implement, and evaluate health promotion interventions to prevent and manage secondary conditions and improve the health of Montanans with disabilities. 9. Increase the number of state and community service provider plans, policies, programs, and procedures that address the health of Montanans with disabilities. 10. Expand the roles, scope, and capacity of MTDH.
Region VIII ADA Center
Provide technical assistance for evaluating the Region VIII ADA Centers performance.