Promoting the Readiness of Minors in Supplemental Security Income (CFDA 84.418P) Achieving Success in Promoting Readiness for Education and Employment (ASPIRE) Six western states have formed a consortium, to conduct the PROMISE experimental design. The ASPIRE project will recruit and enroll 2000 youth with mild to severe disabilities, ages 14 to 16, who receive SSI (Supplemental Security Income) and their families, and implement proven interventions to the 1000 enrolled in the treatment group. ASPIRE states of Arizona, Colorado, Montana, North Dakota, South Dakota and Utah represent diverse populations, varied geography, and demography ranging from urban to rural to frontier and tribal living. ASPIRE will implement a coordinated set of interventions, services and supports to assist and empower youth to succeed in school, prepare for and obtain employment, become more self-determined and independent, and to assist their families in achieving greater financial self-sufficiency. Interventions include case management, benefits planning, paid employment prior to leaving school, self-determination for youth, as well as parent training and financial education for the families. All ASPIRE staff will be trained in the culture and values of poverty, cultural competency and clear verbal and written communication. A strong evaluation team, representing the Universities of Utah, Kansas and Montana, with experience in conducting similar demonstrations and an understanding of the western geography and culture, will design, implement, and conduct formative evaluation. The Utah State Office of Rehabilitation, in partnership with all disability, poverty and employment agencies in the six states, and public and private organizations, will empower youth and families to ASPIRE -- to dream, to imagine and to strive for a better life.
In October 2012, the Rural Institute Transition and Employment Projects started work with Children's Special Health Services (CSHS) at the Montana Department of Public Health and Human Services (DPHHS). Through the contract, project staff are increasing the capacity of CSHS to support children and youth with special health care needs (CYSHCN) to transition successfully into adulthood. Activities include recruiting foster care and CYSHCN representatives for the Rural Institute Consumer Advisory Council; developing and providing four webinar trainings on topics related to the transition needs of CYSHCN; expanding the Montana Transition Listserv to include CYSHCN partners (hospitals, specialty and regional clinics); disseminating health care transition-related information via the Montana Transition Listserv, the Transition and Employment Projects website, and other websites; and developing and disseminating a health care coverage guide for families and youth.
The Montana University Center for Excellence in Developmental Disabilities Education, Research and Service engages in research, provides education and interdisciplinary training, and develops model services that improve the skills, abilities, quality of life and satisfaction of people with disabilities in rural communities, their families and those who serve and support them. Since 1978, The University of Montana Rural Institute has worked to improve the quality of life of Montanans with disabilities and those who live in any of the 32,000 rural communities across the country. Institute initiatives focus on promoting independence, productivity, integration and community inclusion in rural and frontier communities. Through our many projects and programs, we seek to increase the knowledge and awareness of consumers, service providers, professionals, policymakers, and the general public by disseminating information that results from our training, research and service initiatives. Our basic operating philosophy is that we are consumer-responsive, family-focused, and sensitive to the cultural heritage and values of people with disabilities and their families by developing appropriate procedures and practices. The so-called "core" grant provides effective and efficient administrative and programmatic support to assist faculty, staff and students in meeting the Rural Institute mission.
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.
The Rural Institute for Inclusive Communities, the Bureau of Business and Economic Research and the New Directions program within the Department of Physical Therapy and Rehabilitation Science at the University of Montana propose a collaborative project to investigate the behavioral economics of effort and participation.
People with disabilities participate in most aspects of community living at lower rates than people without disabilities. Rehabilitation researchers and practitioners have made significant progress in conceptualizing and measuring participation, but the value of these static measures is unclear for understanding how personal factors (PF) and environmental factors (EF) affect the choice to participate (WHO, 2001). The complex interaction of PF (e.g., physical conditioning) and EF (e.g., bathroom design) may be reflected by the amount of effort it takes to participate in community life. We endeavor to extend our understanding of this interaction using a mixed methods study derived to examine a behavioral economics model of consumer choice and participation. First, we will conduct a quantitative study of two interventions aimed at reducing the effort required for community participation. Then, we will conduct a series of qualitative interviews to deepen our understanding of effort and participation.
We propose to randomly assign study participants from a population-based sampling frame into either a physical activity intervention to increase personal effort capacity, an environmental intervention to decrease the effort-cost required for bathing or a control group. We will use ecological momentary assessment (EMA) to measure in situ effort and participation before and after the interventions. The EMA will have participants respond to brief (< 2 minutes) surveys eight times per day for one week about their current activity and effort required for the activity. Quantitative data analysis will focus on both traditional between subject outcomes of the experimental design and within subject analysis of variation in perceived effort and participation within and across days of the measurement period. In the qualitative study, we will use grounded theory to investigate how effort is associated with a broader range of PF, EF and choices to participate.
We anticipate results of this study will begin to illuminate how both environmental and personal factors affect participation through their impact on perceived effort. Indeed, with these results, we will continue to build an economic model of disability and participation that begins to specify the relationship between effort capacity, effort cost and participation choices. Development of this model will further rehabilitation and community living research and practice by providing a framework for helping individuals with disabilities and providers choose interventions that can improve participation outcomes. Knowledge translation activities will be tailored to consumer, practice and research audiences.
The Healthy Community Living (HCL) project sprung from a grant to improve people's health by providing support, health promotion, education, and opportunities for people to succeed in reaching personal goals.
To help teach people how to reach their goals, we are creating two classes, Community Living Skills and Living Well in the Community, to guide people in learning skills.
These classes will encourage people to explore skills for community living online and in person with peers and allies.
As part of the project, we are creating a national public photo database which will show people, with and without disabilities, doing things in their community. We hope this database will portray people in an authentic way and demonstrate some of the skills and situations needed for people taking the classes.
Agencies Collaborating on the work of the project:
State / Local Social Services -- Centers for Independent Living
Consumer / Advocacy Organization -- APRIL (Associated Programs for Rural Independent Living)
The University of Kansas and the University of Montana received a Rehabilitation Research and Training Center to Promote Interventions for Community Living (RRTC/PICL). The Center goals are to promote community participation outcomes for adults with physical and multiple co-occurring disabilities, living in the community or transitioning from nursing facilities to the community. Our objectives use a person-environment fit model to investigate evidence based, multifaceted interventions that target change in both individual characteristics and environmental factors to support enhanced community participation. Our research approach starts with a systematic literature review on multifaceted community-based interventions and progresses to a single research project involving three studies: (a) Development and refinement of our Out and About intervention, teaching problem solving and goal setting to support community participation, (b) Efficacy Study 1 using RCT to study the impact of the Home Base intervention to empower consumers to self-assess their home environment and to provide support to enhance their home usability, and (c) Efficacy Study 2 investigating the impact on consumers receiving both interventions, on their community participation. The research supports significant time from Center for Independent Living staff members and advice from our Scientist-Consumer Advisory Panel throughout our research and KT activities. Outcomes will be measured quantitatively and qualitatively and will include: 1) increased usability of consumers' homes, 2) increased health and reduction of secondary health conditions, 3) personal goals achieved, and 3) increased participation in the community. Products will include: 1) Systematic review, 2) National Community Living Resource Center, 6 or more peer reviewed publications, 3) Guide for assessing home usability, 4) webinars, and 5) internet web sites.
(Fee for service)
Living Well is ten week wellness workshop for people with disabilities that helps participants achieve full participation through health maintenance and health promotion activities.
When appropriate, individuals are encouraged to consider health behavior as one tool for increasing participation. Individually chosen goals are the centerpiece for building skills in healthy reactions and communication, managing depressed mood, seeking information, physical activity, nutrition, advocacy, and maintenance of healthy living habits.
Participants report improvements in outlook and positive changes in daily activities, such as new employment, returning to school, or more active social lives. Many participants report the session on systems advocacy as their first exposure to disability rights advocacy.
Individuals who participated in Living Well also report less limitation due to secondary health conditions and reduced health care costs.
Working well with a Disability represents a line of research that translates our work in health promotion to the vocational arena. Access to health-promotion programs is limited for many people with disabilities due to employment, financial, and insurance barriers. The most prevalent secondary conditions reported by VR consumers with physical disabilities include fatigue, physical conditioning problems, sleep problems, chronic pain, depression, eating or weight problems, and anxiety. Many of these conditions are associated with worse employment outcomes for the general population and people with disabilities. Fortunately, health promotion programs can reduce limitation from secondary conditions and may reduce work-related health issues such as employee absenteeism and health care utilization. (http://livingandworkingwell.ruralinstitute.umt.edu/)
(Fee for service)
Working Well with a Disability is a six-week peer-facilitated health promotion workshop that considers health in the context of employment. The course tailors its information to individuals preparing for, or trying to maintain, employment. Working Well can stand alone or serve as an advanced topics class for Living Well with a Disability program graduates whose goal is employment. It is most often delivered in Centers for Independent Living in partnership with VR offices.
The curriculum of Working Well is geared toward developing healthy lifestyle habits and maintaining life balance as participants work toward employment goals. Topics include information and strategies for adopting stress management, nutrition, and physical activity practices, and lifestyle maintenance. During the workshop, participants discuss how their personal life values fit with employment. They reflect on the things that are important to them and how to balance those things with work.
Participants in the Working Well workshops report improved health and capacity to work, enhanced peer support and less isolation, appreciation for the supportive peer community developed during the workshop, and lasting friendships. (http://livingandworkingwell.ruralinstitute.umt.edu
The Montana Assistive Technology Program (MATP) is the Statewide AT Program funded under the Assistive Technology Act of 1998, as amended. MATP’s lead agency is Montana DPHHS: Disability Services Division, Vocational Rehabilitation Services. MATP is located within the University of Montana Rural Institute on Disabilities, Missoula and serves all Montanans with disabilities and their supports.
MATP provides AT information and services in the areas of education, employment, community living, and telecommunications. MATP’s services are consistent with the Rural Institute’s mission of enhancing the independence, productivity, integration, and inclusion of individuals with disabilities through consumer responsiveness as defined in the AT act.
In achieving these goals, MATP provides the following free of charge:
- A short-term AT Equipment Loan Program for individuals to borrow and try AT devices for evaluation purposes before purchasing (available online)
- An AT Demonstration Center for individuals and/or groups to explore, see, and try various AT devices
- An online Equipment Exchange forum for the reutilization of AT devices through giveaways, exchanges, and sales
- A low-interest Financial Loan program to allow individuals to purchase AT devices when other funding is unavailable
The "Montana Autism: Next Steps" project is designed to improve outcomes for young children in Montana who may be at risk for ASD/DD by improving early identification and early intervention efforts in underserved areas of the state. Rural Institute staff works closely with the the "Montana Learn the Signs: Act Early (LTSAE) Ambassador" and other autism and early intervention/ early childhood experts in Montana to accomplish the following four goals: I. Develop and implement a statewide ASD/DD plan with input from partners with a wide variety of stakeholder perspectives; II. Improve the capacity of local providers to deliver universal screening at 18 and 24 months; III. Focus information dissemination efforts on hard-to-reach groups, e.g., American Indian populations and extreme rural and frontier communities; and, IV. Establish the framework for a Montana Autism Toolkit and Roadmap for parents, childcare providers, educators, early intervention providers, and health practitioners. (http://autism.ruralinstitute.umt.edu/)
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.
Individuals from birth through age 21 who are impacted by both vision and hearing loss are eligible for project services. Staff of the Montana Deaf-Blind Project partner with Outreach Consultants from the Montana School for the Deaf and Blind to provide information, technical assistance, and professional development to families and professionals who provide services to individuals who are deaf-blind. (http://mtid.ri.umt.edu/)
The Montana Department of Public Health and Human Services established the Montana Disability and Health Program (MTDH) in 2002. The Department charged MTDH to serve as a focal point for disability programs, services, and activities related to health in the State. The Chief of the Bureau of Chronic Disease Prevention and Health Promotion serves as the Principal Investigator of the program. In addition, the Department has designated the University of Montanan’s Rural Institute on Inclusive Communities as its agent to provide program supports. A faculty member of the Institute serves as Project Director under contract to the Department.
MTDH’s mission is to eliminate health disparities experienced by Montanan’s with disabilities. Specific goals of this program include:
- Enhance program infrastructure and capacity
- Improve state level surveillance and monitoring activities
- Increase awareness of health-related disability policy initiatives
- Increase health promotion opportunities for people with disabilities to maximize health
- Improve access to health care for people with disabilities
- Improve emergency preparedness among people with disabilities
- Effectively monitor and evaluate program activities
MTDH executes this mission (1) by monitoring the health status of Montanans with disabilities, (2) by facilitating the involvement of people with disabilities and their representatives in policy and planning processes of the state, (3) by integrating health issues into the activities of state disability services programs, (4) by integrating disability issues into broader programs and services of the state, (5) by providing training and technical assistance on delivering health promotion services to populations of persons with disabilities, (6) by improving access to health screenings and health care, (7) by promoting improvements in accessibility of community environments to local agencies and organizations providing health and disability program, and (8) by demonstrating new, evidence based approaches to health promotion for people with disabilities.
Organizationally, a CORE Management Team (CMT) provides oversight and direction. The CMT is composed of the directors of the four DPHHS divisions most directly involved in health and disability (Public Health and Safety, Developmental Services, Disability Transition Services, and Senior and Long Term Care). Finally, two faculty members of the University of Montana’s Rural Institute (Project Director and Senior Scientist) staff the program and participate as members of the CMT.
Additionally, a CMDH provides advice to the CMT and conducts programmatic initiatives of its own. The CMDH is composed of individuals with disabilities from State designated geographic regions, various disability service providers, and key State agency personnel. Programmatically, staff of the Rural Institute organizes data about issues of disability and health to present to the CMT. The CMT assesses the data, seeks advice from the CMDH and sets priorities for policy and program implementation. Depending on the area, the CMT may set program goals and procedures for their own divisions, collaborate with each other to achieve a goal, identify other agencies of State government that should integrate disability and health priorities and practices into their programs, or direct the bona fide agents to conduct specific program activities. Finally, the CMT monitors and assess program performance. (http://mtdh.ruralinstitute.umt.edu/)
To give high school students an on-campus educational experience which prepares them for transition from high school to college and self-advocacy while in college.
Movin’ On is a 4 day, 3 night campus experience that provides students who are within 20 months of school completion an opportunity to learn about college life.
Students will attend a 4-day seminar, staying for 3 nights in a university dorm. Parents will attend the introduction luncheon with a question and answer session following check-in. The parent/family seminar will cover rights and responsibilities of students under the ADA and Section 504, and the differences between high school and higher education policies and practices. Students will also learn how to request reasonable accommodations/ modifications and how to effectively communicate with instructors. Other topics covered during the four days will include assistive technology, vocational rehabilitation (VR) services, general academic support resources, attending a university lecture and class (tailored to the participants), financial literacy for students, university housing and a panel presentation by current UM students. Social skills and recreation will be part of the well-rounded curriculum in order to give students a realistic campus experience. Students will prepare a reflection project to present to the group on the final day.
The sponsoring organization (University of Montana in Year One) will be responsible for participant recruitment. This will occur through direct mailings to VR counselors and OPI staff. Targeted recruitment to will be focused on LEAs and secondary schools across Montana. Recruitment and applications will be completed by June 15, 2015. Individual applicants will apply directly to UM through an online system. VR counselors and education-based staff are not responsible for participant registration.
Students must be PETS (pre-employment transition services)-funding eligible. They must still be in high school (not graduated) when they participate. This means students between their junior/senior years. We may include students who are a year younger.
On the drop-off day, parents/families will be invited to a 90 minute luncheon and meeting that addresses post-secondary realities for families. It will include an active Q&A session with university Disability Student Services (DSS) and UM Admissions representatives.
Movin’ On is funded by Montana’s Disability and Employment Transitions (DET) program as a “pre-employment transition service.” The overall program cost includes student materials, lodging, food, individual services (travel to and from campus, PCAs, interpreters), program activities, administration and staffing, and planning activities for 19-20 students. The UM project team will collaborate with the participants (using the participants’ VR counselor for assistance and advice, if needed) to make individual services arrangements. Costs related to these services will be covered under this subcontract.
Movin’ On is a collaborative effort between the Rural Institute for Inclusive Communities and the UM Disability Services for Students Office. Program staff includes faculty, students and staff from the sponsoring Montana University System (MUS) institution. The program is designed to be adopted at other MUS campuses.
The Out and About intervention will be a blended adaptation of two interventions, one a long established evidence-based intervention to promote wellness for people with physical disabilities called Living Well with a Disability and the other a health promotion intervention currently under development focused exclusively on setting goals related to health and self-advocacy skills.This research project is part of a larger Research and Training Center (Promoting Interventions for Community Living - PICL) out of the University of Kansas. The Home Base project is the other intervention within this center. The two projects will eventually be merged and tested together.
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.
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.
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.
The study uses a survey to construct a measure of CIL services and how they are delivered (process dimensions). We are interested in how CIL staff members and board members view the services offered by their organization and their ability to help consumers more fully participate in the community. They rank the importance of the services and their satisfaction with them. The next phase of the project will survey consumers for their perspectives to reﬁne the measurement tool. This project develops and tests a measurement tool for community participation. This tool will provide centers for independent living (CILs), which serve people with disabilities, with a scientiﬁc method for measuring the effectiveness of their services. With the information provided by this new tool, CILs may enhance their services, modify staff training, and tailor programs to help their consumers participate more fully in the community.
Over 56 million Americans live in rural areas; some because they have always lived there; others because they moved there for opportunity, for beauty, or to escape urban stress. Nearly 20% of them live with a disability. While rural America is their home, living there can place them at a disadvantage. Compared to their urban counterparts, rural Americans with disabilities experience higher rates of poverty, higher unemployment, and poorer health. Despite adoption of the ecological paradigm of disability, most disability and rehabilitation researchers still uses individual approaches to achieve the community-level outcomes. This creates a mismatch of problem-solving methods; a gap that needs to be filled.
To fill that gap, we engaged a wide range of key stakeholders in developing an ecological research and knowledge translation framework to address issues of importance to people with disabilities living in rural America. First, we propose to apply the methods of geographic science to understand the broad context of disability in rural America, including the composition and migration of the population. Second, we propose an innovative, new research framework for conducting disability research on the rural ecology of disability. We will conduct a series of four related studies in six rural towns scattered across three rural regions around the nation. These studies will establish baselines of key environmental factors and levels of individual health and participation, and assess the interactions between these features over time. In addition, we will develop two interventions and implement them within those same communities. Third, we propose to initiate a line of research to improve the health of children and youth with disabilities living and going to school in small towns and rural communities. Fourth, we propose a series of studies designed to enhance employment of people with disabilities living in rural areas by improving the efficiency and effectiveness of vocational rehabilitation services.
We also propose an ambitious knowledge translation (KT) program organized using ecological principles. Our KT program begins by involving those who are expected to use or benefit from the results of research in the design of the research itself. As research progresses, we use multiple methods to increase awareness of the issues addressed, to promote contemplation of change, and to support use or adoption through training and technical assistance. Finally, we integrate the findings from our research and that of others with the experience of people with disabilities living in rural areas to educate the next generation of disability leaders, service providers, and researchers.
The ecological paradigm of disability and the emerging new paradigm for rural America intersect at the concept of community. This proposal ties these trends together. In doing so, the RTC:Rural continues to provide leadership in disability research, creates useful information and tools people can use, and serves as a national resource center. (http://rtc.ruralinstitute.umt.edu/)
Rural residents face an “access penalty,” a significant gap in the accessibility of small towns and rural environments that reduces their opportunities to participate in community life. Information that helps develop consensus on the nature of such a problem and that provides a means to evaluate progress in solving it provides a foundation for rural community development. The goal of this project is to promote the participation of people with disabilities in community life by enhancing accessibility. Our specific aim is to develop and demonstrate procedures for integrating information about a community’s accessibility into the local planning process. We will use the measures created in R5 to develop a Community Accessibility of Rural Events (CARE) Report Card and web site. Advocates in three selected communities will use the CARE Card to build community awareness about the importance of planning accessible events and to set community goals and expectations for enhancing accessibility of community events. We will evaluate the utility of such an approach by comparing the accessibility of events in the three CARE communities to that of three similar communities that do not participate in the CARE process. If effective, access to and inclusion in the CARE web site will be systematically expanded to more communities.
Project dates: 2013-2018
Funded by: National Institute on Disability and Rehabilitation Research Grant No. H133B130028
Principal staff: Craig Ravesloot, Ph.D., Tom Seekins, Ph.D., Tracy Boehm, M.P.H., Tannis Hargrove, M.S., Lillie Greiman, M.A.
Health care resources are fewer and more dispersed geographically in rural areas, making it more challenging to access resources, health information and can create barriers to healthcare management. Within the rural context, self-management can reduce the need for acute medical services and potentially reduce secondary conditions related to impairments. The goal of this project is to develop a mobile, technology-based ecological health promotion intervention using shared-decision making that CIL staff and consumers can use to implement health promotion interventions for common secondary health conditions. The goals of the project include creating a mobile application for us with a tablet computer that present RTC:Rural health promotion materials adapted from our Living Well curriculum, construct evidence based decision support probabilities for intervention choices by analyzing data from past health promotion projects, develop CIL training materials for one-on-one facilitation with consumers using tablet computers, recruit participants in rural communities to review the mobile application, refine self-assessment and update decision support probabilities based on consumer data, and post the new application to the Google Play store and market to APRIL members, rural health clinics, and rural public health offices.
Geography studies the relationship between people and resources in place. As a discipline, it offers methods for understanding the diverse and complex nature of rural America. This programmatic line of research will address major questions of resource allocation and provide recommendations on policy and program practices.
The American Community Survey has released new data on disability in rural areas for the first time in 13 years. These data allow us to address the urgent need to update analyses of the geographic distribution of people with disabilities living in rural America. We will use these data, in conjunction with a Geographic Information System (GIS), to depict the distribution and status of people with disabilities living in rural areas. This analysis serves as the basis for understanding the geographic relationship among people with disabilities living in rural areas and their service providers, specifically Centers for Independent Living, Aging and Disability Resource Centers, and hospitals. Outcomes of this analysis will provide opportunity to strategically coordinate the locations of service facilities and improve service delivery in isolated rural communities.
Similarly, many policy makers believe that people who acquire disability simply move to urban areas for services. Without evidence to the contrary, these urban myths lead to distortions in policy and program. Migration is known to be selective of individual characteristics, especially of age and education, but knowledge about the mobility behavior of people with disabilities is limited. We will develop methods for studying the migration behavior of people to provide accurate information that can be used in agenda setting and policy development. Beyond providing an understanding of migration behavior, it will shed light on causes of rural- urban differences in disability levels and the role being played by disability in place or disability migration.
Project dates: 2013-2018
Funded by: National Institute on Disability and Rehabilitation Research Grant No. H133B130028
This project will being to shed light on the person and environment factors that are most salient for predicting and potentially improving rural community participation. There is a great need to understand rural community participation in order to inform development of interventions and public policy. The goal of this project is to advance the understanding of how the biopsycho-ecological characteristics of people in the rural context are related to community participation. The objectives include identification of representative rural communities through analysis of ACS data and direct consultation with APRIL and CIL’s serving the rural communities, recruit a representative sample, collect longitudinal survey data, identify features of rural people with disabilities and their environments that contribute to community participation, and disseminate result to policy makers, CIL’s and consumers.
People who live in rural areas have been described as resilient. Resilience is the ability of adults to maintain relatively stable and healthy levels of psychological and physical functioning after experiencing potentially disruptive or traumatic events. Resilience is the product of both personal and environmental factors. For example, gender, race and age are personal factors, and education and social support are environmental factors associated with resilience.
In this study, researchers from the University of Kansas will interview individuals from our Ecology of Rural Disability study. Specifically, they will select individuals that we would expect to be participating at very low levels based on responses to the survey. For example, we may select individuals who report high levels of secondary conditions and environmental barriers but who also report high levels of participation. We will interview these individuals to understand how and why they overcome personal and environmental barriers to participate in their communities.
Project dates: 2013-2018
Funded by: National Institute on Disability and Rehabilitation Research Grant No. H133B130028
Principal staff: Craig Ravesloot, Ph.D.
The science of person-environment (P-E) fit seeks to understand how characteristics of the individual interact with environmental features to influence outcomes. For example, when people perceive a good “fit” between themselves and an environment, they are more likely to stay in that environment and engage it more fully. Individuals perceive they fit well in their environment when they perceive their goals and values are similar to others, they can meet the demands and they can make a contribution.
In this study, we will examine participants’ sense of fit through real-time assessment to predict community participation. We will use IPod-like devices to ask individuals about their sense of fit in different environments when they are in community. We anticipate that people will participate longer and engage more fully in environments where they believe they fit.
Project dates: 2013-2018
Funded by: National Institute on Disability and Rehabilitation Research Grant No. H133B130028
Principal staff: Craig Ravesloot, Ph.D., Tracy Boehm, M.P.H., Tannis Hargrove, M.S., Lillie Greiman, M.A.
Participation does not occur in a vacuum; it occurs in the context of community events. Both the venue and the program must be accessible for people with disabilities to participate. This project addresses the need to assessment procedures for assessing accessibility of events and programs by developing and testing a method for measuring opportunities in rural environments (MORE). The goal of this project is to facilitate participation of people with disabilities in community life by promoting community accessibility. The objectives include developing and evaluating methods for assessing event accessibility and MORE, establishing the validity of inner-oberserver reliability of the observation tools, computer the density of opportunity scores for rural communities and make comparisons across communities to examine variability of rural community access, establish a baseline of communities architectural and event accessibility and conduct an 18 month follow-up.
The Rural Contracted Services project explores state Vocational Rehabilitation agency access to job development services provided by vendors in rural communities. The project includes three studies. Using qualitative interviews with VR informants, Study 1 examines current VR agency purchasing practices for job placement and development services, current provider availability within each state and region, and agency strategies for delivering services when providers are not present. Study 2 is informed by study one to examine how different payment methods affect competitive employment outcomes using RSA 911 data. Study 3 examines vendor decision-making regarding service delivery to rural areas, including the advantages and disadvantages of different payment arrangements such as fee-for-service or milestone payments to overcome geographic risk. We will conduct qualitative interviews with both small and large vendors operating under a variety of payment arrangements.
Results from these three studies will serve as a basis for developing VR practice recommendations. The recommendations will outline effective third-party payment arrangements that promote access for rural consumers. These findings are important because third party providers often provide the bulk of job placement and development services. When these services are not available for purchase, VR counselors provide them. For rural consumers, this can significantly delay case progression because many counselors visit out-locations infrequently and are unable to provide timely services (Rigles, Ipsen, Arnold, & Seekins, 2011). Additionally, VR offices indicate that lack of access to community rehabilitation programs “impedes positive consumer outcomes” (U.S. Department of Education, 2005, p. 35).
The Use of Social Media for Employment project is designed to improve VR counselors’ social media and online job search competencies. To achieve this, we propose two studies. Study 1 consists of a VR social policy analysis to explore barriers to and facilitators of effective social media use in counseling practice. We will use policy findings to develop a recommended social media policy that promotes social media and online job search strategies within counseling practice while addressing ethical and confidentiality concerns. Study 2 is broken into three phases to (1) assess current counselor use and confidence using social media and online job search strategies, (2) develop a social media and online job search training intervention, and (3) evaluate the efficacy of the intervention for increasing counselor use of social media and online job search with their consumers. (http://telecomtoolbox.ri.umt.edu/)
The Rural Self-Employment Opportunities project will work with a state Vocational Rehabilitation agency to modify, evaluate, and refine a self-employment toolkit, materials, and training materials for VR counselors. During Phase 1 researchers will document self-employment procedures and develop counselor materials and training in collaboration with a state VR agency. Phase 2 includes a formative evaluation of the screening process, toolkit, and training materials. During phase 3, researchers will further pilot-test the developed self-employment process and procedures in two additional state VR programs. If successful, this project will result in an evidence-based self-employment process, created by VR stakeholders, modified by and for use within VR agencies, and tested in additional VR agencies.
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 Rural Institute serves as the Project Evaluator for the Montana Office of Public Instruction (OPI) Montana Behavioral Initiative (MBI) implementation in targeted, high need schools. We provide process and outcome evaluation, and assist with general program evaluation activities. The primary evaluation activity is to describe and summarize implementation efforts so that effective and efficient MBI replication may be accomplished. We also assist OPI in helping local education agencies (LEA) improve the quality, accessibility, and usefulness of LEA data collection and data-based decision making. We coordinate our evaluation activities with the NITT-Project AWARE-SEA. The evaluation plan measures the following outcomes: (a) an increase in the number of MBI schools and LEAs, particularly high-need and Indian Country schools; (b) a more strategically located cadre of statewide MBI coaches who can devote more time to helping LEAs implement MBI; (c) a full-time MBI Director; (d) an increase in the number of schools using Quaglia Student Voice; (e) more effective coordination of resources; (f) improvement in school climate in MBI schools; (g) an increase in school safety--a decrease in bullying and reduction in discipline referrals, suspensions, and expulsions; (h) increased instructional time; and, (i) improved overall academic achievement. Over the five years of the grant, we expect to serve the following Montana LEAs: Ashland, Brockton, Browning, Butte, Frazer, Hayes/Lodgepole, Heart Butte, Kalispell, Lodge Grass, Miles City, Pine Hills/Riverside, Poplar, Pryor, Wolf Point, and Wyola.
The purpose of this spinal cord model systems project is to address and work toward improving the health and well-being of people with spinal cord injury (SCI). The University of Montana, under the supervision of Dr. Rosemary Hughes, contracts with the Texas Model Spinal Cord Injury System (TMSCIS) project at TIRR-Memorial Hermann (TIRR) to support its high level of contributions to the National SCI Database and Registry and assist with the dissemination of information based on the analyses of those data. Additionally, we will partner closely to conduct a clinical trial of a psychological health promotion intervention for women with SCI delivered in the online virtual world of Second Life and co-facilitated by subcontract PI Hughes. Our innovative online approach will reduce environmental and other barriers to participation, representing the first group intervention designed to respond to the unique psychological needs of women with SCI. The intervention will be tested with a national sample of 192 community-living women with SCI who will be randomly assigned to either a group that will participate in the 10-session intervention, or to a control group that will receive intervention materials at the end of the intervention trial. Using a within- and between-groups pre/post-test design with three- and six-month follow-up assessments at three time points (pre-intervention, post-intervention, and 6-month follow-up), the team will have the capacity to examine the immediate and longer-term efficacy of the intervention and the mechanisms through which the intervention influences psychological health outcomes. The TMSCIS will also collaborate with four other Model Systems program on collaborative module projects.
The Relations among Pain, Depression, and Resilience and their Prediction of Life Satisfaction in Men and Women with Spinal Cord Injury
The goal of this study is to examine chronic pain, resilience, depression and satisfaction with life among approximately 100 men and 100 women with spinal cord injury over the course of one year. Data will be collected in the Greater Houston Area of Texas.
The University of Montana Rural Institute has been a leader in the area of transition planning for youth with disabilities since 1995. Activities have included:
- Provision of education and training to schools, families, students and agencies
- Development of innovative strategies and transition models;
- Demonstration, outreach and technical assistance, both on-site and long distance;
- Promotion of systems changes to support effective transition for youth from school to adult life; and
- Information dissemination.
Since 2000, we’ve focused several of our projects on customized community employment for youth with significant disabilities. We have developed and implemented unique models of transition planning that continue to evolve as we learn more from the youth and families with whom we work.
Our transition activities are unique in that they promote:
- Customized Employment strategies for youth with disabilities;
- The use of Social Security work incentives for students;
- Transition planning for middle school students;
- Collaborative funding across agencies to create individually-driven employment supports;
- Self-employment as vocational experience or as a post-school outcome; and
- Self-determination for youth as we empower them to identify strengths, skills, and needs for transition planning.
The Utah Regional Leadership Education in Neurodevelopmental Disabilities (URLEND) is a regional program that supports Montana trainees through the Rural Institute. The Maternal Child Health Bureau renewed the URLEND grant this year, extending funding for the program for an additional five years. The URLEND program, a joint effort of the University of Utah School of Medicine-Department of Pediatrics, Utah State University-Center for Persons with Disabilities (a University Center for Excellence in Developmental Disabilities Education, Research, and Service), and the Utah Department of Health's Bureau for Children with Special Health Care Needs was first funded in 2001 and ran successfully for 5 years before being refunded in 2006 for an additional 5 years. The URLEND Program's Goals include: 1) Strengthen and further expand the functional, programmatic, and evaluative infrastructure of URLEND in partnership with ID, MT, ND, and WY to prepare exemplary leaders in the health care system; 2) Provide interdisciplinary leadership experiences to URLEND trainees within the context of integrated didactic, clinical, and leadership/research activities; and 3) Provide evidenced-based CE/training, consultation, and technical assistance opportunities to health care professionals in UT, ID, MT, ND, and WY that address current and emerging priorities and concerns in the provision of family-centered, culturally competent, community-based integrated systems of care.
URLEND Leadership trainees gain knowledge to enhance and integrate their clinical, research, and leadership skills to become exemplary leaders in their fields. Leadership trainees must complete at least 300 clock hours (over 2 semesters) to receive a stipend and participate as long-term leadership trainees. Given the expectations of the URLEND program with its focus on leadership skills, trainees participating at a less intensive level of a time commitment would not be able to complete the didactic, clinical, research and evaluation, and leadership requirements.
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.