Great Big Story : How a Doctor Without Legs Treats Patients in Her Mountain Village

Since she was a young girl, Li Juhong dreamed of becoming a doctor. Then, at 4 years old, she lost her legs in a tragic and painful accident. But that experience didn’t weaken Juhong’s resolve; rather, it drove her to help others in pain. Now, the 38-year-old is one of two doctors responsible for around 2,000 people in the mountainous Chinese village of Wadian. Armed with her medical training and a determination that often sees her work well into the night, Juhong says she feels “happy and lucky” to have helped so many people in her village.

Source: Great Big Story : How a Doctor Without Legs Treats Patients in Her Mountain Village

DSP Crisis is Profound: New Report on the Impact of Quality Services for People with IDD

ANCOR Announces the Release of Its Workforce Paper

Source: ANCOR Announces the Release of Its Workforce Paper | ANCOR | American Network of Community Options and Resources

Community-based services to people with intellectual and developmental disabilities are facing one of the most major and growing workforce crises in the United States labor market.  Which is why, the American Network of Community Options and Resources (ANCOR) brought together national disability organizations and workforce experts last week to preview its new report entitled, Addressing the Disability Services Workforce Crisis of the 21st Century. Participants of ANCOR’s March 23rd Workforce Summit also discussed potential policy solutions moving forward.

ANCOR’s report compiles the latest data on the direct support professional (DSP) workforce, offers a historical overview of the workforce crisis, and offers solutions on how it can be addressed.

“For almost fifty years, ANCOR has represented providers of disability services in Washington, DC and watched the workforce crisis grow into a public health crisis,” said ANCOR CEO Barbara Merrill, “We are proud of the strides we have made in Congress and with previous Administrations, but this report marks the beginning of an even stronger movement to take measurable steps toward addressing the workforce crisis.”

ANCOR members and leaders of ANCOR’s National Advocacy Campaign, Daryn Demeritt and Chris Sparks, led ANCOR membership in ensuring the report was comprehensive and offered concrete solutions.

“The DSP crisis is profound and we see it in our daily operations across the country,” said Demeritt of ResCare based in Kentucky, “ANCOR’s report comes at a pivotal moment when we need to take action and cannot risk ignoring the impact it has on the quality of services provided to Americans with intellectual and developmental disabilities.“

“This is an instance where failure is not an option,” added Sparks of Exceptional Person, Inc. (EPI) in Iowa, “Millions of people with disabilities rely on DSPs so that they can access their communities, engage with their families and friends, and participate in the workforce themselves.  There are not enough DSPs to meet the need, and the waiting lists for these services are only growing. ANCOR’s report offers the solutions that need to be harnessed now to avoid decline of this successful program.”

Click here to read the Executive Summary of the ANCOR Workforce Report

Click here to access the full ANCOR Workforce Report

Click here to visit ANCOR’s Workforce Website

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The American Network of Community Options and Resources is a national trade association representing more than 1,200 private providers of community living and employment supports and services to more than 800,000 individuals with disabilities with a workforce that’s over half a million strong. ANCOR advocates for the crucial role private providers play in enhancing and supporting the lives of people with disabilities and their families.

Through its National Advocacy Campaign, ANCOR seeks to obtain the resources to recruit, train and retain a sustainable direct support workforce. ANCOR provides organization, professional, leadership development and networking opportunities and services and is continually working toward partnerships and collaborations that support our mission, which is to advance the ability of our members in supporting people with intellectual and developmental disabilities to fully participate in their communities.www.ancor.org

Addressing the Disability Services Workforce Crisis of the 21st Century

American Network of Community Options and Resources 2017

2015 Median Annual Cost of Care In:
Nursing Facilities:$91,250
Home Services*: $45,760
Adult Day Care*: $17,940
*Fall under the community services umbrella.

Executive Summary

Intellectual and developmental disabilities (IDD) services are contending with external market disruptions which severely affect workforce retention and recruitment and are causing a public health crisis. Without qualified staff, agencies are limited in how they offer client-driven services, namely assisting individuals with IDD in living where, with whom and how they choose.

IDD services are a unique marriage of the private sector and the public good; providers, who range from small family-operated agencies to multi-state organizations, offer services funded by the government so that individuals with IDD can live full lives in the community instead of institutions. These services are delivered through dedicated staff called direct service professionals (DSPs). DSPs perform a wide range of work, from coaching individuals so they can find jobs to helping medically fragile individuals eat and get ready for the day. Agencies use their business acumen to deliver efficiencies so that services in the community are less costly to the government than institutions, while increasing the quality of outcomes for individuals because they can decide what help they want. However, agencies’ ability to meet this endeavor is severely hampered by a steadily growing workforce crisis.

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Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery

Adam B. Hill, M.D.

N Engl J Med 2017; 376:1103-1105

March 23, 2017 DOI: 10.1056/NEJMp1615974

http://www.nejm.org/doi/full/10.1056/NEJMp1615974

My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic. Several years ago, I found myself sitting in a state park 45 minutes from my home, on a beautiful fall night under a canopy of ash trees, with a plan to never come home. For several months, I had been feeling abused, overworked, neglected, and under-appreciated. I felt I had lost my identity. I had slipped into a deep depression and relied on going home at night and having a handful of drinks just to fall asleep. Yet mine is a story of recovery: I am a survivor of an ongoing national epidemic of neglect of physicians’ mental health.

AUDIO INTERVIEW

Interview with Dr. Stuart Slavin on depression and suicide among physicians and trainees and how to address stigma associated with mental illness.

Interview with Dr. Stuart Slavin on depression and suicide among physicians and trainees and how to address stigma associated with mental illness. (6:24)

In the past year, two of my colleagues have died from suicide after struggling with mental health conditions. On my own recovery journey, I have often felt branded, tarnished, and broken in a system that still embroiders a scarlet letter on the chest of anyone with a mental health condition. A system of hoops and barriers detours suffering people away from the help they desperately need — costing some of them their lives.

Last year, I decided I could no longer sit by and watch friends and colleagues suffer in silence. I wanted to let my suffering colleagues know they are not alone. I delivered a grand-rounds lecture to 200 people at my hospital, telling my own story of addiction, depression, and recovery. The audience was quiet, respectful, and compassionate and gave me a standing ovation. Afterward, hundreds of e-mails poured in from people sharing their own stories, struggles, and triumphs. A floodgate of human connection opened up. I had been living in fear, ashamed of my own mental health history. When I embraced my own vulnerability, I found that many others also want to be heard — enough of us to start a cultural revolution.

My years of recovery taught me several important lessons. The first is about self-care and creating a plan to enable us to cope with our rigorous and stressful work. Personally, I use counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and hot showers. I’ve worked hard to develop self-awareness — to know and acknowledge my own emotions and triggers — and I’ve set my own boundaries in both medicine and my personal life. I rearranged the hierarchy of my needs to reflect the fact that I’m a human being, a husband, a father, and then a physician. I learned that I must take care of myself before I can care for anyone else.

The second lesson is about stereotyping. Alcoholics are stereotyped as deadbeats or bums, but being humbled in your own life changes the way you treat other people. An alcoholic isn’t a bum under a bridge or an abusive spouse: I am the face of alcoholism. I have been in recovery meetings with people of every color, race, and creed, from homeless people to executives. Mental health and substance-abuse conditions have no prejudice, and recovery shouldn’t either. When you live with such a condition, you’re made to feel afraid, ashamed, different, and guilty. Those feelings remove us further from human connection and empathy. I’ve learned to be intolerant of stereotypes, to recognize that every person has a unique story. When we are privileged as professionals to hear another person’s story, we shouldn’t take it for granted.

The third lesson is about stigma. It’s ironic that mental health conditions are so stigmatized in the medical profession, given that physicians long fought to categorize them as medical diagnoses. Why do medical institutions tolerate the fact that more than half their personnel have signs or symptoms of burnout? When mental health conditions come too close to us, we tend to look away — or to look with pity, exclusion, or shame.

We may brand physicians who’ve had mental health conditions, while fostering environments that impede their ability to become and remain well. When, recently, I moved to a new state and disclosed my history of mental health treatment, the licensing board asked me to write a public letter discussing my treatment — an archaic practice of public shaming. Indeed, we are to be ashamed not only of the condition, but of seeking treatment for it, which our culture views as a sign of weakness. This attitude is pervasive and detrimental — it is killing our friends and colleagues. I’ve never heard a colleague say, “Dr. X wasn’t tough enough to fight off her cancer,” yet recently when a medical student died from suicide, I overheard someone say, “We were all worried she wasn’t strong enough to be a doctor.” We are all responsible for this shaming, and it’s up to us to stop it.

The fourth lesson is about vulnerability. Seeing other people’s Facebook-perfect lives, we react by hiding away our truest selves. We forget that setbacks can breed creativity, innovation, discovery, and resilience and that vulnerability opens us up to personal growth. Being honest with myself about my own vulnerability has helped me develop self-compassion and understanding. And revealing my vulnerability to trusted colleagues, friends, and family members has unlocked their compassion, understanding, and human connection.

Many physicians fear that showing vulnerability will lead to professional repercussions, judgment, or reduced opportunities. My experience has been that the benefits of living authentically far outweigh the risks. When I introduced myself in an interview for a promotion by saying, “My name is Adam, I’m a recovering alcoholic with a history of depression, and let me tell you why that makes me an exceptional candidate,” I got the job. My openly discussing recovery also revealed the true identity of others. I quickly discovered the supportive people in my life. I can now seek work opportunities only in environments that support my personal and professional growth.

The fifth lesson is about professionalism and patient safety. We work in a profession in which lives are at risk, and patient safety is critically important. But if we assume that the incidence of mental health conditions, substance abuse, and suicidal ideation among physicians is similar to (or actually higher than) that in the general population, there are, nevertheless, many of us out there working successfully. The professionals who pose a risk to patient safety are those with active, untreated medical conditions who don’t seek help out of fear and shame. Physicians who are successfully engaged in a treatment program are actually the safest, thanks to their own self-care plans and support and accountability programs.

Instead of stigmatizing physicians who have sought treatment, we need to break down the barriers we’ve erected between our colleagues who are standing on the edge of the cliff and treatment and recovery. Empathy, unity, and understanding can help us shift the cultural framework toward acceptance and support. Mentally healthy physicians are safe, productive, effective physicians.

The last lesson is about building a support network. My network has been the bedrock of my recovery. You can start small and gradually add trusted people, from your spouse and family to friends, counselors, support groups, and eventually colleagues. Then when you fall flat on your face, there will be someone to pick you up, dust you off, and say, “Get back out there and try it again.” A support network can also hold you accountable, ensuring that you remain true to your own personal and professional standards.

Without question, my own successful recovery journey has made me a better physician. My newfound perspective, passion, and perseverance have opened up levels of compassion and empathy that were not previously possible. I still wear a scarlet A on my chest, but it doesn’t stand for “alcoholic,” “addict,” or “ashamed” — it stands for Adam. I wear it proudly and unapologetically.

When a colleague dies from suicide, we become angry, we mourn, we search for understanding and try to process the death . . . and then we go on doing things the same way we always have, somehow expecting different results — one definition of insanity. It’s way past time for a change.

Disclosure forms provided by the author are available at NEJM.org.

SOURCE INFORMATION

From the Indiana University School of Medicine and the Riley Hospital for Children, Indianapolis.

Medicaid Work Requirements – Legally Suspect

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Source: Medicaid Work Requirements – Legally Suspect

Executive Summary

Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is “legally suspect.” They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. “A number of courts,” Perkins and McDonald write, “have recognized that states may not ‘add additional requirements for Medicaid eligibility’ that are not set forth in the Medicaid Act.” They also note that the purpose of Medicaid is to “furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish ‘rehabilitation and other services to help [such individuals] attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries.”

Medicaid Work Requirements – Not a Healthy Choice

Executive SummaryIn an effort to win conservative members’ support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman,  Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements “run counter to the purpose of Medicaid.” They conclude, “Work requirements would stand Medicaid’s purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents.”DOWNLOAD PUBLICATION

Source: Medicaid Work Requirements – Not a Healthy Choice

nTIDE February 2017 Jobs Report: Americans with Disabilities Continue to Contribute to Job Gains

nTIDE February 2017 Jobs Report: Americans with Disabilities Continue to Contribute to Job Gains

Source: nTIDE February 2017 Jobs Report: Americans with Disabilities Continue to Contribute to Job Gains

by Anna Brennan-Curry | Mar 10, 2017

Kessler Foundation and University of New Hampshire release nTIDE Report – Monthly Update

Durham, NH – Employment continues to increase for Americans with disabilities, building on the solid start to the new year, according to today’s National Trends in Disability Employment – Monthly Update (nTIDE), issued by Kessler Foundation and University of New Hampshire’s Institute on Disability (UNH-IOD). Achieving positive employment outcomes is especially challenging for high schools that serve young adults with moderate to severe disabilities. Promising approaches are based on intervening early, coordinating educational and vocational resources, and cultivating local employers.

nTIDE: Comparison of People with and without Disabilities (February 2016 & 2017)

The February numbers indicate that people with and without disabilities are contributing to U.S. job gains. In the Bureau of Labor Statistics (BLS) Jobs Report released Friday, March 10, the employment-to-population ratio for working-age people with disabilities increased from 26.0 percent in February 2016 to 28.1 percent in February 2017 (up 8.1 percent; 2.1 percentage points). For working-age people without disabilities, the employment-to-population ratio increased slightly from 72.3 percent in February 2016 to 72.8 percent in February 2017 (up 0.7 percent; 0.5 percentage points). The employment-to-population ratio, a key indicator, reflects the percentage of people who are working relative to the total population (the number of people working divided by the number of people in the total population multiplied by 100).

“The improvement in the proportion of people with disabilities working continues for the eleventh consecutive month,” according to John O’Neill, PhD, director of employment and disability research at Kessler Foundation. “This is the longest run of positive news since we began reporting the employment situation of people with disabilities in 2013,” he added.

The labor force participation rate for working-age people with disabilities increased from 30.2 percent in February 2016 to 31.5 percent in February 2017 (up 4.3 percent; 1.3 percentage points). For working-age people without disabilities, the labor force participation rate increased slightly from 76.1 percent in February 2016 to 76.4 percent in February 2017 (up 0.4 percent; 0.3 percentage points). The labor force participation rate is the percentage of the population that is working or actively looking for work.

“The trend in the employment of people with disabilities keeps marching upwards; of course there is still quite a ways to go,” said Andrew Houtenville, PhD, associate professor of economics at UNH.

Students with disabilities often struggle after graduating from the supportive environment of special services high schools, and are unprepared to transition into the work force. Bridge to Employment, a promising new pilot program funded by Kessler Foundation, is an example of the efforts to ease this transition for students in New Jersey who attend the Atlantic County Special Services School District (ACSSSD).

JEVS Human Services created the program to address the employment needs of the hardest to serve students. Taking a sophisticated approach, the program begins with a holistic assessment of the values, interests, personalities, and aptitudes of the students, in order to find work placements that are a good fit and provide possibilities for the students to develop—thus improving retention and reducing the long-term burden on the workforce development system. The program also connects students early on with the New Jersey Division of Vocational Rehabilitation Services (DVRS), a program collaborator, so there’s no gap in services for the students. Another key element to the program is the addition of a dedicated professional called a career navigator to help place students, in part by developing visual resumes using PowerPoint format, an engaging format for presenting their individual skills, interests, and strengths.

“We look forward to seeing how well the program fills the vital need for supports and services for high school students transitioning to the workplace,” said Elaine E. Katz, MS, CCC-SLP, senior VP of grants and communications at Kessler Foundation. “If Bridge to Employment succeeds in transitioning the ACSSSD students who are hardest to serve, this program could serve as a model for effective transition programs in other counties in New Jersey as well.”

In February 2017, among workers ages 16-64, the 4,409,000 workers with disabilities represented 3.1 percent of the total 142,437,000 workers in the U.S.

The next nTIDE will be issued on Friday, April 7, 2017. Follow the news on Twitter #nTIDE.

Join our nTIDE Lunch & Learn series, starting today, March 10 at 12:00pm EST. This live broadcast, hosted via Zoom Webinar, will offer attendees Q&A on the latest nTIDE findings, provide news and updates from the field, as well as host-invited panelists to discuss current disability-related findings and events. Rita Landgraf, Professor of Practice and Distinguished Health and Social Services Administrator in Residence, University of Delaware, College of Health Sciences, joins Drs. Houtenville and O’Neill, Michael Murray of Office of Diversity and Inclusion at the U.S. Office of Personnel Management (OPM), and Denise Rozell, Policy Strategist at the Association of University Centers on Disabilities (AUCD), to discuss today’s findings as well as the positive return on advancing employment of individuals with disabilities. You can join live, or watch the recordings at: www.ResearchonDisability.org/nTIDE.  Find updates on Twitter #nTIDELearn.

NOTE: The statistics in the National Trends in Disability Employment Update are based on Bureau of Labor Statistics numbers, but are NOT identical. They’ve been customized by the University of New Hampshire to efficiently combine the statistics for men and women of working age (16 to 64). NTIDE is funded, in part, by grants from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) (9ORT5022-02-00 & 90RT5017) and Kessler Foundation.

About Kessler Foundation

Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility, and long-term outcomes – including employment – for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities. For more information, visit www.KesslerFoundation.org.

About the Institute on Disability at the University of New Hampshire

The Institute on Disability (IOD) at the University of New Hampshire (UNH) was established in 1987 to provide a coherent university-based focus for the improvement of knowledge, policies, and practices related to the lives of persons with disabilities and their families. For information on the NIDILRR-funded Employment Policy and Measurement Rehabilitation Research and Training Center, visit www.ResearchonDisability.org.

For more information, or to interview an expert, contact:

Carolann Murphy, 973.324.8382, CMurphy@KesslerFoundation.org

An Ordinary, Extraordinary Day

OFCCP Director Blogs About Updated Veteran/People with a Disability Regulations

– See more at: http://outsolve.com/blog/ofccp-director-blogs-about-updated-veteran-people-with-a-disability-regulations#sthash.tvtBwib0.dpuf

Karla wrote for her daughter, a high school student with cerebral palsy who, her mom points out, “will be as qualified as anyone else” when she enters the workforce. Gerald wrote to make sure we didn’t forget the continuing barriers Vietnam veterans like him still face when trying to enter or re-enter the workforce. And Mike wrote just to say thank you – for helping people “to live improved lives by having a job.”

For millions of workers around the nation, March 24 was just another Monday, the first day of another week of work. But at the Office of Federal Contract Compliance Programs, March 24 was a special day: the day our rules expanding employment opportunities for qualified workers with disabilities and protected groups of veterans went into effect.

For my staff; for Karla, Gerald and Mike; for the hundreds of people who wrote to us supporting our proposals during the rulemaking process; and for thousands of people like them, March 24 was a day of new opportunities. In fact, leaders from the National Organization on Disability and the Easter Seals have suggested that March 24, 2014, will join the anniversary of the Americans with Disabilities Act and even Veteran’s Day as another major milestone in our nation’s journey of expanding rights for veterans and people with disabilities.

These two rules are game-changers. But change is a process, not a switch. That’s true for the contractor community, and it’s true for all of us. Thousands of people have already participated in OFCCP webinars on the new rules, and more training will be coming over the next three months.

At OFCCP, we are committed to getting this right. We know it’s important to be flexible, open and inclusive; to be good enforcers as well as good listeners. We also know that diverse workplaces are better workplaces. They are safer and fairer; they are more productive and, yes, more profitable.

Our job is to protect workers, promote diversity and enforce the law. In doing so, we facilitate the success of businesses, workers and the federal agencies that rely on contracted work. That’s good government and good business sense working together for the good of the country we serve.

Patricia A. Shiu is the director of the Office of Federal Contract Compliance Programs.

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