As many as one of every five Americans has a disability or chronic health condition. In rural areas, that proportion is even higher (23%).

As the U.S. population ages, the numbers of people with disability and chronic conditions will predictably increase, which accounts for a growing national interest in the health and wellness of individuals with disabilities. While composing about 20% of the population, individuals with disabilities account for nearly half of all medical expenditures.

Healthy People 2010, the nation's blueprint for a healthy population, has added a chapter focused on eliminating the health disparities experienced by people with disabilities. Individuals with disabilities or chronic health conditions often develop secondary conditions. For example, a person with multiple sclerosis may develop depression as a secondary condition that further restricts his or her ability to do things independently.

As part of a national movement to promote the health and wellness of all people with disability, the Centers for Disease Control and Prevention (CDC) provide significant programmatic support for our research, development, and services. Researchers at The University of Montana RTC: Rural and at the University of Kansas RTC/IL have focused considerable effort on the Living Well with a Disability program. A health promotion and wellness program for adults with physical disabilities, Living Well is based on independent living philosophy and rural traditions of self-care. The program is an eight-week workshop which introduces a goal-setting and goal clarification process, and teaches skills for generating, implementing, and monitoring solutions to problems.   Living Well also provides tools for managing one's health and making healthy lifestyle changes, increasing physical activity, developing and maintaining healthy relationships, improving nutrition, avoiding depression and frustration, and advocating for community health to maintain gains. We have shown Living Well to be cost-effective, increasing the health of participants and reducing medical care costs over 12 months (See Research Progress Reports #6 and #7).

Research Goals:

While no longer a formal research project, we continue to disseminate the program and to track its application. Our goals are to make this effective program widely available, to track its utility, and to estimate its effects.

Methods:

We have completed the formal research studies but continue to offer
internet-based and on-site training to help others implement the program. We work with the state-based disability and health network of programs established by CDC, as well as a wide range of other programs. We track the organizations and staff who participate in training, estimate the number of people with disabilities who complete the workshop, and use our findings to project the training's effects.

Results:

To date, we have trained 202 Living Well facilitators from 72 community-based organizations in 17 states. The combined efforts of these facilitators have produced an estimated 218 Living Well with a Disability workshops and have served 1,585 consumers. We estimate these programs have increased participants' annual symptom-free days by 19,020 days, and that total cost savings range from $1.5 to $2.5 million. To date, discounting the cost of the program, the estimated net benefit to healthcare payers is between $538,900 and $1,588,170.

Conclusions and Next Steps:

Many adults with disability are Medicaid recipients. In addition to benefiting Living Well workshop participants, this program can represent a significant savings to Medicaid. We are working to establish reimbursement mechanisms that would provide reliable financial support to local programs conducting the Living Well program.

Resources:

Disability and Health Team, Centers for Disease Control and Prevention:
http://www.cdc.gov/ncbddd/dh/default.htm 

National Center on Physical Activity and Disability: http://www.ncpad.org 

Christopher Reeve Paralysis Foundation: http://www.apacure.com 

Amputee Coalition of America: http://www.amputee-coalition.org 

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For more information, contact: Craig Ravesloot, Director of Health Projects
(303) 774-6196 
email the Rural Institute 

Meg A. Traci, Project Director, Montana Disability and Health Program
406-243-4956

Research and Training Center on Disability in Rural Communities, The University of Montana Rural Institute: A Center of Excellence in Disability Education, Research and Services, 52 Corbin Hall, Missoula, MT 59812-7056
888-268-2743 toll-free; 406-243-5467 (V); 406-243-4200 (TTY); 406-243-2349 (fax)
http://rtc.ruralinstitute.umt.edu | http://mtdh.ruralinstitute.umt.edu

Our research is supported by grant #R04/CCR818823-01 from the Centers for Disease Control. Opinions expressed are the author's and are not necessarily those of the funding agency. This report was prepared by Tom Seekins, RTC: Rural 2004. It is available in standard text, Braille, large print and text formats.  The Rural Rehabilitation Progress Report Series is edited by Diana Spas.

Questions? Would you like to receive periodic updates about our research and training activities? Do you have comments or suggestions about this site? E-mail your requests, comments and suggestions to Diana Spas or call 888-268-2743 and ask for the Information Coordinator.