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As government increasingly strives to control costs of social programs, researchers work to develop cost-effective interventions.

In 1995, Tom Seekins, Glen White, Craig Ravesloot and colleagues described a brief community-based wellness program for adults with spinal cord injuries that reduced disability due to secondary conditions by 37 percent and reduced physician visits by 45 percent over six months. Extrapolating from the data, the estimated savings in medical expenses alone could have offset the cost of the wellness program within 18 to 20 months of its completion. 

Initial enthusiasm was tempered by the sample's relatively small size.  Also the intervention with evaluated with a non-equivalent control group design. The research continued with a larger, more representative sample, a more rigorous design, and additional data collection on costs and preferences.

This model for improving health and increasing the independence of adults with physical disabilities is standardized, empirically-grounded, and community based. The program is delivered by consumer-controlled independent living centers and is based on research linking secondary conditions to theoretical models, such as Antonovsky's Sense of Coherence (1987) and Abramson, Seligman and Teasdale's Reformulated Learned Helplessness Models (1978).

Recruitment methods and determination of "readiness" can maximize the cost-effectiveness of this health promotion model for adults with disabilities. Researchers asked:

1. What are the characteristics of those individuals with disabilities who are most likely to be interested in and to participate in a health promotion program?
2. What variables predict whether a person would benefit from participation in a health promotion program?
3. What techniques are most effective for recruiting individuals with disabilities into health promotion activities?
4. How can we support those who aren't quite "ready" to manage their own health?
5. How does a readiness intervention affect the program's overall cost-effectiveness?

Cost-effectiveness is also enhanced if participants maintain and improve their health after the program ends. Researchers looked at participants' post-intervention behavior and asked:

1. How does the intervention effectively program in maintenance and generalization?
2. What additional information, services, or supports help participants maintain health gains? When should they be supplied?

Partners:

RTC: Rural enjoys an ongoing, productive collaboration with the national organizations of  independent living centers.  The Association of State and Territorial Disability Prevention Programs, and several Regional Rehabilitation County Extension Programs provided guidance, and a state Medicaid representative sits on our advisory group.

RTC: Rural's goal was to assess the cost-effectiveness of a community-based model for preventing and managing secondary conditions experienced by adults with physical disabilities. To meet this goal, researchers:

• Replicated the Montana/Kansas "Living Well with a Disability" health promotion model, evaluated its applicability across settings and types of disability, and assessed its cost-effectiveness.
• Conducted a longitudinal evaluation of the model's efficacy in preventing and managing secondary conditions.
• Developed and evaluated methods for recruiting participants into health promotion programs.
• Developed and tested "readiness for health" assessments, and assessed the cost-effectiveness of meeting participants' readiness needs.
• Developed and evaluated procedures for maintenance and generalization of health gains.
• Developed and implemented technology transfer procedures to disseminate  materials and methods to public health agencies, managed care providers, and community-based disability service programs.

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PowerPoint Presentation: Living Well with a Disability Symposium: Development, Implementation and Evaluation of a Nationally Recognized Health Promotion Intervention for Adults with Disabilities Presented at "Navigating Our Future: Aligning Strategies and Science", the 2nd National Conference of the National Center on Birth Defects, Developmental Disabilities, Disability and Health and Inheritable Blood Disorders, Washington DC, July 26-28, 2004. PDF format (Posted 8/16/04)

 

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For more information, contact:

Tom Seekins,Ph.D.,  Director, 
RTC: Rural, The University of Montana Rural Institute: A Center for Excellence in Disability Education, Research and Services, 52 Corbin Hall, Missoula, MT 59812-7056 (888) 268-2743 or (406) 243-2654    
email the Rural Institute

Opinions expressed are those of RTC: Rural staff and may not reflect not those of the U.S. Department of Education.

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