Using a Community Based Participatory Research (CBPR) approach, the project partners worked to clarify the health promotion needs of adults with developmental disabilities, identify strengths and weaknesses of the current system, and develop an action plan. Through this action plan, community agencies and therapists would become empowered to address needs, build ongoing community capacity to respond to emergent health/wellness needs, and advocate for appropriate systems of care

Esquerra, Teresa

Hill, Mary Thelander

Hobbs, Robert

Hoelzel, Leslie

VanLeit, Betsey

English

University of New Mexico

University of New Mexico
UNM Digital Repository
Occupational Therapy Health Sciences Center Student Scholarship
4-22-2009
Health Disparities for Adults with Developmental
Disabilities: Exploration of Health Promotion
Services, Systems and Strategies.
Mary Thelander Hill
Teresa Esquerra
Betsey VanLeit
Leslie Hoelzel
Robert Hobbs
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Recommended Citation
Hill, Mary Thelander; Teresa Esquerra; Betsey VanLeit; Leslie Hoelzel; and Robert Hobbs. "Health Disparities for Adults with
Developmental Disabilities: Exploration of Health Promotion Services, Systems and Strategies.." (2009).
https://digitalrepository.unm.edu/ot/1
The group format provides opportunity for member interaction and contains in-
depth data about the process explored (Corring, 2001).
Reducing Health Disparities for Adults with Developmental Disabilities:
Exploration of Health Promotion Services, Systems and Strategies in Bernalillo County
Mary Thelander Hill, MOTS, Teresa Esguerra, MOTS, Advisor: Betsy VanLeit, PhD, OTR/L, Committee Members: Leslie Hoelzel, MS, Robert Hobbs, OTR/L 
University of New Mexico, Department of Pediatrics, School of Medicine, Occupational Therapy Graduate Program 
Background
Results
Proposed Model
Health disparities experienced by adults who have intellectual and
developmental disabilities (I/DD) are influenced by personal and
environmental factors and include increased incidence of obesity, diabetes,
heart disease, oral diseases, polymedication, iatrogenesis, social isolation,
less active lifestyles and poor nutritional habits. Health practitioners receive
little training about the health habits and potential of adults with I/DD. Limited
access to transportation, 70% unemployment and a poverty rate that is
double that of the general population influence the health condition of adults
with I/DD. To address these barriers, disability policy must recognize the
desire of adults with I/DD to have the same choices and opportunities as
anyone else and encourage wellness (Marks & Heller 2003).
In New Mexico, health and safety information about individuals served on the
Developmental Disabilities Waiver Program is documented on the Individual
Service Plan (ISP). However, there is no section on the ISP to systematically
document common health indicators such as body mass index, diabetes
status, or osteoporosis status (NMDOH DDSD, 2009a). Additionally, the state
of New Mexico, the Metro Region and Bernalillo County do not have a formal
system of cataloging health related information for individuals served on the
DD waiver. In 2008, a non-scientific survey of ISPs, that included Bernalillo
County revealed that only 22 of 47 surveyed ISPs had documentation of
adequate team discussion of the person’s health-related issues. (NMDOH
DDSD).
Transcript analysis and codebook development revealed a pattern of enabling and disabling factors influencing the
health and wellness of adults with I/DD in Bernalillo County. Factors related to the individual (values, choices,
abilities and understanding), direct supports (knowledge, modeling, motivation, values and financial concerns) and
the larger social context (culture, policy, resources, marketing, service delivery access, and social norms) can be
supports or barriers to wellness of adults with I/DD. A model of supports and barriers to wellness for the
population of people is proposed. The model demonstrates the importance of the relationship between direct care
staff and the individual and how contextual factors (both social and political) impact this fundamental partnership.
Verbatim transcriptions of the focus groups were reviewed by project partners to identify recurring
themes. Internal validity was ensured the process of member checking, in which all community partners verified
the initial codes and keywords accurately reflected the transcribed data (Henderson & Rheault, 2004). A codebook
was developed from common themes and keywords recognized by all community partners in the preliminary data
analysis, inclusion and exclusion criteria, and sample quotes from the transcripts.
Data Analysis
References
Corring,D. (2001).  Focus group research.  In J. Cook (Ed.), Qualitative research in occupational 
therapy: strategies and experiences (pp. 75-87).  Albany, NY: Delmar Thompson Learning.
Henderson, R. & Rheault, W. (2004).  Appraising and incorporating qualitative research in evidence-
based practice.  Journal of Physical Therapy Education, 18, 35-40.
Marks, B.A., Heller, T. (2003). Bridging the equity gap: health promotion for adults with intellectual 
and developmental disabilities. The Nursing Clinics of North America. 38: 205-228.
New Mexico Department of Health, Developmental Disabilities Supports Division.  (2008). 
Developmental disabilities supports division, FY 2008 annual report. Retrieved on 9/30/09 from 
http://www.health.state.nm.us/ddsd/resourcesupportbureaupublications/ 
Data/documents/2008DDSDAnnualReport.pdf
New Mexico Department of Health, Developmental Disabilities Supports Division.  (2009a). 
Developmental disabilities supports division – new ISP.  Retrieved on 10/13/2009 from 
http://www.health.state.nm.us/DDSD/PromisingPractes/ISP.htm
Vanleit, B.J. & Kaul, E. (2008). Reducing health disparities for adults with developmental 
disabilities: Exploration of health promotion services, systems, and strategies in Bernalillo County.  
Grant submitted to the University of New Mexico Community Based Participatory Research Grants 
Program.  1-11.
Active Wellness Photos used with permission by ARCA, Inc.  http://www.arc-a.org
“Bernalillo County” composite photograph used with permission by Adam R. Hill
Study Design
Using a Community Based Participatory Research (CBPR) approach, the
project partners worked to clarify the health promotion needs of adults with
developmental disabilities, identify strengths and weaknesses of the current
system, and develop an action plan. Through this action plan, community
agencies and therapists would become empowered to address needs, build
ongoing community capacity to respond to emergent health/wellness needs,
and advocate for appropriate systems of care.
Project partners included UNM Occupational Therapy Graduate Program
(faculty and students), ARCA, a community-based organization that has
offered an innovative health and wellness curriculum to adults with I/DD since
2005, and RDH Occupational Therapy Professional Corporation (community-
based therapists who work extensively with adults with developmental
disabilities).
Recommendations/Implications for Practice
Three focus groups conducted in the Spring of 2009 included ARCA staff
members (health & wellness instructors, nursing, nutritionists, administrators,
and group home staff) community therapists (OT, PT, SLP and BSC) and
family members of individuals with I/DD. ARCA and RDH identified the
purposeful sample of focus group participants. The principal investigator (Dr.
Betsy Vanleit) facilitated the focus group conversations on the following three
areas of inquiry:
1. How are health promotion interventions currently being provided to adults
with developmental disabilities in Bernalillo County?
2. What are the factors that support the health and wellness of adults with
DD?
3. What are the barriers to health and wellness of adults with DD?
Limitations and Future Research
There are several limitations to our study. The convenience
sample of focus group participants was largely comprised of
higher level professionals (therapists, medical staff, and
administrative personnel) with family members and direct care
staff members underrepresented overall. Future research
should include perspectives from individuals served and more
from direct supports. Additionally, future research should
include viewpoints from a variety of community agencies and
from representatives of the DD Waiver system itself.
Bernalillo County Model
Factors of the individual, direct support and larger social 
context that may promote wellness, or may be barriers to 
wellness for aduts with I/DD
Project Aims
Sample Code-Book Data 
Code Keyword Sample Text
Caregiver Modeling Excitement “You know, if the staff are motivated and hyped about it, a 
lot of times, the individuals will be too.” (2/23/2009)
Financial Concerns Grocery Budgets “I think that money and staffing really affect what people 
eat.” (4/15/2009)
Social Support Social Motivators “We all can find excuses for not choosing good lifestyle 
choices, and people with disabilities are no different than 
the rest of the population.” (4/16/09)
Direct care supports drive wellness for this population: 
provide training and help create buy-in.
Make health promotion information available; 
make it fun; make it motivating.
There should be flexibility in direct care staff training
so that specific skills can be applied to further
promote health and wellness for adults with IDD.
More resources (time, staff, money)
are needed in health promotion efforts
for adults with IDD.
Systematic surveillance instruments are needed in
New Mexico to fully comprehend and address
health promotion needs of adults with IDD.


Health Disparities for Adults with Developmental Disabilities: Exploration of Health Promotion Services, Systems and Strategies.

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Health Disparities for Adults with Developmental Disabilities: Exploration of Health Promotion Services, Systems and Strategies.

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