DISABILITY AND PUBLIC POLICY IN THE UNITED STATES

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DISABILITY AND PUBLIC POLICY IN THE UNITED STATES

• Katherine D. Seelman, Ph.D.
• Associate Dean and Professor
• School of Health and Rehabilitation Science
• University of Pittsburgh, USA
• www.shrs.pitt.ed Kds31_at_pitt.edu
• Chinese Conference on Rehabilitation Medicine
• Beijing, PRC
• October 22-26, 2001

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Greetings from the Faculty and Students
University of Pittsburgh School of Health and
Rehabilitation Science toChinese Colleagues
Chinese Society of RehabilitationMedicine and
Engineering
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Purpose of Presentation

• Identify stages in the development of Disability
  Policy in the United States in the 20th Century
• Introduce national government rehabilitation and
  disability agencies
• Explain the role of interest groups

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Stages in U.S. Disability Policy

• Stage I Income and Health Benefits Policies
• Stage II Education and Work Services Policy and
• Stage II-III Research and Accessibility Policy
• Stage IV Civil Rights/Human Rights Policy

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Stage I National and State Disability Income
Benefits Policy

• Types of Programs
• Programs for those injured at work or veterans
• Programs that pay benefits to persons who are
  disabled and poor
• General Disability Programs that that pay
  benefits to those who are enrolled in/insured by
  the program

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Stage I Income Benefits Legislation

• Social Security Act, 1935, benefits to retirees
  and blind people.
• Social Security Disability Insurance, 1956,
  benefits for people who could show they were
  disabled and who had paid into the system.
• Supplemental Security Income, 1974, benefits for
  disabled, blind and aged people who are poor.

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Stage I Health Benefits Policy

• Overall authority for health care is divided
  between the private sector and federal, state and
  local governments.
• Health care insurance is provided mainly by
  employers
• Public insurance through Medicare or Medicaid

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Stage I Health Legislation--Medicaid

• Social Security Act, 1965, Medicaid
• Sets up a partnership between different levels of
  government
• Aims at improving access and quality of health
  care for the poor.

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Stage I Health LegislationMedicaid (continued)

• Mandatory benefits include hospital and physician
  services, screening and treatment of children for
  various sicknesses and impairments.
• Optional benefits have been used to assist
  disabled with assistive technology and home aides

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Stage I Health Legislation--Medicare (continued)

• Social Security Act, 1965, Medicare
• Beneficiaries
• those over 65 years old,
• those disabled and receiving Social Security cash
  benefits
• those suffering from end-stage renal disease

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Stage I Health LegislationMedicare (continued)

• Medicare Structure
• Part A Hospital Insurance covers hospital
  expenses for specified periods
• Part B Voluntary, benefits covers a wide range
  of physician and outpatient services, surgical
  procedures, ambulance services very limited long
  term care coverage

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Stage II Beyond Income and Health Policy to
Community Integration and Research

• Education Policy
• Employment and Work Policy
• Research
• Accessibility

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Stage II Education and Work Policy and
Legislation

• Individuals with Disabilities Education Act,
  1975, requires participating states to furnish
  all children with disabilities a free,
  appropriate public education in the least
  restrictive setting.
• Rehabilitation Act, 1973, federal support for
  training and placing people with physical and
  mental disabilities into employment.

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Stage II Governmental Support for Rehabilitation
and Disability Research

• U.S. National Institute on Disability and
  Rehabilitation Research http//www.ed.gov/office
  s/OSERS/NIDRR
• U.S. Department of Veterans Affairs
  http//www.vard.org/cent/centers.htm

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Stage II Governmental Support for Rehabilitation
and Disability Research (continued)

• National Science Foundation
• http// www.nsf.gov
• National Center for Medical Rehabilitation
  Research (National Institutes of Health)
• http//www.nichd.nih.gov

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Stage II National Government Support for
Rehabilitation and Disability Research

• Other agencies
• Access Board
• Office of Disability, Aging and Long Term Care
• Social Security Administration
• U.S. Department of Housing and Urban Development
• U.S. Department of Transportation

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Stage II National Institute on Disability and
Rehabilitation Research (NIDRR) Mission

• Research to support re-integration into society
• New Paradigm of Disability Disability is a
  relationship between impairment and the
  environment

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Stage II NIDRR Long Range Plan Research
Elements

• Employment Outcomes
• Health and Function
• Technology for Access and Function
• Independent Living and Community Integration
• Information Dissemination
• Associated Areas Disability Statistics, outcome
  measures, international

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Stage II NIDRR Programs

• Rehabilitation Research Training Centers
• Rehabilitation Engineering Research Centers
• Model Systems in Spinal Cord, Traumatic Brain
  Injury and Burn Rehabilitation

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Stage II NIDRR Programs (continued)

• Advanced Rehabilitation Training Projects
• Americans with Disabilities Act Technical
  Assistance
• Assistive Technology Act

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Stage II NIDRR Research Structure

• Centers of Excellence Model
• Competitive grants process
• IRB
• Peer Review
• Program Review

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Stage II NIDRR Organization

• Budget FYI 2001 138 million
• Staff 40
• Government cooperation Interagency Committee on
  Disability Research

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Stage II-Stage III Accessibility

• Built Environment
• Information Technology and Telecommunications
• Transportation
• Consumer Products

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Stage II-Stage III Accessibility Policy and
Legislation

• Architectural Barriers Act, 1968 access to the
  built environment for wheelchair users and others
• Hearing Aid Compatibility Act of 1988, for hard
  of hearing access to telephone
• Telecommunications Accessibility Enhancement Act,
  1988 for deaf access to telephone

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Stage II- Stage III Accessibility Policy and
Legislation

• Technology-Related Assistance for Individuals
  with Disabilities Act 1988 (Assistive Technology
  Act, 1998)
• to integrate assistive technology into lives of
  disabilities, at home, at school, at work and in
  the community
• to support technical assistance, training,
  finance and information dissemination

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Stage IIStage III Accessibility Policy and
Legislation

• Section 508 of the Rehabilitation Act, 1998,
  requires national government agencies to have
  their electronic and information technology
  accessible, including all electronic devices such
  as computers, xerox machines, telephones

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Stage IIStage III Accessibility Policy and
Legislation

• Television Decoder Circuitry Act, 1990, universal
  design in televisions for closed captioning use
  by deaf and hard of hearing people and all people
  in noisy places
• Telecommunications Act of 1996, main national law
  for regulating communications, requires equipment
  access

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Stage III Civil Rights and Full Citizenship

• Americans with Disabilities Act, 1990
• Purpose Clear and comprehensive mandate for the
  elimination of discrimination against individuals
  with disabilities

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Stage III Americans with Disabilities Act

• Definition of disability
• Physical or mental impairment that substantially
  limits one or more of the major life activities
• A record of such an impairment
• Being regarded as having such an impairment

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Stage III Americans with Disabilities Act

• Overview
• Title I Employment bans discrimination
  against qualified individual with a disability
  because of disability in employment
• Title II Public Services bans exclusion from
  participation or benefits of services, programs
  or activities of a public entity such as public
  transportation and public meetings

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Stage III Americans with Disabilities Act
(continued)

• Overview
• Title III-Public Accommodations and Services
  Operated by Private Entities bans
  discrimination on the basis of disability by any
  person who owns or operates a place of public
  accommodation such as hotels, restaurants, health
  care providers
• Title IV-Telecommunications ensures that relay
  services are available to the extent possible for
  deaf and speech-impaired individuals

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Conclusions

• Stages from Welfare to Citizenship
• Interventions and resources of the national
  government
• Type of interest groups
• Stage I Medicine and Social Work
• Stage II Educators, Counseling,
  Engineers, Architecture, Medicine,
  Consumers
• Stage III Consumer Advocates