people with disabilities officially classified as a population experiencing health disparities

People with disabilities officially classified as a population experiencing health disparities

Written by Eliott Hamilton, Student Informatician

In September 2023, the National Institute on Minority Health and Health Disparities (NIMHD) officially classified people with disabilities as a population experiencing health disparities. This decision is a game changer for disability-inclusive research and highlights the pressing need to better understand and address the unique healthcare obstacles individuals with disabilities face.

What are Health Disparities?

A health disparity is a “health difference that adversely affects disadvantaged populations in comparison to a reference population, based on one or more health outcomes. All populations with health disparities are socially disadvantaged due in part to being subject to racist or discriminatory acts and are underserved in health care.”

Disparities in health outcomes are categorized as:

  • A higher likelihood of disease, an earlier onset of disease, or a more aggressive progression of disease
  • Increased mortality rates with certain health conditions, including premature mortality
  • Greater global burden of disease (GBD)
  • Lower outcomes on self-reported data tracking day-to-day functioning and symptom collections

For people with disabilities, health disparities can vary as widely as disabilities themselves, but many people within the disability community share experiences, like health conditions not taken seriously, poorer mental health, and reduced life expectancy due to limited treatment options.

What does NIMHD’s decision mean for people with disabilities?

The National Institute on Minority Health and Health Disparities (NIMHD)’s decision to recognize and research people with disabilities as a population that experiences health disparities is significant for several reasons: 

Recognition of Unique Challenges: People with disabilities often face unique health challenges related to their disabilities. These challenges can include higher rates of certain health conditions, barriers to accessing healthcare, and disparities in health outcomes. Recognizing disability as a category for health disparities research acknowledges the specific needs and experiences of this population.

Inclusivity in Research: By designating people with disabilities as a population with health disparities, the NIH is highlighting the importance of inclusivity in research. It emphasizes the need to include individuals with disabilities in health studies to better understand their health status, identify disparities, and develop interventions that address their specific needs.

Promoting Health Equity: The designation demonstrates the commitment to promoting health equity for all populations, including those with disabilities. It acknowledges disparities in health outcomes and healthcare access exist within the disability community and emphasizes the importance of addressing these inequities.

Policy Implications: The recognition of people with disabilities as a population with health disparities can have implications for policy development and resource allocation. It may lead to focused initiatives, interventions, and policies directed at improving the health and well-being of people with disabilities, thereby reducing disparities.

Advocacy and Awareness: The designation helps raise awareness about the unique health challenges faced by people with disabilities, fostering advocacy for their rights and healthcare needs. It encourages a broader understanding of health disparities beyond traditional demographic categories, recognizing disability as a significant factor

What Are the Future Implications?

With this decision to acknowledge people with disabilities as a researchable population, the NIMHD is specifically focusing on the need for additional, more inclusive research. Alongside this designation, the NIMHD announced new research funding designated to disability healthcare equity – incentivizing researchers to address unique health disparities the disability community faces.

In addition to understanding health outcomes specific to the disability community, funding research to address disability healthcare equity is the first step in supporting inclusive research in healthcare. Future studies by the NIMHD will likely incorporate a more accurately diverse representation of the general population. 

Representation of people with diverse disabilities in health disparities research leads to a better understanding of unique health needs, challenges disabled people face within their healthcare, and the wide range of disparities the community deals with daily.

HDI dedicates Maurice Dawson, Jr. Training Rooms

Christina Espinosa remembers Maurice Dawson as a beloved member of HDI’s community. 

“Maurice was one of the few people at HDI as a member of our tech team that was able to connect with people across the institute…that was inherently special to be able to be someone got to connect with so many people but was also always very present and willing to help problem solve” Espinosa, the Community Education Division Director, said. “He had his own quirky style of humor. He was amazing with sending memes. He would always send back a meme on chat or in Teams.”

His friends and colleagues deeply appreciated how eager he was to help people with any of their tech-related problems and how quick he was with a joke in team meetings. Many member’s of HDI’s team were devastated when he passed away last year. But since then, HDI has made multiple efforts to honor his memory. 

As one of these efforts, they’ve created space for community and education at their new location in Lexington’s Huguenard building. 

There are two spaces at Huguenard that were dedicated to Dawson’s memory during its Feb. 16 ribbon cutting – the training room and the meeting room, as he was a common fixture in both places at HDI’s previous Coldstream offices. Some members of Dawson’s family were also there in attendance. His mother said a few words. She was just really grateful that we got to know him and were able to honor him in that place, too,” Espinosa said. 

Already the training room is seeing use. “Any project that needs to reserve a space that can house twenty to potentially forty people can reserve it for trainings for larger project meetings,” Espinosa said. “It’s also being currently used as a spot to gather for lunch, as a as an opportunity to connect with other HDI staff.” 

In addition, Dawson’s art and photographs of the Coldstream Farm decorate these spaces. 

In addition to these dedications, HDI is also honoring Dawson through its Maurice Dawson, Jr. Technology Training Initiative. 

HDI Podcast Logo

State of HDI: Quality Improvement and Data with Laura Butler

Transcript

[Patti] Hello, and welcome to the State of HDI, a podcast of the University of Kentucky Human Development Institute. I’m Patti Singleton, and in the studio with me today is Laura Butler, director of the Kentucky Core Indicators Project. Laura, it’s so good to have you here.

[Laura] Thanks, Patti. I’m happy to be here.

[Patti] Laura, today’s topic is on quality improvement and data. So, tell me about this project.

[Laura] So, the National Core Indicators is a project where we survey adults who are receiving services from the state. So, in Kentucky’s case, it’s two Medicaid waiver services, the Michelle P waiver and the supports for Community Living waiver. 48 other states also participate in the survey. And there are other surveys within the project as well.

[Patti] So, 48 states, that’s a lot of data. So, based on the data you’ve collected, and you’ve seen, how is Kentucky performing as compared to some of the other states?

[Laura] So, it depends on the items that we look at. And that is one of the things that our quality improvement committee does look at is to see how Kentucky does rank in terms of some different areas. They call them indicators for this survey and to see how Kentucky is performing nationally, and compared to some other states that might be benchmark states for us.

[Patti] And you mentioned a committee, can you tell me who is represented on that committee? 

[Laura] Yeah, so the committee is made up of some other HDI’ers, as well as some folks from different state agencies, including the division of developmental and intellectual disability, and also most importantly, family members of people who are receiving the services and people who are actually receiving the services.

[Patti] So, I assume this dataset can really help people with advocacy and policy efforts.

We’re seeing that happen more and more on a local and state level, which is really exciting. And then the data are also being used for federal quality management and assessment measures.

[Patti] So having such a large data set likely also gives a great picture of progress of people with disabilities over time. And so, what are some of those trends? 

[Laura] As with everything else, we saw changes during COVID. We did stop surveying in March 2020, when everything else stopped. But we did have about three fourths of our surveys completed at that point. So, we did look at that data as an immediate pre pandemic snapshot. And so, we – like the rest of the country – saw people, fewer people working, fewer people spending time in the community, things like that. But we’ve seen a really significant rebound in that in the last year. The survey has changed somewhat, it does change in response to different things that are going on in the community. So, there are survey questions that have been added to measure what is called often the final rule or the settings rule that Medicaid has. And that’s about how people live as you would think with the settings rule. Those are newer questions. So, we’re seeing some changes there. As people, as agencies and providers try to get in line with that role. We see other changes as well in terms of employment, it goes up and down. Other items in terms of people who have meaningful relationships, or people who feel lonely, those go up and down. But generally, we see positive trends for Kentuckians in those items.

[Patti] I certainly think a lot of people have probably a stress response when we think about data. And so, tell me how this project is making data into information we can all use.

[Laura] Yeah, so it’s really important for us that people use the data, the big survey that we use is collected directly from people who are receiving the services. So, it is a really important perspective. So, we want to see it used. So, what we do is present the data in a number of different ways. We have just the data tables for people who are really into just raw data and looking at that. We have those out there. Then we also work to create some easy-read documents. The National – National Core Indicators folks do that as well with a larger data, but we do it with the data that we see here in Kentucky and specifically with the items that the quality improvement committee looks at. So, we work with people with disabilities to help us develop those and make sure that they work for a different variety of people. So, we probably have some that are meant for provider agencies, some that are meant for people who are receiving services, others that can be used for policymakers.

[Patti] And we’ll make sure that we have links to those in the show notes today. So finally, what changes do you see in the future?

[Laura] So, it’s really hard to tell. I think the national folks that design the survey are really responsive to what is happening in the community and what’s happening with policy and politics, honestly. And so, as things change, we’ll see that change as well. One of the issues that’s really big right now is getting enough people to provide services. So, the workforce of people who are providing services is really challenging right now. And that really impacts the quality of life for people who are receiving these services. So, we’re seeing right now the emphasis on that workforce, the direct support professionals, and we’re seeing a lot of emphasis on making sure that those people are retained and paid well and treated well, and we do have a survey. It’s called the State of the Workforce survey that’s specific to measuring that in terms of compensation and retention of the direct support professionals.

[Patti] Well, Laura, it was so great to sit down with you today and learn more about your project.

[Laura] Thanks for having me, Patti.

Minority Stress & LGBTQIA2S+ Mental Health

Written by Eliott Hamilton, Student Informatician

Terms to Know

  • LGBTQIA2S+ – Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Two-Spirit, + (representing all other Queer & Trans identities not represented in the acronym
  • Heterosexism – prejudice against any non-heterosexual form of behavior, relationship, or community, particularly the denigration of lesbians, gay men, and those who are bisexual or transgender.
  • GSRM – Gender, Sexual, & Romantic Minorities
  • Transgender – An adjective describing a person who does not identify with the gender they were assigned at birth
  • Cisgender – An adjective describing a person who does identify with the gender they were assigned at birth
  • Nonbinary – An adjective describing anyone who identifies as a gender outside of the man/woman binary. This term can be used as an individual identity or as an umbrella term for many gender identities that do not fall within the gender binary.
  • Marginalization – The process through which an individual or group with distinctive qualities becomes identified as one that is not accepted fully into the larger group.
  • Multiply Marginalized – An adjective describing a person who is a part of two or more marginalized groups.
  • BIPOC – Black, Indigenous, & people of color
  • AAPI – Asian American and Pacific Islanders

What is Minority Stress Theory?

Minority Stress Theory describes the additional stress that members of marginalized communities experience due to stigma.

Stigma and Minority Stress

Stigmatization is driven by imbalances in social, economic, and political power. It also furthers these imbalances by limiting opportunities for stigmatized groups while reducing barriers for socially dominant group.

The Process of Stigma: 1. Labeling: Human differences are identified and labeled. 2. Stereotyping: Labeled differences are linked to undesirable characteristics within the dominant culture. 3. “Othering:” Stigmatized groups and individuals are separated out from the rest of society, creating an “us vs. them” mentality. 4. Discrimination: “Othered” groups and individuals experience discrimination which leads to unequal access to resources.

How is minority stress different?

Minority stress is additional stress that adds to the regular stressors everyone faces. Regular stressors, such as applying for jobs or looking for housing, are also made worse by minority stress.

Minority Stress and Mental Health

People from the LGBTQIA2S+ community are more likely to experience harassment, bullying, discrimination, and even violent hate crimes, such as assault, than cisgender and heterosexual people. Experiencing and witnessing discrimination related to LGBTQIA2S+ identity can lead to feelings of isolation and fear.

LGBTQIA2S+ youth are exposed to harmful rhetoric about their identities through peers, media, and sometimes, family, leading to low self-esteem and internalized homophobia & transphobia.

These experiences lead to hyper-vigilance and increase the risk of depression, anxiety, and suicidal idealization, harming the overall health of romantic, sexual, and gender diverse communities.

Legislation, Location, and Minority Stress

Minority stress is experienced to different degrees depending on geographic location and dominant cultures. Those living in states or countries where LGBTQIA2S+ identity is highly politicized or criminalized are more likely to be impacted by minority stress.

Support from family, peers, educators, and healthcare providers significantly lowers the risk of mental health impacts and suicidal ideation.

Intersectionality

Multiply marginalized members of the LGBTQIA2S+ community, such as people with disabilities, BIPOC, AAPI, Jewish, or Muslim sexual and gender diverse individuals, are more likely to experience minority stress and often experience minority stress for each of their marginalized identities.

Members of the trans & non-binary community are more impacted by minority stress compared to cisgender members of the LGBTQIA2S+ community. Gender Stress Theory, based on Minority Stress Theory, describes the additional stress that gender diverse communities experience due to stigma.

Healthy Coping Strategies/Minimizing Harm

Minimizing the effects of minority stress is important for the mental and physical health of romantic, sexual, and gender diverse communities. Some healthy coping strategies include:

  • Connect with Others: Minority stress can lead to feelings of isolation and make social settings seem overwhelming. However, staying connected with other members of the community and people you trust is important for mental health. Try socializing with small groups in safe environments or joining a community support group to make new friends.
  • Unplug: Social media and news sources are often flooded with content related to anti-LGBTQIA2S+ legislation, leading to constant exposure to minority stress. Be sure to take intentional breaks from social media and news sources. Try putting your phone on silent and curling up with a good book or spending time in nature.
  • Prioritize your Physical Health: Minority stress can be draining, overwhelming, and takes a toll on physical health over time. Try investing in your health by staying hydrated, getting enough sleep, or moving your body in ways that feel good to you. Trying a new healthy recipe can also be a fun way to invest in your physical health.
  • Find a Creative Outlet: Sometimes words aren’t enough. Try finding a creative way to express yourself, whether that is dancing, painting, or playing an instrument. Creativity can help you process the emotions related to minority stress.
  • Talk to a Professional: Identity based discrimination is challenging to process. Be sure to check in with yourself often, and reach out to a mental health professional for support if you are struggling. Resources can be found through the UK Counseling Center or at libguides.uky.edu/LGBTQ/counseling.

https://doi.org/10.1016/j.pcl.2016.07.003

https://doi.org/10.2174/2210676611666211105120645

https://doi.org/10.1080/00918369.2019.1591789

https://doi.org/10.1111/sltb.12856

https://www.apa.org/pi/aids/resources/exchange/2012/04/minority-stress

https://doi.org/10.1016/j.socscimed.2008.03.012

https://stacks.cdc.gov/view/cdc/33691

https://dictionary.apa.org/heterosexism

https://dictionary.apa.org/marginalization

8 apps to thrive as a person with ADHD

8 apps to thrive as a person with ADHD

Written by Eliott Hamilton, Student Informatician

Attention-Deficit/Hyperactivity Disorder (ADHD) affects about 10 million adults. While ADHD comes with many strengths like creative thinking and the ability to hyperfocus on a task, it also leaves many people struggling to navigate a world that was not made for them. 

People with ADHD often struggle to manage time, start or complete tasks, or stay organized. This can affect all areas of life from work and school to relationships and mental health.

Navigating these challenges is frustrating and overwhelming for many people with ADHD and conventional approaches to overcoming these obstacles might not meet the needs of everyone. Smartphone apps can help bridge those gaps. Whether it’s managing tasks or practicing mindfulness, these digital allies can be invaluable in fostering productivity and personal growth.

Note: Apps can be helpful for getting work, chores, homework, and other to-dos done on a daily basis; however, they are not meant to replace help from a mental health care professional.

8 apps to thrive as a person with ADHD

Planta

  • Who it’s best for: Plant lovers who struggle with consistent care routines
  • iOS rating: 4.8
  • Android rating: 4.3
  • Price: 1 month Premium Plant Care for $7.99 or 12 months for $35.99

Planta is a personalized reference tool for creating and tracking plant care routines. Users input their plants to get notifications when it’s time to water, fertilize, and re-pot each plant. Planta includes a photo-based identification tool, a light meter to test light levels in each room, and a diagnosis feature for struggling plants. Planta is a useful tool for those who struggle with object permanence or task management and can help plant parents keep their plants happy and healthy. 

Calm

  • Who it’s best for: People who want to improve their mental health by focusing on mindfulness and minimizing stress
  • iOS rating: 4.8
  • Android rating: 4.4
  • Price: The Calm app is free to download; however, most content is through the paid subscription at $14.99/month or $69.99/year.

People with ADHD tend to experience increased stress levels and burnout. Mindfulness is a powerful tool for mitigating these challenges and promoting self-growth. Calm is a mental health resource that promotes sleep, meditation, and relaxation as tools to live stress-free. Calm offers mindfulness exercises through guided meditations, video lessons on gentle movement, and sessions supporting recovery from burnout. Calm also includes tailored soundscapes and music to support focus, relaxation, or restful sleep. 

Headspace

  • Who it’s best for: People who want science-backed material covering a wide range of mental health topics
  • iOS rating: 4.8
  • Android rating: 4.5
  • Price: Annual: $69.99/year | Monthly: $12.99/month

Headspace is another mindfulness tool designed to provide accessible mental health support. Headspace’s science-based guided meditations, mindfulness exercises, and mental health coaching tools are all designed and facilitated by a team of counselors, psychologists, and social workers. Headspace offers resources to handle a wide range of mental health challenges and to build lasting habits.

Obsidian

  • Who it’s best for: Visual thinkers and learners
  • iOS rating: 4.6
  • Android rating: 4.0
  • Price: free for personal use

Many people with ADHD are visual thinkers and learners who often struggle with traditional note-taking methods that lack visual connections across topics and note sections. Obsidian is a writing app that can be customized for various types of writing, including journaling, note-taking, and project management. Files are stored locally to promote privacy and are non-proprietory, so notes can be accessed outside of the Obsidian app. Users can also create links between notes for easy reference, build diagrams and charts directly onto a text file, and view the connections between linked files in an interactive graph, making it great for anyone who struggles with note organization or forgetfulness.

Habitica

  • Who it’s best for: Game-lovers who want to improve habits or increase productivity when completing tasks
  • iOS rating: 4.0
  • Android rating: 3.8
  • Price: Premium subscription available: $4.99/month | $14.99/three months | $29.99/six months | $47.99/year

Many people with ADHD struggle to maintain adequate dopamine levels, making task management a constant struggle. Habitica is a role-playing game that transforms completing everyday tasks into a dopamine-rich experience by turning them into a game to support habit-building. Users create an avatar, input daily tasks, habits, or to-do lists, then fight to conquer the task “monsters.” Completing tasks gains users in-game rewards to customize and buff their avatars. Habitica also offers a social productivity feature, allowing friends to hold each other responsible or take on monsters in “super accountability mode” where individual users’ activity affect the group as a whole.

Remember the Milk

  • Who it’s best for: Anyone who wants to keep multiple lists in one place
  • iOS rating: 4.7
  • Android rating: 4.4
  • Price: free accounts available; Pro Version available for $49.99/year.

ADHD frequently involves difficulties with memory and object permanence. Maintaining a well-organized list can help overcome these challenges and ensuring nothing is overlooked. Remember The Milk is a shareable, multi-list task-organizer that can sync across devices and calendars. Tasks can be added with due dates, priority rankings, future repetitions, and tags to better support detailed organization. Users can customize notifications to send through email, text, and various mobile apps and delegate by sharing tasks and lists with others. Remember The Milk also includes options for subtasks, breaking down the big tasks into manageable chunks.

Key Ring

  • Who it’s best for: Savings lovers and loyalty card collectors
  • iOS rating: 4.5
  • Android rating: 3.5
  • Price: Free

Many people with ADHD are familiar with the dreaded “ADHD tax,” referring to the financial challenges often paired with ADHD. Key Ring is designed to manage all shopping tools in one place. Users can add loyalty and membership cards without the bulk of physical cards. Key Ring also includes a search function to find local deals. Users can save favorite items and be notified when new sales start.

Clarify ADHD

  • Who it’s best for: People who want to reframe their mindset to view ADHD as a strength and learn to work with their ADHD rather than against it
  • iOS rating: 4.4
  • Android rating: 4.1
  • Price: $40/year for Premium

Clarify introduces thoughtful features designed to nurture the strengths of ADHD minds, shifting the focus from overcoming challenges to promoting inherent capabilities. Clarify is a support app designed for those with ADHD offering personalized strategies for time management, overcoming task avoidance, and maximizing productivity. Clarify guides users in daily, centering activities and in creating immersive to-do lists that fuel focus throughout the day. It features a Deep Work Room where tasks are approached one at a time with a visual timer and ambient music to occupy your phone and promote hyperfocus to achieve tasks. Clarify offers 2-minute audio coaching sessions that highlight the benefits of ADHD, reframing it as a positive asset.


Navigating the world with ADHD can be frustrating, overwhelming, and isolating. While work, school, and extracurricular schedules may not be created with neurodivergence in mind, it is still possible to thrive in all areas by working with ADHD. Embracing a digital toolkit empowers individuals with ADHD to create a personalized approach to their daily lives and highlight the valuable assets that come with neurodivergent thinking and identity. 


For more information and resources on ADHD, visit www.cdc.gov/ncbddd/adhd/index.html or www.chadd.org