The Issue
Limited access to quality dental care for people with disabilities can have serious consequences, leading not only to oral diseases but chronic conditions including diabetes and heart disease. Unfortunately, significantly smaller percentages of people with disabilities are accessing that care than their counterparts without disabilities. A CDS study on health disparities, made possible by a grant from the Centers for Disease Control and Prevention, showed 41 percent of Delawareans with disabilities reporting either never having seen a dentist or having had their last visit more than a year earlier, compared with just 27 percent of people without disabilities.

Until 2019, Delaware was also one of only three states that did not provide Medicaid dental benefits to adults with disabilities who are more than 21 years old. That’s finally about to change, with Gov. John Carney signing Sen. Bryan Townsend’s bill extending dental coverage to adult Medicaid recipients.

Our Interventions
Myriad factors affect oral health: demographic, including age, race/ethnicity and gender; social and economic, including education, employment, insurance and income; one’s physical environment, including housing, recreational opportunities, transportation, geography and safety; one’s health behaviors, including one’s smoking and drinking habits and fruit and vegetable consumption; access to quality health care in which providers have linguistic and cultural competency; and other factors, including genetics and health literacy.

CDS is aiming to improve access to quality oral health care and services for people with disabilities by cultivating cultural competency related to disability among dental professionals in Delaware. To that end, the Center developed disability cultural competency trainings for dental professionals based on best practices and two surveys: one of people with disabilities, the other of dentists.

The Survey – Patients
In 2016, CDS developed and conducted a dental care survey to determine the oral health needs of Delawareans with disabilities. Some 173 adults with disabilities and 113 parents of individuals ages 6 to 49 with disabilities participated in the survey. Parents of children with disabilities completed the surveys to relate their experience with access to dental care for their children with disabilities. Parents of adults with disabilities participated in cases where an adult child with a disability could not fill out the survey because of cognitive or functional limitations.

The findings of the survey guided the development of disability cultural competency trainings for dental professionals in Delaware, which aim to help them become more sensitive to the needs and preferences of patients with disabilities.

The Survey – Dentists
In collaboration with the Delaware State Dental Society (DSDS), CDS in 2016 conducted a survey of dentists to determine their current capacity and needs regarding patients with disabilities. The survey reached out to 351 dentists who had active Delaware licenses and provided dental care to patients and who could be accessed through DSDS. Some 171 dentists participated in the survey through an electronic or paper format.

The dentists reported patient behavior as being the greatest barrier to providing dental care to patients with disabilities. They also reported it is most important for dental professionals to know about behavior management. The findings of the dentist survey, coupled with those of the patient survey, guided the development of disability cultural competency trainings.

The Trainings
A CDS analysis of its dental survey data suggested an effective way to promote oral health equity in Delaware would be to offer the dental workforce training in individualized care and disability awareness. Supported by a grant from the U.S. Health Resources and Services Administration (HRSA), CDS and the Delaware Bureau of Oral Health and Dental Services partnered to develop and host four such training sessions, which took place across the state between January 2018 and June 2018.

Accessible, open-captioned videos of each session can be found here. The trainings were presented by three health care professionals who specialize in supporting patients with disabilities. They covered four main topics: a summary of significant findings from the oral health surveys administered to dentists and people with disabilities; general considerations for all dental professionals to accommodate people with disabilities; specific strategies for planning and administering care; and disability awareness and sensitivity. The dental staff who attended these sessions completed pre- and post-training surveys. Access the evaluation of their responses here to learn how they say the experience changed them.

For further information about the oral health project, contact Beth Mineo at mineo@udel.edu.

https://www.cds.udel.edu/health/oral-health/?fbclid=IwAR2zPlod24v-yZk3WHYcGBMkrpiJ5kmKIbCyn9lNQ0cAEcSSGsEWI5ZRQvw

CDS Instructional Coach Megan Pell and other education specialists at the Women’s Leadership Conference Delaware warned that particular groups of female students are being disproportionately targeted for out-of-school suspensions and expulsions. Pell and her fellow panelists were hosted by UD’s Delaware Academy for School Leadership and Partnership for Public Education Jan. 24 at Dover Downs.

A member of the Delaware Positive Behavior Support Project, Pell said rates of exclusionary discipline – punishments that remove students from class – “[are] up tremendously” among certain groups of female students, notably African Americans. A 2018 Government Accountability Office report on discipline disparities, for example, found that “Black girls were suspended from school at higher rates than boys of multiple racial groups and every other racial group of girls.”

Several panelists expressed hope that a recent bill signed into law by Gov. John Carney could help reverse those trends. Sponsored by former Senate Majority Leader Margaret Rose Henry, the legislation requires yearly reports from Delaware schools on disciplinary practices. It mandates schools that regularly exceed thresholds on suspension or expulsion rates take action to change their approach.

Pell said this reflects a growing belief among educators that restorative practice, which emphasizes group communication and consideration of the sources of behavior, offers a more effective way to discipline and rehabilitate students than suspension or expulsion. Here too, the panel identified a gender difference, this time among school administrators: females are more likely to apply such joint problem-solving strategies.

However, between an increasing statewide commitment to analyzing school data and the scrutiny of disciplinary practices stemming from Sen. Henry’s bill, those gender gaps may close, said Pell.

Spectrum Scholars, a joint effort by CDS and JPMorgan Chase to make the college-to-career path more accessible for UD students with autism, held its first community training session last week in collaboration with UD Residence Life & Housing. More than 20 resident assistants (RAs) gathered in Purnell Hall to hear Vincent Varrassi, a specialist in postsecondary education for young adults with disabilities, discuss challenges facing college students with autism.

The session marks the beginning of a multi-year series of autism acceptance training's the recently-launched Spectrum Scholars will offer to UD faculty, staff and students and local employers. The program also provides coaching, mentoring and internship opportunities to participating UD students with autism pursuing degrees in computer and information sciences and electrical and computer engineering.

Varrassi explained to the RAs that certain characteristics of autism, such as difficulty interpreting nonverbal communication, reluctance to initiate conversations, repetitive behaviors and heightened sensitivity to noise and touch, present social and academic barriers to college success for students with autism.

Showing these students empathy, Varrassi said, is vital, particularly in situations where RAs and residents with autism are at risk of misunderstanding each other. He emphasized the need for flexibility and a willingness to listen because finding the best supports for each individual requires asking “questions we need to think about as a community.”

This “glimpse into the life of people with autism … will help me be more empathetic and understanding when I see behavior that might at first seem troubling,” said Corey Moore, an RA in James Smith Hall.*

Sam, an autistic UD student, and Spectrum Scholars ambassador showed the RAs the difference between person-first (“student with autism”) and identity-first (“autistic student”) language. Agreeing with Varrassi about the importance of understanding an individual’s preferences, she encouraged RAs to ask residents with autism which they preferred rather than guess and risk causing offense.

If the RAs in attendance left the session with “a better understanding of what it means to be autistic,” Sam said, “that knowledge means that they can adapt their own behavior. They’ll hopefully recognize issues … and be more prepared to act on those issues if need be.”

*Corey Moore spoke as an individual student for this dispatch, not as a representative of Residence Life & Housing.

As Election Day in November approaches, the University of Delaware’s Center for Disabilities Studies is talking about civic engagement in the disability community.

In a panel to mark the Center’s 25th anniversary Tuesday, national experts discussed barriers to voting for people with disabilities. Those barriers include polling places that are not ADA-compliant or polling place workers who are unfamiliar with accessible ballot-casting technology.

Michelle Bishop is a voting rights specialist with the National Disability Rights Network. She says across the country, voter participation among disabled people tends to lag behind that of non-disabled people by about six percent.

“That six percent is about an extra three million voters … that’s enough voters to turn any election we’ve ever had in the United States. ”

Delaware Attorney General Matt Denn joined the discussion. He notes that in the First State, disability rights don't tend to factor into candidates’ platforms.

“I’ve run for statewide office a bunch of times and it’s been pretty rare that I’ve been asked questions that are specific to that community and it's needs,” he said. “As much as there is a need to make sure that polling places are accessible … there’s an equally compelling need to make sure that people are asked the right questions when they run and are held accountable.”

Beth Mineo is director of the Center for Disability Studies. She hopes the programming will spark dialog to“galvanize” the community.

“When you’re talking about the disability community, we have so far yet to go. Obviously, civic engagement is going to be the thing that eventually changes policy.”

In addition to inaccessibility of polling places, Bishop says state-level voter competency laws can disenfranchise citizens with mental disabilities.

Some states bar voting for individuals under guardianship who have been deemed generally incompetent by a court.

As of 2016, Delaware was one of 25 states with laws barring voting only if a court has determined that an individual specifically lacks the capacity to vote, according to the Bazelon Center for Mental Health Law, the Autistic Self-Advocacy Network and the National Disability Rights Network.

Bishop adds that if more people with disabilities were included in decision-making processes surrounding elections, there would likely be fewer accessibility issues.

Other panelists included representatives from the International Foundation for Electoral Systems, the American Association of People with Disabilities and Stanford Law School.