Rural disability, self-reliance, and the utilization of mental health services.

Background: The intersection of rurality, disability, self-reliance values, and utilization rates of mental health services (MHS) is under-researched.

Objective: To better understand the differences between unmet need and no perceived need for MHS between noncore, micropolitan, and metropolitan adults with disabilities.

Methods: We conducted logistic regression analyses of the 2022 National Survey on Health and Disability (NSHD) to identify associations between demographic characteristics and odds of reporting unmet need for MHS or no perceived need for MHS.

"Too few, too far away, for what is paid": Consumer voices about the personal assistance worker crisis.

Background: The growing gap between demand and supply of personal assistance service (PAS) workers presents a significant burden to those who use services. The intensity and duration of hardship is growing, and consumer voices need to be heard and incorporated into the national dialogue.

Objective: This paper explores how PAS worker shortages manifest themselves in the daily lives of people with disabilities using or needing PAS services in the United States.

Counting everyone: evidence for inclusive measures of disability in federal surveys.

The US Census Bureau has used the American Community Survey six-question set (ACS-6) to identify disabled people since 2008. In late 2023, the Census Bureau proposed changes to these questions that would have reduced disability prevalence estimates by 42%. Because these estimates inform funding and programs that support the health and independence of people with disabilities, many disability researchers and advocates feared this change in data collection would lead to reductions in funding and services.

The hidden crisis: Long COVID's association with housing stability and home accessibility among people with disabilities.

Background: The COVID-19 pandemic has given rise to the emerging phenomenon known as Long COVID, characterized by persistent symptoms long after the acute infection has passed. However, the relationship of Long COVID on housing stability and home accessibility remains underexplored.

Objective: This manuscript aims to comprehensively examine the association of Long COVID on housing stability and accessibility, identifying challenges faced by people with Long COVID and potential strategies to address them.

Vocational Rehabilitation Service Receipt, Service Expenditures, and Ruralness.

Background: An important factor embedded within Vocational Rehabilitation (VR) delivery capacity relates to geography, such as distance from the VR office and availability of service providers or community rehabilitation programs.

Objective: We explored receipt of VR job search and placement services based on distance to an urban center, demographic, and disability variables after controlling for local employment conditions.

Methods: Using 2015 RSA-911 case services data, we used probit to produce estimates for each combination of service and service source (agency and purchased), and Ordinary Least Squares (OLS) and semi-parametric regression to estimate log expenditures for each service category.

"Everything is a Mess. I'm Just Trying to Survive It.": Impacts of COVID-19 on Personal Assistance Services.

In the United States, eight million people have disabilities related to self-care (having serious difficulty with bathing and dressing). Of these, approximately 2.3 million receive paid personal assistance services (PAS) to assist with activities of daily living.

Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy.

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18-64, uses both question sets and contains other disability questions.

Transportation Patterns of Adults With Travel-Limiting Disabilities in Rural and Urban America.

Introduction: Lack of transportation is a significant barrier to community participation for many disabled adults. Living in a rural area introduces additional transportation barriers, such as having to travel long distances to access services or socialize, and limited public transit options. While the importance of transportation access is clear, the mix of different transportation options used by people with disabilities to participate in their communities is less understood, particularly among those who do not or cannot drive.

Examining rural-urban disparities in perceived need for health care services among adults with disabilities.

Purpose: The purpose of this study is to parse out differences between unmet need and perceived need for health care services among rural and urban adults with disabilities in the United States. While unmet need focuses primarily on environmental factors such as access to health insurance or provider availability, perceived need relates to personal choice. This distinction between unmet and perceived need is largely ignored in prior studies, but relevant to public health strategies to improve access and uptake of preventive care.

Events Across the Life Course Contribute to Higher Mobility Impairment Rates in Rural U.S.

Purpose: This paper investigates how life events such as injuries, health insurance coverage, geography, and occupation contribute to mobility disability rates over time. Findings can inform policies and practices to address factors that may contribute to disability in rural and urban areas.

Methods: We utilized 27 waves of the National Longitudinal Survey of Youth (NLSY) data from 1979 to 2016 to explore how past injury, occupation, health insurance coverage, and rurality predicted mobility impairment at ages 40 and 50 using regression analysis.

COVID-19 vaccination hesitancy among Americans with disabilities aged 18-65: An exploratory analysis.

Background: It is important for people with disabilities to be vaccinated against COVID-19 because, as a group, they are at increased risk of severe outcomes. While there are multiple vaccines available to prevent COVID-19, a considerable proportion of Americans report some hesitancy to becoming vaccinated, including people with disabilities.

Objective: We conducted a study to explore what factors may contribute to COVID-19 vaccination hesitancy among Americans with disabilities.

Reaching people with disabilities to learn about their experiences of social connection and loneliness.

Background: People with disabilities experience higher rates of social isolation and loneliness than people without disabilities, but there is limited information about how these conditions are manifested in people with specific types of disabilities.

Objectives: Using data collected as part of the second administration of the National Survey on Health and Disability (n = 2,132), our objectives were to determine if disability type and recruitment method added explanatory power to observed levels of social connectedness, after controlling for socio-demographic and environmental indicators.

Methods: We used hierarchical regression to evaluate how socio-demographic, disability, environmental, and recruitment type explained four outcome variables for different dimensions of social connectedness, including satisfaction with social activity, quantity of social connections, quality of social connections, and loneliness.

A cross-sectional analysis of trust of information and COVID-19 preventative practices among people with disabilities.

Background: Trust of information shapes adherence to recommended practices and speed of public compliance during public health crises. This is particularly important for groups with higher rates of high-risk health conditions, including those aged 65 and over and people with disabilities.

Objective: We examined trust in information sources and associated adherence to COVID-19 public health recommendations among people with disabilities living in metropolitan, micropolitan, and noncore counties.

Evaluating MTurk as a recruitment tool for rural people with disabilities.

Background: Recruitment of people with disabilities often occurs through disability organizations, advocacy groups, service providers, and patient registries. Recruitment that relies exclusively on established relationships can produce samples that may miss important information. The MTurk online marketplace offers a convenient option for recruitment.

Vocational Rehabilitation (VR) funding of job development and placement services: Implications for rural reach.

Background: Results-based funding models can improve Vocational Rehabilitation (VR) client employment outcomes, but evidence suggests that gaps in services occur when provider risk is not compensated.

Objective: The purpose of this qualitative study is to learn how VR agencies deliver and pay for job development and placement services, the factors that shape decision-making, and the outcomes of such decisions.

Methods: Administrators from 40 VR agencies identified informants to take part in qualitative interviews about how their agency delivers, contracts, and pays for job development services.

The Effect of Ruralness on Vocational Rehabilitation Applications.

Background: Most of the literature on evaluating vocational rehabilitation (VR) programs has taken application to the VR program as given despite the obvious selection issues associated with the decision to apply.

Objective: In this paper, we focus on the decision to apply for VR services and, in particular, on the effect of ruralness on that decision.

Methods: We use ordinary least squares with and without state-specific fixed effects along with maximum likelihood estimation (MLE) to estimate models of the application decision.

Differences in social connectedness and perceived isolation among rural and urban adults with disabilities.

Background: Social isolation has been compared to smoking in terms of risk to public health. Some groups are at particularly high risk for these feelings, including people with disabilities and rural residents. Few studies have considered the potentially compounding effects of disability status and rural residency.

Underrepresentation of adolescents with respiratory, mental health, and developmental disabilities using American Community Survey (ACS) questions.

Background: Disability prevalence estimates are used to identify populations, establish priorities and allocate funding for a broad range of federal, state, and local initiatives. Increasingly, these estimates are based on a set of six questions developed and tested for use in the American Community Survey (ACS). A key assumption about the ACS disability screeners is that they sufficiently capture the entire population of people with disabilities, but some studies indicate that certain disability groups are underrepresented.

Vocational Rehabilitation Agency Guidance on Social Media Use: A Policy Analysis.

Given vocational rehabilitation's (VR) substantial role in workforce development, it follows that agencies would encourage and support consumers using the most current job-seeking methods, including social media. Recent data, however, show that online strategies are limited in VR practice and that many agencies lack comprehensive policies to guide social media use. We conducted a qualitative analysis to examine current VR social media policies and procedures and offer recommendations for policy development.

Why stay home? Temporal association of pain, fatigue and depression with being at home.

Background: Community participation is important to most people with disabilities despite the fact that common secondary conditions like pain, fatigue and depression may increase the difficulty of leaving home. Despite decades of research on these secondary conditions, little is known about how they are associated with being at home.

Objective: We used Ecological Momentary Assessment data to examine within subject fluctuation in these secondary conditions to examine their effect on the likelihood that participants remain at or return home.

An investigation into the temporal scaling of community participation measurement.

Purpose: Community participation remains fundamental to contemporary models of disability. However, the effect of temporal scaling on the measurement of participation has not been explored. This study examined the similarities and differences between two different temporal scales (i.