Disability is increasingly becoming one of the major health concerns in the world. According to the 2011 World Health Organization, 15% of the world's population has a disability (Vornholt et al., 2018). However, this estimation is considered low because every country has different definitions of disability. Based on WHO's definition, disability consist of impairments, participation restrictions, and activity limitation that result in negative aspects of the interaction between an individual's health condition and contextual factors. In the U.S, approximately 18.7% of the population have disabilities ranging from mild to severe conditions. Consequently, individuals with disabilities comprise the largest percentage of unemployed individuals in the community (Vornholt et al., 2018). Their abilities and health outcomes often depend on their community's social and environmental circumstances ("Disability and Health | Healthy People 2020", 2020). For that reason, Healthy People 2020 recognizes the need for intervention through public health programs that promote health, improve the social and environmental living conditions, and promote community participation of individuals with disabilities of all ages.
Overview, Background, and Significance of the Problem
Background and Significance
Adolescents with disabilities are among the neediest of all the people living with disabilities. In most cases, teenagers with disabilities are associated with poverty, social isolation, and discrimination. According to Graham et al. (2017), approximately 150 million children and adolescents below 18 years live with a disability and face these challenges in their community. Approximately 5.7% of children and adolescents below 18 years have disabilities. The prevalence increased between 2014 and 2016 from 5.76 to 6.99 in 2016. The most common type of disability among American children is Autism Spectrum Disorder, which increased from 3.57% in 2014 to 4.55% in 2016. The prevalence is high among individuals living in low income communities. Asian and Hispanic Latino female children comprise a large percentage of individuals with disabilities ("Disability and Health | Healthy People 2020", 2021). Therefore, it is important to understand the intervention programs that aim at improving the social and environmental circumstances of children and teenagers with disabilities.
Risks of the Disease
Children and adolescents with disabilities experience risks in various aspects of life. For one, they have the risk of failing in education. Byrnes & Muller (2017) mention that professional education in America is regulated through accreditation standards and agencies. The accreditation is based on the idea that one must be competent in areas of future practice for eligibility for a license. However, disabilities prevent an individual student from showing competence in certain aspects of education. This affects their education and licensure for future practice. Also, disability limits the teenager's opportunity to develop relationships (Byrnes &Mulle, 2017). They often experience low self-esteem hence creating social-sexual isolation. In addition, there is a high risk of financial dependence and an underdeveloped career. Children and teenagers develop disabilities before the development of a strong work ethic and education that would support substantial employment. These risks affect the quality of life of an individual as well as the general daily living activities.
Epidemiological Analysis of the Problem
As the American population ages and increases, the percentage of children and teenagers with disabilities increases. The American Community Survey (ACS) estimates that in 2016, less than 1% of children under five years had disabilities. Children aged between 5 and 17 years had a rate of 5.6% (Kraus et al., 2018). This percentage increase as people age; hence age is a factor in the development of disabilities. In addition, poverty is also interlinked with disability. Many children with disabilities come from economically disadvantaged families (Thompson, 2017). Thompson further states that conflicts and accidents may also generate trauma and injuries that may lead to disability in case of delays in obtaining healthcare. Furthermore, based on HP2020, people with disabilities are characterized by risk factors such as inappropriate medications, delays in receiving periodic preventive or primary care, and serious psychological distress. As a result, these children spend less time in the regular education classroom.
Application of HP 2020
In relation to disability issue, Healthy People 2020 has a primary goal of maximizing health, improving environmental and social living conditions, chronic disease prevention, and promotion of full community participation, health equity, choice, and quality of life ("Disability and Health | Healthy People 2020", 2020). Further, there are various objectives under HP2020, including increasing the number of states and tribes that have public health surveillance and promotion programs for individuals with disabilities. It is also meant to increase the number of population-based data systems used to assess and screen people with disabilities. Most importantly, HP2020 aims to increase the number of programs and schools that provide graduate-level studies in disability and health and the number of teenagers with a disability who spend 80% of their time in regular education programs.
The above goals and objectives are meant to reduce the challenges and risks faced by children and teenagers with disabilities. The goal of improving the environmental and social conditions can be effective as it will enhance positive interaction between the disabled children with the contextual factors. Promoting health equity and community participation reduces the discrimination and social isolation experienced by individuals with disabilities. Improving public health surveillance improves the data and thus revealing the number of resources required for intervention. The number of schools will improve the competency of individuals with disabilities and curb the risk of failed education and unemployment. Therefore, the HP2020 objectives and goals are relevant to the disability issue among children below 18 years.
Guidelines and Screening Methods
The guidelines provided by WHO (2011) indicate that screening of individuals with disabilities should be based on evidence. The most relevant screening tool in America is the Ages and Stages Questionnaire (ASQ), which has 30 items focusing on five domains of child development. If the child obtains a score that is lower than the cut-off in any domain, it is considered "screen positive"; otherwise, it is screen negative (Faruk et al., 2020). The validity of the method is that it measures the domains of development such as fine motor, personal-social, problem-solving, gross motor, and communication, which are the aspects that show the presence of risk of disability. It can, therefore, be used on children and teenagers to identify a wide range of disabilities.
Population-Level Planning Interventions
In order to reduce the challenges faced by children and teenagers with disabilities, various interventions are being adopted at a population level. For one, HP2020 suggests providing them with more health services, vaccination,and psychological support ("Disability and Health | Healthy People 2020", 2020). Hinton et al. (2017) also report that Task Force-recommended interventions from The Community Guide are applied to individuals with disabilities. Providing training for caregivers and people who interact with this population would also be effective. Besides, assuring physical accessibility in institutions is also effective. Most importantly, involving people with disabilities in the planning for population-level interventions reduces the barrier to community participation (Hinton et al., 2020). The task force assigned to work on implementing these interventions tracks the outcomes by continuously assessing the groups involved. Therefore, the effectiveness of such programs enhanced through increased interaction of the stakeholders involved in the programs.
The public health programs and interventions provided by the HP2020 would be effective in reducing the challenges faced by children and teenagers with disabilities. Approximately 150 million children and adolescents have disabilities in America. These people often face discrimination, social isolation, and poverty. As a result, they die prematurely, fail to complete education, and become unemployed, among other impacts. For that reason, the goals and objectives outlined by HP2020, such as increasing schools, maximizing their health, and increasing programs can be effective in helping minimize the challenges. In addition, intervention strategies such as training people who interact with these children, providing psychological support, and improving physical accessibility can significantly improve their quality of life.
Byrnes, J. F., & Muller, J. L. (Eds.). (2017). Bioarchaeology of impairment and disability: Theoretical, ethnohistorical, and methodological perspectives. Springer.
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Faruk, T., King, C., Muhit, M., Islam, M.K., Jahan, I., ulBaset, K., Badawi, N. and Khandaker, G., (2020). Screening tools for early identification of children with developmental delay in low-and middle-income countries: a systematic review. BMJ Open, 10(11), p.e038182.
Graham, N., Schultz, L., Mitra, S., & Mont, D. (2017). Disability in Middle Childhood and Adolescence.
Hinton, C. F., Kraus, L. E., Richards, T. A., Fox, M. H., & Campbell, V. A. (2017). The guide to community preventive services and disability inclusion. American journal of preventive medicine, 53(6), 898-903.
Kraus, L., Lauer, E., Coleman, R., and Houtenville, A. (2018). 2017 Disability Statistics Annual Report. Durham, NH: University of New Hampshire. Retrieved from https://disabilitycompendium.org/sites/default/files/user-uploads/2017_AnnualReport_2017_FINAL.pdf
Thompson, S. (2017). Disability prevalence and trends.
Vornholt, K., Villotti, P., Muschalla, B., Bauer, J., Colella, A., Zijlstra, F., Van Ruitenbeek, G., Uitdewilligen, S. and Corbiere, M., (2018). Disability and employment–overview and highlights. European journal of work and organizational psychology, 27(1), pp.40-55.