Purpose/Objective: Health care providers’ attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers’ clinical decision making, less research has focused on providers’ attitudes about disability. The aim of this study was to examine providers’ explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people’s explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna’s (2008) model of two-dimensional prejudice to compare provider’s explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers’ explicit and implicit attitudes. Results: While on average, provider’s explicit attitudes (M = 4.41) indicated little prejudice, their implicit attitudes (M = 0.54) revealed they moderately preferred nondisabled people—they were aversive ableists. Correlates of providers’ explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability). Conclusions/Implications: This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study’s findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities.

Telehealth use rapidly expanded during the COVID-19 pandemic. Understanding if, and how, people from disabilities used telehealth during the pandemic is vital to assuring this evolving and increasingly common form of health care is equitably developed and delivered to avoid reproducing the health disparities people with disabilities already face. Our aim was to explore the use of telehealth among people with disabilities during the pandemic. We conducted a weighted secondary analysis of United States Census Bureau data (April-July 2021) from 38,512 (unweighted) people with disabilities. Our findings revealed 39.8% of people with disabilities used telehealth during the second year of the pandemic, ranging from 34.5% of people with hearing disabilities to 43.3% of people with mobility disabilities. There were also differences in telehealth use based on sociodemographics. Telehealth promises to open doors to more equitable health care access for many people with disabilities, but only if access barriers are removed.

Article 25 of the Convention on the Rights of Persons with Disabilities recognizes that people with disabilities (PWD) have the right to the "highest attainable standard of health without discrimination on the basis of disability." 1 Yet, according to the World Report on Disability, 2 PWD experience structural, 3,4 financial, 5,6 cognitive/knowledge, 7,8 attitudinal, 9 and physical barriers, 10,11 to preventive, 12-14 primary, 15 and specialty care. 16 Adults with physical disabilities are at higher risk of foregoing or delaying necessary care, 5 having unmet medical, dental, and prescription needs compared with adults without disabilities. 17,18 In the United States, PWD have higher rates of risky health behaviors, including smoking, drinking, obesity, and sedentary lifestyles. 19 The health and well-being of PWD are directly related to the availability of appropriate health care services. 20 Lack of timely access to primary and preventive care can result in the development of chronic and secondary conditions as well as the exacerbation of the disabling condition itself, 21-23 resulting in poorer health outcomes for PWD. 4,9,24,25 Now that the existence and some of the underlying causes of health care disparities have been established, the challenge lies in developing, implementing, and sustaining effective strategies to eliminate health disparities in community and clinical settings. 26 Confronted with multiple barriers to care and a fragmented health care system, PWD benefit from supportive resources to effectively coordinate care and access health care services, public benefit programs, legal rights, and their health condition. 27 A growing body of research suggests that peer health navigator (PHN) interventions are a promising communitydirected approach to breaking down barriers to care for people from underserved communities and therefore empowering them to navigate a complex health care system more successfully. Peer health navigators (PHN) are people from the target community who have received specialized training to provide culturally appropriate services and supports. Peer health navigators' focus is on helping people navigate the complex and often fragmented health care delivery systems. This differentiates them from other peer interventionists, such as community

Current revisions to the accreditation standards for occupational therapy (OT) education include proposed changes to experiential learning. The AOTA Fieldwork/Experiential Learning Ad Hoc Committee recommends that fieldwork Level I experiences be replaced with a new model of experiential education that includes the use of standardized patients and simulation (AOTA, 2017). The purpose of this article is to present critical perspectives about standardized patient simulation and disability simulation to support informed decision-making about the integration of experiential learning in OT professional education. In standardized patient simulation, actors play the roles of clients and important others in therapeutic scenarios; in disability simulation, students act out impairments in a variety of settings. While these forms of simulation are commonly used within OT education, they are critiqued for failing to present participants with authentic lived experiences of disability. This paper presents alternative approaches that would more fully align the OT curriculum with perspectives and priorities of intersectional disability communities. Recommendations to be considered by educators and educational programs include becoming familiar with relevant literature across fields and communities; developing long-term partnerships with disability organizations and community members; involving people with disabilities in the development, implementation, and evaluation of experiential learning opportunities; and providing experiential learning opportunities that take place outside educational and clinical settings and that attend to multiple intersecting dimensions of people with disabilities' lived experiences. Together, these recommendations can help ensure that students have access to evidence-based educational approaches and best practices that accurately reflect the self-identified needs, concerns, and priorities of intersectional disability communities.ABSTRACT Current revisions to the accreditation standards for occupational therapy (OT) education include proposed changes to experiential learning. The AOTA Fieldwork/Experiential Learning Ad Hoc Committee recommends that fieldwork Level I experiences be replaced with a new model of experiential education that includes the use of standardized patients and simulation (AOTA, 2017). The purpose of this article is to present critical perspectives about standardized patient simulation and disability simulation to support informed decision-making about the integration of experiential learning in OT professional education. In standardized patient simulation, actors play the roles of clients and important others in therapeutic scenarios; in disability simulation, students act out impairments in a variety of settings. While these forms of simulation are commonly used within OT education, they are critiqued for failing to present participants with authentic lived experiences of disability. This paper presents alternative approaches that would more fully align the OT curriculum with pe...

Purpose:Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.Method:This study examined how states utilized waivers to provide for people with BI.Results:Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.Conclusions:Of those waivers for people with BI, there were vast differences across states and services.

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OBJECTIVE. This qualitative study explored occupational therapy practitioners’ perspectives about integrating principles from the field of disability studies (DS) into clinical education and practice. METHODS. After a conference presentation about DS, three simultaneous focus groups were conducted with 27 occupational therapy practitioners. A constant comparative, grounded-theory approach was used to identify themes across groups. RESULTS. Identified themes included convergences and divergences between the profession of occupational therapy and the field of disability studies, influence of perspectives of disability on service delivery, clinician navigation of systemic barriers, and incorporation of DS-aligned intervention strategies into practice. CONCLUSION. Despite points of alignment, occupational therapy has not fully addressed DS critiques. Practitioners recognized professional, systemic, and societal barriers and the need for more educational experiences, resources, and professional reflexivity and dialogue to inform the integration of DS concepts into practice.

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