NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
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Armin, Julie S; Williamson, Heather J; Rothers, Janet; Lee, Michele S; Baldwin, Julie A JMIR Research Protocols, 12 (e37801), 2023. @article{Armin2023, title = {An adapted cancer screening education program for Native American women with intellectual and developmental disabilities and their caregivers: Protocol for feasibility and acceptability testing}, author = {Julie S Armin and Heather J Williamson and Janet Rothers and Michele S Lee and Julie A Baldwin }, url = {https://www.researchprotocols.org/2023/1/e37801}, doi = {10.2196/37801}, year = {2023}, date = {2023-02-13}, journal = {JMIR Research Protocols}, volume = {12}, number = {e37801}, abstract = {Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC. |
Armin, Julie S; Williamson, Heather J; Begay, Andria; Etcitty, Jennifer; Attakai, Agnes; Russell, Kim; Baldwin, Julie A Adapting a Cancer Screening Education Program for Native American Women with Disabilities Journal Article Int J Environ Res Public Health, 19 (15), 2022. @article{Armin2022, title = {Adapting a Cancer Screening Education Program for Native American Women with Disabilities}, author = {Julie S. Armin and Heather J. Williamson and Andria Begay and Jennifer Etcitty and Agnes Attakai and Kim Russell and Julie A. Baldwin}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9368495/}, doi = {10.3390/ijerph19159280}, year = {2022}, date = {2022-07-29}, journal = {Int J Environ Res Public Health}, volume = {19}, number = {15}, abstract = {Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, “What are the influences on breast and cervical cancer screening for Native American women with IDD?” with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, “What are the influences on breast and cervical cancer screening for Native American women with IDD?” with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD. |
Tomasa, Lynne; Williamson, Heather J Springer, 2021, ISBN: 978-3-030-81276-8. @book{Tomasa2022, title = {Belonging and inclusion during the aging process for individuals with intellectual and developmental disabilities}, author = {Lynne Tomasa and Heather J Williamson}, url = {https://link.springer.com/chapter/10.1007/978-3-030-81277-5_8}, doi = {10.1007/978-3-030-81277-5_8}, isbn = {978-3-030-81276-8}, year = {2021}, date = {2021-11-28}, booktitle = {Engaging communities to foster belonging for individuals with intellectual and developmental disabilities}, publisher = {Springer}, abstract = {Future planning is a person-family-centered process that involves ongoing communication and an understanding of the person with a disability, their family, and the supports needed to have a meaningful quality of life. Individual characteristics, interpersonal relationships, family roles, service systems, policies, and societal factors can impact planning for the future. This chapter highlights the importance of promoting future planning and how to support individuals with an intellectual and developmental disability (IDD) and their families. The chapter begins with an overview of the issues faced by a society that is aging followed by a review of research regarding planning domains, role of family members, relationships, and planning strategies. The chapter also uses four family stories to illustrate how a planning tool can be used to facilitate communication about their futures. Lastly, future planning is discussed using the ten dimensions of Carter’s (2016) belonging framework as well as how resilience can be enhanced through the future planning process. The chapter concludes with discussion questions, tools, and resources for individuals with IDD and their families which can support future planning.}, keywords = {}, pubstate = {published}, tppubtype = {book} } Future planning is a person-family-centered process that involves ongoing communication and an understanding of the person with a disability, their family, and the supports needed to have a meaningful quality of life. Individual characteristics, interpersonal relationships, family roles, service systems, policies, and societal factors can impact planning for the future. This chapter highlights the importance of promoting future planning and how to support individuals with an intellectual and developmental disability (IDD) and their families. The chapter begins with an overview of the issues faced by a society that is aging followed by a review of research regarding planning domains, role of family members, relationships, and planning strategies. The chapter also uses four family stories to illustrate how a planning tool can be used to facilitate communication about their futures. Lastly, future planning is discussed using the ten dimensions of Carter’s (2016) belonging framework as well as how resilience can be enhanced through the future planning process. The chapter concludes with discussion questions, tools, and resources for individuals with IDD and their families which can support future planning. |
Lee, Michele S; Peart, Jillian R; Armin, Julie S; Williamson, Heather J Journal of Health Disparities Research and Practice, 14 (3), 2021. @article{Lee2021c, title = {A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act}, author = {Michele S. Lee and Jillian R. Peart and Julie S. Armin and Heather J. Williamson}, url = {https://digitalscholarship.unlv.edu/jhdrp/vol14/iss3/2 }, year = {2021}, date = {2021-10-01}, journal = {Journal of Health Disparities Research and Practice}, volume = {14}, number = {3}, abstract = {Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. |
Abdul-Chani, Monical; Moreno, Christopher P; Reeder, Julia A; Zuckerman, Katherine; Lindly, Olivia Perceived community disability stigma in multicultural, low-income populations: Measure development and validation Journal Article Research in Developmental Disabilities, 115 , 2021. @article{Abdul-Chani2021, title = {Perceived community disability stigma in multicultural, low-income populations: Measure development and validation}, author = {Monical Abdul-Chani and Christopher P Moreno and Julia A Reeder and Katherine Zuckerman and Olivia Lindly}, url = {https://doi.org/10.1016/j.ridd.2021.103997}, doi = {10.1016/j.ridd.2021.103997}, year = {2021}, date = {2021-05-29}, journal = {Research in Developmental Disabilities}, volume = {115}, abstract = {Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities. |
Kumar, Amit; Rivera-Hernandez, Maricruz; Karmarkar, Amol M; Chou, Lin-Na; Kuo, Yong-Fang; Baldwin, Julie A; Panagiotou, Orestis A; Burke, Robert; Ottenbacher, Kenneth J Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults Journal Article Journal of the American Geriatrics Society, 00 (00), pp. 1-8, 2019. @article{Kumar2019, title = {Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults}, author = {Amit Kumar and Maricruz Rivera-Hernandez and Amol M. Karmarkar and Lin-Na Chou and Yong-Fang Kuo and Julie A. Baldwin and Orestis A. Panagiotou and Robert Burke and Kenneth J. Ottenbacher}, url = {https://doi.org/10.1111/jgs.16202}, doi = {10.1111/jgs.16202}, year = {2019}, date = {2019-10-19}, journal = {Journal of the American Geriatrics Society}, volume = {00}, number = {00}, pages = {1-8}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Williamson, Heather J; Fisher, Kim W; Madhavni, Devanshi; Talarico, Lori Inclusion, 7 (1), pp. 24-40, 2019. @article{Williamson2019, title = {#ADA25 Campaign: Using Social Media to Promote Participation, Social Inclusion, and Civic Engagement of People With Intellectual and Developmental Disabilities}, author = {Heather J Williamson and Kim W Fisher and Devanshi Madhavni and Lori Talarico}, url = {https://www.mdpi.com/1660-4601/16/1/44}, doi = {10.3390/ijerph16010044}, year = {2019}, date = {2019-03-01}, journal = {Inclusion}, volume = {7}, number = {1}, pages = {24-40}, abstract = {Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks. |
Teufel-Shone, Nicolette I; Schwartz, Anna L; Hardy, Lisa J; Heer, Hendrik De D; Williamson, Heather J; Dunn, Dorothy J; Polingyumptewa, Kellen; Chief, Carmenlita Supporting New Community-Based Participatory Research Partnerships Journal Article International Journal of Environmental Research and Public Health, 16 (1), pp. 44, 2019. @article{Teufel-Shone2019, title = {Supporting New Community-Based Participatory Research Partnerships}, author = {Nicolette I Teufel-Shone and Anna L Schwartz and Lisa J Hardy and Hendrik De D Heer and Heather J Williamson and Dorothy J Dunn and Kellen Polingyumptewa and Carmenlita Chief}, url = {https://www.mdpi.com/1660-4601/16/1/44/htm}, year = {2019}, date = {2019-01-01}, journal = {International Journal of Environmental Research and Public Health}, volume = {16}, number = {1}, pages = {44}, abstract = {Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline. |
Williamson, Heather J; Perkins, Elizabeth A; Massey, Oliver T; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Levins, Bruce L Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports Journal Article Journal of Policy and Practice in Intellectual Disabilities, 15 (3), pp. 214-225, 2018. @article{Williamson2018, title = {Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports}, author = {Heather J Williamson and Elizabeth A Perkins and Oliver T Massey and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Bruce L Levins}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jppi.12258}, year = {2018}, date = {2018-08-24}, journal = {Journal of Policy and Practice in Intellectual Disabilities}, volume = {15}, number = {3}, pages = {214-225}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS. |
Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review Journal Article OTJR: Occupation, Participation and Health, 37 (4), pp. 227-236, 2017. @article{Williamson2017b, title = {Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review}, author = {Heather J Williamson and Graciela M Contreras and Erica S Rodriguez and Jennifer M Smith and Elizabeth A Perkins}, url = {http://journals.sagepub.com/doi/abs/10.1177/1539449217714148}, year = {2017}, date = {2017-07-13}, journal = {OTJR: Occupation, Participation and Health}, volume = {37}, number = {4}, pages = {227-236}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment. |
Williamson, Heather J; Perkins, Elizabeth A; Levin, Bruce L; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Massey, Oliver T Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas Journal Article Intellectual and Developmental Disabilities, 55 (2), pp. 84-96, 2017. @article{Williamson2017b, title = {Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas}, author = {Heather J Williamson and Elizabeth A Perkins and Bruce L Levin and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Oliver T Massey}, url = {http://www.aaiddjournals.org/doi/10.1352/1934-9556-55.2.84}, year = {2017}, date = {2017-04-01}, journal = {Intellectual and Developmental Disabilities}, volume = {55}, number = {2}, pages = {84-96}, abstract = {Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs. |
2023 |
Armin, Julie S; Williamson, Heather J; Rothers, Janet; Lee, Michele S; Baldwin, Julie A JMIR Research Protocols, 12 (e37801), 2023. @article{Armin2023, title = {An adapted cancer screening education program for Native American women with intellectual and developmental disabilities and their caregivers: Protocol for feasibility and acceptability testing}, author = {Julie S Armin and Heather J Williamson and Janet Rothers and Michele S Lee and Julie A Baldwin }, url = {https://www.researchprotocols.org/2023/1/e37801}, doi = {10.2196/37801}, year = {2023}, date = {2023-02-13}, journal = {JMIR Research Protocols}, volume = {12}, number = {e37801}, abstract = {Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC. |
2022 |
Armin, Julie S; Williamson, Heather J; Begay, Andria; Etcitty, Jennifer; Attakai, Agnes; Russell, Kim; Baldwin, Julie A Adapting a Cancer Screening Education Program for Native American Women with Disabilities Journal Article Int J Environ Res Public Health, 19 (15), 2022. @article{Armin2022, title = {Adapting a Cancer Screening Education Program for Native American Women with Disabilities}, author = {Julie S. Armin and Heather J. Williamson and Andria Begay and Jennifer Etcitty and Agnes Attakai and Kim Russell and Julie A. Baldwin}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9368495/}, doi = {10.3390/ijerph19159280}, year = {2022}, date = {2022-07-29}, journal = {Int J Environ Res Public Health}, volume = {19}, number = {15}, abstract = {Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, “What are the influences on breast and cervical cancer screening for Native American women with IDD?” with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Like other minoritized groups, people with disabilities experience lack of access to health care. People with intellectual and developmental disabilities (IDD), which are lifelong disabilities diagnosed in childhood requiring varying levels of support for completing daily activities, are less likely to receive preventive health care such as cancer screening. Furthermore, Native American women are less likely than White women to receive cancer screenings. In this qualitative research with Native American women with IDD, their caregivers, healthcare and service providers, and community leaders, we asked, “What are the influences on breast and cervical cancer screening for Native American women with IDD?” with the goal of adapting an existing cancer screening education program. Semi-structured in-depth interviews (N = 48) were audio recorded and transcribed verbatim for analysis. Two coders used a constant comparative method to code and revise the a priori codebook with subthemes and new codes. Results highlighted individual, interpersonal, and community/institutional influences on screening, emphasizing the individual effects of social inequity on this population, the importance of ableist bias in recommending cancer screenings, and opportunities to integrate traditional ways of knowing with allopathic medicine. Results of this work were used to adapt a cancer screening education program for Native American women with IDD. |
2021 |
Tomasa, Lynne; Williamson, Heather J Springer, 2021, ISBN: 978-3-030-81276-8. @book{Tomasa2022, title = {Belonging and inclusion during the aging process for individuals with intellectual and developmental disabilities}, author = {Lynne Tomasa and Heather J Williamson}, url = {https://link.springer.com/chapter/10.1007/978-3-030-81277-5_8}, doi = {10.1007/978-3-030-81277-5_8}, isbn = {978-3-030-81276-8}, year = {2021}, date = {2021-11-28}, booktitle = {Engaging communities to foster belonging for individuals with intellectual and developmental disabilities}, publisher = {Springer}, abstract = {Future planning is a person-family-centered process that involves ongoing communication and an understanding of the person with a disability, their family, and the supports needed to have a meaningful quality of life. Individual characteristics, interpersonal relationships, family roles, service systems, policies, and societal factors can impact planning for the future. This chapter highlights the importance of promoting future planning and how to support individuals with an intellectual and developmental disability (IDD) and their families. The chapter begins with an overview of the issues faced by a society that is aging followed by a review of research regarding planning domains, role of family members, relationships, and planning strategies. The chapter also uses four family stories to illustrate how a planning tool can be used to facilitate communication about their futures. Lastly, future planning is discussed using the ten dimensions of Carter’s (2016) belonging framework as well as how resilience can be enhanced through the future planning process. The chapter concludes with discussion questions, tools, and resources for individuals with IDD and their families which can support future planning.}, keywords = {}, pubstate = {published}, tppubtype = {book} } Future planning is a person-family-centered process that involves ongoing communication and an understanding of the person with a disability, their family, and the supports needed to have a meaningful quality of life. Individual characteristics, interpersonal relationships, family roles, service systems, policies, and societal factors can impact planning for the future. This chapter highlights the importance of promoting future planning and how to support individuals with an intellectual and developmental disability (IDD) and their families. The chapter begins with an overview of the issues faced by a society that is aging followed by a review of research regarding planning domains, role of family members, relationships, and planning strategies. The chapter also uses four family stories to illustrate how a planning tool can be used to facilitate communication about their futures. Lastly, future planning is discussed using the ten dimensions of Carter’s (2016) belonging framework as well as how resilience can be enhanced through the future planning process. The chapter concludes with discussion questions, tools, and resources for individuals with IDD and their families which can support future planning. |
Lee, Michele S; Peart, Jillian R; Armin, Julie S; Williamson, Heather J Journal of Health Disparities Research and Practice, 14 (3), 2021. @article{Lee2021c, title = {A Scoping Review of Barriers and Facilitators to Pap Testing in Women with Disabilities and Serious Mental Illnesses: Thirty Years After the Americans with Disabilities Act}, author = {Michele S. Lee and Jillian R. Peart and Julie S. Armin and Heather J. Williamson}, url = {https://digitalscholarship.unlv.edu/jhdrp/vol14/iss3/2 }, year = {2021}, date = {2021-10-01}, journal = {Journal of Health Disparities Research and Practice}, volume = {14}, number = {3}, abstract = {Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Thirty years after the Americans with Disabilities Act (ADA) was passed, promising equal access to health services for people with disabilities and serious mental illness, research on Pap testing continues to uncover health disparities among women with disabilities and women with serious mental illnesses, including those that identify as an ethnic/racial minority. The purpose of this paper is to describe and present the literature on the barriers and facilitators women with disabilities and women with serious mental illnesses face with receiving a Pap test using the social ecological model. We also examined the degree to which racial/ethnic minority women were included in these articles. |
Abdul-Chani, Monical; Moreno, Christopher P; Reeder, Julia A; Zuckerman, Katherine; Lindly, Olivia Perceived community disability stigma in multicultural, low-income populations: Measure development and validation Journal Article Research in Developmental Disabilities, 115 , 2021. @article{Abdul-Chani2021, title = {Perceived community disability stigma in multicultural, low-income populations: Measure development and validation}, author = {Monical Abdul-Chani and Christopher P Moreno and Julia A Reeder and Katherine Zuckerman and Olivia Lindly}, url = {https://doi.org/10.1016/j.ridd.2021.103997}, doi = {10.1016/j.ridd.2021.103997}, year = {2021}, date = {2021-05-29}, journal = {Research in Developmental Disabilities}, volume = {115}, abstract = {Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Stigma and knowledge about disabilities differ across groups, impacting care. No validated measures of perceived community disability stigma exist for families in multicultural communities, at risk for disparities. |
2019 |
Kumar, Amit; Rivera-Hernandez, Maricruz; Karmarkar, Amol M; Chou, Lin-Na; Kuo, Yong-Fang; Baldwin, Julie A; Panagiotou, Orestis A; Burke, Robert; Ottenbacher, Kenneth J Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults Journal Article Journal of the American Geriatrics Society, 00 (00), pp. 1-8, 2019. @article{Kumar2019, title = {Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults}, author = {Amit Kumar and Maricruz Rivera-Hernandez and Amol M. Karmarkar and Lin-Na Chou and Yong-Fang Kuo and Julie A. Baldwin and Orestis A. Panagiotou and Robert Burke and Kenneth J. Ottenbacher}, url = {https://doi.org/10.1111/jgs.16202}, doi = {10.1111/jgs.16202}, year = {2019}, date = {2019-10-19}, journal = {Journal of the American Geriatrics Society}, volume = {00}, number = {00}, pages = {1-8}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Williamson, Heather J; Fisher, Kim W; Madhavni, Devanshi; Talarico, Lori Inclusion, 7 (1), pp. 24-40, 2019. @article{Williamson2019, title = {#ADA25 Campaign: Using Social Media to Promote Participation, Social Inclusion, and Civic Engagement of People With Intellectual and Developmental Disabilities}, author = {Heather J Williamson and Kim W Fisher and Devanshi Madhavni and Lori Talarico}, url = {https://www.mdpi.com/1660-4601/16/1/44}, doi = {10.3390/ijerph16010044}, year = {2019}, date = {2019-03-01}, journal = {Inclusion}, volume = {7}, number = {1}, pages = {24-40}, abstract = {Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Social media is used for civic engagement and building social inclusion. Twitter is one social media tool that facilitates conversations on important societal events. A digital divide between the general population and people with intellectual and developmental disabilities (IDD) remains. Given the divide, we sought to understand the inclusion of the community of people with IDD in the conversations around the 25th anniversary of the Americans with Disabilities Act of 1990 (ADA). We conducted a content analysis of tweets associated with the anniversary and few tweets referenced the community of people with IDD. Our findings suggest that people with IDD are not included in larger civic conversations. Implications include targeted social media training for people with IDD and their support networks. |
Teufel-Shone, Nicolette I; Schwartz, Anna L; Hardy, Lisa J; Heer, Hendrik De D; Williamson, Heather J; Dunn, Dorothy J; Polingyumptewa, Kellen; Chief, Carmenlita Supporting New Community-Based Participatory Research Partnerships Journal Article International Journal of Environmental Research and Public Health, 16 (1), pp. 44, 2019. @article{Teufel-Shone2019, title = {Supporting New Community-Based Participatory Research Partnerships}, author = {Nicolette I Teufel-Shone and Anna L Schwartz and Lisa J Hardy and Hendrik De D Heer and Heather J Williamson and Dorothy J Dunn and Kellen Polingyumptewa and Carmenlita Chief}, url = {https://www.mdpi.com/1660-4601/16/1/44/htm}, year = {2019}, date = {2019-01-01}, journal = {International Journal of Environmental Research and Public Health}, volume = {16}, number = {1}, pages = {44}, abstract = {Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Marginalized communities have a documented distrust of research grounded in negative portrayals in the academic literature. Yet, trusted partnerships, the foundation for Community-Based Participatory Research (CBPR), require time to build the capacity for joint decision-making, equitable involvement of academically trained and community investigators, and co-learning. Trust can be difficult to develop within the short time between a funding opportunity announcement and application submission. Resources to support community- and academic-based investigators’ time to discuss contexts, concerns, integration of expertise and locally acceptable research designs and data collection are limited. The National Institutes of Health (NIH) funded Center for American Indian Resilience and the Southwest Health Equity Research Collaborative have implemented an internal funding mechanism to support community and academic-based investigators’ travel cost and time to discuss complementary areas of interest and skills and to decide if moving forward with a partnership and a collaborative grant proposal would be beneficial to the community. The rationale and administration of this Community-Campus Partnership Support (CCPS) Program are described and four examples of supported efforts are provided. Centers and training programs frequently fund pilot grants to support junior investigators and/or exploratory research. This CCPS mechanism should be considered as precursor to pilot work, to stimulate partnership building without the pressure of an approaching grant application deadline. |
2018 |
Williamson, Heather J; Perkins, Elizabeth A; Massey, Oliver T; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Levins, Bruce L Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports Journal Article Journal of Policy and Practice in Intellectual Disabilities, 15 (3), pp. 214-225, 2018. @article{Williamson2018, title = {Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports}, author = {Heather J Williamson and Elizabeth A Perkins and Oliver T Massey and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Bruce L Levins}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jppi.12258}, year = {2018}, date = {2018-08-24}, journal = {Journal of Policy and Practice in Intellectual Disabilities}, volume = {15}, number = {3}, pages = {214-225}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS. |
2017 |
Williamson, Heather J; Contreras, Graciela M; Rodriguez, Erica S; Smith, Jennifer M; Perkins, Elizabeth A Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review Journal Article OTJR: Occupation, Participation and Health, 37 (4), pp. 227-236, 2017. @article{Williamson2017b, title = {Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review}, author = {Heather J Williamson and Graciela M Contreras and Erica S Rodriguez and Jennifer M Smith and Elizabeth A Perkins}, url = {http://journals.sagepub.com/doi/abs/10.1177/1539449217714148}, year = {2017}, date = {2017-07-13}, journal = {OTJR: Occupation, Participation and Health}, volume = {37}, number = {4}, pages = {227-236}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) often experience health disparities. To address disparities, Healthy People 2020 includes specific disability and health goals focused on improving health care access. The study’s purpose was to review the literature exploring health care access for adults with IDD to identify opportunities for occupational therapy research and practice. A scoping review was completed of articles discussing health care access among adults with IDD in the United States. Thirty-seven articles met the inclusion criteria. Results are framed using the ecology of human performance theory identifying person and environmental issues affecting health care access of adults with IDD. Opportunities exist for occupational therapy to improve participation and health of adults with IDD through engaging in research and practice efforts addressing health care access. Occupational therapy could develop interventions to establish skills and abilities and recommend changes to the health care environment. |
Williamson, Heather J; Perkins, Elizabeth A; Levin, Bruce L; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Massey, Oliver T Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas Journal Article Intellectual and Developmental Disabilities, 55 (2), pp. 84-96, 2017. @article{Williamson2017b, title = {Implementation of Medicaid managed long-term services and supports for adults with intellectual and/or developmental disabilities in Kansas}, author = {Heather J Williamson and Elizabeth A Perkins and Bruce L Levin and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Oliver T Massey}, url = {http://www.aaiddjournals.org/doi/10.1352/1934-9556-55.2.84}, year = {2017}, date = {2017-04-01}, journal = {Intellectual and Developmental Disabilities}, volume = {55}, number = {2}, pages = {84-96}, abstract = {Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs. |