Access to Health and Social Services Among Culturally Diverse Persons with Disabilities in Public Housing

BACKGROUND/PURPOSE

The need for supportive housing is growing as more persons with disabilities seek community-based housing options that allow personal independence. Not only institutional and structural, but also cultural barriers to health and social services have been identified among persons-of-color (POC). Low-income POC with developmental disabilities have greater difficulties meeting their basic daily needs (Koenig, 2015; Schmaling & Williams, 2017), which can lead to housing instability and hospitalization. This study compares study outcome variables of persons with developmental disability (PDD) vs. non-PDD, and POC (including Asian and Others) vs. White. It is hypothesized study outcome variables are significantly poorer among PDD and POC. Findings highlight social justice concerns and needs to improve community-based, comprehensive, and culturally-sensitive services. 

METHODS

Utilizing a social-determinants-of-health framework, several local health and social service agencies formed the Housing with Services (HWS) project to provide comprehensive and culturally-specific services alongside affordable housing to persons with disability and older adults in Portland Oregon. All 1400+ residents of 10 HWS properties were invited to participate in a government-funded evaluation of the effectiveness of the HWS. Only initial survey data were used, and the final sample size was 541 including 49 PDD; and 331 Whites, 95 Asians, and 98 Others (missing = 17).

Study variables included: age, food insecurity, healthy activities, receiving help for shopping, travel, money management, and personal care, receiving help from friends and service agencies, perceived friend and family connections, satisfaction with living environment, risk factors affecting quality of life (QoL), self-rated QoL, and overall health. ANCOVA were conducted to test main and interaction effects controlling for age.

RESULTS

Controlling for age, in comparison with non-PDD, persons with developmental disability reported: higher food insecurity, more help received from agencies, and lower QoL. Asians: (a) reported more help from friends than Whites, (b) expressed higher satisfaction with their living environment than Others, (c) reported highest family connections, and lowest risk factors affecting QoL. Others reported higher food insecurity than Whites. Two-way ANCOVA tests revealed QoL among PDD was significantly lower than non-PDD Whites, but significantly higher than non-PDD Others (F(2) = 4.89, p = .008, Partial eta squared = .23).

CONCLUSIONS/IMPLICATIONS

Food security and QoL were lower among PDD, but agency help was also more available. Asians appeared having more social connections, experiencing satisfaction with their living environment and lower risk factors affecting QoL. Interestingly, Others comprised of American Indian (n = 9), Black (n = 29), Hispanic (n = 11), multi-race (n = 38), and other (n = 11) with developmental disability reported higher QoL, which could mean that Others with developmental disability were more connected with caregiving agencies than non-PDD Others. On the other hand, for Asians, having developmental disabilities had no effect on their perceived QoL. In these properties, a local Asian health and social service agency has been a strong and long-term partner that provides culturally sensitive services. Asian residents have built trust with service providers. This relationship may explain such unique findings among Asians with developmental disabilities. However, these findings need further investigation.