A REPORT TO THE PRESIDENT AND THE CONGRESS

April 26, 1993

National Council on Disability
1331 F Street NW
Suite 1050
Washington, DC 20004-1107

(202) 272-2004 Voice
(202) 272-2074 TT
(202) 272-2022 Fax

Summary of:

Proceedings of a Conference Co-Sponsored by the National Council on Disability and Jackson State University

May 6-7, 1992

and

A Public Hearing Held by the National Council on Disability on How Minorities with Disabilities Are Faring Under the ADA

October 21, 1992

The views contained in the report do not necessarily represent those of the Administration, as this document has not been subjected to the A-19 Executive Branch review process.

Letter of Transmittal

April 26, 1993

The President
The White House
Washington, DC 20500

Dear Mr. President:

The National Council on Disability is pleased submit to you this special report entitled Meeting the Unique Needs of Minorities With Disabilities: A Report to the President and the Congress. We are particularly proud of this report, because it addresses a set of issues that has been largely overlooked by U.S. policymakers.

The National Council has targeted the significant, unmet needs of minorities with disabilities as a policy priority. Minorities constitute a disproportionate share of the disability community and have a unique set of needs in addition to those experienced by other people with disabilities. Many minority persons with disabilities face discrimination on the basis of both minority status and disability. This report reflects the results of a recent National Council conference on minorities with disabilities co-sponsored with Jackson State University in Mississippi, and a public hearing identifying the needs of minorities with respect to the Americans with Disabilities Act of 1990 (ADA), P.L. 101-336, held in San Francisco, California.

With the completion of this report, the National Council remains fully committed to ensuring that the unique needs of minorities with disabilities and their families are addressed. It is only then that we can rest assured that all of our citizens with disabilities have access to the American dream. We look forward to working with you in achieving that essential goal.

Sincerely,

John A. Gannon
Acting Chairperson
February 1993-Present

Sandra Swift Parrino
Chairperson
October 1983-February 1993

(This same letter of transmittal was sent to the President Pro Tempore of the Senate and the Speaker of the House of Representatives.)

ACKNOWLEDGMENTS

The National Council on Disability wishes to thank the members of the Minorities with Disabilities Working Group and others who contributed to its minorities with disabilities initiative, including the many individuals who participated in its conference and testified at its hearing. The administration of Jackson State University was particularly helpful in developing and implementing the conference, including Dr. James E. Lyons, Sr., President; Dr. Herman Smith, Interim President; Dr. Frank Giles; and Dr. Celestine R. Jefferson. We would also like to acknowledge Alyce Jenkins, Dr. Evelyn Davis, Dr. Sylvia Walker, Dr. Vannoy Thompson, Wolanda Thompson, Edward Brewington, Elysse L. Brewington, Edward Shields, Dr. Theda R.W. Zawaiza, Dr. Ruben C. Warren, David Cabrera, David Belgrave, William Murrain, Carl Boyd, F. Burns Vick, Jr., Hope Yasui, and Dr. Frederick D. Bedell. The Council truly appreciates the support of the U.S. Department of Justice through the participation of John R. Dunne, former Assistant Attorney General for Civil Rights, and John L. Wodatch, Chief of the Public Access Section.

TABLE OF CONTENTS

MISSION OF THE NATIONAL COUNCIL ON DISABILITY

NATIONAL COUNCIL ON DISABILITY, MEMBERS AND STAFF

PROJECT STAFF

CONFERENCE PAPERS

EXECUTIVE SUMMARY

1. INTRODUCTION: MINORITIES WITH DISABILITIES
   
   
2. EDUCATION
   
   
3. VOCATIONAL REHABILITATION
   
   
4. EMPLOYMENT
   
   
5. EMPOWERMENT
   
   
6. MENTAL HEALTH
   
   
7. PHYSICAL HEALTH
   
   
8. PREVENTION OF DISABILITIES
   
   
9. SUBSTANCE ABUSE
   
   
10. RESEARCH NEEDS

REFERENCES

APPENDICES

1. Conference Program
   
   
2. List of Conference Participants
   
   
3. ADA Watch Hearing Agenda
   
   
4. Biographies of National Council Members and Staff

The National Council on Disability is an independent federal agency composed of 15 members appointed by the President of the United States and confirmed by the U.S. Senate. It was established in 1978 as an advisory board within the Department of Education. The Rehabilitation Act Amendments of 1984 transformed the Council into an independent agency. The mission of the National Council on Disability is to provide leadership in the identification of emerging issues affecting people with disabilities and in the development and recommendation of disability policy to the President and the Congress. The statutory mandate of the National Council includes the following:

• Reviewing and evaluating on an ongoing basis the effectiveness of all policies, programs, and activities concerning individuals with disabilities conducted or assisted by federal departments or agencies;
  
  
• Assessing the extent to which federal policies, programs, and activities provide incentives for community-based services, promote full integration of individuals with disabilities, and contribute to the independence and dignity of individuals with disabilities;
  
  
• Providing to the Congress, on an ongoing basis, advice, recommendations, and any additional information that the National Council or the Congress considers appropriate;
  
  
• Providing ongoing advice to the President, the Congress, the Commissioner of the Rehabilitation Services Administration (RSA), the Assistant Secretary of the Office of Special Education and Rehabilitative Services (OSERS), and the Director of the National Institute on Disability and Rehabilitation Research (NIDRR) on programs authorized in the Rehabilitation Act;
  
  
• Establishing general policies for reviewing the operation of NIDRR;
  
  
• Submitting an annual report with appropriate recommendations to the President and the Congress regarding the status of research affecting persons with disabilities and the activities of RSA and NIDRR;
  
  
• Providing advice to the RSA Commissioner on policies;
  
  
• Making recommendations on ways to improve research; the collection, dissemination, and implementation of research findings; and the administration of services affecting persons with disabilities;
  
  
• Reviewing and approving standards for independent living programs;
  
  
• Reviewing and approving standards for Project With Industry programs;
  
  
• Providing guidance to the President's Committee on Employment of People with Disabilities; and
  
  
• Issuing an annual report to the President and the Congress on the progress that has been made in implementing the recommendations contained in the National Council's January 30, 1986, report, Toward Independence.

While many government agencies address issues and programs affecting people with disabilities, the National Council is the only federal agency charged with addressing, analyzing, and making recommendations on issues of public policy that affect people with disabilities regardless of age, disability type, perceived employment potential, economic need, specific functional ability, status as a veteran, or other individual circumstance. The National Council recognizes its unique opportunity to facilitate independent living, community integration, and employment opportunities for people with disabilities by ensuring an informed and coordinated approach to addressing their concerns and eliminating barriers to their active participation in community and family life.

Members

John A. Gannon, Acting Chairperson, Cleveland, Ohio, and Washington, D.C.
A. Kent Waldrep, Jr., Vice Chairperson, Plano, Texas
Linda Wickett Allison, Dallas, Texas
Ellis B. Bodron, Vicksburg, Mississippi
Larry Brown, Jr., Potomac, Maryland
Mary Ann Mobley Collins, Beverly Hills, California
Anthony H. Flack, Norwalk, Connecticut
Robert S. Muller, Grandville, Michigan
George H. Oberle, PED, Stillwater, Oklahoma
Sandra Swift Parrino, Former Chairperson, Briarcliff Manor, New York
Mary Matthews Raether, McLean, Virginia
Shirley W. Ryan, Chicago, Illinois
Anne Crellin Seggerman, Fairfield, Connecticut
Michael B. Unhjem, Fargo, North Dakota
Helen Wilshire Walsh, Greenwich, Connecticut

Staff

Andrew I. Batavia, J.D., M.S., Executive Director
Edward P. Burke, Chief, Government Liaison
Billie Jean Hill, Program Specialist
Mark S. Quigley, Public Affairs Specialist
Brenda Bratton, Executive Secretary
Stacey S. Brown, Staff Assistant
Janice Mack, Administrative Officer
Lorraine Williams, Office Automation Clerk

National Council on Disability
Initiative on Minorities with Disabilities

Larry Brown, Jr., Chairperson
Mary Ann Mobley Collins
Anthony H. Flack
John A. Gannon
George H. Oberle, PED
Sandra Swift Parrino
Mary Mathews Raether
A. Kent Waldrep, Jr.

Report Editors

Tennyson J. Wright, Ph.D., CRC
Paul Leung, Ph.D.

Conference Coordinators

Frederick D. Bedell, Ed.D.
Celestine R. Jefferson, Ed.D.

Project Officers

Andrew I. Batavia, J.D., M.S.
Kate Seelman, Ph.D.

Report Production Managers

Andrew I. Batavia, J.D., M.S.
Edward P. Burke
Mark S. Quigley
Billie Jean Hill
Judy Cleary/EEI

This report summarizes the papers commissioned by the National Council for the conference and the testimony provided at the ADA Watch hearing on minorities with disabilities. The views expressed and the recommendations presented are those of the authors and witnesses and do not necessarily represent those of the Council.

1. Introduction: Minorities with Disabilities

Paul Leung, Ph.D.
University of Illinois, Urbana-Champaign
Champaign, Illinois

Tennyson J. Wright, Ph.D., CRC
University of South Florida
Tampa, Florida

2. Educational Needs of Minorities with Disabilities

Frederick D. Bedell, Ed.D.
President, Del-K Educational Consultancy Services
Albany, New York

3. The Vocational Rehabilitation of Minorities

Frank L. Giles, Ph.D., CRC
Department of Special Education & Rehabilitative Services
Jackson State University
Jackson, Mississippi

4. Employment of Minorities with Disabilities

Alyce Earl Jenkins, M.Ed., CRC
Associate Professor, College of Education and Human Services
Wright State University
Dayton, Ohio

5. Empowerment of Minorities with Disabilities

Eva P. Britt, Staff Attorney
Information, Protection, and Advocacy Center
for Handicapped Individuals, Inc. (IPACHI)
Washington, DC

6. Mental Health and Minorities: Emerging Issues

Timothy Summers, M.D.
Jackson, Mississippi

7. Prevention of Primary and Secondary Disabilities

Julie Clay
Rural Institute on Disabilities
University of Montana
Missoula, Montana

8. Minorities, Physical Health and Disability

Anita Leal, Ph.D.
Director, Employee Support Program
University of California, Santa Cruz
Santa Cruz, California

9. Substance Abuse and Disabilities Among Minorities

James G. Brown, Ph.D.
Florida Department of Labor and Employment Security
Division of Vocational Rehabilitation
Tallahassee, Florida

10. Research Needs Related to Minorities with Disabilities

Paul Leung, Ph.D.
University of Illinois, Urbana-Champaign
Champaign, Illinois

People with disabilities have always been excluded from the bounty of our nation's resources. Minorities with disabilities, in particular, have been the most disenfranchised of the disenfranchised. It is time that we bring them into the fold as full, first-class participants in our society.

Hon. Rev. Jesse L. Jackson
National Rainbow Coalition

The National Council on Disability, recognizing our society's general neglect of the needs of minority persons with disabilities, and the many social disadvantages that such individuals encounter, developed a key initiative on addressing the needs of minorities with disabilities. Meeting the unique needs of minorities with disabilities has been a priority for the National Council for several years. This report represents one of the many efforts that the Council has made to seek full inclusion for minorities in disability policy decisionmaking and development.

Disability policy and disability politics are like other areas of domestic policy and politics in our nation--they are dominated by the culture, values, and biases of the majority middle class. Unless we make determined and targeted efforts to ensure the inclusion of minorities in the policymaking process, we will not develop policies and programs that address their unique needs. Too often, little consideration is given to the needs of African Americans, Hispanic Americans, Asian Americans, Native Americans, and other minorities with disabilities. The United States consists of a diverse population and we must make a conscious effort to meet the needs of all our people.

Persons with disabilities who are also members of minorities face double discrimination and a double disadvantage in our society. They are more likely to be poor and undereducated and to have fewer opportunities than other members of the population. It is not certain why this is the case, but we can surmise that it results from the cumulative effect of poor socioeconomic status and poor health that place minorities at greater risk of disability and at greater risk of not receiving needed services if they have a disability.

The National Council's minorities with disabilities initiative has thus far included two major events--a national conference and a public hearing on the broad array of issues concerning minority persons with disabilities.

National Conference on Minorities with Disabilities

On May 6-7, 1992, at Jackson State University, the National Council on Disability convened a national conference entitled "Addressing the Unique Needs of Minorities with Disabilities: Setting an Agenda for the Future." The conference considered a wide range of disability issues, including education, rehabilitation, employment, empowerment, mental health, physical health, prevention, substance abuse, and research, as they relate to the concerns of minorities. (See Appendix A for the Conference Program.)

The conference was attended by 186 persons, most from minority backgrounds. (See Appendix B for a List of Conference Participants.) A variety of papers was commissioned by the National Council from experts on minority and disability issues, including persons with disabilities, service providers, and researchers. The papers addressed each of the nine subject areas of the conference. After the papers were presented at the conference by their authors, other experts presented their reactions to them.

The conference papers and reactions are discussed in sections 2 through 10 of this report. A summary of the general findings and recommendations of conference participants is presented in this Executive Summary. Specific recommendations concerning the various subject areas of the conference are presented in the relevant sections of this report.

Conference Findings and Recommendations

The proceedings of the conference--both in the commissioned papers and in the reactions of the experts who responded to them--contain sets of policy recommendations to improve the lives of minority persons with disabilities. Throughout the presentations, and implicit in the recommendations, are findings on the needs of minorities with disabilities. While specific consensus was not sought at the conference, there was considerable overlap among the various findings and recommendations made by participants.

This report provides a synthesis of the many findings and recommendations presented throughout the conference. The recommendations are based upon a general assumption among conference participants that disability policy and government programs should target those in our society who often have the least and need the most. The consistency of the findings and recommendations demonstrates not only their credibility, but the urgency for action.

Findings

The findings of the conference are as follows:

1. Issues involving minority persons with disabilities are complex and require the coordinated attention of many government programs as well as the competencies of professionals from many different disciplines.
   
   
2. As a group, minority persons with disabilities are more at risk, have fewer personal and family resources, have less knowledge and understanding of externally available resources, and fare less well socioeconomically than do minorities without disabilities.
   
   
3. There has been limited research on issues related to minority persons with disabilities, and consequently there are insufficient data on these populations to offer substantial guidance for policy or service development.
   
   
4. Staff for service delivery systems, including the state/federal vocational rehabilitation program, are not sufficiently trained to work with multicultural populations.
   
   
5. There have been insufficient outreach efforts to ensure the participation of minority persons with disabilities in the mainstream of their communities.
   
   
6. There have been insufficient efforts to address issues concerning prevention of disability that often affect minority persons, including the effects of racism, violence, substance abuse, and poor general health.
   
   
7. There is a need to develop and implement a data set sufficiently descriptive to assess incidence and prevalence of disabilities and the impact of interventions among all minority populations regardless of population size.
   
   
8. Education continues to be a key factor for minority persons with disabilities in achieving success; therefore, it must be designed to be more positive, focusing on the abilities of children with disabilities rather than on their limitations.
   
   
9. Minority children with disabilities require adequate academic accommodations and support through the attention of sensitive educational personnel and mentors.
   
   
10. The ADA holds great promise for minority persons with disabilities, but the promise will be realized only if specific efforts are made for outreach, education, and removal of barriers in minority communities.
    
    
11. There is a need to develop grassroots networks and to establish a funded pool of resources to help minority persons with disabilities become part of the mainstream of their communities.

Recommendations for Policymakers

The following are general recommendations that were developed during the conference. Additional specific recommendations relating to the various topics addressed by the conference can be found at the end of each section of this report.

1. Federal, state, and local agencies should coordinate government policies and programs to meet the needs of minority persons with disabilities, using the competencies of professionals from many different relevant disciplines.
   
   
2. Policies should be established by all federal, state, and local agencies that administer existing government programs to ensure the inclusion of minorities with disabilities in their programs.
   
   
3. Congress should authorize targeted research on minorities with disabilities, and federal disability research agencies such as the National Institute on Disability and Rehabilitation Research (NIDRR) and the National Center for Medical Rehabilitation Research (NCMRR) should plan and fund such research.
   
   
4. Federal disability research agencies such as NIDRR and NCMRR should develop policies that include minorities with disabilities in all disability and rehabilitation-related research.
   
   
5. Service delivery systems, including the state/federal vocational rehabilitation program, should train staff sufficiently to work with multicultural populations.
   
   
6. All federal, state, and local disability programs should develop outreach efforts to ensure the full participation of minority persons with disabilities.
   
   
7. The Department of Health and Human Services (DHHS) should develop a specific initiative to address issues concerning the prevention of disability for minority persons, including the effects of racism, violence, substance abuse, and poor general health.
   
   
8. Federal disability research agencies such as NIDRR and NCMRR should develop a data set sufficient to assess the incidence and prevalence of disabilities and the impact of intervention among all minority populations, regardless of the size of the population.
   
   
9. The Department of Education should develop policies and programs to improve the outcomes of education systems for minority persons with disabilities.
   
   
10. The Department of Labor should develop policies and programs to ensure that minority persons with disabilities will be able to participate as full members in the workforce of the future.
    
    
11. All federal, state, and local agencies responsible for implementing the ADA, including the Department of Justice, the Equal Employment Opportunity Commission, the Department of Transportation, the Federal Communications Commission, the Access Board, and NIDRR, should target greater resources to minority populations with disabilities and the communities in which they live.
    
    
12. Federal, state, and local government should foster the development of grassroots networks connected to more formal regional and national networks for the dissemination of new information and technology and should establish a funded pool of resources to help minority persons with disabilities.

Recommendations for the National Council

The following recommendations specifically target actions for the National Council on Disability, the primary sponsor of the conference, to consider:

1. Establish a National Council policy that all programs of the Council will include the perspectives of minority populations.
   
   
2. Develop and implement a national task force on minority populations with disabilities to assist in the review of ongoing and prospective Council programs and activities.
   
   
3. Collaborate with all federal agencies that address disability issues to ensure that policies and activities affecting minority populations with disabilities meet their needs.
   
   
4. Maintain liaison with national minority organizations (e.g., National Urban League, NAACP) for advice, as well as outreach toward minority populations with disabilities.
   
   
5. Initiate national and regional meetings to increase awareness of disability issues, particularly issues concerning the ADA, by minority organizations and their constituencies.
   
   
6. Continue to hold forums addressing disability issues that affect minority populations in settings that are fully accessible to minority persons with disabilities.
   
   
7. Establish relationships with other federal agencies that affect minority populations with disabilities, such as the Bureau of the Census and the National Institutes of Health, to ensure adequate and appropriate data to assess the need for, and impact of, service delivery programs.
   
   
8. Monitor progress within the federal government to ensure the participation of minority persons with disabilities in all aspects of federal policy and programming.
   
   
9. Increase outreach to minority populations with disabilities using different languages and alternative approaches to ensure effective communication.

ADA Watch Hearing on Minorities with Disabilities

On October 21, 1992, in San Francisco, California, the National Council held a public hearing on how minorities with disabilities are faring under the Americans with Disabilities Act of 1990 (ADA). (See Appendix C for hearing agenda.) This hearing was part of two National Council initiatives: the Minorities with Disabilities initiative, discussed above, and the ADA Watch initiative, which monitors implementation of the ADA. A summary of the testimony and recommendations presented at the hearing is provided in this Executive Summary.

The testimony and recommendations from the hearing supported one of the major findings of the National Council from the first year of ADA Watch: "Minorities with disabilities, overrepresented in the disability community, are significantly underreached by current ADA information and technical assistance efforts." This finding, in conjunction with the testimony presented, further supports the Council's major ADA Watch recommendation concerning minorities with disabilities:

New materials and dissemination strategies should be developed that are targeted to, and sensitive to the needs of, African Americans, Hispanic and Latino Americans, Asian Americans/Pacific Islanders, Native Americans, and other minority populations.

Hearing Testimony and Recommendations

The individuals who testified at the ADA Watch hearing on minority issues discussed their experiences with discrimination on the basis of disability and minority status, as well as their difficulty in gaining access to the resources needed to become self-sufficient. They also presented a variety of recommendations to remedy the problems confronted by minorities with disabilities. As with the conference, there was substantial consistency among the recommendations of the witnesses.

Hearing Testimony

An overarching finding of the ADA Watch hearing on persons from minority backgrounds with disabilities was that such individuals have greater difficulty obtaining employment and gaining access to public accommodations and transportation than do other Americans with disabilities. Witnesses testified that persons from minority backgrounds with disabilities tend to have the following characteristics:

• Are more disabled (i.e., have more functional limitations) than other members of the disability community as a result of such factors as socioeconomic status, educational level, and occupation;
  
  
• Face the double challenge of having to contend with discrimination on the basis of both disability and minority status;
  
  
• Have the added obstacle of being subjected to greater negative attitudes by the majority in society than other minority groups;
  
  
• Have language and communication differences that complicate their ability to obtain meaningful information and technical assistance on the ADA;
  
  
• Have differences in cultural values, low self-concepts, and distrust of "government" and "systems," which affects the way they respond to policies and programs;
  
  
• Are isolated from the mainstream of American life, reducing potential benefits under the ADA;
  
  
• Do not have appropriate training and career development opportunities appropriate from the standpoint of cross-cultural and cross-disability familiarity; and
  
  
• Are unable to take full advantage of the ADA and other disability policies because of a lack of (a) effective educational and training models, (b) adequate role models, (c) appropriate vehicles of communication, and (d) economic opportunity.

Recommendations

The following are recommendations of witnesses from the ADA Watch hearing on minorities with disabilities:

1. Require that all ADA implementation activities be sensitive to the linguistic differences, communication styles, and cultural attributes of the various minority groups and persons with disabilities in those groups.
   
   
2. Ensure that federal funding is set aside for public and community-based agencies to develop and implement multicultural approaches to providing information, technical assistance, and services related to the ADA.
   
   
3. Develop services and publications that focus on minority and disability groups--and that use their preferred language and/or method of communication--for information dissemination, outreach activities, and technical assistance on the ADA.
   
   
4. Appropriate funds for public agencies and private community-based entities to develop and implement training and to provide opportunities for economic independence for minorities with disabilities.
   
   
5. Establish a high priority on public policies that focus on self-esteem development, advocacy, and personal empowerment of minorities with disabilities.
   
   
6. Apply appropriate economic and human resources to enforce the ADA through vigorous compliance investigation, mediation, and legal redress for minorities with disabilities.
   
   
7. Designate and fund at a reasonable level a federal entity to collect, analyze, and disseminate data periodically on the various minority groups with disabilities.
   
   
8. Explore the extent to which the spirit and letter of the ADA can be extended to Native Americans who live on reservations.
   
   
9. Develop and fund leadership training activities for minorities with disabilities to further to foster their increased self-advocacy and empowerment.
   
   
10. Analyze the extent to which minorities, including ethnic minorities with disabilities for whom English is a second language, are inappropriately placed in special education, and develop strategies to eliminate inappropriate placements.
    
    
11. Provide incentive funding for colleges and universities to train disability and other (legal, health, etc.) professionals and providers to be sensitive to the needs of people of different races, ethnicities, cultures, and disabilities.
    
    
12. Explore ways to eliminate existing disincentives for minorities with disabilities to use publicly-funded programs and services and to increase responsiveness to professional interventions.

Minority persons with disabilities are among the most untapped of our nation's resources. Most have not been given an opportunity to contribute productively to the well-being of our society. It is essential to the success of our country in the 21st Century to utilize the resources of minority persons with disabilities.

Larry Brown, Jr.
Council Member
National Council on Disability

Minorities and Disability

Minority populations in the United States can be defined or described in many different ways, depending upon whether the emphasis is on race, ethnicity, or culture. For the purposes of this report, the focus will be primarily on African Americans, Hispanic Americans, Asian Americans/Pacific Islanders, and Native Americans. During the last decade, there has been tremendous growth in these minority populations in the United States.

U.S. Bureau of the Census (1990) data indicate that there are 30 million African Americans (an increase of 13.2% since 1980); 22.4 million Hispanic Americans (an increase of 53%); 7.3 million Asian Americans (an increase of 107.8%); and 2.0 million Native Americans (an increase of 37.9%). In comparison, the European American (i.e., White) population grew 6.0% since 1980. The projections into the year 2000 are as dramatic; for example, current minority populations in California are projected to become the majority by the turn of the century.

In her conference paper on the physical health of minorities with disabilities, Dr. Anita Leal describes the four minority groups as follows:

African Americans

• Largest minority population in the United States--12% of the general population.
  
  
• In 1987, only 64%, compared to 77% of European Americans, had graduated from high school.
  
  
• In 1986, 31.1%, compared to 11% of European Americans, lived below the poverty level.
  
  
• Worst health status among minority groups.

Hispanic Americans (Latino Americans)

• Second largest minority group in the United States--8% of the general population.
  
  
• Heterogeneous group comprised of people of Mexican, Cuban, Puerto Rican, and Central and South American origin.
  
  
• Share a common language--Spanish--either as a first or second language.
  
  
• Considered an ethnic group and are classified as "White" 90% of the time in racial categories.
  
  
• Forty-nine percent of Hispanic Americans over age 25 have not completed high school.
  
  
• Proportion of children under 18 years living in poverty is significantly greater than non-Hispanics (47.7% vs. 38.3%).
  
  
• Based on limited data, their health status is closer to that of European Americans than that of other minority groups.

Asian Americans/Pacific Islanders

• Fastest growing population in the United States--2% of the general population.
  
  
• Major subgroups are Filipinos, Chinese, Japanese, Vietnamese, Asian Indians, and Koreans.
  
  
• Data are scant on health risks and morbidity patterns.
  
  
• Only a few epidemiologic surveys have been done in the West and most studies have been conducted in Hawaii.
  
  
• Median family income is higher than that of other minority groups and European Americans; however, Vietnamese have a very low average family income.

Native Americans and Native Alaskans

• Smallest minority group in the United States--1% of the general population.
  
  
• Poverty rates are similar to those of African Americans and Hispanic Americans.
  
  
• Second worst health status among minority groups, after African Americans.

Minorities with Disabilities

As a result of factors such as poverty, unemployment, and poor health status, persons of minority backgrounds are at high risk of disability. Based largely on population projections and substantial anecdotal evidence, it is clear that the number of persons from these minority populations who have disabilities is increasing. Moreover, based on similar projections, the proportion of minority populations with disabling conditions will probably increase at even faster rates than that of the general population.

However, due to a disturbing lack of hard data on minority populations with disabilities, it is not certain precisely how many members of minority groups have disabilities or how fast this population is growing. Most of the data available on minority populations with disabilities relate to African Americans. Some data are available on Hispanic Americans and Native Americans, and almost none are available on Asian Americans.

Bowe (1992), using 1988 U.S. Bureau of the Census Current Population Survey Data, reported approximately 2,512,000 African American working-age adults with disabilities. The only major prevalence study on minorities with disabilities found that African Americans and Hispanic Americans with disabilities have lower incomes and lower educational levels than their European American counterparts (Asbury, Walker, Maholmes, Rackley, and White, 1991).

Neglect of Minorities with Disabilities

These data, or lack thereof, suggest the need for much more research on minority populations with disabilities. The needs of such individuals have been ignored largely for two reasons:

First, minority populations have been generally preoccupied with their own particular needs related to survival and elimination of discrimination and racism; disability issues affecting minorities have not been a priority.

Second, the disability community has been preoccupied with general disability issues, such as access to health insurance, personal assistance services and assistive technology; issues specifically affecting minorities with disabilities have not been emphasized.

Overall, public policies and programs of service delivery for Americans with disabilities have been designed for the general population and have not adequately benefited people with disabilities from minority populations. Even the passage of the ADA may not, by itself, have a substantial impact on minorities unless both the minority and majority communities become much more aware of, and sensitive to, the needs of minorities with disabilities.

The need to address the concerns of minorities with disabilities arises from several perspectives.

First, as noted earlier, the number of minority persons with disabilities is increasing and will continue to increase.

Second, minorities constitute a disproportionate share of the population of persons with disabilities.

Third, the future workforce needs of America will be met not only by its diverse racial and ethnic populations, but by persons within those populations who have disabilities.

Finally, minority persons with disabilities have the right to equal opportunity in our society and the right to benefit fully from disability policies.

National Council/Jackson State University Conference

On May 6-7, 1992, in Jackson, Mississippi, the National Council on Disability and Jackson State University held a national conference on meeting the needs of minorities with disabilities. Experts on minority and disability issues, including researchers, service providers, and government officials, developed and presented papers. The conference was a key component of the National Council's initiative to ensure that the needs of minority persons with disabilities are met.

Over the past several decades, there has been a growing awareness that minorities with disabilities in the U.S have even fewer opportunities than other people with disabilities. To address their problems, two conferences were planned and implemented collaboratively by professional, state and federal agencies prior to 1990. These events were held at predominantly African American colleges and universities.

The National Association of Non-White Rehabilitation Workers convened the first conference at Tuskegee University in Alabama in 1973 and the second conference at Jackson State University in Mississippi in 1980. Among the issues addressed at each event were the status of minorities with disabilities, state and federal support for addressing the needs of minorities with disabilities, and the availability of qualified professionals to serve minorities with disabilities.

Since these conferences, few collective efforts have focused on the "state of affairs" of minorities with disabilities. In the fall of 1991, the National Council on Disability approached the Administration of Jackson State University about hosting a national invitational conference on meeting the needs of persons with disabilities. The purposes of this conference were to:

• Assemble educators, researchers, service providers, administrators, students and other interested persons to examine the state of affairs of minorities with disabilities in the U.S.
  
  
• Identify recommendations for improving the quality of life of minorities with disabilities.
  
  
• Develop a document to be disseminated to educators, human service agency administrators, elected officials and other interested persons to inform them of the problems encountered by minorities with disabilities population.
  
  
• To develop an agenda for the future to identify and address the unique needs of minorities with disabilities.

ADA Watch Hearing on Minorities

On October 21, 1992, in San Francisco, California, the National Council held a public hearing on how minorities with disabilities are faring under the Americans with Disabilities Act of 1990 (ADA). This hearing was part of the National Council's ADA Watch initiative, as well as its Minorities with Disabilities initiative.

Fifteen panelists were featured presenters at the hearing. The ethnically diverse panel included five African Americans, five Hispanic Americans, three Asian Americans, one Native Hawaiian, and one Native American. Nine of these individuals have at least one severe disability, two have a child or parent with a disability, and the others are professionals who focus primarily on the needs of ethnic minorities with disabilities.

In addition to the panelists, 16 witnesses presented testimony during two "open microphone" sessions. Ten have at least one disability. Approximately 55 other persons, many with disabilities, attended the hearing. The testimony and recommendations of the panelists and witnesses are summarized in the Executive Summary to this report, as well as in the specific sections of the report on the nine subject areas.

Based largely on the testimony at the hearing, the National Council on Disability (1993a) found that "[m]inorities with disabilities, overrepresented in the disability community, are significantly underreached by current ADA information and technical assistance efforts." The general recommendation of the National Council (1993a) concerning minorities with disabilities, based on the first year of ADA Watch, was the following:

New materials and dissemination strategies should be developed that are targeted to, and sensitive to the needs of, African Americans, Hispanic and Latino Americans, Asian Americans/Pacific Islanders, Native Americans, and other minority populations.

Overview of Report

The National Council/Jackson State University Conference and the conference proceedings that this report summarizes are part of a legacy of national, regional, and local conferences that began in the 1960s and continue to bring issues confronting minorities with disabilities to the forefront of our society. Focusing on the issues that particularly affect minority populations with disabilities, the conference planners selected nine subject areas: education, vocational rehabilitation, employment, empowerment, mental health, prevention, physical health, substance abuse, and research.

Each subject area by itself is important. However, each area can also be seen under the broad umbrella of the ADA and other disability laws protecting all people with disabilities, including minorities with disabilities. The National Council commissioned papers on each of the conference subject areas as they relate to minorities with disabilities, and asked other experts to react to the papers after they were presented. Several of the papers presented at the conference discuss how the ADA affects minorities with disabilities. The papers are summarized in sections 2 to 10 of this report.

Statistical data vary widely within the papers. Much of this variability results from the different sources used, as well as from differences in definition. Certainly, such discrepancies in data point to the need for consistent definitions of disabilities among persons from minority populations, as well as uniform approaches to data collection and measurement. Some of the papers use data that are anecdotal and experiential. The paucity of "hard data" reflects limitations in current knowledge and suggests an extensive research agenda on minorities with disabilities.

The information contained in this report has been abstracted by the editors from the original papers commissioned by the National Council. The complete papers, which are contained in the unpublished conference proceedings, are a rich source of data and information. They substantiate, from very different perspectives, some of the day-to-day concerns of persons with disabilities who are also members of minority ethnic/racial populations. In addition, they contain some practical solutions that can be utilized to improve the lives of persons with disabilities and enable the empowerment process to occur.

A complete copy of the conference proceedings is available from the National Council on Disability for those who are interested in in-depth knowledge of the topics summarized in this report. Readers are encouraged to use this information and to incorporate the recommendations into policies and practices to enhance the quality of the lives of minority persons with disabilities. We hope that readers will be challenged by the information and will become an active part of the process to empower minority persons with disabilities to be full participants in American society.

Our education system is overloaded, confused, and bogged down. We need to refocus our educational priorities and concentrate on the restructuring of our educational system. We need to go back and take a page out of the successful methodologies used in the one-room school house. We do not need to segregate students. We need to find ways to mainstream.

Frederick D. Bedell, Ed.D.

The National Commission on Excellence in Education Report, A Nation At Risk (1983), brought two important concepts to the forefront in education: 1) the interdependence of an achieving nation and achieving students and 2) the idea of being "at risk," a term now used to describe children whose achievement is undermined by health, social, educational, and/or economic factors.

A report to the President and the Congress of the National Council on Disability (1989), The Education of Students with Disabilities: Where Do We Stand? found that students with disabilities generally are at risk, and minority students with disabilities are particularly at risk, of inadequate preparation for employment and for full participation as citizens in our society. It is clear that for our nation to achieve, all of its students must achieve, including all of its students with disabilities.

Primary Issues

The present education system is overloaded and confused. Poverty, racism, cultural differences, the dissolution of families, and the weakening of home influences are among the contributing social factors that challenge the schools. When these variables are combined with low self-esteem, peer pressure, lack of self-discipline, and inadequate role models, students do not arrive at school ready to learn. To exacerbate the situation, those who are prepared to learn are often subjected to inappropriate curricula, inadequate support services, and, in some instances, a hostile school environment.

As dysfunctional as conditions are for students generally, they are worse for students with disabilities and still worse for students with disabilities from minority backgrounds. The problems they confront are discussed in a recent report of the National Council on Disability (1993b) entitled Serving the Nation's Students with Disabilities: Progress and Prospects. In addition to the issues facing students with disabilities generally, there are many issues concerning the education of minority students with disabilities at all levels of the Nation's education system.

Learning must occur for students with disabilities in integrated, mainstreamed settings if they are to be able to compete on an equal basis. Too often, children who are considered at risk find themselves failing in schools that have the least resources, deteriorating physical plants, and dispirited and uninspired teachers. Many students are misplaced, written off, or "fall between the cracks."

Practices in the Education System

Several specific variables have a negative effect on student achievement, particularly among minority students. Among these are the following:

• The disproportionate placement of minorities in special education programs;
  
  
• The placement of minority students in special education programs for longer periods of time than nonminority students;
  
  
• Environmental factors such as malnutrition, poverty, and parental addiction to alcohol and/or other drugs; and
  
  
• The general orientation of the schools toward students with behavioral problems, which does not adequately take into consideration the causes of the problem.

Placement of Minority Students

The Education for All Handicapped Children Act of 1975, Public Law 94-142 (renamed the Individuals with Disabilities Education Act [IDEA]), did little to acknowledge the unique needs of minority children with disabilities. Figueroa (1989) noted that IDEA did not adequately acknowledge the needs of Hispanic American children or those whose native language was not English, and concluded that miseducation of bilingual children may be the norm.

After the passage of the Education for All Handicapped Children Act, 10 million children were identified as "educably mentally retarded." Of that number, 43% were African American. In a paper presented to the National Alliance of Black School Educators, Ruth Love (1989) found that 85% of students in special education programs in Chicago are African American. In school systems in which "ability grouping" is practiced, a disproportionate number of minority children are placed in special education classes.

Misplacement of children into segregated programs often has placed them at a disadvantage. The National Council on Disability (1989) reported several findings from the results of the national study discussed above. Among them are:

• Parents and students reported that schools have low expectations of students with disabilities and establish inappropriate learning objectives and goals;
  
  
• Services often are not available to meet the needs of disadvantaged, minority, and rural families who have children with disabilities;
  
  
• Special education is a relatively separate system of service delivery; and
  
  
• Current thinking regarding effective schools and teaching practices can facilitate the integration of students with special needs into general classrooms.

Recommendations

1. To educate students with disabilities, especially those from minority backgrounds, we must look for a new model that involves a collaborative approach and includes all levels from preschool to higher education.
   
   
2. The education system must affect students with disabilities in a positive, not a negative, manner. There must be a focus in preschool programs on preparing students with disabilities from minority backgrounds to be ready to learn.
   
   
3. Schools must be restructured to eliminate negative effects on students. Cooperative learning is a good example of students' learning through sharing of knowledge rather than competition. Diverse student populations are integrated so that students learn to work together.
   
   
4. Schools must be able to serve students based upon their needs for individualized services. In other words, each student is unique and schools must be able to develop and modify programs to fit each student's needs. True individual service planning would go a long way toward meeting the needs of all students in the educational system.
   
   
5. Finally, students with disabilities from minority populations must have the opportunity to achieve their potential regardless of the level of education. Attention must be given to funding and ways to enhance access to all education, including higher education.

In general, minorities with disabilities are less likely to be accepted or found eligible for state/federal vocational rehabilitation services when compared to Whites with disabilities. If accepted for vocational rehabilitation services, minorities are less likely to be rehabilitated and are provided fewer opportunities for academic training as compared to Whites.

Frank L. Giles, Ph.D., CRC

A major service delivery program for adults with disabilities has been the state/federal vocational rehabilitation program. However, it has been noted that participation by ethnic/racial minority persons within vocational rehabilitation has not been at the levels warranted by their need, taking into consideration their proportion of the population (Atkins and Wright, 1980; Danek and Lawrence, 1982). The Rehabilitation Services Administration (1989) indicates that, of the total of 213,842 persons rehabilitated in 1989, 80.00% were European American, 17.50% were African American, and the remaining 2.5% were from all other minorities.

Public Vocational Rehabilitation and Minorities

Danek and Lawrence (1982) found that more time was required for African Americans than for European Americans to be accepted for vocational rehabilitation services. Herbert and Martinez (1992), analyzing Pennsylvania data, concluded that 33% of European Americans were found ineligible, compared with 40% of minority persons. These statistics support earlier findings by Rivera (1974), who found that Hispanic Americans are more likely than European Americans to be found ineligible for vocational rehabilitation.

For the approximately 500 Native American tribes recognized by the U.S. government, there are approximately 13 tribal-operated vocational rehabilitation programs, but there are relatively little data on rehabilitative outcomes of Native Americans (Martin, Frank, Minkler, and Johnson, 1988). There are almost no data related to the use of vocational rehabilitation programs by Asian Americans.

Barriers to Vocational Rehabilitation

Current participation in the public vocational rehabilitation program by minorities with disabilities is below expected levels. There is a need for the vocational rehabilitation system to be more responsive to the unique needs of minority populations.

Atkins (1988) advocated using an "asset-oriented" strategy, in which the focus is on the individual's strengths and abilities. Belgrave and Walker (1991) highlighted the importance of factors such as transportation in rehabilitation. Rivera and Cespedes (1983) advocated for the use of community structures such as churches and other community organizations as part of the vocational rehabilitation process.

Leung and Sakata (1988) suggested the need to incorporate languages other than English and to use family support systems. Finally, Martin et al. (1988) identified the need for culturally appropriate interventions in the vocational rehabilitation process.

Training Minorities in Rehabilitation Counseling

A related vocational rehabilitation issue involves the training of persons from minority backgrounds as service providers and specifically as rehabilitation counselors in the vocational rehabilitation system.

Only four universities with rehabilitation education programs listed in the National Council on Rehabilitation Education Directory (1992) are considered to be historically African American institutions. Two programs were identified as having significant Hispanic American students while one university noted significant enrollment of Asian Americans. Total minority enrollment in master's level training has been approximately 15 to 16% during the last decade.

Better representation of minority persons in rehabilitation counseling programs will be needed to meet the demands of changing demographics, in which the total numbers of persons of minority background will increase while those currently in the majority will decrease.

Summary

In general, minorities with disabilities are less likely to be accepted or found eligible for state and federal vocational rehabilitation services compared with the overall disability community. If accepted for vocational rehabilitation services, minorities with disabilities are less likely to be rehabilitated and are provided fewer opportunities for academic training compared with other persons with disabilities.

Rehabilitation Services Administration data regarding individuals rehabilitated between FY 1984 and FY 1989 indicate that the numbers of Native Americans/Alaskans and Asian Americans/Pacific Islanders rehabilitated have remained fairly constant during the period. The numbers of Hispanic Americans rehabilitated increased slightly and the numbers of African Americans rehabilitated under programs sponsored by the Rehabilitation Services Administration decreased.

Rehabilitation counseling preservice academic training programs can have a critical impact on the success or failure of minorities with disabilities. Counselors must have an educational background that enables them to work successfully with clients who are of different races or cultures.

Recommendations on Vocational Rehabilitation

1. Federal policies should enable the provision of vocational rehabilitation services that are culturally appropriate.
   
   
2. Research is needed to determine effective models, services, and resources related to the vocational rehabilitation of persons with disabilities from minority racial/ethnic backgrounds.
   
   
3. Training for vocational rehabilitation personnel must include multicultural emphases and clinical training experiences involving persons with disabilities from minority populations.
   
   
4. Preservice education programs must include specific courses related to multicultural experiences and service delivery.
   
   
5. Incentives should be provided for recruitment and education of underrepresented racial/ethnic populations in vocational rehabilitation. The Rehabilitation Services Administration should continue to fund colleges and universities with substantial enrollments of minorities.
   
   
6. There is a need for increased numbers of tribally operated vocational rehabilitation programs to meet the growing needs of Native Americans and Native Alaskans.

We must establish an [employment] agenda for minorities with disabilities which will be multifaceted. Indeed, this interrelatedness of disability, poverty and undereducation dictate implementation of a multidisciplinary, intergovernmental, and interagency approach to the problem.

Alyce Earl Jenkins, M.Ed., CRC

Expansion of employment opportunity is absolutely essential to promoting the economic self-sufficiency of persons with disabilities. However, for persons with disabilities from minority ethnic and racial backgrounds, "employment opportunities, particularly at the higher levels, are sharply limited" (Wright, 1960). The lack of employment opportunities for such individuals results in part from dual sources of discrimination based on minority status and disability; minority women with disabilities may be subject to "triple jeopardy" (Wright, 1988).

High unemployment figures for racial and ethnic minority members with disabilities are particularly significant, in that minority populations themselves have higher incidence and prevalence rates of disabilities than the general population. One study notes that "most ethnic minority persons with a disability are at a high risk given that a larger percentage of this population fall at or below the poverty level" (Asbury, Walker, Maholmes, Rackley, and White, 1991).

According to ADA Watch hearing witnesses, notwithstanding a decade of experience with the Rehabilitation Act, government entities at all levels have failed to take adequate steps to establish appropriate cultural diversity and disability awareness training designed to further recruit, employ, and retain minorities with disabilities within the public sector. The witnesses indicated that the private sector must also be given greater incentives to employ minorities with disabilities.

The problems encountered by minority persons with disabilities in securing and maintaining employment can be the result of exclusionary practices by employers, labor unions, and the vocational rehabilitation service delivery system.

Employers

According to a Louis Harris (1987) poll commissioned by the National Council on Disability, over two-thirds of persons with disabilities are unemployed. Similarly, Bowe (1990) indicated that only 32% of working age (16-64) adults with disabilities work or are actively seeking work. The levels of employment for African Americans with disabilities in the workforce were even lower, at 22% employed; for Hispanic Americans with disabilities, the level was 23% employed. Braddock and McPartland (1987) suggested that there are built-in barriers such as segregated networks, information biases, and negative stereotypes held by employers, all of which result in low employment levels.

Labor Unions

Jenkins stated that, while labor unions have been known for their advocacy of workers' rights, persons with disabilities, including those of minority ethnic/racial backgrounds, have not benefited greatly from their efforts. Labor unions might be reluctant to advocate for ethnic/racial minority persons with disabilities in their negotiations with management.

This neglect may be based upon fears that employment of persons with disabilities may weaken wage structures and that restructuring jobs may lead to contract changes (Whitehead, 1990). Unions often are reluctant to "bend the rules" concerning seniority clauses (Bradford, 1990). Consequently, according to these researchers, unions have not been a progressive force in increasing the numbers of minority persons with disabilities in the workforce.

Education and Employment

Education has always been considered a key to employment success for minorities and persons with disabilities. Yet, education for students with disabilities remains problematic. Brolin and Gysberg (1989), in their study of education and persons with disabilities, concluded that "[s]tudents with disabilities are not attaining greater vocational and independent living success than they did in previous years" (p. 155).

Persons with disabilities, including minorities with disabilities, have been shortchanged in both regular and special education programs. Failure to provide quality, relevant education to minority persons with disabilities results in their continued exclusion from the workforce. This topic is discussed further in section 2 on education.

Vocational Rehabilitation and Employment

The public vocational rehabilitation program is specifically charged with providing services to all persons with disabilities without regard to their race or ethnicity. However, it was noted more than a decade ago (Atkins and Wright, 1980) that ". . . a large percentage of Black applicants were not accepted for service; of applicants accepted for service, a larger percentage of Black cases were closed without being rehabilitated; and Blacks whose cases were closed as successfully rehabilitated were more likely than Whites to be in the lower income levels" (p. 42).

Differential participation in the vocational rehabilitation process serves to exclude minority persons with disabilities from employment opportunities. Although the research that has been conducted in this area has not included all minority groups, it appears that the proportion of minorities with disabilities who gain access to and succeed in the vocational rehabilitation system is much lower than their proportion of the general population, thereby contributing to their low employment figures.

The number of persons from minority populations employed in the vocational rehabilitation system may also be a factor limiting the participation of minority clients. Humphreys (1980) suggested that if we are going to attract minority clients to that system and if we are going to get them the services they so desperately need, we need a much higher proportion of rehabilitation professionals, counselors, supervisors, and administrators who are African American, Hispanic American, Asian American, and Native American.

However, Jenkins (1989) concluded that little is known about the number of minority persons employed as part of the vocational rehabilitation service system. This topic is discussed further in section 3 on vocational rehabilitation.

Recommendations on Employment

1. An agenda for the employment of minority persons with disabilities must be multifaceted. There must be a collaborative effort of employment programs, public education, private enterprise, and health and human services programs to enable minorities with disabilities to access employment.
   
   
2. An advisory body should be established with the support of the Department of Labor to address concerns related to apprenticeships, supported employment, and job restructuring to enhance access of minority persons with disabilities to labor unions.
   
   
3. A national network of employers and minority persons with disabilities should be established to enable the sharing of job leads, to reduce feelings of isolation, and to provide a forum for proactively discussing employment issues.
   
   
4. Strategies should be developed to ensure the inclusion of minority children with disabilities in appropriate education at all levels from preschool to higher education, as already required under the IDEA legislation.
   
   
5. The Rehabilitation Services Administration should use its existing networks to develop a national outreach program targeting minority populations in order to increase their employment levels.

We, in the U.S., are faced with a dilemma of staggering seriousness. Our minority citizens with disabilities are born identified as a minority within a minority. They suffer and are ignored. They are disenfranchised, discriminated against, and are dying physically and spiritually; they are hungry, unclothed, unemployed, unsheltered, and completely unaware of the quality of life which is their constitutional right and guarantee.

Eva P. Britt, J.D.

Empowerment is often described as giving an individual the official power or authority to determine his or her destiny. The conference paper by Eva Britt states that minority persons with disabilities face a double dilemma as a minority within a minority. They have little or no power to advocate for themselves and have not been empowered by the majority society to determine their own destiny.

Minorities with Disabilities

Britt notes the following major problems faced by minority persons with disabilities:

• African Americans and other minorities with disabilities have been and continue to be isolated from the mainstream of health and human service delivery systems;
  
  
• African Americans and other minorities with disabilities are overrepresented in every statistical indicator of lower socioeconomic status and poor health;
  
  
• There are few bilingual persons available to serve those for whom English is a second language;
  
  
• There are a lack of accurate data on the racial/ethnic backgrounds of persons with developmental disabilities;
  
  
• Agencies do not institute outreach programs to encourage participation of African Americans and other minority persons with developmental disabilities;
  
  
• An insufficient number of African American and other minority professionals are trained to work with minority persons with developmental disabilities; and
  
  
• Health and human services agencies generally are not well versed in or familiar with the provisions of the Civil Rights Act-Title VI, The Rehabilitation Act, or the ADA.

Recommendations on Empowerment

Britt stated that serious problems demand creative solutions. Among the solutions she recommended were the following:

1. African Americans and other minorities with disabilities who are knowledgeable of the issues that affect them must be included in implementing solutions.
   
   
2. Organizations such as state protection advocacy systems, state mental health administrators, state developmental disabilities councils, and others must become information and empowerment centers and "think tanks" for the minorities with disabilities.

Members of minority groups perceive themselves as different from the majority group and they are perceived as being different by Whites. These perceived differences, the historical context of the groups' interactions, and their place in economic history have resulted in a complexity of feelings, attitudes and perceptions. These differences have often resulted in differential treatment which permeates the U.S. and its institutions including the mental health system.

Timothy Summers, M.D.

Mental health is a general term that refers to the ability of an individual to negotiate the daily challenges and social interactions of life without cognitive, emotional, or behavioral dysfunction. In addition to socioeconomic variables, mental health is affected by biological and genetic factors, as well as acute or chronic physical conditions.

Demographic information on mental health in minority populations is very limited; diagnosis and prevalence studies are insufficient. Extant epidemiologic studies suggest that minority populations, especially African Americans and Hispanic Americans, have not had resources to cope with mental health problems. For example, an East Baltimore study found that 53% of minorities had unmet mental health needs, in contrast to 44% of non-minorities (DHHS, 1991).

At the same time, African Americans and Hispanic Americans appear to be overrepresented with respect to prevalence of alcohol abuse/dependency and the use of other drugs such as crack cocaine and heroin (as discussed in section 9), and they are more likely than European Americans to be diagnosed as having paranoid schizophrenia. European Americans are more likely to be initially diagnosed as having affective disorders such as depression. Interestingly, subsequent rediagnosis by trained personnel often eliminate these diagnostic differences (DHHS, 1991).

Alcoholism and suicide among Native Americans is significantly higher than in the majority population, with estimates that "alcohol abuse and its consequences are nearly twice as pervasive among Native Americans as among any other population in the U.S." (DHHS, 1991). Again, there are very limited data available on the mental health of Asian Americans, or on whether they or other minorities have adequate access to the mental health system.

In today's multicultural society, mental health workers must consider factors such as beliefs, attitudes, language, and communication difficulties. Mental health workers must be able to correctly interpret behavior and comprehend psychiatric symptoms within the cultural context of the client.

Recommendations on Mental Health

1. In addition to providing traditional interventions such as psychotherapies and medication management, service providers should establish programs for the development of caring communities.
   
   
2. Efforts should be made to stimulate the community's positive response to individuals with mental health needs and to create local initiatives to provide solutions.
   
   
3. Ethnic diversity should be seen as a positive, healthy, and expected characteristic of communities, one to be understood with respect and tolerance.
   
   
4. Significant attitudinal changes and new priorities should be established to find new ways to benefit from old technologies. The lingering notion that persons from minority racial/ethnic backgrounds are inherently inferior to others in our society must be rejected. This attitude has significant negative impact on potential treatment outcomes. Mental health approaches must recognize this problem and create positive alternatives to addressing the needs of persons from minority racial/ethnic backgrounds.
   
   
5. Government programs must be restructured to be more responsive to the needs of minorities with disabilities. Current funding structures may need to be rethought so that new initiatives will have resources. The emerging problems of mental disorders, drug and alcohol abuse, and HIV/AIDS prevalence in minority communities have a direct impact on the larger society. Only through cooperative, collaborative mechanisms will solutions develop.

Disability is not yet fully a part of the debate on the need for better health care for minorities, in particular minorities with disabilities. Instead, epidemiology studies . . . [focus] on pathology and ignore disabilities, to the chagrin of the disability studies' field.

Anita Leal, Ph.D.

The conference paper by Anita Leal entitled "Minorities, Physical Health and Disability" offers a rich discourse on the physical health status of minorities in the United States. The purpose of her paper was to "draw attention to and increase awareness of the unique needs of minorities with disabilities." She presented the following:

• A review of the state of physical health of minorities in the United States;
  
  
• An exploration of available information about minorities with disabilities, current models of the disablement process, and its application to minorities;
  
  
• An examination of the experience of minorities with disabilities in the state/federal vocational rehabilitation system; and
  
  
• Conclusions and recommendations for improving the physical health of minorities.

Minorities with Disabilities

According to Dr. Leal, our society has known for years about the poor physical health of minorities generally and their vulnerability to disability. Despite this awareness, health care providers and agencies know virtually nothing about the following:

• The physical health status of minorities with disabilities;
  
  
• The experience of minorities with disabilities in health care delivery systems;
  
  
• The experience of minorities in the disablement process; and
  
  
• The experience of minorities in the vocational rehabilitation process.

Approximately 35 million Americans have conditions that interfere with major life activities. Dr. Leal cited studies that identify the meaning and concept of disability. Most important, she noted that the traditional meaning has expanded from a medical condition (e.g., physical or mental) to include environmental and contextual factors. She also indicated that little is known about the disablement process experienced by minorities.

The 1980 Bureau of the Census Report (Bowe, 1983) included the following data concerning disability rates among working age adult minorities:

• 8.5% of working adults reported a disability limiting the amount or type of work they could do.
  
  
• Just over 14% of African Americans reported a work disability.
  
  
• 8.4% of Hispanic adults reported a work disability.

Other data cited from the National Health Interview Survey (Ries and Brown, 1991) for the years 1983-85 indicate that a work limitation was reported by as many as 6.1% of European Americans, 10.3% of African Americans, 3.3% of Asian Americans/Pacific Islanders, and 10.4% of Native Americans.

Physical Health Status of Minorities

Among the highlights cited by Dr. Leal from the Secretary's Report of the Task Force on Black and Minority Health (DHHS, 1985) and Health Status of Minorities and Low-Income Groups (DHHS, 1991) were the following:

• The life expectancy of African Americans is 69 years of age as compared to 75 years of age for European Americans.
  
  
• The physical conditions for which risks of death are highest for African Americans under age 45 are tuberculosis, hypertension, and anemia.
  
  
• Death rates for heart disease are higher among African American men and women under age 70 than among European Americans.
  
  
• There is an 11% excess incidence of cancer among African Americans compared with nonminority Americans.
  
  
• High cancer rates for Hispanic Americans included cancer of the stomach, prostate, esophagus, pancreas, and cervix.
  
  
• Heart disease is the leading cause of death for Asians.
  
  
• The death rate of Native Americans under age 45 is strikingly high (43%) because of unintentional injuries, cirrhosis, homicide, suicide, pneumonia, and diabetes.
  
  
• The risk for AIDS among African American and Hispanic American men was almost three times that of European American men in 1989.
  
  
• Fifty-one percent of all female cases of AIDS were among African American women.
  
  
• Nineteen percent of all female cases of AIDS were among Hispanic American women.
  
  
• African Americans have been found to receive fewer health care preventive services than European Americans.

Britt, in her conference paper on empowerment, also presented rather alarming data on the health status of African American children in the United States. She noted the following:

• African American children are much more likely to suffer from poor health than are the majority of their peers;
  
  
• An African American child has a 30% greater probability of dying by his or her 14th birthday than does a European American child;
  
  
• An African American child living in deteriorating housing has a 25% chance of having excessively high levels of lead in his or her teeth and blood;
  
  
• Over 40% of all African American children, compared with 29% of European Americans, do not see a physician each year;
  
  
• Seventeen percent of all African American children have no regular place of care, despite their strong possibility of poor health;
  
  
• Thirteen percent of all African American children are born with low birthweights; and
  
  
• African American adolescent mothers are most likely not to receive prenatal care or to delay it until the last three months of pregnancy.

Recommendations on Physical Health

Dr. Leal concluded that, "[D]isability as a health issue gets minimal attention from the epidemiological community...and the disability community itself neglects minorities in its policy planning." She also noted that, "[T]here is also mounting evidence that medical services as well as disability/rehabilitation services have been underutilized by minorities." She concluded that health care providers and researchers have not linked disability and rehabilitation conceptually or empirically with physical health status and that this particular area must be the focus of research and policy planning.

Among Dr. Leal's recommendations were the following:

1. There is a need for improved collection of information on the incidence and prevalence of disability among minorities;
   
   
2. Existing untapped databases must be accessed and used as a basis for further research;
   
   
3. Additional funds are needed to conduct research on the physical health status of people of minority group origin;
   
   
4. The aggressive recruitment and inclusion of minority researchers and educators in the field of health, disability, and vocational rehabilitation is strongly encouraged; and
   
   
5. Communication must be improved between the minority communities and government agencies that are charged with the provision of health related services, including the Rehabilitation Services Administration.

Strategies need to be developed in which American Indians and other minorities are included in an immediate national agenda for prevention. This will be the only way to ensure that minority populations will have a voice in the development of prevention programs that are relevant to them.

Julie Clay

Four excerpts from Culture Shock: Waking Up in a Foreign Land by Tower were cited as illustrative of the need for culturally appropriate primary and secondary prevention activities. The struggles of these four young persons with differing levels of spinal injury highlighted a series of recommendations. While the focus was on Native Americans, the recommendations have value for all racial/ethnic populations with disabilities.

Native Americans experience the highest percentage (13.4%) of major activity limitations among ethnic groups: it has been estimated that one-third of Native Americans over 18 years of age have a functional limitation. The Indian Health Service recently sponsored a conference, "Disabilities and Their Effects on American Indians and Alaskan Native Communities." Participants in the conference developed recommendations in four areas: an Indian Health Service definition of disability; education, identification, and prevention; service delivery; and information.

As discussed in the Introduction and section 7 on physical health, disability occurs at a greater rate among most racial and ethnic minorities. Approximately 14.1% of adults in the African American population are considered "disabled," compared with 8.4% of the European American population. The unemployment rate for African Americans with disabilities is estimated to be approximately 60% to 90%. Poverty is the primary underlying factor that contributes to a high incidence of disability among African Americans.

It is important that any model of primary and secondary prevention recognize the importance of culture. For example, within the American Indian population, spirituality is an integral part of wellness. Spiritual beliefs, such as wellness as the harmony of body, mind, and spirit, must be part of any preventive efforts.

Recommendations on Prevention

1. Develop strategies specifically targeted at minority populations to decrease the prevalence of disability caused by injuries and chronic diseases. The goal is to reduce the incidence of disabilities resulting from a variety of factors, including environmental factors that cause or contribute to new disabilities.
   
   
2. Ensure that primary and secondary prevention of disability among minorities receives national attention and becomes a policy priority through increased education. Request that the Centers for Disease Control (CDC) obtain and disseminate knowledge of the variables that lead to disabilities in minority populations and how to prevent them.
   
   
3. Develop a community model of primary and secondary prevention that includes culturally relevant strategies. This will require that minority persons with disabilities most directly affected must be a part of the effort to develop a strategy.
   
   
4. Develop a survey instrument to measure incidence and prevalence of various disabilities in minority populations. This will allow the identification of risk factors, the magnitude of risk, and the degree to which risk can be contro