Web Posted on: February 24, 1998

PREVENTION OF SECONDARY INJURIES FOR FARMERS AND FARM WORKERS WITH DISABILITIES

Tracy Keninger
Easter Seal Society of Iowa, Inc.
FaRM Program
P.O. Box 4002
Des Moines, IA 50333-4002
Voice/TDD/Message (515)289-1933, ext. 251
Fax (515)289-1281
E-mail: essia@netins.net

INTRODUCTION

According to the Department of Public Health Disability and Injury Prevention of Iowa in 1996, there were 2,433 farm related injuries, 66 of them fatal. An average of 85 injuries for every 100,000 population and 2.5 injuries for every 100 Iowa farms were reported. These disabilities and conditions range from high level spinal cord injuries to heart disease and arthritis. Included were amputations, head injuries, spinal cord injuries, arthritis, heart disease, orthopedic injuries, neuromuscular diseases, visual impairments, polio, diabetes, and hearing impairments.

When a farm family member experiences a physical disability, that disability affects the entire family. Each family member must, in their own way, go through an adjustment process to the disability. The adjustment healing process for a disability or serious illness is similar to the grieving process individuals experience after the death of a loved one or a divorce. The stages that one may experience include denial, anger, anxiety over the implications of the disability, depression, and bargaining with service providers, family, friends, and God. The stage the person is experiencing can greatly affect his/her ability to perform tasks safely. Denial of the seriousness of a limitation can lead to careless behavior. Anger and depression can cause clouded judgment that may lead to an injury. These experiences increase the risk of an additional injury to the individual or family member.

Prior to the initiation of this project, farm families who remained on the farm following the onset of a physical disability were forced to cope on their own. Injuries often occurred because of the lack of appropriate assistive technologies. When living in a rural area, the nearest durable medical supplier may be one or two hours away. Because farmers are self employed, they often have inadequate or no medical insurance coverage. If they do have medical coverage, it often does not include coverage for durable medical equipment. The stress placed on the family due to the role changes was often extreme. The disabled family member was no longer able to perform the task and thus the responsibility was left up to the children. The children were asked to perform farm tasks that they had not performed before, exposing them to safety hazards.

Farmers returning to work without appropriate technologies were often faced with dangerous situations. Farmers who were not able to return to work faced the depression that can accompany unemployment. In addition, these farm families also faced the added stress of financial burdens exacerbated by the inability to work. Because of the distance between neighbors and the lack of contact with other individuals with a similar disability, isolation became an issue.

In response to the above-mentioned conditions, the Easter Seal Society of Iowa, Inc. Farm Family Rehabilitation Management (FaRM) Program, with collaboration from W.K. Kellogg Foundation, Iowa Program for Assistive Technology, Mid-Iowa Health Foundation, Iowa State University Extension, and the Iowa Division of Vocational Rehabilitation initiated a program for the prevention of secondary injuries among farm families affected by physical disabilities.

METHODS

Through this collaborative effort, the following areas were developed: a Peer Support Technology Network (PSTN), Easter Seal Equipment Services, “Farming Safely with a Disability” video and tip sheets, and onsite services.

PSTN was established in response to reported feelings of isolation. FaRM Program staff recommended those consumers we had served in the past whom we thought would be effective peer support volunteers. These potential volunteers were contacted by phone or mail and invited to attend the training. Seventy peer support volunteers attended two days of mandatory training which included instruction in the following areas: psychological adjustment process to a disability, sexuality and the disabled individual, worksite modifications, listening skills, policy and protocol, assistive technology for farming with a disability, prevention of secondary injuries, grief and loss, role model sessions, and counseling skills. Each of these individuals was instructed on how to identify danger signs related to depression and suicide and were given the proper referral instructions. They were also instructed on the importance of knowing their limits and knowing when to contact the FaRM Program staff for assistance. PSTN volunteers were given lists of potential referral contacts in their part of the state. During these training sessions the volunteers were given an opportunity to share their personal “tips” on the prevention of secondary injuries with the rest of the group.

FaRM Program staff reviewed all peer contacts and provided any additional information that was needed by the consumer. Safety tip sheets specific to the person’s disability, along with “Farming Safely with a Disability” video were made available to all consumers. A quarterly newsletter was distributed to all PSTN members to keep them informed of upcoming events as well as to share safety tips.

Upon completion of a consent form by the newly disabled individual, FaRM staff personnel called the PSTN volunteer and made them aware of the other person’s background information. The background information included the person’s age, how their disability occurred, and other issues related to their disability. The people who were matched together, in most cases, had similar disabilities, or similar concerns and challenges. A match is defined as contacting the volunteer and the newly disabled individual encouraging them to communicate and correspond with each other. Then, PSTN volunteers met face to face with consumers, contacted each other by phone, or corresponded through writing letters. Information on assistive technology, psychological adjustment to the disability, and/or safety tips were shared. Records were kept on matches made and FaRM staff personnel followed with a phone call or an onsite visit with both people involved with the match. In the follow-up we evaluated the effectiveness of the match and determined whether the individual wanted to continue to be matched with the current PSTN volunteer, or if they preferred to be matched with someone else.

Through the Easter Seal Equipment Services Program we were able to obtain, refurbish, and provide used assistive technologies to families who could not afford these technologies and were at risk of experiencing secondary injuries. These technologies included van lifts, wheelchairs, walkers, canes, and other devices. Volunteers and staff delivered the equipment across the entire state. Either a FaRM Program staff or the consumer would obtain the required consent from a physician or physical therapist and complete a basic application form. Easter Seals also asked for a $20.00 processing fee. However, individuals were not denied the service if they were not able to afford the fee.

“Farming Safely with a Disability” tip sheets and video tape were made available to all FaRM Program consumers, as well as any service providers. The tip sheets and video contain information on specific safety concerns to be considered when farming with a disability. The video included interviews with four farmers who tell their personal stories related to farming safely with a disability. These educational materials continue to be available by contacting the FaRM Program.

The FaRM Program staff performed onsite services to farm family members across the state of Iowa. The services included agricultural worksite modification consultation, coordination of community and health care services, independent living services, alternative agricultural exploration, and information and referral. The FaRM Program received referrals from a wide variety of sources, including hospitals, Division of Vocational Rehabilitation, and family members. Then, the consumer would be called to arrange for an appointment to visit them at their farm. The rural rehabilitation technologist operated the Mobile Assistive Technology Unit known as the “machine shop on wheels”. The heavy half ton van, with a raised roof, was equipped with a variety of tools including saws, welders, drills, and the necessary tools to fabricate various pieces of assistive technology on the farm site. It is very difficult to locate commercially available equipment that can be retrofitted to meet the specific individualized needs of the consumer, as well as the individual design of various pieces of machinery. Because of the unique needs and the expense of commercially available equipment, the hand fabricated assistive technologies were much more feasible. With the appropriate pieces of assistive technology, the chance for the occurrence of secondary injuries was decreased significantly.

RESULTS

During this project, from November 1, 1992 to October 31, 1995, a total of 155 PSTN matches were made. The types of disabilities represented by these matches included: multiple sclerosis, cerebral palsy, mental retardation, quadriplegia, paraplegia, leg amputations, stroke, orthopedic disabilities, head injuries, arthritis, arm amputations, and visual impairments.

Additional on-site services from project staff were received by 409 consumers. These services included injury prevention consultation, agricultural worksite modification consultation, coordination of community and health care services, rural independent living services, and information and referral. A total of 233 awareness presentations were given throughout the state to service providers and farm-related groups. These presentations focused on farming safely with a disability and the availability of different types of assistive technologies. Over 500,000 individuals were reached as a result of these awareness presentations.

More than 1,000 assistive technologies such as wheelchairs, walkers, canes, commodes, hoyer lifts, and various other pieces of equipment were made available through the Easter Seal Equipment Services Program.

DISCUSSION

The most effective strategy that was used by this project in the prevention of secondary injuries, was the PSTN. Through our evaluation, the one-to-one contact with other farm family members was shown to have the most impact. Consumers consistently stated that this was the most important and effective aspect of all the services we provided.

In the evaluation of the project, the important role of emotional support (i.e. knowing you are not alone, being given hope) kept emerging. This was particularly true of the individuals receiving peer support. They often viewed emotional support as, at least equal, if not more important than technical assistance.

The distribution of assistive technology was one of the greatest challenges faced by our project staff. Transporting the needed equipment to the consumers posed a financial difficulty. To overcome this difficulty, staff and volunteers were utilized to transport the technology to the consumer. Despite the fact that this method worked, the project staff did not feel it was the best use of time or money.

All of the above-mentioned services continue to be provided through the Easter Seal Society of Iowa FaRM Program. For additional information, requests can be sent to: Easter Seal FaRM Program, P.O. Box 4002, Des Moines, IA 50333-4002.

REFERENCES

Schootman M, Harlan M. Farm-related injuries. Iowa Department of Public Health Disability and Injury Prevention, April 1996.

Maxson N. Voices: Speaking up for changes in rural health care access, new research defines problems, offers tested solutions. Rural Exchange 1996; 9:4-5.

Willkomm T. Additional injuries/illnesses experienced among farmers with disabilities. The Easter Seal Society of Iowa: Des Moines, IA, October 1992.